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Background: Telehealth can extend the reach of specialist palliative care providers to ensure that patients can access specialist services closer to home. Aim: To examine the cost and consequences of the Specialist Palliative Rural Telehealth (SPaRTa) service compared to the traditional non-specialist general practice-based services for people requiring palliative care. Design: The costs and outcomes for SPaRTa were compared using cost-consequence analysis principles, with a focus on net benefit and return on investment. Costs were estimated from the perspective of the health service provider for the 2020/2021 financial year, and cost-offsets associated with change in location of death and change in hospital transfers. Setting/participants: Patients of the SPaRTa in Queensland Australia. Results: During study period 5472 consultations were conducted from four major metropolitan hub sites to regional, rural, and remote areas at a total cost of $4 426 644. When remuneration for consultations, change to location of death and reduction in ambulance transfers were taken into account, the net-benefit to the state health system was $1 244 060, giving a return on investment of $1.28 for every dollar spent. SPaRTa complimented existing local care services, and enabled access to specialist care into the home. Conclusions: SPaRTa resulted in potential cost savings for the health service by enabling more convenient access to palliative care services outside of hospital settings. Decisions regarding funding for telepalliative care should consider not only the costs, but also the potential benefits to both the service providers, and the patients and families receiving this care. [ABSTRACT FROM AUTHOR]

Background: Provision of culturally responsive sexual health care for international students is important, given the large numbers of international students in Australia and known lower levels of health literacy among this cohort. Team-based care in general practice has the potential to provide this care. Methods: A qualitative study that developed and evaluated a team-based model of care for female, Mandarin-speaking, international students in a university-based general practice. The model involved patients attending a consultation with a Mandarin-speaking nurse with advanced skills in sexual health who provided education and preventive health advice, followed by a consultation with a GP. Evaluation of the model explored patient and healthcare worker experiences using a survey and a focus group of patients, and interviews with healthcare workers. Data were analysed using a general inductive approach. Results: The consultation model was evaluated with 12 patients and seven GPs. Five patients participated in a focus group following the consultation. Survey results showed high levels of patient satisfaction with the model. This was confirmed via the focus group findings. Healthcare workers found the model useful for providing sexual health care for this cohort of patients and were satisfied with the team approach to patient care. Conclusions: A team-based approach to providing sexual health care for international students was satisfactory to patients, GPs and the practice nurse. The challenge is providing this type of model in Australian general practice under the current funding model. Research has shown that there is a need for culturally responsive sexual and reproductive health care for international students from China. This study evaluated a team-based model of care that involved a practice nurse who spoke Mandarin, and had advanced skills in sexual health care, who provided preventive care advice followed by a consultation with a GP. The model was well received by both patients and GPs; however, the challenge is finding appropriate mechanisms of funding for this model of care in Australian general practice. [ABSTRACT FROM AUTHOR]

This narrative review isl describing the most common TMJ conditions and suggest a straightforward, clinically relevant and feasible treatment workflow for each of these. The suggestions for treatment will be based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), the Swedish National Board of Health and Welfare National guidelines for general dentistry as well as the Swedish Academy for Temporomandibular Disorders' National guidelines for TMD screening, diagnosis and treatment with the target audience of general practitioners. [ABSTRACT FROM AUTHOR]

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]

Community health workers (CHWs) are increasingly addressing health disparities in primary care settings; however, there is little information about how primary care practitioners (PCPs) interact with CHWs or perceive CHW roles. We examined PCP engagement with CHWs in adult primary care settings. Overall, 55% of 1504 PCPs reported working with CHWs; involvement with CHWs differed by some PCP demographic and practice-related factors. While PCPs perceived CHWs as engaging in most nationally endorsed CHW roles, they identified several barriers to integrating CHWs into care teams. Findings can inform ongoing efforts to advance health equity through integrating CHWs into primary care practices. [ABSTRACT FROM AUTHOR]

The United States Advisory Committee on Immunization Practices (ACIP) recommends vaccination against meningococcal serogroups A, C, W, and Y (MenACWY) for all 11–12-year-olds, with a booster dose for 16-year-olds, and against meningococcal serogroup B (MenB) for 16–23-year-olds under shared clinical decision-making (SCDM). However, uptake of the MenB vaccine and the MenACWY booster dose is low. This study investigated United States physicians' knowledge, attitudes, and practices regarding recommending MenB and MenACWY vaccines to non-high-risk older adolescents and young adults. An online survey was conducted in April–May 2022 among pediatricians, family physicians (FPs), general practitioners (GPs), and internists who had recommended the MenB and/or the MenACWY vaccine(s) to at least one 16–23-year-old in the past year. Among 407 participants, 50% correctly identified MenB as the leading cause of meningococcal disease among adolescents and young adults. Furthermore, 46% of physicians (47% of pediatricians, 40% of FPs and GPs, 53% of internists) answered correctly that MenB vaccination is recommended under SCDM, and 82% of physicians (96% of pediatricians, 70% of FPs and GPs, 65% of internists) answered correctly that MenACWY vaccination is routinely recommended. Among MenB-vaccinators, 78% reported having received some training or other information on implementing SCDM, and 65% rated recommending MenB vaccination as very important. Knowledge gaps, which varied by specialty, were identified regarding meningococcal disease and vaccine recommendations, particularly regarding MenB. Targeted education of physicians may facilitate discussions about MenB vaccination. [ABSTRACT FROM AUTHOR]

Copyright of Archives Medical Review Journal / Arsiv Kaynak Tarama Dergisi is the property of Cukurova University, Faculty of Medicine 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.)

Background: Completion of a research assignment is a requirement for specialist training in South Africa. Difficulty with completion delays graduation and the supply of family physicians. The aim of this study was to explore the experience of registrars with their research in postgraduate family medicine training programmes. Methods: An explorative descriptive qualitative study. Extreme case purposive sampling selected registrars who had and had not completed their research on time, from all nine training programmes. Saturation was achieved after 12 semi-structured interviews. The framework method was used for data analysis, assisted by ATLAS.ti software. Results: The assumption of prior learning by teachers and supervisors contributed to a sense of being overwhelmed and stressed. Teaching modules should be more standardised and focussed on the practical tasks and skills, rather than didactic theory. Lengthy provincial and ethics processes, and lack of institutional support, such as scholarly services and financial support, caused delays. The expertise of the supervisor was important, and the registrar-supervisor relationship should be constructive, collaborative and responsive. The individual research experience was dependent on choosing a feasible project and having dedicated time. The balancing of personal, professional and academic responsibilities was challenging. Conclusion: Training programmes should revise the teaching of research and improve institutional processes. Supervisors need to become more responsive, with adequate expertise. Provincial support is needed for streamlined approval and dedicated research time. Contribution: The study highlights ways in which teaching, and completion of research can be improved, to increase the supply of family physicians to the country. [ABSTRACT FROM AUTHOR]

Background: Universal health coverage (UHC) improves national health outcomes while addressing social inequalities in access to quality healthcare services. The district health system (DHS) is critical to the success of UHC in South Africa through the National Health Insurance (NHI) scheme. Family physicians (FPs), as champions of primary care, are central to the DHS operation and implementation of NHI. Methods: This was a qualitative exploratory study that used semi-structured interviews to explore FPs views and engagement on NHI policy and implementation in their districts. Ten FPs were included through purposive sampling. Results: Most of the FPs interviewed were not engaged in either policy formulation or strategic planning. The NHI bill was seen as a theoretical ideology that lacked any clear plan. Family physicians expressed several concerns around corruption in governmental structures that could play out in NHI implementation. Family physicians felt unsupported within their district structures and disempowered to engage in rollout strategies. The FPs were able to provide useful solutions to health system challenges because of the design of their training programmes, as well as their experience at the primary care level. Conclusion: Healthcare governance in South Africa remains located in national and provincial structures. Devolution of governance to the DHS is required if NHI implementation is to succeed. The FPs need to be engaged in NHI strategies, to translate plans into actionable objectives at the primary care level. Contribution: This study highlights the need to involve FPs as key actors in implementing NHI strategies at a decentralised DHS governance level. [ABSTRACT FROM AUTHOR]

Un colloque organisé en 2012 par le S.P.F. Santé publique,intitulé « médecin généralistes et psychothérapeute : collaborateurs santé ? » a permis de mettre en évidence une volonté de collaboration entre les médecins généralistes et les psychologues sans pouvoir en définir le contenu ou les modalités. Les définitions de la collaboration restent très vagues et variables. Le Consortium pancanadien pour l'interprofessionnalisme en santé définit la collaboration comme une pratique par laquelle des professionnels de santé travaillent avec d'autres professionnels de santé, le patient et sa famille. Nous pourrions également définir la collaboration interprofessionnelle comme un système et une pratique de communication entre différents professionnels de santé travaillant ensemble sur base d'intervention commune. De ce fait la collaboration ne peut être dissociée ni de ces acteurs, ni de sa forme, ni de son objectif, ni de ses objectifs. Ces derniers doivent être définis en termes de moyens, de santé publique, et de population. La collaboration entre médecin généraliste et psychologues en encore au stade de l'ébauche en terme d'opérationnalité : les différentes études ne permettent pas d'apporter une dimension opérationnelle à la collaboration en répondant aux cinq questions suivantes : Qui sont les acteurs de la collaboration ? Pourquoi collaborent-ils ? Comment se déroule la collaboration ? Qui en est le bénéficiaire ? Et dans quel(s) but(s) collaborent-ils ? A symposium organised in 2012 by the F.P.S Public Health, entitled "General practitioners and psychotherapists: health collaborators?" highlighted a desire for collaboration between general practitioners and psychologists, without being able to define the content or methods. Definitions of collaboration remain very vague and variable. The Canadian Interprofessional Health Collaboration defines collaboration as a practice in which health professionals work with other health professionals, the patient and his/her family. We could also define interprofessional collaboration as a system and practice of communication between different health professionals working together on the basis of common action. Thus collaboration cannot be dissociated from these actors, nor from its form, nor from its objective. The latter must be defined in terms of means, public health and population. Collaboration between general practitioners and psychologists is still at the draft stage in terms of operationality: the various studies do not allow us to bring an operational dimension to collaboration by answering the following five questions: Who are the actors of the collaboration? Why do they collaborate? How does the collaboration take place? Who is the beneficiary? And for what purpose(s) do they collaborate? [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.)

Background: Boston Children's Hospital's Level IV Neonatal Intensive Care Unit (NICU) discharges about a third of its medically complex infants home. Parental feedback indicated a need for more education and training in discharge preparation. Purpose: The NICU to Nursery (N2N) program was created to better prepare parents to care for their medically complex infants following Level IV NICU discharge. The goals were to (1) mitigate safety risks, (2) assess parent satisfaction, (3) assess pediatric primary care providers' (PCPs') satisfaction, (4) assess community visiting nurses' and PCPs' knowledge deficits, and (5) develop educational materials. Methods: The N2N program provided parents with pre- and postdischarge assessments with an experienced nurse. Parents completed a survey following assessments to measure satisfaction. To enhance PCPs' knowledge, they were sent summary reports and asked for feedback. PCP feedback, along with a needs assessment of community visiting nurses, guided the development of free Web-based educational videos. Results: One hundred and fifty-five parents participated in the N2N program. Parents' educational needs included medication education, safe sleep, and well-infant care, with some requiring significant nursing interventions for safety risk mitigation. Most PCPs found the home visit reports helpful. Knowledge deficits identified among PCPs and community visiting nurses included management of tubes and drains, growth and nutrition, and emergency response. More than 100,000 providers viewed the 3 Web-based educational videos developed. Implications for Practice and Research: The N2N program fills a crucial gap in the transition of medically complex infants discharged home. The next steps are developing best practices for virtual in-home assessments. [ABSTRACT FROM AUTHOR]

This is part of a series of articles on vascular access in emergencies. The other two articles were on intra osseous lines and central venous lines. These are critical lifesaving emergency skills for the primary care professional. In this article, we will provide an overview of umbilical vein catheterisation highlighting its importance, the indications, contraindications, techniques, complications and nursing considerations. By familiarising healthcare providers with this procedure, we hope to enhance their knowledge and skills, ultimately leading to improved outcomes in the neonatal population. [ABSTRACT FROM AUTHOR]

Radiation‐induced brachial plexopathy (RIBP) is an iatrogenic, progressively disabling, and often very late effect of adjuvant radiotherapy most commonly seen in breast cancer survivors but also in those treated for lymphoma, lung, and head and neck cancers. In late‐onset RIBP following breast cancer, the nerve injury is chronic and irreversible, occurring more commonly when axillary and/or supraclavicular nodes have been irradiated, as well as the breast/chest wall. RIBP is manifested initially by paresthesia, hypoesthesia, dysesthesia, and later by weakness in the ipsilateral hand with those symptoms progressing distally to proximally up through the shoulder. Depressed/absent deep tendon reflexes in the upper extremity and muscle fasciculations occur also. Neither patients nor their health care providers tend to associate these unusual neurological symptoms with cancer treatments received ≥20 years prior, often failing to link these sensory‐motor symptoms with radiotherapy decades before. Because long‐term follow‐up of these patients now typically falls to general practitioners, many cases may be missed or misdiagnosed because of the rarity of this disorder. Physiatrists and allied rehabilitation professionals must be aware of this progressively disabling, incurable condition to provide appropriate diagnoses and compensatory rehabilitation therapies. Additionally, professional oncology organizations should include RIBP in their long‐term, survivorship guidelines for breast cancer. Researchers examining the iatrogenic late effects of radiotherapy should extend their follow‐up periods well beyond the current 5–6 years to ascertain the true incidence of RIBP today. Rehabilitation providers must continue to advocate for awareness, diagnosis, and management of iatrogenic outcomes experienced by long‐term cancer survivors. [ABSTRACT FROM AUTHOR]

Current evidence shows that early interventions in children with autism spectrum disorder (ASD) are more efficient and associated with better long-term outcomes. This also highlights the need for early recognition of children with ASD symptoms by family physicians and referral to child psychiatrists. This study aimed to evaluate how family physicians' knowledge about ASD is reflected in clinical practice by making a diagnostic evaluation of the cases referred with suspected ASD. The study included 149 cases that family physicians referred to child psychiatrists regarding the assessment for ASD. Diagnostic evaluation of the subjects was carried out using the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) criteria. Childhood Autism Rating Scale (CARS) and Autism Behavior Checklist (ABC) were used in the evaluation process. Denver II developmental screening inventory was used to evaluate all subjects under six. The mean age of all participants was 39.1 (±13.2) months, and in ASD cases, it was 34.6 (±7.8) months. Of all referred cases, 72,5% were diagnosed according to the DSM-5 criteria. The most common diagnoses were global developmental delay (28.9%), language disorder (15.4%), ASD (15.4%), and attention deficit hyperactivity disorder (8.7%), respectively. The most common reason for referral specified on the consultation note was delayed speech, with a rate of 87.2%. In addition, 148 (99.3%) of the symptoms noted on the referral note were clustered within the DSM-5 ASD A criteria and 19 (12.8%) within the ASD B criteria. Developmental delay was more prominent in cases with ASD when compared to those with global developmental delay and language disorder. The most common diagnosis was a global developmental delay in referred cases, and only some of the symptoms seen in ASD from the referral notes of family physicians stood out as the reason for referral. These results underline the necessity of continuing ASD training for family physicians. [ABSTRACT FROM AUTHOR]

Pharmacists embedded in general practice can improve medicines optimisation and patient safety, but Australia has been slower to adopt and fund this model than other comparable countries. Over the last decade there have been various local programs integrating pharmacists in general practice across Australia. This article summarises the results of an evaluation in Canberra from 2016–2021. Pharmacists predominantly conducted clinical activities, including medication reviews and clinical audits. General practitioner (GP) acceptance and implementation of medication review recommendations was high (75%). General practice pharmacists were able to achieve positive clinical outcomes in asthma and smoking cessation. Surveys and interviews identified that the general practice pharmacist role was welcomed by patients, GPs, and other healthcare professionals. Patient satisfaction was very high, with patients supporting the expansion of this pharmacy service. Collaboration between the pharmacists and other healthcare professionals was high. Some pharmacists left employment in general practice after less than a year. Introducing a clear job description could be beneficial in retaining pharmacists, improving trust and working relationships, and enhancing collaboration. The majority of clinical activities conducted by the pharmacists had the potential to improve patient care and decrease healthcare costs. Apart from healthcare savings, benefit–cost ratios of income generated and costs reduced by pharmacists when compared to salaries suggested that pharmacists may be cost‐beneficial in some scenarios. Absence of funding for this model of care remains a barrier to wider adoption in Australia and needs addressing. This study was approved by the University of Canberra Human Research Ethics Committee (Project number: 15–235) and funded under the Primary Health Network Program (Grant number: 25097479). [ABSTRACT FROM AUTHOR]

Copyright of Pediatric Endocrinology, Diabetes & Metabolism is the property of Termedia Publishing House 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.)

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.)

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.)

Copyright of Salud Uninorte is the property of Fundacion Universidad del Norte 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.)

Opioid prescribing requires careful planning to minimise the risk of serious adverse outcomes. However, documentation of discharge opioid plans for patients and their general practitioners (GPs) is inconsistent, particularly when opioids are commenced in the emergency department or after surgery. We describe an initiative to promote consistent discharge opioid plan communication by implementing an opioid management plan (OMP) in our hospital's electronic medical record. Completion of an electronic form by the prescriber generates an OMP note in the medical history, which is used by the pharmacist to provide tailored opioid patient education. The OMP also populates the discharge summary that is sent to the GP and the Australian national digital health record platform, My Health Record. Preliminary evaluation shows incorporating OMP documentation into routine workflows has assisted prescribers to consistently document the plan for supplied opioids, supporting continuity of care. Workflow optimisation is ongoing to further improve discharge summary documentation and provision of patient‐friendly written information. This study was conducted as a quality improvement project and audits conducted as part of the project were approved by Austin Health's Office for Research (Project No: LNR/18/Austin/155). Informed patient consent was not required by Austin Health. [ABSTRACT FROM AUTHOR]

Scleroderma, or systemic sclerosis, is a multisystem autoimmune disorder characterized by hardening and fibrosis of the skin. To date, only a small number of case reports have established a relationship between scleroderma and external cervical resorption (ECR). The aim of this case report is to document the case of a patient with multiple external cervical resorption lesions, who was referred to our unit. A 54-year-old female patient, with a 10-year history of systemic sclerosis diagnosed by her rheumatologist, was referred to our unit regarding extensive ECR. A total of 14 maxillary and mandibular teeth with ECR were detected by clinical examination and cone-beam computed tomography. The characteristic vascularity of resorptive defects with profuse bleeding upon probing was not evident. The patient declined any active treatment owing to the desire to avoid lengthy and unpredictable treatment, which may hasten the loss of her teeth. General practitioners should be aware of the relationship between connective tissue disorders and ECR. Although not well established in the literature, the vascular changes implicated in scleroderma may stimulate the odontoclastic processes involved in ECR. [ABSTRACT FROM AUTHOR]

Introduction: Alabama is a largely rural state and is ranked 48th in health outcomes among all states in 2020. Although health literacy is essential to improve patient outcomes, health literacy assessments are not routinely incorporated into the medical setting. The purpose of this study is to explore perspectives on health literacy from primary care providers in the rural deep South and the use of health literacy assessments. These assessments help providers evaluate their understanding of their patients' literacy levels and their adapting methods to foster the best health outcomes for their patients. Participants: The study population consisted of twelve healthcare professionals serving patients from five rural communities in Alabama. These healthcare professionals included eight (67%) physicians and four (33%) nurse practitioners. Results: Many providers in this study reported not having a formal method of assessing patients' health literacy status. Instead, most used their judgment or surrogate methods (e.g., reading office brochures) to determine patients' ability to perceive the information presented to them and use it to manage their health. Conclusions: Healthcare providers must consider assessing health literacy simply and uniformly. For example, using newer health literacy measures that are valid and easy to use could provide helpful information about patients' ability to comprehend and use health information. Additionally, social support networks and/or health care advocates should be considered as an intervention to address health illiteracy. [ABSTRACT FROM AUTHOR]

We aimed to investigate the effects of the urban or rural dwelling of patients with epilepsy living in Giresun on their use of health services, quality of life, and self-efficacy. In this cross-sectional study, patients with epilepsy who were admitted to the neurology outpatient clinic between January 2022 and August 2022 were evaluated. All the participants were individually interviewed to complete the Epilepsy Self-Efficacy Scale (ESES) and Quality of Life in Epilepsy Inventory (QOLIE-10) questionnaire. The frequency of admission to the emergency department, neurology outpatient clinic, and general practitioner clinic where the primary reason for the visit was epilepsy in the last year was determined using the hospital database. This study was composed of 109 patients. The rural dwelling was found in 45% of the participants. The mean age of seizure onset was significantly lower in patients dwelling in rural areas Mean GP and ED visits didn't differ according to dwelling. On the other hand, mean neurology outpatient clinic visits were significantly lower in patients living in rural areas. The QOLIE-10 didn't differ according to the dwelling. However, lower ESES results were obtained in patients living in rural areas. This study shows that there is a disparity in neurologist visits among patients with epilepsy dwelling in rural areas. Furthermore, lower ESES scores were found in these patients. Educational interventions should be addressed particularly to the patients dwelling in rural areas to strengthen self-efficacy, and fill the gaps for the shortage of health personnel and qualified health care. [ABSTRACT FROM AUTHOR]

Background. The message of undetectable HIV viral load equals untransmissible (U=U) is important to reduce HIV stigma. We examined Australian general practitioner (GP)s' agreement of and discussion with clients about U=U. Methods. We conducted an online survey through GP networks from April to October 2022. All GPs working within Australia were eligible. Univariable and multivariable logistic regression analyses were performed to identify factors associated with: (1) agreement of U=U; and (2) discussing U=U with clients. Results. Of 703 surveys, 407 were included in the final analysis. Mean age was 39.7 years (s.d.: 8.4). Most GPs (74.2%, n = 302) agreed with U=U, but only 33.9% (n = 138) had ever discussed U=U with clients. Key barriers to discussing U=U were lack of relevant client presentations (48.7%), lack of understanding about U=U (39.9%), and difficulty identifying those who would benefit from U=U (6.6%). Agreement with U=U was associated with greater odds of discussing U=U (adjusted odds ratio (AOR) 4.75, 95% confidence interval (CI): 2.33-9.68), younger age (AOR 0.96 per additional year of age, 95%CI: 0.94-0.99), and extra training in sexual health (AOR 1.96, 95%CI: 1.11-3.45). Discussing U=U was associated with younger age (AOR 0.97, 95%CI: 0.94-1.00), extra training with sexual health (AOR 1.93, 95%CI: 1.17-3.17), and negatively associated with working in a metropolitan or suburban area (AOR 0.45, 95%CI: 0.24-0.86). Conclusion. Most GPs agreed with U=U, but most had not discussed U=U with their clients. Concerningly, one in four GPs were neutral or disagreed with U=U, suggesting that further qualitative research to understand this finding, and implementation research to promote U=U among Australian GPs, is urgently needed. [ABSTRACT FROM AUTHOR]

Objective is to investigate the knowledge and attitude among Indonesian dentists in prescribing medication for oral lesions. A cross-sectional survey recruited 497 dentists from 23 provinces consisting of general practitioners and specialists. A triangulation strategy was undertaken utilizing a quantitative design with a validated 39-item structured questionnaire, followed by a qualitative approach in-depth interview with 15 consenting participants. Logistic regression was used and inductive theme analysis was employed. Female gender was correlated with dentists' knowledge of oral lesion drug administration (p=0.029), whereas continuing dental education (p=0.025) and a high degree of knowledge (p=0.001) also had a significant impact on dentists' attitudes. 56.1% of dentists treated oral lesions on their own, and 39.5% referred oral medicine specialists. The most prevalent oral lesion themes were trauma-induced and diabetes-related lesions. The majority of respondents were unable to describe the characteristics and appropriate treatment for oral lesions. The quantitative analysis of dentists' knowledge and attitude in Indonesia revealed a high level, however, the qualitative assessment revealed the inverse. Dentists have difficulty detecting and identifying the various forms of oral lesions and their treatment. Therefore, it is strongly recommended that dentists improve their oral lesion training. [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.)

The article highlights a dentist's experience with the Waterlase laser-assisted irrigation technology and shares lessons to general practitioners doing endodontics. Practical benefits of Waterlase include ease of learning and use, versatility across procedures, patient comfort and satisfaction. Clinical benefits include effective debris and smear layer removal, enhanced disinfection and bactericidal effects, while its economic and marketing benefits are attracting patients and practice growth.

Introduction: Non-Hodgkin's lymphoma (NHL) is a broad term for malignancies of the lymphoreticular system. NHL of the oral cavity is relatively rare and can manifest in a variety of ways, which can make initial diagnosis difficult. Objectives: We discuss two contrasting cases of patients who initially presented with oral lesions to highlight the heterogeneity of lymphoma in the oral cavity and the importance of a thorough history and examination. Methods: Case note review was undertaken for Case 1 and Case 2. Results: Case 1 involves a 56-year-old male who was referred from his general practitioner to the oral and maxillofacial surgery (OMFS) emergency clinic with a three-week history of painful, intra-oral, ulcerated swellings in all four quadrants. He had recently developed fever, drenching night sweats and unexplained weight loss. The patient was admitted under OMFS until biopsy confirmed NK-T cell NHL. Case 2 involves a 68-year-old male who was urgently referred by his dentist, who had noticed a red patch on the left hard/soft palate junction at routine check-up. On examination, there was a 15mm erythematous, fixed submucosal lump on the left hard/soft palate junction. He was otherwise asymptomatic. Biopsy confirmed follicular B-cell NHL. Both patients were referred to haematology for ongoing care. Conclusions: For intra-oral lesions, lymphoma should be considered as a differential diagnosis until ruled out by biopsy. Biopsies should be performed promptly in order to prevent delays in treatment. A thorough history may help to identify the presence of 'B symptoms'. [ABSTRACT FROM AUTHOR]

Pneumonia is a respiratory illness that is highly infectious and affecting one or both lungs. It can lead to fatalities if left undiagnosed and untreated in time. While a radiologist can diagnose pneumonia just by looking at a chest X-ray, there are certain factors that may increase the chances of a misdiagnosis such as fatigue, multi-presenting symptoms, or inadequate overall experience in assessment of patients with low-prevalence presentations. A publicly available chest X-ray dataset was used in this study to create a portable executable clinical decision support tool to help determine the existence of pneumonia on a given chest X-ray image. ResNet50, DenseNet201, Xception, MobileNetV2, and ResNet101 were retrained to confirm pneumonia in chest X-rays both on the original and augmented dataset. An ensemble network was also constructed to improve the results by combining the strengths of the included pre-trained models using average probability. In this study, a total of 37 experiments were performed. Since there are instances when no single model excels on all metrics, the model with the highest Matthews Correlation Coefficient (MCC) was selected as the best model. MCC outputs an optimal score only if the classifier was able to get a high percentage for both positive and negative samples. To increase further the performance of the ensemble model, a novel method was introduced that determines which pre-trained model will give the greatest increase in the ensemble model performance when removed from the ensemble. The result is the identification of the best ensemble model variant consisting of only ResNet50, DenseNet201, Xception, and ResNet101 with Accuracy=93%, Precision=91%, Recall=98%, F1-Score=94%, Specificity=83%, MCC=85%. A stand-alone no-install application was created for this purpose to enable those with limited access or no access to internet to run the tool on their Window-based computer. Our tool can be used as portable stand-alone clinical decision support tool by radiologists when evaluating possible pneumonia case. It can also be used as a teaching tool for general practitioners and medical students. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva 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.)

Objective: To describe oral healthcare services administered during the lockdown in the Eastern Mediterranean region and to investigate the role of socio-professional characteristics of dental practitioners or their self-reported COVID-19 infection.Material and Methods: A questionnaire was distributed to dental practitioners in all healthcare sectors in Jordan, Egypt, and Saudi Arabia. Results: There was a total of 335 participants, with the majority being females (N=225, 67.2%) and general practitioners (N=202, 60.3%). Cellulitis was the most common emergency encountered (N=108). The most common urgent procedures were for pulpitis, abscesses, and pericoronitis (N=191, 130, and 95, respectively). Country-specific significant associations were pulpitis in Egypt and Jordan, broken symptomatic teeth in Jordan, and biopsy in Egypt (p<0.05). The Ministry of Health was significantly associated with the management of dental infections, avulsion, and orthodontic emergencies, while university hospitals were significantly associated with advanced restorative procedures (p<0.05). Male practitioners performed significantly more procedures, particularly surgical emergencies (p<0.05). Conclusion: Dental infections were the most common complaints among dental patients during lockdown. Country- and sector-specific dental procedures are detected. Male gender seems to play a determinant role in performing a higher number of procedures, particularly for surgical emergencies. [ABSTRACT FROM AUTHOR]

Introduction: Access to ultrasound imaging services is limited in rural areas and point-of-care ultrasound (POCUS) has the potential to address this gap. We aimed to examine how POCUS is utilised by doctors in contemporary Australian rural general practice. Methods: A portable ultrasound machine and access to a training course were provided to four general practices in rural South Australia, and the type and frequency of POCUS scans were recorded, along with user information, between July 2020 and June 2021. Participating general practitioners (GPs) completed a survey at the commencement of the study regarding their previous experience and confidence in using POCUS for specific assessments and procedures. Results: Of the 472 scans recorded, most (95%) were for clinical indications, 3% for teaching activities and 2% for self-learning. Overall, 69% were obstetric scans, followed by abdominal (12%), gynaecological procedures (10%), other procedural (7%) and thoracic exams (1.5%). Users reported higher confidence for lower complexity POCUS. Conclusion: Although POCUS has diverse potential applications in rural practice, GPs reported limited confidence for certain scans and used POCUS predominantly for obstetric indications. Further studies should examine the barriers to POCUS utilisation, with particular attention to training requirements, reimbursement for use and access to machines. [ABSTRACT FROM AUTHOR]

Introduction: Stress is a phenomenon accompanying everyday life. Various reactions of the body are activated during stress, including activation of the hypothalamo-pituitary-adrenal endocrine axis and the autonomous nervous system. Their activity could be assessed by the measurement of biological stress marker molecules - salivary α-amylase and cortisol - on one side and heart rate, and blood pressure monitoring, on the other. The aim of the present study is to determine whether the daily professional routines cause stress development among general practitioners (GPs) who work in rural, distant areas in the territory of the Republic of Bulgaria. Methods: One hundred and twenty-eight GPs were asked to answer a questionnaire to assess their health conditions, habits, priority objectives and interests, as well as their moral and ethical relationships with the patients. On this basis 40 participants were selected and outlined for the present survey (n=40, mean age 55.92±8.8). Four salivary samples were collected from each participant during 1 week: two on Monday (one in the morning and one after work) and two on Friday, by the same mechanism. The salivary samples collection was followed by measurement of blood pressure and pulse. This non-invasive survey was based on an ELISA method for quantitative determination of the marker molecules in saliva. The blood pressure and pulse were measured by blood pressure monitor. Results: The levels of the salivary a-amylase were significantly higher at the end of the working day, especially on Friday (142.28±23.34 U/mL, p=0.018), but not between the beginning and the end of the week. The normal cortisol awakening response, characterized by a peak in the levels of cortisol after wake-up, followed by a slow decrease during the day, was detected only at the beginning of the week. The data show a significant impairment of this regularity at the end of the week. Moreover, the levels of cortisol, measured for the morning samples, show a decrease at the end of the week (25.73±10.51 ng/mL) in comparison to the beginning of the week (30.1±10.84, p=0.033). The analyses on the effect of smoking (p=0.002) and alcohol consumption (p=0.036) on stress development show a significant increase in the levels of the salivary α-amylase, but not on the levels of salivary cortisol. The changes in the blood pressure indicate stress development at the end of the week (p=0.04), while the pulse showed changes within a day rather than during the week. The values of the pulse were higher at the end of the day. Conclusion: The professional lives of the GPs who work in distant and rural places are associated with stress development. Different habits from the daily routine, such as alcohol consumption, smoking and physical activity, could be considered as modulators of stress development. [ABSTRACT FROM AUTHOR]

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Introduction and Objective. In spite of the general current decrease in COVID-19 incidence, the epidemiological situation on the territory of the Czech Republic is still unfavourable. Nurses play an essential role in the fight against this disease. Materias and method. A non-standardized questionnaire was used to discover the expectations regarding nursing care provided during the COVID-19 pandemic. The sample of respondents was constructed using quota selection. The sample consisted of 1,815 respondents. Results. The study identified a significant correlation between the age of respondents and the method used to contact general practitioners (p < 0.001). The oldest respondents (65+) more likely contacted GPs by phone. Respondents with basic education used outpatient services more often before than during the pandemic (p < 0.05). The behaviour of nurses was considered as professional and accommodating. The oldest respondents (65+) reported nurses did not to make them feel rushed. Other age groups rated nurses more critically (p < 0.01). Respondents, especially women, described the psychological burden on nurses during the COVID-19 pandemic as demanding (p < 0.01). Women, more than men, reported that nurses lacked protective equipment during the pandemic (p < 0.05). The use of an online system was significantly influenced by respondent education (p 0.001). Respondents with lower education were less likely to welcome this option. Conclusions. Due to the persisting COVID-19 incidence on the territory of the Czech Republic, citizens' opinions of the position of nurse in primary care in the period of COVID- 19 pandemics need to be known.The behaviour of nurses was considered to be accommodating and satisfactory. [ABSTRACT FROM AUTHOR]

The study aimed to determine which factors affected a Thai general practitioner's (GP) intent to take integrative medicine and health (IMH) training. From the literature review, it was noted that IMH has other similar programs globally with names such as complementary and alternative medicine (CAM) and complementary and integrative medical procedures (CIM). Additionally, three latent variables were selected for the study and used in the confirmatory factor analysis (CFA) and structural equation model (SEM) LISREL 9.10 path analysis of the five hypotheses. The SEM results for each GP's training attendance intention (TAI) discovered that first in importance was each medical professional's learning ability (LA), then their perception of the innovative training course (ITC), and finally, their innovative attitude (IA). Final determination was then made that all the causal variables in the model had a positive influence on TAI, with the variability of factors influencing TAI (R2) at 41%. The three causal variables determined to affect TAI had total effect values of 0.64 (LA), 0.52 (ITC), and 0.43 (IA), respectively. [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]

Importance: Integrated care for children is rarely studied, especially in low- and middle-income countries, where generalists often provide mental health care.Objectives: To explore the effect of adding a child and youth component to an existing adult collaborative care program on mental health outcomes and receipt of care.Design, Setting, and Participants: This cluster randomized trial was conducted within an adult collaborative care program in Tehran, Iran. General practitioners (GPs), their 5- to 15-year-old patients, and patients' parents were included. Children and youths coming for routine medical visits who scored greater than the cutoff on the Strengths and Difficulties Questionnaire (SDQ) were followed up for 6 months. The study was conducted from May 2018 to October 2019, and analysis was conducted from March 2020 to August 2021.Interventions: GPs were randomized to either a 2.5-day training on managing common child mental health problems (intervention) or refresher training on identification and referral (control).Main Outcomes and Measures: Primary outcome was change in SDQ total problems score; secondary outcomes included discussion of psychosocial issues by the GPs and receipt of mental health care during the follow-up period.Results: Overall, 49 GPs cared for 389 children who scored greater than the cutoff on the SDQ (216 children in intervention group, 173 in control group). Patients' mean (SD) age was 8.9 (2.9) years (range, 5 to 15 years), and 182 (47%) were female patients. At 6 months, children in the intervention group had greater odds of receiving mental health care during the study (odds ratio [OR], 3.0; 95% CI, 1.1 to 7.7), parents were more likely to report that intervention GPs had discussed parent (OR, 2.1; 95% Cl, 1.1 to 3.8) and child (OR, 2.0; 95% Cl, 0.9 to 4.8) psychosocial issues, and intervention GPs were more likely to say they had provided counseling (OR, 1.8; 95% Cl, 1.02 to 3.3). However, there was no greater improvement in SDQ scores among children seen by intervention vs control GPs. Adjusted for clustering within GP, the variables used for balanced allocation (practice size, practice ownership, and study wave), and the other variables associated with change in SDQ scores over time, there was not a significant time-treatment interaction at either the 3- or 6-month follow-up points (linear combination of coefficients for intervention, 0.57 [95% CI, -1.07 to 2.22] and -0.08 [95%CI, -1.76 to 1.56], respectively). In a subgroup of GPs with practices composed of 50% or more children, children seen by intervention GPs improved to a significantly greater extent (-3.6 points; 95% CI, -6.7 to -0.46 points; effect size d = 0.66; 95% CI, 0.30 to 1.01) compared with those seen by control GPs.Conclusions and Relevance: In this cluster randomized trial, GP training on managing common child mental health problems did not demonstrate greater improvement in child SDQ scores. Child mental health training for GPs in collaborative care can improve children's access to mental health care, but prior experience working with children and their families may be required for GPs to use a brief training in a way that improves child outcomes.Trial Registration: ClinicalTrials.gov Identifier: NCT03144739. [ABSTRACT FROM AUTHOR]

Little is known regarding the outcomes and distinguishing characteristics of lawsuits related to endodontic procedures. This study used a verdict-based data from United States of America to analyze the factors associated with endodontic malpractice lawsuits and mitigate the risk of litigation. The LexisNexis legal database was used to search for endodontic malpractice cases from January 1, 2000 to December 31, 2021 using the terms "medical malpractice" and (I) "endodontist" (II) "endodontics" (III) "root canal" (IV) "dental pulp." Each case was reviewed for reported medical characteristics and litigation outcomes. A total of 650 cases were initially identified, and 97 cases were included in the final analysis. Eighty-four (86.6%) of the 97 defendants were general practitioners; 42 cases favored the plaintiff, 53 (54.6%) favored the defendant, 1 was partial win/loss, and 1 was settled. The annual case mean was 4.41 ± 2.17 (Mean ± SD). The major allegations favored for the patients involving paresthesia, root perforation, rubber dam not use, wrong tooth therapy, and infections. Plaintiffs who claimed with post-procedural reasons had a significantly higher winning rate than non-post-procedural reasons (P < 0.05). In the present study, 54.6% of endodontic litigation favored the dentists in the US. The authors recommend that general practitioners refer complicated cases to endodontists and treat carefully to avoid paresthesia, canal perforation and infections. Clinicians should always diagnose and treat correctly, shared decision making with the patient, use rubber dam routinely, and timely management to prevent malpractice claims. [ABSTRACT FROM AUTHOR]

Over the past twenty years, dental practice in Saudi Arabia has developed considerably, along with increase in population's knowledge of their rights. However, there is a lack of evidence and research on dental malpractice lawsuit cases in Saudi Arabia. The aim of this study was to assess the prevalence and content of legal suits regarding dental malpractice in Saudi Arabia, and to explore the factors and circumstances that were associated with these cases. This was a retrospective study on dental malpractice litigation cases between January 2017 and December 2020. Only cases with final court verdicts were included. The cases were collected from 13 Medico-Legal Committee (MLC) across Saudi Arabia while practitioners' data were retrieved from the General Directorate of Healthcare Licensing at Ministry of Health (MOH). A designed data sheet was used, which was categorized into three main sections: plaintiff demographic data, defendant demographic, data case details in the court. During the four years period, 864 cases with verdicts were studied. Most of the cases were against general dental practitioners, and majority of complaints involved prosthodontic procedures followed by endodontics. The majority of the malpractice lawsuit cases (93 %) were against non-Saudi dental practitioners and 72 % were against experienced practitioners with more than ten years of experience. Almost all cases were in the private sector. Only 10 % of cases had a consent form previously provided to the patients before treatment, and most of cases lacked proper medical documentation. The mean average trial period was 3.3 months and 76 % of defendants were found guilty. The number of cases is rising since 2017. Good documentation, compliance to informed consent protocols and dental privileges helped practitioners to avoid being found guilty. [ABSTRACT FROM AUTHOR]

Gastric cancer is an inflammation-related cancer triggered by Helicobacter pylori infection. Understanding of the natural disease course has prompted the hypothesis that gastric cancer can be prevented by administering a short-course antibiotic treatment to eradicate the H. pylori infection and interrupt this carcinogenic cascade. Results from randomized controlled trials and cohort studies have repeatedly confirmed this concept, which has moved attention from individual management of H. pylori infection to population-wide implementation of screening programs. Such a paradigm shift follows a three-tier architecture. First, healthcare policy-makers determine the most feasible and applicable eligibility, invitation, testing, referral, treatment, and evaluation methods for an organized screening program to maximize the population benefits and cost-effectiveness. Second, provision of knowledge and effective feedback to frontline general practitioners, including choice of diagnostic tests, selection of eradication regimens, and the indication of endoscopic examination, ensures the quality of care and increases the likelihood of desired treatment responses. Third, initiatives to raise population awareness are designed regarding the impact of H. pylori infection and risky lifestyle habits on the stomach health. These programs, with increased accessibility and geographic coverage in progress, will accelerate the decline in morbidity, mortality, and associated costs of this preventable malignancy. [ABSTRACT FROM AUTHOR]

Research from past decades has suggested that anabolic-androgenic steroid (AAS) users are often sceptical of their physicians' level of knowledge regarding AAS. We questioned whether contemporary British AAS users and non-AAS-using weightlifters would display similar distrust of their general practitioners. We distributed anonymous questionnaires to 61 AAS-using and 106 non-AAS-using male British weightlifters at gymnasiums and via online social media sites. Respondents rated their general practitioners' knowledge regarding health- and drug-related topics, using 10-point Likert scales from 0 (worst) to 10 (best). AAS users also rated their degree of trust in various sources of information about AAS, using similar scales, and were asked whether they had disclosed their AAS use to various categories of individuals. We then compared our findings with the results from a 2004 American study that had used virtually identical methodology. Both AAS-using and non-using weightlifters rated their general practitioners favourably on knowledge of general health and disease, cigarette smoking, and alcohol, with mean scores ranging from 6.8 to 8.7. However, respondents scored their general practitioners significantly lower on knowledge of AAS, with mean ratings of 4.3 to 4.9 from AAS non-users and only 2.4 to 2.9 from users. Among various sources of information about AAS, users trusted their doctors significantly less than "underground" guides or Internet sites. Only 22 (36 %) of the AAS users had ever disclosed their use of these drugs to any physician. These findings closely resembled those of the earlier American study, with contemporary British men reporting even greater mistrust of their physicians on weightlifting- and AAS-related topics than their American counterparts. Despite increasing AAS use worldwide and mounting evidence of the long-term dangers of these drugs, contemporary British weightlifters in general and AAS users in particular appear to remain distrustful of their physicians' knowledge of fitness sports, performance-enhancing supplements, and especially AAS. [ABSTRACT FROM AUTHOR]