Objective To understand the willingness of general practitioner(GP) to enhance working competence in community healthcare centers in Shanghai and provide a basis for the competence training of GPs in community healthcare centers. Methods In August 2023,GPs were selected from some community healthcare centers in Shanghai and their willingness to enhance working competence were studied by a questionnaire survey.The survey included 39 secondary indicators in three dimensions:general practice theory,skills,and humanity. Results A total of 1 192 GPs completed the questionnaire,with an effective rate of 100%.The total score of GPs' willingness to enhance their working competence was 258.45±80.93,and the mean score of the three dimensions was 6.63±2.08.The score for the general practice theory was the highest (6.92±1.95),while that for general practice humanity was the lowest (6.44±2.34) among the three dimensions.The score of willingness to enhance working efficiency differed across different age ranges (P<0.001),professional titles (P<0.001),years of work (P<0.001),and educational backgrounds of GPs (P=0.039).Those with the age younger than 30 years old,junior professional titles,less than 5 years of work experience,and a college degree or below had the highest willingness score to enhance their working competence.Among the top three secondary indicators of willingness score in each dimension,the top three methods of working competence enhancement were community general practice and specialized healthcare services combined with outpatient learning,flexible further training,and continuing education courses.Conclusions There is an urgent need for young GPs in community healthcare centers in Shanghai to enhance their working competence.Targeted enhancement plans can be provided to different groups of GPs with different characteristics through community general practice and specialized healthcare services combined with outpatient learning,flexible further training,and continuing education courses,which can further enhance the ability and quality of the GP team.
Humans ; China ; General Practitioners/psychology* ; Surveys and Questionnaires ; Community Health Centers ; Clinical Competence ; Female ; Adult ; Male ; Attitude of Health Personnel ; Middle Aged

OBJECTIVES: The aim of this study was to describe general practitioners (GPs)' opinions and practices of preventive care and patients' opinions, attitudes, and behaviors towards prevention. METHODS: The data stemmed from a cross-sectional national survey on prevention conducted in Switzerland from 2015 to 2016. In total, 170 randomly drawn GPs and 1154 of their patients participated. The GPs answered an online questionnaire and the patients answered a questionnaire administrated by fieldworkers present at their practices. RESULTS: Both patients and GPs agreed that delivering preventive care is the dedicated role of a GP. It appeared that beyond classical topics of prevention such as cardiovascular risk factors, other prevention areas (e.g., cannabis consumption, immunization, occupational risks) were scarcely covered by GPs and reported as little-known by patients. In addition, GPs seemed to use a selective approach to prevention, responding to the clinical context, rather than a systematic approach to health promotion. The results also highlight possibilities to improve prevention in family medicine through options such as more supportive tools and public advertising, more time and more delegated tasks and, finally, a more recognized role. CONCLUSIONS: Despite an unfavorable context of prevention within the healthcare system, preventive care in family medicine is reasonably good in Switzerland. However, some limitations appear regarding the topics and the circumstances of preventive care delivery. A global effort is needed to implement necessary changes, and the responsibility should be broadened to other stakeholders.
Cannabis ; Cross-Sectional Studies ; Delivery of Health Care ; General Practitioners ; Health Personnel ; Health Promotion ; Humans ; Immunization ; Risk Factors ; Switzerland

OBJECTIVE: The most existing research has predominantly focused on city rather than township hospitals. This study aimed to explore depressive symptoms and its associated factors among general practitioners and nurses in Chinese township hospitals.METHODS: This cross-sectional study was carried out in Liaoning, China in 2016. 2,000 general practitioners and nurses in Chinese township hospitals were recruited and 1,736 of them became final subjects (effective response rate: 86.8%). Data on depressive symptoms, workplace violence (WPV), psychological capital (PsyCap), and demographic factors were collected through questionnaires. Hierarchical multiple regression was used to explore the factors related to depressive symptoms. Asymptotic and resampling strategies were applied to examine the potential mediating effect of PsyCap.RESULTS: The prevalence of depressive symptoms among the participants was 49.9%. Workplace violence was positively associated with depressive symptoms, whereas psychological capital and its components of hope, optimism and resilience were negatively associated with depressive symptoms. Psychological capital and its components of hope, optimism and resilience all played partial mediating roles between workplace violence and depressive symptoms.CONCLUSION: Nearly half of general practitioners and nurses surveyed suffered from depressive symptoms. Reduction of workplace violence and development of psychological capital can be targeted for interventions to combat depressive symptoms.
Asian Continental Ancestry Group ; China ; Cross-Sectional Studies ; Demography ; Depression ; General Practitioners ; Hope ; Humans ; Negotiating ; Optimism ; Prevalence ; Workplace Violence

The new 2019 Japanese Society of Hypertension (JSH) guidelines for the management of hypertension are now available; these update the previous guidelines published in 2014. The primary objective of the guideline is to provide all healthcare professionals with a standard management strategy and appropriate antihypertensive treatments to prevent hypertension-related target organ damage and cardiovascular events. The major changes in the new guideline relate to the definition of normal blood pressure (BP) and target BP. The terms ‘normal BP’ and ‘high normal BP’ used in the JSH 2014 guidelines are replaced with terms ‘high normal BP’ and ‘elevated BP,’ respectively. There was no change to the office BP diagnostic threshold for hypertension (140/90 mmHg). Recommended target office and home BP values for patients with hypertension aged <75 years and/or high-risk patients are <130/80 mmHg and <125/75 mmHg, respectively. Corresponding targets for elderly patients with hypertension (age≥75 years) are 140/90 and 135/85 mmHg, respectively. The goal is that these changes will contribute to reducing cardiovascular events, especially stroke and heart failure, in Japan. The dissemination of the JSH 2019 guidelines and implementation of a home BP-based approach by all general practitioners in Japan might be facilitated by digital hypertension management using health information technology.
Aged ; Antihypertensive Agents ; Asian Continental Ancestry Group ; Blood Pressure ; Delivery of Health Care ; Evidence-Based Practice ; General Practitioners ; Heart Failure ; Humans ; Hypertension ; Japan ; Medical Informatics ; Stroke

Fecal calprotectin (FC) is a calcium- and zinc-binding protein of the S100 family, mainly expressed by neutrophils and released during inflammation. FC became an increasingly useful tool both for gastroenterologists and for general practitioners for distinguishing inflammatory bowel disease (IBD) from irritable bowel syndrome. Increasing evidences support the use of this biomarker for diagnosis, follow-up and evaluation of response to therapy of several pediatric gastrointestinal diseases, ranging from IBD to nonspecific colitis and necrotizing enterocolitis. This article summarizes the current literature on the use of FC in clinical practice.
Colitis ; Diagnosis ; Enterocolitis, Necrotizing ; Follow-Up Studies ; Gastrointestinal Diseases ; General Practitioners ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Irritable Bowel Syndrome ; Leukocyte L1 Antigen Complex ; Neutrophils

BACKGROUND: Medicines and Healthcare products Regulatory Agency (MHRA) guidance for patients with metal-on-metal (MoM) hip replacements was provided in 2012 and updated in 2017 to assist in the early detection of soft-tissue reactions due to metal wear debris. A large number of MoM hip replacements were undertaken at our hospital trust. A program of recall for all patients with MoM hip replacements was undertaken and MHRA guidelines were implemented. In this study, we aimed to investigate the effectiveness of the revised MHRA guidelines in the detection of early adverse reactions to metal debris and to re-evaluate the indications for metal artifact reduction sequence magnetic resonance imaging (MARS-MRI) and revision surgery. METHODS: Identification and recall of all patients with MoM hip replacements from 2001 were conducted by using theatre logs, patient records, clinical coding information, and consultant logbooks. Two senior arthroplasty consultants reviewed X-rays and patient records. Postal questionnaires were forwarded to patients, together with requests for general practitioners to complete cobalt and chromium blood tests. The two consultant-led review of MOM replacements was undertaken with further radiological investigations (X-rays, MARS-MRI) performed according to the 2017 guidance with support of consultant radiologists. RESULTS: Of 674 identified patients, 297 were available for review: 26 patients did not have MoM implants, 36 were untraceable, 59 refused follow-up, 87 moved out of area, 147 had died, and 22 already had revision. Of 297 patients, 126 were women and 171 were men; age range was 39 to 95 years (mean age, 69 years); 126 had resurfacing and 171 had MoM replacements. Twenty-six patients had elevated metal ions. Thirty-three patients underwent MARS-MRI: MARS-MRI results were positive in 17 and negative in 16. Of 17 patients with positive MARS-MRI, 10 patients were asymptomatic and seven were waiting revision. CONCLUSIONS: Positive MARS-MRI can often occur in the absence of elevated metal ion levels; elevated blood metal ion levels do not mean MARS-MRI will be positive. All patients with MoM replacements were at risk. It is imperative to assess patients regularly for symptoms that may raise clinical suspicion and maintain a low threshold to performing MARS-MRI.
Arthroplasty ; Artifacts ; Chromium ; Clinical Coding ; Cobalt ; Consultants ; Delivery of Health Care ; Female ; Follow-Up Studies ; General Practitioners ; Hematologic Tests ; Hip ; Hospitals, District ; Humans ; Ions ; Magnetic Resonance Imaging ; Male

Septic arthritis is a serious medical condition that can lead to significant complications if misdiagnosed or mismanaged. A rare case of a 1st metatarso-phalangeal joint septic arthritis in a native joint is presented in a patient with no significant risk factors. A 41-year-old patient was referred by his general practitioner owing to ongoing pain and swelling over his native 1st metatarso-phalangeal joint with difficulty on weightbearing for three months. After a series of investigations, including blood tests and a foot magnetic resonance imaging, which were inconclusive, the patient was led to the operating theatre for sampling and washout of his joint. The samples taken in the theatres revealed septic arthritis with Streptococcus mitis as the causative microorganism. The patient was treated with six weeks of oral antibiotics with a good functional outcome. This case report illuminates this rare condition and makes foot and ankle surgeons aware of its existence. A high suspicion for this condition can prevent misdiagnosis and mismanagement.
Adult ; Ankle ; Anti-Bacterial Agents ; Arthritis, Infectious ; Diagnostic Errors ; Foot ; General Practitioners ; Hematologic Tests ; Humans ; Joints ; Magnetic Resonance Imaging ; Risk Factors ; Streptococcus mitis ; Surgeons ; Weight-Bearing

The Korean Society for Healthcare-associated Infection Control and Prevention ran a nationwide database of healthcare associated infection surveillance system. Korean National Healthcare-associated Infections Surveillance System (KONIS) is a nationwide surveillance network to perform of healthcare associated infection surveillance using standardized methods. Intensive care unit surveillance was begun on July 2006 and SSI module was added in 2007. The enrollment criteria of intensive care unit surveillance were general hospitals over 400 beds with infection control practitioner and doctors in 2006 but the criteria were expanded to over 200 beds size hospitals in 2016. Overall 70.5% hospitals were included in 2017. All tertiary care hospitals were enrolled. Less than 300 beds hospitals accounted for 59%. KONIS validation study has been performed from 2008 biennially. Future directions of KONIS include expansion of participating hospitals and multicenter intervention modules and new modules for special units such as neonatal intensive care units.
Cross Infection ; Hospitals, General ; Humans ; Infant, Newborn ; Infection Control ; Infection Control Practitioners ; Intensive Care Units ; Intensive Care Units, Neonatal ; Korea ; Prospective Studies ; Tertiary Healthcare

OBJECTIVES: The aim of this study was to examine whether coordination between healthcare providers at an inpatient rehabilitation facility and healthcare providers in a community setting improves osteoporosis medication use in the community. METHODS: In 2012, a coordination project between an inpatient geriatric rehabilitation facility located in north-central Israel and general practitioners in the community setting was initiated. In this retrospective pseudo-experimental study, we compared osteoporosis medication use among patients who were hospitalized at the facility following an osteoporotic fracture during 2011–2012, and who constituted the control group (n=20), and patients who were hospitalized at the facility during 2013–2015, and who constituted the trial group (n=129). Data were collected from the patients' records and from records of the health maintenance organization concerning medications issued to the patients by pharmacies. RESULTS: Differences were observed between the trial and the control group in osteoporosis medication management by healthcare providers, both at the inpatient rehabilitation facility and in the community, suggesting favorable trends. However, osteoporosis medication use in the community was slightly lower in the trial group, then in the control group (32.8% vs. 34.2%, respectively). A regression analysis indicated that the only variable predicting use of osteoporosis medications in the community was a previous diagnosis of osteoporosis in the community. CONCLUSIONS: The study results indicate that mere coordination between the healthcare settings is insufficient in order to ensure continued care in the community, emphasizing the need for an osteoporosis coordinator.
Delivery of Health Care ; Diagnosis ; General Practitioners ; Health Maintenance Organizations ; Health Personnel ; Humans ; Inpatients ; Israel ; Osteoporosis ; Osteoporotic Fractures ; Pharmacies ; Rehabilitation ; Retrospective Studies

OBJECTIVES: In this study, a clinical decision support system was developed to help general practitioners assess the need for orthodontic treatment in patients with permanent dentition. METHODS: We chose a Bayesian network (BN) as the underlying model for assessing the need for orthodontic treatment. One thousand permanent dentition patient data sets chosen from a hospital record system were prepared in which one data element represented one participant with information for all variables and their stated need for orthodontic treatment. To evaluate the system, we compared the assessment results based on the judgements of two orthodontists to those recommended by the decision support system. RESULTS: In a BN decision support model, each variable is modelled as a node, and the causal relationship between two variables may be represented as a directed arc. For each node, a conditional probability table is supplied that represents the probabilities of each value of this node, given the conditions of its parents. There was a high degree of agreement between the two orthodontists (kappa value = 0.894) in their diagnoses and their judgements regarding the need for orthodontic treatment. Also, there was a high degree of agreement between the decision support system and orthodontists A (kappa value = 1.00) and B (kappa value = 0.894). CONCLUSIONS: The study was the first testing phase in which the results generated by the proposed system were compared with those suggested by expert orthodontists. The system delivered promising results; it showed a high degree of accuracy in classifying patients into groups needing and not needing orthodontic treatment.
Artificial Intelligence ; Dataset ; Decision Support Systems, Clinical ; Decision Support Techniques ; Dental Informatics ; Dentition, Permanent ; Diagnosis ; General Practitioners ; Hospital Records ; Humans ; Machine Learning ; Malocclusion ; Orthodontists ; Parents