Education Of Primary Care Physicians Research Articles

Clinical cohort of nonalcoholic fatty liver disease in a primary care setting.

Nonalcoholic fatty liver disease (NAFLD) is increasingly common, and primary care physicians (PCPs) are often the first to diagnose NAFLD. While guidelines on NAFLD management in primary care exist, there are limited data on clinical practice patterns. We gathered data from over 370,000 patients with at least one PCP visit between July 2016 and September 2023. Using ICD-10 codes to identify patients with a diagnosis of NAFLD or Nonalcoholic Steatohepatitis (NASH), we extracted demographics, comorbidities, laboratory results, prescriptions, imaging orders, and referrals to describe their care. We identified 10,334 patients with a diagnosis code of NAFLD (93.1%) and/or NASH (16.7%) during a PCP visit. Just over half (54.8%) were female, mean age was 52.8 years, and mean BMI was 33.2 kg/m2 with 90% having overweight or obese. More than 50% had hypertension and hyperlipidemia, and 38% had diabetes. At the diagnosis visit, 2.7% had ultrasound elastography ordered, 2.7% liver biopsy, and less than 1% magnetic resonance elastography. During follow-up ranging from 0 to 7 years, patients had a mean of 15 encounters, during which 4% were diagnosed with fibrosis or cirrhosis. Only 24.2% of patients were referred to a nutritionist and 18% had an appointment, and only 0.7% were referred to hepatology and 3.8% saw a hepatologist. PCPs have not widely implemented clinical practice guidelines for NAFLD, resulting in suboptimal care including for the substantial minority with fibrosis or cirrhosis. Patients might benefit from targeted NAFLD education for PCPs and improved decision and management support.

Eosinophilic Cellulitis (Well’s Syndrome) and Eosinophilic Granulomatosis with Polyangiitis (Churgg-strauss Syndrome); Different Clinical Entities, or a Single Spectrum of Disease? A Case Study, Discussion and Literature Review

This case study represents an unusual presentation female in her seventies who presented with a chronic eosinophilic rash without systemic involvement on a background of psoriatic arthritis (pSA) and Sjogren’s Syndrome (sSS). Biopsy of the lesions identified flame figures. The differentials for such lesions are wide, however this case discusses three of the most likely differentials including Eiosinophilic Cellulitis (Well’s Syndrome), Eosionophilic Granlomatosis with Polyangiitis (Churgg Strauss Syndrome) and Granulomatous Dermatitis (GD). A common aberrant eiosinophilic response is dicussed and a review of the literature identifies the possibility that these diagnoses represent a single spectrum of disease, rather than separate clinical entities. Whilst the provoking incident was not able to be established in this case, the possibility of covid-19 vaccination contributing to the development of lesions is discussed. This case highlights the importance of conducting skin biopsies of unusual lesions that do not follow an expected clinical course and that skin biopsies might need to be performed opportunistically by emergency departments especially in rural areas where dermatology services are lacking. A lack of knowledge of various complex systemic diseases that present with unusual skin lesions often results in missed diagnosis and delayed patient care. Education of primary care physicians and healthcare professionals working in emergency departments is required to ensure timely biopsy and appropriate serology with screening for underlying systemic diseases including malignancy is required to prevent missed diagnosis and delayed care.

Advancing Global Health Through Primary Care Physician Education on Suicide Prevention.

The rising global suicide rate presents a major public health concern, resulting in the loss of over 700,000 lives annually. Discrepancies in the impact of suicide among diverse populations underscore the necessity for targeted prevention strategies. Primary care providers (PCPs) play a crucial role in identifying and managing suicide risk, particularly in underserved areas with limited access to mental health care. Educating PCPs about evidence-based interventions and suicide prevention strategies has demonstrated effectiveness in reducing suicide rates. Landmark initiatives in Australia, Sweden, and Hungary have successfully lowered suicide rates by implementing educational programs for PCPs focused on suicide prevention. Denmark, previously afflicted by some of the highest rates globally in the 1980s, has significantly reduced its figures and now ranks among countries with the lowest rates in high-income nations. Collaborative programs involving PCPs and health workers in low-resource regions have also shown promising outcomes in suicide prevention efforts. Enhancing the expertise of PCPs in suicide prevention can fortify healthcare systems, prioritize mental health, and ultimately save lives, contributing to global health endeavors aimed at addressing the pervasive issue of suicide.

Implementation of an antimicrobial stewardship program for urinary tract infections in long-term care facilities: a cluster-controlled intervention study

BackgroundWidespread inappropriate use of antimicrobial substances drives resistance development worldwide. In long-term care facilities (LTCF), antibiotics are among the most frequently prescribed medications. More than one third of antimicrobial agents prescribed in LTCFs are for urinary tract infections (UTI). We aimed to increase the number of appropriate antimicrobial treatments for UTIs in LTCFs using a multi-faceted antimicrobial stewardship intervention.MethodsWe performed a non-randomized cluster-controlled intervention study. Four LTCFs of the Geriatric Health Centers Graz were the intervention group, four LTCFs served as control group. The main components of the intervention were: voluntary continuing medical education for primary care physicians, distribution of a written guideline, implementation of the project homepage to distribute guidelines and videos and onsite training for nursing staff. Local nursing staff recorded data on UTI episodes in an online case report platform. Two blinded reviewers assessed whether treatments were adequate.Results326 UTI episodes were recorded, 161 in the intervention group and 165 in the control group. During the intervention period, risk ratio for inadequate indication for treatment was 0.41 (95% CI 0.19–0.90), p = 0.025. In theintervention group, the proportion of adequate antibiotic choices increased from 42.1% in the pre-intervention period, to 45.9% during the intervention and to 51% in the post-intervention period (absolute increase of 8.9%). In the control group, the proportion was 36.4%, 33.3% and 33.3%, respectively. The numerical difference between intervention group and control group in the post-intervention period was 17.7% (difference did not reach statistical significance). There were no significant differences between the control group and intervention group in the safety outcomes (proportion of clinical failure, number of hospital admissions due to UTI and adverse events due to antimicrobial treatment).ConclusionsAn antimicrobial stewardship program consisting of practice guidelines, local and web-based education for nursing staff and general practitioners resulted in a significant increase in adequate treatments (in terms of decision to treat the UTI) during the intervention period. However, this difference was not maintained in the post-intervention phase. Continued efforts to improve the quality of prescriptions further are necessary.Trial registrationThe trial was registered at ClinicalTrials.gov NCT04798365.

Screening and Referral Strategies for the Early Recognition of Psoriatic Arthritis Among Patients With Psoriasis: Results of a GRAPPA Survey.

This study aimed to explore the experiences of dermatologists and rheumatologists in the early recognition of psoriatic arthritis (PsA) and to identify potential improvements to the current shared-care model. A 24-question survey addressing referral strategies was constructed by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) project steering committee and sent to all members (n = 927). Questions addressed the use of screening tools, frequency of PsA in patients with psoriasis, therapeutic decision making, and suggestions for earlier PsA recognition and current unmet needs. There were 149 respondents (16.1% response rate), which included 113 rheumatologists from 37 countries and 26 dermatologists from 16 countries. Of the dermatologists, 81% use PsA-specific screening instruments. Conversely, rheumatologists reported that only 26.8% of patients referred to them from all sources had been assessed with screening tools. Although dermatologists reported that a mean of 67% of suspected PsA cases were confirmed, rheumatologists reported a mean of 47.9% of confirmed cases. Both specialties reported similar views regarding optimization of the diagnostic process and indicated that the best approach involved combining patient-reported (ie, screening tools) and physician-confirmed findings. Moreover, both specialties identified the education of primary care physicians (PCPs) and dermatologists as the greatest priority to improve PsA screening. The survey indicated the current unmet needs in the early recognition of PsA. Important areas to address include improving the use of screening instruments, increasing the education of community-based dermatologists and PCPs, and using a combination of patient-reported and physician-confirmed findings in the screening approach.

Modelling the Clinical and Economic Impacts of Foundation-Funded versus Staff-Driven Quality Improvement Mental Health Strategies

BACKGROUND Employing a valid and reliable clinical measurement system established in 2002 within our regional Child and Adolescent, Addictions, Mental Health, and Psychiatry Program, we have been able to measure the effect of the general service system, a novel pre-admission initial family group session to orient families to treatment, and an acute at home care service deigned to divert admissions from emergency to in-home support rather than inpatient admission. Additionally, the modelled clinical effect and economic impact of two community programs; one school-based mental health literacy program and one primary care physician training and education program focusing on the management of children's mental health problems. In this paper, we present an established clinical measurement system combined with standardized cost evaluation strategy to assess the respective cost/benefit impacts of four service innovations. METHODS The clinical measurement system has been described in detail, as has its role in measuring the impact of community-level training on the quality of referrals. Our financial department developed standardized per diem cost references for levels of care within our system. The cost references permitted comparison of groups that were exposed and unexposed to the system innovations before and after the initiation of service and community innovations. The school-based mental health literacy program was a regional implementation of a national program (https://mentalhealthliteracy.org/). The primary care physician education was an internationally develop program from the United States (https://thereachinstitute.org). The other two projects were accomplished on a somewhat smaller local scale and at lower overall cost. The pre-admission initial family group session was a bottom-up, staff-designed and developed quality improvement project. The acute at home project, while funded by the children’s hospital foundation as were the two national and international projects. the acute at home project was a top-down director-designed project with one manager and a coordinator. RESULTS The four innovations were evaluated employing the same model. In each case the clinical space created by each innovation was measured in terms of the cost saved comparing the same outcomes (re-admission rates and lengths of stay) over comparable time intervals between and within pre/post exposed and unexposed groups, whilst controlling for clinical effects of exposure and time. The clinical measurement system helped determine group effects to ensure that the target groups were comparable within each initiative’s exposed and unexposed groups and were appropriately distinct between initiatives (eg, appropriate clinical groups were served by each initiative). While four projects were different and served somewhat different patient groups, the pre-admission initial family group session was the most cost effective. The physician training program was both effective and cost neutral. The school-based mental health literacy program was the least evaluable due to the direction of implementation and tended to increase referrals rather than create clinical space for more affected youth, as might be expected. The acute at home project successfully diverted less suicidal patients away from inpatient readmission over the evaluation period. DISCUSSION The main implications for mental health policy derives from linking standardized cost and clinical measurement models permitting economic evaluation of system and community level innovations. Pre and post clinical and cost measurements within and between exposed and unexposed groups for each innovation or project permitted estimation of benefits and cost. CONCLUSIONS The projects varied in focus together with the evaluability of each project, yet this provided important information for health system innovation and renewal within the context of fiscal constraint. The ranking of the projects in terms of their overall benefits and costs may guide decision-making where maximum return on investment makes the most sense.

Knowledge and Attitude towards Obstructive Sleep Apnea among Primary Care Physicians in Northern Regions of Saudi Arabia: A Multicenter Study.

Obstructive sleep apnea (OSA) is a serious and often underreported condition, despite its highly prevalent distribution. Primary care physicians (PCPs) play an integral role in screening and managing patients with a high risk of developing OSA. This northern Saudi Arabian cross-sectional survey assessed the knowledge and attitude towards OSA among 264 randomly selected PCPs using the OSA Knowledge and Attitude (OSAKA) questionnaire. Among the participating PCPs, 43.9% and 45.1% had low scores in the knowledge and attitude categories, respectively. More than three-fourths (78%) of them recognized that an overnight sleep study is the gold standard for diagnosing OSA. Regarding referral, 39.4% of the OSA patients encountered by the PCPs were referred to ENT specialists, while 21% were referred to sleep clinics, and 18.2% were referred to pulmonologists. Nearly half (50.8%) of the participants recognized OSA as an important clinical disease, and 56.8% were confident in caring for OSA patients. Spearman's correlation of the current study identified a positive correlation between knowledge scores and attitude scores (rho-0.151, p = 0.017). It is important to improve PCPs' knowledge regarding OSA and the necessity for referral through different training methods. Furthermore, the study findings emphasize the need to include appropriate OSA programs and continuing medical education for PCPs.

S1621 Evaluating Knowledge and Approach Towards Helicobacter pylori Diagnosis and Management Among Primary Care Physicians in Cameroon, West Africa

Introduction: Low-middle income countries have high Helicobacter pylori prevalence, with acquisition mostly in early childhood. Recent studies from Africa show especially high rates of resistance to first-line antibiotics used to treat H. pylori. We sought to assess the knowledge and practices of primary care physicians (PCPs) in the diagnosis and management of H. pylori infection in Cameroon. Methods: A hospital-based cross-sectional study was conducted in 4 randomly selected regions of Cameroon, from November 2021 to June 2022. PCPs were recruited by non-probability convenience sampling and interviewed by pre-structured questionnaire on knowledge and approach to H. pylori diagnosis and management. Chi-square, Fisher exact, and Student’s t-tests were performed for descriptive analyses. Multivariable logistic regression was used to examine associations between knowledge and practice, with the model adjusted by PCP age, geographic region, number of patients, and years in practice. Analysis was performed in SAS version 9.4. Results: A total of 382 PCPs were included (Table). Most (60%) were males, between the ages of 26 – 30 years (60%). The majority had been 2 – 6 years in practice (57%), saw < 10 patients per day (54%), and had not attended postgraduate training on H. pylori (87%). About 80% of PCPs considered H. pylori the cause of GERD symptoms, and about 42% thought H. pylori the main cause of dyspepsia (Figure). The dominant diagnostic tests used were serology (53%) and stool antigen (31%). The most prescribed antibiotics for H. pylori eradication were Amoxicillin (AMX, 83%), Clarithromycin (CLA, 74%), and Metronidazole (MNZ, 65%). The most frequently used first-line therapies were AMX/CLA/MNZ & PPI concomitant (40%), AMX/CLA/PPI triple (22%), and AMX/MNZ/PPI triple (15%). Forty-eight percent of PCPs stated they treated H. pylori infection without a confirmed diagnosis; 38% reported not treating asymptomatic cases with a positive H. pylori test or referring such cases to a gastroenterologist; 52% request laboratory confirmation of H. pylori eradication, with the majority (58%) using serology. If first-line therapy fails, 54% of PCPs then refer to gastroenterologists. Large gaps exist between PCP perception of guidelines versus actual practice for H. pylori diagnostic tests: serology (75%), stool antigen (83%), or urea breath (87%). Conclusion: The majority of PCPS lack the knowledge for adequate diagnosis and management of H. pylori. Strategies targeting PCP education are needed to improve the management of H. pylori infection in Cameroon.Figure 1.: Knowledge (Panel A) and approach (Panel B) of Primary Care Providers (PCPs) regarding diagnosis of H. pylori infection in Cameroon, 2022. Table 1. - Population characteristics of primary care physicians in Cameroon, 2022 Age n (%) 21 – 25 years old 64 (17.5) 26 – 30 years old 218 (59.7) 30 – 59 years old 83 (22.7) Gender Female 148 (38.7) Male 229 (60.0) Prefer not to say 5 (1.3) School of Training FHS Bamenda 67 (17.5) FHS Buea 99 (25.9) FMBS Yaoundé 23 (6.0) FMPS Douala 81 (21.2) ISS UDM Bangante 31 (8.1) ISTM Nkolondom 13 (3.4) Trained abroad 68 (17.8) Region of Practice Littoral 144 (37.7) Northwest 74 (19.4) Southwest 95 (24.9) West 69 (18.1) Years in Practice Less than 2 years 122 (33.4) 2 - 6 years 210 (57.3) 6 or more years 33 (9.0) Number of patients per day ≤ 10 197 (54.12) 10 - 19 128 (35.2) ≥ 20 39 (10.7) Attended postgraduate training and/or conferences on H. pylori No/Unsure 330 (86.8) Yes 50 (13.2)

Early identification and treatment of women's cardiovascular risk factors prevents cardiovascular disease, saves lives, and protects future generations: Policy recommendations and take action plan utilizing policy levers.

Cardiovascular diseases (CVD) including heart attacks, strokes, heart failure, and uncontrolled hypertension are leading causes of death among women of all ages. Despite efforts to increase awareness about CVD among women, over the past decade there has been stagnation in the reduction of CVD in women, and CVD among younger women and women of color has in fact increased. We recommend taking action using policy levers to address CVD in women including: (1)Promoting periodic screening for risk factors including blood pressure, lipids/cholesterol, diabetes for all women starting at 18-21 years, with calculated atherosclerotic CVD (ASCVD) risk score use among women 40 years or older. (2)Considering coronary artery calcium (CAC) screening for those with intermediate risk per current guidelines. (3)Enhancing Obstetrics and Gynecologyand primary care physician education on reproductive age CVD risk markers, and that follow-up is needed, including extended postpartum follow-up. (4)Offering Health Coaching/motivational Interviewing to support behavior change. (5)Funding demonstration projects using different care models. (6)Creating a Stop High Blood Pressure consult line (for providers and patients) and providing other support resources with actions consumers can take, modeled after the California tobacco quit line. And (7)Requiring inclusion of adverse pregnancy outcomes in all Electronic Health Records, with reminder systems to follow-up on hypertension post-partum.

Quality improvement initiatives in the care and prevention of fragility fractures in the Asia Pacific region.

SummaryThis narrative review summarises ongoing challenges and progress in the care and prevention of fragility fractures across the Asia Pacific region since mid-2019. The approaches taken could inform development of national bone health improvement Road Maps to be implemented at scale during the United Nations ‘Decade of Healthy Ageing’.PurposeThis narrative review summarises recent studies that characterise the burden of fragility fractures, current care gaps and quality improvement initiatives intended to improve the care and prevention of fragility fractures across the Asia Pacific region.MethodsThe review focuses on published studies, reports and quality improvement initiatives undertaken during the period July 2019 to May 2022.ResultsEpidemiological studies conducted in countries and regions throughout Asia Pacific highlight the current and projected increasing burden of fragility fractures. Recent studies and reports document a persistent and pervasive post-fracture care gap among people who have sustained fragility fractures. Global initiatives developed by the Fragility Fracture Network and International Osteoporosis Foundation have gained significant momentum in the Asia Pacific region, despite the disruption caused by the COVID-pandemic. The Asia Pacific Fragility Fracture Alliance has developed educational resources including a Hip Fracture Registry Toolbox and a Primary Care Physician Education Toolkit. The Asia Pacific Osteoporosis and Fragility Fractures Society—a new section of the Asia Pacific Orthopaedic Association—is working to engage orthopaedic surgeons across the region in the care and prevention of fragility fractures. The Asia Pacific Consortium on Osteoporosis developed a framework to support national clinical guidelines development groups. Considerable activity at the national level is evident in many countries across the region.ConclusionDevelopment and implementation of national Road Maps informed by the findings of this review are urgently required to respond to the epidemiological emergency posed by fragility fractures during the United Nations ‘Decade of Healthy Ageing’.

Effectiveness of training primary care physicians about the principles of smoking treatment

Aim. To evaluate the impact of training primary care physicians about the principles of smoking treatment on the rate of successful quitting among their patients.Material and methods. Within the regional program on cardiovascular prevention among men aged 45-55 years, a study was made on the effectiveness of an educational seminar for primary care physicians (clustered quasi-experimental study). The main group consisted of 70 physicians (subjects of intervention) who underwent face-to-face training at a 3-hour interactive seminar on the principles of behavioral and drug treatment of smoking patients. In the following year, they consulted 423 smokers (subjects of analysis). The comparison group was represented by 174 doctors trained with extramural program who consulted 654 smokers. The doctors of both groups were provided with methodological and informational support in the form of short guides and brochures for patients. The main outcome studied was smoking cessation in patients one year after physician training. The comparison of outcomes was carried out taking into account the cluster structure of data using hierarchical regression. The initial imbalance of comparison groups in history of smoking, quit attempts, as well as level of alcohol consumption was corrected at the analysis stage.Results. In total, 12,6% of patients in the observed cohort quit smoking after one year, which was significantly higher than the common successful self-quit rate (3-5%). The likelihood of quitting smoking was strongly influenced by a particular doctor (ICC=0,326). Face-to-face interactive training of physicians significantly increased the probability of successful refusal in patients compared with distance learning (adjusted hazard ratio (HR) =4,8; odds ratio (OR) =5,3, 95% confidence interval (CI), 2,7-10,6, p&lt;0,001). The likelihood of successful withdrawals among patients among primary care physicians was much higher than among health center patients (adjusted HR=4,5; adjusted OR, 5, 95% CI, 1,2-20,6, p=0,027).Conclusion. Education of primary care physicians in the principles of smoking treatment, combined with the provision of information materials for patients, significantly increases the success rate among motivated smokers. At the same time, a face-to-face interactive seminar is much more effective than distance learning. General practitioners demonstrate the best professional productivity, regardless of the training form.

Cutaneous Melanoma Systematic Diagnostic Workflows and Integrated Reflectance Confocal Microscopy Assessed with a Retrospective, Comparative Longitudinal (2009-2018) Study.

The increasing global burden of melanoma demands efficient health services. Accurate early melanoma diagnosis improves prognosis. To assess melanoma prevention strategies and a systematic diagnostic-therapeutical workflow (improved patient access and high-performance technology integration) and estimate cost savings. Retrospective analysis of epidemiological data of an entire province over a 10-year period of all excised lesions suspicious for melanoma (melanoma or benign), registered according to excision location: reference hospital (DP) or other (NDP). A systematic diagnostic-therapeutical workflow, including direct patient access, primary care physician education and high-performance technology (reflectance confocal microscopy (RCM)) integration, was implemented. Impact was assessed with the number of lesions needed to excise (NNE). From 40,832 suspicious lesions excised, 7.5% (n = 3054) were melanoma. There was a 279% increase in the number of melanomas excised (n = 203 (2009) to n = 567 (2018)). Identification precision improved more than 100% (5.1% in 2009 to 12.0% in 2018). After RCM implementation, NNE decreased almost 3-fold at DP and by half at NDP. Overall NNE for DP was significantly lower (NNE = 8) than for NDP (NNE = 20), p < 0.001. Cost savings amounted to EUR 1,476,392.00. Melanoma prevention strategies combined with systematic diagnostic-therapeutical workflow reduced the ratio of nevi excised to identify each melanoma. Total costs may be reduced by as much as 37%.

Global Alzheimer’s Platform Foundation® (GAP) development of a transatlantic Alzheimer’s disease clinical trial network

AbstractBackgroundThe Global Alzheimer’s Platform Foundation® (GAP) was launched in 2015 in response to the critical need to improve the delivery of Alzheimer’s disease (AD) clinical trials. Over 80 AD sites have joined GAP’s growing network (GAP‐Net). While initial efforts were focused on North America, a top priority of the platform was to develop an international trial network.MethodDevelopment of a transatlantic site network in Europe: (1) Site identification: European sites that participated in the European Prevention of Alzheimer’s Dementia (EPAD) network were approached as well as other leading sites. (2) Program identification: Sites were surveyed to understand what services were needed to improve AD trial delivery. Existing GAP programs that could be optimized in Europe with limited changes were identified along with new programs. (3) Infrastructure development: Europe‐specific agreements, regulatory strategies, and communication plans were developed to ensure alignment with the global mission. Evaluation and onboarding processes were also developed.ResultSite identification: Over 50 sites in Europe are currently onboarding. Sites are located primarily in western Europe. Program identification: Existing GAP programs that can be optimized in Europe will include accelerated study start‐up services, rater certification, transportation support, and recruiting programs (media toolkits, trial videos, social / earned media support, and regional recruitment summits). Programs that will need to be modified or developed include trial design input, prescreening support, education of primary care physicians, and advocacy group collaboration. Infrastructure development: 44 sites have returned surveys and metrics, 20 sites have been approved to join the network, and will be approached to sign the European Network Agreement.ConclusionIn partnership with leading clinical research sites in Europe, GAP has begun developing a European site network. The processes developed for GAP‐Net in North America will be leveraged to support a GAP European network that can reduce the duration and cost and improve the quality of AD clinical studies. GAP will intensify collaboration with site networks in other countries to share learning and, where possible, to implement GAP‐enabled trials. These efforts will further GAP’s aim of achieving a fully global network of sites to enhance speed, efficiency, and quality of AD clinical trials.

Early diagnosis of giant cell arteritis - the basis of good outcome

Purpose: If untreated, giant cell arteritis can lead to blindness and stroke. The study objectives were to assess diagnostic procedures and treatment in early interventional clinic in University Clinical Centre Maribor in patients with temporal arteritis.&#x0D; Methods: Retrospective study (from 2012 to 2017) of patients diagnosed with temporal arteritis. We assessed epidemiological data, delay of diagnosis, and diagnostic procedures. Results were assessed with statistical methods (SPSS 22.0).&#x0D; Main goal: The main goal was to determinate the delay in days between symptom onset and admission to the interventional rheumatology clinic and to assess the causes of delay.&#x0D; Results: Fifty-three GCA (66 % female) patients with mean age 76.25 (from 63–89 years) years were included. Mean time duration of symptoms before admission to our early interventional clinic was 33.74 (0–180) days. The diagnostic procedure was completed in mean time of 2.04 days from the presentation at our interventional rheumatology clinic. The median time to the temporal artery biopsy (TAB) performed in 52 /53 patients was 2 days, with the median 2 days to the preliminary histological results from admission. TAB was positive in 43 (81.1%) of cases. The median time from admittance to colour Doppler sonography (CDS) of aortic arch branches was 2 days and it was positive in all 19 (35.8%) performed cases. 16 (30.2%) patients had polymyalgia rheumatica, 35 (66%) patients had visual disturbances, permanent one eye blindness occurred in 12 (22.64%) patients, and 2 (2.8%) patients experienced permanent blindness on both eyes. Seventeen patients (32.1%) were initially treated with intravenous methylprednisolone pulse. The mean initial dose of oral methylprednisolone was 45.55 (± 15.54) mg. All patients received low dose Aspirin.&#x0D; Conclusion: Early diagnosis and treatment of giant cell arteritis are very important as miss- or non-diagnosed GCA can lead to permanent blindness of the patient. With better education and public awareness, better access and better professional education of primary care physicians, and early admission to secondary interventional clinics we might spare these patients from the devastating consequences of the GCA.

Lupus: Controversies and Education for Primary Care Physicians

GLADEL, the Latin American Lupus Study Group, is organizing two sessions at the PANLAR 2021 Congress.

Revealing Hepatitis B Virus as a Silent Killer: A Call-to-Action for Saudi Arabia.

Background: The Kingdom of Saudi Arabia (KSA) was the first country in the Middle East to adopt the hepatitis B virus (HBV) vaccine. Despite an expanded HBV immunization program and significant progress in HBV prevention in the country, HBV infection is a significant public health burden. This review lists coordinated solutions for healthcare stakeholders, patients, and health authorities to curb HBV and its impact in KSA. It further aims to draw policymakers’ attention to key priorities to bridge HBV care gaps in the country.Methods: As part of the pre-engagement activity, medical experts across KSA were interviewed to gain a preliminary understanding of the current unmet needs in HBV management in the country. Top-recommended action points derived from the pre-engagement activity were discussed. Key priority action points to curb the impact of HBV in KSA were identified.Results: The priority action points together with the challenges and unmet needs in the management and care of HBV in KSA were: (a) establish a national-level registry, (b) implement screening campaigns, (c) improve linkage of care between primary care physicians (PCPs) and specialists, and (d) increase PCP education and awareness.Conclusion: This work is an endeavor to set the stage for a strategic policy framework aimed at eliminating HBV in KSA. The action points/steps for the identified priorities must run parallelly across various regions in KSA, to successfully manage and further eliminate the threat of HBV.

Patient and family experience with transthyretin amyloid cardiomyopathy (ATTR-CM) and polyneuropathy (ATTR-PN) amyloidosis: results of two focus groups

BackgroundTransthyretin amyloidosis, or ATTR, is a progressive and debilitating rare proteopathy generally manifested as either transthyretin amyloid polyneuropathy (ATTR-PN) or transthyretin amyloid cardiomyopathy (ATTR-CM). Irrespective of the clinical presentation, affected patients manage a chronic and life-threatening condition that severely impacts their quality of life. Although the primary symptoms and diagnostic criteria for ATTR are increasingly being discussed in the medical literature, due in large part by continual advances in uncovering disease pathophysiology, there exists a surprising paucity of published data on the patient journey and family experience. In order to address this disparity, two focus groups, one for ATTR-CM and one for ATTR-PN, were convened and asked to describe the diagnostic process, symptoms, and impact on their own quality of life that was experienced from these rare and typically misdiagnosed illnesses.ResultsPatients in both ATTR groups often underwent a long and difficult diagnostic odyssey characterized by seemingly nonspecific physical manifestations resulting in mismanagement and suboptimal care, inadequate interventions, and delays in establishing the correct diagnosis, which was integral to determining the specialized treatment they needed. Collectively, patients with ATTR-CM and patients with ATTR-PN reported a similar number of symptoms, but the type of symptoms varied. The ATTR-CM group identified intolerance to activity, inability to exercise, insomnia and fatigue as the most challenging symptoms. The ATTR-PN group identified fatigue, diarrhea/constipation and sensory deficits as the most difficult symptoms. In general, ATTR was reported to be highly stressful for both patients and their families. Spouses of patients with ATTR-CM were often in a caregiver role and reported experiencing considerable anxiety. Patients with ATTR-PN were stressed not only by the physical consequences of their illness, but also by its effects on their parents and other relatives, as well as concerns about children and grandchildren inheriting the disease-causing mutations associated with ATTR. Despite such challenges, family members are identified as an important resource of coping, motivation, inspiration and support.ConclusionsSeveral steps can be taken to reduce the challenges and burdens of living with ATTR, including increased education for primary care physicians and specialists who unknowingly encounter ATTR, increased access to and ready availability of mental health services and support, and increased engagement with support groups and advocacy organizations. Input from patients and their representatives should guide clinical trials, increase the availability of genetic testing, and generate natural history and qualitative studies detailing patients’ experience. Although each recommendation is impactful in itself, taken together they would jointly facilitate a shortened and ameliorated patient journey through more timely diagnosis and greater access to personalized medical care.

Amplifying Expertise in Rural West Virginia through Project ECHO: Impactful Partnerships and Community-Engagement.

Limited specialty care access is a major contributor to rural health disparities. Extensions for Community Healthcare Outcomes (ECHO) is an innovative training and education strategy to address the need for trained specialty care in rural areas, such as West Virginia (WV). This article describes the successful implementation of ECHO projects in diverse subject areas facilitated by unique partnerships between the WV Clinical and Translational Science Institute (WVCTSI) and its practice partners. WV Project ECHO aims to provide education and training in specialty areas through the use of technology and partnerships. A case-based session coupled with a brief relevant didactic presentation is used to amplify rural provider specialty expertise through education of primary care physicians (PCPs) in specific clinical areas. Foundational partnerships and impact are described. Key lessons learned include leveraging existing partnerships and implementing projects based on provider needs. A unique result of WV Project ECHO is WV Medicaid's decision to accept case presentations made during the Hepatitis C ECHO session as the specialty consultation requirement (e.g., hepatologist or infectious diseases) for Medicaid coverage of hepatitis C drugs, thus increasing the number of patients receiving Hepatitis C treatment. A multi-partnered community approach facilitated by the widespread use of a technology-based provider education platform has facilitated the availability of curative therapy for a potentially fatal disease.

Allergic rhinitis: what is the patient's choice of drug based on? Russian study's results

Allergic rhinitis (AR) is a disease that significantly affects the quality of life (QOL) of the patients. Scientific researches that reveal the reasons for the uncontrolled course of AR and the low level of QoL in patients are rare. Of this study was to establish how often patients with moderate AR seek medical care or prefer to choose a drug on their own in a pharmacy. The study consisted of an online survey of 328 adults over the age of 18 who bought drugs in a pharmacy for treatment of AR. The respondents were divided into two groups: 1) those who bought the drug according to the recommendation of a doctor (164), 2) those who chose the drug on their own (164). The study revealed a dissonance between the severity of clinical symptoms of AR and how patients assess their QoL. The majority of patients estimated the symptoms of AR as moderate, but the disease itself was characterized as mild, not interfering with daily activity and sleep. The more severe the manifestations of AR were, the more often patients did not seek medical care from a doctor, preferring an independent choice of drugs, the help of a pharmacist, or focusing on long-standing doctor's recommendations. 48% of patients have never visited a doctor for AR. We have found a discrepancy between the optimal choice of drugs for the treatment of AR and the patient's attitude to this choice. 95% of patients purchased oral antihistamines from the pharmacy, 71% - decongestants, 26% - vitamins and food supplements. Although topical steroids were recommended by a doctor in 57% of cases, only 37% of patients bought intranasal corticosteroids in a pharmacy. When choosing a drug, 36% of patients preferred the advice of pharmacists; almost 50% followed advice from relatives and friends, 23% of patients used information from the Internet. This study confirmed a tendency towards a decrease in patient adherence to modern AR therapy algorithms. Patient seeking medical care for AR is extremely low. It is required to optimize the education of primary care physicians and pharmacists, develop educational programs for patients.

Attitudes toward Complementary and Alternative Medicine, Beliefs in Afterlife and Religiosity among Psychiatrists, Psychologists and Theologists.

The aim of our study was to investigate the differences in beliefs, attitudes toward CAM, beliefs in afterlife and religiosity among the sample of psychiatrists, psychologists, and theologists. Relationship among these constructs could have impact on the concept of mental health. Research was conducted in the Split urban area, Croatia, during 2017 on a sample of psychiatrists (n=51), psychologists (n=55), and theologists (n=25). Participants were presented a figure of the human body, which contained numbers identifying eight different regions of the body. Participants were asked to select which region best represents the location of the self, soul, and mind in the body. We used CAIMAQ (The Complementary, Alternative and Integrative Medicine Attitudes Questionnaire) which contains five subscales. The Afterdeath Beliefs Scale was used to measure the varieties of afterlife beliefs. Analyses showed that applied questionnaires have appropriate reliability and expected factor structure. The most frequent locations of the Soul were 9 (37%, Not located in any centralized region in the body) and 5 (31% chest), whereas Self and Mind were mostly located in the head (43% and 73%). Psychiatrists and psychologists have average scores on positive pole of CAIMAQ but did not differ significantly (p>0.05). There were statistical differences between theologists and psychologists/psychiatrists on two subscales: "nutritional counseling and dietary/food supplements can be effective in the treatment of pathology" and "attitudes toward a holistic understanding of the disease" (p<0.05). There were significant correlations between religion and three CAIMAQ subscales. Although they were mostly religious, psychiatrists and psychologists had a higher average score on Annihilation than theologists. They also did not believe in body resurrection and connection between behavior during life and after death. The results of our study could have impact on the concept of mental health and in the future must be deeper evaluated within qualitative research methodology.