Integrative and Collaborative Approach in the Chronic Management of Obesity in Primary and Tertiary Care Setting: Vall Hebron-SAP Muntanya Healthcare Route.

INTRODUCTION: In the context of obesity pandemic, the health care providers involved in the primary care should have a significant role. Several guidelines for the management of obesity in primary care were proposed recently. In general lines, these guidelines include recommendation on the baseline assessment, therapy, and algorithm for referral to specialized obesity clinic and follow-up. Nevertheless, at present, there is no guideline or protocol that continuously and bidirectionally links the two settings: primary care and specialized obesity clinic. METHODS: We present a model of continuous, bilateral, and integrative interaction between primary care units and reference tertiary care setting in the chronic management of obesity that is already implemented in a public health system. RESULTS: The novelty of our algorithm is that incorporates the support and continuous communication with the specialized obesity clinic of the tertiary care setting from the beginning in the management of a patient with obesity, in a bidirectional manner. CONCLUSION: This kind of bidirectional and continuous collaboration will help engage health care providers in the management of obesity, optimize efforts, shorten the time until proper intervention, personalize the approach and, finally, save costs for the health system.

Primary and Community Care Transformation in Post-COVID Era: Nationwide General Practitioner Survey.

Introduction: The health emergency caused by COVID-19 has led to substantial changes in the usual working system of primary healthcare centers and in relations with users. The Catalan Society of Family and Community Medicine designed a survey that aimed to collect the opinions and facilitate the participation of its partners on what the future work model of general practitioners (GPs) should look like post-COVID-19. Methodology: Online survey of Family and Community Medicine members consisting of filiation data, 22 Likert-type multiple-choice questions grouped in five thematic axes, and a free text question. Results: The number of respondents to the questionnaire was 1051 (22.6% of all members): 83.2% said they spent excessive time on bureaucratic tasks; 91.8% were against call center systems; 66% believed that home care is the responsibility of every family doctor; 77.5% supported continuity of care as a fundamental value of patient-centered care; and >90% defended the contracting of complementary tests and first hospital visits from primary healthcare (PHC). Conclusions: The survey responses describe a strong consensus on the identity and competencies of the GP and on the needs of and the threats to the PHC system. The demand for an increase in health resources, greater professional leadership, elimination of bureaucracy, an increase in the number of health professionals, and greater management autonomy, are the axes towards which a new era in PHC should be directed.

Outcome of Root Canal Treatments Provided by Endodontic Postgraduate Students. A Retrospective Study.

The aim of this study was to assess the preoperative, intraoperative, and postoperative factors that influenced complete periapical healing in teeth that underwent primary root canal treatment (RCT), in patients treated by postgraduate students in endodontics. Factors were retrieved and compared with the periapical status during the follow-up visit. Healing was considered as the absence of clinical and radiological symptoms. Variables significantly associated by the chi-squared test were included in a logistic regression model (LRM). Preoperative factors associated with healing were: American Society of Anesthesiology (ASA) status (p = 0.01); the absence of preoperative pain (p = 0.04); positive response to pulp tests; when the RCT cause was caries, pain, abscess, or sinus tract; probing depth <4 mm; the absence of mobility; absence or <4 mm periapical lesion (p < 0.01). In the LRM, the factors included were: absence or <4 mm periapical lesion; probing depths <4 mm; RCT caused by caries, pain, abscess, or sinus tract; the tooth was not a bridge abutment. Postoperative factors were: teeth with direct restoration; teeth that did not act as a support for a fixed prosthetic restoration; the favorable condition of the coronal restoration (p < 0.01). In the LRM, only the status of the coronal restoration was included. Preoperative conditions and the adequate fit of the coronal restoration influenced the outcome of RCT.