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Purpose: The purpose of this study was to evaluate a computerized touch-screen version of the asthma-specffic quality-of-life (cA-QOL) questionnaire against the conventional paper-and-pencil version (pA-QOL) for equivalence, time for completion, user preference, and ease of use. Methods: A total of 261 patients were recruited. A randomized cross-over design was used. Patients in group A completed the cA-QOL first while waiting to see a physician, and completed the pA- QOL version after seeing the physician. Patients allocated in group B completed these questionnaires in the reverse order. The patients were asked questions about user preference and ease of use of the cA-QOL. The time taken to complete both versions of the questionnaire was measured. Results: Weighted kappa coefficients of all items showed almost per- fect agreement. The time required to complete the pA-QOL is faster than the time for cA-QOL. The patients who preferred the cA-QOL were 37.5%, while those who preferred the pA-QOL were 29.9%. Most patients reported that the cA-QOL was "easy" or "very easy" to complete. Conclusion: The cA-QOL is the computerized equivalent of the pA-QOL. The findings herein demonstrate that the cA-QOL can be helpful to nurses in busy practices for assessing, collecting, and evaluating their patients' health related quality of life. [ABSTRACT FROM AUTHOR]

Gives advice on how to pass Paper 2, a module used in testing both established and discovered knowledge of relevance to general practice of medicine. Reasons why Paper 2 is machine-marked; How the questions are constructed; Materials to read for the preparation; recommended examination techniques.

The words used to refer to weight and individuals with large bodies can be used to reinforce weight stigma. Given that most previous research has examined preferred terminology within homogenous groups, this research sought to examine terminology preferences across populations. This paper reports on data gathered with the general public, family physicians, and obesity researchers/practitioners. Participants were asked about the words they commonly: (1) used to refer to people with large bodies (general public); (2) heard in their professional contexts (physicians and obesity specialists); and (3) perceived to be the most socially or professionally acceptable (all samples). Similarities and differences were evident between samples, especially related to weight-related clinical terms, the word fat, and behavioral stereotypes. The results provide some clarity into the differences between populations and highlight the need to incorporate use of strategies that may move beyond person-first language to humanize research and clinical practice with people with large bodies. [ABSTRACT FROM AUTHOR]

The author comments on the discussion paper "Thoughts on the state of Family Medicine in South Africa" presented at 16th National Family Practitioners Conference in Cape Town. He discusses the role of family physicians in the provision of quality private medical services, clinical governance and all teaching levels within the district health system (DHS). Particular focus is given to family medicine training programme to ensure high-standard care in state health services.

Discusses suggestions in preparing for the Critical Reading Question paper for general practitioners in Great Britain. Selecting reading material; Maximizing the use of the material.

The purpose of this research is to investigate the extent to which Australia's northern cities have become increasingly important mediators of migration of nurses and general practitioners (GPs) to the regional north since the 1980s. Over that period, national and provincial policy has focused on 'regionalisation' of health workforce development, including creating education and training infrastructure outside of metropolitan areas. This paper hypothesises that the effectiveness of regionalisation in northern Australia should be reflected in an increased net flow of GPs and nurses from northern cities (which are the hubs of education and training) to the regional north. Data from the seven Australian Census between 1986 and 2016 are used to model changing patterns of migration. Overall, there was limited evidence of substantial change in migration patterns, although for GPs there was a reduction in migration from the key metropolitan source markets (Brisbane and Adelaide) matching an increase in supply from northern cities. Northern cities have consistently been the source of about one quarter of new nurse and GP migrants to the regional north, but the regional north has become a much less favoured destination for professionals leaving northern cities as cities' populations have grown much faster than regional populations. Net flows have remained small and for nurses have favoured the cities while for GPs favoured the regional north. The paper concludes that, while there is limited evidence of increased 'spillover' of labour from the cities to the regional north, there is also no evidence of the cities increasingly 'spongeing' regional labour. Cities and regional migration systems may be increasingly disconnected as labour demands diverge, but new connections are being created with the rest of non-metropolitan Australia. The research is the first to analyse health professional migration over such a long period, and contributes to the debates about the roles of cities in sparsely populated areas in the development of their rural and remote hinterlands. • There is no evidence of increasing 'sponge' or 'spillover' relationships between northern cities and the regional north. • Large investment in 'regionalisation' of workforce development has not led to an increase in intra-northern migration. • There is evidence of increasing net loss of health professionals from the regional north to other regional Australia. • Regionalisation may be an ineffective strategy for growing the health professional workforce in the regional north. [ABSTRACT FROM AUTHOR]

Aim. The aim of this study was to assess the knowledge, attitudes and the rules of proceeding concerning primary health care (PHC) doctors in the field of screening diagnostics for cognitive disorders in elderly people in Poland. Material and methods. The study included 175 PHC doctors. A validated anonymous questionnaire was used. The survey was conducted using the PAPI (Paper and Pencil Interviews) and CAWI (Computer Assisted Web Interviews) methods. Results. The vast majority of the respondents (n = 159; 91.4%) saw the advisability of screening for cognitive disorders in the age group >65 years of age, but only 53 subjects (30.29%) believed that these tests should be conducted by general practitioners (GPs). According to the surveyed doctors, the main obstacle in the diagnostics of cognitive functions is the lack of time - this was the opinion of 142 (81.14%) respondents. When dementia was suspected, the respondents usually ordered laboratory tests and referred patients to a neurologist (n = 111; 63.4%). The Mini Mental Status Examination (MMSE) and the Clock Drawing Test (CDT) were the most popular scales assessing cognitive functions, known by 120 doctors (68.57%), and 122 respondents (69.71%), respectively. Conclusions. Polish GPs are aware of the necessity of screening for cognitive disorders in seniors. Currently, there are no mechanisms within the primary health care system that would enable proper early screening for dementia in people at high risk (i.e. >65 years of age). The development of standards for the early detection of cognitive disorders within the primary health care system in Poland seems to be an urgent need. [ABSTRACT FROM AUTHOR]

Copyright of Collected Papers of the Faculty of Law in Split / Zbornik Radova Pravnog Fakulteta u Splitu is the property of Split Faculty of Law and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Prescribing and consuming drugs more than necessary is considered polypharmacy, which is both wasteful and harmful. The purpose of this paper is to establish an innovative data mining framework for analyzing physicians' prescriptions regarding polypharmacy. The approach consists of three main steps: pre-modeling, modeling, and post-modeling. In the first step, after collecting and cleaning the raw data, several novel features of physicians are extracted. In the modeling step, two popular decision trees, i.e., C4.5 and Classification And Regression Tree (CART), are applied to generate a set of If-Then rules in a tree-shaped structure to detect and describe physicians' features associated with polypharmacy. In a novel approach, the Response Surface Method (RSM) as a tool for hyper-parameter tuning is simultaneously applied along with Correlation-based Feature Selection (CFS) to enhance the performance of the algorithms. In the post-modeling step, the discovered knowledge is visualized to make the results more perceptible and is, then, presented to domain experts to evaluate whether they make sense or not. The framework was applied to a real-world dataset of prescriptions. The results were confirmed by the experts, which demonstrated the capabilities of the data mining framework in the detection and analysis of polypharmacy. The derived If-Then rules can be beneficial for healthcare managers and policy-makers to recognize physicians' prescribing patterns and take suitable actions to support medicine management and develop high-quality prescribing guidelines. [ABSTRACT FROM AUTHOR]

This is the third and final paper in the series. Oral and dental complications of head and neck cancers, and the associated treatments, can be devastating to patients. General dental practitioners are likely to encounter affected patients at various points along their treatment journey, which may involve the management of treatment side-effects or facilitating the post-treatment rehabilitation. This paper will discuss accepted preventive regimens for patients, management of treatment side-effects and specific cases of restorative rehabilitation post-treatment, highlighting the levels of treatment that can usually be provided in primary and secondary care settings. CPD/Clinical Relevance: This paper aims to provide the reader with knowledge and confidence to manage the dental needs of head and neck cancer patients and post-treatment side-effects. [ABSTRACT FROM AUTHOR]

Early diagnosis of the malignant melanoma allows a cure rate of up to 90% of patients. Thus, our goal was relating to develop of the specialized, multi-strategic diagnostic system supporting dermatologists and in the long run for general practitioners ensuring objective reliable and user-independent results. Achieving such a goal required elaboration of a fully automatic processing and analysis of digital images of melanocytic skin lesions. In this paper, we were focused on methods of medical annotations analysis, i.e., textual vectors of features observed by dermatologists within the analyzed ELM (i.e., Epi-Luminescence Microscopy) images. Thus, three different learning models and three different medical procedures (so-called melanocytic strategies) for a visual inspection of the melanocytic skin lesions were used. The results indicated improving the diagnosis of the the lesion' digital images, since the high accuracy values for each of three tested/analyzed learning models (above 90%) were obtained. [ABSTRACT FROM AUTHOR]

Background: Oral Lichen Planus (OLP) is a chronic autoimmune mucocutaneous condition, the exact etiology of which is still unknown. It is known to occur chiefly in adults and has a reported prevalence of 0.5–2% in general population and < 2–3% of total in pediatric population. OLP is considered as Oral Potentially Malignant Disorder with a malignant transformation rate of 1–2% in adults. Its occurrence in children is a rare finding with few cases reported in the literature. As a result, it gets misdiagnosed by the general practitioner and hence, there is a need to consider OLP in differential diagnosis of white lesions of oral cavity even in children. Therefore, in this paper, we present six cases of childhood OLP along with their management and follow-up. Case series: We present here six patients aged between 11 and 13 years who presented either as incidental finding or as symptomatic lesions and were diagnosed with OLP. Symptomatic patients were treated with topical steroid ointment and both the symptomatic and asymptomatic patients were followed-up. We have also presented literature review of childhood OLP reported in PubMed, Medline and google scholar from 1980 till December 2020. Conclusion: OLP is unusual in children and is often left untreated due to low awareness among the patients. Can be often misdiagnosed and should be considered in differential diagnosis of any white lesion of oral cavity. Any such lesions must be correctly diagnosed in time to institute appropriate management and follow-up. [ABSTRACT FROM AUTHOR]

Copyright of Collegium Antropologicum is the property of Croatian Anthropological Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Langerhans cell histiocytosis (LCH) is a collection of three idiopathic disorders categorised by the proliferation of specialised Langerhans cells (immature dendritic cells) and mature eosinophils. Case report: In this paper, we demonstrate a case of a 22-year-old male patient with a complaint of persistent pain in the mandible. Discussion: The purpose of this paper is to present a brief summary of the existing diagnostic and treatment strategies for LCH relevant to the oral and maxillofacial region, and to analyse the differential diagnosis and evaluation of these patients. Conclusion: This case is an important reminder of the potential clinical and radiographical presentation of LCH with oral involvement, and highlights the role of the general dental practitioner in early diagnosis and prompt referral. [ABSTRACT FROM AUTHOR]

This paper aims to provide insights on the association between exposure to rural general practice vocational training placements and subsequent rural practice location in Western Australia. We further explore the possibility that the observed associations might depend on an individual's rural upbringing and or an individual's exposure to general practice during medical school. To this end, a cross-sectional analysis of practice location of 353 general practitioners who completed their vocational training through WA General Practice Education and Training between 2010 and 2017 was conducted. The empirical analysis uses a fully recursive conditional mixed process estimator to jointly estimate the probabilities that a general practitioner (GP) completes their vocational training placement at a rural location and subsequently practices at a rural location. The results show that GPs who chose rural locations for their first and last vocational training placements are more likely to practice at a rural location compared to their counterparts choosing metropolitan locations. Also, the probability of subsequent rural practice is further strengthened by having a rural background and having exposure to general practice during medical school even after controlling for potential confounders. The results also indicate that GPs stay in rural locations for reasons linked to their career, family and lifestyles. This evidence underscores the importance of vocational training organisations in WA and reinforces the need for ongoing rural opportunities in training to ameliorate location-based disparities in the distribution of the GP workforce in Western Australia. • We examined the association between GP vocational training placement and subsequent practice location in Western Australia. • Evaluated the joint influence of a rural upbringing and prevocational exposure to general practice on rural practice. • GP vocational training placements in rural and remote areas strongly predict subsequent rural practice. • A rural background in sync with prevocational exposure to general practice increases the probability of rural practice. [ABSTRACT FROM AUTHOR]

After bariatric surgery, patients with obesity achieve sustainable weight loss, gain in mobility, quality of life and life expectancy. Bariatric surgery can lead to remission of type 2 diabetes or to long term glycaemic control for patients with type 2 diabetes, while medical treatment has a preventive efficacy on micro and macrovascular complications. This has led to the concept of metabolic surgery to treat type 2 diabetes. Despite the benefits, only a small proportion of eligible patients undergo bariatric/metabolic surgery. Powerful antidiabetic medications, self-estimated lack of knowledge by medical professionals and fear of surgical complications are some of the arguments to prefer medical treatment of type 2 diabetes obesity versus metabolic surgery. We have reviewed in this paper the barriers which explain the low referral rate to metabolic surgery. With the point of view of the diabetologist, the general practitioner and the patient, we have addressed them to help clinicians and patients model an evidenced-based patient-oriented medical plan. [Display omitted] • Metabolic surgery for patients with type 2 diabetes and a BMI ≥30 kg/m2 can lead to remission of type 2 diabetes or ensure long term glycaemic control • Long term RCTs comparing metabolic surgery and evidence based type 2 diabetes medical treatment are needed • Developing education on obesity, weight stigma and metabolic surgery for patients and health care providers is encouraged [ABSTRACT FROM AUTHOR]

Background: Health policy-makers in Africa are looking for local solutions to strengthen primary care teams. A South African national position paper (2015) described six aspirational roles of family physicians (FPs) working within the district health system. However, the actual contributions of FPs are unclear at present, and evidence is required as to how this cadre may be able to strengthen health systems. Methods: Using semi-structured interviews, this study sought to obtain the views of South African district health managers regarding the impact made by FPs within their districts on health system performance, clinical processes and health outcomes. Results: A number of benefits of FPs to the health system in South Africa were confirmed, including: their ability to enhance the functionality of the local health system by increasing access to a more comprehensive and coordinated health service, and by improving clinical services delivered through clinical care, capacitating the local health team and facilitating clinical governance activities. Conclusions: District managers confirmed the importance of all six roles of the FP and expressed both direct and indirect ways in which FPs contribute to strengthening health systems’ performance and clinical outcomes. FPs were seen as important clinical leaders within the district healthcare team. Managers recognised the need to support newly appointed FPs to clarify their roles within the healthcare team and to mature across all their roles. This study supports the employment of FPs at scale within the South African district health system according to the national position paper on family medicine. [ABSTRACT FROM PUBLISHER]

Purpose: The purpose of this paper is to examine the effectiveness of treatment of panic and agoraphobia by medication versus cognitive behaviour therapy. Design/ methodology/approach: A survey questionnaire was used to elicit the responses from a total of forty-nine (N=49) subjects that met the DSM-111-R diagnostic criteria for panic disorder as well as agoraphobia. The subjects were derived from two integrated treatment programs that used combined-behavioural therapies for the treatment of panic disorder and agoraphobia, and they had completed treatment within a twelve month period. Analysis was conducted using t-tests and ANCOVA. Results/findings: A significant difference was found between the two forms of treatment - medication and combined behaviour therapy. However, there was no significant difference found between the two types of treatment providers (general practitioners and psychiatrists). [ABSTRACT FROM AUTHOR]

Supernumerary teeth can develop in any location of the mandible or maxilla and may have a significant impact on the developing dentition. This paper reviews the prevalence, aetiology and classification of supernumerary teeth. It also describes their clinical characteristics and management options. A case report involving the interdisciplinary management of delayed eruption of central incisors due to the presence of a supernumerary tooth is outlined. [ABSTRACT FROM AUTHOR]

Copyright of Collegium Antropologicum is the property of Croatian Anthropological Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Oromandibular dystonia (OMD) is characterised by sustained or repetitive involuntary movements of the jaw, face, and tongue. People with the condition may present to their dentist, general practitioner, or a secondary care specialist with non-specific symptoms including jaw or facial pain, bruxism, subluxations or dislocations of the jaw; fractured teeth or dental restorations, or both; or jaw tremor. Many clinicians are not aware of the disorder and this can lead to delayed diagnoses, unnecessary complications, and inappropriate treatment. OMD is an important diagnosis not to miss because referral for specialist management can provide good long-term results. To aid early, accurate diagnosis, this paper focuses on the key clinical features of the disorder and its dental and medical mimics. [ABSTRACT FROM AUTHOR]

'Making Every Contact Count' (MECC) is a government initiative headed by Public Health England and other organizations to provide support for patients to make positive behaviour changes to their health and wellbeing. The aim of MECC is to reduce the number of long-term diseases in the population that are attributable to behavioural risks factors. Primary dental practitioners are well positioned to provide the recommended brief advice on smoking, alcohol consumption and other factors. This article will highlight current guidance relating to these modifiable risk factors, and explain how dentists can interact with general medical practitioners in order to improve patient health. The aim of this paper is to provide details on what health issues the dentist should screen for, as well as the ways in which information can be passed onto the doctor in order to provide the best possible care for the patient. CPD/Clinical Relevance: Dentists are well positioned to ask and investigate issues relating to the patient's general health. This key information can be passed onto the general practitioner in order to address patient needs effectively. [ABSTRACT FROM AUTHOR]

The 2014 Curricular Guidelines of the medical undergraduate courses include Mental Health (MH) as one of the required areas of internship. The objective of this paper is to present the integrated internship for MH and Family and Community Medicine (FCM) of UFRJ, as well as the rationale for choosing Primary Health Care (PHC) as the setting for the internship training. It presents a report of the experience of the integrated internship for MH and FCM of UFRJ and the discussion of its theoretical frameworks. The high prevalence of psychological distress and mental disorders in PHC, the fact that PHC is the gateway to the unified national health system (SUS) and the fact that the medical school must train general practitioners, make PHC a privileged locus for the training of medical interns in mental health. [ABSTRACT FROM AUTHOR]

Dental anxiety is common within the population and can detrimentally affect the delivery of dental care for those patients affected. Non-pharmacological-based behaviour management techniques are available to the clinician but may not be sufficient or applicable for every patient. In such cases, intravenous conscious sedation with midazolam has been demonstrated to be safe, effective and well tolerated. The present article reviews the criteria and guidance which must be addressed by the dental team when establishing an intravenous conscious sedation service in a primary dental care setting. CPD/Clinical Relevance: General dental practitioners may wish to consider establishing a conscious sedation service in their practices to facilitate the care of nervous patients or those undergoing prolonged, unpleasant treatments such as surgical procedures. The present paper aims to highlight the considerations which require to be addressed in order to establish such a service for adult patients using intravenous midazolam. [ABSTRACT FROM AUTHOR]

Background: Patient feedback websites or doctor rating websites are increasingly being used by patients to give feedback about their health care experiences. There is little known about why patients in England may give Web-based feedback and what may motivate or dissuade them from giving Web-based feedback.Objective: The aim of this study was to explore patients' views toward giving Web-based feedback and ratings to general practitioners (GPs), within the context of other feedback methods available in primary care in England, and in particular, paper-based feedback cards.Methods: A descriptive exploratory qualitative approach using face-to-face semistructured interviews was used in this study. Purposive sampling was used to recruit 18 participants from different age groups in London and Coventry. Interviews were transcribed verbatim and analyzed using applied thematic analysis.Results: Half of the participants in this study were not aware of the opportunity to leave feedback for GPs, and there was limited awareness about the methods available to leave feedback for a GP. The majority of participants were not convinced that formal patient feedback was needed by GPs or would be used by GPs for improvement, regardless of whether they gave it via a website or on paper. Some participants said or suggested that they may leave feedback on a website rather than on a paper-based feedback card for several reasons: because of the ability and ease of giving it remotely; because it would be shared with the public; and because it would be taken more seriously by GPs. Others, however, suggested that they would not use a website to leave feedback for the opposite reasons: because of accessibility issues; privacy and security concerns; and because they felt feedback left on a website may be ignored.Conclusions: Patient feedback and rating websites as they currently are will not replace other mechanisms for patients in England to leave feedback for a GP. Rather, they may motivate a small number of patients who have more altruistic motives or wish to place collective pressure on a GP to give Web-based feedback. If the National Health Service or GP practices want more patients to leave Web-based feedback, we suggest they first make patients aware that they can leave anonymous feedback securely on a website for a GP. They can then convince them that their feedback is needed and wanted by GPs for improvement, and that the reviews they leave on the website will be of benefit to other patients to decide which GP to see or which GP practice to join. [ABSTRACT FROM AUTHOR]

Retention is normally required after active orthodontic tooth movement in order to maintain tooth position and minimize the effects of age-related changes to the dentition. The aim of this article is to define stability, retention and relapse with reference to the literature and to review the evidence with regards to clinical effectiveness of different types of fixed and removable retainers and wear regimens, with emphasis on systematic reviews and Randomized Controlled Trials (RCTs). Furthermore, to discuss the general dental practitioner's role and responsibility in managing patients after active orthodontic treatment. CPD/Clinical Relevance: It is common practice for orthodontists to review patients for one year after active orthodontic treatment. Beyond this period, monitoring of the patient's long-term retention is often carried out in general dental practice. This paper provides an overview of orthodontic retention, including retainer types, wear regimens and a discussion of the common problems associated with retainers and advice on management. [ABSTRACT FROM AUTHOR]

Head and neck cancer is a group of cancers that affects the oropharynx, nasopharynx, laryngopharynx and neck. With improving survival rates for patients, general dental practitioners (GDPs) are becoming increasingly likely to engage in the care of affected patients. Therefore, a sound clinical knowledge of the aetiology, treatment and rehabilitation for head and neck cancer is essential for all practitioners who may be involved in the care pathways for such patients. CPD/Clinical Relevance: This paper provides an update on the prevalence, risk factors, diagnosis and classification of head and neck cancer. [ABSTRACT FROM AUTHOR]

The aim of this article is to encourage general dental practitioners (GDPs) to obtain feedback from patients on a regular basis and act on it. This article will familiarize clinicians with the current concepts of patient experience, patient satisfaction and patient reported outcome measures. It will explore the reasons why dentists should engage in seeking patients' opinions and will shed light on some of the validated questionnaires which are in use in the UK and internationally. Aspects of care considered important by patients are explored and important questions which should be included when developing individual practice questionnaires are highlighted. We build on previous Dental Update articles on this subject by taking the reader through the concept of the Plan Do Study Act (PDSA) cycle and how this can be utilized. This paper will not only allow dentists to improve and grow their practices, but also contribute towards clinical governance and the ethos of patient-centred care. CPD/Clinical Relevance: This article enables dental professionals to appreciate the importance of obtaining patient feedback on key issues relating to their dental care. It suggests ways in which dental teams could engage in obtaining patient feedback and act upon it to develop the quality of services. [ABSTRACT FROM AUTHOR]

Hypertension is the commonest risk factor contributing to the global burden of disease. Public Health England estimates that, in England, 24% of the population are hypertensive, with 40% possibly undiagnosed. With this in mind, dentists, in particular those undertaking sedation, are in a perfect position to screen for high blood pressure and refer on for further detailed assessment. This paper outlines when a referral to the General Medical Practitioner (GP) should be considered, when sedation should be deferred and how hypertension is diagnosed and managed in primary care based on the National Institute for Health and Care Excellence (NICE)/British Hypertension Society (BHS) guidelines. CPD/Clinical Relevance: The purpose of this article is to update General Dental Practitioners (GDPs), including those who practise IV Midazolam sedation, on how patients who present with suspected hypertension are managed by their GP. Consideration is given to what blood pressures are deemed safe to sedate and what blood pressures should be referred for further assessment, even if considered safe to sedate. [ABSTRACT FROM AUTHOR]

Introduction Falls prevention is a key activity for general practitioners, occupational therapists and other allied health professionals. Despite evidence for multidisciplinary community-based interventions, uptake of falls prevention is variable. General practitioners are crucial in identifying older people at risk of falls and referring for intervention. This research aims to identify the current practice of general practitioners in falls prevention and to identify opportunities for occupational therapists in particular to extend their role in falls prevention in primary care. Method A total of 4000 paper surveys were mailed to randomly selected general practitioners within 209 clinical commissioning groups in England. Online surveys were also distributed via clinical commissioning groups to approximately 3200 general practitioners. Descriptive analysis of the data was undertaken. Results A total of 152 general practitioners responded. More than half indicated they were familiar with the UK guidelines for falls risk screening, but less than a third implemented these. Only 31% routinely asked older people if they had fallen. Whilst 90% identified occupational therapists as providing evidence-based falls prevention, only 74% referred to occupational therapy. Conclusion There are gaps in general practitioners' falls prevention referral practices to occupational therapists and allied health professionals. Better general practitioner pathways could enhance the quality of falls-prevention care for older people at risk. [ABSTRACT FROM AUTHOR]

The first primary motivation of this paper is to propose new methods for measuring similarity between interval-valued fuzzy sets based on an order relation of the intervals, which are a possible and necessary similarity measure. To capture the basic idea of the suggested approach, one has to realize that an interval-valued fuzzy set (IVFS) can be considered as a family of closed intervals describing imprecise information, or uncertainty, on the possible belongingness of each element of the universe of discourse and the dependence between them. Consequently, any relation between two interval-valued fuzzy sets could be analyzed using the links between the corresponding families of intervals. The core of the proposed methodology is based on the description of possible and necessary inclusion and the width of the corresponding intervals in epistemic issues, i.e. optimistic (possible) and pessimistic (necessary) measures. Our second motivation is to use our concept of measures to early detect the risk of depressive episodes among students tested for this research. We propose an effective algorithm to estimate the risk of depressive episodes. By using machine learning methods concerning uncertainty, we obtained more sensitivity to diagnosis compared to the currently used tests, e.g., CESD-R. We aim to identify the risk of depressive states before they are indicated in other tests such as CESD-R, which can prevent the appearance of symptoms after early medical consultation. In the initial study, we were able to achieve a 4-week faster diagnosis of at-risk depression in 20% of subjects who had CESD-R at risk, so we are talking about a more sensitive test, in this sense, as a result of this work. The proposed methodology, in the form of a system, will be used in medical centers by general practitioners or entrepreneurs for their subordinates to eliminate depression-related breaks at an early prevention stage. • Effectively may be described uncertainty by similarity in the optimistic (possible) and pessimistic (necessary) issues for interval-valued fuzzy sets. • The need to create a sensitive test for early depression diagnosis and depression prevention with life-threatening episodes. • The usefulness of the method of machine learning in diagnosing depression and also in avoiding its severe cases. [ABSTRACT FROM AUTHOR]

General Dental Practitioners (GDPs) and Dental Care Professionals (DCPs) have a duty of care to ensure that patient safety is at the forefront of their clinical practice. Medical emergencies, although rare, can occur in the dental setting, and early, effective management of these emergencies can, not only save lives, but also improve long-term outcomes. A case is reported which highlights a safety incident involving accidental self-administration of an adrenaline auto-injector (AAI) into a digit during a medical emergencies training session. Consequently, the aim is to raise awareness of these unexpected safety incidences and propose a protocol for the treatment of such injuries. CPD/Clinical Relevance: This paper highlights the importance of vigilance when undertaking a medical emergency training course, and the introduction of a new protocol to be used in cases of accidental AAI injury. [ABSTRACT FROM AUTHOR]

The successful implementation of the ongoing roll-out of free GP care for all private patients in Ireland, begun in 2015, requires an estimate of its impact on GP utilisation. However, estimates of this impact vary widely. For example, a recent study based on administrative records of six GP practices, predicts an extra 4.4 million GP visits. This paper argues that little reliance should be placed on this estimate due to methodological and sample selection issues, as well as the use of demonstrably inappropriate assumptions. Instead, more reliance should be placed on estimates derived from retrospective self-reporting surveys (e.g. Growing Up in Ireland, the Irish Longitudinal Study on Ageing) which suggest that extending free GP care to all private patients is likely to result in an increase of around 2.5 million GP visits. The increase in demand for GP services occasioned by free GP care feeds into the wider debate about the enhanced role of primary care in Ireland and the corresponding increase in funding. [ABSTRACT FROM AUTHOR]

Copyright of Konuralp Medical Journal / Konuralp Tip Dergisi is the property of Duzce University Medical School and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Reinforcers are helpful for teaching students with special needs. The literature suggests that reinforcers are a useful resource when teaching a new skill. Reinforcers typically fall into four broad categories, which include sensory, activity, tangible, and social. In order to select the most effective reinforcers for a student, an individualized and systematic assessment should be conducted. To accomplish this, teachers will need to consider various factors, including the student's cultural and linguistic backgrounds. Thus, the purpose of this paper is to discuss four considerations for culturally appropriate reinforcers that are highlighted in the literature. These include: (1) practicing cultural self-awareness, (2) valuing other cultures, (3) obtaining family perspectives, and (4) implementing differentiated reinforcers. The goal is to provide practitioners with general guidelines for identifying reinforcers for students with special needs from culturally diverse backgrounds. [ABSTRACT FROM AUTHOR]

Aim: In Croatia, doctors of dental medicine and doctors of medicine obtain their diplomas at two autonomous schools. Materials and Methods: The two professions continue to operate autonomously later on. The goal of this research is to search for the most frequent reasons for insufficient interprofessional cooperation between these two professions. A literature search was conducted on the PubMed website (US National Library of Medicine, National Institutes of Health) in February 2023 using the keywords "interprofessional cooperation, dentist, medical doctor/MD/general practitioner" and included studies on humans published in the last 10 years. After the literature search process, 18 published papers were reviewed. Results: According to the search results, interprofessional cooperation is rare, related to patient treatment (almost never to disease prevention), occurs only through personal engagement, on a voluntary and informal level, mostly with private acquaintances. The exception here is the cooperation of certain surgical specializations in the face and jaws area (maxillofacial surgery, oral surgery, otorhinolaryngology), which complement each other in certain institutions. The absence of unique, joint protocols in the treatment of certain diseases also leads to poor coordination and cooperation between medical doctors and dental medicine. As an example, there is a tendency of general practitioners, who often encounter acute toothaches, to prescribe antibiotics for such conditions. From that example, it can be seen that besides insufficient communication, there is also deficient knowledge of the other profession that contributes to the development of bacterial resistance and the consequent increase in morbidity. Conclusion: There is a need for future research on the relationship and cooperation of these two professions in order to lay the foundations for a targeted improvement of interprofessional cooperation. This would indirectly be manifested in a positive effect on the health of both individuals and society as a whole, which would have a beneficial effect on the financial burden of the healthcare system and contribute to the economic improvement of the state. [ABSTRACT FROM AUTHOR]

The user role in the design of information systems is increasingly portrayed as active and complex, and the relationships between users and developers are portrayed as blurry. Information systems have become ubiquitous in most work processes, and users typically rely on several large scale information systems tightly integrated into other information systems, machines and work practices. In this paper we propose the notion of generativity as a framework to assess generative socio-technical characteristics of such systems, conceptualized as information infrastructures. Further, the paper will discuss the role these characteristics play in users' involvement by exploring the ways in which users can contribute as designers and thereby expand on the conceptual views of users and design processes of generative information infrastructures. Empirically, this paper presents the evolution of an information system for cooperation between general practice and hospital laboratories, where users in both settings participated in the design process. The system was designed using agile methods, and design and implementation were continuous and iterative co-existing processes. The case showed that a high degree of generativity in the system itself is a necessary condition for users to make changes. However, in an integrated and complex setting the flexibility of the existing and integrated systems will heavily influence the possibility to make changes. The paper also provides an in-depth illustration of how user and designer roles evolve together with circumstances and relationships. However, we argue that this type of evolvement requires dedicating a considerable amount of time and effort to achieve a climate in which such evolvement can take place. Finally, design is more than just the development of technology. It is also the development of work practices in which users' contributions are decisive. Designing work practices alongside the design of the technology has given rise to insights that feed directly into the design process. Acknowledging users' substantial contributions in design processes can aid in refining conceptualizations of users and developers along with bolstering efforts to facilitate appropriate user involvement. [ABSTRACT FROM AUTHOR]

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Abstract: A cancer diagnosis is one of the most difficult diagnoses for any person to receive and cope with. Numerous individuals turn to religion or their spiritual beliefs to find meaning through the process of coping with such a serious illness. Therefore, in recent years research on religious coping has received increased attention. The aim of the present paper is to examine the area of religious coping, along with its dimensions and ways to assess it, as it relates to cancer. Moreover, this paper presents a relatively new approach to the psychological treatment of individuals with cancer. Namely, Acceptance and Commitment Therapy (ACT) is a spiritually and religiously sensitive treatment. This approach aims to first explore a person''s values (including spiritual and religious values), to subsequently help the person accept any experience that the person has no control over in light of these values, and to then commit and take actions consistent with these values. Recent evidence providing initial support for this approach is discussed. Finally, a case example is presented to illustrate how ACT may be carried out to address religious coping in outpatient clinical practice with cancer patients. [Copyright &y& Elsevier]

The environments and landscapes in which we live and work say much about who we are and how we act, yet there is little in the literature that considers Primary Care professionals' reflections on workspace and its impact on practice. The paper addresses this lacuna by presenting the findings of Phase II of a novel, two-year, mixed-methods study of UK General Practitioner (GP) workspace. Phase II employed photo-biographic-elicitation interviews supported by photobiographic data from Phase I, to examine 8 GPs' understandings of their workspace in relation to professional practice and self-identity. Through distillation and summation of datasets, the paper establishes the pivotal role of workspace in Primary Care. Unlike many qualitative studies, the paper emphasizes ambiguity and difference rather than certainty and similarity as characteristics that prove to be of major significance in understanding the particularity of GP workspace. Like CHAUCER's Canterbury Tales, GPs' individual stories are set as a sequence of tales within what might be called a frame narrative-the overarching narrative of British general practice providing the frame for the particular stories of the practitioners. Although working environments may be similarly structured, how GPs perceive, perform within, and move through their own setting is unique to each. [ABSTRACT FROM AUTHOR]

The Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994 was introduced in Indian Parliament in 1994 and became operational since 1996. But ever-falling female sex ratio in 2001 especially in some of the northern stales continues to be a matter of concern. Based on both the secondary and primary information collected in the field from all districts of Punjab, this paper attempts to find out the extent of untrained doctors (both allopathic and non-allopathic) using ultrasound machines, the purpose for which ultrasound scans are being conducted and to understand the referral mechanism for undertaking an ultrasound scan the paper has important policy implications. Among other things, the paper points out that much is required to be done to stop female foeticide in the state. [ABSTRACT FROM AUTHOR]

This paper, written by a General Practitioner (GP) with interest in genetics, and a Professor of Cancer Genetics, has two broad aims. First, to highlight the importance of recognising people who might have an increased predisposition of developing specific cancers, estimated from their family history, and secondly to outline how these people may be managed both in primary and secondary care and by the regional genetics unit. The paper covers why it is important to be concerned about a family history of cancer, and provides key facts about familial breast, colorectal and ovarian cancer, with relevant NICE guidelines. There is discussion about how to ascertain relatives at risk of cancer, and once these relatives have been identified, how they might be managed through the National Health Service. The two key threads of the paper are the importance of good communication between the patient and physician, and the need for close collaboration between primary and secondary care and the regional genetics units. [ABSTRACT FROM AUTHOR]

Until the so-called sanitary reform (1978), which introduced a Beveridge system, in Italy existed a peculiar kind of general practitioner, paid by municipalities, who ensured healthcare to those not covered by social insurance. In small towns those physicians also carried out the function of Health Officers, performing Public Health duties. We had the possibility to study the very large archive of one of them, doctor Sgandurra from Farindola, a village in the Abruzzi Region (central Italy): in the paper we briefly analyse six public health acts that he issued in the first half of the 1950s. [ABSTRACT FROM AUTHOR]

Background: The growth in the volume of online patient feedback, including online patient ratings and comments, suggests that patients are embracing the opportunity to review online their experience of receiving health care. Very little is known about health care professionals' attitudes toward online patient feedback and whether health care professionals are comfortable with the public nature of the feedback.Objective: The aim of the overall study was to explore and describe general practitioners' attitudes toward online patient feedback. This paper reports on the findings of one of the aims of the study, which was to explore and understand the concerns that general practitioners (GPs) in England have about online patient feedback. This could then be used to improve online patient feedback platforms and help to increase usage of online patient feedback by GPs and, by extension, their patients.Methods: A descriptive qualitative approach using face-to-face semistructured interviews was used in this study. A topic guide was developed following a literature review and discussions with key stakeholders. GPs (N=20) were recruited from Cambridgeshire, London, and Northwest England through probability and snowball sampling. Interviews were transcribed verbatim and analyzed in NVivo using the framework method, a form of thematic analysis.Results: Most participants in this study had concerns about online patient feedback. They questioned the validity of online patient feedback because of data and user biases and lack of representativeness, the usability of online patient feedback due to the feedback being anonymous, the transparency of online patient feedback because of the risk of false allegations and breaching confidentiality, and the resulting impact of all those factors on them, their professional practice, and their relationship with their patients.Conclusions: The majority of GPs interviewed had reservations and concerns about online patient feedback and questioned its validity and usefulness among other things. Based on the findings from the study, recommendations for online patient feedback website providers in England are given. These include suggestions to make some specific changes to the platform and the need to promote online patient feedback more among both GPs and health care users, which may help to reduce some of the concerns raised by GPs about online patient feedback in this study. [ABSTRACT FROM AUTHOR]

An increased burden of chronic and complex conditions treated in the community and an aging population have exacerbated the primary care workload. Predicted nursing shortages will place further stressors on this workforce. High quality clinical placements may provide a strategic pathway to introduce and recruit new nurses to this speciality. This paper is Part 2 of a two part series reporting the findings of a mixed methods project. Part 1 reported on the qualitative study and Part 2 reports on the quantitative study. Forty-five pre-registration nursing students from a single Australian tertiary institution and 22 primary care Registered Nurse (RN) mentors who supervised student learning completed an online survey. Students largely regarded their primary care placement positively and felt this to be an appropriate learning opportunity. Most RNs were satisfied with mentoring pre-registration nursing students in their setting. Furthermore, the RNs desire to mentor students and the support of general practitioners (GPs) and consumers were seen as key enablers of pre-registration nursing placements. Findings from this study provide a preliminary impression of primary care clinical placements from the perspective of pre-registration nursing students and registered nurse mentors. Further research should examine whether a broader scope of non-traditional health settings such as non-government organisations, charities, pharmacies, welfare and social services can also provide appropriate learning environments for pre-registration nursing students. [ABSTRACT FROM AUTHOR]

Abstract: As a consequence of the Health and Social Care Act general practitioners (GPs) have a pivotal role in the commissioning of services. Analysis of GPs' satisfaction with imaging may help to ensure that these services meet their needs as well as offering an opportunity to re-evaluate the quality of the imaging services provided. To date, however, there is a paucity of research relating to GPs' satisfaction with diagnostic imaging services. This paper assesses levels of GPs' satisfaction with a diagnostic imaging service in a single locality in order to identify areas for potential service improvement. The research consisted of two phases; Phase 1 consisted of five semi-structured interviews with GP trainees. Phase 2 used the themes generated from the interviews to inform the construction of a satisfaction survey targeted at all GPs practising in the locality. The study found that although GPs are largely satisfied with the service they received, there were areas identified for potential improvement. These are the speed with which radiological reports were generated, the detail of the reports themselves, access to reports for investigations to which GPs' patients have been referred from other sources, access to feedback and guidance on how to make the best use of the service and access to images. Recommendations are made for implementing improvements or solutions which will address each of these areas. [Copyright &y& Elsevier]

Objectives: This study aimed to investigate the views of students involved in rural community-based medical attachments during their final year at medical school. The programme has been in existence for some time, but no formal evaluation thereof has yet taken place. This paper describes the first two phases of what is described as a quality improvement project: namely to describe the problem state and to discuss possible activities to improve the programme. Design, setting and subjects: The study adopted a mixture of quantitative and qualitative type research. Data were collected by means of a self-administered questionnaire which students at Nelson R Mandela Medical School, University of KwaZulu-Natal, completed at the end of their Family Medicine rotation. Consent was obtained from the participants and ethical approval granted by the University of KwaZulu-Natal Humanities and Social Science Ethics Committee. Results: Students were generally positive about their rural attachment experience. The majority (86%) believed that their skills adequately prepared them to enter the community. Allocation of a supervisor and rostering were found to be of great importance. Academic activities provided adequate learning opportunities. The majority (76%) of students who used hospital accommodation found it to be satisfactory, although it was an area that needed attention. Technological support was lacking. Fewer than 50% of students had access to such facilities. Conclusion: Students' responses were generally positive about the rural attachment experience, but logistical and technological support issues, as well as that of accommodation, need to be addressed if the programme is to flourish. Community-based education in a rural district hospital can provide unique learning opportunities for students if the opportunities are identified and the programme is well managed. [ABSTRACT FROM AUTHOR]

Abstract: The impact of physician sex on dimensions of medical care such as treatment prescriptions and referrals has been underexplored, especially in a pain context. Also, few studies have analyzed whether physician sex moderates the influence of patients' or clinical situations' characteristics on pain management practices or its mediating processes. Therefore, our goal was to explore whether physician sex moderates the effects of patient (distressed) pain behaviors and diagnostic evidence of pathology (EP) on treatment prescriptions and referrals for chronic low-back pain, and to explore the mediating role of pain credibility judgments and psychological attributions on these effects. A total of 310 general practitioners (GPs; 72.6% women) participated in a between-subjects design, 2 (patient pain behaviors) × 2 (EP) × 2 (GP sex) × 2 (patient sex). GPs were presented with vignettes depicting a fe(male) chronic low-back pain patient, with(out) distress and with(out) EP (eg, herniated disc). GPs judged the patient's pain and the probability of treatment prescriptions and referrals. Results showed that EP had a larger effect on male than on female physicians' referrals to psychology/psychiatry. Also, GP sex moderated the pain judgments that accounted for the effect of EP and pain behaviors on prescriptions. These findings suggest framing medical decision-making as a process influenced by gender assumptions. Perspective: This paper shows that physician sex moderates the influence of clinical cues on pain management practices and the mediating role of pain judgments on these effects. It may potentially increase clinicians' awareness of the influence of gender assumptions on pain management practices and contribute to the development of more gender-sensitive services. [Copyright &y& Elsevier]

Abstract: For many years, drug delivery to the inner ear has been a challenge to physicians in the treatment of inner ear disorders. In the past decade, the field of inner ear drug delivery has emerged with the development of new biomaterials and drug delivery technologies to improve the effectiveness of inner ear drug therapy. This paper reviews a number of inner ear drug delivery strategies including systemic, intratympanic, and intracochlear delivery. A focus of this review is the recent advances in intratympanic delivery of medications; approaches utilizing novel biomaterials as well as other recent developments are also discussed. Biotechnology-based approaches, such as gene and stem cell therapy methods are also reviewed. Among the various strategies, local drug delivery approaches including intratympanic and intracochlear drug delivery methods that limit systemic exposure are particularly promising. These inner ear drug delivery systems provide a new opportunity to improve the treatment of inner ear disorders. [Copyright &y& Elsevier]

Glaucoma is a sight-threatening condition. A general practitioner (GP) should be able to diagnose glaucoma, know about the different management options, and refer appropriately. The aim of this paper is to provide a background to glaucoma, and describe the assessment and management of glaucoma patients. The role of the GP in the management of glaucoma and in creating awareness of glaucoma is put into perspective. [ABSTRACT FROM AUTHOR]