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Background Objective Methods Results Conclusion There is a need for unified guidance in the management of acneiform rash induced by epidermal growth factor receptor inhibitors (EGFRi) among dermatologists.To establish unified international guidelines for the management of acneiform rash caused by EGFR inhibitors, based on an experts' Delphi consensus.The initiative was led by five members of the European Academy of Dermatology and Venereology Task Force ‘Dermatology for Cancer Patients’ who developed a questionnaire that was circulated to a group of 32 supportive oncodermatology experts in Europe, Canada, Argentina, the US States and Asia. The questionnaire consisted of 84 statements in total, regarding diagnosis and treatment of EGFRi‐induced acneiform rash. Experts responded to an anonymous 5‐point Likert scale survey. The coordinators collected the first‐round responses that were checked for consensus (≥75% agreement in positive [agree or strongly agree] or in negative [disagree or strongly disagree] vote). The statements that did not reach strong consensus in the first round were revised, according to experts' feedback, for a second‐round survey.Strong consensus was reached in 75/84 (89.3%) of the statements, whilst moderate consensus was achieved in 6/84 elements. Key points include consideration of low‐dose isotretinoin for refractory grade II/III acneiform rash, use of topical steroid‐sparing agents like topical pimecrolimus in the maintenance phase and use of doxycycline in either 100 or 200 mg per day as prophylactic treatment. Interestingly, experts did not recommend topical antibiotics, neither for prevention, nor for treatment. Consensus failure in 3/84 objects is mostly related to the lack of robust data on these topics.This consensus offers crucial insights often overlooked by radiotherapists, general practitioners, dermatologists and oncologists, and it is expected to improve the management of oncologic patients treated with EGFRi in different settings and continents. [ABSTRACT FROM AUTHOR]

Zanubrutinib has been approved for treating patients with different lymphoproliferative disorders and now represents a significant breakthrough in treating relapsed/refractory and previously untreated patients with chronic lymphocytic leukemia (CLL). Because few systematic studies or comparative randomized clinical trials have been conducted, optimal use of zanubrutinib in approved indications may be challenging. This article presents the results of a group discussion among an ad hoc constituted panel of experts to identify and address unmet clinical needs (UCNs) in using zanubrutinib in patients with CLL. Key UCNs were selected according to the criterion of clinical relevance using the Delphi process. Panel members reviewed the results of first‐line and upstream controlled trials in which the efficacy and toxicity profile of zanubrutinib and other BTK inhibitors were investigated in patients with CLL. Based on a critical discussion of data, the panel produced recommendations for using zanubrutinib and proposals for new studies to increase the evidence for the optimal treatment of patients with CLL. The recommendations given by the panel are intended for use not only by expert centers but, above all, by less experienced hematologists as well as general practitioners. [ABSTRACT FROM AUTHOR]

Primary cutaneous B‐cell lymphomas (PCBCLs) are lymphoproliferative disorders that appear on the skin without evidence of extracutaneous manifestations at the time of diagnosis. There is a lack of evidence‐based guidelines for their clinical management due to the availability of very few large scale studies and controlled clinical trials. Here we present and discuss a series of major unmet clinical needs (UCNs) in the management of PCBCLs by a panel of 16 experts involved in research and clinical practice of PCBCL. The Panel produced recommendations on the appropriateness of the clinical decisions concerning the identified clinical needs and proposed research for improving the knowledge needed to solve them. Recommendations and proposals were achieved by multiple‐step formalized procedures to reach a consensus after a comprehensive analysis of the scientific literature. Recommendations and proposals lay in the domain of classification uncertainties of PCBCL, optimization of diagnosis, optimization of prognosis, optimization of staging and critical issues on therapeutic strategies with particular focus on new treatments. These recommendations are intended for use not only by experts but above all by dermatologists and hematologists with limited experience in the field of PCBCLs as well as general practitioners. [ABSTRACT FROM AUTHOR]

Background: Electronic prescription (e-prescription) was introduced in 2020 in Australia during the COVID-19 pandemic. This research aimed to explore general practitioners (GPs) and community pharmacists' experience with, and facilitators and barriers to, the use of e-prescription. Methods: This qualitative study used semi-structured interviews with GPs and pharmacists in Greater Sydney to explore their experience with e-prescription. Thematic analysis used descriptive and mixed inductive and deductive approaches. The Technology Acceptance Model (TAM) was used to further interpret and organise the themes. Results: Eleven GPs and nine pharmacists were interviewed. Thirteen themes were elicited, seven of which were categorised as benefits (facilitators) and six were challenges (barriers). Four facilitator themes (convenience for healthcare providers (HCPs) and patients, addressing issues with paper prescriptions, contactless nature reducing access barriers during COVID-19 lockdown, and enabling patients to manage multiple prescriptions) were mapped to the TAM construct of 'perceived usefulness'; and one facilitator (an easier process) and two barrier themes (lack of information during implementation, and technological issues) were mapped to the TAM construct of 'perceived ease of use'. Themes that fell outside these constructs were separately categorised: four barrier themes (reluctance of some patients and HCPs to change, patient expectations of 'instant prescription' and lost opportunities for best-practice care, HCPs' perceptions of inadequate governmental governance, and ongoing costs) were 'other issues with e-prescription', and two facilitator themes (providing training on the use of e-prescription for HCPs and patients, and making e-prescription more streamlined) were 'suggestions to improve'. Conclusion: There are many facilitators and barriers to the use of e-prescription. Our findings may inform the future promotion of e-prescription post-COVID-19 pandemic. Further research should focus on consumers' perspectives of e-prescription. It is inevitable that electronic prescriptions will one day supersede paper prescriptions, but there is resistance to their implementation at the practitioner and patient levels. This paper explored GPs and pharmacists' experience and views, and found that while e-prescription improves the quality of patient care, there are several challenges to its effective use. Findings may inform the future promotion of e-prescription, particularly post-COVID-19 pandemic, and guide future research in exploring consumer perspectives. [ABSTRACT FROM AUTHOR]

As the first point of contact for patients, General Practitioners (GPs) play a crucial role in the National Health Service (NHS). An accurate primary diagnosis from the GP can alleviate the burden on specialists and reduce the time needed to re-confirm the patient's condition, allowing for more efficient further examinations. However, GPs have broad but less specialized knowledge, which limits the accuracy of their diagnosis. Therefore, it is imperative to introduce an intelligent system to assist GPs in making decisions. This paper introduces two data augmentation methods, the Complaint Symptoms Integration Method and Symptom Dot Separating Method, to integrate essential information into the Integration dataset. Additionally, it proposes a hybrid architecture that fuses the features of words from different representation spaces. Experiments demonstrate that, compared to commonly used pre-trained attention-based models, our hybrid architecture delivers the best classification performance for four common neurological diseases on the enhanced Integration dataset. For example, the classification accuracy of the BERT+CNN hybrid architecture is 0.897, which is a 5.1% improvement over both BERT and CNN with 0.846. Finally, this paper develops an AI diagnosis assistant web application that leverages the superior performance of this architecture to help GPs complete primary diagnosis efficiently and accurately. [ABSTRACT FROM AUTHOR]

Background: Gallbladder polyps are increasingly being identified due to the widespread use of abdominal ultrasound imaging. They are concerning lesions due to their potential malignant risk. It is hoped that managing them correctly will play a role in improving poor survival rates of gallbladder cancer. Awareness of these lesions is lacking. Management continues to be guided by expert opinion and observational studies and a number of consensus statements exist. Objective: This paper reviews and summarises the current literature and provides an approach for general practitioners based on the available guidance. Discussion: Although minor variation exists between consensus statements, the risk of malignancy for gallbladder polyps is still largely dictated by size, with those ≤5 mm generally considered to pose little risk and not requiring follow-up, whereas those ≥10 mm considered at greater risk and requiring referral for cholecystectomy. [ABSTRACT FROM AUTHOR]

Objective: The causal effect of successive population-wide lockdowns in response to increased COVID-19 cases on mental health has yet to be examined using robust methods. A natural experiment design underpinned by objective data can improve our understanding surrounding the definitive impact of social distancing restrictions. Methods: The study employed a natural experiment design underpinned by objective data. Health service cost for visits to general practitioners and psychologists and medication dispensing costs served as objective measures of mental health. Difference-in-difference (DID) estimators, which in this study quantify differences in spending changes between groups over time, were produced based on three comparisons: Victoria 2020 lockdown comparison, Victoria 2021 lockdown comparison, and New South Wales (NSW) 2021 lockdown comparison. Specifically, differences in public health service spending during lockdown periods and the same timeframe in 2019 for Victoria and NSW, and control groups (remaining states and territories), were compared. Results: Positive estimator values indicate that public health service spending for Victoria and NSW increased more during lockdown periods compared to control states and territories. The Victorian lockdowns of 2020 and 2021, but not the NSW lockdown of 2021, resulted in increased public spending for general practitioner mental health consults (2020 DID estimator: $8498.96 [95% CI $4012.84, $12,373.57], 2021 DID estimator: $6630.06 [95% CI $41.27, $13,267.20], all monetary values in AUD$) and short visits to psychologists (2020 DID estimator: $628.82 [95% CI $466.25, $796.00], 2021 DID estimator: $230.11 [95% CI $47.52, $373.98]). The first Victorian lockdown in 2020 and the NSW lockdown in 2021 resulted in greater spending on short visits to clinical psychologists. Spending on long visits to psychologists and clinical psychologists and medication spending did not change. Conclusions: Strict lockdowns can have an adverse impact on population mental health. The impact is particularly evident in those who have a history of previous mental health concerns but does not necessitate extra use of medications, suggesting that psychological care can address the adverse impact of the lockdowns. What is known about the topic? Previous research varied in methodology, using self-reports and healthcare data to understand COVID-19 social distancing public health measures' effects on mental health. What does this paper add? This study introduces robust, objective data via a natural experiment design, examining the impact of successive lockdowns on mental health service usage and medication expenditures in specific Australian regions. What are the implications for practitioners? Findings highlight the need for flexible mental health services that can swiftly respond to increased demands during prolonged restrictions, without necessarily increasing medication use, guiding future policy and resource allocation. [ABSTRACT FROM AUTHOR]

Background: Dizziness and vertigo are common referrals to Ear Nose Throat (ENT) outpatient services however these services have long waitlists for assessment. Primary contact physiotherapy-led vestibular clinics are recognized as improving access to care. This pilot study investigated agreement between physiotherapists and an ENT medical practitioner for diagnostic and management decisions in patients attending a primary contact physiotherapy-led vestibular clinic. Methods: Prospective blinded inter-rater agreement study undertaken in an ENT primary contact physiotherapy-led vestibular clinic. Participants were adults referred to ENT from general practitioners, triaged (Category 2 or 3) to the primary contact physiotherapy-led vestibular clinic with clinical symptoms consistent with vestibular disorder. Primary outcome measures included agreement of diagnoses and management decisions made by an ENT medical practitioner and Physiotherapist based on a vestibular physiotherapy assessment. Adverse events were reviewed 11 months post data collection. Gwet's first order agreement co-efficient (AC1) calculated inter-rater reliability between physiotherapy and ENT. Results: Fifty-one participants were recruited consecutively from the primary contact physiotherapy-led vestibular clinic. Physiotherapy and ENT had a substantial agreement (AC1 0.613) on diagnosis. AC1 between physiotherapy and ENT for recommending Magnetic resonance imaging (0.810) and computerized tomography (0.935) both indicated near perfect agreement. There was moderate to near-perfect agreement regarding management recommendations between physiotherapy and ENT. Substantial agreement (AC1 0.720) was found for recommendations for ENT input, near perfect agreement (AC1 0.933) for neurology input and moderate agreement (AC1 0.574) for physiotherapy input. There were no adverse events from physiotherapist's management decision, based on final recommendations undertaken 11-months post data collection. Conclusions: Physiotherapists and ENT medical practitioner made comparable diagnostic and management decisions, based on physiotherapy and audiology hearing assessment, for adults with signs of vestibular dysfunction, within an ENT primary contact physiotherapy-led vestibular clinic. This study provides support for this type of Physiotherapy-led service in managing patients referred to an ENT service with vestibular dysfunction. Key points: 1. This is the first study investigating interprofessional agreement between physiotherapists and an ENT medical practitioner in the diagnosis and management of patients within an ENT primary contact physiotherapy-led vestibular clinic (recommendations were based on a vestibular physiotherapy assessment as participants were not directly assessed by ENT). 2. Physiotherapists and ENT agreement on diagnosis was substantial. 3. Agreement between physiotherapy and ENT on requesting MRI brain and CT head were near perfect; and agreement between physiotherapy and ENT for onward management to ENT, neurology or physiotherapy was moderate to near perfect. 4. There were no adverse events from physiotherapy's management decision, based on the final recommendations. 5. This paper provides support for the competency of physiotherapists in managing patients referred to ENT with vestibular dysfunction and the safety of ENT primary contact physiotherapy-led vestibular clinics, albeit the presence of bias given the recommendations were based on a vestibular physiotherapy assessment only. [ABSTRACT FROM AUTHOR]

Background: Exposure to domestic and family violence is a pervasive form of complex trauma and a major global public health problem. At the frontline of the health system, primary healthcare practitioners are uniquely placed to support individuals with experiences of trauma, yet their views on trauma-informed primary care are not well understood. This systematic review of qualitative literature sought to explore primary healthcare practitioners' perspectives on trauma-informed primary care. Methods: Eight databases were searched up to July 2023. Studies were included if they consisted of empirical qualitative data, were conducted in general practice or equivalent generalist primary healthcare settings, and included the perspectives of primary healthcare practitioners where they could be distinguished from other participants in the analysis. Thematic synthesis was used for analysis. Results: 13 papers met inclusion criteria, representing primary care settings from the United States, Canada, Australia, and Norway. Three key themes were developed: Changing the paradigm, Building trust, and Navigating the emotional load. Findings shed light on how primary healthcare practitioners perceive and strive to practise trauma-informed primary healthcare and the challenges of navigating complex, trauma-related work in the primary care environment. Conclusions: This review supports the need for recognition of the value of primary care in supporting patients with histories of trauma and violence, the development of interventions to mitigate the emotional load worn by primary healthcare practitioners, and further work to develop a deep and consistent understanding of what trauma-informed primary care encompasses. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions Physical activity is an important behaviour for managing the ten times increased risk of type 2 diabetes after gestational diabetes. Previous studies exploring physical activity promotion in healthcare focus on general practitioners but have not explored the gestational diabetes pathway. Therefore, this paper explores the barriers to and suggestions for, activity promotion along the gestational diabetes healthcare pathway.The paper was written in accordance with the Standards for Reporting Qualitative Research. Patient and Public Involvement with women who had lived experiences of gestational diabetes informed purposeful sampling by identifying which healthcare professional roles should be targeted in participant recruitment. Participants were recruited through word‐of‐mouth, that is, email and connections with local healthcare service leads. Twelve participants took part in semi‐structured one‐to‐one interviews, analysed using reflexive thematic analysis.Participants included a Public Health Midwife (n = 1), Diabetes Midwifes (n = 3), Diabetes Dietitian (n = 1), Diabetes Consultants (n = 2), Diabetes Specialist Nurse (n = 1), general practitioners (n = 2), Practice nurse (n = 1) and a Dietitian from the UK National Diabetes Prevention Program (n = 1). Six themes were generated: ‘management of gestational diabetes takes precedent’, ‘poor continuity of care’, ‘lack of capacity to promote PA’, ‘beliefs about the acceptability of PA promotion’, ‘resources to support conversations about PA’ and ‘adapting healthcare services for women post‐gestational diabetes’.During pregnancy messaging around physical activity is consistent, yet this is specific for managing gestational diabetes and is not followed through postnatally. Improvements in continuity of care are necessary, in addition to ensuring the availability and links with wider exercise and activity schemes. [ABSTRACT FROM AUTHOR]

Background: Primary care is an essential pillar of health systems. Many countries have implemented different policies to improve access to primary care. However, persistent challenges remain. This paper offers a critical analysis of the evolution of primary care coverage in Portugal, focusing on the number of patients without an assigned general practitioner (GP). Methods: We collected and analyzed publicly available data from 2009 to 2023 to decompose primary care coverage in three components: the number of patients enrolled in primary care units (demand-side effect), the number of GPs measured in full-time equivalent (supply-side effect), and the average number of patients on each GP's list (patient-to-GP ratio, capturing a productivity effect). We provide national and local level estimates for these three components. Results: Between 2009 and 2023, there was an overall decline in the number of patients enrolled in primary health care units. Concurrently, there was also a net decrease of GPs measured in full-time equivalent. Additionally, there was a progressive reduction in the average number of patients on each GP's list. The rise in the number of patients without an assigned GP is attributed not only to a reduction in the number of physicians, but also to a decrease in the patient load per doctor. Conclusions: Hiring additional GPs may not suffice to enhance coverage. Achieving higher coverage may imply revisiting patient load per doctor or considering alternative care models. Understanding the challenges related to GP coverage is critical for improving the efficiency of primary care. [ABSTRACT FROM AUTHOR]

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Women in the Netherlands with non-western migration backgrounds experience domestic violence at the intersection of culture and gender, and visit their general practitioners (GPs) with health concerns related to the violence. Drawing on semi-structured interviews with GPs, this paper illuminates how GPs navigate the process of decision-making around intervention in domestic violence, with particular attention to the role of autonomy. Patient autonomy is a core principle in Dutch general practice. The term refers to the principle that GPs must respect that competent adults can make autonomous decisions about the care they do and do not want, and that GPs must respect patients' views, choices, and ways of life. The interview data shows great variation in how GPs respond in situations of domestic violence against women with non-western migration backgrounds. Deploying 'somatechnics of perception', this paper explores how GPs' perceptions of their patients' autonomy are both the agent and effect of a complex and embodied negotiation of gender, race, culture, ethnicity, medical ethics, and morality. In highlighting how these patients' autonomy is rendered (un)intelligible and (il)legible in contextually specific ways, this paper sheds light on how GPs in the Netherlands can better assist women with non-western migration backgrounds who experience domestic violence. [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]

Background: Changes in demographics with an older population, the illness panorama with increasing prevalence of non-communicable diseases, and the shift from hospital care to home-based care place demand on primary health care, which requires multiprofessional collaboration and team-based organization of work. The COVID-19 pandemic affected health care in various ways, such as heightened infection control measures, changing work practices, and increased workload. Objectives: This study aimed to investigate the association between primary care practices' organization, and quality and safety changes during the COVID-19 pandemic. Design: Data were collected from 38 countries in a large online survey, the PRICOV-19 study. For this paper, the participating practices were categorized as "Only GPs", comprising practices with solely general practitioners (GPs) and/or GP trainees, without any other health care professionals (n = 1,544), and "Multiprofessional," comprising practices with at least one GP or GP trainee and one or more other health professionals (n = 3,936). Results: Both categories of practices improved in infection control routines when compared before and during the COVID-19 pandemic. A larger proportion of the multiprofessional practices changed their routines to protect vulnerable patients. Telephone triage was used in more "Multiprofessional" practices, whereas "Only GPs" were more likely to perform video consultations as an alternative to physical visits. Both types of practices reported that the time to review new guidelines and scientific literature decreased during the pandemic. However, both had more meetings to discuss directives than before the pandemic. Conclusions: Multiprofessional teams were keener to introduce changes to the care organization to protect vulnerable patients. However, practices with only GPs were found to be more aligned with video consultations, perhaps reflecting the close patient-doctor relationship. In contrast, telephone triage was used more in multiprofessional teams. [ABSTRACT FROM AUTHOR]

Objective: The Australian federal government is considering a 'digital front door' to mental healthcare. The Brain and Mind Centre at the University of Sydney has published a discussion paper advocating that the government should adopt a comprehensive model of digital triage and monitoring (DTM) based on a government-funded initiative Project Synergy ($30 million). We critically examine the final report on Project Synergy, which is now available under a Freedom of Information request. Conclusion: The DTM model is disruptive. Non-government organisations would replace general practitioners as care coordinators. Patients, private psychiatrists, and psychologists would be subjected to additional layers of administration, assessment, and digital compliance, which may decrease efficiency, and lengthen the duration of untreated illness. Only one patient was deemed eligible for DTM, however, during the 8-month regional trial of Project Synergy (recruitment rate = 1/500,000 across the region). Instead of an unproven DTM model, the proposed 'digital front door' to Australian mental healthcare should emphasise technology-enabled shared care (general practitioners and mental health professionals) for the treatment of moderate-to-severe illness. [ABSTRACT FROM AUTHOR]

Background: The CELTIC ranges project aims to deliver a comprehensive range of reference intervals for commonly ordered laboratory investigations suitable for use in an Irish population as well as enabling comparison with relevant international studies. In this paper, we describe our methodology used throughout the entire project and present paediatric reference intervals for renal profile tests in plasma (sodium, potassium, urea and creatinine). Methods: 1023 children aged up to 17 years were recruited from our hospital's general practitioner paediatric phlebotomy clinic. Clinical chemistry analyses were performed on the Roche modular system and statistical analysis was completed in line with CLSI guideline EP28-A3c. Results: The plasma reference interval for sodium for ages 0.45–16.99 years was 137–143 mmol/L in 1000 subjects (combined genders). For plasma potassium, the corresponding ranges between 1 and 16.99 years (combined genders) were 3.6–4.8 mmol/L. Apart from neonates and in keeping with other studies, age partitioning for electrolytes was not required. Data for plasma creatinine (enzymatic methodology) and urea is also presented and, as anticipated, required partitioning for both age and gender. Conclusions: Our renal profile findings are broadly consistent with those of international studies, for example, CALIPER, HAPPI, NORDIC, PRINCE and KiGGs. Moreover, the CELTIC ranges study is also based on over 1000 subjects whose samples were analysed on the widely used Roche modular analytics system. We also expect the findings will improve knowledge of children's metabolic health in Ireland. [ABSTRACT FROM AUTHOR]

The emergence of the highly contagious coronavirus disease has led to multiple pandemic waves, resulting in a significant number of hospitalizations and fatalities. Even outside of hospitals, general practitioners have faced serious challenges, stretching their resources and putting themselves at risk of infection. Telemonitoring systems based on Internet of things technology have emerged as valuable tools for remotely monitoring disease progression, facilitating rapid intervention, and reducing the risk of hospitalization and mortality. They allow for personalized monitoring strategies and tailored treatment plans, which are crucial for improving health outcomes. However, determining the appropriate monitoring intensity remains the responsibility of physicians, which poses challenges and impacts their workload, and thus, can hinder timely responses. To address these challenges, this paper proposes an expert system designed to recommend and adjust the monitoring intensity for COVID-19 patients receiving home treatment based on their medical history, vital signs, and reported symptoms. The system underwent initial validation using real-world cases, demonstrating a favorable performance (F1-score of 0.85). Subsequently, once integrated with an Internet of Things telemonitoring system, a clinical trial will assess the system's reliability in creating telemonitoring plans comparable with those of medics, evaluate its effectiveness in reducing medic–patient interactions or hospitalizations, and gauge patient satisfaction and safety. [ABSTRACT FROM AUTHOR]

Introduction: Development and implementation of the Townsville Lung Cancer Referral Pathway [TLCRP] aims to reduce delays and improve referral patterns of people with suspected lung cancer in north Queensland, Australia. Reported in this paper is the experiences and perspectives of general practitioners [GPs] and specialists of the TLCRP. Methods: This was a descriptive qualitative study nested within a larger project evaluating TLCRP, utilising a broader implementation science framework. In-depth, semi-structured interviews with GPs and specialists were conducted. An iterative, inductive thematic analysis of interview transcripts was used to derive key codes, then grouped into themes regarding participant experiences and perceptions. Results: Data analysis identified two major themes and several sub-themes. The major themes were variation in the uptake of TLCRP and enhancing coordinated care and communication. Discussion: Several enablers and barriers to implementing TLCRP were identified. Barriers to adaptation of TLCRP included lack of clinical time, resistance to changing referral patterns, lack of familiarity or experience with HealthPathways and technology issues. Conclusion: Emerging themes from this study may be used to reduce the barriers and improve uptake of TLCRP and other health care pathways in the local health service and may have wider relevance in other settings. [ABSTRACT FROM AUTHOR]

Axial spondyloarthritis (axSpA) is an inflammatory joint disease whose predominant symptom is inflammatory pain in the spine. It occurs in approximately 1% of the population, with a higher incidence in men. Spinal pain in the course of spondyloarthritis is called inflammatory back pain. In addition to inflammatory back pain, other symptoms of axSpA include enthesitis, peripheral arthritis and extra-articular symptoms. A patient's family history and human leukocyte antigen B27 (HLAB27) should also be considered, as these correlate closely with a higher incidence of spondyloarthritis. AxSpA is often underdiagnosed, and no specific serological test or physical examination can determine the diagnosis of spondyloarthritis. Despite good knowledge of the disease, the time between the first symptoms and diagnosis is still too long, which adversely affects the subsequent treatment options, as well as the mental and economic condition of patients. Patients are not referred to a rheumatologist quickly enough. Therefore, the features of inflammatory back pain, the symptoms associated with axial spondyloarthritis and the diagnostic tests should be well known by general practitioners and other specialists to whom patients with pain are first referred. This would accelerate accurate diagnosis and prompt implementation of appropriate treatment. This paper discusses symptoms of axSpA and emphasises the importance of prompt diagnosis in patients with complaints typical of spondyloarthritis. [ABSTRACT FROM AUTHOR]

Access to allied health services offers significant benefits for people living with dementia, yet access is currently fragmented and inconsistent. The 2023–2024 budget allocated AU$445 million to further enable general practice-led, multidisciplinary teams, with integrated care located within practices, including employment of allied health professionals. Such team care models are recognised by The Royal Australian College of General Practitioners as vital to delivery of high-quality care for older adults. They are especially relevant for over 250,000 Australians who live with dementia in the community. However, not all allied health professionals are currently based within general practices. Future, sustainable general practice-led models of multidisciplinary care that connect patients with external allied health providers could be considered for a comprehensive and collaborative approach to care. Our focus is on people living with dementia, who are at greater risk of preventable vision impairment. Poor vision and/or ocular health can be detected and managed through regular eye examinations, which are predominantly delivered by community-based optometrists in Australia, in a primary care capacity. However, people living with dementia are also less likely to have regular eye examinations. In this paper, we highlight the value of ensuring access to primary eye care services as part of post-diagnosis dementia care. We illustrate the important role of primary care practitioners in building and sustaining connections with allied health professions, like optometry, through effective referral and interprofessional communication systems. This can help break down access barriers to dementia-friendly eye care, through promoting the importance of regular eye tests for people living with dementia. Access to allied health services offers significant benefits for people living with dementia, yet access is currently fragmented and inconsistent. People living with dementia are at greater risk of experiencing vision impairment, preventable through regular eye examinations usually provided by community-based optometrists in a primary care capacity. We encourage all primary care practitioners to 'think vision' when consulting with people living with dementia, and advocate for a schedule of regular eye tests post-diagnosis. This article belongs to the Collection Access to Primary Health Care. [ABSTRACT FROM AUTHOR]

Background: Epidemiological studies often rely on self-reported health problems and validation greatly improves study quality. In a study of late effects after childhood cancer, we validated self-reported cardiovascular problems by contacting general practitioners (GPs). This paper describes: (a) the feasibility of this approach; and (b) the agreement between survivor-reports and reports from their GP. Methods: The Swiss Childhood Cancer Survivor Study (SCCSS) contacts all childhood cancer survivors registered in the Swiss Childhood Cancer Registry since 1976 who survived at least 5 years from cancer diagnosis. We validated answers of all survivors who reported a cardiovascular problem in the questionnaire. Reported cardiovascular problems were hypertension, arrhythmia, congestive heart failure, myocardial infarction, angina pectoris, stroke, thrombosis, and valvular problems. In the questionnaire, we further asked survivors to provide a valid address of their GP and a consent for contact. We sent case-report forms to survivors' GPs and requested information on cardiovascular diagnoses of their patients. To determine agreement between information reported by survivors and GPs, we calculated Cohen's kappa (κ) coefficients for each category of cardiovascular problems. Results: We used questionnaires from 2172 respondents of the SCCSS. Of 290 survivors (13% of 2172) who reported cardiovascular problems, 166 gave consent to contact their GP and provided a valid address. Of those, 135 GPs (81%) replied, and 128 returned the completed case-report form. Survivor-reports were confirmed by 54/128 GPs (42%). Of the 54 GPs, 36 (28% of 128) confirmed the problems as reported by the survivors; 11 (9% of 128) confirmed the reported problem(s) and gave additional information on more cardiovascular outcomes; and seven GPs (5% of 128) confirmed some, but not all cardiovascular problems. Agreement between GPs and survivors was good for stroke (κ = 0.79), moderate for hypertension (κ = 0.51), arrhythmias (κ = 0.41), valvular problems (κ = 0.41) and thrombosis (κ = 0.56), and poor for coronary heart disease (κ = 0.15) and heart failure (κ = 0.32). Conclusions: Despite excellent GP compliance, it was found unfeasible to validate self-reported cardiovascular problems via GPs because they do not serve as gatekeepers in the Swiss health care system. It is thus necessary to develop other validation methods to improve the quality of patient-reported outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Kunming Medical University / Kunming Yike Daxue Xuebao is the property of Kunming Medical Journal 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 Exercise is widely understood to improve health outcomes in children and adolescents and to contribute to the prevention and management of many chronic conditions. Australian children are not currently meeting the recommended physical activity guidelines, and these habits are likely to extend into adulthood without intervention. Objective The aim of this paper is to provide general practitioners (GPs) with the tools to perform a basic exercise assessment with children and adolescents and an understanding of the core principles of exercise prescription for general and special paediatric populations. Discussion GPs are limited by time often precluding the assessment of exercise levels in children and adolescents unless it is immediately relevant to their presentation. This article discusses simple methods of assessing physical activity, the importance of appropriately prescribed exercise and its benefits for physical, psychological and social health and wellbeing. [ABSTRACT FROM AUTHOR]

Background Most Australian adults are insufficiently physically active, creating an economic and moral imperative to support exercise care in general practice. Objective To provide an overview of exercise care in general practice to support sustained solutions for patients living with chronic disease. Discussion Exercise care should be considered a fundamental component of high-quality consultations, including assessing, advocating and monitoring for physical activity. Exercise levels and cardiorespiratory fitness can be considered ‘vital signs’ for tracking over time. Modest gains in physical activity levels have clinical benefits, warranting approaches that engage patients in any amount of time in exercise. Resources are available to support general practitioners (GPs) to incorporate exercise care into routine consultations. GPs can print or save the links provided in this paper and use platforms such as GoShare to connect patients to the resources. Over 15 exercise-specific clinical practice guides are available through The Royal Australian College of General Practitioners’ Handbook of non-drug interventions. [ABSTRACT FROM AUTHOR]

This article discusses the definition of general medicine and generalists in Japan. The authors, who are Japanese physicians practicing general medicine, provide their perspective on the nature of general medicine and generalists. They argue that there should be a distinction between the definition of generalists and general medicine in Japan, and that the scope of consideration should be broadened to include other types of physicians such as emergency physicians, intensivists, and palliative care physicians. The authors also highlight the importance of considering the differences between Japanese and English expressions and cultural backgrounds when defining general medicine and generalists. They call for collaboration among generalists from various positions to discuss the qualities and competencies required for the development of general medicine. [Extracted from the article]

Colorectal cancer (CRC) is a common malignant tumor of the gastrointestinal tract, which has become a serious threat to human health worldwide. This article exhaustively reviews colorectal cancer's incidence and relevance, carcinogenesis molecular pathways, up-to-date treatment opportunities, prophylaxis, and screening program achievements, with attention paid to its regional variations and changes over time. This paper provides a concise overview of known CRC risk factors, including familial, hereditary, and environmental lifestyle-related risk factors. The authors take a closer look into CRC's molecular genetic pathways and the role of specific enzymes involved in carcinogenesis. Moreover, the role of the general practitioner and multidisciplinary approach in CRC treatment is summarized and highlighted based on recent recommendations and experience. This article gives a clear understanding and review of the gains and challenges of modern medicine towards CRC. The authors believe that understanding the current patterns of CRC and its revolution is imperative to the prospects of reducing its burden through cancer prevention and cancer-adjusted treatment. [ABSTRACT FROM AUTHOR]

Background: This paper aimed to describe the legal worries of Australian general practitioners (GPs) and nurses regarding end-of-life care provided in the aged care setting. Methods: An analysis of responses to the final, open-ended question of a cross-sectional online survey of GPs and nurses practising in aged care settings in Queensland, New South Wales and Victoria was undertaken. Results: Of the 162 GPs and 61 nurses who gave valid responses to the survey, 92% (151 GPs and 55 nurses) responded to the open-ended question. Participants identified concerns across all relevant areas of end-of-life law. The most common concerns were substitute decision-makers or family member(s) wanting to overrule an Advance Care Directive, requests for futile or non-beneficial treatment and conflict about end-of-life decision-making. Participants often also identified concerns about their lack of legal knowledge and their fear of law or risk related to both end-of-life care generally and providing medication that may hasten death. Conclusions: Australian GPs and nurses working in aged care have broad-ranging legal concerns about providing end-of-life care. Legal concerns and knowledge gaps identified here highlight priority areas for future training of the aged care workforce. The law supports good end-of-life clinical practice by facilitating health care that aligns with the values and goals of patients, including those residing in residential aged care facilities. GPs and nurses here reported broad-ranging legal concerns relevant to providing end-of-life care within aged care, including substitute decision makers/family members wanting to overrule Advance Care Directives, requests for futile or non-beneficial treatment and conflict about decision-making. Participants' concerns can inform end-of-life legal training for aged care GPs and nurses. [ABSTRACT FROM AUTHOR]

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Background: The COVID-19 pandemic was associated with an increase in child and adolescent mental health disorders, with subsequent worsening of patient access to specialist mental health care. Clinicians working in the community were faced with increased demands to diagnose and manage pediatric mental health disorders, without always having the confidence and knowledge to do so. We therefore developed COnnecting Mental-health PAediatric Specialists and community Services (COMPASS)—a collaborative model designed to upskill community clinicians in child and adolescent mental health care and provide them with better access to child and adolescent psychiatry expertise. COMPASS comprises (1) an online Community of Practice (CoP) with fortnightly one-hour sessions covering: anxiety; aggression and challenging behaviours; depression; self-harm and suicidality; eating disorders; and autism spectrum disorder/complex cases and (2) primary and secondary consultations for general practitioners and paediatricians with an experienced child psychiatrist. We aimed to assess the impact of COMPASS on community clinician self-reported confidence in: managing common child and adolescent mental health disorders (Objective 1, primary outcome); navigating the mental health care system (i.e. knowing how services are organised, accessed, and how to refer patients, Objective 2); diagnosing conditions (Objective 3); prescribing psychotropic medications (Objective 4) as well as the impact on, clinician practice and wellbeing (Objective 5) and outcomes of patients referred by COMPASS clinicians to the child psychiatrist (Objective 6). Methods: We evaluated COMPASS in its first year, with COMPASS running from March to July 2021. Participating clinicians completed pre-post surveys evaluating change in Objectives 1 to 4 above, using study-designed measures. A purposive sample of clinicians was then invited to a semi-structured interview to understand their experience of COMPASS and its impacts on practice and wellbeing (Objective 5). We adopted an inductive approach to the qualitative analysis using the Framework Method. This involved selecting five random transcripts which were double coded and categorized, to generate an initial framework against which all subsequent transcripts were analysed. Themes and subthemes were generated from the data set, by reviewing the matrix and making connections within and between clinicians, codes and categories One child psychiatrist completed a 2-week logbook of the nature and outcomes of primary and secondary consultations (Objective 6). Findings: 51 (86%) clinicians attended CoP sessions and completed pre-post surveys, with 92% recommending COMPASS to peers. Clinicians reported increased confidence in the pharmacological and non-pharmacological management of all conditions, most notably for management of self-harm. They also reported increased knowledge of how to navigate the mental health system and prescribe medications. Qualitative analysis (n = 27 interviews) found that COMPASS increased clinician wellbeing and reduced feelings of professional isolation and burnout. Over the 2-week snapshot, the child psychiatrist consulted on 22 patients and referred all back to the community clinician. Conclusions: COMPASS is associated with improved clinician confidence to manage child and adolescent mental health concerns, navigate the mental health system, improved clinician wellbeing, and reduced need for ongoing mental health care by specialists. [ABSTRACT FROM AUTHOR]

Aim Method Results Conclusion Faecal immunochemical testing (FIT) is used to triage people with signs or symptoms of a colorectal cancer (CRC). Recent guidelines have recommended further research to improve access, uptake and return of FIT. This systematic scoping review aims to understand the barriers and facilitators to FIT testing in symptomatic patients.Qualitative, quantitative and mixed‐methods studies published after September 2013 were included. MEDLINE, EMBASE and PsycINFO databases were searched to identify publications examining barriers and facilitators to FIT. Initially, the data underwent thematic analysis, and subsequently, factors were aligned to components of the Capability, Opportunity, Motivation, Behaviour model. All outcomes are presented in adherence to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines.One thousand two hundred thirty‐two papers were identified; 11 met the inclusion criteria. Barriers and facilitators were identified at the patient (e.g., knowledge), provider (e.g., general practitioner awareness) and service level (e.g., method of providing FIT kits). Factors were categorised into the subcomponents of the model: psychological capability (e.g., lack of FIT knowledge), reflective motivation (e.g., beliefs regarding FIT sampling and faeces being unhygienic) and automatic motivation (e.g., embarrassment, scary, anxiety provoking). Gaps in knowledge emerged in three domains: (1) patient experience, (2) FIT pathway and (3) healthcare professionals experience of FIT.This systematic scoping review provides a summary of the literature on FIT uptake, and identified factors across multiple levels and components. To increase adherence to FIT completion within primary care, a multifaceted theory and evidence‐based approach is needed to underpin future behavioural science interventions. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusions\nKEY POINTSAccording to the UN Committee Against Torture, all state parties to the Torture Convention have a responsibility to meet the rehabilitation needs of torture victims who have sought asylum within their borders. General practitioners (GPs) can play a crucial role in identifying torture victims and securing rehabilitation when needed. There is a pressing knowledge gap on the knowledge and practices of GPs vis-à-vis potentially tortured patients, and an urgent need for research that investigates GPs’ practices of identification, referral, and rehabilitation – in Norway and beyond. This article presents an exploratory qualitative pilot study that investigates the experiences of GPs in Oslo vis-à-vis this patient group.Semi-structured interviews with five experienced GPs in the greater Oslo area. Interview data was analyzed through thematic analysis and discussed within a theoretical framework seeing GPs as street-level bureaucrats.Issues that emerged in the pilot involve a consistent professional confidence and a particular concern for victims of sexual violence and sexualized torture. The pilot also found a troubling commonsensical reasoning about identification in the asylum process. The GPs asked for the re-establishment of specialist rehabilitation centers for refugees and torture victims to consult in case of need. Alas, the study also confirmed that GPs are a difficult profession to recruit for research.This study indicates that GPs are important actors in terms of identifying torture victims after resettlement, but that there are shortcomings in their training and knowledge, in the overall organization of the healthcare system, and in specialized healthcare, that limit prospects for rehabilitation.To what extent are torture victims met or identified by GPs in resettling contexts? This paper presents a pilot study designed to address this knowledge gap and prepare future studies. We found:GPs were confident in their abilities to identify and meet torture victims in a good way – and in the value that is patient-doctor continuity in general medicine.Troubling commonsensical reasoning about identification in the asylum process and in consultations.A lack of and need for qualified and available expertise to consult with and/or refer tortured patients to.GPs were confident in their abilities to identify and meet torture victims in a good way – and in the value that is patient-doctor continuity in general medicine.Troubling commonsensical reasoning about identification in the asylum process and in consultations.A lack of and need for qualified and available expertise to consult with and/or refer tortured patients to. [ABSTRACT FROM AUTHOR]

In this paper Atlantic blue marlin (ABM) optimization algorithm, Boops optimization (BO) algorithm, Chironex fleckeri search optimization (CSO) algorithm, general practitioner-sick person (PS) optimization algorithm are applied for solving factual power loss reduction problem. Natural actions of Atlantic blue marlin are emulated to design the Atlantic blue marlin (ABM) optimization algorithm and populace in the examination space is capriciously stimulated. Boops optimization (BO) algorithm is designed by imitating the stalking physiognomies of Boops. CSO is based on the drive and search behavior of Chironex fleckeri. A general practitioner will treat a sick person with various procedures which have been imitated to model the Projected PS algorithm. Inoculation, medicine and operation are the procedures considered in the PS algorithm. Atlantic blue marlin (ABM) optimization algorithm, Boops optimization (BO) algorithm, Chironex fleckeri search optimization (CSO) algorithm, general practitioner – sick person (PS) optimization algorithm validated in IEEE 57, 300 systems and 220 KV network. Factual power loss lessening, power divergence restraining, and power constancy index amplification have been attained. [ABSTRACT FROM AUTHOR]

Background Institutions are established patterns of recurrent social relationships playing a fundamental part in all our lives. The family is the best-known institution, but other 'total' institutions serve as organisations directly affecting the lives of many individuals in the healthcare sector. Objective This paper examines the sociological theory of institutionalisation as applied to individuals admitted to aged-care facilities, where the complete life-rounds of inmates occur within clearly defined limits. The study provides a framework to enable general practitioners, nurses and healthcare professionals to better appreciate the processes involved as individuals adapt to their new environment. Discussion Sociology provides valuable insights for healthcare providers in understanding how individuals adapt to their loss of independent living and find themselves subjected to intimate regulation in the total institution. The biopsychosocial model of healthcare delivery is better understood when we as health professionals have greater insights to appreciate the competing processes at work. [ABSTRACT FROM AUTHOR]

This paper systematically reviewed the process of primary health care development of China over the past 45 years, and summarized the achievements of primary health care based on data related to primary health care draw from 2010-2012 China Health Statistics Year book, 2013-2017 China Health and Family Planning Statistical Yearbook and 2018-2022 China Health Statistics Year book. Data of the infant mortality rate, maternal mortality rate, and average life expectancy were from the World Bank in China and upper middle income countries in 2023. The development of primary health care of China was summarized into four phases, and the achievements included the improvement of the primary health care network, coverage expansion of basic health insurance, the increase of funding and coverage of basic public health services, the steady improvement of family doctor contracts, and the continuous improvement of women's and children's health, with major health indicators ranking among the top upper middle-income countries. The current challenges include the unbalanced development of infrastructure construction in the primary medical and health system, the decline in the proportion of medical insurance funds, the lack of vitality of the management system, the low level of remuneration and imperfect incentive system. This paper summarizes the enlightenment of international experience for China's primary health care, and puts forward the future development directions and strategies.

Background: Functional somatic disorders (FSD) are a common problem across medical settings and remain challenging to diagnose and treat. Many patients with FSD undergo sequential and unnecessary extensive diagnostic work-up, which is costly for society and stressful for patients. Previous studies have shown that the empirically based FSD diagnostic entities are interrater reliable and stable over time. Objective: The aim of this study was to investigate whether internists who have received adequate training and with sufficient time per patient could diagnose FSD. Design: This was a prospective diagnostic accuracy study. The study was conducted from May 2020 to April 2022. Participants: The study included 27 consecutive patients referred by their general practitioner to a non-psychiatric diagnostic clinic for assessment of physical symptoms on suspicion of FSD. Interventions: The internists received a 30-hour training course in the use of a tailored version of the SCAN interview. Main measures: The main outcome measure was the agreement between the diagnoses of the internists and the reference diagnoses made by specialists in FSD on the basis of the full SCAN interview. Key results: The interrater agreement between the internists and the FSD experts was substantial for any FSD (kappa = 0.63) as well as multi-organ vs. single-organ FSD (kappa = 0.73), indicating good diagnostic agreement. Conclusions: Internists with proper training and sufficient time (3–4 hours) per patient can proficiently diagnose FSD employing a tailored version of the SCAN interview for use in a non-psychiatric diagnostic setting. [ABSTRACT FROM AUTHOR]

Aims: Maintaining continuity of care between doctors and patients is considered a fundamental aspect of quality in primary healthcare. In this study, we aim to examine continuity in Norway over time by computing two commonly used indicators of continuity: the St Leonard's Index of Continuity of Care (SLICC) and the Usual Provider of Care Index (UPC). Method: We employ individual-level data, which covers all primary care consultations. This data includes the identities of each patient and physician, and we can identify each patient's regular general practitioner (GP). The SLICC is calculated as the share of consultations conducted by the patient's regular GP annually from 2006 to 2021. Additionally, we identify each patient's most visited physician and compute the UPC as the share of total consultations conducted by the most visited physician during the same period. Our analysis is conducted at the national level and stratified according to the level of centrality, differentiating between areas of high, moderate, and low centrality. Results: Our findings reveal that, at the national level, SLICC and UPC exhibit remarkable stability, reaching 64 and 71 percent, respectively, in 2021. However, there is significant geographical variation, with the least central areas experiencing less continuous healthcare (SLICC at 49 percent in 2021) than patients residing in more central areas (SLICC at 68 in 2021). Conclusion: Our results demonstrate a high degree of continuity that has been stable over time. However, large geographical variations suggest that policymakers should strive to reduce geographical disparities in healthcare quality. [ABSTRACT FROM AUTHOR]

The U.S. healthcare sector is a large and important industry. However, relatively little is known about the localization and colocalization patterns of healthcare services within an urban area. By using Yelp data from over 3000 healthcare service establishments in the Phoenix area, this paper applies a recent spatial econometric technique to the analysis of healthcare services. The results reveal that spatial concentration varies across distances and types of healthcare services. Localization is more prevalent at closer distances, and general practitioners tend to be more dispersed than specialists. Colocalization with hospitals is most likely for specialists while family practices and dentistry services tend to locate away from hospitals. Different types of location patterns across different types of healthcare services are relevant for informing policies addressing healthcare access and competition in healthcare markets. [ABSTRACT FROM AUTHOR]

This paper reports on the curriculum development for social work student placements in primary health care. Social work in General Practice [GP] is an emerging area for social work practice, able to fill a gap in primary health. The inclusion of social work in GP practices can be complex. Social work placements offer an opportunity for students to become familiar with this practice setting and undertake social work relevant learning; however, they need to be well prepared for such placements and able to articulate and use social work knowledge and processes. They offer an opportunity for GPs to understand what social workers can do and offer to the GP community. We have used available research, support of an active reference group and two surveys to develop a curriculum for social work students in GP practices. We provide an overview of the literature and the methods of developing the curriculum. We describe how feedback and curriculum design principles were used. Core aspects of the curriculum and accompanying resources are outlined. The discussion highlights that the curriculum was a valuable tool in not only inducting students into a GP placement setting but as a meaningful reference guide throughout the entirety of placement. Social work students undertaking placements in GP settings need to be able to understand and articulate the role of social work in primary health care; A curriculum for social work placements in primary health care provides students the opportunity to consider the clinic context, the role of social work in primary health care and getting started in GP settings; Feedback and guidance from a range of interdisciplinary stakeholders is invaluable in developing resources for interdisciplinary work. [ABSTRACT FROM AUTHOR]

Background: Many countries are experiencing an increased demand for health care and a shortage of health professionals in rural areas, impacting an individual's ability to receive timely treatment. The management of uncomplicated urinary tract infections by community pharmacists is usual practice in some regions of the United Kingdom and Canada, and Queensland, Australia. Aim: To systematically gather, assess, and synthesize the available peer-reviewed published literature on the management of uncomplicated UTIs by community pharmacists in women aged 16–65 years, provide an understanding of the clinical and economic evidence, while also identifying the essential components of interventions employed. Method: A systematic review was conducted to identify primary studies detailing interventions for the management of uncomplicated UTIs by community pharmacists. PubMed, PsycINFO, Scopus, Cochrane, CINAHL, EMBASE, and Web of Science were searched to February 2023. Non-primary and qualitative studies were excluded. Study details were recorded in a tailored data extraction form. The quality of studies was assessed using the Joanna Briggs Institute tools. Results: Ten publications were included following review of 2129 records. High self-reported cure rates between 84 and 89% and referral rates of about 7% were reported. A single study found pharmacist management was cost effective compared to general practitioner management. No randomized controlled trials were found and papers were of variable quality. Conclusion: Preliminary evidence suggests pharmacist-led management of uncomplicated UTIs is safe and effective, however no firm conclusion can be provided since the methodologies reported in included studies have significant limitations. [ABSTRACT FROM AUTHOR]

Background: Nocturnal enuresis is generally considered a children's condition, yet it may persist 1%–2% in adolescence and early adulthood. Refractory patients often demand follow‐up by multidisciplinary teams, which is only restricted to some of the expert tertiary centers. However, there are no standardized transition programs/guidelines when follow‐up must be passed from pediatric to adult healthcare providers. Aim, Materials & Methods: To investigate this issue, we conducted a literature search on enuresis transition, which resulted in no articles. We, therefore, proceeded in a rescue search strategy: we explored papers on transition programs of conditions that may be related and/or complicated by enuresis, nocturia, or other urinary symptoms (chronic diseases, CKD, bladder dysfunction, kidney transplant, neurogenic bladder). Results: These programs emphasize the need for a multidisciplinary approach, a transition coordinator, and the importance of patient and parent participation, practices that could be adopted in enuresis. The lack of continuity in enuresis follow‐up was highlighted when we investigated who was conducting research and publishing on enuresis and nocturia. Pediatric disciplines (50%) are mostly involved in children's studies, and urologists in the adult ones (37%). Discussion: We propose a stepwise approach for the transition of children with enuresis from pediatric to adult care, depending on the clinical subtype: from refractory patients who demand more complex, multidisciplinary care and would benefit from a transition coordinator up to children/young adults cured of enuresis but who persist in having or present lower urinary tract symptoms (LUTS)/nocturia later on. In any case, the transition process should be initiated early at the age of 12–14 years, with adequate information to the patient and parents regarding relapses or LUTS/nocturia occurrence and of the future treating general practitioner on the enuresis characteristics and comorbidities of the patient. [ABSTRACT FROM AUTHOR]

Background: The healthcare sector is responsible for 5.2% of CO2 emissions in Germany. The prescribing of medicines is a significant contributor. Among the prescribed medicines, metered dose inhalers (MDIs) play a decisive role due to the propellant gases they contain. A relevant reduction in emissions is possible by switching to dry powder inhalation systems (DPI). Aim: The guideline "Climate-conscious prescribing of inhalants" is intended to provide assistance in the prescribing of inhaled medicines by summarising the available evidence on the decision between DPI and MDI and explicitly addressing the aspect of climate damage caused by propellants. It addresses everyone involved in prescribing and counselling those affected. Materials and methods: The S2k guideline was drawn up under the joint leadership of DEGAM (German College of General Practitioners and Family Physicians) and the German Society for Pneumology and Respiratory Medicine (DGP) under moderation of the AWMF (Association of the Scientific Medical Societies in Germany). The main contents from a practical perspective are presented in this paper. Results: Overall, MDIs account for a high proportion of inhaler prescriptions in Germany. The aspects of climate damage should be considered when prescribing MDIs. In order to facilitate implementation in practice, several decision aids were developed. Conclusion: The guideline is the first to address the importance of prescribing a group of medicines in relation to climate change. The degree of implementation of the guideline recommendations can be determined by future analyses of prescription data. A planned practical test is required to check the acceptance of the decision aids. [ABSTRACT FROM AUTHOR]

Background: Medical simulation is essential for surgical training yet is often too expensive and inaccessible in low- and middle-income countries (LMICs). Furthermore, in otolaryngology-head and neck surgery (OHNS), while simulation training is often focused on senior residents and specialists, there is a critical need to target general practitioners who carry a significant load of OHNS care in countries with limited OHNS providers. This scoping review aims to describe affordable, effective OHNS simulation models for early-stage trainees and non-OHNS specialists in resource-limited settings and discuss gaps in the literature. Methods: This scoping review followed the five stages of Arksey and O'Malley's Scoping Review Methodology. Seven databases were used to search for articles. Included articles discussed physical models of the ear, nose, or throat described as "low-cost," "cost-effective," or defined as <$150 if explicitly stated; related to the management of common and emergent OHNS conditions; and geared towards undergraduate students, medical, dental, or nursing students, and/or early-level residents. Results: Of the 1706 studies screened, 17 met inclusion criteria. Most studies were conducted in HICs. Most models were low-fidelity (less anatomically realistic) models. The most common simulated skills were peritonsillar abscess aspiration and cricothyrotomy. Information on cost was limited, and locally sourced materials were infrequently mentioned. Simulations were evaluated using questionnaires and direct observation. Conclusion: Low-cost simulation models can be beneficial for early medical trainees and students in LMICs, addressing resource constraints and improving skill acquisition. However, there is a notable lack of contextually relevant, locally developed, and cost-effective models. This study summarizes existing low-cost OHNS simulation models for early-stage trainees and highlights the need for additional locally sourced models. Further research is needed to assess the effectiveness and sustainability of these models. Key points: Question: What is the current landscape of low-cost otolaryngology-head and neck surgery simulation for early medical trainees and students? Finding: In this scoping review we identified 17 studies that met inclusion criteria. Most studies were developed in high-income countries, and most models were not locally sourced. Meaning: There is a notable lack of low-cost OHNS simulation models that are relevant for early medical trainees and students. [ABSTRACT FROM AUTHOR]

The advent of digital technologies has spurred the development of wearable sensing devices marking a significant shift in obtaining real-time physiological information. The principal objective is to transition from blood-centric monitoring to minimally invasive modalities, which will enable movement from specialised settings to more accessible environments such as the practices of general practitioners or even home settings. While subcutaneously implanted continuous monitoring devices have demonstrated this transition, detection of analytes from sample matrices like skin interstitial fluid (ISF), is a frontier that offers attractive minimally invasive routes for detection of biomarkers. This manuscript presents a comprehensive overview of our work in subdermal wearable biosensing patches for the simultaneous monitoring of glucose and lactate from ISF in ambulatory conditions. The performance of the subdermal wearable glucose monitoring patch was evaluated over a duration of three days, which is the longest reported duration reported till date. The subdermal wearable lactate sensing patch was worn for the duration of the exercise. Our findings highlight a critical observation that biofouling effects become apparent after a 24 h period. The data presented in this manuscript extends on the knowledge in the areas of continuous metabolite monitoring by introducing multifunctional polyphenol polymer films that can be used for both glucose and lactate monitoring with appropriate modifications. This study underscores the potential of subdermal wearable patches as versatile tools for real-time metabolite monitoring, positioning them as valuable assets in the evolution of personalised healthcare in diverse settings. [ABSTRACT FROM AUTHOR]

• Radiation therapy underutilisation is contributing to the global burden of cancer. • The most prevalent health professional influence identified was referral. • Misconceptions of the referrer role during a radiotherapy pathway was highlighted. • Gaps in referrer knowledge of radiation oncology can result from limited education. • Limited knowledge can lead to inaccurate perceptions of radiation oncology. The underutilisation of radiation therapy (RT) is contributing to the significant global burden of cancer with studies identifying actual utilisation rates are significantly lower than evidence-based optimal utilisation rates. Attributing factors vary considerably, ranging from patient preference, referrer bias, to geographic variations. The aim of this scoping review is to map and synthesise the current literature reporting on barriers and facilitators influencing utilisation of RT globally. Four online databases; Medline, Embase, Scopus and CINAHL identified articles dated between 1993 and 2023. Study eligibility included reporting on RT services, specifically barriers and influences on utilisation of RT. Title and abstract screening, followed by full text review was performed as per PRISMA guidelines. Variables were extracted and categorised into patient, health professional (HP) and department level influences. In total, 340 studies were included in the scoping review. HP influences (included in this specific review) were reported in 225 (66 %) papers with the most prevalent HP influence being referral (n = 187; 83 %). Of the HP papers, 114 (51 %) identified knowledge and education as an influence on RT utilisation. Subsequently, role interpretation, describing the assumed role adopted by the General Practitioner as the patients advocate, educator, manager or carer was identified in 89 (40 %) studies. This scoping review demonstrates the range of factors impacting RT utilisation. The results suggest referrer knowledge and understanding gaps impact RT utilisation internationally. Future research and intervention into referrer RT education is required to limit the impact of such influences. [ABSTRACT FROM AUTHOR]

Purpose: In long-term follow-up, it remains uncertain whether tonsillectomy, a procedure associated with significant comorbidity, can be substituted with partial tonsillectomy in patients with recurrent tonsillitis. This paper is to present the 5-year follow-up data of our previous study titled "Total versus subtotal tonsillectomy for recurrent tonsillitis—a prospective randomized noninferiority clinical trial."The underlying study was performed as single-blinded prospective noninferiority procedure in patients with recurrent chronic tonsil infection, where one side was removed completely (tonsillectomy) and the other side partially (intracapsular/partial tonsillectomy). Five years after surgery, we collected data on the frequency of tonsillitis in the first, second, third, fourth, and fifth year post-surgery. We obtained assessments from patients, their ENT physicians, and general practitioners separately. To assess the impact of surgical therapy on overall quality of life, we employed the Glasgow Benefit Inventory (GBI).Out of the 111 patients initially included in the years 2015–2018, 79 were eligible for the 5-year follow-up, representing a 71% follow-up rate. The mean follow-up time was 60 months. Notably, during the first 12 months post-surgery, no cases of bacterial inflammation were observed in the remaining tonsillar tissue following partial tonsillectomy, suggesting noninferiority compared to total tonsillectomy. This effect remained consistent over the 5-year study period. GBI results indicate that both total and partial tonsillectomy positively impact the physical and mental health of patients with recurrent tonsillitis.Considering that partial tonsillectomy is associated with less pain and reduced postoperative bleeding, it may emerge as a potential replacement for total tonsillectomy as the standard method in the future.Materials and methods: In long-term follow-up, it remains uncertain whether tonsillectomy, a procedure associated with significant comorbidity, can be substituted with partial tonsillectomy in patients with recurrent tonsillitis. This paper is to present the 5-year follow-up data of our previous study titled "Total versus subtotal tonsillectomy for recurrent tonsillitis—a prospective randomized noninferiority clinical trial."The underlying study was performed as single-blinded prospective noninferiority procedure in patients with recurrent chronic tonsil infection, where one side was removed completely (tonsillectomy) and the other side partially (intracapsular/partial tonsillectomy). Five years after surgery, we collected data on the frequency of tonsillitis in the first, second, third, fourth, and fifth year post-surgery. We obtained assessments from patients, their ENT physicians, and general practitioners separately. To assess the impact of surgical therapy on overall quality of life, we employed the Glasgow Benefit Inventory (GBI).Out of the 111 patients initially included in the years 2015–2018, 79 were eligible for the 5-year follow-up, representing a 71% follow-up rate. The mean follow-up time was 60 months. Notably, during the first 12 months post-surgery, no cases of bacterial inflammation were observed in the remaining tonsillar tissue following partial tonsillectomy, suggesting noninferiority compared to total tonsillectomy. This effect remained consistent over the 5-year study period. GBI results indicate that both total and partial tonsillectomy positively impact the physical and mental health of patients with recurrent tonsillitis.Considering that partial tonsillectomy is associated with less pain and reduced postoperative bleeding, it may emerge as a potential replacement for total tonsillectomy as the standard method in the future.Results: In long-term follow-up, it remains uncertain whether tonsillectomy, a procedure associated with significant comorbidity, can be substituted with partial tonsillectomy in patients with recurrent tonsillitis. This paper is to present the 5-year follow-up data of our previous study titled "Total versus subtotal tonsillectomy for recurrent tonsillitis—a prospective randomized noninferiority clinical trial."The underlying study was performed as single-blinded prospective noninferiority procedure in patients with recurrent chronic tonsil infection, where one side was removed completely (tonsillectomy) and the other side partially (intracapsular/partial tonsillectomy). Five years after surgery, we collected data on the frequency of tonsillitis in the first, second, third, fourth, and fifth year post-surgery. We obtained assessments from patients, their ENT physicians, and general practitioners separately. To assess the impact of surgical therapy on overall quality of life, we employed the Glasgow Benefit Inventory (GBI).Out of the 111 patients initially included in the years 2015–2018, 79 were eligible for the 5-year follow-up, representing a 71% follow-up rate. The mean follow-up time was 60 months. Notably, during the first 12 months post-surgery, no cases of bacterial inflammation were observed in the remaining tonsillar tissue following partial tonsillectomy, suggesting noninferiority compared to total tonsillectomy. This effect remained consistent over the 5-year study period. GBI results indicate that both total and partial tonsillectomy positively impact the physical and mental health of patients with recurrent tonsillitis.Considering that partial tonsillectomy is associated with less pain and reduced postoperative bleeding, it may emerge as a potential replacement for total tonsillectomy as the standard method in the future.Conclusion: In long-term follow-up, it remains uncertain whether tonsillectomy, a procedure associated with significant comorbidity, can be substituted with partial tonsillectomy in patients with recurrent tonsillitis. This paper is to present the 5-year follow-up data of our previous study titled "Total versus subtotal tonsillectomy for recurrent tonsillitis—a prospective randomized noninferiority clinical trial."The underlying study was performed as single-blinded prospective noninferiority procedure in patients with recurrent chronic tonsil infection, where one side was removed completely (tonsillectomy) and the other side partially (intracapsular/partial tonsillectomy). Five years after surgery, we collected data on the frequency of tonsillitis in the first, second, third, fourth, and fifth year post-surgery. We obtained assessments from patients, their ENT physicians, and general practitioners separately. To assess the impact of surgical therapy on overall quality of life, we employed the Glasgow Benefit Inventory (GBI).Out of the 111 patients initially included in the years 2015–2018, 79 were eligible for the 5-year follow-up, representing a 71% follow-up rate. The mean follow-up time was 60 months. Notably, during the first 12 months post-surgery, no cases of bacterial inflammation were observed in the remaining tonsillar tissue following partial tonsillectomy, suggesting noninferiority compared to total tonsillectomy. This effect remained consistent over the 5-year study period. GBI results indicate that both total and partial tonsillectomy positively impact the physical and mental health of patients with recurrent tonsillitis.Considering that partial tonsillectomy is associated with less pain and reduced postoperative bleeding, it may emerge as a potential replacement for total tonsillectomy as the standard method in the future. [ABSTRACT FROM AUTHOR]

Background Addressing current health challenges requires the integrated and continuous health care services. The collaboration between primary care providers (PCPs) and medical specialists other than general practice is the most common means of achieving this objective. The patterns and effect of collaborative working between different disciplines has a direct impact on the quality of integrated service delivery, which is critical to improving patient health outcomes. Objective To systematically review the characteristics of studies related to collaboration patterns between PCPs and medical specialists, contents of collaboration patterns and effects reported by the authors by using scoping review methods. Methods On September 3 in 2022, PubMed, EmBase, Web of Science, CNKI, and Wanfang Data Knowledge Service Platform were searched for literature related to collaboration between PCPs and medical specialists from inception to the date of search. The characteristics of literature, collaboration patterns and effects were extracted. The elemental decomposition of collaboration patterns was performed based on Mulave 'Gearing Up' model and the contents of collaboration patterns were integrated and demonstrated using content analysis method. Results A total of 420 relevant papers were included, of which 214 (51.0%) were committed to evaluating the effects of collaboration patterns, but specific contents of collaboration patterns could be extracted from 82 (19.5%) papers. The distinctive characteristics revealed by the extraction of limited information on the details of collaboration patterns included clear and formalized collaboration patterns, evidence-based guidelines/norms support for collaborative service contents, information systems and dedicated coordinators support for the collaboration between PCPs and specialists. Among the 82 papers, a total of 54 (65.9%) papers clearly reported indicators of effect, of which 90.7% (49/54) reported positive impact on service delivery and outcomes, ranging from service provision process, service utilization and health-related outcome indicators, however, higher proportion (90.7%, 49/54) of studies reporting positive effects could not exclude the presence of publication bias. Conclusion When collaboration patterns between PCPs and medical specialists other than general practice are implemented in integrated health services, it is necessary to ensure that approaches and contents of collaboration are specified, as well as the focus on the support of information systems and coordinators. Intervention studies related to health system and policy should emphasize describing the details of intervention design and implementation processes. Methodological quality assessment and meta-analysis are necessary to conduct in future studies on this topic.

The letter discusses a research paper on the role of general practitioners (GPs) in dementia prevention. While the paper suggests that GPs can play a role in preventing dementia, the letter argues that a broader approach focused on a "public brain health agenda" may be more effective. The letter also raises concerns about the implementation of dementia screening within primary care and the potential impact on the workload of GPs. Additionally, the authors suggest exploring potential barriers and unintended consequences of implementing dementia screening. The letter concludes by highlighting the need to balance prevention efforts with the care of those who are already sick. [Extracted from the article]

This study aimed to identify socio-demographic determinants, risky behaviors and type of drug use, and the association with visiting by general practitioners (GP) in the last 12 months or outpatient service use among people who inject drugs (PWID). Studies in English published before November 1 2021, were searched for on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on the factors associated with visiting by GP or outpatient service use among PWID. After a detailed assessment of over 17,348 papers, a total of 13 studies met the eligibility criteria. Greater odds of visits to the GP in the last 12 months or outpatient service use was associated with (i) being younger, (ii) being female, (iii) employment status, (iv) having public health insurance, (v) individuals who shared needles, (vi) individuals who were prescribed benzodiazepines, (vii) history of taking prescribed mental health medications, (viii) individuals who got methadone maintenance treatment (MMT) and (X) individuals who had used primary care services. The present research findings highlighted that a significant proportion of the study participants used GP or outpatient service use/outpatient psychiatrist, suggesting that the focus should not be restricted to PWID. [ABSTRACT FROM AUTHOR]