Evaluation of the MoleMate(trade mark) training program for assessment of suspicious pigmented lesions in primary care.
Inform Prim Care. 2008;16(1):41-50
Authors: Wood A, Morris H, Emery J, Hall PN, Cotton S, Prevost AT, Walter FM
BACKGROUND: Pigmented skin lesions or ‘moles’ are a common presenting problem in general practice consultations: while the majority are benign, a minority are malignant melanomas. The MoleMate(trade mark) system is a novel diagnostic tool which incorporates spectrophotometric intracutaneous analysis (SIAscopy) within a non-invasive scanning technique and utilises a diagnostic algorithm specifically developed for use in primary care. The MoleMate(trade mark) training program is a short, computer-based course developed to train primary care practitioners to operate the MoleMate(trade mark) diagnostic tool. OBJECTIVES: This pre-trial study used mixed methods to assess the effectiveness and acceptability of a computer-based training program CD-ROM, developed to teach primary care practitioners to identify the seven features of suspicious pigmented lesions (SPLs) seen with the MoleMate(trade mark) system. METHOD: Twenty-five practitioners worked through the MoleMate(trade mark) training program: data on feature recognition and time taken to conduct the assessment of each lesion were collected. Acceptability of the training program and the MoleMate(trade mark) system in general was assessed by questionnaire. RESULTS: The MoleMate(trade mark) training program improved users’ feature recognition by 10% (pre-test median 73.8%, p<0.001), and reduced the time taken to complete assessment of 30 SPLs (pre-test median 21 minutes 53 seconds, median improvement 3 minutes 17 seconds, p<0.001). All practitioners’ feature recognition improved (21/21), with most also improving their time (18/21). Practitioners rated the training program as effective and easy to use. CONCLUSION: The MoleMate(trade mark) training program is a potentially effective and acceptable informatics tool to teach practitioners to recognise the features of SPLs identified by the MoleMate(trade mark) system. It will be used as part of the intervention in a randomised controlled trial to compare the diagnostic accuracy and appropriate referral rates of practitioners using the MoleMate(trade mark) system with best practice in primary care.
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Implementation and impact of the Gold Standards Framework in community palliative care: a qualitative study of three primary care trusts.
Palliat Med. 2008 Sep;22(6):736-743
Authors: Walshe C, Caress A, Chew-Graham C, Todd C
The Gold Standards Framework (GSF) has been widely adopted within UK general practices, yet there is little understanding of its impact on the provision of community palliative care services. This study presents data on the anticipation and adoption of the GSF within three Primary Care Trusts in North West England. Forty-seven interviews were conducted with generalist and specialist palliative and primary care professionals. Important aspects of the GSF identified were the patient register, communication and out-of-hours protocols. Positive benefits to professionals included improved communication between professionals and appropriate anticipatory prescribing. Negative aspects included increased nursing workload and the possibility of fewer or later visits for patients. Many respondents believed that the GSF needed local champions to be sustainable. Slow or incomplete adoption was reported. The GSF was recognised as important because it facilitated changes to previously difficult aspects of work between professionals, but few respondents reported direct benefits to patient care.
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Prevalence of peripheral arterial disease in patients with diabetes mellitus in a primary care setting.
Med J Malaysia. 2007 Jun;62(2):130-3
Authors: Rabia K, Khoo EM
The aims of the study were to determine the prevalence of peripheral arterial disease (PAD) in diabetic patients and in different ethnic groups at a primary care setting, and to evaluate risk factors associated with PAD in these diabetic patients. A cross sectional study of 200 diabetic patients over 18 years old who attended a primary care clinic at a teaching hospital in Kuala Lumpur, Malaysia was carried out. Face-to-face interviews were conducted using structured questionnaires for demographic characteristics and risk factors evaluation. Blood pressure measurements, assessment of peripheral neuropathy and ankle brachial pressures were performed. PAD was diagnosed by an ankle brachial pressure index (ABPI) of <0.9 on either leg. The overall prevalence of PAD was 16% in this diabetic population. The prevalence of PAD was 5.8% in Malays, 19.4% in Chinese and 19.8% in Indians. The prevalence of peripheral neuropathy was 41%, foot ulcer 9.5%, and gangrene 3.0%. The presence of foot ulcer was weakly associated with PAD (P=0.052). No significant relationships were found between age, gender, smoking status, duration of diabetes mellitus, hypertension, dyslipidaemia, and PAD. PAD is common in the diabetic population of this study.
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