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.

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.

Physically active primary care physicians consult more on physical activity and exercise for patients: A public teaching-hospital study

Physical activity and exercise(PAE)improve quality of life and reduce the effects of chronic diseases.Primary care physicians(PCPs)play an important role to encourage PAE in patients.We aim to assess PCPs'current PAE consultation practices and their enablers/barriers in daily clinical practice.We had 64 PCPs(age[35.3±4.7]y,47 women)that completed self-administered questionnaires on PAE consultation practices,training,and confidence levels.PCPs(n=42)also completed the International Physical Activity Questionnaire-Short Form to assess their physical activity(PA)levels.We conducted correlation,one-way analysis of variance and a linear regression to assess the associations between enablers,barriers and PA levels to PAE consultation practices.On average,PCPs consulted on PAE in 49.7%of their daily clinical appointments.Majority of PCPs(70%)strongly agreed that more PAE knowledge were needed to increase consultation practices.Top three barriers related(p<0.001)to practices were lack of PAE education(r=0.47),patients’preference of pharmaceutical interventions(r=0.45)and lack of continuing education in PAE for PCPs(r=0.37).Physically active PCPs(health-enhancing PA levels,n=6)gave significantly more daily consultations in PAE,73.2%±21.9%,compared to inactive PCPs(n=13),37.4%22.8%(p=0.013).In our regression output,PCPs who had higher PA levels consulted more on PAE daily(R^(2)=0.38,p<0.001)while controlling for age.Conclusion,PCPs require more knowledge on PAE and need be physically active themselves to increase PAE consultation for patients in their daily practice.Medical education should consider including more PA and exercise topics that may benefit both physicians and their patients.

How Specialists Become Primary Care Physicians in Japan

Background: Most countries have a shortage of Primary Care (PC) physicians. Japan has mitigated this problem by specialists making a mid-career change to PC when they go into private practice. This study examines the circumstances under which specialists shift to PC. Methods: Since the division between specialists and PC physicians is blurred in Japan, we focus on Physicians Providing Home Visits (PPHV). The list of PPHV was obtained from the local medical associations in two neighboring medical planning areas in Japan. The methods used were a questionnaire and in-depth interviews. Results: Of the 46 listed as PPHV, 38 responded to the questionnaires. Physicians mainly acquired their knowledge and skills in primary care from post-graduate clinical training and on the job training after becoming PPHV. The specialists who had moved to PC were equally knowledgeable regarding PC as those had taken the PC accreditation exam. The in-depth interviews revealed that the higher income earned in clinics and being able to retain their identity as a specialist were also important factors. Conclusions: The factors that contributed to physicians making a mid-career change from specialists to PC were their experiences after being certified, the higher income in clinics and the ability to retain their professional identity as specialists. These enabling factors might also be applicable for increasing the ratio of PC physicians at the global level although further studies are required.

Treatment patterns of primary care physicians vs specialists prior to subspecialty urogynaecology referral for women suffering from pelvic floor disorders

BACKGROUND There are approximately 25% of women in the United States suffering from pelvic floor disorders (PFDs) and this number is predicted to rise. The potential complications and increasing healthcare costs that exist with an operation indicate the importance of conservative treatment options prior to attempting surgery. Considering the prevalence of PFDs, it is important for primary care physician and specialists (obstetricians and gynecologists) to be familiar with the initial work-up and the available conservative treatment options prior to subspecialist (urogynecologist) referral. AIM To assess the types of treatments that specialists attempted prior to subspecialty referral and determine the differences in referral patterns. METHODS This is a retrospective cohort study of 234 patients from a community teaching hospital referred to a single female pelvic medicine and reconstructive surgery (FPMRS) provider for PFD. Specialist vs primary care provider (PCP) referrals were compared. Number, length and treatment types were studied using descriptive statistics. RESULTS There were 184 referrals (78.6%) by specialists and 50 (21.4%) by PCP. Treatment (with Kegel exercises, pessary placements, and anticholinergic medications) was attempted on 51%(n = 26) of the PCP compared to 48%(n = 88) of the specialist referrals prior to FPMRS referral (P = 0.6). There was no significant difference in length of treatment prior to referral for PCPs vs specialists (14 mo vs 16 mo, respectively, P = 0.88). However, there was a significant difference in the patient’s average time with the condition prior to referral (35 mo vs 58 mo for PCP compared to specialist referrals)(P = 0.02). CONCLUSION One half of the patients referred to FPMRS clinic received treatment prior to referral. Thus, specialists and generalists can benefit from education regarding therapies for PFD before subspecialty referral.

Job Satisfaction and Mental Health among Physicians in Primary Health Care Centers in Kuwait

Objectives: To measure the level of job satisfaction among primary health care physicians Ministry of Health (MOH) Primary Healthcare Center (PHC) physicians, to evaluate the physicians’ mental health, and to assess their associated factors. Study Setting: Kuwait Ministry of Health, Primary Care Centers. Study Design: Cross-sectional study. Data Collection: The study was conducted from July to September, 2017. Of 746 questionnaires distributed to all PHC physicians in the MOH, 417 questionnaires were completed. Information was collected on socio-demographic characteristics, work and health-related factors, job satisfaction (using the Warr-Cook-Wall job satisfaction scale), and mental health (using General Health Questionnaire). Principal Findings: Of participants, 40.8% were male, and 24.9% were Kuwaitis. Median overall job satisfaction was 71.4%. There were significant differences in overall job satisfaction with the physician rank (p = 0.008) and governorate (p = 0.05). The GPs were moderately satisfied with work surroundings;work freedom;recognition;degree of responsibility;salary;opportunity to use abilities;attention given to suggestions;relationship with hospital physicians, colleagues, and fellow workers;relations between management and workers;working hours;and the amount of variety in their job, but more satisfied with their immediate supervisors. Conclusions: Job satisfaction of PHC physicians is critical for the improvement of health systems. This study showed that GPs (General Practitioners) were more satisfied overall than previously reported studies done in Kuwait. They were moderately satisfied with their salary and the amount of variety in work.

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.

Interventions to improve communication between nurses and physicians in the intensive care unit: An integrative literature review

Effective communication among healthcare professionals in the intensive care unit (ICU) is a particular imperative,with accurate and efficient interdisciplinary communication being a critical prerequisite for high-quality care.Nurses and physicians are highly important parts of the healthcare system workforce.Thus,identifying strategies that would improve communication between these two groups can provide evidence for practical improvement in the ICU,which will ultimately improve patient outcomes.This integrative literature review aimed to identify interventions that improve communication between nurses and physicians in ICUs.Three databases (Medline,CINAHL,and Science Direct) were searched between September 2014 and June 2016 using 11 search terms,namely,nurse,doctor,physician,resident,clinician,ICU,intensive care unit,communication,teamwork,collaboration,and relationship.A manual search of the reference lists of found papers was also conducted.Eleven articles met the inclusion criteria.These studies reported on the use of communication tools/checklists,team training,multidisciplinary structured work shift evaluation,and electronic situation-background-assessment -recommendation documentation templates to improve communication.Although which intervention strategies are most effective remains unclear,this review suggests that these strategies improve communication to some extent.Future studies should be rigorously designed and outcome measures should be specific and validated to capture and reflect the effects of effective communication.

Rabeprazole test for the diagnosis of gastro-oesophageal reflux disease: Results of a study in a primary care setting

AIM： To determine the diagnostic value of the rabeprazole test in patients seen by general practitioners. METHODS： Eighty-three patients with symptoms suggestive of GERD were enrolled by general practitioners in this multi-centre, randomized and doubleblind study. All patients received either rabeprazole （20 mg bid） or a placebo for one week. The diagnosis of GERD was established on the presence of mucosal breaks at endoscopy and/or an abnormal esophageal 24-h pH test. The test was considered to be positive if patients reported at least a ＂clear improvement＂ of symptoms on a 7-point Likert scale. RESULTS： The sensitivities of the test for rabeprazole and the placebo were 83% and 40%, respectively. The corresponding specificity, positive and negative predictive values were 45% and 67%, 71% and 71%, and 62% and 35%, respectively. A receiver operating characteristics （ROC） analysis confirmed that the best discriminatory cut-off corresponded to description of ＂clear improvement＂ CONCLUSION： The poor specificity of the proton-pump inhibitor （PPI） test does not support such an approach to establish a diagnosis of GERD in a primary care setting.

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.

Evaluation of Methods for Dissemination of Prostate Cancer Survivorship Guidelines: A Survey of Primary Care Providers

Objectives: To assess potential knowledge gaps between primary care providers (PCPs) and cancer specialists, Michigan Cancer Consortium guidelines were developed and disseminated statewide. We evaluated the impact of dissemination of these guidelines on PCP attitudes and beliefs regarding management of prostate cancer (PC) post-treatment sequelae. Methods: Guidelines were disseminated via hard-copy and web-link mailed to 12,000 Michigan PCPs in 2009, and via 5 CME presentations to 181 PCPs in 2010-2011. 132 initial surveys were collected from CME attendees and 549 follow-up surveys were received 20 months after the initial mailing. Results: Surveyed PCPs indicated erectile dysfunction (88%), incontinence (84%), anxiety (54%) and fear of the unknown (50%) as frequent post-treatment sequelae. A minority of PCPs (≤41%) felt “very comfortable” assessing PC patients for ten post-treatment sequelae at the initial survey, which increased by up to 27% on follow-up survey. 93% of PCPs that received guidelines by mail and CME presentation had incorporated them into practice, compared with 72% of PCPs that received guidelines solely by mailing. Similarly, a greater proportion reported practice pattern changes (65% vs. 34%, p = 0.0003). A higher proportion felt CME events (69% vs. 57%) and expert presentations (64% vs. 44%) were “very effective”, when comparing attendees and non-attendees. Conclusions: Guideline distribution resulted in increased comfort with survivorship issues and incorporation into the practices of the majority of PCPs surveyed. A greater impact was observed in PCPs that attended a CME presentation than in those that received guidelines only by mailing.

Primary Care Practitioners’ Views on the Use of Proton Pump Inhibitors Associated with Alginate-Antacids for Better Gastroesophageal Reflux Disease Symptom Control: Results of a National Survey in Spain

Background: Gastroesophageal reflux disease (GERD) is a prevalent disease in Western countries. Despite effective treatment modalities, in some patients total symptom control is not achieved in clinical practice. A cross-sectional study was designed to assess primary care practitioners’ views on the effectiveness of proton pump inhibitors (PPI) as monotherapy in the control of the most common symptoms of GERD (heartburn and regurgitation), as well as to determine the level of implementation of the “combined therapy” (PPI + alginate-antacids). Methods: A questionnaire on different aspects of the management of GERD was completed by 1491 primary care physicians. The questionnaire was composed of 11 close-ended questions with one-choice answer, with a total of 52 items, covering the main data from patients presenting with GERD. Results: Treatment with PPI alone was mostly considered insufficient for the control of GERD symptoms. The combined treatment of PPI + alginate-antacids was used for 37% and 21% of physicians for treating heart-burn and regurgitation, respectively. A better control of symptoms, an increase in the onset of action and to reduce nocturnal acid breakthrough were the most frequently argued reasons for the use of PPI + alginate-antacids. A high percentage of participants believed that treatment with PPI alone was insufficient for the control of symptoms and 39.8% of physicians reported the persistence of heartburn, 38.6% the persistence of regurgitation and 43.2% the persistence of epigastric discomfort in more than 25% of their patients treated with PPI as monotherapy. The most common schedule for the use of the antacid medication was on demand. Conclusions: Spanish primary care physicians consider that a high proportion of GERD patients continue to suffer from symptoms during PPI treatment alone. Ondemand “combined therapy” (PPI + antacid) is considered an efficient option to control reflux symptoms still troublesome in patients with PPI treatment alone.

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.

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.

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.

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.

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.

Self-care in stroke patients and the capability of primary caregivers

Stroke rehabilitation, especially for patients with sequelae, lacks practicable rehabilitation training methods. Using the convenience sampling method, self-care ability in 60 stroke patients was investigated for 6 months to 2 years post-stroke （sequelae stage）, as well as the capability of primary caregivers selected from two communities in Shanghai, China. Influential factors were analyzed. Results demonstrated that only 37% of stroke patients exhibited strong self-care ability, and 43% of primary caregivers provided high levels of care. Results also demonstrated that self-care ability in stroke patients, as well as the capability of primary caregivers, should be improved. A total of 47% of stroke patients participated in community rehabilitation training, and self-care ability was significantly better in this group than in patients who did not receive rehabilitation training. Thus it is necessary to develop systematic, individualized, and family-based rehabilitative strategies to improve community rehabilitation training modes and strengthen rehabilitation guidance for patients and caregivers.