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BackgroundAimDesign and settingMethodResultsConclusionRecruiting and retaining International Medical Graduates (IMGs) has been identified as a key component in addressing the ongoing workforce crisis in general practice. However, research shows IMG General Practitioners (GPs) face unique challenges compared to their UK-trained counterparts, impacting their welfare, retention in the workforce, and ability to provide patient care.This study examined the challenges facing early-career IMG GPs, the help and support they access and want to access, and their perceptions and utilisation of the help and support available.A mixed-methods study that collected primary data in an online survey and interviews between March and May 2023.Early-career IMG GPs based in South West England were invited to complete an online survey consisting of 5-point Likert-scale and free-text questions. Interviews were completed with key informants and some survey respondents. Qualitative data were analysed thematically. Data from the survey and interviews were analysed and merged using a convergent parallel design.Based on 29 survey replies and 9 interviews, four interrelated themes were identified: (i) communication and language, (ii) racism, unequal treatment, and developing coping mechanisms (iii), exclusion and being ‘othered’, and (iv) adapting to new ways of living and working. Although some IMG GPs access help and support, many feel this is insufficient and poorly accessible.IMG GPs face interrelated and unique challenges in their personal and professional lives and do not feel adequately supported by the NHS. Addressing this disconnect will be vital to sustaining the general practice workforce. [ABSTRACT FROM AUTHOR]

Iron deficiency anemia is a significant global health concern, diagnosed by measuring hemoglobin concentrations in combination with plasma ferritin concentration. This study investigated the variability in ferritin reference intervals among laboratories in the Netherlands and examined how this affects the identification of iron-related disorders. Ferritin reference intervals from 52 Dutch ISO15189-certified medical laboratories were collected. Ferritin, hemoglobin and mean corpuscular volume data of non-anemic apparently healthy primary care patients, measured by four laboratory platforms (Beckman, Abbott, Siemens, and Roche), were collected (n=397,548). Median ferritin levels were determined per platform, stratified by sex and age. The proportion of ferritin measurements outside of the reference interval was calculated using the reference intervals from the 52 laboratories (using a total of n=1,093,442 ferritin measurements). Lastly, ferritin data from 3,699 patients as captured in general practitioner (GP) data from the PHARMO Data Network were used to assess the variation of abnormal ferritin measurements per GP. Median plasma ferritin concentrations were approximately four times higher in men and twice as high in postmenopausal women compared to premenopausal women. Moreover, there are substantial differences in the median plasma ferritin concentration between the four platforms. However, even among laboratories using the same platform, ferritin reference intervals differ widely. This leads to significant differences in the percentages of measurements classified as abnormal, with the percentage of ferritin measurements below the reference limit in premenopausal women ranging from 11 to 53 %, in postmenopausal women from 3 to 37 %, and in men from 2 to 19 %. The percentage of ferritin measurements above the reference limit in premenopausal women ranged from 0.2 to 11 %, in postmenopausal women from 3 to 36 % and in men from 7 to 32 %. The lack of harmonization in ferritin measurement and the disagreement in plasma ferritin reference intervals significantly impact the interpretation of the iron status of patients and thereby the number of iron disorder diagnoses made. Standardization or harmonization of the ferritin assays and establishing uniform reference intervals and medical decision limits are essential to reduce the substantial variability in clinical interpretations of ferritin results. [ABSTRACT FROM AUTHOR]

Prisoners are at increased risk of multiple health conditions relative to the general population. The effective management of long-term conditions amongst prisoners is vital to reducing health inequalities. A nominal group was conducted exploring facilitators and barriers to the identification, diagnosis, and treatment of chronic physical illness amongst older adult prisoners in England and Wales, as well as innovations and suggestions for improvement in this area. The nominal group included 12 prison staff from a range of professions and specialist roles, including nurses, general practitioners, consultants, junior doctors, researchers, and managers. Eight key themes were identified from group discussions, including: 1) primary and secondary care interfaces; 2) quality and outcomes framework (QOF); 3) healthcare during transitions; 4) prison environments and lifestyles; 5) expert patients; 6) service design and healthcare roles; 7) telemedicine; and 8) data availability. The importance of collaboration between prison staff, primary and secondary healthcare professionals, and patients themselves to effectively manage long-term conditions infiltrated several themes. Further research is needed to determine the most effective interventions for managing chronic illness and multimorbidity amongst older prisoners. This research is urgently required given the ageing prisoner population and could help to standardise healthcare across the prison estate. [ABSTRACT FROM AUTHOR]

There are increasing numbers of older women in prison in England and Wales. The needs of older women in prison have been under researched and are often unmet. This paper explores staff and expert perspectives on the needs of older women in prison through a nominal group attended by six participants, including a consultant at the UK Health Security Agency; a General Practitioner; a postgraduate student completing a project on older women in prison; an academic researcher with expertise on older women in prison; a National Women's Health, Social Care, and Environment Review Group lead; and a HMMPS Diversity and Inclusion Lead. Six key themes were identified: 1) health screening; 2) health services and unmet health needs; 3) emotional wellbeing; 4) social and family connections; 5) the need for a professional's forum; and 6) limited data and research. Participants agreed that this population's needs are not adequately met. Moving forward, structures must be put in place to ensure that older women's needs are understood and met, and their voices heard. [ABSTRACT FROM AUTHOR]

Background: Diagnostic testing is prevalent among children with persistent non-specific symptoms (PNS), and both undertesting and overtesting have negative consequences for child and society. Research in adults with PNS has shown that GPs use diagnostic testing for reasons other than diagnosis, but comparable research has not, to the best of our knowledge, been conducted in children. Understanding GPs' perspectives of testing decisions in children could provide insights into mechanisms of undertesting and overtesting. Aim: To investigate GPs' perspectives of conducting or refraining from diagnostic testing in children with PNS and the differences compared with their motives when treating adults. Design and setting: Qualitative study using semi-structured interviews with Dutch GPs. Method: We purposively sampled GPs until data saturation. Reasons for conducting or refraining from diagnostic tests were explored using two real-life cases from daily practice. Online video interviews were transcribed verbatim. Data were collected and analysed concurrently by thematic content analysis. Results: Twelve GPs participated. Their decision making involved a complex trade-off among four themes: medical considerations (for example, alarm symptoms), psychosocial factors (for example, doctor–patient relationship), consultation management (for example, 'quick fix'), and efficient resource utilisation (for example, sustainability). Compared with when treating adults, GPs were more hesitant to conduct diagnostic testing in children because of their higher vulnerability to fearing invasive procedures, lower probability of organic disease, and reduced autonomy. Conclusion: As in adults, GPs' decisions to conduct diagnostic tests in children were motivated by reasons beyond diagnostic uncertainty. Educational programmes, interventions, and guidelines that aim to change the testing behaviours of GPs in children with PNS should target these reasons. [ABSTRACT FROM AUTHOR]

Background: Older people have greater comorbidity and medication burden. Adverse drug reactions occur in up to 30% of older people within one month of hospital discharge. General practitioners are key stakeholders in transitions of care from hospital to the community. Aim: The study aimed to explore general practitioner perspectives of adverse drug reactions in older people after hospitalisation, investigating the medication-related issues encountered and possible approaches to reduce the risk. Method: An invitation to participate in the study was sent to general practitioners in Southern Tasmania, Australia. A semi-structured interview occurred in person at their practice or online. The questions covered experiences with managing medication in older people after hospital discharge, challenges and risks involving adverse drug reactions and suggestions to prevent adverse drug reactions. The interviews were transcribed and analysed through thematic analysis. Results: Twelve general practitioners were interviewed, revealing four themes describing challenges, including (i) complex patients and acceptance of risk, (ii) patient confusion and decline in hospital, (iii) time taken to manage older patients and (iv) communication challenges. Three themes describing recommendations were identified, including (i) clear communication on discharge, (ii) patient involvement and (iii) roles for pharmacists. Conclusion: Prevention of adverse drug reactions after hospital discharge may require clear and timely communication to general practitioners, patients and families to be educated and empowered to help manage their own health and risk, and pharmacists to support both patients and general practitioners in managing the risks. [ABSTRACT FROM AUTHOR]

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Introduction: Aortic stenosis (AS) and pulmonic stenosis (PS) are two of the most common canine congenital heart diseases (CHD), with a high relative risk for Newfoundland dogs to develop inherited subvalvular AS. For this reason, a cardiovascular screening program has been set up by the French Newfoundland kennel club in order to manage mattings and reduce AS prevalence. Materials and methods: The records of untreated and non-anesthetized adult Newfoundland dogs screened between 2010 and 2023 were retrospectively reviewed. All dogs underwent physical examination and standard transthoracic echocardiography with concomitant ECG tracing. All examinations were reviewed by one single board-certified specialist in cardiology. Results: A total of 921 dogs were screened during the study period (female:male sex ratio = 1.94, median age [IQR] = 1.9 years [1.6–2.7], body weight = 55.0 kg [50–60]). For most dogs (90.6% for AS and 91% PS), a single examination was required to obtain a definitive cardiac status, although most operators (122/133 = 91.7%) were non-specialist general practitioners. Out of the 921 screened dogs, 913/921 (99.1%) and 919/921 (99.8%) were respectively free of AS and PS, with no AS and PS detection during the last 3 years of the program. The inbreeding coefficient, which was assessed from the pedigree analysis of all screened dogs except one, was not significantly different between dogs with either AS (0.59%; P = 0.86) or PS (0.39%; P = 0.72) and those without any arterial stenosis (0.39%). Conclusion: This 14-year cardiovascular screening program has experienced a strong involvement of veterinarians, breeders, and owners throughout France. Unlike reports from other European and North American countries, this program suggests the low and decreasing prevalence of both AS and PS in the Newfoundland breed in France. [ABSTRACT FROM AUTHOR]

AbstractBackground and aimsDesign, participants, and settingFindingsConclusionsAlcohol use disorder (AUD) and hazardous alcohol use are common but underdiagnosed in primary health care (PHC). This study aimed to explore general practitioners’ (GPs’) experiences and perceptions of using B-Phosphatidylethanol (PEth), a specific quantitative biomarker for alcohol use, in their clinical work with patient consultations and treatment follow-up in Swedish PHC.Individual interviews were conducted with GPs and resident GPs (n 20) in Swedish PHC and analysed using qualitative content analysis.The overarching theme PEth testing in primary health care—a game changer and a challenge illustrated that PEth testing has improved the prerequisites for the GP-patient interaction while making it more complex. Four categories underpinned this theme: Comprehending the context, describing the challenges in the GP-patient interaction when hazardous alcohol use or AUD was suspected; Getting the pieces in place, illustrating the struggle of integrating PEth testing into clinical practice and how it diminished the role of alcohol history taking; The challenges and facilitators of the conversation, comprising both the difficulties in informing about PEth testing and the positive impact on the interaction, and Considerations based on the PEth test results, emphasising the consequences of elevated PEth test results and their influence on physicians’ motivation to using PEth.PEth is an important tool in the identification of hazardous alcohol use. Emerging ethical dilemmas regarding patient information on PEth testing and management of medical and medico-legal obligations when test results indicate high alcohol use need to be addressed in future guidelines for clinical management of PEth. [ABSTRACT FROM AUTHOR]

Background: Challenges in the patient–provider relationship are prevalent, underscoring the importance of patient-centred care, which is respectful and responsive to patients' needs. General practitioners (GPs), also known as family doctors, serve as gatekeepers in primary care and are well positioned to deliver this type of care. However, effectively implementing patient-centred care remains a challenge. While behaviour change interventions have been developed to enhance patient-centred care in general practices, a comprehensive understanding of the facilitators and barriers to their implementation is lacking. This review aims to examine contextual factors of implementing interventions for patient-centred care by GPs. Implementation research analyses all aspects of application, including factors influencing it, processes involved and outcomes achieved within different contexts. The review will use the updated Consolidated Framework for Implementation Research (CFIR 2.0) to analyse influential factors and the Behaviour Change Wheel (BCW) to define interventions to promote behaviour change in patient-centred care. Methods: This systematic literature review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of five databases (Ovid MEDLINE, CINAHL, EMBASE, Cochrane Library and Web of Science) will be conducted to identify barriers and facilitators for implementing interventions in promoting patient-centred care by GPs. The CFIR 2.0 framework will guide the categorization and synthesis of barriers and facilitators, while the BCW will be employed to define the interventions. Two independent reviewers will conduct study screening, data extraction, quality appraisal and data analysis. Any disagreements between the reviewers will be resolved through the involvement of additional reviewers. Discussion: This protocol outlines a systematic review utilizing an updated framework-based approach to identify and synthesize evidence on barriers and facilitators to implementing behaviour change interventions by GPs. The findings will provide insights into the effectiveness of these interventions in enhancing patient-centred care and will inform future research and clinical practice. This review will identify gaps and challenges in existing studies and propose strategies for the effective implementation of behavior change interventions among GPs. Additionally, it will inform clinical practice by refining behaviour change interventions to enhance the delivery of patient-centred care by GPs. Trial registration: PROSPERO: CRD42023485014. [ABSTRACT FROM AUTHOR]

Early addiction disorders screening is recommended in primary care. The goal of health system reform is to include allied health professionals in this screening. The appropriation of their new role has not yet been explored. The main aim of this study was to examine the perspective of allied health professionals in primary care on the screening of addictive disorders. This qualitative study inspired by the grounded theory was carried out between August 2018 and July 2019. Semi-structured individual interviews and focus groups were organized to include of primary care health professionals (physiotherapist, nurse, midwife, pharmacist, and dentist). Thirteen semi-structured individual interviews and four focus groups were recorded and coded. The paramedics described the advantages of their professions for the detection of addictions: home visits, prescription history, habit of intimate subjects, close consultations, etc. Despite daily practice-specific observation posts, they sometimes remained silent witnesses, and their helplessness hindered identification. They felt both closer to the patients and less legitimate than the doctors in dealing with addictions. Finally, their desire for a multidisciplinary approach was limited by the fear of disturbing the doctor and the confusion between betrayal and medical secrecy. Paramedical professionals claimed to have a complementary role to play in identifying addictions. Their reluctance echoed the concept of self-censorship, already described in studies with addictologists and patients. These results must be compared with the opinions of general practitioners and patients. [ABSTRACT FROM AUTHOR]

Background: A lack of medication adherence among patients with rheumatoid arthritis (RA) has been reported. Inter-professional collaborations seem essential for an optimal therapeutic management of patients. The aim of this study was to analyse the barriers and facilitators of general practitioners (GPs) for the implementation of collaborative support programmes in RA. Methods: A qualitative semi-structured study using face-to-face or telephone interviews was conducted. Eligible participants included French GPs referring patients with RA. Interviews were audio-recorded and then transcribed. Data were analysed using Braun and Clarke's thematic analysis framework with Nvivo®12 software. Results: Nineteen GPs were interviewed between August 2019 and February 2020. Five themes were identified in the care of their patients with RA. GPs reported being mainly involved in diagnosis and orientation, and frequently asked for pain management and explanation/reformulation of previously given information. They perceived their patients to be adherent to their treatments, although they frequently identified reasons for non-adherence. Regarding their perception of the community-hospital relationship, they sometimes considered it insufficient and expected more immediate interactions. Additionally, most interviewed GPs had no expectation regarding increased collaborations with community pharmacists (CPs) and several GPs were motivated to be more involved in a patient support programme. However, barriers were identified: lack of time and training, and insufficient payment. Conclusions: The implementation of a collaborative patient support programme in RA should be developed taking into account the barriers and facilitators identified by GPs who appeared to be aware of the causes of potential non-adherence, and were particularly interested in receiving more information about the therapeutic monitoring of patients by hospital professionals. [ABSTRACT FROM AUTHOR]

Background: Unhealthy behaviours contributing to cardiovascular issues, diabetes, strokes, and cancer, pose significant health risks. General practitioners (GPs) are pivotal in guiding behaviour change, with Motivational Interviewing (MI) showing promise. MI, developed by William Miller and Stephen Rollnick, aims to enhance motivation for change. Despite its efficacy in areas like smoking cessation and weight loss, its uptake among French GPs remains uncertain. Methods: This qualitative study was to explore GPs' understanding of MI, its perceived benefits and the obstacles to its implementation in western Brittany (Finistère). Semi-structured interviews, conducted by two female trainees, explored MI knowledge, benefits, and barriers with a thematic analysis. Results: Between November 2020 and May 2021, 11 semi-structured interviews were conducted with GPs. Participants had a limited understanding of MI, often confusing it with persuasion. MI was seen as a patient-centered tool fostering behavioural change, with reported benefits in cancer screening, chronic disease management, and vaccination. However, barriers such as time constraints, limited training availability, and systemic issues hinder its adoption. Participants emphasized MI's utility for challenging cases but noted it was unnecessary for engaged patients. MI could also enhance doctor-patient relationships and physician satisfaction. Overcoming barriers requires addressing logistical issues, integrating MI into training, and promoting its long-term efficiency to improve healthcare outcomes. Conclusion: This study highlighted GPs' limited knowledge of MI but recognized its value in promoting patient-centered care and behaviour change. GPs identified its potential in areas like cancer screening, chronic disease management, and vaccine hesitancy while noting barriers such as time constraints and insufficient training. Addressing these challenges through better integration into training and practice could enhance patient outcomes and provider satisfaction. Focused efforts are needed to translate MI's potential into routine clinical use. [ABSTRACT FROM AUTHOR]

AbstractObjectiveDesignSettingSubjectsOutcome measuresResultsConclusionRelative one-year cancer survival rates in the Baltic states are lower than the European mean; in the Nordic countries they are higher than the mean. This study investigated the likelihood of General Practitioners (GPs) investigating or referring patients with a low but significant risk of cancer in these two regions, and how this was affected by GP demographics.A survey of GPs using clinical vignettes.General Practice in Denmark, Estonia, Finland, Latvia, Lithuania, Norway, and Sweden.General Practitioners.A regional comparison of GPs’ stated immediate diagnostic actions (whether or not they would perform a key diagnostic test and/or refer to a specialist) for patients with a low but significant risk of cancer (between 1.2 and 3.6%).Of the 427 GPs that completed the questionnaire, those in the Baltic states, and GPs that were more experienced, were more likely to arrange a key diagnostic test and/or refer their patient to a specialist than those in Nordic Countries or who were less experienced (p < 0.001 for both measures). Neither GP sex nor practice location within a country showed a significant association with these measures.While relative one-year cancer survival rates are lower in the Baltic states than in four Nordic countries, we found no evidence that this is due to their GPs’ reluctance to take immediate diagnostic action, as GPs in the Baltic states were more likely to investigate and/or refer at the first consultation. Research on patient and secondary care factors is needed to explain the survival differences. [ABSTRACT FROM AUTHOR]

Background: Complete vaccination coverage is recommended by multiple sclerosis (MS) societies for patients with multiple sclerosis (pwMS) to mitigate infection risks associated with disease-modifying therapies (DMTs). Objectives: To analyze vaccination coverage and its determinants in pwMS compared to healthy controls, considering vaccination hesitancy, MS-specific vaccination beliefs, trust in information sources, and the role of general practitioners (GPs). Methods: This cross-sectional multicenter observational study was conducted in six German MS centers. The primary endpoint was a vaccination index (VI) comprising eight standard vaccinations (range 0–1, with higher VI indicating better vaccination coverage). Secondary endpoints included validated measures of general vaccination hesitancy, MS-specific vaccination beliefs, and trust in information sources. Data were collected through questionnaires, vaccination card analysis, and a survey of GPs who vaccinate pwMS. Results: VI tended to be lower in pwMS (n = 397) compared to healthy controls (n = 300; 0.58 ± 0.30 vs 0.62 ± 0.31, p = 0.057). In pwMS receiving highly effective DMTs, VI did not differ significantly from those on no/platform DMTs. Vaccination hesitancy was comparably low, with no differences between pwMS and controls. Vaccination hesitancy, beliefs, and trust in information sources explained only 10%–16% of the variance in VI. Among 109 GPs, 82% cited reluctance to vaccinate pwMS due to concerns about MS-related side effects or interactions with DMTs. Conclusion: Despite clear recommendations from MS societies for full vaccination of all pwMS, vaccination coverage remains worryingly low. Approximately half of the patients lack standard vaccination coverage, even those on highly effective DMTs. In fact, vaccination coverage in pwMS tended to be even lower than in healthy controls. Vaccination hesitancy and other intrinsic factors do not sufficiently explain the low vaccination rates. Inconsistent vaccination recommendations from GPs due to uncertainties about vaccine safety and DMT interactions likely contribute. Plain language summary: Vaccination coverage in multiple sclerosis patients: what influences it and why it matters Vaccinations are crucial for people with multiple sclerosis (MS) to protect them from infections that may worsen their condition, especially during certain treatments. However, many MS patients are not fully vaccinated. This study examines vaccination rates and factors that affect whether MS patients receive vaccines. We found that general practitioners often hesitate to recommend vaccines due to concerns about safety and treatment interactions. Our results suggest that vaccinations should be administered by specialized vaccination centers to ensure patients receive the appropriate care. [ABSTRACT FROM AUTHOR]

Background: Pursuing excellence in healthcare delivery systems is an ongoing process. In this process, continuing medical education (CME) is essential for medical professionals to maintain high standards of patient care. In China, where the healthcare sector is undergoing considerable reforms and faces challenges owing to socioeconomic development and demographic shifts, an effective CME system is vital for general practitioners (GPs). Methods: A cross-sectional survey of CME programs was conducted between 2016 and 2023. The external characteristics of the programs were systematically gathered and statistically analyzed. The programs were subsequently subjected to a competency-based assessment by using the six core competencies outlined by the American Board of Medical Specialties and the Accreditation Council for Graduate Medical Education as a framework. Furthermore, keywords were extracted for the CME program names based on the International Classification of Primary Care. Visual analysis was performed via VOSviewer software, facilitating a content-based evaluation of the programs. Results: A total of 6,607 items were obtained. A total of 3,815 CME programs were subjected to statistical analysis, and 2,895 CME programs were comprehensively evaluated for content and capability. A diverse range of CME providers were identified, with hospitals and publishing/education companies being the primary providers. Since 2019, a significant increase in online CME offerings has been noted. However, the regional distribution of the CME programs was uneven, with Shanghai, Zhejiang, and Beijing leading but western China lagging. Furthermore, most programs focused on patient care and medical knowledge in competency-based CME evaluations, with less emphasis on interpersonal and communication skills. Content-based CME evaluations revealed that the teaching focus is the diagnosis, treatment, and primary care management of elderly patients and chronic diseases such as diabetes and hypertension. Conclusions: Our findings underscore the essential role of CME in equipping GPs with the competencies required to navigate the evolving landscape of medical knowledge and practice, suggesting a more systematic, relevant, and individualized approach to training GPs. Therefore, there is an opportunity to increase the quality of primary care and contribute to the Healthy China 2030 Plan. [ABSTRACT FROM AUTHOR]

Survivors of sellar/suprasellar tumors involving hypothalamic structures face a risk of impaired quality of life, including tumor- and/or treatment-related hypothalamic obesity (TTR-HO) defined as abnormal weight gain resulting in severe persistent obesity due to physical, tumor- and/or treatment related damage of the hypothalamus. We analyze German claims data to better understand treatment pathways for patients living TTR-HO during the two years following the index surgical treatment. A database algorithm identified patients with TTR-HO in a representative German payer claims database between 2010 and 2021 (n = 5.42 million patients). Claims from 37 patients with TTR-HO were analyzed on a quarterly basis over 2 years. The analysis considered inpatient, outpatient, and prescription data. In the follow-up period, patients with TTR-HO are hospitalized 3.68 times on average; 37% of hospitalizations in year 1 and 31% in year 2 are due to TTR-HO. On average, patients see a general practitioner 12.27 times and various specialists 20.45 times. The need for complex neuroendocrine therapy develops quickly, with most patients having 2–3 neuroendocrine prescriptions in any given quarter. The management of patients with TTR-HO requires frequent inpatient and outpatient visits for tumor follow-up and management of incident comorbidities, and most patients with TTR-HO require intense polytherapy. [ABSTRACT FROM AUTHOR]

Background and Objective: Approximately 7.4% of the German population matched the criteria of impeding, chronic non-cancer-related pain in 2014. Guidelines emphasize the importance of a holistic treatment approach. The project RELIEF aims to develop and evaluate a multifaceted case-management intervention to foster the holistic management of chronic pain in general practice. To inform intervention development, this study explored expectations and perceived role models of general practitioners (GP) and patients regarding chronic non-cancer-related pain management in general practice with a focus on patient expectations of GPs and themselves, as well as GP expectations of patients and their anticipation of patient's expectations. Methods: Data were collected via semi-structured guide-based interviews with general practitioners and patients. Pseudonymized verbatim transcripts were analyzed using an inductive–deductive approach with a structuring qualitative content analysis. The Theoretical Domains Framework served as an analytical framework to explore behavioral aspects associated with expectations and role perceptions. Results:n = 25 interviews were analyzed (GP: n = 10, patient: n = 15). Findings indicate that patients considered themselves as the main actor in the therapy process yet expected guidance and care coordination from their GP. The essential role GPs play in pain management was emphasized. Role models indicated by GPs and some patients represent a care ideal, which was also reflected in discussed expectations. GPs anticipated that patients would place high relevance on pharmacological options. Patients highlighted their preference of non-pharmacological and alternative treatment options. Conclusions: Our findings demonstrate the importance of holistic, individually tailored chronic pain management in general practice. Systematic, multifaceted case management, as planned in the RELIEF project, may contribute to high-quality primary care for affected individuals. [ABSTRACT FROM AUTHOR]

Background: Case-Based Learning (CBL) and Problem-Based Learning (PBL) are popular methods in medical education. However, we do not fully understand how they affect the clinical thinking skills of Assistant General Practitioner (AGP) trainees. This randomised controlled trial aimed to assess the effectiveness of combining CBL and PBL and compare their impact on the clinical thinking skills of AGP trainees with that of traditional lecture-based learning (LBL). Methods: This randomised controlled trial involved 70 second-year AGP trainees who were randomly assigned to either the CBL-PBL group or the LBL group using a simple randomisation method. The CBL-PBL group engaged in a curriculum that integrated case-based and problem-based learning, whereas the LBL group followed a traditional lecture-based format, as described in the syllabus. To evaluate clinical thinking skills, the participants were assessed using the Clinical Thinking Skills Evaluation Scale (CTSES) and an assistant general practitioner's professional knowledge test. In addition, this study analysed various factors that influence clinical thinking skills. Results: Compared with the LBL group, the CBL-PBL group showed significantly improved performance in all domains assessed by the CTSES in post-course tests (p < 0.001). Specifically, the mean scores for critical, systematic, and evidence-based thinking showed notable improvement in the CBL-PBL group. Additionally, the scores on the professional knowledge test reflected a substantial increase in this group. Furthermore, multiple linear regression analysis showed that both CBL-PBL curriculum performance scores and number of weekly article readings significantly influenced the development of clinical thinking skills. Conclusion: The CBL-PBL teaching method positively influenced the clinical thinking skills of assistant general practitioner trainees, with a positive correlation between these skills and course performance in the CBL-PBL curriculum. Trial registration: Not applicable. [ABSTRACT FROM AUTHOR]

Background: In Malaysia, the recent COVID-19 pandemic had increased the workload of all health professionals, especially primary care doctors (PCDs). Hence, this study aimed to determine the level of work-related stress and factors associated with higher levels of work-related stress among PCDs in Malaysia during this pandemic. Methods: A cross-sectional study was conducted online using Google Forms™. Sociodemographic as well as work and workplace data were collected. The Job Demand Inventory, Physicians' Lack of Professional Autonomy, and Health Professions Stress Inventory questionnaires were used to assess the job demand score, job autonomy score, and the level of work-related stress, respectively. Multiple linear regression was performed to determine the significant factors associated with higher work-related stress. Results: A total of 301 PCDs participated in this study with the majority being female (76.1%), Malay (67.8%), married (73.1%), medical officers (68.8%), and worked in urban (70.4%) and public primary care clinics (83%). The mean (SD) score for work-related stress was 62.8 (18.4), (score range 0-120). PCDs who had any degree of worry about being alienated by friends and relatives because of close contact with COVID-19 patients had higher work-related stress levels compared to PCDs who did not have any worry [rarely (b = 10.23, 95% CI:5.57, 14.89), sometimes (b = 10.41, 95% CI:5.68, 15.13), often (b = 10.12, 95% CI:4.16, 16.08), and always (b = 14.65, 95% CI:7.43, 21.89)]. The other significant factor was higher job demand scores (b = 1.13, 95% CI:0.91, 1.35). In contrast, PCDs who always received support from supervisors at their workplace were found to have lower work-related stress levels compared to those who did not receive any support (b=-5.65, 95% CI:-10.38, -0.93). Conclusions: The level of work-related stress among Malaysian PCDs during the COVID-19 pandemic was higher compared to American PCDs and Malaysian physicians before the pandemic but lower compared to Australian emergency physicians during the pandemic. Urgent measures to address the above-mentioned associated factors should be implemented as another pandemic may be just around the corner. [ABSTRACT FROM AUTHOR]

Background: Women with a history of hypertensive disorders of pregnancy (HDP), including chronic hypertension, gestational hypertension, and preeclampsia have an increased risk of cardiovascular disease (CVD). Current research suggests that general practitioners are unaware of women's HDP history, and although ideally placed to follow-up with these women, there is limited understanding of current CVD prevention practices in women after HDP. Additionally, preeclampsia confers a higher CVD risk compared to other types of HDP, and Australian research suggests that lower socioeconomic status (SES) is associated with a higher incidence of both HDP and CVD. Therefore, the aim of the analysis was to investigate awareness of CVD risk and care received from health professionals among women with a history of HDP and examine differences between type of HDP and SES. Methods: Analysis of a cross-sectional survey of 293 Australian women with a history of HDP (from 2017 onwards). Data were analysed using basic descriptive statistics. To assess differences in HDP type and SES, one-way ANOVA was used to assess continuous variables and χ2 tests for categorical variables, with P < 0.05 considered statistically significant. Results: Most women with a history of HDP were unaware of their increased CVD risk (68%). Women with a history of preeclampsia, gestational hypertension or preeclampsia were more aware of CVD risk compared to those with chronic hypertension (p = 0.02). Regardless of HDP type or SES, women post-HDP were less likely to receive assessment and management of lifestyle CVD risk factors compared to blood pressure. Most women felt supported in managing stress and mental health, but not for managing body weight, smoking and sleep. Conclusions: Women with a history of HDP are unaware of their increased CVD risk and are not receiving recommended CVD preventative care, irrespective of HDP type and/or SES. Findings should be used to inform development of tailored CVD prevention interventions in the primary care setting for women following HDP. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has caused psychological distress to the population and healthcare workers. Physicians' well-being is essential and contributes significantly to overall health. This study aimed to assess the strain on Polish general practitioners from the effects of the COVID-19 pandemic and to ascertain the potential predictors of their distress. Methods: Data was collected using a self-reported online questionnaire from 162 GPs in Poland between December 2020 and August 2021 as part of the international PRICOV-19 study. General practitioners' well-being was evaluated using the validated Mayo Clinic's expanded 9-item well-being index (eWBI). Spearman's correlation was used to measure the strength and direction of association between general practitioners' distress level and continuous variables, and for ordinal variables, Gamma correlation was recommended for many tide ranks. We also checked the association of the level of distress with continuous variables by categorizing them and applying the Kruskal-Wallis test likewise for a comparison of the distress in different practice locations. Results: A vast majority (80%) of respondents were considered at risk of distress during the COVID-19 outbreak, with an eWBI score of 2 or more. Higher distress scores were exhibited among general practitioners who reported increased responsibilities during the COVID-19 pandemic and perceived need for additional training. The experience of collaboration with neighbouring practices and the provision of adequate governmental support emerged as significant protective factors against distress. No correlation was observed between Polish general practitioners' distress level and years of professional experience, number of patients in the practice, number of doctors working there, the practice's location, or working with more vulnerable patient populations. Conclusions: Our findings proved that COVID-19 placed an extraordinary emotional burden on Polish general practitioners and highlighted the importance of targeted support services and resource allocation to primary healthcare in Poland in case of any potential future crisis similar to the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: Individually rare, rare diseases are collectively common resulting in frequent health system use. Navigating the health system persists as a challenge. Primary care provides longitudinal contact with the health system and is placed to provide integrated rare-disease-care. Methods: This scoping review used Joanna Briggs Institute and PRISMA methods with a Consolidated Framework for Implementation Research based data extraction tool to find how integrated rare-disease-care is delivered, enablers and barriers to the same, in primary care settings in contemporary literature in OECD countries. Results: The Primary Care Provider (PCP) role varies from routine primary care to shared-rare-disease-care models. In the 26 papers, the most frequently cited PCP roles included involvement in diagnosis (n = 14), care coordination (n = 16), primary and preventative care (n = 18), management of components of rare-disease-care (n = 13), and treatment monitoring (n = 10). Individuals whose PCP was actively involved in their care were reported to have shortened diagnostic delay, improved transitions of care across the lifespan, reduced unplanned utilization of emergency and hospital services, comprehensive psychosocial care, improved quality of life across environments including home, school and work and improved palliative care experiences. Conclusions: Sufficient communication from specialists, information, resources, time and reimbursement for complex care are still needed. Future integrated-rare-disease-care models should be developed by, or with, PCPs. [ABSTRACT FROM AUTHOR]

The text discusses the life and death of Emanuel Feuermann, a renowned cellist who faced challenges due to his Jewish background during the rise of the Nazis. Despite his success as an international artist, Feuermann's death at the age of 39 following a hemorrhoidectomy highlights the concept of failure to rescue in medical care. The article delves into the circumstances surrounding his surgery, the involvement of his surgeon, and the subsequent medical errors that led to his untimely death, leaving a void in the music world. [Extracted from the article]

Introduction The evolving global landscape has led to increased involvement of the French armed forces, exposing military personnel to operational challenges that can affect their mental well-being. As a result, psychiatry has become the second most common reason for Medical Evacuation (MEDEVAC). In war zones where specialized medico-psychological consultations may not be readily available, medical officers play a vital role in providing initial care. Therefore, there is a growing emphasis on the precise evaluation of these practices. Materials and Methods In this retrospective observational study, we analyzed MEDEVAC request files from the Operational Health Headquarters (Patient Medical Request sheets), Aeromedical Evacuation Mission Order sheets, and hospital records from the entire military hospital complex in the Île-de-France region for French military personnel who underwent low-priority MEDEVAC (P3) for medico-psychological reasons from a non-metropolitan area to metropolitan France. The study spanned from January 1, 2013, to December 31, 2016. The primary objective is to evaluate the concordance of diagnoses between general practitioners and psychiatrists. The secondary objective is a detailed description of the introduction of psychotropic drugs, especially benzodiazepines, by the medical officer in the field. Results In total, our study included 610 patients. Significant differences were observed between diagnoses made by military general practitioners and military psychiatrists, except for "psychotic disorders" and "other diagnoses" categories. During hospitalization, benzodiazepines were prescribed to 26.5% of repatriated patients, antidepressants to 12.7%, hypnotics to 17.6%, neuroleptics to 24.23%, and hydroxyzine to 18.8%. Upon discharge, benzodiazepines were prescribed to 23.5% of patients, antidepressants to 17.8%, hypnotics to 9.9%, neuroleptics to 28.9%, and hydroxyzine to 19.7%. The chi-squared test revealed significant differences in prescription between military operations and hospitalization for all molecules except hydroxyzine. Among patients diagnosed with Psychological Disorder Related to a Traumatic Event (TPRET) (<1 and >1 month) by psychiatrists during hospitalization, 66.2% were prescribed benzodiazepines during operational theaters, 24.3% continued during hospitalization, and 16.8% received a prescription upon discharge. The duration of missions often hinders precise psychiatric diagnoses, leading medical officers to transmit clinical data for optimized specialized care at military training hospitals. Furthermore, significant differences in therapeutic administration between medical officers and psychiatrists, particularly in benzodiazepine prescriptions for patients with TPRET, highlight the importance of prioritizing psychotropic prescription modalities in the training of medical officers on mental disorders. Strengthening operational preparations in recent years could enable more practitioners to benefit from these measures. Conclusions We suggest several measures to enhance the transmission of medical information between medical officers and military psychiatrists. First, optimizing the drafting of Patient Movement Requests could involve implementing pre-filled drop-down menus or providing an adapted bilingual lexicon, facilitating the optimal transmission of clinical information for repatriated patients. Second, strengthening the training of medical officers before deployment and sharing the "Emergency Psy Kit," a comprehensive support tool developed by French military psychiatrists, would further enhance the tool kit available to field practitioners for judiciously prescribing psychiatric drugs. [ABSTRACT FROM AUTHOR]

The total number of spine surgeries per year and their related deaths in Japan has not been adequately estimated in the literature. We retrospectively reviewed the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) between April 2014 to March 2021, which covers 99.9 % of health insurance claim receipts by general practitioners. The annual number of surgeries was counted using K codes, a procedure classification unique to Japan, and classified into the following six categories; percutaneous vertebroplasty, endoscopic surgery, open discectomy, laminoplasty/laminectomy, instrumentation surgery, and others. The data distribution was also summarized by sex and age. Additionally, by reviewing DPC database-related papers for evaluation of the mortality rate after spine surgery in Japan, the number of spine surgery-related deaths was calculated. The NDB showed that the number of spine surgeries analyzed in this study increased from 170,081 in 2014 to 193,903 in 2019, with a slight decrease in 2020. The ratio of instrumentation surgery increased from 33.0 % in 2014 to 37.9 % in 2020. The rate of patients aged 75 or older increased 31.6 % to 39.6 %. Combining these findings with DPC data showing a mortality rate of 0.1 % to 0.4 % revealed that the estimated number of deaths related to spine surgery in Japan ranged from 200 to 800 per year. Approximately 200,000 spine surgeries and 200 to 800 spine surgery-related inpatient deaths were estimated to have occurred in Japan around 2020. [ABSTRACT FROM AUTHOR]

Little is known regarding those who die by suicide without having received help. The aim of this study was to compare those who died by suicide without having attended psychiatric care with controls (a) with a psychiatric diagnosis and (b) from the general population. Cases were all individuals 15+ who lived in Denmark during 2010–2021 and had died by suicide without having attended hospital-based psychiatric care. Cases were matched to controls from the two comparison-groups using a 1:10 ratio and compared using age-and sex-adjusted logistic regression analyses. Geographical variations in psychiatric care utilization were examined. Among 7119 individuals who died by suicide, 3474 (48.8 %) had not attended psychiatric care. Compared to controls with a psychiatric diagnosis, cases were more likely to be male (OR, 3.9, 95% CI, 3.6–4.2), older (80+ years: OR, 10.7, 95 % CI, 9.2–12.5), have lost a close relative (OR, 1.8, 95 % CI, 1.3–2.6) or recently retired (OR, 1.4, 95 % CI, 1.0–1.1.8). Compared to controls from the general population, cases were associated with male sex (OR, 4.6, 95 % CI, 4.2–5.0), living alone (OR, 2.3, 95 % CI, 2.2–2.5), unemployment (OR, 2.1, 95 % CI, 1.8–2.5), as well as having lost a close relative (OR, 5.0, 95 % CI, 3.5–7.2) or divorced within the last 1 year (OR, 3.6, 95 % CI, 2.7–4.9). Characteristics and preceding events were limited to available register data. About half of all who died by suicide had not attended psychiatric care. Being older, male, or exposed to recent stressors were some of the major markers when compared to controls. • Almost half of all people who died by suicide in Denmark between 2011-2021 did not receive psychiatric care prior to suicide. • Compared to psychiatric controls cases were more likely to be male, of older age, recently retired, or recently bereaved. • Compared to general population controls, cases were more likely to be male, living alone, recently ebereaved or divorced. • Almost 53% of cases visited a general practitioner in the 6 months prior, and 34% got a prescription for psychopharmaceuticals. [ABSTRACT FROM AUTHOR]

Purpose: To report the health-seeking behaviors of individuals with acute viral conjunctivitis during an outbreak. Methods: A cross-sectional survey was carried out in the Raipur district of Chhattisgarh after an outbreak of acute conjunctivitis in July–August 2023. Results: The treatment choices were pharmacies (51.4%), ophthalmologists (21.1%), quacks (non-qualified doctors) (6.8%), general practitioners (1.6%), home remedies (5.2%), and no treatment (13.9%). Treatment preferences were influenced by place of residence (P < 0.001), occupation (P = 0.002), socioeconomic category (P < 0.001), and highest level of education of male (P < 0.001) and female (P < 0.001) members within the household. The overall expenditure was higher when patients sought treatment from quacks (INR 427.27 ± 202.21), followed by ophthalmologists (INR 374.57 ± 251.31) and pharmacies (INR 201.39 ± 102.65) (P < 0.001). Individuals aged 21–40 years (odds ratio [OR]: 0.24, 95% CI: 0.05–1.03, P = 0.055) and those from villages (OR: 0.16, 95% CI: 0.07–0.32, P < 0.001) were less likely to use prophylaxis. Individuals from families with high level of education of male members (OR: 2.70, 95% CI: 1.08–7.20, P = 0.039) or large family sizes (OR: 6.27, 95% CI: 2.42–19.09, P = 0.039) were more likely to use prophylaxis. The use of separate items of daily use reduced the risk of spread of conjunctivitis (OR: 0.24; 95% CI: 0.06–0.35, P = 0.035). Conclusion: Several insights into health-seeking behaviors among individuals with conjunctivitis during an outbreak were identified in this study, which can aid public health interventions during future outbreaks. [ABSTRACT FROM AUTHOR]

Background: The meaning and characteristics embedded in proprietary drug names have the potential to affect name recall, perceptions of drug benefits and risks, and attitudes toward a drug. In this study, we examined: (1) whether names that reference the drug's medical indication affect consumers' and primary care physicians' (PCPs') perceptions of the drug and (2) whether names that overstate the drug's efficacy affect consumers' and PCPs' perceptions of the drug. Methods: We conducted an online experiment with 455 PCPs and 450 consumers to test the effects of fictitious proprietary prescription drug names. Participants were randomized to view one neutral drug name, one name that overstated the drug's efficacy, and five names that referenced the drug's medical indication. Results: Names that referenced the drug's medical indication and names that overstated the drug's benefit both influenced perceptions of efficacy and risk compared to neutral names. For several outcomes, names evoking medical indications had similar effects to those designed to overstate the drug's efficacy. The patterns of effects were similar for PCPs and consumers. Conclusion: Findings suggest drug names alone can be sufficient to produce attitudes and risk and benefit perceptions about drugs, even in the absence of any information beyond the drug's medical indication. [ABSTRACT FROM AUTHOR]

The SARS-CoV-2 virus infection, the most severe pandemic in recent human history, found healthcare systems around the world more or less unprepared. Adjusting to this challenge involved changes in the daily routines of healthcare systems, as well as the patients, once again highlighting the importance of primary care (family physician or general practitioner). In the context of the COVID-19 pandemic, the family doctor in Romania played a crucial role in patient management, rapidly adapting to the changes and challenges imposed by the state of emergency. Their involvement quickly evolved from in-person consultations to online assessments, as they took on responsibilities such as monitoring patients in isolation or quarantine and issuing necessary medical leaves. Moreover, family doctors were directly involved in the COVID-19 vaccination process, facing challenges related to access to scheduling platforms and limited resources of protective equipment. Although they were on the front line of the healthcare response, recognition through incentives or compensations came late and incompletely, and their efforts in combating the pandemic were often overlooked. Designating family doctors' offices as public utility medical units (regardless of their organisational form) and supporting their activities through increased equipment and medical devices provided by local or central authorities are the keys to fighting for human lives in critical situations. Implementing clear and universal rules regarding the competencies (skills) and duties of family doctors, both in normal life situations and in exceptional circumstances, is of utmost importance. Little is known about the dedicated work and dedication of family physicians to their patients. Few studies have been carried out on the activity of the family doctor and their professional difficulties during the pandemic period. Some studies, on a small number of subjects, tried to evaluate the psychological adaptation of the family doctor to the new epidemiological situation. The aim of this narrative review is to highlight the difficulties to which family doctors had to adapt, comparing the data from the Romanian medical system with those discovered in the medical literature regarding family doctors from all over the world. [ABSTRACT FROM AUTHOR]

The market for commercial fresh pet food is growing, and the general practitioner should be prepared to discuss fresh pet food diets and explain how to compare them to traditional dry and canned pet food diets. Underlying client inquiries are not only the concept of pet humanization but also the increasing media attention and publicity about the role of food processing in human health and disease states. Understanding new concepts such as ultraprocessed foods and advanced glycation end-products will help veterinarians when discussing with clients. [ABSTRACT FROM AUTHOR]

Objective: Individuals with inflammatory arthritis require long‐term rheumatologist care for optimal outcomes. We sought to determine if socioeconomic status (SES) influences general practitioner (GP) and specialist physician visit frequency and out‐of‐pocket (OOP) visit costs. Methods: We linked data from Australian Rheumatology Association Database (ARAD) participants with rheumatoid arthritis or psoriatic arthritis to the Pharmaceutical Benefits (PBS) and Medicare Benefits Schedule from 2011 to 2018. Small‐area SES was approximated as quintiles of the Index of Relative Socioeconomic Advantage and Disadvantage. A comorbidity index (Rx‐Risk) was determined from PBS data. Analysis was performed using panel regression methods. Results: We included 1,916 ARAD participants (76.3% rheumatoid arthritis, 71.1% women, mean ± SD age 54 ± 12 years and disease duration 6 ± 4 years). Participants averaged 9.0 (95% confidence interval [CI] 8.6–9.4) annual GP visits and 3.9 (95% CI 3.8–4.1) annual specialist physician visits. After adjustment for sex, age, education, remoteness, and comorbidity, there was an inverse relationship between annual GP visit frequency and higher SES quintile (–0.6, 95% CI –0.9 to –0.3 visits per quintile) and a direct relationship between more frequent specialist visits and higher SES (linear slope 0.3, 95% CI 0.2–0.5 visits per quintile). Average OOP costs/visit were higher for specialist physician (AUD$38.43; 95% CI 37.34–39.53) versus GP visits (AUD$7.86; 95% CI 7.42–8.31), and higher SES was associated with greater OOP cost. Conclusion: Patients with higher SES have relatively fewer GP visits and more specialist physician visits compared with patients with lower SES, suggesting individuals with lower SES may receive suboptimal specialist physician care. OOP costs may be a contributing factor. [ABSTRACT FROM AUTHOR]

Background: Research activity usually improves outcomes by being translated into practice; however, there is developing evidence that research activity itself may improve the overall performance of healthcare organisations. Evidence that these relationships represent a causal impact of research activity is, however, less clear. Additionally, the bulk of the existing evidence relates to hospital settings, and it is not known if those relationships would also be found in general practice, where most patient contacts occur. Aim: To test 1) whether there are significant relationships between research activity in general practice and organisational performance; and 2) whether those relationships are plausibly causal. Design and setting: National data were analysed between 2008 and 2019, using cross-sectional and longitudinal analyses on general practices in England. Method: Cross-sectional, panel, and instrumental variable analyses were employed to explore relationships between research activity (including measures from the National Institute for Health and Care Research Clinical Research Network and the Royal College of General Practitioners) and practice performance (including clinical quality of care, patient-reported experience of care, prescribing quality, and hospital admissions). Results: In cross-sectional analyses, different measures of research activity were positively associated with several measures of practice performance, but most consistently with clinical quality of care and accident and emergency attendances. The associations were generally modest in magnitude; however, longitudinal analyses did not support a reliable causal relationship. Conclusion: Similar to findings from hospital settings, research activity in general practice is associated with practice performance. There is less evidence that research is causing those improvements, although this may reflect the limited level of research activity in most practices. No negative impacts were identified, suggesting that research activity is a potential marker of quality and something that high-quality practices can deliver alongside their core responsibilities. [ABSTRACT FROM AUTHOR]

The article "Achieving earlier diagnosis of symptomatic lung cancer" from the British Journal of General Practice highlights the importance of early detection of lung cancer to improve survival rates. It emphasizes the need for targeted screening using low-dose computed tomography (LDCT) and promoting awareness of symptoms to encourage timely medical consultation. The document also discusses the role of chest X-rays (CXR) in diagnosing symptomatic lung cancer and suggests interventions to facilitate prompt investigation and referral for patients with symptoms. Additionally, it addresses the challenges faced by patients who have never smoked in accessing timely diagnosis and treatment. [Extracted from the article]

Background: A large number of individuals suffer from post-COVID-19 condition (PCC), characterised by persistent symptoms following a SARS-CoV-2 infection with an impact on daily personal and professional activities. This study aims at examining which (health) care services are used by PCC patients in the German federal state of Lower Saxony, and how these patients manage their condition. The perspectives of patients, informal caregivers and general practitioners (GPs) will be considered. Methods: The study will employ a mixed methods design. Patients' perspective will be evaluated through an online survey of: (1) 21,000 adult individuals with a PCC diagnosis (ICD10 U09.9!) in their statutory health insurance claims data in 2022 ("AOK survey") and (2) a self-selected sample of adult individuals with a proven SARS-CoV-2 infection in 2023 and persistent symptoms ("public survey"). Additional data sources will be claims data (n = 27,275) and 25–30 semi-structured interviews. Informal caregivers' perspective will be collected through an online survey and semi-structured interviews. GPs' perspective will be evaluated through four focus groups involving six to eight participants each and an online survey of all registered and practicing GPs in Lower Saxony (approximately 5,000). All survey data will be descriptively analysed. In addition, correlation analyses and multivariable regression analyses will be conducted, for example on factors influencing affected individuals' use of medical services. Interview and focus group data will be subjected to qualitative content analysis. A health economic analysis will be used to determine the costs of PCC to health care payers, patients and society. The project will conclude with an expert workshop to discuss the results and derive recommendations. Discussion: The results of the study will provide a multidimensional description of the (health) care situation and needs of patients with PCC, and derive recommendations for improving health care. Trial registration: The VePoKaP study is registered at the German Clinical Trials Register (DRKS00032846). [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the performance of a deep learning-based segmentation model for predicting outcomes of non-surgical endodontic treatment. Preoperative and 3-year postoperative periapical radiographic images of each tooth from routine root canal treatments performed by endodontists from 2015 to 2021 were obtained retrospectively from Thammasat University hospital. Preoperative radiographic images of 1200 teeth with 3-year follow-up results (440 healed, 400 healing, and 360 disease) were collected. Mask Region-based Convolutional Neural Network (Mask R-CNN) was used to pixel-wise segment the root from other structures in the image and trained to predict class label into healed, healing and disease. Three endodontists annotated 1080 images used for model training, validation, and testing. The performance of the model was evaluated on a test set and also by comparison with the performance of clinicians (general practitioners and endodontists) with and without the help of the model on independent 120 images. The performance of the Mask R-CNN prediction model was high with the mean average precision (mAP) of 0.88 (95% CI 0.83–0.93) and area under the precision-recall curve of 0.91 (95% CI 0.88–0.94), 0.83 (95% CI 0.81–0.85), 0.91 (95% CI 0.90–0.92) on healed, healing and disease, respectively. The prediction metrics of general practitioners and endodontists significantly improved with the help of Mask R-CNN outperforming clinicians alone with mAP increasing from 0.75 (95% CI 0.72–0.78) to 0.84 (95% CI 0.81–0.87) and 0.88 (95% CI 0.85–0.91) to 0.92 (95% CI 0.89–0.95), respectively. In conclusion, deep learning-based segmentation model had the potential to predict non-surgical endodontic treatment outcomes from periapical radiographic images and were expected to aid in endodontic treatment. [ABSTRACT FROM AUTHOR]