Departments Of Family Medicine Research Articles

Knowledge and attitude towards ankle sprain management among primary care physicians in the department of family medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia

ABSTRACT Introduction: Family doctors are the primary care providers for ankle sprains, which are a prevalent condition that they treat with great care. Family physicians’ differing management styles and levels of knowledge about established recommendations may have a substantial influence on patient outcomes. Aims: The current study aimed to assess the level of awareness among family physicians regarding established guidelines for ankle sprain management. Materials and Methods: A cross-sectional study was conducted targeting all available and accessible primary care physicians within the Department of Family Medicine at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia during the period from 2023 to May 2024. Data were collected using an online questionnaire that was initiated by the study researchers after comprehensive review of similar articles in the literature. Results: A total of 88 primary care physicians were included. Physicians’ ages ranged from 25 to 60 years with a mean age of 33.4 ± 7.4 years old. A total of 47 (53.4%) were males, 29 (33%) were residents, 28 (31.8%) were consultants, 16 (18.2%) were senior Registrar, and 9 (10.2%) were GPs. A total of 41 (46.6%) of the study physicians had an overall good knowledge level about ankle sprain while most of them (53.4%) had poor knowledge level. A total of 55 (62.5%) of the study physicians utilize the Ottawa Ankle Rules to guide the need for X-ray imaging in ankle sprains, and 52 (59.1%) routinely provide information on preventive measures to patients diagnosed with an ankle sprain. Conclusion: The study found that primary care physicians have average knowledge about ankle sprains, diagnosis, classification, and treatment, with lower knowledge of follow-up plans. They need training and educational programs.

Health profile assessment of school children of Jodhpur District of Rajasthan

ABSTRACT Background: The health and nutritional status of young children is an index of national investment within the development of its future manpower. There is a limited data available on health profile among adolescents in India. Thus, this study was undertaken with the target of assessing the nutritional status and morbidity pattern of school children Jodhpur district of Rajasthan. The objectives of this study were to assess the health profile including general physical examination, anthropometric measurements, morbidity pattern and addiction among school-going children of Jodhpur. Material and Methods: A school-based observational cross-sectional study was carried out among the nearby schools pertaining to our urban and rural health centres associated with the Department of Community Medicine and Family Medicine, AIIMS Jodhpur. Result: A total of 525 school children participated in the study. On general physical examination, it was observed that the majority (4.1%) of the school children from rural area were seen with ‘flag sign’ in comparison with those in urban region. Fluorosis was observed in the majority (60.2%) in rural schools in comparison with urban and this was found to be statistically significant (P = 0.000). The majority (21, 0.04%) of them were suffering from hearing loss, among them (13,61.9%) were from rural area in comparison with (08, 38.1%) in urban and this difference was found to be statistically significant. (0.000*). Anaemia was observed in (210, 40.0%) of the school children. Conclusion: The study brings out the need for intensified and targeted school health awareness programmes for school-going children and utilization of various services.

Primary care in the COVID-19 pandemic and beyond: Lessons from Ontario.

To understand the role of primary care in the COVID-19 pandemic to provide insight into its functioning and inform potential reforms. The now dissolved Ontario COVID-19 Science Advisory Table (Science Table) was formed in July 2020 to provide decision makers and the public with a synthesis of rapidly evolving evidence related to COVID-19. The Science Table was based at the Dalla Lana School of Public Health at the University of Toronto, and supported by Public Health Ontario. Authors worked with the leadership and secretariat of the Science Table to synthesize evidence and inputs. Authors drew on their expertise in research, policy, and front-line care delivery and coupled this with data analysis and reviews of the literature relevant to the topic areas discussed. Data analysis and literature reviews were done with the support of the Ontario Medical Association, the INSPIRE-Primary Health Care research program, and the Department of Family and Community Medicine at the University of Toronto. Experts conducted a rapid review of the briefs prior to publication, and authors presented the briefs' content at a series of meetings attended by Science Table members for their input. As Science Table briefs were intended to provide rapid-response answers to important health system questions in real time, the intent was not to conduct a systematic review but rather to gather available relevant evidence and present it in a form that could be used by policy-makers. This summary describes the work of primary care during the COVID-19 pandemic in Ontario up to September 2022; outlines current challenges in primary care capacity and structure; and makes recommendations for strengthening the sector to better address population needs for current and future public health priorities. While the focus is on Ontario, many of the findings are relevant to other jurisdictions in Canada and elsewhere. Universal formal attachment to an accountable interprofessional primary care team supported by adequate infrastructure should be the cornerstone of pandemic recovery planning.

Role of ivermectin and colchicine in the treatment of COVID-19: a randomized controlled clinical trial.

The objective of this study was to assess the effectiveness of ivermectin and colchicine as treatment options for coronavirus disease 2019 (COVID-19). A three-arm randomized controlled clinical trial was conducted in the Triage Clinic of the family medicine department at Ain Shams University Hospitals on participants who had been diagnosed with moderate COVID-19. Patients aged < 18 years or > 65 years, with any co-morbidities, pregnant or lactating females, and those with mild or severe COVID-19 confirmed cases were excluded. Sealed envelopes were used for randomization of intervention or control. Patients are followed until there was improvement of symptoms and no development of new symptoms for over one month. A total of 120 patients (40.16 ± 10.74 years) with COVID-19 were enrolled; 40 patients in each arm. Out of them, 44 (36.6%) were male and 76 (63.4%) were female. Fever and cough were the predominant symptoms in each group. There was no statistically significant difference in the mean duration of fever between the ivermectin, colchicine, and control groups (7.3 ± 1.68, 6.6 ± 1.58, and 7.075 ± 1.58 days, respectively). The majority of patients (67.5%, 70%, and 72.5%) were completely cured within 10 days of infection, with no differences between the three groups (p > 0.05). A statistically significant improvement of inflammatory markers occurred in each of the three groups over time with no statistically significant difference between them. Ivermectin and colchicine have no beneficial effect over standard care in the treatment of COVID-19.

Prevalence and Risk Factors of Functional Dyspepsia: A Population-Based Study

Background: Functional dyspepsia is one of the most common functional gastrointestinal disorders and affects more than 20% of the population. This study aimed to determine the prevalence of functional dyspepsia according to Rome IV criteria and its relation with social determinants.Methods: This cross-sectional study was conducted in the Department of Family Medicine, Kartal Dr Lutfi Kırdar City Hospital Tuzla Training and Research Primary Health Care Center, Istanbul, Turkey from May - December 2019. The participants (aged 18-78) were selected using randomized sampling by a family physician according to the records. All participants underwent a clinical interview based on a questionnaire based on Rome IV criteria. The factors that were significant in the binary comparison were taken into logistic regression analysis (Backward: LR) to determine the causal relationship. P-values 0.05 were considered statistically significant.Results: A total of 350 participants were enrolled to the study (43.4 %; n=152 male and 56.6%; n=198 female). The prevalence of functional dyspepsia was 16.9% (n=59). 62.7% (n=37) of dyspeptic patients had epigastric pain syndrome and 67.8% (n=40) of them had postprandial distress syndrome. Daily tee consumption, body mass index, and family history were found as social factors related to functional dyspepsia.Conclusion: The prevalence of functional dyspepsia was 16.9% according to Rome IV criteria and most of the patients were female. Obesity was an important factor related to dyspepsia. Dyspeptic symptoms must investigate especially in obese female patients.Keywords: Dyspepsia, functional dyspepsia, prevalence

Tactics for Institutional Advocacy to Increase Research Capacity in a Family Medicine Department.

Family medicine as a specialty has steadily increased its research capacity. Specific approaches are needed to attain the following: 1) Advocate for increased funding for Departments of Family Medicine from institutional leadership. 2) Identify and promote promising practices for chairs to support and fund research participation within their departments and institutions. Having each assumed the chair position recently, the authors summarize the specific approaches taken to expand the research capacity in a midsized urban and a large research intensive urban public university family medicine department. They included: obtaining adequate support from the Dean and other institutional programs at the time of on-boarding, focusing on established research themes within the department, ensuring the recruited faculty had high likelihood of success via their track record and mentorship, and getting the buy-in from all faculty through sharing of vision and helping everyone establish their scholarly niche.

Building Research Capacity (BRC): Purposes, Components, and Activities to Date.

The Building Research Capacity (BRC) initiative was founded in 2015 as a collaboration between the Association of Departments of Family Medicine (ADFM) and the North American Primary Care Research Group (NAPCRG). It aims to enhance family medicine research engagement by helping develop researchers, research educators, and research leaders. Through consultations, a fellowship, tailored presentations at national conferences, and ongoing assessment, BRC addresses the dynamic needs of various stakeholders in family medicine research. There is a growing need for organized efforts in primary care research capacity development, and BRC is positioned to provide ongoing leadership and direction. Targeted areas of growth for BRC are expansion and diversification, collaboration, and iterative evaluation and adaptation. A commitment to innovation, inclusivity, and adaptability propels BRC toward transformative growth in family medicine research.

Changes in Diversity, Equity, and Inclusion Activities of Family Medicine Departments.

Institutional racism causes worse health outcomes for patients of racial/ethnic minority groups via limited access to health care, disparities in quality of care delivered, and lack of physician diversity. Increased attention to racism in 2020 led many medical institutions to examine their diversity, equity, and inclusion (DEI) efforts. In the context of increased national attention to health equity, this study sought to investigate the current status of DEI infrastructure by evaluating leadership and support related to DEI in family medicine departments in 2020 and 2021. We analyzed department and chair characteristics as well as departmental DEI infrastructure (ie, leadership and actions) from Association of Departments of Family Medicine survey data in 2020 (data collected from June to September 2020) and 2021 (data collected from September to December 2021). We performed multiple regression analyses to evaluate whether department characteristics or specific DEI activities were associated with increased DEI infrastructure in 2021 compared to 2020. Of the 165 department chairs sent the survey in both 2020 and 2021, 56 (33.9%) responded both years. Departments with a designated DEI leader increased from 42.9% in 2020 to 60.7% in 2021, but about 40% of departments lacked key supports for this position (ie, funding, staff support, and a pathway for advancement). Regression analysis did not demonstrate associations between independent variables and three measures of departmental DEI activities. This study demonstrates that designated leadership for DEI work increased in family medicine departments between 2020 and 2021.

Model for an International Case Sharing Program to Enhance Global Palliative Care Education.

In Thailand, the field of palliative medicine is growing but access and training remain limited. We sought to expand education of resident physicians at Chiang Mai University (CMU) in Thailand through development of an international case sharing program. The goals of this project were to increase knowledge of core palliative care topics, to cultivate a culture of reflective clinical practice, and to create a model for collaboration in international palliative care education that can be replicated by other institutions. We used a virtual case conference platform, in which two Family Medicine residents from CMU selected a challenging palliative care case. They prepared the case using an outline that included reflections on ethics, compassion and social responsibility. The residents presented the case in English to palliative care faculty from Thailand and Minnesota. Each case was followed by unstructured discussion. Over the course of 5.5 years (Nov 2018 - Mar 2024), 14 cases were presented. Each case discussion included at least 3 to 7 core palliative care topics. The program was adopted as one of the core activities of the Department of Family Medicine at CMU and led to clinical practice changes. We present a sustainable, convenient, low-cost, cross-cultural palliative care case conference model that has the potential to enrich palliative care education globally.

The Impact of Health Education on Hemoglobin A1C in Diabetic Patients at the Family Medicine Department of King Fahad Armed Forces Hospital in Jeddah.

Diabetes mellitus (DM) is a long-term condition associated with severe complications. Individuals with diabetes must make numerous self-management decisions and participate in diverse care activities. Diabetes self-management education and support assist patients in making these decisions and performing these activities, enhancing their health outcomes. The study aims to assess the effects of health education on median hemoglobin A1c (HbA1C) levels, the development of diabetic complications, and the number of hospital admissions in patients with uncontrolled type 2 DM. This prospective quasi-experimental study, conducted at King Fahad Armed Forces Hospital in Jeddah, Saudi Arabia, from September 2020 to September 2022, assessed the impact of a structured diabetic education program on uncontrolled type 2 DM patients. The study involved 100 patients with HbA1c >8%: 50 in the intervention group who received the program and 50 in the control group who did not. HbA1c levels were measured before and after the intervention. Data was collected securely, and an experienced biostatistician performed statistical analysis. The two groups found no significant differences in age, disease duration, HbA1c, medication type, insulin type, education level, employment, and clinical visits. However, the control group had significantly more females (40 (81.6%) vs. 32 (64%), p=0.049), and the intervention group had larger family sizes (43 (86%) with >4 members vs. 21 (42.9%), p<0.0001). The intervention group showed a significant decrease in HbA1c from baseline across all measurements post-educational program (p<0.0001), whereas the control group did not show significant changes. Economic status also differed significantly (p=0.024). No significant differences were found between groups in follow-up HbA1c measurements. The study demonstrates that the diabetic education program at King Fahad Armed Forces Hospital effectively lowered HbA1c levels in type 2 DM patients, confirming the program's role in enhancing glycemic control through structured self-management education and support.

Diversity in Family Medicine Research.

In conjunction with the North American Primary Care Research Group (NAPCRG) Annual Conference in 2023, leaders in the field of family medicine came together to discuss and produce a Family Medicine Research Agenda. While multiple areas were discussed, diversity, equity, and inclusion did not rise to the top as research priorities. This article discusses the 3 areas family medicine leaders see as necessary to produce high-quality research. The authors present ideas on how diversity, equity, and inclusion can be prioritized in each area. In the first area, "Grow the family medicine research workforce by expanding pathways and strengthening mentorship," the authors present existing models, with an emphasis on those pathway programs proven to increase scholarship and research, such as the Leadership Through Scholarship Fellowship sponsored by the Society of Teachers of Family Medicine (STFM) and the Building Research Capacity Program sponsored by the Association of Departments of Family Medicine (ADFM). In the second area, "Increase funding for family medicine research and advocate for enhanced health policy and support," the authors present ideas on greater utilization of NIH diversity supplements as well as institutional advocacy by family medicine chairs to create seed grants and provide opportunities for diverse faculty to engage in research. Chairs can also increase the diversity of the researcher pool by recruiting among local full-time clinicians, a more diverse group than most faculties. For the final area, "Build a national infrastructure for organizing and optimizing family medicine research opportunities," the authors present solutions including following demographic data surrounding authorship and reviewing for journals; having dedicated committees or editors focused on diversity, equity, and inclusion; and using demographic data from conference submissions to encourage those from underrepresented backgrounds to translate their presentations into a manuscript. These strategies can help equity, diversity, and inclusion become central to our research and be used as a national model for other specialties attempting to do the same.

Cost-Effectiveness of Computer-Assisted Cognitive Behavioral Therapy for Depression Among Adults in Primary Care

Approximately 1 in 5 adults are diagnosed with depression in their lifetime. However, less than half receive help from a health professional, with the treatment gap being worse for individuals with socioeconomic disadvantage. Computer-assisted cognitive behavioral therapy (CCBT) is an effective and convenient strategy to treat depression; however, its cost-effectiveness in a sociodemographically diverse population remains unknown. To evaluate the cost-effectiveness of clinician-supported CCBT compared with treatment as usual (TAU) in a primary care population with a substantial number of patients with low income, limited computer or internet access, and lack of college education. This economic evaluation was a randomized clinical trial-based cost-effectiveness analysis. The trial was conducted at the Departments of Family and Geriatric Medicine and Internal Medicine at the University of Louisville. Enrollment occurred from June 24, 2016, to May 13, 2019. Participants had mild to moderate depression and were followed up for 6 months after treatment completion. The last follow-up assessment was conducted on January 30, 2020. Statistical analysis was performed from August 2023 to August 2024. CCBT intervention was provided for 12 weeks and included 9 modules ranging from behavioral activation and cognitive restructuring to relapse prevention strategies, supported by telephonic sessions with a clinician, in addition to TAU, which included standard clinical management in primary care. The primary health outcome was quality-adjusted life years (QALYs), estimated using the Short-Form 12 questionnaire (SF-12). The secondary outcome was treatment response, defined as at least 50% improvement in the Patient Health Questionnaire. The intervention cost included sessions with mental health clinicians and the cost of the CCBT software, plus the cost of loaner computer and internet data plan for low-resource households. An incremental cost-effectiveness ratio (ICER) was computed, while adjusting for baseline scores, age, and sex. The cost-effectiveness acceptability curve presented the probability of CCBT being cost-effective for a range of willingness-to-pay values. Among the 175 primary care patients included in this study, 148 (84.5%) were female; 48 (27.4%) were African American, 2 (1.2%) were American Indian or Alaska Native, 4 (2.5%) were Hispanic, 106 (60.5%) were White, and 15 (8.6%) were multiracial; and the mean (SD) age was 47.03 (13.15) years. CCBT was associated with better quality of life and higher chance of treatment response at the posttreatment and 6-month time points, compared with the TAU group. The ICER for CCBT was $37 295 (95% CI, $22 724-$66 546) per QALY, with a probability of 89.4% of being cost-effective at a willingness-to-pay threshold of $50 000/QALY. The ICER per case of treatment response was $3623 (95% CI, $2617-$5377). In this trial-based economic evaluation, CCBT was found to be cost-effective, compared with TAU, in primary care patients with depression. As this study included individuals with low income and with limited internet access who are underrepresented in cost-effectiveness studies, it has important policy implications for addressing unmet needs in sociodemographically diverse populations.

Effect of fasting on cardiovascular risk factors among healthy adult Muslims attending primary care, Kano, Northern Nigeria

BackgroundCardiovascular diseases (CVD) are among the most prevalent and preventable chronic diseases in the 21st century The global burden of disease: 2004 update. The Report in Sections. A person’s risk of developing CVD can be reduced by adopting healthy lifestyles, spiritual and religious practices The American Heart Association Life’s Simple 7 in African Americans of the Jackson Heart Study. Fasting as a spiritual practice is not exempted from these benefits. Most world’s religions recommend a period of fasting. The obligatory Ramadan fasting in Islam may provide an interesting opportunity to reduce food intake and increase physical activity. The main objective of this study is to investigate the effect of Ramadan fasting on cardiovascular risk factors on healthy adult Muslims.MethodThe study was pre/post-test single arm intervention conducted at the staff clinic of Family Medicine department, AKTH, and Northwest, Nigeria. Kano. The study recruited healthy adults 18yrs and above not on any medications that can affect metabolic profiles consecutively from two weeks before Ramadan fasting of 2018 and the last week of Ramadan of the same year. The questionnaire included information on sociodemographic, clinical parameters and Lifestyle pattern.ResultThirty healthy volunteers were included in this study, 25 males (83.3%) and 5 females (16.7%). The mean age was 38.23 ± 6.35(SD). Twenty-five participants were married (83.3%) with 4 singles (13.3%) and 1 divorcee (3.3%). During Ramadan fasting, weight reduced (67.90 ± 11.61 versus 66.53 ± 12.13 4th week of Ramadan p-value < 0.002) Body Mass Index (22.89 ± 3.63 versus 4th week of Ramadan 22.38 ± 3.64 p-value < 0.002) and systolic blood pressure (120.33 ± 19.91versus 4th week of Ramadan 115.33 ± 14.32 p-value 0.003) reduced significantly compared to baseline. The waist circumference, pulse rate, fasting blood sugar and cholesterol were reduced but were not statistically significant.ConclusionThe result from this study suggested that Ramadan fasting may be a useful means of reducing burden of cardiovascular diseases, as the improved cardiovascular risk factors associated with fasting may translate into a significant health benefit.

OSTEOARTHRITIS AND METABOLIC SYNDROME: KEY ASPECTS OF PATIENT MANAGEMENT

Introduction: Osteoarthritis is a major health concern, and along with coronary heart disease and arterial hypertension, forms a triad of the most common diseases among the adult population. Osteoarthritis significantly reduces the quality of life, leads to disability, and increases mortality rates. Globally, nearly 240 million people suffer from osteoarthritis (about 10% of men and 18% of women over the age of 60). In terms of disease burden, osteoarthritis ranks: first in complications of the musculoskeletal system, second in the number of visits to family doctors, and third in cases of disability. Patients with osteoarthritis, particularly those with comorbid conditions and metabolic syndrome, face a high prevalence of cardiovascular diseases and an increased risk of premature death. Goal: to elucidate modern insights into the pathogenetic links between osteoarthritis and metabolic syndrome, and to justify new approaches to improving treatment for patients with this pathology. Materials and Methods: A literature search was conducted using scientific databases, employing methods of analysis, comparison, and generalization of information about the relationship between osteoarthritis and metabolic syndrome. The study was carried out at the Department of Family Medicine and Therapy at Poltava State Medical University, based in the Regional Rheumatology Center of M. V. Sklifosovskiy Poltava Regional. The study involved 40 patients, both outpatients and inpatients, including 26 women (65%) and 14 men (35%), aged 54-69 years, with primary osteoarthritis of X-ray stages I-II according to the Kellgren-Lawrence scale, in combination with metabolic syndrome. The control group consisted of 20 individuals. Results. A 12-month monitoring of this group of patient was conducted, revealing mild to moderate manifestations of metabolic syndrome along with polymorbid conditions such as chronic obstructive lung diseases and genitourinary system disorders. Most frequently, one, and rarely two, comorbid conditions were detected, along with one or two diseases unrelated to osteoarthritis. The most common progressive conditions observed were arterial hypertension, ischemic heart disease, heart failure, obesity, type 2 diabetes, and digestive system diseases. The primary goal in managing patients with osteoarthritis and metabolic syndrome is to significantly reduce cardiovascular risk and mortality. This involves developing a comprehensive concept of metabolic syndrome and osteoarthritis, identifying patients at high cardiovascular risk, and implementing preventive measures, including lifestyle modifications and the use of appropriate medications. Conclusions. The study revealed a significant clinical effect from the use of therapy that included coxibs in 78% of patients in the main group with osteoarthritis combined with metabolic syndrome. A positive outcome was observed in terms of pain reduction, a reduction in inpatient treatment duration by 2-3 days, and extended remission periods. For this category of patients, primary prevention should focus on weight loss, increased physical activity, and normalization of metabolic disorders.

A PATIENT WITH OSTEOARTHRITIS AND HYPERTENSION IN GENERAL MEDICAL PRACTICE

Osteoarthritis is one of the most common diseases in Ukraine and worldwide, often leading to early disability in people of working age, making it both a medical and social concern. According to the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases, as well as the International Society for the Study of Osteoarthritis, it is known that a middle-aged patient with osteoarthritis typically has four accompanying pathologies. In elderly patients, in addition to osteoarthritis, up to eight other chronic conditions are often diagnosed. Comorbidity is frequently observed in middle-aged patients with osteoarthritis. Understanding the pathogenetic links between osteoarthritis and comorbid conditions plays an important role in the timely diagnosis and treatment of these diseases, helping to maintain a high quality of life for patients. Objevtive: the study of the pathogenesis of osteoarthritis and arterial hypertension, along with the proposed therapy for treating comorbidities in patients with both osteoarthritis and arterial hypertension, aims to enhance the treatment outcomes. Materials and methods. Analytical and bibliosemantic methods were used in this study. During the scientific search, 38 modern literature sources were reviewed and analyzed concerning the pathogenetic impact on the development of osteoarthritis and arterial hypertension, as well as their shared mechanisms in the development and progression of both conditions. The study was carried out at the Department of Family Medicine and Therapy of the Regional Rheumatology Center, M. V. Sklifosovsky Poltava Regional Hospital. A total of 50 people were examined; the main group consisted of 35 individuals with stage II hypertension, grade 2, combined with stage II knee osteoarthritis (according to the Kellgren-Lawrence scale), with joint dysfunction of stages 1-2. These patients were aged 40-65 years (mean age 51.8±2.14 years). The duration of hypertension was 10.07±1.24 years, and the duration of manifested osteoarthritis was 8.56±1.03 years. The comparison group consisted of 20 individuals with stage II, grade 2 hypertension (mean age 52.5±2.38 years), with a mean hypertension duration of 11.31±1.17 years. The clinical diagnosis of osteoarthritis was established according to the recommendations of the European Alliance of Associations for Rheumatology (2018). The diagnoses of comorbid conditions were confirmed in accordance with relevant orders from the Ministry of Health of Ukraine, with verification by specialized experts. Patients with osteoarthritis received standard treatment, and, when necessary, additional treatment for comorbid conditions was prescribed (a hypotensive combination of an ACE inhibitor and long-acting calcium. Results: The presence of osteoarthritis exerts an additional negative impact on heart rate variability in patients with hypertension. The reduction of the Low Frequency/High Frequency (LF/HF) index due to the use of this therapy (a combination of an ACE inhibitor and a long-acting calcium antagonist in doses of 4/5 mg, 4/10 mg, 8/5 mg, 8/10 mg) in the treatment of patients with comorbidity of hypertension and osteoarthritis contributes to the activation of the sympathetic nervous system, reduction of patient mortality, balancing of the nervous system by inhibiting sympathetic nervous tone, and lowering high blood pressure. Conclusions: The proposed combination therapy for patients with osteoarthritis and hypertension contributes to prolong remission of both the primary disease and comorbid conditions, reduces the frequency of hospitalizations, and shortens inpatient treatment by 3-4 days.

Knowledge, attitude, practices, and perceived barriers to using point-of-care ultrasound by Asian primary care physicians – a mixed method study

BackgroundAlthough research shows that point-of-care ultrasound is helpful in primary care, there is little research on point-of-care ultrasound use and the barriers to its use in Asia. This study estimated the prevalence of primary care physicians using point-of-care ultrasound in Hong Kong and assessed their perceived knowledge, attitude, practices, and barriers to using point-of-care ultrasound.Study designThis was a mixed-method study: cross-sectional survey, followed by semi-structured interviews. Primary care physicians who were members of the Hong Kong College of Family Physicians and/or were clinical teachers affiliated with the Department of Family Medicine and Primary Care at the University of Hong Kong were invited to participate.ResultsA total of 330 and 14 completed the survey and interviews, respectively. The prevalence of respondents using point-of-care ultrasound was 22.5%. Perceived knowledge was fair (mean score: 1.9 out of 4; SD: 0.6). The attitudes were mostly positive (mean score: 3.0 out of 4; SD: 0.5). Majority stated that barriers to using point-of-care ultrasound were related to training (90.9%), the competence of point-of-care ultrasound skills (90.2%), and clinical support (89.5%). Qualitative data identified that most participants found point-of-care ultrasound useful; however, participants felt that its use was limited by their competence of point-of-care ultrasound and by factors related to their clinical practice.ConclusionsAlmost a quarter of respondents are using point-of-care ultrasound with a majority having positive attitudes. They lack confidence in their skills as knowledge is poor but simultaneously find training and clinic support limited.

Evaluation of a longitudinal Indigenous health elective in family medicine

Background: In response to the Truth and Reconciliation Commission of Canada Calls to Action 22 to 24 around health, the Department of Family Medicine at the University of Calgary piloted a novel Indigenous Health Longitudinal Elective (IHLE) to give first year residents longitudinal experiences in Indigenous healthcare environments. The purpose of this evaluation was to capture the successful qualities and identify areas for improvements to ensure feasibility of the IHLE pilot program. Methods: Between November 2022 and April 2023, semi-structured interviews were completed with seven participants of the IHLE and included a mix of residents, preceptors, and clinic staff members. Qualitative thematic analysis was used to gain an in-depth understanding of the IHLE program experiences of all participants. Results: Benefits of the IHLE program include a deeper understanding of the values and priorities critical to working in healthcare with Indigenous peoples in Southern Alberta. Areas for improvement include clarity around IHLE program structure; clearly defining roles and responsibilities for preceptors; increased opportunities for reciprocity and relationality; and a deeper self-reflection process. Conclusion: Recommendations for future iterations of the IHLE include ensuring preceptors are trained and engaged, while providing residents more opportunities for relationality and peer debriefing. Results from this study may also help inform future Indigenous health programming in family medicine.

Transect Walk in the Community, a Tool to Understand Community Resources by Medical Undergraduates of an Academic Institution

Introduction: A transect walk is a methodological walk in a well-defined pathway within a particular community/society while simultaneously drawing attention to the location of the community, distribution of resources, different social problems, and the opinion of local people regarding those problems. It is a well-accepted method related to participatory research action. However, the transect walk should have been utilized in the context of undergraduate medical education. Thus, we conducted this study to understand the feasibility and utilization of transect walks in undergraduate medical education. Methodology: We conducted a transect walk activity involving 25 undergraduate students in a village under the rural field practice area of the Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar. We prepared a checklist before conducting the transect walk based on available literature. The checklist was prepared for conducting a resource type of transect walk. The students were divided into four small groups and finally prepared a common diagram after merging all initial diagrams for better understanding and utilization of the activity. Results: The student identified different housing types, various water sources, and places for garbage disposal. They also identified important institutions like banks, local administration offices, and schools. The problem such as the absence of a wastewater disposal system, was identified during this activity. Conclusion: Students utilized the transect walk to understand the various public health issues and resources. This method was found to be an effective way of understanding different community resources.

Strategies and Barriers for Diversity, Equity, Inclusion, and Antiracism Work in Family Medicine Departments: A CERA Study.

Medical schools and family medicine organizations have been working on advancing diversity, equity, inclusion, and antiracism (DEIA). Black, Indigenous, and People of Color (BIPOC) faculty members are disproportionately expected to lead DEIA initiatives, negatively affecting academic promotion and well-being. Our study aimed to describe the existing DEIA initiatives, strategies, and barriers to implementing support for DEIA work, as well as the implications of addressing the minority tax in US and Canadian family medicine departments. We used data collected as a part of the 2023 Council of Academic Family Medicine Educational Research Alliance (CERA) study. The survey was delivered to 227 department chairs across the United States and Canada. The survey response rate was 50.2% (114/227). Sixty-two percent of the respondents strongly agreed that advancing DEIA was important, and 55.4% reported having a DEIA leader, with 75.4% of those positions reportedly held by BIPOC faculty. Lack of funding was identified as the most significant barrier (26.2%), followed by lack of faculty expertise (18.7%). Department chairs who strongly agreed that DEIA work was important were significantly more likely to report having a DEIA committee, mentorship for BIPOC faculty, and a holistic review for faculty recruitment than those who did not strongly agree. Though most department chairs perceived advancing DEIA work as important, appropriate compensation and institutional support are often lacking. Further study is needed to explore ways in which departments can enhance their institutional support for DEIA initiatives.

The future of AI clinicians: assessing the modern standard of chatbots and their approach to diagnostic uncertainty

BackgroundArtificial intelligence (AI) chatbots have demonstrated proficiency in structured knowledge assessments; however, there is limited research on their performance in scenarios involving diagnostic uncertainty, which requires careful interpretation and complex decision-making. This study aims to evaluate the efficacy of AI chatbots, GPT-4o and Claude-3, in addressing medical scenarios characterized by diagnostic uncertainty relative to Family Medicine residents.MethodsQuestions with diagnostic uncertainty were extracted from the Progress Tests administered by the Department of Family and Community Medicine at the University of Toronto between 2022 and 2023. Diagnostic uncertainty questions were defined as those presenting clinical scenarios where symptoms, clinical findings, and patient histories do not converge on a definitive diagnosis, necessitating nuanced diagnostic reasoning and differential diagnosis. These questions were administered to a cohort of 320 Family Medicine residents in their first (PGY-1) and second (PGY-2) postgraduate years and inputted into GPT-4o and Claude-3. Errors were categorized into statistical, information, and logical errors. Statistical analyses were conducted using a binomial generalized estimating equation model, paired t-tests, and chi-squared tests.ResultsCompared to the residents, both chatbots scored lower on diagnostic uncertainty questions (p < 0.01). PGY-1 residents achieved a correctness rate of 61.1% (95% CI: 58.4–63.7), and PGY-2 residents achieved 63.3% (95% CI: 60.7–66.1). In contrast, Claude-3 correctly answered 57.7% (n = 52/90) of questions, and GPT-4o correctly answered 53.3% (n = 48/90). Claude-3 had a longer mean response time (24.0 s, 95% CI: 21.0-32.5 vs. 12.4 s, 95% CI: 9.3–15.3; p < 0.01) and produced longer answers (2001 characters, 95% CI: 1845–2212 vs. 1596 characters, 95% CI: 1395–1705; p < 0.01) compared to GPT-4o. Most errors by GPT-4o were logical errors (62.5%).ConclusionsWhile AI chatbots like GPT-4o and Claude-3 demonstrate potential in handling structured medical knowledge, their performance in scenarios involving diagnostic uncertainty remains suboptimal compared to human residents.