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Purpose: In this study, we aimed to assess (1) the agreement between patient self-reports and general practitioner (GP) reports of the chronic conditions affecting the patients and (2) the agreement between patients and GPs on health priorities in a primary care setting.Method: Patients were recruited in the Parisian area of France by a convenience sample of GPs; eligibility criteria required that the GP was the patient's listed primary care provider for at least 12 months. Participants were asked to report all the patient's current chronic conditions by using a previously developed list of 124 chronic conditions and write a list of up to 3 priority conditions.Results: From April to May 2017, 233 patients were recruited from 16 GP practices. Agreement between the number of conditions reported by patients and by GPs was moderate (intraclass correlation coefficient 0.59, 95% CI, 0.50 to 0.69). Agreement between patient self-reports and GP reports of each chronic condition ranged from very good (eg, κ = 0.85 for hypothyroidism) to poor (eg, κ = 0.12 for chronic anxiety disorder). Among the 153 patient-GP pairs for which both the patient and GP wrote a priority list, 45 (29.4%) of patients' first priorities did not appear anywhere on the corresponding GPs' lists, and 19 (12.4%) pairs had no matching priority condition.Conclusions: Agreement between patients and their GPs varied widely depending on the diseases reported. Low agreement on health priorities suggests a need for improvement to ensure better alignment between patient and physician perspectives. [ABSTRACT FROM AUTHOR]

Objectives: To systematically assess registration details of ongoing randomised controlled trials (RCTs) targeting 10 common chronic conditions and registered at ClinicalTrials.gov and to determine the prevalence of (1) trial records excluding patients with concomitant chronic condition(s) and (2) those specifically targeting patients with concomitant chronic conditions. Design: Systematic review of trial registration records. Data sources: ClinicalTrials.gov register. Study selection: All ongoing RCTs registered from 1 January 2014 to 31 January 2015 that assessed an intervention targeting adults with coronary heart disease (CHD), hypertension, heart failure, stroke/transient ischaemic attack, atrial fibrillation, type 2 diabetes, chronic obstructive pulmonary disease, painful condition, depression and dementia with a target sample size ≥100. Data extraction: From the trial registration records, 2 researchers independently recorded the trial characteristics and the number of exclusion criteria and determined whether patients with concomitant chronic conditions were excluded or specifically targeted. Results: Among 319 ongoing RCTs, despite the high prevalence of the concomitant chronic conditions, patients with these conditions were excluded in 251 trials (79%). For example, although 91% of patients with CHD had a concomitant chronic condition, 69% of trials targeting such patients excluded patients with concomitant chronic condition(s). When considering the co-occurrence of 2 chronic conditions, 31% of patients with chronic pain also had depression, but 58% of the trials targeting patients with chronic pain excluded patients with depression. Only 37 trials (12%) assessed interventions specifically targeting patients with concomitant chronic conditions; 31 (84%) excluded patients with concomitant chronic condition(s). Conclusions: Despite widespread multimorbidity, more than three-quarters of ongoing trials assessing interventions for patients with chronic conditions excluded patients with concomitant chronic conditions. [ABSTRACT FROM AUTHOR]

Background Systematic reporting of funding sources is recommended in the CONSORT Statement for abstracts. However, no specific recommendation is related to the reporting of conflicts of interest (CoI). The objective was to compare physicians' confidence in the conclusions of abstracts of randomized controlled trials of pharmaceutical treatment indexed in PubMed. Methods We planned a three-arm parallel-group randomized trial. French general practitioners (GPs) were invited to participate and were blinded to the study's aim. We used a representative sample of 75 abstracts of pharmaceutical industry-funded randomized controlled trials published in 2010 and indexed in PubMed. Each abstract was standardized and reported in three formats: 1) no mention of the funding source or CoI; 2) reporting the funding source only; and 3) reporting the funding source and CoI. GPs were randomized according to a computerized randomization on a secure Internet system at a 1:1:1 ratio to assess one abstract among the three formats. The primary outcome was GPs' confidence in the abstract conclusions (0, not at all, to 10, completely confident). The study was planned to detect a large difference with an effect size of 0.5. Results Between October 2012 and June 2013, among 605 GPs contacted, 354 were randomized, 118 for each type of abstract. The mean difference (95% confidence interval) in GPs' confidence in abstract findings was 0.2 (-0.6; 1.0) (P = 0.84) for abstracts reporting the funding source only versus no funding source or CoI; -0.4 (-1.3; 0.4) (P = 0.39) for abstracts reporting the funding source and CoI versus no funding source and CoI; and -0.6 (-1.5; 0.2) (P = 0.15) for abstracts reporting the funding source and CoI versus the funding source only. Conclusions We found no evidence of a large impact of trial report abstracts mentioning funding sources or CoI on GPs' confidence in the conclusions of the abstracts. Trial Registration ClinicalTrials.gov identifier: NCT01679873 [ABSTRACT FROM AUTHOR]

Certaines études rapportent une chute de l'empathie clinique des étudiants en médecine lors de leur première année d'externat. Or, différentes pédagogies expérientielles et interactives pourraient limiter sa chute, voire favoriser son développement. Cette étude évalue l'efficacité d'un module associant simulations humaines (jeux de rôle et consultations avec patients simulés) et groupes Balint sur l'évolution de l'empathie des étudiants. Une étude interventionnelle monocentrique prospective avec évaluation avant et après du module pédagogique a été mise en place à destination d'étudiants de quatrième année de médecine en Île-de-France. L'empathie était mesurée par auto-questionnaire Jefferson Scale of Empathy – Medical Students et les connaissances par questions à réponse multiples. Les scores des 100 étudiants d'empathie autoévaluée montrent une amélioration statistiquement significative entre avant (108,8 ± 11,9) et après (113,7 ± 10,4 ; p < 0,001) le module. Une amélioration statistiquement significative entre avant (2,3 ± 1,1) et après (2,9 ± 1,2 ; p < 0,001) est retrouvée pour les 101 étudiants ayant rempli les questionnaires de connaissances. Enfin, une faible corrélation positive a été retrouvée (r = 0,256) entre les améliorations des questionnaires d'empathie et de connaissances. La simulation humaine associée aux groupes Balint semble favoriser le développement de l'empathie cognitive des étudiants en médecine en contexte français. Leur transposition sous visioconférence avec jeux en téléconsultation semble une voie pertinente et alternative aux limites de la réalité virtuelle dans les domaines non techniques. Some studies have reported a decline in medical students' clinical empathy during their first-year internships. Empathic skills in doctor–patient relationships have proven to have substantial benefit on the physiological as well as psychological parameters, and on the patients' and physicians' satisfaction. A range of experiential and interactive training modules have the potential to limit this decline and even foster the development of empathy, and yet French medical schools do not routinely implement such non-technical training. Moreover, there is no consensus about the concept of empathy, and previous studies rarely coordinate their definition with the method chosen to implement how it is measured. This study aims to evaluate the effectiveness of a training module that combines human simulations (simulated patient interviews and role-playing) and Balint groups in order to develop medical students' empathy as a measured cognitive attribute, declarative knowledge, and their correlation. We implemented a monocentric prospective study of fourth-year medical students from the Île-de-France area, which included pre/post-test assessment. First-year clinical interns initially completed five role-play sessions of one hour and a half each, with a group of 12 to 14 students led by a trained senior medical doctor. The sessions addressed successively issues of the doctor–patient relationship, breaking bad news scenarios, management of chronic conditions, violence and aggression, inappropriate treatment requests, or communication about medical errors. A pre-briefing session provided oral and written instruction and promoted a non-judgmental approach. Then two students role-played the doctor–patient interaction. Finally, a three-stage debriefing supported reflective learning. Subsequently, the students attended six Balint group sessions of one hour and a half each, within the same groups. One of the students was encouraged to bring up a challenging clinical situation. Then, the trained Balint supervisor invited all the students to share their observations, so as to explore the assumptions, beliefs and emotions raised by this account, and to collectively reframe the multiple perspectives on the case. At the end of the year, each student carried out two ten-minute consultations with a simulated patient, without an observer. The clinical scenarios were an HIV diagnosis disclosure and resisting a request for a prescription for antibiotics for a common cold. After each simulation, the simulated patient (SP) provided direct feedback to the student, with at times additional feedback given by their supervisor. The SP feedback was focused on empathy. The level of the medical students' empathy was assessed using the self-reported Jefferson Scale of Empathy, which measures their declarative knowledge through multiple-choice questions. Of the 100 students who completed the empathy questionnaires, we found a statistically significant difference between the pre (108.8 ± 11.9) and post-test (113.7 ± 10.4; P < 0.001). On the three JSPE-MS subscales, two students reported a statistically significant improvement (perspective taking; and the ability to put themselves in the patient's shoes). Of the 101 students who completed the knowledge questionnaires, we found a significant difference between the pre (2.3 ± 1.1) and post-test (2.9 ± 1.2; P < 0.001). Moreover, a weak correlation was found (r = 0.256) between improvements of empathy and knowledge assessments. These results in the French context are consistent with those reported in international literature on the benefits of implementing simulation training and Balint groups to limit the decline of empathy during the medical students' first clinical internships. These results are further reinforced by the consistency between the definition of empathy and the implementation of a means to measure it as a cognitive dimension. The reliance on self-assessment of empathy might lessen the validity of these results and stresses the need for a wider multidimensional approach. The quality of the evidence is also limited by a monocentric, non-randomized and non-controlled design, which calls for further research. The use of human simulations combined with Balint groups seems to support the development of the cognitive empathy of medical students in the French context. Given the recent developments in remote learning worldwide to comply with social distancing measures, their online translation into role-played tele-consultations would appear to be a very topical opportunity, while also avoiding the inherent limitations of virtual reality to address non-technical skills. [ABSTRACT FROM AUTHOR]

Background: More than half of French medical GP trainees (GPTs) suffer from burnout., Aim: To define and follow the evolution of risk factors, such as empathy and coping strategies, associated with burnout in this population., Design & Setting: Prospective longitudinal study involving volunteers of 577 Parisian university GPTs in 2012., Method: Self-reported anonymous online questionnaires were sent three times every 6 months to all participants. Stress was measured using the Intern-Life scale and burnout using the Maslach Inventory, and anxiety and depression measured using the Hospital Anxiety and Depression Scale (HADS). Sociodemographic, professional, and personal data, including coping strategies and measures of empathy were also collected., Results: In total 343 questionnaires were fully completed at baseline (T0): 304 were usable at baseline, 169 were usable at 6 months (T1) and 174 at 1 year (T2). Stress rates decreased sharply between T1 (scores 42.96) and T2 (17.08), while scores for burnout remained relatively stable: more than 13% of GPTs had high scores in all three dimensions of burnout. Depersonalisation increased from 61% (T1) to 66% (T2). One hundred and four paired samples were analysed between T0 and T1, and between T1 and T2. Emotion-centred coping was associated with emotional exhaustion ( P <0.05), while professional support reduced it. Experiences of aggression increased depersonalisation ( P <0.05). Social support, problem-centred coping, perspective-taking empathy, and professional support improved the sense of personal accomplishment ( P <0.05)., Conclusion: Tools to help GPTs are available but are underused. More training in doctor-patient relationships and understanding of medical hidden curricula are necessary to decrease burnout among GPTs and improve their wellbeing and patient care., Competing Interests: The authors declare that no competing interests exist.

Objectives: To describe the potential workload for patients with multimorbidity when applying existing clinical practice guidelines., Design: Systematic analysis of clinical practice guidelines for chronic conditions and simulation modelling approach., Data Sources: National Guideline Clearinghouse index of US clinical practice guidelines., Study Selection: We identified the most recent guidelines for adults with 1 of 6 prevalent chronic conditions in primary care (ie hypertension, diabetes, coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), osteoarthritis and depression)., Data Extraction: From the guidelines, we extracted all recommended health-related activities (HRAs) such as drug management, self-monitoring, visits to the doctor, laboratory tests and changes of lifestyle for a patient aged 45-64 years with moderate severity of conditions., Simulation Modelling Approach: For each HRA identified, we performed a literature review to determine the potential workload in terms of time spent on this HRA. Then, we used a simulation modelling approach to estimate the potential workload needed to comply with these recommended HRAs for patients with several of these chronic conditions., Results: Depending on the concomitant chronic condition, patients with 3 chronic conditions complying with all the guidelines would have to take a minimum of 6 to a maximum of 13 medications per day, visit a health caregiver a minimum of 1.2 to a maximum of 5.9 times per month and spend a mean (SD) of 49.6 (27.3) to 71.0 (34.5) h/month in HRAs. The potential workload increased greatly with increasing number of concomitant conditions, rising to 18 medications per day, 6.6 visits per month and 80.7 (35.8) h/month in HRAs for patients with 6 chronic conditions., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Background: Few studies have addressed the pragmatic management of ambulatory patients with suspected community-acquired pneumonia (CAP) using a precise description of the disease with or without chest X-ray (X-ray) evidence., Aims: To describe the characteristics, clinical findings, additional investigations and disease progression in patients with suspected CAP managed by French General Practitioners (GPs)., Methods: The patients included were older than 18 years, with signs or symptoms suggestive of CAP associated with recent-onset unilateral crackles on auscultation or a new opacity on X-ray. They were followed for up to 6 weeks. Descriptive analyses of all patients and according to their management with X-rays were carried out., Results: From September 2011 to July 2012, 886 patients have been consulted by 267 GPs. Among them, 278 (31%) were older than 65 years and 337 (38%) were at increased risk for invasive pneumococcal disease. At presentation, the three most common symptoms, cough (94%), fever (93%), and weakness or myalgia (81%), were all observed in 70% of patients. Unilateral crackles were observed in 77% of patients. Among patients with positive radiography (64%), 36% had no unilateral crackles. A null CRB-65 score was obtained in 62% of patients. Most patients (94%) initially received antibiotics and experienced uncomplicated disease progression regardless of their management with X-rays. Finally, 7% of patients were hospitalised and 0.3% died., Conclusions: Most patients consulting GPs for suspected CAP had the three following most common symptoms: cough, fever, and weakness or myalgia. More than a third of them were at increased risk for invasive pneumococcal disease. With or without X-rays, most patients received antibiotics and experienced uncomplicated disease progression.