Background: Specialized disease centers require nurses with interdisciplinary core competencies; however, standardized systems for evaluating these competencies are lacking. Based on the Iceberg Model, we aimed to construct an evaluation index system for interdisciplinary core competencies of nurses in a digestive disease center using the Delphi method. We sought to provide a scientific basis for the training, evaluation, and management of nursing talent in specialty centers. Methods: Grounded in the Iceberg Model and the Chinese Registered Nurse Competency Framework, preliminary competency dimensions and an item pool were developed through literature review and semi-structured interviews. Two rounds of Delphi expert consultation were conducted to screen and finalize indicators at all levels. The mean normalization method was used to calculate the weight of each indicator. Results: The questionnaire response rates for the two rounds of Delphi expert consultation were 93.75% and 100%, respectively. The expert authority coefficients were 0.850 and 0.847. Kendall's W coefficients were 0.281 and 0.258, respectively (P<0.01). The final evaluation index system for the interdisciplinary core competencies of nurses in digestive specialty centers comprised eight primary, 26 secondary, and 88 tertiary indicators. Conclusions: The evaluation index system for interdisciplinary core competencies of nurses in digestive disease specialty centers constructed in this study is scientifically sound and reliable, with strong specialty-specific characteristics and clinical applicability. It provides a scientific and quantitative basis for the access, training, assessment, and evaluation of nursing talent in specialty centers.

This systematic review aims to investigate barriers and facilitators that Health Care Professionals (HCPs) experience during the implementation of a lifestyle intervention for patients with overweight or obesity targeting weight loss in primary care. Overweight and obesity are one of the most pressing public health problems worldwide and have severe health consequences. Lifestyle interventions are the first treatment in line for patients with overweight and obesity. HCPs are trained to provide lifestyle interventions, but implementing these interventions in primary care remains challenging as HCPs face multiple barriers. There is no clear overview of the perceived barriers and facilitators experienced by HCPs to implement lifestyle interventions targeting weight loss for patients with overweight or obesity in primary care. Main reported barriers by HCPs were lack of time, unavailability of staff, lack of tools and limited financial resources. Interventions fitting HCPs workflow, structural financial support, training and tools were reported as facilitators for successful implementation of the intervention. Policy makers should ensure future lifestyle interventions take these barriers and facilitators into account enhancing the implementation and delivery of the intervention by HCPs to their patients in practice.

BACKGROUND:Asthma is a prevalent chronic condition in children, and is often not sufficiently controlled. Children and parents may have a different interpretation of the level of asthma control, which can lead to suboptimal treatment. This systematic review aims to synthesize literature regarding concordance between children and their parents in the perception of asthma control. METHODS:A systematic literature search was conducted in EMBASE, MEDLINE, Web of Science, and Google Scholar up to February 5, 2025. Studies were included if they involved children aged 4-18 with asthma and their parents, assessed asthma control using questionnaires validated for children or derived from guidelines, and compared results of children and their parents. All healthcare settings were included. Four reviewers independently screened the studies and two extracted the data. Methodological quality was assessed using the Newcastle Ottawa Scale. RESULTS:Nine publications were included, with a total of 1,693 children and 1,693 parents. Various questionnaires and guidelines were used to assess asthma control. The quality of the majority of the studies was rated satisfactory or good. The agreement between children and parents ranged from weak to very good. In many cases, there was a significant difference between the answers of the children and their parents: children often perceived their asthma to be less controlled compared to their parents. DISCUSSION:The perception of asthma control is frequently discordant between children and parents, with children often reporting lower levels of asthma control. These findings highlight the importance and potential beneficial effects of shared decision-making between children, caregivers, and healthcare providers in improving treatment outcomes.

BACKGROUND:Adults with intellectual disability (ID) experience frailty up to 20 years earlier than the general population, potentially increasing their risk of age-related comorbidities and mortality at a younger age. This study investigates the relationship between frailty, assessed with the Intellectual Disability Frailty Index (ID-FI) and its Short Form, and all-cause mortality over 10 years in older adults with ID. Accurate mortality prediction may help identify high-risk individuals and assist in creating targeted interventions for adults with ID. METHODS:Data from 982 participants aged ≥ 50 years (mean age = 61.6 ± 8 years) with borderline to profound ID were analysed over a 10-year follow-up within the Healthy Ageing and Intellectual Disabilities (HA-ID) cohort. Frailty was assessed using the 51-item ID-FI and the 17-item ID-FI Short Form, which measure frailty scores that can be classified into five categories: relatively fit, prefrail, mildly frail, moderately frail and severely frail. Cox proportional hazards models were used to assess the predictive validity of both indices for all-cause mortality. RESULTS:Of 982 study participants, 433 (44.1%) were deceased during 10-year follow-up. Higher frailty scores were significantly associated with increased mortality risk, independent of age, sex, level of ID and Down syndrome. Compared to relatively fit participants, the hazard ratios (HRs) for mortality for the ID-FI were as follows: 1.53 (95% CI = 1.14-2.05) for prefrail, 3.17 (95% CI = 2.31-4.36) for mildly frail, 5.37 (95% CI = 3.66-7.89) for moderately frail and 10.00 (95% CI = 6.49-15.43) for severely frail participants. A similar pattern was demonstrated for the ID-FI Short Form. Both indices demonstrated fair predictive accuracy (AUC = 0.72) for 10-year all-cause mortality. CONCLUSIONS:Both the ID-FI and ID-FI Short Form are predictive for 10-year mortality risk in adults with ID. Future research should investigate how frailty changes over time and develop strategies to improve care for adults with ID.

Summary Daily intranasal corticosteroids improved quality of life most in adolescents (12–18 years) with seasonal allergic rhinoconjunctivitis. Antihistamines showed greater quality‐of‐life improvement than intranasal corticosteroids in children (6–11 years).

Allergic rhinitis (AR) is a common condition affecting 23

Background:Asthma is the most common chronic illness among children in primary care, causing a significant burden. While nurse-led care has proven effective in secondary and tertiary care, its impact in primary care remains unclear. The aim of the present study was to evaluate the effectiveness of protocolled nurse-led care (PC) versus usual care (UC) on asthma control in children with asthma in primary care. Methods:This was a cluster randomised controlled trial with 18 months' follow-up including children aged 6-12 years with asthma in primary care. Children prescribed inhaled corticosteroids (ICS) at least once, or at least two short-acting β-agonist (SABA) prescriptions, or had at least one SABA prescription combined with an International Classification of Primary Care code for asthma or bronchial spasm within the past year were eligible for inclusion. Clusters were randomised to PC or UC. The primary outcome was change in Childhood Asthma Control Test (C-ACT) scores. Secondary outcomes included uncontrolled asthma rates, quality of life, exacerbations, spirometry and care satisfaction. Results:49 practices enrolled 90 patients (63.3% male, mean age 9.6 years, median C-ACT 23 (interquartile range 5.0)). 51 children received PC and 39 UC. C-ACT scores were consistently higher in the PC group, with significant differences at 6 (p=0.044), 12 (p=0.031) and 18 months (p=0.045). Median nurse review visits were 2 (range 0-6) per child. Conclusion:PC significantly improves asthma control in children aged 6-12 years in primary care, with a feasible number of nurse visits.

Erroneous and malpractice claim cases reflect knowledge gaps and complex contextual factors. Incorporating such cases into clinical reasoning education (CRE) may enhance learning and diagnostic skills. However, they may also elicit anxiety among learners, potentially impacting learning. As a result, the optimal utilization of such cases in CRE remains uncertain. This study aims to investigate the effect of erroneous and malpractice claim case vignettes on anxiety and future diagnostic performance in CRE and explores possible underlying factors that may influence learning, including self-reported confidence in the final diagnosis, learners’ satisfaction, and retrospective impact of the cases. In this three-phase experiment, GP residents and supervisors were randomly assigned to one of three experimental conditions: neutral (without reference to an error), erroneous (involving a diagnostic error), or malpractice claim (involving a diagnostic error along with a malpractice claim description). During the first session, participants reviewed six cases exclusively in the version of their assigned condition, with anxiety levels measured before and after. In the second session, participants solved six neutral clinical cases featuring the same diagnoses as those in the learning phase but presented in different scenarios, along with four filler cases. Diagnostic performance and self-reported confidence in the diagnosis were assessed. The third session measured learners’ satisfaction and longer-term impact on the participants. Case vignettes featuring diagnostic errors or malpractice claims did not lead to increased anxiety and resulted in similar future diagnostic performance compared to neutral vignettes. Additionally, self-reported confidence, learners’ satisfaction and long-term impact scores did not differ significantly between conditions. This suggests these cases can be integrated into CRE programs, offering a valuable source of diverse, context-rich examples that broaden case libraries without interfering with diagnostic performance or causing anxiety in learners.

Background Detailed community-based perspectives on patient experiences with telemedicine are currently lacking, yet essential to assess clinical applicability of telemedicine during and beyond pandemics, alike COVID-19. The aim of this study was to expose patient perspectives on virtual compared to in-person consultations, including determinants of these preferences. Methods We invited 5864 participants of the population-based Rotterdam Study to fill in a validated questionnaire using both close-ended and free-text questions. The questionnaire was sent on 30 July 2020, following a period of lockdowns and closures of non-essential workplaces. It assessed preferences for physician contact, healthcare utilisation, socioeconomic factors, and overall health. Those who experienced at least one virtual consultation (telephone or video call) between March 2020 and the beginning of July 2020 were asked whether those consultations were more, equally or less pleasant than in-person consultations, and to detail their experiences through free-text comments. These narrative data were examined using thematic analysis. Results 4514 participants completed the questionnaire (response rate 77.0%, 58.7% women, mean age 70.8 ± 10.5 years). 1103 participants (24.4%) reported having had experience with virtual consultations. Half of these participants considered virtual consultations less pleasant than in-person consultations (N = 556; 50.4%), while 11.5% found it more pleasant. In total, we coded free-text comments of 752 participants. Prominent themes behind patient preferences for virtual or in-person consultations were lack of nonverbal communication, lack of physical examination, consultation scheduling, personal circumstances, and the presence of somatic and/or language barriers. Conclusions Based on the experiences of a large elderly patient population, we showed that preference for virtual or in-person consultations is dependent on personal and situational variety, and their interplay. Healthcare providers should consider patients’ complex care needs and evaluate the potential added value of nonverbal communication and physical examination before scheduling a virtual consultation.

In recent decades, the prevalence of mental health problems among children and young people (CYP) has increased. It is unclear whether this increase in prevalence has also led to changes in health care utilization for these problems in general practice (GP). We therefore investigated time trends in incidence and consultation rates for eight mental health problems in CYP in Dutch general practice. We conducted a longitudinal population-based study using a GP-database (Rijnmond Primary Care Database) between 2016 and 2022. We extracted monthly data on mental health problems in CYP (0–24 years) in general practice. Using negative binomial models, we calculated trends for GP-registered incidence and consultation rates for different age and sex categories for the complete study period and for the period before the COVID-19 pandemic. Consultation rates of all eight mental health problems increased significantly over time. Additionally, incidence rates for attention deficit hyperactivity disorder and depressive problems in both sexes, and anxiety problems in females increased significantly. Although we observed a decrease in incidence and consultations in the first months of the COVID-19 pandemic, overall trends did not differ from pre-pandemic trends. Our findings suggest an increasing workload for GPs for mental health problems in CYP. These observations imply the need for policymakers and GP-councils to develop new strategies which deal with these trends to ensure appropriate support and resources in the future.

BACKGROUND:Given the high risk of cardiovascular diseases (CVD) in adults with intellectual disabilities (ID), there is a strong need for accurate understanding on CVD prevalence and incidence in this population. This information is important to ensure optimal care and resource allocation. However, systematic reviews on this topic are limited. Therefore, this systematic review aimed to provide a comprehensive synthesis of studies on the prevalence and incidence of CVD in adults with ID, including subgroup data. METHOD:We performed a systematic search in Embase, Medline ALL, Web of Science, Cochrane Central, PsycINFO and Google Scholar up to 21 January 2025, including peer-reviewed articles on CVD prevalence or incidence in adults with ID. Article screening and data extraction were independently performed by two researchers. Data were synthesised by CVD diagnosis. When available, data were reported separately for different subgroups. The methodological quality was assessed by two independent researchers. This review followed the PRISMA guidelines. RESULTS:In 55 articles, prevalence and incidence rates were identified for coronary artery disease (prev 0%-12.9%; inc 2.0-2.8 per 1000py), myocardial infarction (prev 0%-7.9%; inc 0.3-2.8 per 1000py), heart failure (prev 0.8%-18.6%; inc 12.5 per 1000py), cerebrovascular disease (prev 0.7%-15.0%; inc 2.55 per 1000py), stroke (prev 1.3%-17.2%; inc 2.7-3.2 per 1000py), peripheral arterial disease (prev 0.4%-20.7%; inc 1.1 per 1000py), venous thrombosis (prev 0.6%-12.4%; inc 0.8-4.1 per 1000py) and atrial fibrillation (prev 0.8%-6.3%). Subgroup data have been reported based on age, sex, level of ID, aetiology of ID, living circumstances, CVD risk factors, data collection methods and source populations. Overall, higher prevalence and incidence rates were reported in older people and in studies that used physical measurements for diagnosis. CONCLUSIONS:Due to variability in methodological quality, clinical characteristics and high statistical heterogeneity, drawing conclusions about CVD prevalence and incidence in adults with ID is challenging. Therefore, the subgroup data presented in this review are valuable for identifying rates within specific subgroups. Longitudinal studies along with research employing valid and reliable data collection methods (preferably objective measurements) aligned with studies in the general population, clear reporting of individual CVD diagnoses and subgroup analyses will offer valuable additional insights in future research.

Atopic diseases, including atopic dermatitis (AD), asthma and allergic rhinoconjunctivitis (AR), are common childhood conditions [1-3]. Although studies in open populations (via general population-based surveys) suggest varying prevalence trends, physician-diagnosed rates in primary care remain underexplored. Recent literature questions the assumption of an increase in atopic disease prevalence, emphasising shifts in increased disease awareness rather than true epidemiological changes [2, 4, 5]. This study examines the prevalence and incidence of atopic diseases in children within the Rijnmond Primary Care Database (RPCD) [6], including children with the atopic triad—that is, children who have been diagnosed with AD, asthma and AR at any time during childhood. We conducted a retrospective cohort study using RPCD, a regional database covering over 500,000 primary care patients from 240 general practices in Rotterdam–Rijnmond, the Netherlands. We included children aged 0–18 years from 2013 to 2021. Atopic diseases were identified using International Classification for Primary Care (ICPC) codes combined with pharmaceutical prescription data utilising the Anatomical Therapeutic Chemical (ATC) codes. Additional study methods, including the relevant ICPC and ATC codes for case selection, and results are available in the Open Science Framework online repository: https://osf.io/4kwb2/?view_only=959223bea5534b31aef5c84e5ac6c13d. AD and asthma were defined as at least two consultations and two prescriptions, while AR required two consultations plus either two prescriptions or a positive radioallergosorbent test (RAST). A case was considered resolved if no further ICPC or ATC records appeared for 2 years. We analysed data from 66,382 children in 2021, of whom 22,123 had AD, asthma or AR. Median follow-up time was 3.34 years. The incidence rates for AD and asthma remained stable over time, while AR increased from 0.89 to 1.48 per 100 PYs (p < 0.001). Corresponding prevalence rates for AR rose from 4.26 to 6.62 per 100 PYs (p < 0.001). The prevalence of the atopic triad also increased from 0.14 to 0.28 per 100 PYs (p < 0.001). The prevalence rates for all atopic diseases and the age-specific prevalence rates are displayed in Figure 1. Age-specific analysis (Figure 1) showed peak prevalence for AD at 3 years (median onset: 2.9 years, IQR: 1.0–7.6), asthma at 17 years (median onset: 9.6 years, IQR: 7.6–12.5) and AR at 17 years (median onset: 10.3 years, IQR: 7.3–13.6). The atopic triad peaked at age 11 (0.35 per 100 PYs, 95% CI: 0.28–0.43). Sex-specific analysis revealed that AD was more common in boys until age five, after which it became more prevalent in girls. Asthma and AR were more frequent in boys throughout the whole childhood. The atopic triad was more prevalent in boys (0.25 per 100 PYs) than in girls (0.19 per 100 PYs), with peak rates at age 11 for boys (0.41 per 100 PYs, 95% CI: 0.31–0.53) and age 17 for girls (0.34 per 100 PYs, 95% CI: 0.25–0.46). Our findings indicate stable incidence and prevalence rates for AD and asthma between 2013 and 2021, while AR and the atopic triad prevalence increased. This may be due to previous underdiagnosis, increased physician awareness and environmental factors. Although we did not observe any decrease in prevalence rates during the COVID-19 pandemic, the impact of COVID-19 restrictions on healthcare utilisation during 2020–2021 should be considered when interpreting trends. Asthma, AR and AT were more prevalent in boys throughout childhood, whereas AD was initially more common in boys but later in girls after age 13. The atopic triad prevalence was three times higher than expected by chance, supporting findings of distinct atopic disease trajectories. Sex differences align with existing literature, suggesting hormonal and environmental factors contribute to disease persistence [7, 8]. A major strength of our study is the large sample size of the RPCD, which contains data from more than 500,000 primary care patients. However, limitations inherent to database research must be considered. Our study outcomes rely on ICPC and ATC codes, which are subject to individual GP coding variability. While overestimation is minimised by requiring multiple consultations and prescriptions, underestimation may occur in milder cases that require less healthcare. Additionally, disease duration might be underestimated for children with mild symptoms whose cases close after 2 years without follow-up consultations. Despite this, our estimates align with previous primary care research [9]. Another limitation is the absence of data on ethnicity, family history and environmental exposures such as pets or secondhand smoke. Finally, food allergy could not be studied due to the lack of a specific ICPC code, restricting our focus to the atopic triad of AD, asthma and AR. In conclusion, the prevalence of AR and the atopic triad is rising in primary care, while AD and asthma did not increase and remained stable. Primary care physicians play a crucial role in identifying atopic children early and ensuring appropriate treatment strategies, including emollient therapy, corticosteroids and lifestyle modifications. Further research is needed to explore risk factors and trajectories in primary care populations. W. Kuan Chung conceptualised this study, performed the extraction, analysis and interpretation of the data and drafted and revised the manuscript. Evelien R. van Meel, Evelien I. T. de Schepper, Madelon van Tilborg-den Boeft, Arthur Bohnen and Patrick J. E. Bindels were involved in conceptualising the study, data interpretation and critically reviewing the manuscript. Laura Struik performed the data extraction. All authors read and approved the final submitted manuscript and agree to be accountable for all aspects of the work. We thank the Rijnmond Primary Care Database (RPCD) collaborators for providing the data used in this study. Beyond usual salary, no one received financial compensation for their contributions. The study (project number 2021-027) was approved by the Governance Board of RPCD. Patient data are de-identified; therefore, no patient consent was required. The authors declare no conflicts of interest. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

General practice is a unique setting to identify overweight and obesity in children. General Practitioners (GPs) can play an important role to signal and managing overweight and obesity in children. However, GPs experience various barriers such as limited time, uncertainty about the parents' reaction and there are ambiguities about the referral options. GPs emphasized that they are in need of supportive tools to fulfill this role. Parents indicate that they are open to a conversation with the GP about their child's weight, provided that the GP is honest and respectful. In co-creation with GPs and parents a supportive tool for GPs was developed. The tool Kindopgewicht.nl consists of a child's specific BMI-calculator, weight-related conversation techniques and an intervention map with an overview of available referral options. This tool should support GPs to identify, address and refer children with overweight and obesity in daily practice.

Introduction Asthma is the most prevalent chronic condition in children in primary care. Asthma control can be quantified using the Childhood Asthma Control Test (C-ACT), which includes questions for both children and their parents. However, there can be discrepancies between children and parents in their perceptions of asthma control. Objective This longitudinal study determines the difference in the perceptions of asthma control between children in primary care and their parents using the C-ACT, measured at five points in time. Method Children aged 6-12 with asthma who are being treated in primary care were eligible. Data was obtained using electronic questionnaires from the Rotterdam Asthma Trial from baseline to 18 months follow-up. The primary outcome was a difference in C-ACT scores between parents and their children. The data was analyzed using Spearman's correlation and intraclass correlation coefficient (ICC). Results We included 90 children and their parents. The mean age of the children was 9.6 years (SD 1.7). At baseline, the children gave a median C-ACT score of 9/12 (IQR 2.5) and the parents gave a median score of 14/15 (IQR 3.0). Children's median C-ACT scores were significantly lower throughout the study period (p < 0.001). The Spearman test showed moderate to strong correlation (0.659-0.775, and the ICC showed good agreement (0.750-0.813). Conclusion This study showed that parents gave significantly higher scores for the individual items of the C-ACT than their children. Considering the child's perspective on their symptoms is crucial when deciding on additional asthma treatment measures.

BACKGROUND:Previous research has shown that older adults with intellectual disabilities are at increased risk of cardiovascular diseases (CVD). However, longitudinal studies investigating the actual incidence of CVD and its associated risk factors in this population are limited. Such research is essential for optimising healthcare delivery and informing effective resource allocation. Therefore, this study aimed to examine CVD incidence in older adults with intellectual disabilities and explore its associations with participant characteristics and risk factors. METHOD:A prospective longitudinal study was conducted in older adults (≥ 50 years) with intellectual disabilities as part of the Healthy Ageing and Intellectual Disabilities study. Baseline measurements were performed in 2009-2010, with follow-up assessments, including medical record reviews, in 2020-2023. Incidence rates for myocardial infarction (MI), heart failure (HF) and stroke were calculated by sex and 10-year age categories. Competing risk analysis was performed to examine the associations between CVD diagnoses during follow-up and baseline participant characteristics/CVD risk factors, accounting for mortality as a competing risk. RESULTS:Among 598 participants (62.0 ± 8.5 year; 49.3% female), with a mean follow-up of 8.6 years, incidence rates were 2.3 per 1000 person years for MI, 7.2 for HF, and 5.3 for stroke. Hypertension (HR 3.17; p < 0.001), Down syndrome (HR 2.66; p < 0.01) and antipsychotic use (HR 1.98; p = 0.04) were associated with an increased CVD risk during follow-up. CONCLUSIONS:A lower incidence of MI and similar to higher incidence of HF and stroke were found in older adults with intellectual disabilities than in the general population. Further research, including a focus on the association of CVD incidence with Down syndrome, is needed. Meanwhile, proactive assessment and management of CVD risk factors, such as hypertension and antipsychotic use, are important for improving cardiovascular health in older adults with intellectual disabilities.

Asthma and allergic rhinitis (AR) are common disorders of the respiratory tract that often coincide. Control of AR symptoms can improve asthma outcomes in patients with co-existing diseases. Our aim is to produce a systematic review of the effectiveness of conventional anti-AR medication for asthma outcomes in patients with both diseases. The Embase, Medline and Cochrane databases were searched for publications up to October 2024. Randomised controlled trials (RCTs) that reported objective (OAO) or subjective asthma outcomes (SAO) and compared the efficacy of anti-AR medication to placebo or conventional asthma medication were included. Included medication interventions were antihistamines (AH), corticosteroids and leukotriene receptor antagonists (LRA). We included thirty-three RCTs. Six had an exclusively paediatric study population, 17 a partially paediatric study population. No clinically relevant improvements were seen in SAO. Quality of life (QoL) showed a significant and clinically relevant improvement in five studies. A significant and clinically relevant improvement of OAO was seen in four studies. LRAs did not show significant improvements from baseline. When compared, corticosteroids performed significantly better than LRAs. Significant improvements in both OAO and SAO were seen more often in studies with AHs than with corticosteroids. Anti-allergic initiated AHs and corticosteroids seemed to have a positive effect on asthma outcomes, with AHs having the tendency to elicit more changes in outcomes than the other studied medication groups. LRAs do not seem to influence asthma outcomes. Most significant improvements were seen in QoL and OAO. SAO did not show clinically relevant improvements.

BACKGROUND:Radiating leg pain is common in patients with low back pain (LBP). In this study, we aimed to determine the prevalence and incidence of LBP with radiating leg pain in Dutch general practice, and to describe the prescribed medications and requested imaging diagnostics. METHODS:The Rijnmond Primary Care Database containing over 500,000 primary care patients was used to select patients ≥18 years with LBP with radiating leg pain between 2013 and 2021. Data on patient characteristics, LBP episodes, prescribed medication and requested imaging in the first 3 months of an episode was extracted. Descriptive statistics were used to present patient characteristics and diagnostic/therapeutic interventions. RESULTS:A total of 27,695 patients were included. The total number of LBP with radiating leg pain episodes in these patients was 36,268. In 2021, the incidence and prevalence were 19.1 and 25.7 per 1000 patient years, respectively. In 60% of patients, the episode duration was shorter than 1 month. In 62% of the episodes, patients visited the general practitioner (GP) one to two times. In 59% of the episodes, at least one medication was prescribed, non-steroidal anti-inflammatory drugs (NSAIDs) being the most common one (45%). In approximately 11% of the episodes, additional diagnostic imaging was requested. CONCLUSION:LBP with radiating leg pain is common in Dutch general practice patients. About 2/3rd were prescribed pain medications. Dutch request few to none diagnostic imaging for these patients which is in line with clinical practice guidelines. SIGNIFICANCE:In this new study, we have gained insights into the incidence and prevalence of LBP with radiating leg pain in Dutch general practice. Both remained fairly stable over the study period of 9 years (2013-2021). Overall, the care burden regarding seeking contact with the GPs and the requested diagnostics seem not to be that high. In 62% of the care episodes, there were one or two consultations with the GP, and in 11% of the episodes a diagnostic imaging was requested. Pain medications frequently prescribed (i.e. 2/3rd of the episodes), with NSAIDs being the most common ones.

Purpose Deliberate reflection on initial diagnosis has been found to repair diagnostic errors. We investigated the effectiveness of teaching students to use deliberate reflection on future cases and whether their usage would depend on their perception of case difficulty.Method One-hundred-nineteen medical students solved cases either with deliberate-reflection or without instructions to reflect. One week later, all participants solved six cases, each with two equally likely diagnoses, but some symptoms in the case were associated with only one of the diagnoses (discriminating features). Participants provided one diagnosis and subsequently wrote down everything they remembered from it. After the first three cases, they were told that the next three would be difficult cases. Reflection was measured by the proportion of discriminating features recalled (overall; related to their provided diagnosis; related to alternative diagnosis).Results The deliberate-reflection condition recalled more features for the alternative diagnosis than the control condition (p = .013) regardless of described difficulty. They also recalled more features related to their provided diagnosis on the first three cases (p = .004), but on the last three cases (described as difficult), there was no difference.Conclusion Learning deliberate reflection helped students engage in more reflective reasoning when solving future cases.Practice pointsLearning deliberate reflection helped students engage in more reflective reasoning when solving future cases, regardless of described difficulty.Students who had not been taught deliberate reflection remembered more discriminating features (i.e. engaged in more reflective reasoning) when they expected cases to be difficult compared to cases that had not been described as difficult.Future studies should investigate whether teaching medical students the deliberate reflection procedure would also lead to improved diagnostic accuracy.

Abstract Background HIV indicator condition-guided testing is recommended by guidelines to identify undiagnosed HIV infections. However, general practitioners (GPs) frequently see patients for indicator conditions without testing them for HIV. The aim of this study was to evaluate whether implementing HIV teams, using trained GP ambassadors, promoted local HIV indicator condition-guided testing practices in urban GP centers in the Netherlands. Methods We conducted a prospective implementation study between May 2021 and March 2023. Patients ≥ 18 years newly diagnosed with HIV indicator conditions in three GP centers were included. The intervention consisted of HIV expert led education for GPs with a stepwise implementation of point-of-care testing (phase 1), followed by adding peer-to-peer case feedback by trained GP ambassadors (phase 2). Questionnaires were used to assess the experiences and beliefs of HIV indicator condition-driven testing in patients and GPs. The primary outcome was the overall HIV testing rate in patients diagnosed with indicator conditions compared to pre-implementation. Secondary outcomes were HIV testing rate per phase and per indicator condition, HIV positivity rate, and patients’ and GPs’ experiences with this testing strategy. Results In 132,338 patient visits, 846 (0.6%, 95%CI 0.6–0.7%) HIV indicator conditions were diagnosed, including 485 sexually transmitted infections (57.3%). Overall, 215 (25.4%) indicator conditions were tested for HIV after the implementation of HIV teams. The testing rate was comparable between the two phases (25.2% versus 25.9%, p = 0.83). The testing rates pre- and post-implementation were comparable (21.3% versus 25.4%, p = 0.33). The most frequently tested HIV indicator conditions were unexplained weight loss (n = 13, 41.9%), unexplained lymphadenopathy (n = 8, 38.1%), and sexually transmitted infections (n = 161, 33.2%). Three patients (1.4%, 95%CI 0.3–4.0%) tested positive for HIV. Test acceptance in patients was high as was the self-perceived knowledge of GPs on HIV indicator conditions. Conclusions Implementing HIV teams did not enhance HIV indicator condition-guided testing in urban GP centers from a low HIV prevalence setting. The high patients acceptance rate and self-perceived knowledge among GPs regarding HIV indicator conditions did not manifest in high HIV testing rates. Patients accepted testing, but a gap was found between the self-perceived knowledge of GPs regarding HIV indicator conditions and testing, and the actual HIV testing rate. Trial registration ClinicalTrials.gov NCT05225493 (registration date: 17-01-2022).