Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK. He recently attended the Society for Academic Primary Care annual conference in Exeter, England.
The declaration of Alma Ata, over forty years ago, was a key milestone in the development of general practice. Generations of physicians may remember how it defined their career. Dr Shannon Barkley, World Health Organisation Technical Officer for Primary Health Care Services and Family medicine, described the changes that have occurred since then, leading to the 2018 Declaration of Astana. Looking back, we can see why the Declaration of Alma Ata was so important and how the principles outlined are still as fresh and relevant as they then were. There has been progress although different countries move at different speeds. “Health for all by the year 2000” wasn’t achieved but the Millennium Development Goals” were quite successful and the focus has been, more recently, on universal health coverage. I asked Shannon to tell us a little more about the Declaration ...continue reading →
Sir Denis Pereira Gray, OBE, is a consultant at St Leonard’s Research Practice, Exeter, and Emeritus Professor at the University of Exeter in the United Kingdom
A few weeks ago a blog by Domhnall MacAuley picked up on an article that I had written in the British Journal of General Practice, entitled “Academic general practice: a viewpoint on achievements and challenges.” The article was written to ask some big questions and to stimulate debate about academic general practice and Domhnall's blog followed it up interestingly and extended the issues.
I am still optimistic about academic general practice. General practice is the key branch of the medical profession and there are still many aspects of it to be discovered. Yes of course “big data” are a new resource and need new techniques, but a place remains for clinical research in general practice and in single research active general practices too. However, the relationships and the support for research in clinical settings need clarification and funding. The prime role of single practice research is to study new clinical developments, to scope their potential, and pave the way for bigger definitive studies. Single practices do have the numbers for statistical significance if they choose their subject ...continue reading →
Interview with Dr. Christopher Parshuram, critical care specialist with the Hospital for Sick Children in Toronto. He is the lead author of a randomized trial published in CMAJ looking at patient safety, resident well-being and continuity of care for three resident duty schedules in the ICU. Work schedules incorporating shorter periods of continuous duty affected neither doctors' daytime sleepiness nor adverse outcomes in patients.
Interview with Dr. Thomas Maniatis, internal medicine training program director and clinical ethicist at McGill. Dr. Maniatis is the author of a commentary published in CMAJ. He argues that resident duty-hour reform must be further evaluated in order to design systems that provide maximal benefit and minimal harms for all involved.
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