Assessment of the knowledge, attitudes, and behaviors of individuals presenting to family medicine polyclinics for COVID-19 and influenza vaccines: a study in a Turkish population

BACKGROUND: Vaccines are one of the most important weapons in protection against diseases, especially pandemics lacking available treatment. The objective of this study was to investigate the knowledge, attitudes, and behaviors of individuals presenting to family medicine polyclinics for COVID-19 and influenza vaccines. METHOD(S): The cross-sectional descriptive study comprised healthy individuals who presented to family medicine polyclinics in Ankara Training and Research Hospital, Ankara, Turkiye between 10 December 2020 and 31 January 2021. Data on participants' knowledge and attitudes for COVID-19 and influenza vaccines were collected through questionnaire surveys. In total, 521 individuals aged older than 18 years were included in the study. RESULT(S): If a COVID-19 vaccine were available, 34.4% (N.=179) of respondents would be vaccinated, and 35.3% (N.=184) of respondents would not consider vaccination. Of those considering COVID-19 vaccination, 55.3% (N.=99) of respondents deemed the vaccine an effective way of providing protection against the virus. Increased willingness to have the COVID-19 vaccine was associated with the following factors: considering the influenza vaccine an effective protection method (P<0.001), a history of influenza vaccination (P=0.003), and concern about COVID-19 related death rates (P=0.008). CONCLUSION(S): The most common reasons for COVID-19 vaccine hesitancy and refusal were fear of vaccine-related side effects and a lack of perceived research evidence on the vaccine. Having a positive view of the influenza vaccine had a positive impact on attitudes toward the COVID-19 vaccine.Copyright © 2022 EDIZIONI MINERVA MEDICA.

A Qualitative Study Exploring the Impact of Covid-19 Pandemic on Teaching and Learning of Family Medicine Course among Undergraduates in a Local University in Malaysia

Introduction: The COVID-19 pandemic significantly impacted the global teaching and learning process (TnL). Unfortunately, to date, not many qualitative studies have been published specifically on the impact of COVID-19 on the Family Medicine course, particularly in Malaysia. Hence, this study aimed to explore the impact of COVID-19 pandemic on the teaching and learning experience of undergraduate students undergoing their Family Medicine course at a local university. Methods: A qualitative study using focused group discussion (FGD), was conducted among undergraduate students during the lockdown period. A semi-structured interview guide was used to interview 20 students, in their fifth undergraduate year, undertaking their fourth to fifth week of a total six-week course. They were selected using purposive snowball sampling method. There were four focus group discussions (FGD) with five students in a group. All interviews were audio-taped, transcribed verbatim, and the contents were analysed using the standard content analysis framework. Subsequently, thematic content analysis was conducted, and three major themes were produced. Results: The three major themes were (1) facilitators to learning, (2) barriers to learning, and (3) rooms for improvement. Conclusion: Although COVID-19 pandemic had significant impact on TnL of Family Medicine course among undergraduates, the students remained optimistic and proposed some improvement from their point of view. However, a creative, realistic, effective, and impactful way of TnL, particularly in clinical aspects should be developed and experimented. Technological progress and advancement should permit this idea to be achievable and implemented in near future. [ FROM AUTHOR] Copyright of Malaysian Journal of Medicine & Health Sciences is the property of Universiti Putra Malaysia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

[Clinical quality governance-a practical approach in general practice with the example of influenza vaccination]. / Klinische Qualitätssteuerung ­ ein praktischer Versuch in der Hausarztpraxis am Beispiel der Influenzaimpfung.

We understand clinical quality governance (CQG) as quality management in the clinical domain. In 2020, presumably due to the coronavirus pandemic, more patients requested to be vaccinated against influenza as compared to previous years so that it became apparent that there would be a shortage for high-risk patients. To meet the problem, we started a CQG process. This article is explicitly not a research article but an exemplary description of a CQG process intended as a stimulus and for discussion. We initiated the following process: (1) evaluation of the present state, (2) patients who already had requested a vaccination were prioritized and vaccinated first, and (3) contacting via telephone and vaccination of high-risk patients not on the list. We chose patients with chronic obstructive pulmonary disease (COPD) older than 60 years as an indicator for the group of highest priority. In the beginning only 3 (8%) of our 38 patients with COPD were vaccinated against influenza. After prioritization and vaccination of the high-risk collective in the list of those who had requested to be vaccinated, 25 (66%) of our 38 patients with COPD were vaccinated. After a phone call of high-risk patients not on the list, 28 (74%) patients were vaccinated. This represents an increase of vaccination coverage from 8% to 74% which is close to the rate recommended by the World Health Organization (WHO). In times of a pandemic, family physicians occasionally have to deal with a scarcity of resources and have to develop strategies for fair resource allocation. Not only in this context is CQG worth the effort. The generation of list queries could be improved by the providers of electronic patient records.

COVID-19 vaccine short-term adverse events in the real-life family practice in Krakow, Poland.

BACKGROUND: In manufacturers' trials, vaccination against COVID-19 proved to be safe and effective. The officially reported frequency of vaccine adverse events (VAEs) in Poland is lower than that declared by the manufacturers. The anti-vaccination activists questioned the trustworthiness of official data. OBJECTIVES: The aim was to explore the real-life prevalence of VAEs in general practice settings and the factors that may influence it. METHODS: In this pragmatic, mixed prospective and retrospective study, patients vaccinated against COVID-19 between May and October 2021 in three GP practices in Krakow, Poland, were enrolled. Their demographic (age, sex, level of education) and clinical data (weight and height, smoking status, history of allergies, COVID-19 and chronic diseases) were collected. Then, they were interviewed about VAEs they experienced. RESULTS: Out of 1530 patients invited to participate, 1051 (69%) agreed and were eligible for analyses. Only 8.8% did not report any VAE. Pain at the injection site was the most frequently reported reaction (800, 76.2%). The most prevalent systemic ones were excessive fatigue/lethargy (527, 50.6%), sleep/circadian rhythm disturbances (433, 41.6%) and headache (399, 38.3%). Fifty required medical assistance - 39 experienced presyncope (3.7%) and 11 loss of consciousness (1.1%). Only two others were hospitalised. Females, younger adults, those with higher education and with a history of COVID-19 reported systemic VAEs more frequently, while those who were older and obese were less likely to report local reactions. CONCLUSION: Although more than 90% of patients vaccinated against COVID-19 in general practice settings may experience VAEs, in short-term observation, the vast majority are localised and mild.

COVID-19's impact on family medicine resident training and wellness.

Background: The COVID-19 global pandemic has raised many challenges in training family medicine residents. Family medicine is at the frontline for treating and managing patients with COVID-19. Attention is needed on the critical issue of the effect of the pandemic on resident training, the safety of those performing needed medical services, and the psychological well-being of trainees. Methods: We performed a cross-sectional, 25-question survey-based study to evaluate the perceived effect of the COVID-19 pandemic on family medicine residents' training and residents' well-being in the state of Texas. Results: A total of 250 Texas-based family medicine residents were surveyed with a response rate of 12.8% (n = 32). After the pandemic began, all residents worried about exposing their loved ones to COVID-19, and 65% felt like the COVID-19 pandemic negatively impacted their training overall. Respondents indicated that changes occurred in their respective residency curricula that altered training such as canceling of scheduled lectures (84.3%) and more telemedicine visits (56.25%). There was a significant difference for postgraduate year level and the effect on rotation assignments, with more disruption to the first- and third-year residents (P = 0.03). Conclusions: The COVID-19 pandemic has had a notable impact on the perception of quality of training and mental health within family medicine. Our findings may guide programs in how to proactively target pandemic-related training challenges.

Expanding Access to Opioid Use Disorder Treatment Via Telehealth in Lewis County, Washington

Purpose of Study Lewis County is in southwest Washington state. With a population per square mile of 31.4, Lewis County is more rural than the rest of the state (101.2 per square mile). Citizens of the county, as well as health care workers at Chehalis Family Medicine (located in Lewis County), report concerns over rates of opioid use disorder. While Lewis County's age adjusted rate per 100,000 of deaths due to opioid overdose from 2014-2017 was lower than that of Washington state (7.6 vs 9.3), its rate of opioid related hospitalizations was significantly higher (110.7 vs 81.5). Methods Used An asset-based approach was used to learn how Lewis County has been addressing opioid use disorder amongst its citizens. Interviews with health care providers, patients at Chehalis Family Medicine, and the pastor of a local church were performed. These conversations revealed a lack of access to public transportation creates a major barrier to receiving opioid use disorder treatment. A literature review of interventions implemented in rural areas to deliver medically assisted opioid use disorder treatment was performed. Summary of Results The recent use of telemedicine to deliver suboxone treatment at Chehalis Family Medicine has increased access to medically assisted treatment of opioid use disorder. Telemedicine has become more prevalent with some loosening of governmental regulations due to the COVID-19 pandemic. Based upon articles by Guille et al and Weintraub et al, administration of medically assisted opioid use disorder treatment via telehealth offers a means to expand access to care in rural communities. They demonstrated no significant differences in patient outcomes. Implementation of telemedicine at other suboxone clinics in Lewis County would improve access to suboxone treatment. Conclusions A strength-based framework allows the existing assets in Lewis County to be appraised so future work can build upon what has already proved effective for the community. Regarding opioid use disorder treatment, Lewis county has several low barrier suboxone clinics which could increase access for rural patients through implementation of telemedicine. Chehalis Family Medicine's recent success with telemedicine in suboxone treatment could serve as a template for how to do so effectively.

Containing an Island: Coronavirus (Covid-19) Outbreak in Perhentian Islands, Terengganu State of Malaysia, in 2021

Background: The spread of COVID-19 was inevitable and has not spared small and isolated communities, including the community on Perhentian Island in Besut District, Terengganu. Managing clusters in small islands can be difficult, given the limited resources. This study explores the characteristics of COVID-19 cases and the experience of outbreak containment at Perhentian Island. Methodology: A retrospective study involving record review of COVID-19 cases and at-risk individuals registered under the Perhentian Cluster were retrieved from the Besut District Health Office COVID-19 online registry from the 16th August 2021 until 6th October 2021. All notified cases and close contacts who fulfilled the inclusion criteria were extracted and analysed using descriptive statistics. Result(s): A total of 1,093 out of 2,500 community members of Perhentian Island were screened of which 170 (15.5%) tested positive for COVID-19, while 923 (84.5%) tested negative. Among individuals who tested positive, the majority were adults (52.4%), males (51.8%), Malays (98.8%), and villagers (96.5%). Clinical characteristics were categorized into: asymptomatic (55.9%), had no known medical comorbidities (90.6%), low-risk groups (87.1%), vaccinated (57.6%), and admitted to PKRC (97.1%) for treatment. Multiple agencies were involved in the outbreak containment of the Perhentian Cluster, working collectively and in good coordination. Conclusion(s): The outbreak was attributed to community gatherings and close interactions among villagers. Prompt actions, targeted planning, and inter-agency collaboration were the key factors in successful containment of further spread of COVID-19 in Perhentian Island.Copyright © 2023, Faculty of Medicine, University of Malaya. All rights reserved.

Parameters Affecting the Clinical Course in COVID-19.

Introduction: The entire population is susceptible to COVID-19, and the course of the disease is in a wide spectrum between asymptomatic clinical and critical illness. In this study, it was aimed to see whether the laboratory level CRP, ferritin, D-dimer, lymphocyte and vitamin D values and sociodemographic characteristics are related to the clinical course of the disease in COVID-19 disease, which emerged at the end of 2019 and caused a pandemic all over the world. Material(s) and Method(s): The study was carried out with a total of 100 participants, 50 patients who applied to Kahramanmaras Sutcu Imam University Health Practice and Research Hospital, adult COVID-19 outpatient clinic and 50 patients who applied to the family medicine outpatient clinic between 25.01.2021 and 28.02.2021. The first part of the questionnaire was applied by face-to-face interview method during the application to the hospital and the second part was applied one month later to the participants who applied to the adult COVID-19 outpatient clinic with a positive RT-PCR test. In addition to the CRP, lymphocyte, ferritin and D-dimer values measured in the blood taken at the first visit, the serum vitamin D level was studied. Statistical evaluation of the obtained data was made using SPSS 22 program. For statistical significance, p value below 0.05 was considered significant. Result(s): A total of 100 people were included in this study. Fifty people with COVID-19 infection constitute the case group, and 50 people who have not had COVID-19 infection before constitute the control group. While the mean age was 51.14 +/- 19.36 years in the case group, it was 37.12 +/- 12.64 in the control group. The mean age of the patients in the case group was higher than the mean age of the patients in the control group (p< 0.05). Serum vitamin D result was 14.19 +/- 10.63 ng/mL in the case group and 17.48 +/- 12.69 ng/mL in the control group. Although the vitamin D results of the case group were lower, no statistically significant difference was found between the patient groups (p= 0.179). It was determined that there was a statistically significant relationship between the status of having chronic diseases and the case-control group. Persons with chronic diseases constitute 70.7% of the case group and 29.3% of the control group, while persons without chronic diseases constitute 35.6% of the case group and 64.4% of the control group (p= 0.001). While 14.6% of those with chronic disease had mild 34.1% and 22.0% had a critical illness;23.7% of those without chronic disease had mild 6.8%, severe 5.1% had critical illness. In the study, the rate of severe or critical illness was found to be higher in those with chronic diseases than those without. The severe and critical patient group had higher CRP, Ferritin and D-dimer levels compared to the mildly severe patient group;It was observed that the lymphocyte level was lower (p< 0.05). The rate of severe and critical illness was found to be higher in those who partially pay attention to hand hygiene and mask rules (p< 0.05). Conclusion(s): Laboratory parameters such as CRP, ferritin, D-dimer and lymphocyte values were found to be significant predictors that could help in estimating the severity of the disease. Although it was lower in the case group, it was observed that there was a deficiency in vitamin D levels in both groups and insufficient doses of supplements were taken. In the study, it was observed that transmission was more common in social environments such as family and friends.Copyright © 2023 Bilimsel Tip Yayinevi. All rights reserved.

Risk of Depression in a Suburban Primary Care Setting Before and During the COVID-19 Pandemic.

INTRODUCTION: Major depression is a common disorder affecting millions of adults each year. Many population-based surveys showed an increase in the number people with symptoms of depression at the onset of the COVID-19 pandemic. Our aim was to determine and compare the prevalence of depression risk in a primary care setting before and during the COVID-19 pandemic. METHODS: We conducted a cross-sectional study based on retrospective review of medical records from a large suburban primary care clinic. Records of adults 18 years and older, seen between January 1, 2019 and December 31, 2020 and who had also been screened for depression using the 9-item Patient Health Questionnaire (PHQ-9) were analyzed. RESULTS: Adults 18 years and older who completed the PHQ-9 assessment in 2019 and 2020 were 5078 and 4338, respectively. Risk of depression was 18.2% in 2019 and 14.8% in 2020 (P < .001). In adults under 50 years and those 50 years and older, depression risk was 20.7% versus 15.3% in 2019 (P < .001) and 17.3% versus 12.6% in 2020 (P < .001), respectively. In females, depression risk was 20.0% in 2019 and 16.8% in 2020 (P < .01), and in males, 14.1% in 2019 and 10.6% in 2020 (P < .01). CONCLUSION: Although our results did not reflect the published literature reporting a higher prevalence of depression during the COVID-19 pandemic, they were consistent with reports of increased risk in females and younger adults.

In search of a fix to the primary health care chasm in India: can institutionalizing a public health cadre and inducting family physicians be the answer?

India's woes with an underprioritized and hence underfunded and understaffed public health system continue to plague public healthcare delivery. Though the need for appropriately qualified public health cadre to lead public health programmes is well established, a well-meaning conducive approach to implementing this is lacking. As the COVID-19 pandemic brought back the focus on India's fragmented health system and primary healthcare deficiencies, we discuss the primary healthcare conundrum in India in search of a quintessential fix. We argue for instituting a well-thought and inclusive public health cadre to lead preventive and promotive public health programmes and manage public health delivery. With the aim being to increase community confidence in primary health care, along with the need to augment primary healthcare infrastructure, we argue for a need to augment primary healthcare with physicians trained in family medicine. Provisioning medical officers and general practitioners trained in family medicine can salvage community's confidence in primary care, increase primary healthcare utilization, stymie over-specialization of care, channelize and prioritize referrals, and guarantee competence in healthcare quality for rural communities.

Predictive factors for hospitalization in a cohort of primary healthcare patients with suspected COVID-19

Background: The objective of the study was to identify clinical and demographic factors predictive of hospitalization in primary healthcare patients diagnosed with suspected COVID-19 at the beginning of the pandemic. Method(s): A retrospective cohort study design was used. Patients attended in Casanova primary healthcare centre (CAP) (Barcelona, Spain) for symptoms compatible with possible or confirmed SARS-CoV-2 infection between February 24 and May 30, 2020, were included. Data was collected through the electronic medical record and by telephone interview. Result(s): 518 patients were included, of whom 283 (54.6%) were female. The median age was 50.2 years and 19.3% were aged >= 65 years: 79% were followed on an outpatient basis while the rest were hospitalized. Predictive factors for hospital admission were male sex, older age, a history of ischemic heart disease and the presence of dyspnoea, haemoptysis, nausea and vomiting, with a sensitivity of 48% and a specificity of 95.4%. Odynophagia and nasal congestion were predictors of a good prognosis. Mortality was 2.3% and 25% of deaths did not occur in hospital. Conclusion(s): Nearly 80% of primary healthcare patients received only outpatient care. Male sex, older age, a history of ischemic heart disease and symptoms like dyspnoea, haemoptysis, nausea and vomiting could lead to a greater risk of an unfavorable evolution during COVID-19. Patients with at least one of the above factors, which correlate with a higher hospital admission rate, should receive a closer follow-up to early detect when they can benefit from a hospital evaluation based on their clinical evolution.Copyright © 2023 The Authors

93rd EGPRN Conference

The proceedings contain 20 papers. The topics discussed include: experiences and expectations of medical students and GP teachers regarding long-term mentoring relationships in longitudinal general practice tracks: preliminary results of an ongoing qualitative study;the COVID-19 pandemic: reorganization of health services and coping of health care workers in primary healthcare;benefits and challenges of using virtual primary care during the COVID-19 pandemic: from key lessons to a framework for implementation;the long-term effect of COVID-19 - primary care survey;a study of burnout and associated factors in Irish GPs and GP trainees during the COVID-19 pandemic;challenges of research on person-centered care in general practice: a scoping review;the patient-centered care and its relation to the outcomes of care in family medicine;and shared decision-making enhances vaccination rates in adult patients in outpatient care - a systematic review and meta-analysis.

Assessing Changes in Blood Pressure Capture in Primary Care Emr Systems during the Covid-19 Pandemic

Background Primary care electronic medical records (EMRs) data can be used to inform health services, disease surveillance, and interventions. However, its utility is reliant on how well variables are captured. The COVID-19 pandemic shifted primary care delivery to virtual care resulting in fewer patients having their blood pressure (BP) checked in office. As such, BP may not be well documented in the structured fields of the EMR. In the EMR, BP's are used to identify patients who have hypertension, assess rates of hypertension screening, and evaluate hypertension management. The purpose of this study was to determine the change in BP documentation during the COVID-19 pandemic. Methods Data for this study were from the University of Toronto Practice-Based Research Network (UTOPIAN) Data Safe Haven, a EMR database which contains clinical records from family medicine clinics in Ontario, Canada. Hypertension visits (ICD-9 billing code 401) were assessed pre-pandemic (Jan 2017-Dec 2019) and during the pandemic (Jan 2020-Dec 2021) for structured BP. A sample of 12% of hypertension visits during the pandemic without structured BP measures were reviewed to determine if BP was recorded in an unstructured format. Two abstractors reviewed progress notes of patient charts to identify if BP was recorded. Results were analyzed using descriptive statistics. Results Pre-pandemic, 67% of hypertension visits had a BP recorded in structured fields (OR=4.14, 95% CI: 4.04-4.23), however this significantly decreased during the pandemic with only 33% of cases having a recorded BP (OR=0.24, 95% CI: 0.23-0.24). In the pandemic, 55% of hypertension visits were virtual. In the pandemic, 10% of virtual visits (OR=0.01, 95% CI: 0.01-0.01), versus 59% of in-person visits did have a structured BP (OR=2.48, CI: 2.37-2.60). Abstractors reviewed 3200 hypertension visits without structured BP. 55% of hypertension visits had a BP recorded in the unstructured progress notes. Conclusion There are clear gaps in pandemic BP recordings most likely due to high rates of virtual visits. Given that virtual visits will continue, future research should develop strategies for capturing BP from progress notes in EMR databases.Copyright © 2023 American College of Cardiology Foundation

The Impact of COVID-19 on Same-Day LARC Initiation Among Adolescents

Background: Same-day long-acting reversible contraception (LARC) is cost-effective and convenient. There have been no studies on how the COVID-19 pandemic impacted same-day LARC for adolescents. We aimed to determine the patient- and provider-level factors associated with same-day LARC placement for adolescents 12 months before and after COVID-19 protocols started on 3/15/2020. Method(s): This retrospective cohort study analyzed existing electronic health records from a large healthcare system in the Southeastern U.S. Adolescents included (N=954) were 10-19 years old and received outpatient LARC from 3/15/2019 to 3/14/2021. A logistic regression model determined the relationship of multiple variables on receipt of same day LARC before and during COVID-19. An interrupted time series examined changes in same-day LARC initiation during the 12 months before and after 3/15/2020. Our institutional IRB approved the study. Result(s): While more adolescents initiated same-day LARC (61%) compared to those who did not (39%), fewer adolescents received same-day LARC during the pandemic (58%) compared to before (64%). Only county concordance was associated with same-day LARC both before and during the pandemic (aOR=2.31 and 1.83 respectively, both p< 0.05) (Table 1). During the pandemic, a few factors reduced the odds of same-day LARC:1) public insurance (aOR=0.52, p< 0.01, vs. private insurance), 2) non-OBGYN providers (pediatrics [aOR=0.34, p< 0.01], family medicine [aOR=0.53, p< 0.01] or internal medicine [aOR=0.13, p< 0.05], vs. OBGYN), and 3) advanced practice practitioners (aOR=0.46, p< 0.001, vs. physicians). There was no significant change in average monthly same-day LARC insertions before and after 3/15/2020 (p>0.05) (Figure 1). Conclusion(s): We identified differences in adolescent same-day LARC initiation during the pandemic by county concordance, insurance status, provider specialty, and provider type. Some potential explanations include barriers to accessing clinical care, such as fewer in-person appointments, reduced public transportation, or limited parental ability to transport their adolescent due to difficulties in childcare for other children. Additionally, fewer same-day LARC by providers in general pediatrics and medicine during the pandemic may suggest that non-LARC concerns took priority during in-person visits. Findings from this study may guide policy and programmatic interventions to improve access to same-day LARC for all adolescent populations. Supporting Figures or Tables: https://www.scorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1373188-1-ANY(1).docx https://www.scorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1373188-2-ANY(2).docxCopyright © 2023

Heyde Syndrome Complicated by Essential Thrombocythemia: A Case Report.

Heyde syndrome is a multisystem disorder characterized by the triad of aortic stenosis (AS), gastrointestinal bleeding, and acquired von Willebrand syndrome. Age-related degeneration is the most common cause of aortic stenosis and is frequently encountered in today's aging society. Approximately 20% of patients with severe aortic stenosis have Heyde syndrome. We encountered an older patient with primary thrombocytosis who was brought to a rural community hospital with bloody stools and was diagnosed with bleeding from an intestinal arteriovenous malformation. A final diagnosis of Heyde syndrome was made based on the presence of severe aortic stenosis and the presence of schistocytes in peripheral blood smears. Valvular diseases can complicate chronic hematological diseases. When the rapid progression of anemia and segmented red blood cells in the peripheral blood are observed in patients with severe aortic stenosis, Heyde syndrome should be considered based on peripheral blood smears and clinical course.

Specialty-Specific Entrustable Professional Activities: A Bridge to Internship.

Background Undergraduate medical education aims to prepare learners to become capable residents. New interns are expected to perform clinical tasks with distant supervision reliant on having acquired a medical degree. However, there is limited data to discuss what entrustment residency programs grant versus what the medical schools believe they have trained their graduates to perform. At our institution, we sought to foster an alliance between undergraduate medical education (UME) and graduate medical education (GME) toward specialty-specific entrustable professional activities (SSEPAs). These SSEPAs create a bridge to residency and help students structure the final year of medical school while striving for entrustability for day one of residency. This paper describes the SSEPA curriculum development process and student self-assessment of competence. Methodology We piloted an SSEPA program with the departments of Family Medicine, Internal Medicine, Neurology, and Obstetrics & Gynecology. Utilizing Kern's curriculum development framework, each specialty designed a longitudinal curriculum with a post-match capstone course. Students participated in pre-course and post-course self-assessments utilizing the Chen scale for each entrustable professional activity (EPA). Results A total of 42 students successfully completed the SSEPA curriculum in these four specialties. Students' self-assessed competence levels rose from 2.61 to 3.65 in Internal Medicine; 3.23 to 4.12 in Obstetrics and Gynecology; 3.62 to 4.13 in Neurology; and 3.65 to 3.79 in Family Medicine. Students across all specialties noted an increase in confidence from 3.45 to 4.38 in Internal Medicine; 3.3 to 4.6 in Obstetrics and Gynecology; 3.25 to 4.25 in Neurology; and 4.33 to 4.67 in Family Medicine. Conclusions A specialty-specific curriculum utilizing a competency-based framework for learners traversing the UME to GME journey in the final year of medical school improves learner confidence in their clinical abilities and may lead to an improved educational handoff between UME and GME.

Cancer detection during the COVID-19 pandemic-Experiences in primary care and recommendations for the future.

Background: To describe general practitioners (GPs) experiences with the impact COVID-19 on the duration of cancer detection. Methods: Cross-sectional survey study among Dutch GPs. Results: Fifty-eight GPs participated. During the first wave, COVID-19-related delays were experienced by 88%, 52%, and 67% of GPs in the contact-seeking, primary care, and referral phases, respectively. GPs reported delays due to telehealth consultations, longer waiting times and patient's concerns of COVID infections and overburdening GPs. Conclusions: The majority of GPs experienced delays in cancer diagnostic processes during the beginning of the COVID pandemic, which was most prominent in the timeliness in which patients sought GP care.

Health Service Management and Patient Safety in Primary Care during the COVID-19 Pandemic in Kosovo.

BACKGROUND: Several changes must be made to the services to ensure patient safety and enable delivering services in environments where the danger of infection of healthcare personnel and patients in primary care (PC) institutions is elevated, i.e., during the COVID-19 pandemic. OBJECTIVE: This study aimed to examine patient safety and healthcare service management in PHC practices in Kosovo during the COVID-19 pandemic. METHODS: In this cross-sectional study, data were collected using a self-reported questionnaire among 77 PHC practices. RESULTS: Our main finding reveals a safer organization of PC practices and services since the COVID-19 pandemic compared to the previous period before the pandemic. The study also shows a collaboration between PC practices in the close neighborhood and more proper human resource management due to COVID-19 suspicion or infection. Over 80% of the participating PC practices felt the need to introduce changes to the structure of their practice. Regarding infection protection measures (IPC), our study found that health professionals' practices of wearing a ring or bracelet and wearing nail polish improved during the COVID-19 pandemic compared to the pre-pandemic period. During the COVID-19 pandemic, PC practice health professionals had less time to routinely review guidelines or medical literature. Despite this, implementing triage protocols over the phone has yet to be applied at the intended level by PC practices in Kosovo. CONCLUSIONS: Primary care practices in Kosovo responded to the COVID-19 pandemic crisis by modifying how they organize their work, implementing procedures for infection control, and enhancing patient safety.

Improving outcomes in co-morbid diabetes and COVID-19: A quasi-experimental study.

BACKGROUND: High-risk people living with diabetes (PLWD) have increased risk for morbidity and mortality. During the first coronavirus disease 2019 (COVID-19) wave in 2020 in Cape Town, South Africa, high-risk PLWD with COVID-19 were fast-tracked into a field hospital and managed aggressively. This study evaluated the effects of this intervention by assessing the impact of this intervention on clinical outcomes in this cohort. METHODS: A retrospective quasi-experimental study design compared patients admitted pre- and post-intervention. RESULTS: A total of 183 participants were enrolled, with the two groups having similar demographic and clinical pre-Covid-19 baselines. Glucose control on admission was better in the experimental group (8.1% vs 9.3% [p = 0.013]). The experimental group needed less oxygen (p  0.001), fewer antibiotics (p  0.001) and fewer steroids (p = 0.003), while the control group had a higher incidence of acute kidney injury during admission (p = 0.046). The median glucose control was better in the experimental group (8.3 vs 10.0; p = 0.006). The two groups had similar clinical outcomes for discharge home (94% vs 89%), escalation in care (2% vs 3%) and inpatient death (4% vs 8%). CONCLUSION: This study demonstrated that a risk-based approach to high-risk PLWD with COVID-19 may yield good clinical outcomes while making financial savings and preventing emotional distress.Contribution: We propose a risk-based approach to guide clinical management of high risk patients, which departs significantly from the current disease-based model. More research using randomised control trial methodology should explore this hypothesis.