Future healthcare providers and professionalism on social media: a cross-sectional study.

BACKGROUND: Nowadays, social media have become central in the daily lives of people, including healthcare professionals. Fears arise that the accelerated growth of these social platforms was not accompanied by the appropriate training of the healthcare students and workers on the professional use of social media. This study primarily aimed to assess the awareness of the healthcare students at Beirut Arab University, Lebanon on the professional standards of social media. It also aimed to assess the presence of differences in the practices and attitudes of healthcare students according to gender and major. METHODS: A cross-sectional study was designed, and a paper-based questionnaire was distributed to healthcare students. Chi-Square test was used to analyse certain findings. RESULTS: Out of 1800 students approached, 496 participated in the questionnaire. All participants used social media. Only 19.5% (96/496) of them had received a structured education on the professional use of social media during their university study. The majority of students (349/488, 71.5%) thought that the professional standards on social media are distinct from those established in face-to-face interactions. Female students were more likely to get adequate answers in accordance with international guidelines. There were statistically significant differences in the practices and attitudes of students belonging to different majors (p value < 0.05). CONCLUSION: The line between what is professional on social media, and what is not, remains blurred for healthcare students. This study uncovered the need for clear and updated evidence-based guidelines assisting students in making the most appropriate decisions in the various online scenarios faced in healthcare practice.

A systematic review of general practice-based pharmacists' services to optimize medicines management in older people with multimorbidity and polypharmacy.

BACKGROUND: Few studies have evaluated roles of general practice-based pharmacists (PBPs), particularly in optimizing medicines management for older people with both multimorbidity and polypharmacy. OBJECTIVE: To explore the types and effectiveness of services provided by PBPs, either alone or in collaboration with other primary health care professionals, that sought to optimize medicines management for older people with multimorbidity and polypharmacy. METHODS: Eight electronic databases and three trial registries were searched for studies published in English until April 2020. Inclusion criteria were randomized controlled trials, non-randomized controlled trials and controlled before-and-after studies of services delivered by PBPs in primary care/general practice, for patients aged ≥65 years with both multimorbidity and polypharmacy that focused on a number of outcomes. The Cochrane risk of bias tool for randomized trials (RoB 1) and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) assessment tool were used for quality assessment. A narrative synthesis was conducted due to study heterogeneity. RESULTS: Seven studies met inclusion criteria. All included studies employed PBP-led medication review accompanied by recommendations agreed and implemented by general practitioners. Other patient-level and practice-level interventions were described in one study. The limited available evidence suggested that PBPs, in collaboration with other practice team members, had mixed effects on outcomes focused on optimizing medicines management for older people. Most included studies were of poor quality and data to estimate the risk of bias were often missing. CONCLUSION: Future high-quality studies are needed to test the effects of PBP interventions on a well-defined range of medicines management-related outcomes.

Optimizing medicines use for older people (aged ≥ 65 years) with multimorbidity (the presence of two or more long-term conditions) and polypharmacy (the concomitant use of four or more medicines) is urgent due to an ageing population which commonly has complex medications regimens. It is anticipated that pharmacists who have been integrated into general practices [also called practice-based pharmacists (PBPs)] will positively impact on patient outcomes through various roles and activities. As the role of PBPs is relatively new, little is known about the exact nature of their role and how these pharmacists will optimize medicines management for older people in a patient-centred manner. The aim of this research was to provide a detailed understanding of how PBPs may enhance optimization of medication management in older people and to study the effects of PBPs' interventions on outcomes-focused on optimizing medicines management for older people with multimorbidity and polypharmacy such as quality of life. The seven included studies indicated that PBP-led interventions such as medication reviews improved a number of outcomes but had either a limited effect or no effect on other outcomes. Further high-quality research is needed in this area.

Electronic Smoking Behavior Among Adult Males in Jordan.

The use of Electronic cigarettes (E-cigarettes) has considerably expanded especially among adults. This paper highlights the behavior regarding E-cigarettes uses among adult males in Jordan. Moreover, we studied the electronic cigarette devices, the electronic cigarette liquids used in them, and the health-related complaints associated with e-smoking. Among smokers, we studied the association between E-cigarette use and their interest in smoking cessation. A questionnaire-based study regarding electronic cigarette prevalence and awareness among Jordanian individuals was conducted with a total sample size of 1536 participants. The questionnaire was distributed using Facebook and WhatsApp social groups. In this study, we included data of a total of 254 adult male participants after excluding non-E-cigarettes smokers, female smokers, and male smokers younger than 18 years old from the previously published study (Electronic Cigarettes Prevalence and Awareness among Jordanian Individuals) to describe electronic smoking behavior among adult males in Jordan. We described smoking behavior, electronic smoking technologies and materials, source of knowledge, and believe regarding electronic smoking among participants. A total of 254 E-cigarette smokers have participated in this study. 104 participants (40.9%) were found to smoke both traditional and electronic cigarettes, 111 (43.7%) quit traditional cigarette smoking and switched to E-cigarettes, and 39 (15.3%) individuals are exclusively e-smokers. More than half of the participants (n = 144; 56.7%) believe E-smoking is not addictive, and 213 (83.8%) suppose that the overall health effects attributable to E-smoking are less severe and not as serious as those related to traditional smoking. The use of E-cigarettes increased both nationally and globally in the past few years and is considered an emerging modality of smoking among non-smokers. Social media and other internet websites are the main sources of knowledge regarding E-cigarettes. Health-related issues and addiction are thought to be less than traditional smoking in considerable percentages of E-smokers. A more comprehensive conception of E-smoking patterns in Jordan is required to approach this phenomenon. Health authorities in collaboration with governmental policymakers are obligate to adopt strict recommendations to control the promotion of E-smoking through social media and other internet websites to limit its distribution among people especially youths.

Electronic Cigarettes Prevalence and Awareness Among Jordanian Individuals.

The general awareness regarding E-smoking is varying from country to other depending on multivariable factors. We try to investigate the prevalence of E-Cigarette Awareness, Perceived Harmfulness, Prevalence, and Associations with Smoking-Cessation Outcomes among different age groups and different sex in Jordanian individuals. The study element shaped by data gathered from various questionnaire surveys. The questionnaire was of our own design the method of data collection was through online surveys Different applications were used to distributing the questionnaire including; Whatsapp, Facebook, Instagram, other social applications. The study included 1536 participants. The prevalence of E-smoking is 18% among Jordanian individuals where it is 24.9% in males and 3.5% in females. 47.3% of participants believe that E-smoking has less harmful effects than traditional cigarette smoking while 46.7% believe that E-smoking has the same risk of cigarette smoking. 56% of participants believe the E-smoking can lead to addiction. E-smoking is considered an emerging modality of smoking with limited data regarding its long term impact regarding its addictive behavior and toxic effect. Awareness program regarding E-smoking is mandatory especially for the nontraditional smoker and young people.

Early and Mid-Term Results After Repair of Ischaemic Mitral Regurgitation with Complete Annuloplasty Ring and Incomplete Ring.

BACKGROUND: The choice of ring type for mitral valve (MV) repair is still debatable and usually is left to the surgeon's discretion. AIM: The aim of this study was to compare the early and mid-term results after repair of ischaemic mitral regurgitation (MR) with complete and incomplete annuloplasty rings. METHODS: Collected data included preoperative assessment (age, sex, comorbidities, clinical status, NYHA grade, and the EURO score); intraoperative details (echocardiography, degree of MR, and cross-clamp time); and results (the length of ICU and hospital stay, duration and need for inotropes, duration of mechanical ventilation, and postoperative adverse events). Follow up after discharge included assessment of dyspnea status, the degree and progression of MR, and left ventricular function and dimensions. RESULTS: The present study included 133 patients: 61 with incomplete rings and 72 with complete rings inserted. There was no significant difference in the rate of postoperative complications between the two groups, apart from a significantly higher percentage of patients with incomplete ring who required prolonged ventilation >24 hours (P = 0.002). There were no significant differences between the two groups, regarding the grade of residual MR (P = 0.464), postoperative dyspnea status (P = 0.723), 30-day mortality rate (P = 0.687), and mean duration of survival (P = 0.276). CONCLUSION: The choice of incomplete or complete annuloplasty ring was not associated with a marked difference in the early and midterm results of ischaemic MV repair.

Distance learning in clinical medical education amid COVID-19 pandemic in Jordan: current situation, challenges, and perspectives.

BACKGROUND: As COVID-19 has been declared as a pandemic disease by the WHO on March 11th, 2020, the global incidence of COVID-19 disease increased dramatically. In response to the COVID-19 situation, Jordan announced the emergency state on the 19th of March, followed by the curfew on 21 March. All educational institutions have been closed as well as educational activities including clinical medical education have been suspended on the 15th of March. As a result, Distance E-learning emerged as a new method of teaching to maintain the continuity of medical education during the COVID-19 pandemic related closure of educational institutions. Distance E-Learning is defined as using computer technology to deliver training, including technology-supported learning either online, offline, or both. Before this period, distance learning was not considered in Jordanian universities as a modality for education. This study aims to explore the situation of distance E-learning among medical students during their clinical years and to identify possible challenges, limitations, satisfaction as well as perspectives for this approach to learning. METHODS: This cross-sectional study is based on a questionnaire that was designed and delivered to medical students in their clinical years. For this study, the estimated sample size (n = 588) is derived from the online Raosoft sample size calculator. RESULTS: A total of 652 students have completed the questionnaire, among them, 538 students (82.5%) have participated in distance learning in their medical schools amid COVID-19 pandemic. The overall satisfaction rate in medical distance learning was 26.8%, and it was significantly higher in students with previous experience in distance learning in their medical schools as well as when instructors were actively participating in learning sessions, using multimedia and devoting adequate time for their sessions. The delivery of educational material using synchronous live streaming sessions represented the major modality of teaching and Internet streaming quality and coverage was the main challenge that was reported by 69.1% of students. CONCLUSION: With advances in technologies and social media, distance learning is a new and rapidly growing approach for undergraduate, postgraduate, and health care providers. It may represent an optimal solution to maintain learning processes in exceptional and emergency situations such as COVID-19 pandemic. Technical and infrastructural resources reported as a major challenge for implementing distance learning, so understanding technological, financial, institutional, educators, and student barriers are essential for the successful implementation of distance learning in medical education.

Prevalence of Frontal Sinus Aplasia in Jordanian Individuals.

Our paper aims to investigate the prevalence of frontal sinus aplasia among Jordanian individuals and compare it with values from different populations. Retrospectively, the study was done for 167 of the paranasal sinuses coronal tomography (CT) for patients who attended the clinic from January 2019 to August 2019 in King Abdullah University Hospital Irbid, Jordan. The authors analyzed the multiplanar CT scans to perform our work. The authors excluded the following images from our study: patients younger than 18 years old, patients with history of skull base trauma that impaired visualization of the frontal sinus, and images with fibro-osseous lesions that impaired the visualization of the frontal sinus. The prevalence of bilateral frontal sinus aplasia is 4.2% among Jordanian individuals and 6.6% is the prevalence of unilateral frontal sinus aplasia. Both values are consistent with average values among different populations. Moreover, we noticed the higher prevalence in both the bilateral and unilateral frontal sinus aplasia in males compared to females. The prevalence of frontal sinus aplasia among Jordanian individuals is almost within the same values among different populations. These numbers regarding the bilateral and unilateral frontal sinus aplasia is crucial to push the surgeon to evaluate CT of the paranasal sinuses preoperatively and focus on the presence of frontal sinuses on CT images to prevent unwanted complications during sinus surgeries.

Can we reduce ischemic cholangiopathy rates in donation after cardiac death liver transplantation after 10 years of practice? Canadian single-centre experience

Background: Outcomes in liver transplantation with organs obtained via donation after cardiocirculatory death (DCD) have been suboptimal compared to donation after brain death, attributed mainly to the high incidence of ischemic cholangiopathy (IC). We evaluated the effect of a 10-year learning curve on IC rates among DCD liver graft recipients at a single centre. Methods: We analyzed all DCD liver transplantation procedures from July 2006 to July 2016. Patients were grouped into early (July 2006 to June 2011) and late (July 2011 to July 2016) eras. Those with less than 6 months of follow-up were excluded. Primary outcomes were IC incidence and IC-free survival rate. Results: Among the 73 DCD liver transplantation procedures performed, 70 recipients fulfilled the selection criteria, 32 in the early era and 38 in the late era. Biliary complications were diagnosed in 19 recipients (27%). Ischemic cholangiopathy was observed in 8 patients (25%) in the early era and 1 patient (3%) in the late era (p = 0.005). The IC-free survival rate was higher in the late era than the early era (98% v. 79%, p = 0.01). The warm ischemia time (27 v. 24 min, p = 0.049) and functional warm ischemia time (21 v. 17 min, p = 0.002) were significantly lower in the late era than the early era. Conclusion: We found a significant reduction in IC rates and improvement in ICfree survival among DCD liver transplantation recipients after a learning curve period that was marked by more judicious donor selection with shorter procurement times.

Contexte: L'issue des greffes de foie suite à un don d'organe après décès cardiocirculatoire (DDC) a été sous-optimale comparativement aux dons suivant la mort cérébrale. Cela serait surtout attribuable à une forte incidence de cholangiopathie ischémique (CI). Nous avons évalué l'effet d'une courbe d'apprentissage échelonnée sur 10 ans sur les taux de CI chez des receveurs de greffe de foie après DDC dans un seul centre. Méthodes: Nous avons analysé toutes les greffes de foie consécutives à des DDC entre juillet 2006 et juillet 2016. Les patients ont été regroupés en 2 époques, la première, de juillet 2006 à juin 2011, et la seconde, de juillet 2011 à juillet 2016. Ceux pour lesquels on disposait de moins de 6 mois de suivi ont été exclus. Les paramètres principaux étaient l'incidence de CI et le taux de survie sans CI. Résultats: Parmi les 73 greffes de foie par suite de DDC, 70 receveurs répondaient aux critères de sélection, 32 pour la première époque et 38 pour la seconde époque. Des complications biliaires ont été diagnostiquées chez 19 receveurs (27 %). La cholangiopathie ischémique a été observée chez 8 patients (25 %) de la première époque et 1 patient (3 %) de la seconde (p = 0,005). Le taux de survie sans CI a été plus élevé pendant la seconde époque que pendant la première (98 % c. 79 %, p = 0,01). Le temps d'ischémie chaude (27 minutes c. 24, p = 0,049) et le temps d'ischémie chaude fonctionnelle (21 minutes c. 17, p = 0,002) ont été significativement plus courts durant la seconde époque que durant la première. Conclusion: Nous avons observé une réduction significative des taux de CI et une amélioration de la survie sans CI chez les receveurs de greffes de foie par DDC après une courbe d'apprentissage qui a été marquée par une sélection plus judicieuse des donneurs et des délais d'obtention plus courts.

Nature-Inspired Polymerization of Quercetin to Produce Antioxidant Nanoparticles with Controlled Size and Skin Tone-Matching Colors.

Plant polyphenols have received considerable attention in recent years due to their ability to undergo oxidation-triggered self-polymerization, forming biocompatible versatile coatings and templated nanoparticles (NPs) that can be leveraged for a variety of biomedical applications. Here we show for the first time that untemplated NPs can be conveniently synthesized from the abundant plant polyphenol quercetin (QCT) simply by incubation with an oxidizing agent in a universal organic solvent, followed by self-assembly upon gradual addition of water. The process yielded NPs of around 180-200 nm in size with a range of colors that resembled light to medium-brown skin tones. The NPs were characterized by UV-Vis, FT-IR, and 1H-NMR spectroscopy and by dynamic light scattering and transmission electron microscopy to understand their physicochemical properties. Antioxidant and cell viability assays were also conducted to demonstrate the NPs' free-radical scavenging activity and biocompatibility, altogether providing valuable insights into the structure and function of this emerging class of nanomaterials to guide future biomedical applications.

Optimizing associated liver partition and portal vein ligation for staged hepatectomy outcomes: Surgical experience or appropriate patient selection?

BACKGROUND: Early reports of associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) outcomes have been suboptimal. The literature has confirmed that learning curves influence surgical outcomes. We have 54 months of continuous experience performing ALPPS with strict selection criteria. This study aimed to evaluate the impact of the learning curve on ALPPS outcomes. METHODS: We retrospectively compared patients who underwent ALPPS between April 2012 and March 2016. Patients were grouped into 2 24-month (early and late) periods. All candidates had a high tumour load requiring staged hepatectomy after chemotherapy response, a predicted future liver remnant (FLR) less than 30% and good performance status. RESULTS: Thirty-three patients underwent ALPPS during the study period: 16 in the early group (median age 65 yr, mean body mass index [BMI] 27) and 17 in the late group (median age 60 yr, mean BMI 25). Bilobar disease was comparable in both groups (94% v. 88%, p > 0.99). Duration of surgery was not statistically different. Intraoperative blood loss and need for transfusion were significantly lower in the late group (200 ± 109 mL v. 100 ± 43 mL, p < 0.05). The late group had a higher proportion of monosegment ALPPS (4:1). There were no deaths within 90 days in either cohort. Rates of postoperative complications were not statistically significant between groups. The R0 resection rate was similar. The entire 1-year disease-free and overall survival were 52% and 84%, respectively. CONCLUSION: Excellent results can be obtained in innovative complex surgery with careful patient selection and good technical skills. Additionally, the learning curve brought confidence to perform more complex procedures while maintaining good outcomes.

CONTEXTE: Les premiers résultats sur l'association de la partition hépatique et de la ligature portale pour l'hépatectomie en 2 temps (ALPPS) sont sous-optimaux. La littérature a confirmé que les courbes d'apprentissage influencent les résultats des interventions chirurgicales. Notre étude reposait sur 54 mois consécutifs d'utilisation de la technique ALPPS selon des critères de sélection rigoureux. Elle visait à évaluer l'effet de la courbe d'apprentissage sur les résultats liés à l'ALPPS. MÉTHODES: Nous avons procédé à une comparaison rétrospective des patients traités par l'ALPPS entre avril 2012 et mars 2016. Nous avons divisé les patients en 2 groupes de 24 mois (précoce et tardif). Tous les candidats avaient une charge tumorale élevée nécessitant une hépatectomie en 2 temps après une réponse à la chimiothérapie, un volume estimé de futur foie résiduel (FFR) inférieur à 30 % et un indice fonctionnel favorable. RÉSULTATS: Trente-trois patients ont été traités par l'ALPPS pendant la période de l'étude : 16 dans le groupe précoce (âge médian 65 ans, indice de masse corporelle [IMC] moyen 27) et 17 dans le groupe tardif (âge médian 60 ans, IMC moyen 25). Le taux de maladie bilobaire était comparable entre les 2 groupes (94 % c. 88 %, p > 0,99). La durée de la chirurgie n'était pas statistiquement différente. Les pertes de sang peropératoires et le besoin de transfusion étaient significativement inférieurs dans le groupe tardif (200 ± 109 mL c. 100 ± 43 mL, p < 0,05). Le groupe tardif avait une proportion plus élevée d'ALPPS mono-segmentaires (4:1). Il n'y a eu aucun décès dans les 90 jours parmi les 2 cohortes. Les taux de complications postopératoires n'étaient pas statistiquement significatifs entre les groupes. Le taux de résection R0 était similaire. Les taux de survie sans récidive après une année complète et de survie globale étaient de 52 % et de 84 %, respectivement. CONCLUSION: L'innovation dans le domaine des chirurgies complexes peut donner d'excellents résultats lorsqu'on sélectionne attentivement les patients et que l'on possède de bonnes habiletés techniques. De plus, la courbe d'apprentissage a eu pour effet d'accroître la confiance dans la capacité de réaliser des interventions complexes tout en produisant de bons résultats.

An 8-Year-Old Boy With Hepatic Embryonal Sarcoma Managed With Surgical Resection.

The extent of hepatic tumors in childhood differs from that found in older age groups. Some of these tumors are believed to be quite rare like undifferentiated embryonal sarcoma of the liver (UESL). The challenge in diagnosis arises from the nonspecific clinical, biochemical, and radiological features, with definitive diagnosis requiring pathological confirmation following surgical excision. Treatment options with neoadjuvant chemotherapy and surgical resection with satisfactory outcomes have been reported in the literature as well as in our case. We present the case of an 8-year-old boy who initially presented with nonspecific symptoms and was diagnosed with UESL. Following a multidisciplinary team discussion, he was treated with chemotherapy and surgical resection. Post-resection follow-up with MRI revealed stable findings.

A 20-Year-Old Gossypiboma Causing Small Bowel Obstruction.

Retained foreign bodies including gossypiboma could be silent for years. However, in some cases, it can lead to major complications. Gossypiboma is not frequently reported for multiple reasons, including nonspecific presentation clinically and radiologically, and ethical issues. We present a case of a gossypiboma that was retained for more than 20 years causing a severe intestinal obstruction for an elderly female. The intestinal obstruction was initially thought to be adhesive in nature and was managed initially conservatively, but with failure to improve, the patient was taken for exploratory laparotomy, and the foreign body was found attached to the root of the mesentery posterior to the transverse colon. This case sheds light on the fact that although surgical tools are of great utility, they must be managed with utmost care to prevent complications and secure patients' safety.

Combined Aplasia of Frontal and Sphenoid Sinuses: A case report.

INTRODUCTION AND IMPORTANCE: The paranasal sinuses are a group of four paired air-filled spaces located within the bony skull; maxillary, frontal, sphenoid, and ethmoid sinuses. Paranasal sinuses aplasia is a rare condition that is mainly confined to the frontal sinus unilaterally. Combined aplasia of multiple sinuses along with hypoplasia of other sinuses is extremely rare. This rare case should be considered in mind before scheduling any endoscopic sinus surgery to prevent complications during these surgeries. CASE PRESENTATION: A 13-year-old male patient presented to our ENT clinic complaining of a prolonged history of persistent headache, nasal obstruction, and nasal discharge. He also complained of bilateral ears fullness and facial pain. On physical examination, bilateral purulent nasal discharge with congested inflamed nasal mucosa and both inferior turbinate. The patient was diagnosed to have sinusitis and was started on treatment. The patient returns to our clinic after several weeks with minimal improvement. Computed tomography (CT was obtained and showed completely absent pneumatization of bilateral frontal and sphenoid sinuses. CLINICAL DISCUSSION: The development of the paranasal sinuses appears prenatally which can lead to a variety of PNS anomalies. However, the aplasia or hypoplasia of the PNS is found to be rare. Aplasia is mainly found in frontal and maxillary sinuses with a prevalence of 12 % and 6 %, respectively. While the prevalence of sphenoid sinus aplasia is extremely rare and found to be less than 0.7 %. Moreover, aplasia of multiple sinuses "combined aplasia" is an incredibly unusual finding. CONCLUSION: this patient is one of the extremely rare cases of the combined aplasia of frontal and sphenoid sinuses who was diagnosed and confirmed at an early age without any skeletal, systemic, or hematological abnormalities. Despite that, this rare case should be considered in mind before scheduling any endoscopic sinus surgery to prevent complications during these surgeries.

Development of a core set of clinical skills for pharmacist prescribers working in general practice: A Delphi study.

BACKGROUND: With increasing numbers of pharmacists working in general practices and undertaking patient-facing roles, it has been recognised that they must have the necessary clinical skills. However, previous studies have highlighted that practice-based pharmacists (PBPs) do not feel confident regarding their clinical skills, and it is unclear what skills are needed. OBJECTIVE: To develop a core set of clinical skills (CSs) required for pharmacists who intend to practise as independent prescribers working in general practice/family medicine. METHODS: Based on a previous study, 18 CSs were selected for inclusion in a three-round Delphi consensus questionnaire. These skills were rated by a Delphi panel on a 9-point Likert scale (ranging from 1 = limited importance to 9 = critical). The Delphi panel comprised designated leads of pharmacist independent prescribing programmes in each United Kingdom educational provider listed on the General Pharmaceutical Council website. A CS was included in the core set if 80% or more of participants scored between 7 and 9, and 15% or less scored between 1 and 3. RESULTS: Following Round 1, seven CSs met the criteria for inclusion: 'Measuring heart rate (radial pulse)', 'Assessing respiratory rate', 'Measuring blood pressure (manual, e.g. with aneroid sphygmomanometer)', 'Measuring blood pressure (automated, i.e. electronic blood pressure monitor)', 'Measuring peripheral oxygen saturation (using pulse oximeter)', 'Measuring temperature', 'Measuring Peak Expiratory Flow Rate'. After two further rounds, a further four CSs were included consisting of 'Undertaking a urinalysis', 'Respiratory examination (includes inspection, palpation, percussion and listening to breath sounds)', 'Screening for/assessment of depression and anxiety using a validated questionnaire (e.g. Patient Health Questionnaire-9 [PHQ-9] scoring)', and 'Patient assessment via National Early Warning Score (NEWS)'. No consensus was reached on nine CSs. CONCLUSION: This study has produced a core set of CSs for prescribing pharmacists. This study may contribute to standardisation of training and assessment for pharmacist prescribers working in general practice/family medicine.

GPs' and pharmacists' views of integrating pharmacists into general practices: a qualitative study.

BACKGROUND: Practice-based pharmacists (PBPs) have been introduced into general practice across the UK to relieve some of the pressures within primary care. However, there is little existing UK literature that has explored healthcare professionals' (HCPs') views about PBP integration and how this role has evolved. AIM: To explore the views and experiences of GPs, PBPs, and community pharmacists (CPs) about PBPs' integration into general practice and their impact on primary healthcare delivery. DESIGN AND SETTING: A qualitative interview study in primary care in Northern Ireland. METHOD: Purposive and snowball sampling were used to recruit triads (a GP, a PBP, and a CP) from across five administrative healthcare areas in Northern Ireland. Sampling of practices to recruit GPs and PBPs commenced in August 2020. These HCPs identified the CPs who had most contact with the general practices in which the recruited GPs and PBPs were working. Semi-structured interviews were recorded, transcribed verbatim, and analysed using thematic analysis. RESULTS: Eleven triads were recruited from across the five administrative areas. Four main themes in relation to PBPs' integration into general practices were revealed: evolution of the role; PBP attributes; collaboration and communication; and impact on care. Areas for development were identified such as patient awareness of the PBP role. Many saw PBPs as a 'central hub-middleman' between general practice and community pharmacies. CONCLUSION: Participants reported that PBPs had integrated well and perceived a positive impact on primary healthcare delivery. Further work is needed to increase patient awareness of the PBP role.

Social Determinants of Health Impacting Access to Renal Dialysis for Racial/Ethnic Minorities.

Although widespread, the burden of disease presented by chronic kidney disease (CKD) is not equally distributed among all demographics. Examining the social determinants of health (SDOH) that relate to barriers to renal dialysis care in CKD can help to prevent future disparities. There has not been a study addressing the social factors that create barriers to care for ethnic minority patients with CKD. The aim of this scoping review is to address the SDOH that affects access to renal dialysis for ethnic minority patients in the United States. This study was based on the protocol published by the Joanna Briggs Institute. A total of 349 studies were identified from PubMed, EBSCOhost, and Embase. Each article was screened against population, concept, and context criteria in order to be considered for inclusion. The population was determined to be adults of all genders from underrepresented minority populations. The selected concept was SDOH. The context of this study was the United States population. From the articles selected by the search criteria, neighborhood of residence, mental health care access, glomerular filtration rate (GFR) methodology, socioeconomic status (SES), language barriers, immigration status, and military rank were identified as SDOH affecting access to renal dialysis care. While this study identified four social determinants, more research is needed for the investigation of other possible SDOH contributing to disparities related to CKD and access to renal dialysis care.

General practitioners' experiences with, views of, and attitudes towards, general practice-based pharmacists: a cross-sectional survey.

BACKGROUND: There is limited United Kingdom (UK) literature on general practice-based pharmacists' (PBPs') role evolution and few studies have explored general practitioners' (GPs') experiences on pharmacist integration into general practice. Therefore, this study aimed to investigate GPs' experiences with, views of, and attitudes towards PBPs in Northern Ireland (NI). METHODS: A paper-based self-administered questionnaire comprising four sections was mailed in 2019 to 329 general practices across NI and was completed by one GP in every practice who had most contact with the PBP. Descriptive analyses were used and responses to open-ended questions were analysed thematically. RESULTS: The response rate was 61.7% (203/329). There was at least one PBP per general practice. All GPs had face-to-face meetings with PBPs, with three-quarters (78.7%, n = 159) meeting with the PBP more than once a week. Approximately two-thirds of GPs (62.4%, n = 126) reported that PBPs were qualified as independent prescribers, and 76.2% of these (n = 96/126) indicated that prescribers were currently prescribing for patients. The majority of GPs reported that PBPs always/very often had the required clinical skills (83.6%, n = 162) and knowledge (87.0%, n = 167) to provide safe and effective care for patients. However, 31.1% (n = 61) stated that PBPs only sometimes had the confidence to make clinical decisions. The majority of GPs (> 85%) displayed largely positive attitudes towards collaboration with PBPs. Most GPs agreed/strongly agreed that PBPs will have a positive impact on patient outcomes (95.0%, n = 192) and can provide a better link between general practices and community pharmacists (96.1%, n = 194). However, 24.8% of GPs (n = 50) were unclear if the PBP role moved community pharmacists to the periphery of the primary care team. An evaluation of the free-text comments indicated that GPs were in favour of more PBP sessions and full-time posts. CONCLUSION: Most GPs had positive views of, and attitudes towards, PBPs. The findings may have implications for future developments in order to extend integration of PBPs within general practice, including the enhancement of training in clinical skills and decision-making. Exploring PBPs', community pharmacists' and patients' views of this role in general practice is required to corroborate study findings.

Peritoneal Tuberculosis in a Young Healthy Male Resembling Intra-Abdominal Malignancy.

Intra-peritoneal tuberculosis is a rare disease, accounting for 1-2% of all tuberculosis cases. The absence of characteristic clinical picture of intra-peritoneal tuberculosis makes the diagnosis rarely easy for clinicians as it mimics malignancy. We present a case of a young male patient who presented with peritoneal tuberculosis, aiming to contribute to a better understanding of peritoneal tuberculosis in the literature.

Conversion disorder with aphonia in 12 years old male patient: A case report.

INTRODUCTION AND IMPORTANCE: Conversion aphonia is a rare disease characterized by total loss of voice. It is more commonly reported in females than males, and its diagnosis is based on a comprehensive patient's clinical history, and assessment of vocal cords and other laryngeal structures using Fiberoptic laryngoscopy. Early diagnosis and phonation have a significant role in the treatment. CASE PRESENTATION: A 12-year-old medically free male patient with unremarkable medical history and normal physical, social, cognitive and emotional developmental milestones presented to the otorhinolaryngology clinic with a sudden loss of voice for a duration of 3 days with absence of other associated symptoms. A comprehensive clinical history and general examination were within normal limits, and fiberoptic laryngoscopy revealed a normal-looking laryngeal structure with intact bilateral mobile vocal cords. A diagnosis of psychogenic aphonia was the most likely cause, so speech therapy concurrent with psychotherapy was the mainstay of treatment. Improvement of the patient condition noticed and he restored his speech 4 weeks after initiation of his treatment. CLINICAL DISCUSSION: Psychogenic Aphonia is rare disorder with female predominance and younger age onset when it is compared to males. It is also known as functional neurological symptom disorder (FND) as it is not explained by underlying medical or neurological factors. It is often preceded by psychological trauma or stressors. Diagnosis of Psychogenic Aphonia is challenging and it is often missed and delayed. Accordingly, the delay in diagnosis may significantly affect the ultimate outcome for affected patients. Speech therapy concurrent with psychotherapy represents the mainstay of treatment. CONCLUSION: Being rare disorder, early recognition and diagnosis of conversion disorder with aphonia is crucial. Applying diagnostic criteria which is introduced by American Psychiatric Association in The Diagnostic and Statistical Manual of Mental Disorders (DSM) facilitate the diagnosis. Multidisciplinary approach in management of affected patients ensures better outcome.