Storylines of family medicine Ⅻ:family medicine and the healthcare system

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine,as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world.In‘Ⅻ:Family medicine and the future of the healthcare system’,authors address the following themes:‘Leadership in family medicine’,‘Becoming an academic family physician’,‘Advocare—our call to act’,‘The paradox of primary care and three simple rules’,‘The quadruple aim—melding the patient and the health system’,‘Fit-for-purpose medical workforce’,‘Universal healthcare—coverage for all’,‘The futures of family medicine’and‘The 100th essay.’May readers of these essays feel empowered to be part of family medicine’s exciting future.

Smoking, smoking cessation, and survival after cancer diagnosis in 128,423 patients across cancer types

Dear Editor,Given the systemic and substantial health consequences of smoking and the significant cancer risk from smoking[1,2],it is expected that cancer patients would quit smoking after cancer diagnosis.However,the smoking rate among cancer survivors is only slightly lower than that among the general population[3,4],and 64%of smokers diagnosed with cancer continued to smoke even after they learned they had cancer[5].In addition,some former smokers may resume smoking after surviving cancer[6].A number of previous studies have investigated the association between smoking and clinical outcomes in cancer patients[1,7–10].Nevertheless,most studies were conducted in smoking-related cancers,and evidence for non-smoking-related cancers is limited.There is an urgent need for more convincing evidence showing the harms of smoking and the benefits of smoking cessation to promote smoking cessation in cancer patients and survivors.We systematically studied the associations of smoking status,smoking intensity,age at initiation,and smoking cessation at cancer diagnosis with all-cause mortality in a prospective cohort of 128,423 cancer patients across 23 cancer types from the MD Anderson Cancer Patients and Survivors Cohort.

The Utility of Voided Urine Samples as a Proxy for the Vaginal Microbiome and for the Prediction of Bacterial Vaginosis

Recent work has shown that the vaginal microbiome exerts a strong impact on women's gynecological health.However,collection of vaginal specimens is invasive and requires previous clinical training or the involvement of a trained clinician.In contrast,urine sample collection is routine and noninvasive and does not require involvement of a clinician.We sought to compare the vaginal and urogenital microbiomes to assess the utility of voided urine samples as a proxy for the vaginal microbiome.Paired urogenital and vaginal samples were collected from pregnant women and characterized by 16S rRNA taxonomic profiling.We examined diversities and compositions of paired urogenital and vaginal microbiomes using five discrete strategies to explore the similarity between the vaginal and urogenital microbiomes.A strategy comparing the paired urogenital and vaginal microbiomes in which taxa were assigned using the STIRRUPS database and urine-specific taxa were removed showed no significant difference in diversity and composition between the paired urogenital and vaginal microbiomes.Moreover,the relative abundances of common vaginal taxa were linearly correlated with those in the paired urogenitalmicrobiomes.These similarities suggest that voided urine samples could represent a noninvasive protocol for accurate profiling of the vaginalmicrobiome with likely clinical applications.Finally,a machine learning model was established in which the voided urine microbiome was compared favorably to the vaginal microbiome in predicting bacterial vaginosis.

It takes two to tango: the recruiter’s role in accepting or refusing to participate in group antenatal care among pregnant women—an exploration through in-depth interviews

Objective The purpose of this study was to explore how women are recruited for group antenatal care(GANC)in primary care organisations(PCOs),what elements influence the behaviour of the recruiter,and what strategies recruiters use to encourage women to participate.Method Using a qualitative research design,we conducted 10 in-depth interviews with GANC facilitators working in PCOs.Selected constructs of the domains of the Consolidated Framework for Implementation Research and the Theoretical Domains Framework helped to develop interview questions and raise awareness of important elements during interviews and thematic analyses.GANC facilitators working in multidisciplinary PCOs located in Brussels and Flanders(Belgium)were invited to participate in an interview.We purposively selected participants because of their role as GANC facilitators and recruiters.We recruited GANC facilitators up until data saturation and no new elements emerged.Result We identified that the recruitment process consists of four phases or actions:identification of needs and potential obstacles for participation;selection of potential participants;recruitment for GANC and reaction to response.Depending on the phase,determinants at the level of the woman,recruiter,organisation or environment have an influence on the recruitment behaviour.Conclusion Our study concludes that it takes two to tango for successful recruitment for GANC.Potential participants’needs and wishes are of importance,but the care providers’behaviour should not be underestimated.Therefore,successful recruitment may be improved when introducing a multidisciplinary recruitment plan consisting of specific strategies,as we suggest.