Rural Family Physician Perspectives on Wellness and the Role of Training in Supporting Physician Wellness.

Purpose: Research evaluating the well-being of rural family physicians is limited, resulting in minimal understanding of how to prepare family medicine residents to succeed in rural practice postresidency. Our study aimed to investigate factors associated with maintaining wellness within rural family medicine practices and highlight interventions that rural family physicians identify as important to promote wellness among those seeking future employment in rural settings postresidency. Methods: Forty-eight rural family physicians completed an online survey with qualitative and multiple-choice items including the Mini-Z about physician demographics, burnout, and wellness. We conducted data analysis using NVivo 12 software for qualitative analyses and R 3.6.1 software for descriptive statistics. Results: The majority of participants reportedly maintained wellness in rural family practice (maintenance of wellness=79.17%; denied burnout=62.26%). Burnout rates were similar to the national burnout rates for family physicians (37.74% vs 46%). Participants identified multiple residency interventions that could be implemented to prepare rural family physicians to succeed. Conclusions: This study highlights factors that are associated with the maintenance of wellness among rural family physicians. This is the first study to investigate rural family physician perspectives on residency interventions that may have positive outcomes on wellness postresidency.

Lower Gastrointestinal Conditions: Malabsorption Syndromes.

Malabsorption syndromes are common in family medicine but may be overlooked because of a wide variation in presentation. Classic symptoms include diarrhea, steatorrhea, weight loss, flatulence, and postprandial abdominal pain. Nongastrointestinal manifestations can include elevated levels of liver function markers, anemia, skin conditions, infertility, and bone disease. Associated conditions include lactose intolerance, celiac disease, and exocrine pancreatic insufficiency. Testing should include screening for anemia. A standard test for lactose intolerance is the hydrogen breath test; however, formal testing typically is not required for diagnosis. The diagnosis of celiac disease depends on serologic testing, histologic findings on duodenal biopsy, or both. Patients should not restrict their diets before testing for malabsorption syndromes. If the initial evaluation is negative for celiac disease, other conditions should be considered, including nonceliac gluten sensitivity, irritable bowel syndrome, and fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) intolerance. Therapies for patients with malabsorption syndromes involve dietary modification. A lactose-restricted diet and use of dairy substitutes are recommended for lactose intolerance. A gluten-free diet is the primary intervention for celiac disease. Pancreatic enzyme replacement therapy and replacement of fat-soluble vitamins are the primary therapies for management of exocrine pancreatic insufficiency.

Cancer connect New Zealand: description and retrospective audit.

The Cancer Connect New Zealand (CCNZ) service is a free confidential telephone peer support programme, run by the Canterbury/West Coast Division of the Cancer Society of New Zealand (CSNZ). The programme links people affected by cancer to specially trained peer support volunteers (TPSV) who have been through similar cancer experiences. This service was started in 2005, and now more than 950 New Zealand non-metastatic cancer clients or their care-givers have been matched by qualified CCNZ coordinators. Clients accessed the service for various reasons, including support and advice on the practical, social, family or psychological impacts of their cancer diagnosis and treatment. This paper reports a retrospective audit of the CCNZ service in which paper records of CCNZ matches were reviewed, assessed and described. The audit describes the number (n=156) and type of Cancer Connect matches made during the year July 2008-July 2009. During this period there was a 95% 'on paper' success in matching clients with TPSV. Information included covers: the client's gender; age; cancer type; time from diagnosis; treatment; marital status; geographical region; and most importantly, their reason for referral. This audit was performed to record baseline demographic data of those using and providing the CCNZ service. This information not only offers insight into how the process of matching and usage is applied, it also adds to the literature on peer review support, and informs nurses working with non-metastatic cancer clients and their families where telephone peer support can be found. These results will also inform part 2--a prospective audit/research project to discover any gaps in the CCNZ service and to identify satisfaction, effectiveness and safety of the CCNZ service from the clients, TPSV and referrers perspectives (currently being completed).