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ABSTRACT: Background: Physiotherapists are health professionals who enhance mobility and quality of life (QoL) through clinical reasoning and the application of evaluation and treatment strategies. Their role is crucial in promoting health, preventing injury, and maintaining function. Aim: This paper aims to (1) share early experiences and learnings from integrating physiotherapy in rural primary health care, (2) discuss the scope and role of physiotherapists in the primary care team, (3) list the competencies of physiotherapists in rural primary care settings, and (4) advocate for a re-imagined role of physiotherapists as multi-skilled "primary care physiotherapists." Setting and Method: Using a selection of case stories from rural primary health care settings, the paper provides insights into the integration and impact of physiotherapy within these communities. Results: The integration of physiotherapy in rural primary health care has demonstrated significant benefits in promoting comprehensive primary health care. The case stories highlight the expanded scope and essential competencies of physiotherapists as vital members of the primary care team. Conclusion: This paper emphasizes the critical role physiotherapy plays in primary health care and calls for broader recognition and support for physiotherapists. It underscores the need for a re-imagined perspective of physiotherapists in rural settings, advocating for their role as multi-skilled primary care professionals. [ABSTRACT FROM AUTHOR]

Chronic subdural hematoma (CSDH) is a great mimicker. It should be considered in anyone presenting with chronic headaches that show postural variation. Parkinsonism following CSDH, while known, is only rarely reported in the literature. Hyponatremia, rapid correction of hyponatremia, medications, and mechanical pressure are thought to be risk factors. Here, we report a case of a 61-year-old male diagnosed with bilateral CSDH managed by craniotomy and clot evacuation who developed parkinsonism. We share several learnings (clinical pearls) that emerged from the close collaboration and co-learning curve between a family physician and physiotherapist involved in home-based rehabilitation. In conclusion, while managing the postoperative course of patients with CSDH, clinicians should maintain a high index of suspicion for parkinsonism. Early recognition and appropriate management with syndopa with supportive physiotherapy results in significant improvement of function and quality of life. Notably, parkinsonism following SDH is transient and nonprogressive and may not require lifelong therapy. [ABSTRACT FROM AUTHOR]

This paper examines the main and interactive effects of national culture dimensions and HIV prevalence rates on stigma towards people living with HIV/AIDS (PLHIVA). We examined these various relationships using data from a sample of 68,041 individuals from 49 countries, obtained from the World Values Survey. We used Hierarchical Linear Modeling to conduct our cross-level analyses. Our results indicated that collectivistic societies were positively associated while egalitarian and performance-oriented societies were negatively associated with stigma towards PLHIVA. Additionally, HIV prevalence rates interact with several cultural dimensions to worsen stigma towards PLHIVA. Our findings indicate the need to tailor stigma reduction strategies by taking the national culture dimensions of a given society into consideration when designing and implementing programs. [ABSTRACT FROM AUTHOR]

Background: Despite the notion of stigma as a socio-cultural process with the concept rooted in social space rather than in individual space, global studies examining impact of cultural differences on stigma toward substance use disorders are lacking. Aim: In this study, we aim to study the influence of national culture differences on stigma toward alcohol and substance use disorders. Methods: We analyzed individual-level data from 68,041 respondents from 49 countries on stigma toward alcohol and substance use disorders. We examined the effect of the national culture dimensions and national alcohol and substance consumption rates on stigma toward alcohol and substance use disorders using hierarchical linear modeling. Results: Our hierarchical linear modeling results indicate that cultural dimensions and consumption rates significantly influence stigma. We found significant positive associations between stigma toward AUD and institutional collectivism and assertiveness, but a negative association with future orientation dimension. Like AUD, stigma toward SUD was also positively associated with institutional collectivism and assertiveness, but negatively associated with power distance. Conclusions: The study findings have immense implications for national interventions to decrease stigma and influence policy making. [ABSTRACT FROM AUTHOR]

Context: Pregnancy-related preventable morbidity and mortality remain high in India. Safe delivery services should focus on improving neonatal and maternal outcomes while also enabling a positive childbirth experience. However, high rates of intrapartum obstetric referrals are common. Objective: To describe the timing and the reasons for obstetric referrals to a public tertiary care hospital in Bangalore and characteristics of the referring facilities. Methods: We interviewed 320 women who delivered at the tertiary care hospital within a one-month time frame prior to the interview and who originally planned to deliver elsewhere. Results: Ninety four percent of women in the study reported that the decision to transfer to the tertiary hospital was made after the onset of labour. Referrals were made for medical as well as non-medical reasons. About a third (35%) had to take loans to cover the expenses of childbirth. Conclusions: Referrals frequently occurred after the onset of labour. Our data imply that improving obstetric referral protocols will improve the birth experience and reduce the burden on tertiary care facilities and on the women themselves. [ABSTRACT FROM AUTHOR]

Background and Aims: Intraoperative use of a single bolus dose of tranexamic acid may not be sufficient to prevent bleeding in the early postoperative period. The present study was carried out to compare the effect of two dose regimens of tranexamic acid in reducing perioperative blood loss and the amount of allogenic blood transfusion in abdominal tumor surgery. Material and Methods: In this prospective, controlled, and double‑blind investigation, 60 patients electively posted for abdominal oncosurgical procedures were randomly assigned to receive a single bolus dose of tranexamic acid (10 mg/kg) (Group A), a bolus dose of tranexamic acid (10 mg/kg) followed by infusion (1 mg/kg/h) till 4 h postoperatively (Group B), and a bolus followed by infusion of normal saline (group C). Total intraoperative blood loss, amount of allogenic blood transfusion, postoperative drain collections, and hemoglobin and hematocrit levels were recorded at different time intervals. Data obtained after comparing three groups were analyzed by analysis of variance test for variables following normal distribution, Kruskal–Wallis test for nonparametric data, and post‑hoc Tukey–Kramer test for intergroup analysis. A probability value of less than 5% was considered significant. Results: There was no significant difference in intraoperative blood loss in all the three groups. Both the tranexamic acid groups showed reduction in postoperative blood collection in drain at 6 h and 24 h in comparison to the control group (P < 0.001). There was also a significant difference in the amount of blood in postoperative drain at 24 h within the tranexamic acid groups, where lesser collection was seen in the infusion group (P = 0.007). Hemoglobin and hematocrit levels measured at different postoperative time intervals showed a significant reduction from the baseline in the control group compared to the tranexamic acid groups together. Conclusion: Tranexamic acid causes more effective reduction in post-operative blood loss when used as a bolus followed by an infusion continued in the postoperative period in comparison to its use as a single intravenous bolus in abdominal tumor surgery. [ABSTRACT FROM AUTHOR]

Background and Objectives: Substance use disorder (SUD) is a widespread problem but physicians may feel inadequately prepared to provide addiction care. We sought to assess current addiction medicine curricula in US family medicine residencies (FMRs) and evaluate barriers to improving or implementing addiction medicine curricula.Methods: Questions regarding addiction medicine training were added to the December 2015 Council of Academic Family Medicine Educational Research Alliance (CERA) survey to US FMR program directors to evaluate each FMR's curriculum, potential workforce production, perceived barriers to improving or implementing curricula and faculty training in addiction medicine.Results: Of 461 FMR directors, 227 (49.2%) responded; 28.6% reported a required addiction medicine curricula. Regional variations of having a required curriculum ranged from 41.3% in the Northeast to 20.0% in the South (P=0.07). Of residencies, 31.2% had at least one graduate obtain a buprenorphine prescription waiver in the past year and 8.6% had at least one graduate pursue an addiction medicine fellowship in the past 5 years. Lack of faculty expertise was the most commonly cited barrier to having a curriculum, with only 36.2% of programs having at least one buprenorphine waivered faculty member, 9.4% an addiction medicine board certified faculty, and 5.5% a fellowship trained faculty.Conclusions: Few FMRs have addiction medicine curricula and most graduates do not seek additional training. Multifaceted efforts, including developing model national curricula, training existing faculty, and recruiting addiction trained faculty, may improve addiction medicine training in family medicine residencies to better address the growing SUD epidemic. [ABSTRACT FROM AUTHOR]

Background and Objectives: In the current interferon-free era, family medicine is in a unique position to deliver hepatitis C (HCV) treatment with adequate training. Little is known about attitudes of family medicine program directors (PDs) toward capacity building within their residency programs. We report the results of a nationwide survey of family medicine PDs to examine these attitudes.Methods: This study was part of a CERA (Council of Academic Family Medicine Educational Research Alliance) omnibus survey administered to family medicine PDs between February 2015 and March 2015. Attitudes were assessed using a Likert scale ranging from 1=strongly disagree to 6=strongly agree.Results: We surveyed 452 physicians, with 273 responses (response rate 61%). The majority of PDs (78%) believed that chronic HCV represented a significant problem for primary care, and 61.9% believed their program should take steps to build capacity in HCV treatment. There was no effect of regional HCV prevalence, residency program context, or PD characteristics on intent to build capacity.Conclusions: This is the first report to examine PDs intent to build capacity in HCV treatment in this interferon-free, direct antiviral era. Our findings highlight a historic opportunity to train family physicians and position them on the frontline as HCV treatment providers. [ABSTRACT FROM AUTHOR]

We describe the case of an HIV/AIDS patient with progressive multifocal leukoencephalopathy (PML) associated with immune reconstitution inflammatory syndrome (IRIS) and the diagnostic and management dilemmas in distinguishing between PML and PML-IRIS. This case is relevant to physicians including family physicians who manage immunocompromised patients in their practice. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Maternity care is an essential component of family medicine, yet the number of residency graduates providing this care continues to decline. Residency programs have struggled to identify strategies to increase continuation of obstetric practice among graduates. Leaders in family medicine obstetrics previously proposed a tiered model of training to ensure adequate volume for those desiring to continue maternity care upon graduation. However, whether this approach will be successful is unknown. This study aimed to identify program characteristics and teaching methods that may influence residents to continue obstetrics practice upon graduation. METHODS: A nationwide survey of family medicine residency program directors (PDs) was conducted as part of the 2013 CERA survey to characterize teaching in maternity care and identify program- level predictors of graduate continuation of obstetrics (OB). RESULTS: Family medicine programs, which were communitybased, university-affiliated programs in the Midwest and West, contributed more trainees who continued to provide OB care upon graduation. Trainees at these programs received greater supervision by family medicine faculty preceptors on labor and delivery, reported at least 80 deliveries by graduates during residency, and experienced greater autonomy in decision-making during OB rotations. CONCLUSIONS: This study supports a targeted approach to teaching maternity care in family medicine residency programs. Prioritizing continuity delivery experiences and fostering resident independence are strategies toward promoting increased provision of obstetric care by family medicine graduates. Further research is needed to evaluate the impact of tiered or track systems in practice. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: As the number of people living with HIV steadily increases, severe shortages in the HIV provider workforce in the United States are projected. With an increased emphasis on HIV education during residency, family physicians could play a major role in meeting this need. METHODS: A nationwide survey of family medicine residency program directors (PDs) was conducted to determine their attitudes toward training residents in HIV care. RESULTS: Of 440, 224 (51%) PDs responded to the electronic survey. Teaching HIV care was a high priority for 20% of PDs. Twenty percent of PDs reported residents in their program were providing care to at least five HIV-infected patients. Twenty-five percent of PDs felt that their graduates had the skills to be HIV care providers. Fewer than 25% of PDs reported having a formal HIV curriculum or faculty with adequate HIV expertise. The most favored approaches to strengthen the HIV curriculum by PDs were: (1) a half-day minicourse (30%) and (2) developing a faculty member's expertise in HIV care (17%). A total of 79% of directors saw a need to modify their existing curriculum. CONCLUSIONS: Despite growing numbers of HIV-infected patients, only 25% of family medicine PDs felt that their graduates were adequately trained in HIV primary care, and most saw a need to modify their HIV curricula. Family medicine residency training programs have an important opportunity to develop residency curricula and increase faculty competence to train the next generation of clinicians in HIV care. [ABSTRACT FROM AUTHOR]

This article presents information on emtricitabine/tenofovir, a fixed-dose combination of emtricitabine and tenofovir that was labeled for use as preexposure prophylaxis to prevent HIV-1 infection.