Factors Affecting the Choice of a Clinician for Orthodontic Treatment in Malaysia.

Introduction In Malaysia, orthodontic treatments are provided by general dental practitioners (GDPs) or specialist orthodontists. Evidence suggested that the public could be confused about clinicians providing orthodontic treatments. The objectives of this study were to assess the public understanding of the difference between a specialist orthodontist and a GDP who provides orthodontic treatment and to evaluate the factors that might influence the choice of a practitioner. Methods An online, dual-language survey comprising 185 Malaysian adults was completed. Thirteen questions regarding social demographics, knowledge of clinicians providing orthodontic treatment, and factors that influence the choice of a clinician were asked. Results Around 74% of Malaysian respondents knew the differences between a specialist orthodontist and a GDP providing orthodontic treatment. Being treated by a specialist orthodontist and the cost of treatment were identified as the most important factors in choosing an orthodontic service provider followed by recommendations from GDP, location, testimony, and lastly recommendations from friends/family. Conclusion The majority of Malaysian respondents could identify the difference between a specialist orthodontist and a GDP who provides orthodontic treatment. Being treated by a specialist orthodontist and cost were the main factors that influenced the choice of a clinician providing orthodontic treatment in Malaysia.

Minimizing unnecessary proBNP blood tests: an evaluation of a pop-up form implementation in general practice.

OBJECTIVE: To evaluate the impact of a compulsory pop-up form on the ordering pattern of proBNP blood tests by general practitioners in the Capital Region of Denmark. DESIGN: A follow-up study comparing the average number of proBNP tests ordered before and after the implementation of an intervention. SETTING AND SUBJECTS: From 2016 to 2021, the average number of proBNP tests increased by over 300%. In March 2022, a compulsory pop-up form was introduced in the electronic request system (WebReq), requiring general practitioners to select one of three indications for ordering proBNP, as recommended by the Danish Society of Cardiology. The study included 528 general practitioners in the Capital Region of Denmark, with data available from January 2020 to 2023, encompassing 83,576 proBNP results from 56,645 patients. MAIN OUTCOME MEASURE: The average number of proBNP tests ordered per month and the median level of proBNP before and after the intervention. RESULTS: Following the intervention, the average number of proBNP tests per month decreased by 60% over a 22-month follow-up period. The highest reduction was seen among general practitioners who previously ordered the most tests (≥3 per 1000 biochemical tests). In this group, the median proBNP level increased from 12.1 pmol/L before the intervention to 13.5 pmol/L after the intervention (p < 0.0001). CONCLUSIONS: This study demonstrates a significant decrease in the number of proBNP requests from general practitioners in the Capital Region of Denmark after the introduction of a pop-up form in the requisition system containing the current guidelines.

Evaluation of nurse practitioners' extended scope of practice in a regional hospital emergency department in tropical Australia.

OBJECTIVES: There is very little literature examining the workload and impact of nurse practitioners (NPs) working in emergency departments (ED) in regional and rural Australia. The aim of this paper was to review the ED NPs scope of practice in the ED discharge stream and patient outcomes at Cairns Hospital over a 7-month period. METHODS: This retrospective study examined the ED electronic medical record between 14 May 2019 and 31 December 2019. Cases managed by ED NPs, referrals, procedures performed, representations and disposition data were collected. Adverse events were sought from the Qld Health adverse events register (Riskman), the department complaints register and the ED M&M meeting minutes. RESULTS: A total of 1443 patients were treated by NPs, with ages ranging from 0 to 98 years (median 40 years). Australasian Triage Score (ATS) 3 cases made up 30% of the workload. Other than ATS 3 cases, time to being seen was better than the general department. There were very few unexpected representations, complaints or adverse events. CONCLUSIONS: This study supports the view that NPs working in a regional emergency department can safely manage a variety of patients outside a fast-track model, with a wide age range and a variety of triage categories and diagnoses. We believe this has important implications for the provision of emergency care, especially in regional and rural Australia.

A qualitative study exploring the experiences of advanced clinical practitioner training in emergency care in the South West of England, United Kingdom.

BACKGROUND: Attempting to improve emergency care (EC) advanced clinical practitioner (ACP) training, Health Education England (HEE) South West (SW) implemented a pilot, whereby emergency departments (ED) were provided with enhanced funding and support to help ED consultants deliver teaching and supervision to EC ACPs to ensure more timely completion of EC ACP training compared with previous cohorts training in the region.We explored the experiences of trainee EC ACPs and consultant EC ACP leads working in EDs, which had implemented the new regional pilot. METHODS: We used a qualitative design to conduct semi-structured interviews with trainee EC ACPs and consultant EC ACP leads across five EDs that had implemented the HEE SW pilot. Interview data were analysed thematically. RESULTS: Twenty-five people were interviewed. We identified four themes: (1) the master's in advanced practice could be better aligned with the Royal College of Emergency Medicine credentialling e-portfolio; (2) EC ACP training needs some flexibility to reflect the individual-'one size does not fit all'; (3) supervision and teaching were recognised as important but requires significant staff capacity that is impacted by external pressures and (4) unclear role expectations and responsibilities hinder role transition and impact role identity.It was notable that EC ACPs primarily spoke about the development of their clinical skills both academically and within the workplace, despite there being other skills mentioned in the multiprofessional framework for advanced practice (leadership and management, education and research). CONCLUSION: A clear supervision structure with protected time allocated for teaching and assessment of clinical skills within the ED is essential to facilitate trainee EC ACP progression. However, increasing demands on EDs make this a challenging goal to achieve. Role identity issues continue to persist despite the introduction of new guidance designed to provide more clarity around the ACP role.

Screening tools assessing mental illness in primary care: A systematic review.

BACKGROUND: To better manage patients with a wide range of mental health problems, general practitioners would benefit from diagnostically accurate and time-efficient screening tools that comprehensively assess mental illness. Therefore, the aim of this systematic review was to identify screening tools that either take a multiple-mental disorder or a transdiagnostic approach. As primary and secondary outcomes, diagnostic accuracy and time efficiency were investigated. METHODS: The data bases MEDLINE, Embase, Cochrane Library, Psyndex and PsycINFO were searched. Studies reporting on multiple-mental disorder or transdiagnostic screening tools used in primary care with adult patients were included. Sensitivity, specificity, positive and negative predictive value served as measures of diagnostic accuracy. Time efficiency was evaluated by the number of items of a screening tool and the time required for its completion and evaluation. RESULTS: Eleven studies met the inclusion criteria. The majority of screening tools assessed multiple mental disorders separately. A sub-group of screening tools took a transdiagnostic approach by examining the spectrum of mood, anxiety and stress-related disorders. One screening tool used internalised, cognitive/somatic and externalised dysfunction as transdiagnostic domains of mental illness. Mostly, a sufficient sensitivity and specificity was reported. All screening tools were found to be time efficient. CONCLUSION: The eleven identified screening tools can support general practitioners to identify patients with mental health problems. However, there was great heterogeneity concerning their diagnostic scope of psychopathology. Further screening tools for primary care are needed that target broad constructs of mental illness, such as transdiagnostic factors or personality dysfunction.

Eleven screening tools assessing multiple mental health disorders or taking a transdiagnostic approach in primary care were identified.The tools were time efficient, and offer a satisfactory diagnostic accuracy.Future research should focus on screening tools that target transdiagnostic factors or maladaptive personality traits as informative constructs.

Dementia Rehabilitation Training for General Practitioners and Practice Nurses: Does It Make a Difference?

BACKGROUND/OBJECTIVES: Rehabilitation helps reduce disability in dementia. The Australian National Dementia Action Plan identifies a gap in clear treatment pathways post-diagnosis, affecting the quality of life for those with dementia. This study assessed the impact of a one-day dementia training course and follow-up on GPs' and practice nurses' knowledge, attitudes, and confidence regarding dementia rehabilitation. METHODS: The training, led by two experienced GPs and an academic physiotherapist, covered dementia diagnosis, allied health roles, care planning, and referrals. The follow-up involved applying the learnt material and completing a reflective task. Three longitudinal surveys (Dementia Knowledge Assessment Scale-DKAS, General Practitioners' Attitudes and Confidence towards Dementia Survey-GPACS-D, and Dementia Rehabilitation Scale) and Likert-scale statements were conducted pre-course, post-course, and at four-month follow-up, alongside a focus group. Descriptive and regression analyses were applied to survey data, and content analysis was used for focus group data. RESULTS: Seventeen participants (14 GPs, 3 nurses) completed the pre-post-course survey, with eight (6 GPs, 2 nurses) participating in follow-up and focus group discussions. Post-course, DKAS scores increased by 12.1%, GPACS-D by 10.1%, and the dementia rehabilitation scale by 9.4%. Likert-scale statements improved by 8-79%. At the four-month follow-up, there was a slight, non-significant decline in most measures. Focus groups highlighted the training's impacts, useful components, barriers, and suggestions for improvement. CONCLUSION: Training GPs and practice nurses in dementia rehabilitation enhances knowledge, awareness, and confidence. Ongoing efforts are needed to sustain benefits and address referral barriers for better access to dementia rehabilitation services.

Trauma Connect Clinic: Continuing the trauma case management model for patients affected by traumatic injuries: A quality improvement initiative.

BACKGROUND: A case-management model of care is frequently used in acute-care settings for patients with major traumatic injuries; however, its application to trauma follow-up care after hospital discharge remains unclear. AIM: To describe the services provided by the Trauma Connect Clinic (TCC): a NP- led case management model, in trauma follow-up care. METHODS: An exploratory descriptive study design was used. Data collected included patient and injury characteristics, clinic activities, attendance rates, referral patterns and complications. RESULTS: Three-hundred and twenty-four TCC appointments were scheduled for 194 patients (n = 302) with an attendance rate of 93% (n = 302). Ongoing health issues included pain (n = 22, 37%), thrombotic events (n = 8, 13%) and infection (n = 7, 12%). Clinic activity included 77 referrals to the wider MDT (n = 77), radiology reviews (n = 225) and 39 prescribing events, consisting mainly of analgesia. CONCLUSION: A case management model can successfully deliver trauma follow-up care and efficiently use limited resources. Key elements involve careful assessment and management of patients' physical and emotional needs. Evaluation of longer-term outcomes of this model of care in trauma settings is required.

Unusual Presentation of Myeloid Sarcoma as Thigh Mass.

INTRODUCTION: Myeloid sarcoma (MS) is a tumor containing myeloid blasts, with or without maturation, involving any anatomical site other than the bone marrow. It can occur de novo or following a hematological malignancy. CASE: We report a 6-year-old female who presented with fever and a rapidly enlarging left thigh mass. The initial provisional diagnosis considered was tubercular hip arthritis with an abscess, but imaging investigations suggested neoplastic swelling. A biopsy of the mass showed a malignant small-round cell tumor. Bone marrow aspiration revealed the diagnosis of acute myeloid leukemia without the presence of blasts in the peripheral smear. CONCLUSION: MS is a rare malignancy. The diagnosis is often delayed due to a lack of clinical suspicion and the absence of blasts in peripheral blood. This report aims to enhance the awareness of pediatric nurse practitioners that MS should also be considered as a differential for an extremity mass.

Advanced Practice Providers in Cellular Therapy: Survey Results from the ASTCT APP Special Interest Group Exploring Clinical Roles, Compensation, and Job Satisfaction.

BACKGROUND: Advanced practice providers (APPs), which include physician assistants/associates and advanced practice nurses, are critical members of the transplant and cellular therapy (TCT) care team. Despite broad utilization in transplant centers, there is little published literature on the clinical roles and responsibilities, staffing models, compensation structure, and job satisfaction of TCT APPs. This study represents the results of a national survey administered by the APP Special Interest Group to better characterize the TCT APP workforce. OBJECTIVE: To characterize the TCT APP workforce by investigating clinical roles and responsibilities, compensation and institutional support, and job satisfaction. METHODS: A 25-item web-based survey addressing four domains (transplant center data, APP roles and responsibilities, compensation and institutional support, and job satisfaction). Surveys were sent to participants through a chain-referral sampling method. Data were analyzed using descriptive statistics and multinomial logistic regression. RESULTS: A total of 198 responses were analyzed, representing 64 transplant centers of varying size from 29 states. APPs report working in inpatient and outpatient settings and performing a broad array of TCT-associated procedures including bone marrow biopsy (78%), lumbar puncture (43.2%), intrathecal chemotherapy (47.0%), and cellular infusions (45.9%). Median salary of respondents was $110,000-$119,000 and was significantly associated with geographic location of transplant center and years of experience. A minority of respondents reported no funding (4.2%) or time (9.8%) supporting continuing education. A majority of APPs (55.1%) do not feel they are appropriately paid. A majority (54.3%) did not feel that their center supported a good work-life balance. Nearly 35.4% of respondents did not feel valued in their role. CONCLUSIONS: This survey represents the first to characterize the TCT APP workforce in the United States. APPs are highly integrated into the TCT care team and can serve as means to improve patient access to TCT therapies given a worsening physician shortage. However, the lack of satisfaction with compensation and work-life balance could represent barriers to recruitment and retention of TCT APPs and warrant future studies to better characterize.

Gout diagnoses uncertain when made by general practitioners without serum uric acid testing: an observational study.

OBJECTIVE: General practitioners (GPs) diagnose the majority of all gout patients. They make their diagnosis clinically. Serum uric acid (SUA) level >0.35mmol/l is largely determinative for the clinical diagnosis of gout. We aimed to assess to what extent GPs test SUA when making a first gout diagnosis, and to consider consequences regarding diagnostic certainty of not testing it. METHODS: We calculated proportions of patients from 87 Dutch general practices (1-1-2013 to 1-1-2022) with a first gout diagnosis and a recorded SUA test, evaluated if SUA testing was punctually timed with respect to the diagnosis date, whether SUA levels were >0.35 mmol/L, and whether diagnoses corresponded with diagnoses according to the 'Acute Gout Diagnosis Rule' (AGD-rule). RESULTS: In 43.0% of 7782 patients (mean age 64.4 years; 68.8% male) no SUA test result was recorded, with substantial variation among practices: median 41.9% (IQR 20.2%). 'Gout very likely' according to the AGD-rule was seen in all males and in 83.1% of females when a punctually timed SUA >0.35 mmol/L was present. When such SUA level was lacking, 'Questionable or indeterminate gout diagnosis' was seen in all males and in 67.1% of females, and 'Arthritis diagnosis other than gout' in 32.9% of females. CONCLUSION: GPs diagnosed gout without testing SUA in ~40% of cases. This implies avoidable diagnostic uncertainty with impact for the clinical care of many patients as well as for studies that include primary care patients with gout. Key Points • Serum uric acid (SUA) level > 0.35 mmol is determinative when diagnosing gout: however, it is unknown how often SUA testing is applied as such. • More than 40% of patients with a first gout diagnosis according to general practitioners (GPs) had no SUA test result registered in their medical record. • Gout diagnosing by GPs without SUA testing appeared to lead to avoidable diagnostic uncertainty, as diagnoses are often questionable or sometimes even wrong. • Researchers investigating gout need to take into account diagnostic uncertainty if they include gout patients who are diagnosed in primary care in their studies without SUA information.

Trends in influenza vaccination and its determinants among pregnant French women between 2015 and 2020: A single-center study.

In 2016, only 7% of French women had received an influenza vaccination during their pregnancy. In this vaccine-averse country, the possibility of reaching the rates of 50% observed in other countries remains unknown. To measure the rate of influenza vaccination in a French university maternity. To study its evolution and determinants over the last 5 years. Single-center observational study of all women who gave birth during March 2020 in this maternity. Comparison with rates observed in 2015 in the same conditions. Of the 337 women included in the study, 202 received a vaccination during pregnancy (59.9%). After logistic regression, the factors significantly associated with achieving vaccination were the offer of vaccination during pregnancy, odds ratio (ORa) 26.2 [7.0; 98.2]; previous vaccination, ORa 20.3 [9.6; 42.6]; high education level, ORa 2.9 [1.3; 6.2]; delivery of a CERFA government reimbursement form, ORa 2.5 [1.3; 4.8]; a vaccination offer made by a general practitioner, ORa 2.1 [1.0; 4.4] and not by a hospital midwife, ORa 0.3 [0.1; 0.6]. The rate of vaccination increased from 35% to 59.9% between 2015 and 2020 (p < .001), with a significant increase in the offer of vaccination during pregnancy (+14.6%) - especially by a general practitioner (+17.2%) - and in the rate of women with earlier vaccination (+13.6%). In France, vaccination rates above 50% are possible at a center level. A proposal of vaccination during pregnancy - especially by the general practitioner - seems to be a determining factor in this development.

Validity of the Johns Hopkins Adjusted Clinical Groups system on the utilisation of healthcare services in Norway: a retrospective cross-sectional study.

BACKGROUND: The Adjusted Clinical Groups (ACG) System is a validated electronic risk stratification system. However, there is a lack of studies on the association between different ACG risk scores and the utilisation of different healthcare services using different sources of input data. The aim of this study was therefore to assess the validity of the association between five different ACG risk scores and the utilisation of a range of different healthcare services using input data from either general practitioners (GPs) or hospitals. METHODS: Registry-based study of all adult inhabitants in four Norwegian municipalities that received somatic healthcare in one year (N = 168 285). The ACG risk scores resource utilisation band, unscaled ACG concurrent risk, unscaled concurrent risk, frailty flag and chronic condition count were calculated using age, sex and diagnosis codes from GPs and a hospital, respectively. Healthcare utilisation covered GP, municipal and hospital services. Areas under the receiver operating curve (AUC) were calculated and compared to the AUC of a model using only age and sex. RESULTS: Utilisation of all healthcare services increased with increasing scores in the "resource utilisation band" (RUB) and all other investigated ACG risk scores. The risk scores overall distinguished well between levels of utilisation of GP visits (AUC up to 0.84), hospitalisation (AUC up to 0.8) and specialist outpatient visits (AUC up to 0.72), but not out-of-hours GP visits (AUC up to 0.62). The score "unscaled ACG concurrent risk" overall performed best. Risk scores based on data from either GPs or hospitals performed better for the classification of healthcare services in their respective domains. The model based on age and sex performed better for distinguishing between levels of utilisation of municipal services (AUC 0.83-0.90 compared to 0.46-0.79). CONCLUSIONS: Risk scores from the ACG system is valid for classifying GP visits, hospitalisation and specialist outpatient visits. It does not outperform simpler models in the classification of utilisation of municipal services such as nursing homes and home services and outpatient emergency care in primary healthcare. The ACG system can be applied in Norway using administrative data from either GPs or hospitals.

Prevalence and Practice Characteristics of Advanced Practice Providers in Upper-Extremity Surgery, 2013-2021.

PURPOSE: This study evaluated the prevalence, characteristics, and reimbursement of advanced practice providers, including nurse practitioners and physician assistants, who provide care related to the diagnosis and treatment of diseases and conditions of the hand, wrist, and upper extremities in the United States from 2013 to 2021. METHODS: Our analysis was a retrospective cohort study evaluating the diagnostic, procedural, and therapeutic services provided by advanced practice providers from 2013 to 2021 using the Medicare Provider Utilization and Payment Data Public Use Files from the Centers for Medicare and Medicare Services. The reported provider type and billing codes were used to identify health care professionals providing upper-extremity care such as ordering radiographs, applying casts and splints, and performing procedures on the hand, wrist, or other anatomic regions of the upper extremity. Trends over the study period and available data about services provided were analyzed. RESULTS: From 2013 to 2021, providers of upper-extremity care included 19,525 (64.7%) doctor of medicine or doctor of osteopathic medicine upper-extremity surgeons, 7,612 (25.2%) physician assistants, and 3,042 (10.1%) nurse practitioners. The nonsurgeon providers were more likely to be women and provide care in micropolitan areas with less than 50,000 people compared with upper-extremity surgeons. Overall, the number of advanced practice providers who billed for upper-extremity care increased by 170.9% from 1,965 in 2013 to 5,324 in 2021. Based on these trends, the growth of APPs providing upper-extremity care is expected to continue. CONCLUSIONS: There is a growing prevalence of advanced practice providers in upper-extremity care, and this trend is expected to continue. CLINICAL RELEVANCE: With a growing need for upper-extremity care and predicted shortages in the surgeon workforce, the scope of practice and integration of advanced practice providers merits further discussion and evaluation.

The CO-produced Psychosocial INtervention delivered by GPs to young people after self-harm (COPING): protocol for a feasibility study.

Background: Self-harm in young people is a growing concern and reducing rates a global priority. Rates of self-harm documented in general practice have been increasing for young people in the UK in the last two decades, especially in 13-16-year-olds. General practitioners (GPs) can intervene early after self-harm but there are no effective treatments presently available. We developed the GP-led COPING intervention, in partnership with young people with lived experience and GPs, to be delivered to young people 16-25 years across two consultations. This study aims to examine the feasibility and acceptability of conducting a fully powered effectiveness trial of the COPING intervention in NHS general practice. Methods: This will be a mixed-methods external non-randomised before-after single arm feasibility study in NHS general practices in the West Midlands, England. Patients aged 16-25 years who have self-harmed in the last 12 months will be eligible to receive COPING. Feasibility outcomes will be recruitment rates, intervention delivery, retention rates, and completion of follow-up outcome measures. All participants will receive COPING with a target sample of 31 with final follow-up data collection at six months from baseline. Clinical data such as self-harm repetition will be collected. A nested qualitative study and national survey of GPs will explore COPING acceptability, deliverability, implementation, and likelihood of contamination. Discussion: Brief GP-led interventions for young people after self-harm are needed to address national guideline and policy recommendations. This study of the COPING intervention will assess whether a main trial is feasible. Registration: ISRCTN (ISRCTN16572400; 28.11.2023).

Self-harm, usually by cutting or overdosing on tablets, affects young people, their families and friends, and society. Young people who self-harm are more likely to self-harm again and suffer from anxiety and depression. The leading cause of death in young people is suicide and over half of young people who die by suicide have previously self-harmed. Self-harm results in around £128 million a year of costs to the NHS. The GP is the most frequently contacted health professional in the NHS for young people who have self-harmed. Therefore, the GP consultation provides a crucial opportunity to intervene early to reduce future self-harm. At present there are no interventions that work for GPs to use with young people who have self-harmed. We thus developed with GPs and patients a new GP-led brief treatment focusing on psychological and social factors for young people 16­25 years after self-harm (called COPING) to be delivered over two appointments. We would now like to test the COPING treatment in general practice to understand whether a future large clinical trial of COPING is doable in the NHS. We will recruit study sites from practices around England and train GPs at sites. We will identify potential participants through three recruitment strategies and all participants will receive the COPING treatment. We will collect follow-up data from young people at two, four, and six months from enrolment, and data will include information about mood, self-harm thoughts, and episodes of self-harm. GPs and participants will be invited for an interview to gain their experiences of COPING. An online survey of GPs in England will gauge interest about engagement in a future trial. This study will assess whether COPING can be evaluated in a large clinical trial in NHS general practice. If feasible and acceptable there is the potential for COPING to substantially benefit patients, GPs, and the NHS.

Associations of heat with diseases and specific symptoms in Flanders, Belgium: An 8-year retrospective study of general practitioner registration data.

INTRODUCTION: Global temperature rise has become a major health concern. Most previous studies on the impact of heat on morbidity have used hospital data. OBJECTIVE: This study aimed to quantify the association between ambient temperature and a variety of potentially heat-related medical conditions and symptoms using general practitioner (GP) data, in Flanders, Belgium. METHODS: We used eight years (2012-2019) of aggregated data of daily GP visits during the Belgian summer period (May-September). A distributed lag nonlinear model (DLNM) with time-stratified conditional quasi-Poisson regression was used to account for the non-linear and delayed effect of temperature indicators (minimum, mean and maximum). We controlled for potential confounders such as particulate matter, humidity, and ozone. RESULTS: The overall (lag0-14) association between heat and most of the outcomes was J-shaped, with an increased risk of disease observed at higher temperatures. The associations were more pronounced using the minimum temperatures indicator. Comparing the 99th (20 °C) to the minimum morbidity temperature (MMT) of the minimum temperature distribution during summer, the relative risk (RR) was significantly higher for heat-related general symptoms (RR = 1.30 [95 % CI: 1.07, 1.57]), otitis externa (RR = 4.87 [95 % CI:2.98, 7.98]), general heart problems (RR = 2.43 [95 % CI: 1.33, 4.42]), venous problems (RR = 2.48 [95 % CI:1.55, 3.96]), respiratory complaints (RR = 1.97 [95 % CI: 1.25, 3.09]), skin problems (RR = 3.26 [95 % CI: 2.51, 4.25]), and urinary infections (RR = 1.37 [95 % CI: 1.11, 1.69]). However, we did not find evidence for heat-related increases in gastrointestinal problems, cerebrovascular events, cardiovascular events, arrhythmia, mental health problems, upper respiratory problems and lower respiratory problems. An increased risk of allergy was observed when the minimum temperature reached 17.8 °C (RR = 1.50 [95 % CI: 1.23, 1.83]). Acute effects of heat were observed (largest effects at the first few lags). SUMMARY: Our findings indicated that the occurrence of certain symptoms and illnesses during summer season is associated to high temperature or environmental exposures that are augmented by elevated temperatures. Overall, unlike hospitalization data, GP visits data provide broader population coverage, revealing a more accurate representation of heat-health association.

Managing child abuse or suspected child abuse in primary care: Results from a qualitative study of general practitioners trained in detecting child abuse: Managing child abuse or suspected child abuse in primary care.

INTRODUCTION: Identifying and alerting suspected child abuse enables its investigation and management. In France, anyone can report the situation to child services when child abuse is suspected. However, the number of reports of concern received from physicians is low, and lack of knowledge is a frequent obstacle. This study aimed to explore the practices of trained general practitioners (GPs) regarding the identification and management of suspected child abuse. METHOD: We led a qualitative study from February to November 2021 based on a grounded theory approach. We conducted semi-structured interviews with GPs working in the south of France who had received training in identifying child abuse. We performed an inductive analysis using NVivo software. RESULTS: We interviewed 10 GPs (data saturation with seventh GP). Despite the training, obstacles seemed to persist, such as apprehension of the parents' reaction, the technical difficulties of the process, and the lack of feedback after making a report. Being accompanied by a professional who can be directly contacted would facilitate the communication of worrying information. Without direct links to a single referent, doctors would prefer alternative ways of referring their patients to organizations they were familiar with. DISCUSSION AND CONCLUSION: GPs expressed a need for easy access to childcare professionals to support them in the decision to file a report of suspected child abuse. A multidisciplinary approach and a dedicated point of contact seemed to help the process. Nominating a child protection referent doctor per department and creating specific units in hospitals for children at risk would help GPs get effectual contacts for reporting worrying information and better care for children at risk of abuse.

The Experiences and Perceptions of First Contact Practitioners in Primary Care-A Qualitative Systematic Review.

BACKGROUND: First Contact Practitioners (FCP) have developed as a more advanced physiotherapy clinical role delivering specialist MSK services in GP practice settings. They aim to support GPs in effectively managing increasing patient workloads. As FCPs are now a more established NHS role, it is important to understand how these clinicians perceive their roles to guide and support future service development. AIMS: To review the current evidence regarding the experience of FCPs in the UK. To understand how FCPs perceive their role. To gain an insight into FCP practice which can inform future primary research studies. METHOD: A systematic review of FCP primary qualitative research studies. Multiple database and grey literature search with screening following PRISMA guidelines. Qualitative critical appraisal and analysis used tools and frameworks from the Joanna Briggs Institute. RESULTS: The review reports on 11 included studies which informed the creation of six key concepts impacting upon FCP role experience and perceptions. These were complexity, competency and role development, role understanding, job satisfaction, wellbeing and burnout and service delivery. CONCLUSION: FCP clinicians feel broadly positive about their roles, although they report a clear risk of burnout and associated negative impact on their wellbeing. Job satisfaction is linked to adequate training and developing the competencies required to manage patients in an environment of clinical uncertainty. Having access to regular clinical mentorship is a key requirement and FCPs must adapt to the specific demands of work in a GP practice environment.

Diagnosis and management of suspected Lyme neuroborreliosis-related facial nerve palsy in children by paediatricians and general practitioners: a French survey.

The diagnosis and management of facial nerve palsy in children in Lyme borreliosis endemic area can be complex. The objective of this study was to evaluate the diagnosis and management of children with suspected Lyme neuroborreliosis (LNB)-related facial nerve palsy by general practitioners (GP) and paediatricians. We conducted a prospective national survey of clinical practice between September 2018 and January 2020. The questionnaire was intended for GPs and paediatricians. It is based on two distinct clinical situations (a 10-year-old child and a 5-year-old child) and contains questions about the diagnosis and management of facial nerve palsy in children with a recent tick bite. We obtained 598 responses (350/4125 paediatricians and 245/577 GPs). For a 10-year-old child with a facial nerve palsy in the context of a tick bite, more than half of GPs (52%) required a paediatric infectious consultation and 18% an admission to the hospital for lumbar puncture before the result of Lyme serology. The most prescribed antimicrobial therapies were amoxicillin (32%) and ceftriaxone (29%). For a 5-year-old child, there is no difference in the diagnosis of LNB and treatment except for doxycycline which was less prescribed. Concerning treatment, 18% of practitioners prescribed antibiotic therapy only (14% of GPs vs 21% of paediatricians, p = 0.09), and 17% prescribed antibiotic therapy combined with corticosteroids (14% of GPs vs 19% of paediatricians, p = 0.15). Finally, 93% of GPs and 75% of paediatricians reported to be uncomfortable with the diagnosis of LNB in children. CONCLUSION: Most participants were uncomfortable with the diagnosis of LNB. There was a limited difference in the management of LNB in children between GPs and paediatricians. WHAT IS KNOWN: • Lyme neuroborreliosis (LNB) is the second cause of facial nerve palsy in Europe, and its diagnosis is based on neurological symptoms and a lumbar puncture. However, no clinical criteria could be used to differentiate Bell's palsy and LNB. Moreover, data on the adjunctive corticosteroid treatment and outcome in patients with LNB-related facial nerve palsy are controversial. WHAT IS NEW: • Most participants were uncomfortable with the diagnosis of LNB. Its management was heterogeneous and most often not consistent with guidelines. Only 28% of participants requested a lumbar puncture in cases of suspected LNB, and 17% prescribed antibiotics with corticosteroids. • This study highlights the need for new specific guidelines in management (need for lumbar puncture and/or LB serology) and treatment (time to antibiotic initiation, probabilistic therapy, role of corticosteroids, doxycycline in children younger than 8 years) of LNB in children.

Sources and content of advice sought by parents/guardians prior to emergency department attendance.

AIM: To describe sources of advice and the recommendations given to parents/guardians prior to attending ED with their child. METHODS: This was a prospective observational study of patients presenting to two EDs of a multi-centre Victorian Health service in June 2016. Data collection involved surveying all parents/guardians attending paediatric ED during a 1-week period by trained research assistants. We determined the proportion of eligible respondents who sought advice before attending ED, the source of advice, and the type of advice provided. RESULTS: One thousand sixty-nine patients presented to ED over the 1-week period. There were 730 responses to the survey, of which 65% (477/730) had received a total of 620 recommendations prior to ED attendance. Seventy-six per cent (362/477) had received advice from a single source, 19% (90/477) had received advice from 2 sources, and 5% (25/477) from 3 or more sources. The most common sources of advice were general practice consultations (49%), friends/family (13.5%), and NURSE-ON-CALL (11%). Fifty-four per cent (335/620) of the recommendations were to attend ED immediately and 12% (77/620) were to attend if their child was getting worse. CONCLUSIONS: Most parents and guardians sought advice from a single source prior to attending an ED. The most common source of advice was consultation with a general practitioner and the most common recommendation was to attend ED immediately, or if their child's condition worsened.

Knowledge, attitude, and practice of chronic insomnia management among general practitioners in China: a cross-sectional survey.

BACKGROUND: Chronic insomnia is a common yet often overlooked issue in primary health care. This study investigated the knowledge, attitude, and practices of chronic insomnia management among general practitioners (GPs). METHODS: A cross-sectional online survey was conducted among GPs providing routine care to adults with insomnia in health facilities at all levels in Sichuan Province, China. Additionally, we designed an online questionnaire that included basic information and knowledge, attitudes, and practices regarding chronic insomnia management. RESULTS: We included 420 GPs, 66.2% of whom were female and 58.1% were from community health service centers. Total 198 (47.1%) GPs had received specific training and only 2 GPs (0.5%) correctly answered the knowledge-related questions. Furthermore, only 44 GPs (10.5%) demonstrated excellent practice behaviors, while most GPs (70.2%) expressed high demand for training in insomnia management. Insomnia training experience was associated with higher practice scores (ß = 3.318, p < 0.001). CONCLUSION: This study established an association and correlation between knowledge, attitude, and practice scores in treating insomnia and the sociodemographic characteristics of GPs in China. Although knowledge and practice performance in this field need to be improved, they mostly displayed a positive attitude towards insomnia management. Thus, offering continuing education opportunities to GPs would be highly beneficial.