Didactic Sequences as an Educational Product to Facilitate Teaching-Learning Processes in Lato Sensu Graduate Courses in the Area of Health Management in Primary Care

Teaching strategies can be considered as techniques that are constructed to be used with the objective of promoting teaching and learning in the classroom, so that the teacher is considered a mentor, as he is the one who selects, analyzes, studies, organizes, builds and proposes the most classic tools to facilitate the learning process [1]. This study is an experience report related to the construction of an educational product that consists of the elaboration of pedagogical strategies, characterized by five didactic sequences in the perspective of collaborating with teaching-learning processes in lato sensu graduate courses. The themes that are part of the didactic sequences were built based on the results obtained in scientific research carried out during the development of the strict sensu postgraduate course in Teaching in Health and Technology, which involved: the work of coordinators who work in the field of health management in Primary Care, situations that challenge the management of Primary Care and the potentialities of work in the management of Primary Care. The didactic sequences have fun teaching strategies that provide meaningful learning for a future qualified professional performance. These sequences involve the use of active methodologies and the use of digital tools. The educational product developed seeks to promote benefits that can collaborate with the improvement of Primary Care Management and teaching-learning processes in the training of health professionals. Therefore, the pedagogical strategies, as well as its entire construction process, were developed through the collaboration of professors of the Health and Society discipline at the State University of Health Sciences of Alagoas (UNCISAL), seeking to make it qualify for effective construction of knowledge and that promote its wide use in the academic environment.

Colorectal cancer,screening and primary care: A mini literature review

Colorectal cancer(CRC) is a common health problem,representing the third most commonly diagnosed cancer worldwide and causing a significant burden in terms of morbidity and mortality,with annual deaths estimated at 700000. The western way of life,that is being rapidly adopted in many regions of the world,is a well discussed risk factor for CRC and could be targeted in terms of primary prevention. Furthermore,the relatively slow development of this cancer permits drastic reduction of incidence and mortality through secondary prevention. These facts underlie primary care physicians(PCPs) being assigned a key role in health strategies that enhance prevention and prompt diagnosis. Herein,we review the main topics of CRC in the current literature,in order to better understand its pathogenesis,risk and protective factors,as well as screening techniques. Furthermore,we discuss preventive and screening policies to combat CRC and the crucial role served by PCPs in their successful implementation. Relevant articles were identified through electronic searches of MEDLINE and through manual searches of reference lists.

Primary care and mental health: Where do we go from here?

Primary care has been dubbed the“de facto”mental health system of the United States since the 1970s.Since then,various forms of mental health delivery models for primary care have proven effective in improving patient outcomes and satisfaction and reducing costs.Despite increases in collaborative care implementation and reimbursement,prevalence rates of major depression in the United States remain unchanged while anxiety and suicide rates continue to climb.Meanwhile,primary care task forces in countries like the United Kingdom and Canada are recommending against depression screening in primary care altogether,citing lack of trials demonstrating improved outcomes in screened vs unscreened patients when the same treatment is available,high false-positive results,and small treatment effects.In this perspective,a primary care physician and two psychiatrists address the question of why we are not making headway in treating common mental health conditions in primary care.In addition,we propose systemic changes to improve the dissemination of mental health treatment in primary care.

Evaluation of the Psychological Impact of COVID-19 Pandemic on Chinese Patients with Common Mental Disorders in Primary Care: A Cross-Sectional Study

Purpose: Our study aimed to evaluate the psychological impact of COVID-19 pandemic on Chinese patients with common mental disorders in primary care in Hong Kong. Method: A cross-sectional study was conducted on 102 Chinese patients with common mental disorders and being followed up in two public integrated mental health clinics in Hong Kong from 1st November 2020 to 31st January 2021. Patients would be evaluated about the impact of COVID-19 pandemic on their mood and daily life by using a questionnaire which assessed social distancing effects, financial impact, relationship with family, anxiety and depressive symptoms. The Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 Questionnaire (GAD-7) would also be used to assess patients’ mood symptoms. Factors which were related to COVID-19 pandemic and associated with anxiety or depressive symptoms would be analysed. Results: The mean age of the subjects was 58.0 years and more patients were female (77.5%). There were 84.3% and 72.5% of patients reported their anxiety and depressive symptoms being affected by COVID-19 pandemic respectively. It was found that 17.6% of patients had their income decreased or were unemployed. About one-third (30.4%) of patients indicated that their relationship with their family was worsened while 8.8% was improved. Social distancing was significantly associated with anxiety (p = 0.006) and depressive symptoms (p 0.001) in patients with common mental disorders. Conclusion: There was considerably more psychological impact including an increase in anxiety and depressive symptoms due to COVID-19 pandemic in Chinese patients with existing common mental disorders in primary care. Primary care physicians should raise their awareness of the psychological impact of COVID-19 pandemic on their patients. Our findings shed light on mental health care planning and preventive measures during the COVID-19 pandemic and potential subsequent pandemics.

Knowledge and practices of primary care physicians on the current referral system of diabetic retinopathy in Islamabad and Rawal-Pindi, Pakistan

AIM: To assess the current knowledge and practices in diabetic eye care and referral system regarding diabetic retinopathy(DR) in health centers of Islamabad and RawalPindi. METHODS: A cross-sectional study was carried out in 4 government and private health centers in RawalpindiIslamabad from May 2018 to Oct. 2018. A total of 38 Primary Care Physicians(general practitioners, family physicians, and internists) were recruited out of which data for 2 were either not returned, or were missing partially. Data were collected through a 27-item consented & validated, multiple-choice questionnaire based on physician characteristics, knowledge and practice of diabetic eye care and challenges faced due current DR referral system. Descriptive analyses for all variables were performed including, mean and standard deviation. Analytical analyses were also conducted to study association between different study variables. RESULTS: Mean scores of knowledge for general practitioners, family physicians, and internists were 41.7%, 42.0% and 46.6% respectively. A lack of knowledge, and suboptimal practices were observed regarding signs, symptoms, screening, testing, evaluation and referral of DR regardless of physicians’ specialty, or years in practice. Lack of expertise regarding direct ophthalmoscopy, interpretation of findings, and referral to an ophthalmologist were noted. Physicians who performed consultation and counselling according to patients’ needs referred more patients to an ophthalmologist than those who restricted their consultationto a fixed amount of time and had more patients per unit time(P=0.01). Physicians who had taken care of less than 5 number of patients with DR marked less incorrect answers with no significantly greater number or correct answers compared to physicians who had taken care of more than 5 number of patients with DR(P=0.044). An association of more than 5 patients with DR taken care of with more need based patient consultation and counselling was also noted(P=0.017). An evaluation of the current referral system for DR revealed major loopholes in the health care infrastructure, proper guidelines, properly functioning equipment, check and balances, and lack of guidance to physicians regarding acquiring and updating knowledge regarding DR. CONCLUSION: Lack of updated and adequate knowledge, practices among primary care physicians, and suboptimal diabetic eye care and referral system have contributed to late presentation of DR. Interventions are needed to improve current diabetic eye care, and knowledge and practices of primary care physicians.

Health Training Needs at Primary Care Level Health Facilities in Rural Western Uganda

Introduction: Continual education is recognized worldwide as a tool for the professional development of health care practitioners. It is however effective when the training targets the appropriate needs of the target beneficiaries. This study was therefore aimed at identifying priority training needs of Primary Care Level health professionals in rural Western Uganda. Methods: This was a descriptive cross-sectional survey among 35 rural community health facilities represented by their managers in rural Western Uganda. Participants were invited to Mbarara University of Science and Technology and responded to a self-administered questionnaire and also participated in qualitative group discussions guided by Facilitators from the Community Based Education and Research Services unit within the Community Health Department of Mbarara University of Science and Technology. Priority health training needs were determined based on the computed weighted scores. Results: The majority of managers of rural primary care level health facilities were medical officers by the level of training (51.43%) and male by gender (68.57%). Priority health training needs identified were child health and maternal health with total weighted scores of 12.0 and 10.9 respectively. Qualitatively, emerging themes included;leadership and management, and supervisory roles during student field attachments. Conclusion: Priority health training needs at rural Primary Care level health facilities were child health, maternal health, leadership and management, and supervisory skills. There is dire need to train rural primary care level, health professionals. In-service training based on identified needs should be offered by MUST in partnership with regional stakeholders. This is likely to enhance the quality of services provided by rural primary care level health facilities.

Emergency department visits:Why adults choose the emergency room over a primary care physician visit during regular office hours?

BACKGROUND:It has been estimated that up to one third of all emergency department(ED)visits may be"inappropriate"or non-emergent.Factors that have been speculated to be associated with non-emergent use have been noted to include low socioeconomic status,lack of access to primary care,lack of insurance,convenience of"on demand care"and the patient's individual perception of their complaint urgency.The objective of this study is to identify the reasons contributing to self-perceived non-emergent adult emergency department visits during primary care physician office hours of operation.METHODS:This study was a single-center,descriptive study with questionnaire.The questionnaire was collected from patients meeting exclusion/inclusion criteria who were triaged into an acute or fast track part of the emergency department during regular business hours on Monday through Friday,8:00 am-5:00 pm during the months of July 2011 and August 2011.Questionnaire data were categorical and summarized using counts and percentages.Data collected included patient demographics,information about the patient's primary care provider,and information about the emergency department visit in question.All responses were compared among patients with visits considered to be non-emergent to those considered to be emergent by using individual chi-square tests.RESULTS:There were 262 patients available for the study.The patients were grouped according to their perception of the severity of their complaints.Roughly half of the patients placed themselves into the non-emergent category(n=129),whereas the other half of the patients categorized themselves into the emergent group(n=131).There were statistically significant differences in marital status and employment status between the two groups.It was found that 61.5%of the non-emergent patients were single,while 58.3%of the emergent patients were married.In the non-emergent group,59.7%were unemployed,but in the emergent group 60.3%were employed(P<0.05).However,no other factors were significantly different.CONCLUSIONS:Our study did not identify a statistically significant factor to the reasoning behind why patients choose the emergency department over a primary care physician during regular office hours.The only significant demographic indicating who was more likely to make this choice during the specified time frame was being single and employed with perceived non-emergent complaint.Patients without insurance and/or without a primary care physician were no more likely to visit the emergency department with a self-perceived non-emergent issue than patients with insurance and/or with an established primary care physician.

Alpha-Stim Cranial Electrotherapy Stimulation (CES) for Anxiety Treatment: Outcomes in a United Kingdom (UK) Primary Care Practice

Background: Anxiety disorders are the most common mental disorders, typically treated with psychotherapy and medication. These treatments are not suitable for, acceptable to, or effective for everyone. Alpha-Stim AID is a Cranial Electrotherapy Stimulation (CES) treatment with evidence of effectiveness in treating anxiety disorders. Objective: The aim of this paper is to present outcomes on anxiety, depression, and quality of life of Alpha-Stim use in primary care patients in the United Kingdom’s (UK) National Health Service (NHS) who reported symptoms of anxiety. Methods: Open label patient cohort design. Self-report measures: PHQ-9 (depression), GAD-7 (anxiety) and EQ-5D-5L (health related quality of life). Twenty-three patients with symptoms of anxiety completed a six-week course of Alpha-Stim intervention. Results: Reliable improvement and remission rates respectively were 60.9% and 17.4% for the GAD-7;42.9% and 22.7% for the PHQ-9. Significant improvement and medium/large effect sizes (n2 = 0.59 and 0.56 respectively). EQ-5D-5L results showed significant improvements in quality of life. Perceived quality of life doubled with an improvement of 0.36 on the health index score, this intervention adds 3.64 Quality Adjusted Life Years (QALYs). Limitations: The study was not an RCT, there was no control group. Conclusions: Alpha-Stim AID CES can be delivered through a UK primary care practice, and can have a significant impact on symptoms of anxiety and depression, and improve quality of life in primary care patients with anxiety symptoms. Further feasibility studies in primary care and sufficiently powered RCT are required.

Closing the Gap in Primary Care: A Systematic Review and Interpretation

Objective: The United States faces a health care provider shortage yearly in many areas of the country, but most of all the rural areas are most impacted. The aim of this paper is 2-fold: To understand the factors that drive a medical student’s specialty choice through a systematic review article and how government initiatives consider what is important to students, to understand how other clinicians can help close the gap in primary care in the United States and what policies or barriers prevent them from doing so. Methods: This paper looks at nationally collected data, as well as meta-analysis reviews on the topic to help the reader better understand the issue of health care provider shortages. Conclusion: We must change the way we look at primary care and rural medicine. Rather than investing money in avenues that yield little return on investment, we as a nation should strategically fund and advance the scope of practice for rural medicine to make it attractive and competitive for clinicians to pursue. Being in a large deficit of clinical providers in general in our country, we must try to find new pathways to grow coverage in rural areas before our health care system is no longer equitable.

Combined automated screening for age-related macular degeneration and diabetic retinopathy in primary care settings

Background:Age-related macular degeneration(AMD)and diabetic retinopathy(DR)are among the leading causes of blindness in the United States and other developed countries.Early detection is the key to prevention and effective treatment.We have built an artificial intelligence-based screening system which utilizes a cloud-based platform for combined large scale screening through primary care settings for early diagnosis of these diseases.Methods:iHealthScreen Inc.,an independent medical software company,has developed automated AMD and DR screening systems utilizing a telemedicine platform based on deep machine learning techniques.For both diseases,we prospectively imaged both eyes of 340 unselected non-dilated subjects over 50 years of age.For DR specifically,152 diabetic patients at New York Eye and Ear faculty retina practices,ophthalmic and primary care clinics in New York city with color fundus cameras.Following the initial review of the images,308 images with other confounding conditions like high myopia and vascular occlusion,and poor quality were excluded,leaving 676 eligible images for AMD and DR evaluation.Three ophthalmologists evaluated each of the images,and after adjudication,the patients were determined referrable or non-referable for AMD DR.Concerning AMD,172 were labeled referable(intermediate or late),and 504 were non-referable(no or early).Concurrently,regarding DR,33 were referable(moderate or worse),and 643 were non-referable(none or mild).All images were uploaded to iHealthScreen’s telemedicine platform and analyzed by the automated systems for both diseases.The system performances are tested on per eye basis with sensitivity,specificity,accuracy,and kappa scores with respect to the professional graders.Results:In identifying referable DR,the system achieved a sensitivity of 97.0%and a specificity of 96.3%,and a kappa score of 0.70 on this prospective dataset.For AMD,the sensitivity was 86.6%,the specificity of 92.1%,and a kappa score of 0.76.Conclusions:The AMD and DR screening tools achieved excellent performance operating together to identify two retinal diseases prospectively in mixed datasets,demonstrating the feasibility of such tools in the early diagnosis of eye diseases.These early screening tools will help create an even more comprehensive system capable of being trained on other retinal pathologies,a goal within reach for public health deployment.

When Information Does Not Translate into Knowledge. Ebola and Hemorrhagic Fevers Knowledge among Primary Care Physicians and Nurses

After the first secondarily-transmitted ebola case in Spain, a wave of divergent opinions flooded mass and sanitary media. Very few of these opinions, however, came from experts on epidemiology or hemorrhagic fevers. This observational study aimed to assess the specific knowledge of Primary Care physicians and nurses about ebola and hemorrhagic fevers by means of analyzing the results obtained from a 5-item self-reported questionnaire dealing on hemorrhagic fevers basic knowledge. Validity and reliability of questionnaire were confirmed by a pilot study. The participants were 138 family doctors and nurses from the 64 public Primary Care centers sited in the North Metropolitan Area of Barcelona (1,400,000 inhab;Catalonia, Spain) taking part in training-the-trainers ebola workshops. Overall, there were 117 (84.8%) respondents out from 138 workshop participants;of them were physicians 61 (51.2%). The main age was 46.7 (8.8) years;stating previous specific knowledge on hemorrhagic fevers 39 (33.3%). On the whole, up to 92 (78.6%) of respondents shown a poor knowledge. Previous specific formation was significantly and independently associated with having proper knowledge (p < 0.001);OR = 8.6 (CI 95%: 3.199 - 23.623). In summary, confusion that accompanied the single secondary-transmitted ebola case in Spain could probably be explained by the existence of a serious gap on hemorrhagic fevers knowledge. More accurate, scientific and formally-presented information should be provided to Primary Care physicians and nurses.

Sagittal abdominal diameter as a marker of visceral obesity in older primary care patients

Background Longevity,combined with a higher prevalence of obesity,particularly visceral obesity,has been associated with an increased risk of cardiovascular diseases.Insulin resistance(IR)is an important link between visceral obesity and cardiovascular diseases.An important association has been found between sagittal abdominal diameter,visceral obesity and IR.The objective of this study is to evaluate sagittal abdominal diameter as a marker of visceral obesity and correlate it with IR in older primary health care patients.Methods A cross-sectional study was performed with 389 patients over 60 years of age(70.6±6.9),of whom 74%were female.Their clinical,anthropometric and metabolic profiles were assessed and their fasting serum insulin level was used to calculate the homeostasis model assessment insulin resistance(HOMA-IR).Sagittal abdominal diameter was measured in the supine position at the midpoint between the iliac crest and the last rib with abdominal calipers.Results Sagittal abdominal diameter was significantly correlated with anthropometric measures of general and visceral obesity and with HOMA-IR in both genders.There was no change in the association between sagittal abdominal diameter and HOMA-IR after adjusting for age,sex,diabetes and hypertension.Conclusion It is feasible to use sagittal abdominal diameter in older primary care patients as a tool to evaluate visceral obesity,which is an indicator of cardiovascular risk.

Strategies for recruiting a sample of adults with type 2 diabetes from primary care clinics in rural Appalachia: Incorporating cultural competence

Background:Recruiting research participants from primary care in rural Appalachia is a major challenge and can be influenced by cultural characteristics,making it critically important to incorporate strategies of cultural competence in the overall design of clinical research.Objectives:The purpose of this paper is to describe culturally competent strategies used for recruitment and data collection with a sample of adults with type 2 diabetes from primary care settings in Appalachia.Design:The Purnell model of cultural competence and relevant literature served as a framework for study design.Four overarching approaches informed the organization of recruitment strategies and development of the data collection plan.Procedures:The approaches included selection of research sites,establishing collaborations,sustaining collaborative relationships,and enhancing understanding of benefits of participation.Four recruitment sites were selected based on potential to enhance diversification of participants;multiple steps were included in each of the three remaining approaches to build relationships and gain participation.A study log was maintained to provide evaluation data.Results:Recruitment took 14 months and a sample of 102 subjects provided consent with 101 participants providing complete data.Demographics were representative of the region except that African American participation was higher(6.9%)compared to current north central Appalachia(3%).Over 72%of participants indicated they would be interested in participating in future studies.Conclusions:These findings emphasize the importance of employing strategies for cultural competence in study design.Use of concepts from the Purnell model led to enhanced representativeness and potential for subsequent generalizability.

Contributions of Primary Health Care and Next Step Considerations: A Systematic Review

The essential consideration is the cornerstone of a solid medical care system that provides outstanding health outcomes at a low cost. Medical therapy has evolved over the previous century from concentrating on random etiologies to lifestyle, race, and environmental factors. The aim behind these changes is to serve the public health requirements by delivering frequent and easy services based on the individual, couple, or family. Accurate evaluation of the magnitude by which primary health care contributes to the health care system is essential to the improvement of these contributions and determining next step considerations. The number one factor has been associated with greater access to medical care, better health outcomes, and reduced hospitalization and ER (emergency room) visits. The number one consideration may also help balance the adverse effects of poor financial situations on well-being. Therefore, we need more primary care doctors in the US. Research is also necessary to understand which essential consideration models provide acceptable health results.

Patient-centered medical home and integrated care in the United States: An opportunity to maximize delivery of primary care

The reciprocal relationship between mental and physical health is well established.Undiagnosed,untreated,and poorly managed mental health conditions are associated with numerous physical health complications,poor treatment adherence,and decreased quality of life.Despite growing evidence regarding the importance of effectively addressing these conditions in primary care,the rates of identification remain low and follow-up and management by primary care providers has been criticized.The objective of this review was to demonstrate the role of Patient-Centered Medical Home(PCMH)and mental health integration in addressing comprehensive health care needs in primary care patients,and to describe common barriers and facilitators to the implementation of these types of programs.

Process engineering for primary care:Quality improvement and population health

A fundamental paradox of the health care delivery systems in many industrialized nations is that desired population health metrics are often not achieved despite large expenditures in the health care delivery system.For example,the United States commits nearly 18%of its GDP to the health care delivery system,the largest amount of any nation,yet is 37th in achieving health or health care delivery metrics.This article addresses how general practice can be an important driver of population health in the Chinese health care delivery system through the application of quality improvement methods.The article shows examples of how the cause-and-effect diagram,the process map,and the plan,do,study,act(PDSA)cycle are important techniques to assist primary care practitioners for improving population health.

Primary care for cancers at diagnosis and follow-up:a narrative review

This paper is concerned about the family physician’s role in early cancer diagnosis and follow-up with his/hers patients who have just been diagnosed with cancer;treatment modalities for cancer;and family physician continuous roles for patients who are under definitive cancer treatment,experiencing side-effects of cancer treatment;some of the effective means to reduce these side-effects during cancer treatment and management of oncologic emergencies.Having some knowledge on the current cancer therapies would undoubtedly help family physicians to follow up patients with cancer more confidently,to appreciate their side-effects,symptomatic treatment,recognize the limit of primary care and be even useful for counseling and consultation with patients or their family members with a family history of cancer.Systematic searches with terms comprised“cancer”,“malignancy”,“primary care”,“general practice”,“cancer AND diagnosis”and“cancer AND follow-up”were done in the major databases such as Pubmed,ScienceDirect and Ovid.We employed selective searches with the above terms and their combination in some of the major journal such as The Lancet Oncology,The Lancet,New England Journal of Medicine,etc.These were followed by snowballing the relevant articles from the citation of references in those selected papers.The goal of this narrative review is not to provide exhaustive documentation of sound evidence for practice of primary care for cancer patients at diagnosis and follow-up.It mainly aims to provide specific evidence-based information and suggestions that are thought to be relevant for primary care professionals and policymakers.

Integrated primary care-behavioral health program development and implementation in a rural context

Objective:Despite the known benefits of integrated primary care and behavioral health services,integrated behavioral health services have not been readily used in medical clinics in interior Alaska.With minimal resources,we recently developed an integrated primary care-behavioral health program in a medical clinic in interior Alaska to meet clinic and community needs.The objective of this study was to explore initial program outcomes and determine the feasibility of program development and implementation.Methods:We initially conducted a needs assessment for integrating behavioral health services into primary care.Program development was informed by specific clinic needs.Following program implementation,initial program outcomes were tracked with use of data from the electronic health record and patient and provider use and satisfaction surveys.The level of integration of primary care and behavioral health services was evaluated with the Practice Integration Profile.Results:A total of 188 patients were seen by behavioral health consultants during the initial pilot phase,including 44.0%referred for mental health symptoms,33.1%referred for physical health issues,and 22.3%referred for both mental and physical health issues.The initial program outcomes indicate modest clinical improvement(measured by the nine-item Patient Health Questionnaire)as well as patient and provider satisfaction with the model,and a moderate level of practice integration.Conclusion:On the basis of the initial findings,it appears that our integrated primary care-behavioral health program has the potential to serve an important role in addressing the behavioral health needs of the local population.Our implementation procedure and initial program outcomes suggest that such models are feasible in rural and small-scale settings with minimal overhead costs.

Homeopathy for COVID-19 in primary care:A randomized,double-blind,placebo-controlled trial(COVID-Simile study)

Background:Different homeopathic approaches have been used as supportive care for coronavirus disease 2019(COVID-19)cases,but none has been tested in a clinical trial.Objectives:To investigate the effectiveness and safety of the homeopathic medicine,Natrum muriaticum LM2,for mild cases of COVID-19.Design,setting,participants,and interventions:A randomized,double-blind,two-armed,parallel,singlecenter,placebo-controlled clinical trial was conducted from June 2020 to April 2021 in S?o-Carlos,Brazil.Participants aged>18 years,with influenza-like symptoms and positive result from a real-time polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 were recruited and randomized(1:1)into two groups that received different treatments during a period of at-homeisolation.One group received the homeopathic medicine Natrum muriaticum,prepared with the second degree of the fifty-millesimal dynamization(LM2;Natrum muriaticum LM2),while the other group received a placebo.Outcome measures:The primary endpoint was time until recovery from COVID-19 influenza-like symptoms.Secondary measures included a survival analysis of the number and severity of COVID-19 symptoms(influenza-like symptoms plus anosmia and ageusia)from a symptom grading scale that was informed by the participant,hospital admissions,and adverse events.Kaplan-Meier curves were used to estimate time-to-event(survival)measures.Results:Data from 86 participants were analyzed(homeopathy,n=42;placebo,n=44).There was no difference in time to recovery between two groups among participants who were reporting influenzalike symptoms at the beginning of monitoring(homeopathy,n=41;placebo,n=41;P=0.56),nor in a sub-group that had at least 5 moderate to severe influenza-like symptoms at the beginning of monitoring(homeopathy,n=15;placebo,n=17;P=0.06).Secondary outcomes indicated that a 50%reduction in symptom score was achieved significantly earlier in the homeopathy group(homeopathy,n=24;placebo,n=25;P=0.04),among the participants with a basal symptom score≥5.Moreover,values of restricted mean survival time indicated that patients receiving homeopathy might have improved0.9 days faster during the first five days of follow-up(P=0.022).Hospitalization rates were 2.4%in the homeopathy group and 6.8%in the placebo group(P=0.62).Participants reported 3 adverse events in the homeopathy group and 6 in the placebo group.Conclusion:Results showed that Natrum muriaticum LM2 was safe to use for COVID-19,but there was no statistically significant difference in the primary endpoints of Natrum muriaticum LM2 and placebo for mild COVID-19 cases.Although some secondary measures do not support the null hypothesis,the wide confidence intervals suggest that further studies with larger sample sizes and more symptomatic participants are needed to test the effectiveness of homeopathic Natrum muriaticum LM2 for COVID-19.Trial registration:UMIN Clinical Trials Registry ID:JPRN-UMIN000040602.

Disconnect between primary care and cancer follow-up care: An exploratory study from Odisha, India

Objective:There has been a steady increase in the demand for cancer follow-up care in India.Compared with Western countries,there is little evidence on the capacity of the Indian primary care workforce to accommodate such tasks.We explored the perceptions of oncologists,general practitioners,and patients with regard to the involvement of primary care in cancer follow-up care.Methods:We undertook semistructured focus-group discussions with eight oncologists,nine general practitioners,and 17 cancer patients to gain an understanding of their perceived roles and responsibilities with regard to primary care in delivering follow-up care and the potential concerns.Data from the focus groups were transcribed verbatim,translated,and analyzed with use of a the-matic approach.Results:Most general practitioners felt that their job is to see‘normal’patients,and cancer patients were exceptions to routine care.Oncologists were apprehensive with regard to the com-petence of general practitioners and patient trust.Patients consult oncologists for cancer follow-up care as they perceive it to be very specialized.Patients expressed difficulty in accessing follow-up care and want specialized oncological care by trained personnel in their vicinity.Conclusion:Despite the growing number of cancer survivors,we found a disconnect between primary care and cancer follow-up care.