Background. Plantar cutaneous conditions are the most common causes of foot discomfort limiting ambulation. Identification of indwelling foreign bodies is greatly facilitated by dermoscopy, allowing early detection of the character of the underlying pathological etiology. Furthermore, polarized dermoscopy provides ideal conditions of illumination and three- dimensional visualization of the involved site, without direct contact with the cutaneous surface. This unprecedented report describes its implementation for a solitary hair implanted into plantar skin. Case Presentation. A patient presented with localized plantar discomfort diagnosed as a soft tissue reaction to an embedded single human hair, folded and rooted inside the epidermis. Under magnified vision the phenomenon was characterized, the hair was extracted, the source was manipulated with a hypodermic needle and the lesion was removed with ensuing complete resolution. Conclusions. Previous reports of hair slivers embedded inside the skin were attributed to barbers or animal grooming and the treatment was dictated by the severity of the complications. In this relatively mild case the intervention was greatly facilitated by therapeutic dermoscopy. Therapeutic dermoscopy is advocated for use to evaluate and treat many diverse body surfaces, especially the plantar skin as it raises the likelihood of successful treatment of embedded foreign bodies. Precisely how a single hair may become lodged into normal plantar skin remains to be explained
What is Covid-19? Definition: COVID-19 is the infectious disease caused by the most recently discovered coronavirus. It was first recognized in Wuhan, China, in December 2019. Symptoms: The most common symptoms are fever, tiredness, and dry cough. Some people may have aches and pains, nasal congestion, runny nose, sore throat or diarrhea. Course: Symptoms usually begin gradually. Some people become infected but don’t develop any symptoms. Most people (about 80%) recover from the disease without needing special treatment. Around 1 out of every 6 people becomes seriously ill and develops difficulty breathing. At risk: Older people, and those with underlying medical problems. People with fever, cough and difficulty breathing should seek medical attention.
China was the first country where the novel coronavirus appeared. General Practitioners (GPs) in China are at the forefront of tackling the spread of the virus. While the health sector in China has been under scrutiny globally, many articles have been disseminated within the country about the response. GPs in China are keen to share their experiences with GP colleagues, as other countries go through similar experiences. The hope is that by sharing our experiences, our international colleagues can benefit from what worked well and what went less well. Coronavirus started spreading from Wuhan in Hubei Province in late 2019. As in many parts of China, Wuhan is a hospital-oriented health service, as the family medicine system is not yet fully implemented. The surge of patients to hospitals quickly overwhelmed the health system in Wuhan and surrounding towns and cities, as patients sought testing and treatment, and in the process helped to spread the virus more quickly. The experience has put the spotlight on the ineffectiveness of hospitals as the first port of call for this and other types of virus.
Backgorund: Many models of palliative care have already been implemented, however, a model of health care cannot be directly applied in a country because of the differences in socio-cultural, disease patterns and health systems within the country. This study aimed to conduct a systematic review to analyze models of palliative care and elements of model for palliative care. Methods: A systematic review was conducted. Articles were searched by four electronic databases; PubMed, Web of Science, Ovid and NICE Database. Three reviewers screened the search results and data were classified according to their main objective. Further synthesize was conducted to show element and model of care. Results: The initial search strategy identified 218. Based on Hawker quality assessment scale, only 14 articles met criteria for review and synthesis. Out of 14, 4 articles describe palliative care for chronic disease (heart failure, end stage renal disease) and 10 for cancer. The integrated palliative care model has been the most frequently described. The other models are respite care, care-aide and personal alarm model, family centered advanced care, and end of life care for young adults. This systematic review also identified elements of model for palliative care and categorized as element from patient and family, personnel and health care system. Conclusion: A few studies are describing a model of palliative care and elements of model for palliative care in detail. More detailed methodological and population specifications are needed to accurately find the results.
Background: Chronic musculoskeletal pain (CMSP) is common in older people with multimorbidity (MM). Given the complex etiology of CMSP, it is worthwhile to explore the meanings attached to an individual and its interaction with MM. The study aimed to explore the meanings underneath the experience of CMSP and MM, to generate new insight on the support of pain management in the elderly population. Methods: 20 eligible subjects aged between 65 and 80 were recruited through purposive sampling. Semi-structured in-depth interviews were conducted, with data transcript, coded and analyzed using grounded theory approach. Results: Quotes evolved on the interaction between CMSP and MM, with participants expressed worries of pain may affect disease control. Three themes emerged which included the impact of CMSP on the physical and psychosocial well-being among the elderly with MM, the barriers to pain care in the community, and the perception and strategies on pain management. Conclusions: Older people with CMSP and MM were suffering from a significant physical and psychological impact on their well-being. Self-care remains a preferred adjunct in pain management; support should be strengthened at individual (education) and community (urban development) level.
Background: Older adults who have health conditions with good prognoses typically fall outside the scope of efforts encouraging advance care planning. We developed group and individual versions of an advance care planning program for use in primary care. Methods: We conducted a quasi-experimental trial in a rural family clinic in Japan. Medically stable patients aged ≥65 years were invited to watch an educational video on advance care planning, followed by an individual (n=46) or group-based (n=63) discussion. Advance directive completion was tracked over four months. Participants completed baseline and follow-up questionnaires and reported occurrence of family discussions about advance care planning and attitudes toward advance care planning. Group discussions were recorded and thematically analyzed to identify barriers and facilitators to engaging in advance care planning. Results: Advance directive completion rates were high for both intervention versions but did not significantly differ between arms (85.7% vs. 80.4%, p=0.45). Only one-fifth of patients in both arms discussed advance care planning with their family after the intervention (20.7% and 21.7%, p=0.89). Patients in the group arm rated their experience slightly higher than those in the individual arm (4.2 and 3.9 out of 5, p=0.023). Qualitative analysis of group discussions revealed that patients were affected by their perceptions of societal norms that prioritize family consensus over patient autonomy; however, these perceptions influenced advance care planning behaviors in inconsistent ways. Conclusions: Group-based advance care planning intervention among medically stable older patients is as effective as an individually-focused discussion in promoting advance directive completion. Future research is needed on ways to enhance patients’ ability to discuss advance care planning with their family members.
Abstract Background Self-therapy with various medications is a commonly practised form of children self-care among parents throughout the world, with the prevalence and pattern differing from country to country. Parental knowledge, attitudes, and practices (KAP) regarding self-medication of their children need to be taken into consideration because children are more sensitive to adverse consequences of medication. This study was designed to assess Palestinian parents’ KAP towards self-medication for their children. Methods A descriptive, cross-sectional study was conducted in Palestine from October 2016 to February 2017, using a face-to-face interview questionnaire format, which was adapted from previous studies in this field. Data was collected by convenient sampling. The parents answered a questionnaire covering socio-demographic and economic variables; medication information; knowledge, attitudes, and practices regarding self-medication; and the toxicity of medications used for self-therapy. Results Among the 500 respondents interviewed, the total parents of 357 (73.4%) accepted using medications as self-therapy for their children. The most common reason for using self-medication was previous experience (54.6%). The medications most often used in such self-therapy are antipyretics (95%), followed by skin creams (46%) and anti-cough and anti-influenza medication (44.2%). Parental knowledge about toxicity was found to be inadequate knowledge. For example, around 70% of parents believe that paracetamol and multivitamin are not fatal in cases of overdose. Conclusions Self-medication of children is common among parents in Palestine. There has been a high tendency for parents to self-medicate their children, in particular with antipyretics. Moreover, antibiotics have been used without prescriptions by a large proportion of parents. As such, specific guidelines for appropriate self-therapy should be established. We must encourage pharmacists to educate parents on how to self-medicate medicine in proper doses and at the correct time, as well when the dose reaches a toxic level.
Background: On May, 13 2019, a food poisoning outbreak of diarrhoeal B. cereus associated with contaminated chicken satay occurred in Tegalkenongo village involving villagers after attending mass iftar in a mosque. Health office of Bantul District revealed two attendances were hospitalized in the hospital of PKU Muhammadiyah after consuming food served during mass iftar. Based on the information, we immediately conducted an epidemiological investigation to make sure of the existence of the outbreak. Objectives: This study aimed to investigate the causative agents, source of food poisoning and mode of food poisoning transmission in Tegalkenongo Village. Methods: A retrospective cohort study was used in the epidemiological investigation during one week from 13 May 2019 – 20 May 2019. Results: Based on the investigation, Of the 303 villagers involved in the event, 188 villagers were ill with the median age of cases was 38 years old, the average incubation period was 8 hours, and the predominate symptoms were diarrhea (93.62%), nausea (84.57%), and abdominal cramps (64.89%). Contaminated chicken satay was determined as the source of contamination with adjusted Risk Ratio (aRR) was 4.36; 95% CI 1.1538, 16.5285. Initial epidemiological features and cultures from food items served in the event and stool sample of one patient suggested that the causative agent was Bacillus Cereus which was supported by Klebsiella Pneumoniae. Conclusion: Based on the field investigation result related to symptoms and incubation period and laboratory identification, we conclude that the causative agent was diarrhoeal B. cereus. Keywords: Food poisoning, Bacillus cereus, Klebsiella pneumoniae
Background: Despite recognition of the importance of primary health care, the opportunities for medical students to participate in family medicine clerkships (FMCs) are still inadequate around the world. In order for FMCs to be accepted in the undergraduate curriculum, it is necessary to clarify whether FMCs complement clerkships at teaching hospitals.Methods: Throughout the academic year 2018–2019, a total of 125 fifth-year students in Fukushima Medical University participated in an FMC. The students evaluated themselves at the beginning and end of their FMC whilst the family doctors evaluated students at the end of the FMC. The evaluations were a 5-point scale on 31 items in the following seven areas; objectives in general practice, practical skills and patient care, communication skills, patient-physician relationship, practice of team-based health care, medical practice in society and medical knowledge and problem-solving ability. A multiple regression analysis was conducted to assess whether self-evaluation was increased by clerkships at teaching hospitals where students rotated before the start of FMC. A Wilcoxon signed-rank sum test was used to assess self-evaluation changes before and after the FMC.Results: All 125 students completed the study. Pre-FMC self-evaluation scores for 19 items tended to be higher depending on when the FMC was conducted; the later the semester, the higher the score (e.g. diagnostic reasoning: first semester, 2.23; second semester, 2.48 [p = 0.11]; third semester, 2.61 [p = 0.02]). However, this tendency was not observed in the remaining 12 items: psychological and social background, home medical care, interprofessional work, healthcare system, team-based health care, participate as a member of the team, role of the physician in team collaboration, current medical situation in the community, community-based integrated care system, necessity of primary care, discover necessary tasks, and rank the tasks. In post-FMC evaluation, six of the 12 items were higher than four point in both the self-evaluations and family doctor evaluations. A significant increase was observed between the pre-and post-FMC self-evaluation scores in all 31 items (e.g. diagnostic reasoning: pre 2.2 and post 3.9 [p <0.0001]).Conclusion: The results of the present study suggest that FMCs complement clerkships at teaching hospitals.
Few studies have systematically explored factors affecting medical students’ general practice career choice. We conducted a nationwide multicenter survey (Japan MEdical Career of Students: JMECS) to examine factors associated with students’ general practice career aspirations in Japan, where it has been decided that general practice will be officially acknowledged as a new discipline.
Few studies have systematically explored factors affecting medical students’ general practice career choice. We conducted a nationwide multicenter survey (Japan MEdical Career of Students: JMECS) to examine factors associated with students’ general practice career aspirations in Japan, where it has been decided that general practice will be officially acknowledged as a new discipline. From April to December 2015, we distributed a 21-item questionnaire to final year medical students in 17 medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item. A total of 1264 responses were included in the analyses. The top three specialty choice were internal medicine: 833 (65.9%), general practice: 408 (32.3%), and pediatrics: 372 (29.4%). Among demographic factors, “plan to inherit other’s practice” positively associated with choosing general practice, whereas “having physician parent” had negative correlation. After controlling for potential confounders, students who ranked the following items as highly important were more likely to choose general practice: “clinical diagnostic reasoning (adjusted odds ratio (aOR): 1.65, 95% CI 1.40–1.94)”, “community-oriented practice (aOR: 1.33, 95% CI 1.13–1.57)”, and” involvement in preventive medicine (aOR: 1.18, 95% CI 1.01–1.38)”. On the contrary, “acute care rather than chronic care”, “mastering advanced procedures”, and “depth rather than breadth of practice” were less likely to be associated with general practice aspiration. Our nationwide multicenter survey found several features associated with general practice career aspirations: clinical diagnostic reasoning; community-oriented practice; and preventive medicine. These results can be fundamental to future research and the development of recruitment strategies.
As research in family medicine covers varied topics, multiple methodologies such as qualitative research (QR) and mixed methods research (MMR) are crucial. However, we do not know about the difference in the proportion of QR or MMR between Japan, the UK and the US. This knowledge is needed to shape future research within countries with developing primary care such as Japan and other Asian countries. This study aims to describe the use of QR and MMR in Japanese primary care and compare this to the UK and US; then to make informed recommendations for primary care research.
Detecting and treating dementia at an early stage are important. Although the Revised Hasegawa Dementia Scale (HDS-R) is commonly used to detect dementia, it takes about 10 min to complete. In contrast, the 1-min animal test (OMAT) takes only 1 min to complete and may be a helpful screening test for general practitioners in deciding whether to proceed with administering further diagnostic tests such as the HDS-R. We sought to examine the relationship between the OMAT and HDS-R scores, and determine the cut-off OMAT score that balanced the sensitivity and specificity in identifying HDS-R-positive patients.
Background Few studies have systematically explored factors affecting medical students’ general practice career choice. We conducted a nationwide multicenter survey (Japan MEdical Career of Students: JMECS) to examine factors associated with students’ general practice career aspirations in Japan, where it has been decided that general practice will be officially acknowledged as a new discipline. Methods From April to December 2015, we distributed a 21-item questionnaire to final year medical students in 17 medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item. Results A total of 1264 responses were included in the analyses. The top three specialty choice were internal medicine: 833 (65.9%), general practice: 408 (32.3%), and pediatrics: 372 (29.4%). Among demographic factors, “plan to inherit other’s practice” positively associated with choosing general practice, whereas “having physician parent” had negative correlation. After controlling for potential confounders, students who ranked the following items as highly important were more likely to choose general practice: “clinical diagnostic reasoning (adjusted odds ratio (aOR): 1.65, 95% CI 1.40–1.94)”, “community-oriented practice (aOR: 1.33, 95% CI 1.13–1.57)”, and” involvement in preventive medicine (aOR: 1.18, 95% CI 1.01–1.38)”. On the contrary, “acute care rather than chronic care”, “mastering advanced procedures”, and “depth rather than breadth of practice” were less likely to be associated with general practice aspiration. Conclusions Our nationwide multicenter survey found several features associated with general practice career aspirations: clinical diagnostic reasoning; community-oriented practice; and preventive medicine. These results can be fundamental to future research and the development of recruitment strategies.
Numerous studies around the world has already suggested that burnout among doctors is a global phenomenon. However, studies for burnout in doctors are relatively limited in Chinese communities when compared to the West. As risk factors, barriers to intervention and strategies combatting burnout in different parts of the world can vary a lot due to different social culture and healthcare system, study with a focus at doctors in China from a cultural perspective is a worthful endeavor.
BACKGROUND:The efficacy of implementing practices based on the best evidence is determined by the limitations and preparedness of the structure and processes of the healthcare system as well as healthcare professionals' (HCP) levels of knowledge and acceptance. Facilitating implementation of such practices also partly depends on HCPs' attitudes.METHOD:We investigate the attitudes and beliefs of four groups of physicians in the United Arab Emirates on clinical practice guidelines (CPGs), with a focus on applying revisions to these CPGs in a different setting than the one in which they were developed, and where no locally developed guidelines exist.RESULTS:CPGs were the main source of information for revisions. We identified a rising concern in the applicability of the recommendations, which persists due to a lack of locally developed revisions. Other concerns include the pressures of practice management changes and of coping with the rapid development in resources and the growing demand on its use. Some international and government-endorsed CPGs were still accepted as being the best candidates for adoption.CONCLUSIONS:This group welcomes evidence-based practice and is supported by electronic medical records, structured care programmes, and ongoing quality monitoring. Barriers and facilitators of clinical practice guidelines are discussed and thoughts on effective implementation strategies are considered.
Patients with diabetes on insulin therapy use sharps (e.g., needles) on a regular basis and a considerable proportion of them, within their home environments. These sharps and other bloodstained materials, if not disposed of appropriately has the potential to be a public health hazard.
To be recognized as a primary care physician (PCP), an Indonesian general practitioner (GP) has to follow a formal postgraduate training in primary care. However, 4 years since the regulation was published, the progress of the training is slow. There is a need to deeply investigate the doctors’ perspectives, particularly to explore factors associated with their willingness to follow this training.
A universal health coverage policy was implemented in Thailand in 2002 and led to an increase in accessibility to, and equity of, healthcare services. The Thai government and academics have focused on the large-scale aspects, including effectiveness and impacts, of universal health coverage over one decade. Here, we aimed to identify patients’ perspectives on hospital visits under universal health coverage.
