General Medical Practitioners' Preferences in Referring Patients with Head and Neck Disorders; A Cross-Sectional Evaluative Study in Greece.

Oral and Maxillofacial Surgery (OMFS) is among the newest established medical specialties and its full scope is not fully known by other specialties. The aim of the present study is to record the perception of OMFS scope by general medical practitioners (GMPs) of the National Health Service in Greece. A cross-sectional study was conducted in GMPs via a structured questionnaire. Questions involved various head and neck disorders and possible referring medical specialties. 66 answered questionnaires were included in this study. Participants were established to regional health practices, health centres or hospitals. 77.2% of the participants would refer a facial laceration to a plastic surgeon and only 7.2% to an OMFS. 89.3% would refer a zygoma fracture to an OMFS and 10.6% to an ENT. The vast majority would refer a tongue cancer, a neck mass and a mouth lesion to an ENT (74.8%, 81.8%, and 48% respectively). OMFS scope awareness of GMPs can be considered low. Thus, widening the knowledge of OMFS practice in primary grade medical practitioners is of high importance. Early exposure of medical students to the specialty could be a valid option to achieve this target.

Nine Forward-Backward Translations of the Hopkins Symptom Checklist-25 With Cultural Checks.

Introduction: The Hopkins Symptom Checklist-25 (HSCL-25) is an effective, reliable, and ergonomic tool that can be used for depression diagnosis and monitoring in daily practice. To allow its broad use by family practice physicians (FPs), it was translated from English into nine European languages (Greek, Polish, Bulgarian, Croatian, Catalan, Galician, Spanish, Italian, and French) and the translation homogeneity was confirmed. This study describes this process. Methods: First, two translators (an academic translator and an FP researcher) were recruited for the forward translation (FT). A panel of English-speaking FPs that included at least 15 experts (researchers, teachers, and practitioners) was organized in each country to finalize the FT using a Delphi procedure. Results: One or two Delphi procedure rounds were sufficient for each translation. Then, a different translator, who did not know the original version of the HSCL-25, performed a backward translation in English. An expert panel of linguists compared the two English versions. Differences were listed and a multicultural consensus group determined whether they were due to linguistic problems or to cultural differences. All versions underwent cultural check. Conclusion: All nine translations were finalized without altering the original meaning.

How do general practitioners recognize the definition of multimorbidity? A European qualitative study.

BACKGROUND: Multimorbidity is a challenging concept for general practice. An EGPRN working group has published a comprehensive definition of the concept of multimorbidity. As multimorbidity could be a way to explore complexity in general practice, it was of importance to explore whether European general practitioners (GPs) recognize this concept and whether they would change it. OBJECTIVES: To investigate whether European GPs recognize the EGPRN concept of multimorbidity and whether they would change it. METHODS: Focus group meetings and semi-structured interviews as data collection techniques with a purposive sample of practicing GPs from every country. Data collection continued until saturation was reached in every country. The analysis was undertaken using a grounded theory based method. In each national team, four independent researchers, working blind and pooling data, carried out the analysis. To ensure the internationalization of the data, an international team of 10 researchers pooled the axial and selective coding of all national teams to check the concept and highlight emerging themes. RESULTS: The maximal variation and saturation of the sample were reached in all countries with 211 selected GPs. The EGPRN definition was recognized in all countries. Two additional ideas emerged, the use of Wonca's core competencies of general practice, and the dynamics of the doctor-patient relationship for detecting and managing multimorbidity and patient's complexity. CONCLUSION: European GPs recognized and enhanced the EGPRN concept of multimorbidity. These results open new perspectives regarding the management of complexity using the concept of multimorbidity in general practice. [Box: see text].

The European general practice research network presents the translations of its comprehensive definition of multimorbidity in family medicine in ten European languages.

BACKGROUND: Multimorbidity, according to the World Health Organization, exists when there are two or more chronic conditions in one patient. This definition seems inaccurate for the holistic approach to Family Medicine (FM) and long-term care. To avoid this pitfall the European General Practitioners Research Network (EGPRN) designed a comprehensive definition of multimorbidity using a systematic literature review. OBJECTIVE: To translate that English definition into European languages and to validate the semantic, conceptual and cultural homogeneity of the translations for further research. METHOD: Forward translation of the EGPRN's definition of multimorbidity followed by a Delphi consensus procedure assessment, a backward translation and a cultural check with all teams to ensure the homogeneity of the translations in their national context. Consensus was defined as 70% of the scores being higher than 6. Delphi rounds were repeated in each country until a consensus was reached. RESULTS: 229 European medical expert FPs participated in the study. Ten consensual translations of the EGPRN comprehensive definition of multimorbidity were achieved. CONCLUSION: A comprehensive definition of multimorbidity is now available in English and ten European languages for further collaborative research in FM and long-term care.

Cross-Cultural Validation of the Definition of Multimorbidity in the Bulgarian Language.

INTRODUCTION: Multimorbidity is a health issue with growing importance. During the last few decades the populations of most countries in the world have been ageing rapidly. Bulgaria is affected by the issue because of the high prevalence of ageing population in the country with multiple chronic conditions. The AIM of the present study was to validate the translated definition of multimorbidity from English into the Bulgarian language. MATERIALS AND METHODS: The present study is part of an international project involving 8 national groups. We performed a forward and backward translation of the original English definition of multimorbidity using a Delphi consensus procedure. RESULTS: The physicians involved accepted the definition with a high percentage of agreement in the first round. The backward translation was accepted by the scientific committee using the Nominal group technique. DISCUSSION: Some of the GPs provided comments on the linguistic expressions which arose in order to improve understanding in Bulgarian. The remarks were not relevant to the content. The conclusion of the discussion, using a meta-ethnographic approach, was that the differences were acceptable and no further changes were required. CONCLUSIONS: A native version of the published English multimorbidity definition has been finalized. This definition is a prerequisite for better management of multimorbidity by clinicians, researchers and policy makers.

Say it in Croatian--Croatian translation of the EGPRN definition of multimorbidity using a Delphi consensus technique.

Patients coming to their family physician (FP) usually have more than one condition or problem. Multimorbidity as well as dealing with it, is challenging for FPs even as a mere concept. The World Health Organization (WHO) has simply defined multimorbidity as two or more chronic conditions existing in one patient. However, this definition seems inadequate for a holistic approach to patient care within Family Medicine. Using systematic literature review the European General Practitioners Research Network (EGPRN) developed a comprehensive definition of multimorbidity. For practical and wider use, this definition had to be translated into other languages, including Croatian. Here presented is the Croatian translation of this comprehensive definition using a Delphi consensus procedure for forward/backward translation. 23 expert FPs fluent in English were asked to rank the translation from 1 (absolutely disagreeable) to 9 (fully agreeable) and to explain each score under 7. It was previously defined that consensus would be reached when 70% of the scores are above 6. Finally, a backward translation from Croatian into English was undertaken and approved by the authors of the English definition. Consensus was reached after the first Delphi round with 100% of the scores above 6; therefore the Croatian translation was immediately accepted. The authors of the English definition accepted the backward translation. A comprehensive definition of multimorbidity is now available in English and Croatian, as well as other European languages which will surely make further implications for clinicians, researchers or policy makers.

The European General Practice Research Network presents a comprehensive definition of multimorbidity in family medicine and long term care, following a systematic review of relevant literature.

BACKGROUND: Multimorbidity is a new concept encompassing all the medical conditions of an individual patient. The concept links into the European definition of family medicine and its core competencies. However, the definition of multimorbidity and its subsequent operationalization are still unclear. The European General Practice Research Network wanted to produce a comprehensive definition of multimorbidity. METHOD: Systematic review of literature involving eight European General Practice Research Network national teams. The databases searched were PubMed, Embase, and Cochrane (1990-2010). Only articles containing descriptions of multimorbidity criteria were selected for inclusion. The multinational team undertook a methodic data extraction, according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. RESULTS: The team identified 416 documents, selected 68 abstracts, included 54 articles, and found 132 definitions with 1631 different criteria. These criteria were aggregated into 11 themes that led to the following definition: Multimorbidity is defined as any combination of chronic disease with at least one other disease (acute or chronic) or biopsychosocial factor (associated or not) or somatic risk factor. Any biopsychosocial factor, any risk factor, the social network, the burden of diseases, the health care consumption, and the patient's coping strategies may function as modifiers (of the effects of multimorbidity). Multimorbidity may modify the health outcomes and lead to an increased disability or a decreased quality of life or frailty. CONCLUSION: This study has produced a comprehensive definition of multimorbidity. The resulting improvements in the management of multimorbidity, and its usefulness in long term care and in family medicine, will have to be assessed in future studies.

Is appropriate management of atrial fibrillation in primary care a utopia?

OBJECTIVE: The authors aimed at reporting on whether or not primary care doctors follow atrial fibrillation (AF) treatment protocols, and on the mental distress of such patients. METHODS: A total of 138 patients with first detected or recurrent AF were examined in a health center. Demographic data were collected and their lifestyle and medical history for rhythm-related pathologies and chronic medication were investigated. Physical examination, electrocardiogram (EKG), and in selected cases, lab analysis were carried-out. CHADS2 index was used for assessing the stroke risk in patients with AF, while the General Health Questionnaire-12 (GHQ-12) for personal health perception was performed in all patients. RESULTS: According to CHADS2 the majority of the patients had at least 1 risk factor and half of those receiving oral vitamin K antagonists presented an out-of-range international normalized ratio (INR). In 24 cases, patients used both aspirin and oral anticoagulants, while in 41 cases, medication was corrected according to index. GHQ-12 seemed to be significantly worse in paroxysmal and persistent cases, as well as in women with recurrent AF. Many paroxysmal AF patients under 75 years continued caffeine intake, whereas an extensive use of benzodiazepines was noticed in the majority of patients. CONCLUSIONS: Shortages and limitations of the peripheral or rural units and health centers and inadequate knowledge and application of the guidelines, seemed to be major factors responsible for mismanaging AF patients. More education in prehospital cardiology may contribute in improving management of arrhythmias in primary care.

Knowledge and behaviour of tourists towards the sun, as studied in a region of northern Greece.

INTRODUCTION: Melanoma is considered one of the most malignant cancers. Its appearance is related to various factors such as ultraviolet radiation, recurrent sunburn, and phototype. During the summer holidays approximately 14 million tourists from northern European countries visit Greece; this does not include the local tourists. AIMS: To discover the extent of European visitors' awareness of the risk of sunburn. To explore the level of knowledge gained by local and foreign tourists from preventive campaigns related to the harmful effects of sun exposure. PARTICIPANTS: The sample consisted of 802 travelers from northern European countries, and 726 Greeks who departed from the airport 'Megas Alexandros' during August and September 2002. METHODS: A structured questionnaire was used to gain data about demographics, family history of skin cancer, and identification of phototype. Also requested was information about the hours of sun exposure, and the use of sunscreen (the pattern of application and its sun protective factor [SPF]). Comparisons of mean values between groups were made by Student's t-test, and the association between categorical variables was tested by Pearson's chi(2). Regression analysis was performed to examine the influence of different factors on the likelihood of being sunburned. RESULTS: The majority of foreigners belonged to phototype II or III, while the Greek tourists belonged to phototype III. Foreigners had a higher tendency to burn and a lower tendency to tan. Of the total sample, women presented a higher prevalence of sunburn (p <0.05), and they used sunscreen more frequently (p <0.001) than men did (p <0.001), in both groups. The mean SPF used was 17.3 (SD = 8.98) for the foreigners and 16.0 (SD = 2.0) for the Greeks. The media was the main source of information for both groups. Multiple regression analysis showed that skin type was significantly associated with a high probability of sunburn (p <0.001). Moreover, freckles (p <0.05) were a predictive factor for future sunburn. CONCLUSIONS: Our study showed that skin type is the most important predictor of future sunburn. The role of the primary care physician is to promote and encourage healthy habits, including attitude towards sun exposure. Increased susceptibility to sun-induced damage of persons with phototypes I and II mandates their identification as a target group in all media campaigns.