Department Of General Practice Research Articles

The transition of general practice into an academic discipline: tracing the origins through the first four professors in general practice/family medicine

Being the ‘mother’ of most clinical specialties, general practice is as old as medicine itself. However, as a recognized academic discipline within medical schools, general practice has a relatively short life span. A decisive step forward was taken in 1956 when the University of Edinburgh established its Department of General Practice, and appointed the world’s inaugural professor in the field in 1963. During the 1960s, the pioneering move in Edinburgh was followed by universities in the Netherlands (University of Utrecht), Canada (Western University, Ontario), and Norway (University of Oslo), marking the beginning of global academic recognition for general practice/family medicine. Despite its critical role in healthcare, the academic evolution of general practice has been sparingly documented, with a notable absence of comprehensive accounts detailing its integration into medical schools as an independent discipline with university departments and academic professors. Last year (2023) marked the 60th anniversary of Dr. Richard Scott’s historic appointment as the first professor of General Practice/Family Medicine. Through the lens of the first four professors appointed between 1963 and 1969, we explore the ‘birth’ of general practice to become an academic discipline. In most western countries of today, general practice has become a recognized medical discipline and an important part of the medical education. But many places, this development is lagging behind. The global shaping of general practice into an academic discipline is therefore definitively not completed.

Asking the generalist – evaluation of a General Practice rounding and consult service

BackgroundVascular surgery patients admitted to the hospital are often multimorbid. In case of questions regarding chronic medical problems different specialties are consulted, which leads to a high number of treating physicians and possibly contradicting recommendations. The General Practitioner´s (GP) view could minimize this problem. However, it is unknown for which medical problems a GP would be consulted and if regular GP-involvement during rounds would be considered helpful by the specialists. The aim of this study was to establish and describe a General Practice rounding service (GP-RS), to evaluate if the GP-RS is doable in a tertiary care hospital and beneficial to the specialists and to explore GP-consult indications.MethodsThe GP-RS was established as a pilot project. Between June-December 2020, a board-certified GP from the Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf (UKE) joined the vascular surgery team (UKE) once-weekly on rounds. The project was evaluated using a multi-methods approach: semi-structured qualitative interviews were conducted with vascular surgery physicians that had either participated in the GP-RS (G1), had not participated (G2), other specialists usually conducting consults on the vascular surgery floor (G3) and with the involved GP (G4). Interviews were analyzed using Kuckartz’ qualitative content analysis. In addition, two sets of quantitative data were descriptively analyzed focusing on the reasons for a GP-consult: one set from the GP-RS and one from an established, conventional “as needed” GP-consult service.Results15 interviews were conducted. Physicians perceived the GP-RS as beneficial, especially for surgical patients (G1-3). Optimizing medication, avoiding unnecessary consults and a learning effect for physicians in training (G1-4) were named as other benefits. Critical voices saw an increased workload through the GP-RS (G1, G3) and some consult requests as too specific for a GP (G1-3). Based on data from 367 vascular surgery patients and 80 conventional GP-consults, the most common reasons for a GP-consult were cardiovascular diseases including hypertension and diabetes.ConclusionsA GP-RS is doable in a tertiary care hospital. Studies of GP co-management model with closer follow ups would be needed to objectively improve patient care and reduce the overall number of consults.Trial registrationNot applicable.

Clinico-Epidemiological Profile of COVID-19 of Patients Presenting to Emergency Department of a Tertiary Medical College of Central Nepal

Background Clinico-epidemiological profile of COVID-19 includes varied clinical symptoms like fever, cough, and fatigue, with a potential for rapid community spread through respiratory droplets. Understanding the clinical characteristics of patients is crucial for planning human resources and logistics support. This study aims to identify the clinical characteristics observed in patients suspected of having COVID-19 presenting to emergency department of College of Medical Sciences and Teaching Hospital. MethodsThis is a retrospective cross-sectional study conducted at Department of General Practice and Emergency Medicine of College of Medical Sciences, Bharatpur, Nepal from April 2020 to February 2021. Ethical approval was taken from institutional review committee of College of Medical Sciences. Data was collected from record file of emergency department. Data was entered and analyzed by using descriptive statistical tools in SPSS-20.ResultsMajority (25.2%) of them were in the age group 50-60 years. Mean±SD of age was 55.2±16.5 years. Majority (54.3%) respondents were male. In presenting complaints 71.42% had cough, 69.5% had fever, 62.9% had shortness of breath. Also, 34.28% had severe symptoms, and 33.34% had moderate symptoms, 20% were asymptomatic and 12.38% had mild symptoms. Finding showed that 69.52% of patients required oxygen supplementation. The motility of COVID-19 patients during emergency stay was 6.67% while 36.19% were admitted in ward and 31.43% were admitted in ICU, 20% patients were sent for home isolation.Conclusions Young adults were the most commonly affected age group and males showed a higher incidence of COVID-19. Since many patients were symptomatic with fever and cough as the typical presentations in the emergency department. Majority of patients during presentation had moderate and severe symptoms and needed oxygen supplementation.

Enhancing End-Of-Life Care for Patients and Personnel: A Survey Exploring Personnel’s Experiences and the Potential Impact of an Acute Palliation Kit in the North Denmark Region

Background: Many patients want to die at home, but do not get their wishes fulfilled. To combat this, it is important to understand the challenges that stand in the way of healthcare professionals providing quality end-of-life care (EOL) in the patient’s own home.
 Aim: The aims of this study were to 1) determine if staff at Emergency Departments experienced significant challenges related to EOL care, 2) how often this led to unnecessary hospital admissions, and 3) if a new “Acute Palliation Kit” (APK) might alleviate some of the challenges identified above.
 Methods: This was a cross-sectional survey among doctors (n=53) and nurses (n=74) working in Departments of Emergency Medicine or General Practice in the North Denmark Region. The questionnaire covered the healthcare professionals’ backgrounds, their perceptions of current challenges in EOL care, and the potential effects of the APK.
 Results: Among the healthcare professionals, 53% of responders found the most challenging aspect of EOL care to be “Logistic Issues” and 21% “Time consumption”. Out of the responders, 64% had sometimes, often, or always felt the need to admit/maintain admission/push to admit a dying patient, because it was too challenging to start the EOL care at home. On the potential effect of APK, 74% thought it would save time. In addition, most responders thought it would give both the patient and their next of kins better EOL care.
 Conclusion: This study showed that doctors and nurses in Departments of Emergency Medicine found discharging patients to EOL care at home challenging mainly due to logistic problems leading to hospital admissions. This was often contrary to the patient’s wishes and takes time and resources from the healthcare professionals. In the future, logistics of EOL care must be simplified if fewer patients are to be admitted to die. A pre-packed EOL care kit might reduce logistics but needs evaluation in dedicated studies.

Research-to-practice conference as a component of improving knowledge and mastering professional competencies by medical students and young scientists

Aim. To evaluate the importance of certain aspects of research-to-practice conferences, organized by the Department of General Practice of Pirogov Russian National Research Medical University, as well as its contribution to preparing students for future professional activities within the outpatient healthcare and the impact of these events on the interest of participants and speakers for research work.Material and methods. An anonymous online survey included 37 participants in the discussed conferences regarding the respondents’ motivation to attend conferences, assessment of declared subject coverage, the practical applicability of the knowledge gained and other aspects.Results. The most important motivating factors for conference participation were interest in outpatient healthcare (52,4% for the conference "Internal diseases at the prehospital stage" and 87,5% for the conference "A multimorbid patient — continuity between hospital and clinic"), analysis of interesting cases (66,7% and 75%, respectively) and multidisciplinary focus of activities (47,6% and 68,8%). An important aspect was the coverage of current problems of practical healthcare. The most important results were considered by the majority of participants to be expanding their medical horizons (85,7% and 87,5%) and gaining new knowledge on the declared subject (90,5% and 75%). Almost half of the respondents (52,4% and 56,3%) improved their interest in scientific activities as a result of visiting the conferences.Conclusion. Conducting research-to-practice conferences for students, residents and postgraduates serves as a platform for increasing the knowledge and mastering professional competencies. The results of a survey of conference participants and speakers indicate the relevance of involving students in conferences and the numerous benefits they receive, which are discussed in detail in this article.

Expert consensus on clinical application of Lixuwang~® Xuesaitong Soft Capsules

Lixuwang~® Xuesaitong Soft Capsules(referred to as "Xuesaitong Soft Capsules") have the effects of promoting blood circulation, resolving blood stasis, and dredging meridians and collaterals. They are widely used in the prevention and treatment of cardiovascular and cerebrovascular diseases in clinical practice. Through years of clinical observation, they have shown significant efficacy in ischemic stroke, coronary heart disease, and other diseases, and have been recommended by multiple guidelines, consensus statements, and monographs. Based on the summary of clinical application experience by doctors and existing evidence-based research, following the Technical Specifications for Consensus Development of Chinese Patent Medicine by Clinical Experts issued by Standardization Office of the Chinese Association of Traditional Chinese Medicine, a nominal group method was used to reach 19 recommended opinions/consensus suggestions. This document proposes the timing of medication, syndrome differentiation for medication, therapeutic effects, dosage and administration, treatment duration, economic considerations, and safety considerations in the use of Xuesaitong Soft Capsules for the treatment of ischemic stroke and angina pectoris in coronary heart disease. It is intended for doctors in internal medicine, encephalopathy(neurology), cardiovascular medicine, geriatrics, emergency medicine, general practice, and traditional Chinese medicine departments of various medical institutions, as well as pharmacists in hospitals and pharmacies, as a medication reference when using Xuesaitong Soft Capsules. It is hoped that the widespread application of this consensus can improve the clinical efficacy of Xuesaitong Soft Capsules in the treatment of ischemic stroke and coronary heart disease, promote rational drug use, and reduce medication risks. This consensus has been reviewed and published by the China Association of Traditional Chinese Medicine, with the identification number GS/CACM 323-2023.

Development and validation of a nomogram for arterial stiffness.

Even though as a gold standard for noninvasive measurementof arterial stiffness, carotid-femoral pulse wave velocity (cfPWV) is not widely used in primary healthcare institutions due to time-consuming and unavailable equipment. The aim of this study was to develop a convenient and low-cost nomogram model for arterial stiffness screening. A cross-sectional study was undertaken in the department of general practice, the First Affiliated Hospital of Fujian Medical University. Arterial stiffness was defined as cfPWV≥10m/s. A total of 2717 participants were recruited to construct the nomogram using the least absolute shrinkage and selection operator and logistic regressions. Receiver operating characteristic (ROC) curve, calibration curve, decision curve analysis, clinical impact curve were used to evaluate the performance of the model. The model was validated internally and externally (399 participants) by bootstrap method. Arterial stiffness was identified in 913 participants (33.60%). Age, sex, waist to hip ratio, systolic blood pressure, duration of diabetes, heart rate were selected to construct the nomogram model. Good discrimination and accuracy were exhibited with area under curve of 0.820 (95% CI 0.803-0.837) in ROC curve and mean absolute error=0.005 in calibration curve. A positive net benefit was shown in decision curve analysis and clinical impact curve. A satisfactory agreement was displayed in internal validation and external validation. The low cost and user-friendly nomogram is suitable for arterial stiffness screening in primary healthcare institutions.

Audit of observation ward supporting emergency room at tertiary care hospital: Kathmandu, Nepal

Introduction: Tribhuvan University Teaching Hospital is a tertiary care hospital of Nepal. In an average, 118 cases visit TUTH emergency per day. After initial management in Emergency, patients are either admitted in specialty departments or are observed in observation ward under Department of General Practice. Method: It was audit report carried out among the patients admitted to observational ward of TUTH. It included data of one month. Result: Total of 205 patients were admitted to observation ward, 16 (7.8%) were later on transferred in various other wards of hospital and 189 (92%)patients were admitted in the observation ward. The common admitting diagnosis was seen to be Dengue fever82(40%), followed by COPD 20(9.7%). Conclusion: For those patients presenting in emergency room, observation wards is better alternative for continuing medical care after getting emergency care.

Role of General Practice Led Observation Ward to Support Emergency Ward to Improve Health Outcomes at a Major Kathmandu Hospital in Nepal

Introduction:Tribhuvan University Teaching Hospital (TUTH) is a tertiary care hospital in Kathmandu. The emergency department sees between 130 to 140 cases per day. These patients get initial evaluation and basic investigation for acute emergency management and treatment. Those requiring further treatment are then admitted to the department of General Practice for post emergency care which acts as an observation ward. This step allows for the patients to be observed on a short-term basis and permits patient monitoring and/or treatment for an initial 24-48 hour period and up to a maximum of five days. These steps allow for focused follow up, improved efficiency and minimizes inappropriate admissions to other hospital inpatient wards. This paper evaluates functionality, admission criteria, patient categorization and subspeciality referral to specialty patient care, discharge criteria and cost effectiveness.Method:A descriptive observational study was carried out of the patients admitted to the observational ward between 2020-2021.Results:Most articles suggest these wards improve patient satisfaction and clinical care, decrease length of stay, reduce unnecessary inpatient hospital admissions and are useful in fever under evaluations, COPD, poisoning, pneumonia, mild head injuries, high sugar, hypertension, gastroenteritis etc. Around 14% of patients were sent to the observation ward after acute emergency care. 84% were discharged from observation ward with a mean stay of three days and were followed up in community care or GP OPD. Nine percent were admitted to hospital wards, and 7% transferred to yellow/red area emergencies for derange vitals.Conclusion:Observation wards seem to have advantages, excluding those who will inevitably need longer treatment, reduces cost savings and unnecessary burden of hospital admission.

Metabolic Syndrome among Stable Chronic Obstructive Pulmonary Disease Patients Visiting Outpatient Department of a Tertiary care centre: A Descriptive Cross-sectional Study

Metabolic syndrome; a constellation of obesity, hypertension, and disturbances of lipid and carbohydrate metabolism is a common phenomenon in chronic obstructive pulmonary disease. Systemic inflammation plays an important role in both conditions. The aim of this study was to find out the prevalence of metabolic syndrome among stable chronic obstructive pulmonary disease patients visiting the outpatient Department of a tertiary care centre. A descriptive cross-sectional study was done in the outpatient Department of Pulmonology and General Practice from 1 August 2019 to 31 December 2020. Ethical approval was obtained from Institutional Review Committee [Registration number: 5/(6-11)E2/076/077]. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Among 57 patients with stable chronic obstructive pulmonary disease, the prevalence of metabolic syndrome was 22 (38.59%) (27.48-49.70, 90% Confidence Interval). The prevalence of metabolic syndrome in patients with Global Initiative for Obstructive Lung Disease stages 1, 2, 3, and 4 were 6 (27.27%), 9 (40.90%), 6 (27.27%) and 1 (4.54%) respectively. The prevalence of metabolic syndrome was similar to the other studies done in similar settings. The screening of metabolic syndrome is necessary and stratification for cardiovascular disease risk is important for timely intervention to prevent and decrease morbidities and mortalities. chronic obstructive pulmonary disease; c-reactive protein; metabolic syndrome.

Metabolic Syndrome among Stable Chronic Obstructive Pulmonary Disease Patients Visiting Outpatient Department of a Tertiary care centre: A Descriptive Cross-sectional study.

Metabolic syndrome; a constellation of obesity, hypertension, and disturbances of lipid and carbohydrate metabolism is a common phenomenon in chronic obstructive pulmonary disease. Systemic inflammation plays an important role in both conditions. The aim of this study was to find out the prevalence of metabolic syndrome among stable chronic obstructive pulmonary disease patients visiting the outpatient Department of a tertiary care centre. A descriptive cross-sectional study was done in the outpatient Department of Pulmonology and General Practice from 1 August 2019 to 31 December 2020. Ethical approval was obtained from Institutional Review Committee [Registration number: 5/(6-11)E2/076/077]. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Among 57 patients with stable chronic obstructive pulmonary disease, the prevalence of metabolic syndrome was 22 (38.59%) (27.48-49.70, 90% Confidence Interval). The prevalence of metabolic syndrome in patients with Global Initiative for Obstructive Lung Disease stages 1, 2, 3, and 4 were 6 (27.27%), 9 (40.90%), 6 (27.27%) and 1 (4.54%) respectively. The prevalence of metabolic syndrome was similar to the other studies done in similar settings. The screening of metabolic syndrome is necessary and stratification for cardiovascular disease risk is important for timely intervention to prevent and decrease morbidities and mortalities. chronic obstructive pulmonary disease; c-reactive protein; metabolic syndrome.

Evaluating dermatology education in Australia: Medical students' and junior doctors' perceptions.

Despite a high frequency of dermatological general practice and emergency department presentations, including serious and potentially fatal skin conditions, evidence suggests that undergraduate dermatological education remains sparse. Given this, there exists a need to gauge dermatology-relevant knowledge and skill in our new doctors. An online survey was completed by final-phase medical students and junior doctors from Australian medical schools. The survey appraised self-perceived confidence of dermatology knowledge and skills, in addition to 5 knowledge-based multiple-choice questions. Nine hundred and forty-two eligible responses were completed. Respondents reported low confidence in identifying dermatological conditions in people with skin of colour (μ=1.69), handing over to dermatology colleagues (μ=2.00) and in diagnosing and managing acute/emergency dermatology conditions (μ=1.84). In contrast, participants felt most confident in counselling sun-protective behaviours (μ=3.95) and suturing small wounds (μ=3.43). 76.4% of respondents had not undertaken any dermatology placement, and 70.9% had never been formally assessed in dermatology. Those who received dermatology placement had a significantly higher aggregated self-reported confidence (p < 0.0001) and answered significantly more MCQs correctly (p=0.0419). Those who had been formally assessed had a significantly higher self-reported confidence (p < 0.001) and answered significantly more MCQs correctly (p=0.007). Final-phase medical students and junior doctors exhibit low confidence across many dermatology competencies. Participants believed they need more dermatology education, and seldom feel prepared when exposed to dermatologic pathologies. Introduction of a standardised curriculum, formal assessments and increased clinical exposure are possible solutions.

Patient representation in New Zealand general practice and rural health case-based teaching: a quality improvement exercise.

Introduction Healthcare inequity disproportionately affects minority populations in Aotearoa New Zealand. Healthcare providers may contribute to inequity due to their biases. Medical education can unintentionally promote biases by reinforcing stereotypes or limiting exposure to diversity. Teaching staff from the Department of General Practice and Rural Health suggested a need to review current teaching materials to ascertain if they have the potential to contribute to this bias. Aim The aim of this study was to review case-based teaching material to determine its representation of the New Zealand population, and whether there is potential to contribute to implicit bias. Methods Document analysis of 135 cases used to teach fourth- and fifth-year medical students in the Department of General Practice and Rural Health, Otago Medical School was performed. Demographic, clinical and social features of each case were recorded and analysed. Results Cases typically included patient age (129/135, 95.6%), sex (127/135, 94.1%) and occupation status (91/136, 66.9%). Ethnicity (31/135, 23.0%), living situation (55/135, 40.7%), relationship status (57/135, 42.2%) and sexual orientation (52/135, 40.0%) were less frequently defined. Cases typically represented the population majority norms. Discussion Case-based teaching materials require regular review and updating to match population demographics. There is potential to improve representation of diversity, and hence cultural safety, though review and revision of written teaching cases.

The place of digital triage in a complex healthcare system: An interview study with key stakeholders in Australia's national provider.

Digital triage tools such as telephone advice and online symptom checkers are now commonplace in health systems internationally. Research has focused on consumers' adherence to advice, health outcomes, satisfaction, and the degree to which these services manage demand for general practice or emergency departments. Such studies have had mixed findings, leaving equivocal the role of these services in healthcare. We examined stakeholders' perspectives on Healthdirect, Australia's national digital triage provider, focusing on its role in the health system, and barriers to operation, in the context of the COVID-19 pandemic. Key stakeholders took part in semi-structured interviews conducted online in the third quarter of 2021. Transcripts were coded and thematically analysed. Participants (n = 41) were Healthdirect staff (n = 13), employees of Primary Health Networks (PHNs; n = 12), clinicians (n = 9), shareholder representatives (n = 4), consumer representatives (n = 2) and other policymakers (n = 1). Eight themes emerged from the analysis: (1) information and guidance in navigating the system, (2) efficiency through appropriate care, (3) value for consumers? (4) the difficulties in triage at a distance, (5) competition and the unfulfilled promise of integration, (6) challenges in promoting Healthdirect, (7) monitoring and evaluating digital triage services and (8) rapid change, challenge and opportunity from COVID-19. Stakeholders varied in their views of the purpose of Healthdirect's digital triage services. They identified challenges in lack of integration, competition, and the limited public profile of the services, issues largely reflective of the complexity of the policy and health system landscape. There was acknowledgement of the value of the services during the COVID-19 pandemic, and an expectation of them realising greater potential in the wake of the rapid uptake of telehealth.

Correlation between arterial and venous sodium and potassium values in critically ill patients by arterial blood gas and electrolyte analyzer attending tertiary hospital of Nepal

Introduction: Electrolytes are elements and compounds that occur naturally in the body and control important physiological function. Electrolyte disorder occurs when the levels of electrolytes in the body are either too high or too low. The causes, severity, treatment, and outcomes can vastly differ depending on the implicated electrolyte imbalances. The objective of this study is to comprehend the correlation between sodium and potassium levels measured in critically ill patients attending a tertiary care hospital of Nepal.&#x0D; &#x0D; Method: This study was a hospital based prospective observational comparative study conducted in the Department of General Practice and Emergency Medicine, Bir hospital, Kathmandu, from June 2019 to December 2019. After fulfilling inclusion and exclusion criteria a total of 95 patients were included in the study. Data were entered and analyzed in SPSS 20. The findings were presented in figures and tables. Statistical analysis was done using appropriate formula. Mean, standard deviation and correlation coefficient were calculated.&#x0D; &#x0D; Result: The mean value of arterial sodium was 134.67mmol/L and venous sodium was 135.93mmol/L. The mean value of arterial potassium was 4.0mmol/L and venous potassium was 4.19mmol/L. The correlation coefficient obtained for sodium was 0.703 and for potassium was 0.436. There was positive correlation of arterial sodium and arterial potassium with venous sodium and venous potassium indicating agreement between the parameters.&#x0D; &#x0D; Conclusion: Arterial sodium and arterial potassium can be used instead of venous sodium and venous potassium levels in management of critically ill patients.

A face-to-face national congress experience during the COVID-19 pandemic: A report focussing on the risk of COVID-19 contamination

Background The Congress of the National College of Academic General Practitioners took place in France in June 2021. In total, 1300 participants were registered, provoking concerns about the risk of COVID-19 contamination. Objectives The study objective was to report participation in the first French face-to-face medical congress after restrictions due to COVID-19 and whether it resulted in COVID-19 contamination. Methods We performed two web-based surveys of respectively 46 and 33 questions. The first questionnaire was sent to all congress participants during the congress (and to a panel of non-participants) and investigated demographic characteristics, medical conditions, behaviours related to COVID-19 contamination risk, and the interest of face-to-face congress as compared to virtual congress. Two weeks after the congress, a questionnaire was addressed to the same population and to university General Practice departments to identify incident COVID-19 cases among participants. Results A total of 1001 general practitioners and residents completed the first questionnaire; 752 participated in the congress. The respondents were mainly women (61.3%), with a mean age of 35 (SD 10) years, 96.2% had been vaccinated against SARS-CoV-2, and 11.4% considered themselves at risk for a severe form of COVID-19 for medical reasons. Concerning the interest in attending the congress face-to-face, mean score was 9 over 10 (SD 1.5). No case of COVID-19 was reported among participants according to the second questionnaire (449 respondents). Conclusion During a world pandemic, even participants considering themselves at risk came to a medical congress, highlighting the networking and social aspects of a face-to-face congress.

Abstract 10774: An Ambulatory Syncope Service is a Safe Pathway to Reduce Hospital Admissions

Introduction: Syncope affects up to 50% of people during a lifetime and is a common presentation to Emergency Departments (EDs). The Ambulatory Emergency Care Unit (AECU) Syncope pathway was established at our institution as a route by which low-risk patients presenting with syncope can undergo investigations without requiring hospital admissions as well as reducing length of stay for patients awaiting cardiology input. Hypothesis: The AECU Syncope pathway at Northwick Park Hospital, London, UK is safe and effective in reducing hospital admissions. Methods: We conducted a retrospective study of patients seen via the AECU Syncope pathway in 2020. These were referrals from the Emergency Department, General Practice and Inpatient departments for 24-hour tapes and echocardiograms. Results: A total of 221 patients were referred to the AECU syncope pathway in 2020. Of these, 36 patients (16%) had abnormalities on 24-hour tape. The majority were ectopics (n=12) but patients were also found to have arrhythmias (n=10), bradycardia (n=8) and heart block (n=6). 10 patients had aortic valve dysfunction identified on echocardiogram: 4 had severe aortic stenosis and the rest had milder classifications of aortic valve dysfunction. In total, 42 of the 221 patients had an abnormality on echocardiogram and/or 24-hour tape. Of these 42 patients, 14 were discharged as their abnormalities were insignificant for further cardiology input. 28 were referred to cardiology clinic for review as an outpatient. In terms of readmissions, 6 patients had readmissions within 30 days but only 1 patient had a readmission attributed to syncope, and this was a presyncope episode for which the patient was safety netted for during the previous admission. There were no deaths reported within 30 days of presentation. Within 1 year, there were 2 deaths, but neither were attributed to a major adverse cardiovascular event. Conclusions: The AECU syncope pathway presents a viable, efficient and safe route by which low-risk patients who are under investigation for a presumed syncopal episode can receive cardiology input without requiring a prolonged hospital admission. In doing so, there is a significant benefit to hospitals by reducing strain on bed space and staffing, thereby improving patient flow.

Risk Factors of Coronary Artery Disease: A Hospital-Based Study.

Coronary artery disease is among the leading cause of morbidity and mortality worldwide. There are limited scientific evidence on the risk factors for coronary artery disease specific to the Nepalese context. This study aimed to determine the association of various modifiable cardiovascular risk factors with coronary artery disease in Nepal. It is a hospital-based case-control study conducted among 300 participants. Case group comprised of 150 newly diagnosed coronary artery disease patients attending Manmohan Cardiothoracic Vascular and Transplant Centre while the Age and sex matched non-cardiac patients (n=150) from the outpatient department of the Department of General Practice and Emergency Medicine of Tribhuvan University Teaching Hospital were recruited as controls. Adjusted odds ratios (AOR) were calculated using multivariable logistic regression. Of the 300 participants, 208 (69.3%) were males and 92 (30.7%) were females. The mean age was 59.8 years ± 11 years (standard deviation). In multivariable analysis, current smoking (AOR=3.05, 95% CI: 1.61-5.78), hypertension (AOR=1.82, 95% CI: 1.08-3.09), diabetes (AOR=3.78, 95% CI: 1.91-7.47), family history of coronary artery disease (AOR=2.92, 95% CI: 1.27-6.71), and low high density lipoprotein (AOR= 2.0, 95% CI: 1.17-3.42) were significantly associated with coronary artery disease. Current alcohol use (AOR=0.51, 95% CI: 0.29-0.89) was identified as a protective factor for coronary artery disease. Among the modifiable cardiovascular risk factors, smoking, hypertension, diabetes, and low level of high density lipoprotein were significantly associated with coronary artery disease, which should be considered while developing public health interventions for cardiovascular disease prevention in Nepal in future.

Exploration and Practice of Specialty Training Program in General Practice

Innovation is the lifeline of medical education reform in the new era. Based on the strategic goals of the Healthy China Initiative, we presented in this paper the practical experience of the Department of General Practice, West China Hospital, Sichuan University. We proposed the construction of an integrated model of general practitioner (GP) core competency training program consisting of 4 components, medical service, management, education, and academic ability. The integration of "generalist-specialist" and "hospital-community health service center" forms the basis of the coordinated training rotation plans. This model of training promotes collaboration among the GPs. Furthermore, GP with special interests (GPwSI) training is organically incorporated into the content of the program. In addition, we discussed the diversified approaches to evaluation incorporating formative and summative evaluation measures adopted for the training program. We summarized the innovative implementation plan of GPwSI, which is an efficient, replicable, and generalizable standardized specialty training program compatible with the Healthy China Initiative, intending to contribute constructive information and references to the education reform of the GP standardized training under the new circumstances.

Willingness of French General Practitioners to Prescribe mHealth Apps and Devices: Quantitative Study.

BackgroundThe field of mobile health (mHealth) is constantly expanding. Integrating mHealth apps and devices in clinical practice is a major and complex challenge. General practitioners (GPs) are an essential link in a patient’s care pathway. As they are patients’ preferred health care intermediaries, GPs play an important role in supporting patients’ transition to mHealth.ObjectiveThis study aims to identify the factors associated with the willingness of French GPs to prescribe mHealth apps and devices to their patients.MethodsThis study was part of the ApiAppS project whose overall objective was to help remove barriers GPs face when prescribing mHealth apps and devices by developing a custom-built platform to aid them. The study included GPs recruited from the general practice department of several medical faculties in France (Lyon, Nice, and Rouen) and mailing lists of academic GPs, health care professional associations, and social and professional networks. Participants were asked to complete a web-based questionnaire that collected data on various sociodemographic variables, indicators of their involvement in continued education programs and the amount of time they dedicated to promoting healthy behaviors during patient consultations, and indicators characterizing their patient population. Data on their perceptions of mHealth apps and devices were also collected. Finally, the questionnaire included items to measure GPs’ acceptability of prescribing mHealth apps and devices for several health-related dimensions.ResultsOf the 174 GPs, 129 (74.1%) declared their willingness to prescribe mHealth apps and devices to their patients. In multivariate analysis, involvement in continued education programs (odds ratio [OR] 6.17, 95% CI 1.52-28.72), a better patient base command of the French language (OR 1.45, 95% CI 1.13-1.88), GP-perceived benefits of mHealth apps and devices for both patients and their medical practice and GP-perceived drivers for mHealth apps and device implementation in their medical practice (OR 1.04, 95% CI 1.01-1.07), and validation of mHealth apps and devices through randomized clinical trials (OR 1.02, 95% CI 1.00-1.04) were all associated with GPs’ willingness to prescribe mHealth apps and devices. In contrast, older GPs (OR 0.95, 95% CI 0.91-0.98), female GPs (OR 0.26, 95% CI 0.09-0.69), and those who perceived risks for the patient or their medical practice (OR 0.96, 95% CI 0.94-0.99) were less inclined to prescribe mHealth apps and devices.ConclusionsmHealth apps and devices were generally seen by GPs as useful in general medicine and were, for the most part, favorable to prescribing them. Their full integration in general medicine will be conditioned by the need for conclusive certification, transparency (reliable and precise data concerning mHealth app and device methods of construction and clinical validation), software aids to assist GPs prescribe them, and dedicated training programs.