Self-reported preferences and barriers to continued professional development in primary care physicians: a cross-sectional web-based survey in Qatar.

INTRODUCTION: High quality and effective primary healthcare is a national priority in Qatar. Continuing professional development (CPD) for physicians is a cornerstone of this objective, yet little is known about physicians' preferences or barriers to CPD participation. METHOD: A needs assessment was conducted using a cross-sectional web-based survey of primary care physicians registered with the Department of Healthcare Practitioners (DHP) between March and June 2017. RESULTS: Two-hundred-and-eighty-one complete surveys were submitted representing physicians in both public (N = 129) and private sectors (N = 152). Physicians completed medical degrees and postgraduate training across multiple countries, and most had been practicing in Qatar for 5 years or less. 'Activities during working hours', 'cost' and 'work commitments' were the most common barriers. There was little consensus regarding the optimal timing of CPD activities, although public sector physicians were more likely to indicate weekend activities as a barrier to participation (30% vs. 9%). Over 90% of participants preferred traditional lectures, workshops, case-based sessions, small group and online self-paced learning as formats for CPD delivery, however alternative modes of delivery were also deemed acceptable (> 80% agreement). CONCLUSION: Understanding primary care physicians' barriers and preferences is an essential component of a larger necessitated needs assessment of CPD in primary care practitioners in Qatar. Further research is warranted to understand the underlying beliefs driving physicians' choices and the apparent variation between those working in the public and private sectors. CPD developers should consider approaches to mitigate perceived barriers and understand preferences to maximize the quality of participation.

Plasma Adiponectin and Its Correlation with Carotid Intima-Media Thickness in Obesity and in Type 2 Diabetes and Nonalcoholic Fatty Liver Disease.

Methods and Results: The study included 200 Egyptian subjects. They were divided into four equal groups: group 1: obese patients with NAFLD and T2DM (O+/NAFLD+/DM+), group 2: nonobese patients with NAFLD and T2DM (O-/NAFLD+/DM+), group 3: obese nondiabetic patients with NAFLD (O+/NAFLD+/DM-), and group 4: nonobese healthy control subjects. Plasma adiponectin was measured using ELISA (enzyme-linked immunosorbent assay) technique. Ultrasonography was used to diagnose NAFLD. CIMT was assessed using Doppler ultrasonography. Plasma adiponectin was significantly lower and CIMT was significantly higher in O+/NAFLD+/DM+, as compared with O-/NAFLD+/DM+, O+/NAFLD+/DM-, and control subjects (p < 0.001 for all). A significant negative correlation was found between adiponectin and CIMT in obese patients with NAFLD (p < 0.05), but not in patients with NAFLD and T2DM. The significant independent predictors of CIMT were diabetes duration, BMI (body mass index), albumin/creatinine ratio, and cholesterol. Conclusion: Plasma adiponectin is inversely correlated with CIMT in obese patients with NAFLD, but not in patients with NAFLD and T2DM. Hypoadiponectinemia could be a good indicator of cardiovascular risk in obese patients with NAFLD, with or without T2DM, but not in nonobese patients with NAFLD.

Assessment of early vascular changes in adult females with polycystic ovary syndrome: correlation with insulin resistance.

Polycystic ovary syndrome (PCOS) is the commonest endocrine disorder in females in the reproductive period with estimated prevalence of 5% to 18% [1]. It contributes to the mortality and morbidity in patients with PCOS due to the increased risk of different metabolic and cardiovascular (CV) complications [2]. Despite the presence of obesity in 40-60% of cases [3], the disease may occur in non-obese women. The occurrence of metabolic disorders in non-obese PCOS patients, suggests that the syndrome itself may play a role in the development of metabolic and CV co-morbidities [4]. The identification of early stages of atherosclerosis in patients with PCOS might be useful in the development of new strategies to control modifiable CV risk factors [5]. Assessment of vascular endothelial function (ED) as an initial reversible step in atherosclerosis development, may serve as an integral index for CV risk factor burden [6]. In addition, carotid intima media thickness (CIMT) is a helpful marker for atherosclerosis and for the identification of increased risk of CV disease [7]. Our study assessed the early vascular changes in Egyptian women with PCOS both physically and functionally by looking at the CIMT using high resolution Doppler ultrasound and by measuring ED using brachial artery flow-mediated vasodilatation (FMD). Our results indicate that patients with PCOS have significant ED and premature atherosclerosis which is, to a great extent, independent of obesity and IR. This suggests that PCOS patients are at increased risk for premature CVD and may benefit from early detection and management.

Aortic valve function post-replacement of severe aortic stenosis by transcatheter procedure versus surgery: a systematic review and metanalysis.

Transcatheter aortic valve replacement (TAVR) has shown to reduce mortality compared to surgical aortic valve replacement (sAVR). However, it is unknown which procedure is associated with better post-procedural valvular function. We conducted a meta-analysis of randomized clinical trials that compared TAVR to sAVR for at least 2 years. The primary outcome was post-procedural patient-prosthesis-mismatch (PPM). Secondary outcomes were post-procedural and 2-year: effective orifice area (EOA), paravalvular gradient (PVG) and moderate/severe paravalvular leak (PVL). We identified 6 trials with a total of 7022 participants with severe aortic stenosis. TAVR was associated with 37% (95% CI [0.51-0.78) mean RR reduction of post-procedural PPM, a decrease that was not affected by the surgical risk at inclusion, neither by the transcatheter heart valve system. Postprocedural changes in gradient and EOA were also in favor of TAVR as there was a pooled mean difference decrease of 0.56 (95% CI [0.73-0.38]) in gradient and an increase of 0.47 (95% CI [0.38-0.56]) in EOA. Additionally, self-expandable valves were associated with a higher decrease in gradient than balloon ones (beta = 0.38; 95% CI [0.12-0.64]). However, TAVR was associated with a higher risk of moderate/severe PVL (pooled RR: 9.54, 95% CI [5.53-16.46]). All results were sustainable at 2 years.

Mortality and socio-economic outcomes among patients hospitalized for stroke and diabetes in the US: a recent analysis from the National Inpatient Sample.

The prevalence and incidence of diabetes mellitus (DM) are increasing worldwide. We aim to assess mortality and socio-economic outcomes among patients hospitalized for stroke and diabetes in the US and evaluate their recent trends. We examined: in-hospital mortality, length of stay (LoS), and overall hospital charges in diabetic patients over 18 years old who were hospitalized with a stroke from 2005 to 2014, included in the National Inpatient Sample. In those patients, the mean (SD) age slightly decreased from 70 (13) years to 69 (13) years (p-trend < 0.001). Interestingly, although incident cases of stroke amongst DM patients increased from 17.4 to 20.0 /100,000 US adults (p-trend < 0.001), age-adjusted mortality for those with hemorrhagic strokes decreased from 24.3% to 19.6%, and also decreased from 3.23% to 2.48% for those with ischemic strokes (p-trend < 0.01 for both), but remained unchanged in TIAs patients. As expected, the average total charges per hospital stay almost doubled over the ten-year period, increasing from 15 970 to 31 018 USD/stay (adjusted for inflation). Nonetheless, median (IQR) LoS slightly decreased from 4 (2-6) to 3 (2-6) days (p-trend < 0.001). In total, our data show that, from 2005 to 2014, the incidence of stroke among the diabetes patient population are gradually increasing, in-hospital mortality is steadily decreasing, along with average LoS. Admission costs were up almost twofold during the same period.

We "R" capable of leading CPD in challenging times: A suggested framework for CPD management during COVID-19 and beyond.

This article was migrated. The article was marked as recommended. The Coronavirus (COVID-19) outbreak is arguably one of the greatest public health challenges of our time. Health care providers (HCP) play a vital role in helping to treat and contain Coronavirus and should the virus spread further, HCP are likely to face an increased burden in helping contain the outbreak and in supporting patients and families. This article presents a management framework for continuing professional development (CPD) in relation to the current situational challenges and needs. It should always be remembered that the ultimate goal of CPD is providing optimum patient care and achieving best healthcare outcomes either in customary practice or in exceptionally challenging environments.

Opening Editorial: CPD and Lifelong Learning: a call for an evidence based discussion.

This article was migrated. The article was marked as recommended. Globalization of Continuing Professional Development (CPD) is driven by shared educational principles and management trends that facilitate international standards in CPD. These are enforced through instructional design, clinical teaching and assessment methods based on education theory, effective communication skills, and CPD systems strengthening medical education global principles. The growing interest in recognizing CPD and in globalizing CPD accreditation standards has prompted several collaborative international initiatives which include the promotion of national CPD accreditation systems, international collaborations and partnerships, publications of research data and the mutual recognition of international CPD systems and programs.

Concluding Commentary: A Call for evidence in CPD and Lifelong Learning.

This article was migrated. The article was marked as recommended. The AMEE CPD Committee was invited to oversee the launch of the first themed edition of MedEdPublish on Continuing Professional Development (CPD) for 2019's first quarter and sent a call for papers on evidence-based discussion on CPD and lifelong learning. The main aim was to highlight research and work supporting healthcare professions continuing education and professional development. A collection of seventeen manuscripts of various types such as "New Education Method and Tools", "Research Article", "Case Study", "Practical Tips or Guidelines", "Report of Meeting or Workshop" and "Commentary" were published. The articles portray fundamental good CPD practices encompassing the array of professional competencies needed to provide high quality healthcare. The manuscripts cover various CPD subthemes among which, mentorship and feedback, interactive learning, learning communities and applied technology, interprofessional education, evaluation and assessment, research in CPD, CPD frameworks, patient safety and quality improvement. They also embrace various perspectives and cultural diversity with the deemed adjustments to the regional healthcare teams' needs. The role and responsibilities of CPD educators are emboldened. This edition was a platform to welcome and discuss CPD under various perspectives among the global CPD community.

Roles and Responsibilities in the Provision of Accredited Continuing Medical Education/Continuing Professional Development.

The Cologne Consensus Conference 2015 has focused on "Providers in accredited CME[continuing medical education]/CPD [continuing professional development]". As an outcome of the CCC 2015, the authors of this paper, who were part of the faculty, propose a contemporary definition of the roles and responsibilities of stakeholders involved in the different stages of planning, delivery and evaluation of CME/CPD.

Evolving Alignment in International Continuing Professional Development Accreditation.

Several of the world's accreditation systems for continuing professional development (CPD) are evolving to encourage continuous improvement in the competence and performance of health care providers and in the organizations in which they provide patient care. Clinicians learn best when they can to choose from a diverse array of activities and formats that are relevant and meet their needs. Since choice and diversity are key to meeting clinicians' needs, several CPD accreditors have been engaging in deliberate, concerted efforts to identify a core set of principles that can serve as the basis for determining substantive equivalency between CPD accreditation systems. Substantive equivalency is intended to support the mobility of learners, allowing them to access accredited learning activities that are recognized by various CPD accreditation systems in a manner that maximizes the value of those accreditation systems, while minimizing the burden of adhering to their requirements. In this article, we propose a set of core principles that all CPD accreditation systems must express as the basis for determining substantive equivalency between CPD accreditation systems. The article will illustrate how five CPD accreditation systems (two in the USA, two in Canada, and one in Qatar), differing in focus (activity-based versus provider-based), context, and culture, express these values and metrics, and concludes by identifying the value of substantive equivalency for learners, medical regulators, and CPD accreditation systems.

Premature ejaculation in type II diabetes mellitus patients: association with glycemic control.

BACKGROUND: Premature ejaculation (PE) is a highly prevalent sexual dysfunction among patients with diabetes mellitus (DM). Despite this, the underlying mechanism of this association is poorly understood. In this study, we aimed to investigate the prevalence of PE in a group of patients with DM and explore possible associations linking both conditions together. METHODS: This was a prospective study of subjects recruited with advertisement pamphlets and whose sexual function was assessed using the international index of erectile function-5 (IIEF-5) and the Arabic index of premature ejaculation (AIPE) questionnaires together with stopwatch measured intravaginal ejaculatory latency time (ELT). Participants were divided into two groups; group A subjects had DM and group B were healthy adult males. RESULTS: A total of 488 subjects were recruited. Group A included 199 (40.8%) subjects, while group B included 289 (59.2%). The prevalence of PE and ED was significantly higher in group A subjects (P<0.001). Mean ELT ± standard deviation (SD) was 3.6±2.7 in group A versus 4.3±2.8 in group B (P<0.014). Diabetic patients with erectile dysfunction (ED) showed a significantly higher incidence of PE with significantly shorter ELT. CONCLUSIONS: PE is more prevalent in diabetic patients. DM is a multi-systemic disorder with complications that could help explain the pathophysiology of PE.

Survey of preferred guideline attributes: what helps to make guidelines more useful for emergency health practitioners?

BACKGROUND: Enhancing CPG acceptance and implementation can play a major role in the development and establishment of emergency medicine as a specialty in many parts of the world. A Guideline International Network special interest group established to support collaboration to improve uptake of clinical practice guidelines (CPGs) across the emergency care sector conducted an international survey to identify attributes of guideline likely to enhance their use. METHODS: A Web-based survey was undertaken to determine how CPGs were accessed, the preferred formats and attributes of guidelines, and familiarity with GRADE. The criteria used to identify preferred attributes of guidelines were adapted from the AGREE II Tool. RESULTS: Two hundred six responses were received from 31 countries, 74/206 (36%) from the US, 28/206 (16%) from Canada, 17/206 (8%) from Australia and 15/206 (7%) from the UK. The majority of responses were from physicians (176/206, 85%) with 15/206 (7%) of responses from nurses and 9/206 (4%) from pre-hospital emergency services personnel. The preferred format for guidelines was clinical protocols that incorporated recommendations into workflow, and the most preferred attribute of guidelines was the clear identification of key recommendations. The results also identified that within the group that responded to the question related to GRADE, 66% were unfamiliar with this system for summarizing evidence in relationship to recommendations. CONCLUSIONS: The findings provide the basis for further research to explore the most appropriate formats for guidelines or guidelines resources tailored to the needs of the emergency care providers.