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Family Practice
Journal Prestige (SJR): 1.018
Citation Impact (citeScore): 2
Number of Followers: 17  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0263-2136 - ISSN (Online) 1460-2229
Published by Oxford University Press Homepage  [415 journals]
  • The impact of the COVID-19 pandemic on family medicine residency training

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      Authors: Awadallah N; Czaja A, Fainstad T, et al.
      Abstract: AbstractBackgroundFamily physicians have played a unique clinical role during the COVID-19 pandemic. We hypothesized that the pandemic would be associated with significant deleterious effects on clinical activity, educational training, personal safety and well-being.ObjectiveWe conducted a national survey to obtain preliminary data that would assist in future targeted data collection and subsequent evaluation of the impact of the pandemic on family medicine residents and teaching faculty.MethodsAn anonymous online survey of residents and faculty was distributed via the Association of Family Medicine Residency Directors list serve between 5/21/2020 and 6/18/2020. Survey questions focused on clinical and educational activities, safety and well-being.ResultsOne hundred and fifty-three residents and 151 teaching faculty participated in the survey. Decreased clinical activity was noted by 81.5% of residents and 80.9% of faculty and the majority began conducting telehealth visits (97.9% of residents, 91.0% of faculty). Distance learning platforms were used by all residents (100%) and 39.6% noted an overall positive impact on their education. Higher levels of burnout did not significantly correlate with reassignment of clinical duties (residents P = 0.164; faculty P = 0.064). Residents who showed significantly higher burnout scores (P = 0.035) and a decline in levels of well-being (P = 0.031) were more likely to participate in institutional well-being support activities.ConclusionsOur preliminary data indicate that family medicine residents and teaching faculty were profoundly affected by the COVID-19 pandemic. Future studies can be directed by current findings with focus on mitigation factors in addressing globally disruptive events such as COVID-19.
      PubDate: Fri, 27 Aug 2021 00:00:00 GMT
       
  • COVID-19 and the flu: data simulations and computational modelling to
           guide public health strategies

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      Authors: Tunaligil V; Meral G, Dabak M, et al.
      Abstract: AbstractBackgroundPandemics threaten lives and economies. This article addresses the global threat of the anticipated overlap of COVID-19 with seasonal-influenza.ObjectivesScientific evidence based on simulation methodology is presented to reveal the impact of a dual outbreak, with scenarios intended for propagation analysis. This article aims at researchers, clinicians of family medicine, general practice and policy-makers worldwide. The implications for the clinical practice of primary health care are discussed. Current research is an effort to explore new directions in epidemiology and health services delivery.MethodsProjections consisted of machine learning, dynamic modelling algorithms and whole simulations. Input data consisted of global indicators of infectious diseases. Four simulations were run for ‘20% versus 60% flu-vaccinated populations’ and ‘10 versus 20 personal contacts’. Outputs consisted of numerical values and mathematical graphs. Outputs consisted of numbers for ‘never infected’, ‘vaccinated’, ‘infected/recovered’, ‘symptomatic/asymptomatic’ and ‘deceased’ individuals. Peaks, percentages, R0, durations are reported.ResultsThe best-case scenario was one with a higher flu-vaccination rate and fewer contacts. The reverse generated the worst outcomes, likely to disrupt the provision of vital community services. Both measures were proven effective; however, results demonstrated that ‘increasing flu-vaccination rates’ is a more powerful strategy than ‘limiting social contacts’.ConclusionsResults support two affordable preventive measures: (i) to globally increase influenza-vaccination rates, (ii) to limit the number of personal contacts during outbreaks. The authors endorse changing practices and research incentives towards multidisciplinary collaborations. The urgency of the situation is a call for international health policy to promote interdisciplinary modern technologies in public health engineering.
      PubDate: Fri, 27 Aug 2021 00:00:00 GMT
       
  • NEWS2 to assess suspected COVID-19 in the community: a service evaluation
           of a primary care assessment centre

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      Authors: Zaman I; Beevers Z, Ahmed R, et al.
      Abstract: AbstractBackgroundPrimary care has played a central role in the community response to the coronavirus disease-19 (COVID-19) pandemic. The use of the National Early Warning Score 2 (NEWS2) has been advocated as a tool to guide escalation decisions in the community. The performance of this tool applied in this context is unclear.AimTo evaluate the process of escalation of care to the hospital within a primary care assessment centre (PCAC) designed to assess patients with suspected COVID-19 in the community.Design and settingA retrospective service evaluation of all adult patients assessed between 30 March and 22 April 2020 within a COVID-19 primary care assessment centre within Sandwell West Birmingham CCG.MethodA database of patient demographics, healthcare interactions and physiological observations was constructed. NEWS2 and CRB65 scores were calculated retrospectively. The proportion of patients escalated was within risk groups defined by NHSE guidelines in place during the evaluation period was determined.ResultsA total of 150 patients were identified. Following assessment 13.3% (n = 20) patients were deemed to require escalation. The proportion of patients escalated with a NEWS2 greater than or equal to 3 was 46.9% (95% CI 30.8–63.6%). The proportion of patients escalated to secondary care using NHSE defined risk thresholds was 0% in the green group, 22% (n = 4) in the amber group, and 81.3% (n = 13) in the red group.ConclusionClinical decisions to escalate care to the hospital did not follow initial guidance written for the COVID-19 outbreak but were demonstrated to be safe.
      PubDate: Fri, 27 Aug 2021 00:00:00 GMT
       
  • Primary care responses to the COVID-19 pandemic

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      Authors: Zeber J; Khanna N.
      Abstract: On 11 March 2020, the World Health Organization declared Coronavirus 2019 (COVID-19) a pandemic, one that has since spread across the globe. As of May 2021, COVID-19 has infected over 171 million people, resulting in more than 3.5 million deaths, while pressing hospital and ICU capacities to precarious acuity levels. Yet the international crisis also revealed a disproportionate impact on primary care, leading to severe declines in clinical volumes and revenues, plus interruption in effective preventive care services and chronic disease management. Equally important, we are learning of numerous potential long-term clinical impacts and distressing ongoing chronic health issues stemming from respiratory illness, psychological problems or cognitive deficits and unexplained lingering symptoms (1–3). Primary care training has likely suffered due to early restrictions on personal protective equipment, quarantine of health care workers and reduced morale amongst practicing physicians and nurses (4–6). Rapid adoption of telehealth, and outreach to existing patient populations has created a demand for new methods of care delivery (7) and reimbursement, while concurrently raising a multitude of questions about effectiveness and financial stability (8).
      PubDate: Fri, 27 Aug 2021 00:00:00 GMT
       
  • Self-reported symptoms in French primary care SARS-CoV-2 patients:
           association with gender and age group

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      Authors: Sebo P; Maisonneuve H, Lourdaux J, et al.
      Abstract: AbstractIntroductionThe early identification of COVID-19 patients is of outmost importance in the current pandemic. As with other pathogens, presenting symptoms of SARS-CoV-2 may vary, depending on sociodemographic factors. We aimed to describe the clinical characteristics of COVID-19 patients by age/gender and to assess whether the diagnostic performance of these symptoms varied according to these variables.MethodsWe analysed data from a cross-sectional study involving primary care patients undergoing RT-PCR testing in Lyon, France. Among patients who tested positive, we examined whether there was an association between age/gender and various symptoms. In addition, we calculated the diagnostic performance of the most specific symptoms (smell/taste disorder).ResultsAmong 1543 consecutive patients, 253 tested positive (16%). There were significant age/gender-related differences in symptoms. In middle-aged women, the diagnostic performance of smell/taste disorders were AUC = 0.65 [95%CI 0.59–0.71] and PPV = 72% [95%CI 53–87%], that is higher than in the entire sample (smell/taste disorders: AUC = 0.59 [95%CI 0.57–0.62] and PPV = 57% [95%CI 47–67%]. In contrast, the negative predictive values of smell/taste disorders were similar in both groups (85% [95%CI 81–89%] for middle-age women and 86% [95%CI 85–88%] for the entire sample).ConclusionWe found significant age/gender-related differences in the clinical characteristics of COVID-19 patients. Screening strategies based on smell/taste disorders performed better in middle-aged women, but could not ensure a diagnosis of COVID-19 in any subgroup of patients. Future diagnostic strategies should use age/gender differentiated approaches.
      PubDate: Fri, 27 Aug 2021 00:00:00 GMT
       
  • Knee osteonecrosis after COVID-19

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      Authors: Angulo-Ardoy M; Ureña-Aguilera Á.
      Abstract: AbstractBackgroundCOVID-19 is an emergent infection, the long-term complications of which are still under study. While hypercoagulability is a common feature in severe cases, the incidence of ischemic complications such as osteonecrosis remains unknown. Previous studies on SARS-CoV1 found an increase in osteonecrosis 3–36 months after infection, and it is still unclear if this was related to the use of corticosteroids or to the virus itself.MethodsWe introduce a 78-year-old woman who complained of right knee pain and swelling a month after COVID-19 infection onset. Her knee radiography showed no significant changes compared to previous ones. MRI, on the other hand, found osteonecrosis in the internal femoral condyle. No coagulation abnormalities were found in blood tests.ResultsWhile knee replacement should be her main treatment, it will be long delayed due to the pandemic. In the meantime, we increased her tapentadol and salicylic acid doses and gave her home exercises to improve functionality.ConclusionIn the follow-up after COVID-19, any muscular or joint pain with unusual characteristics should be carefully examined.
      PubDate: Fri, 27 Aug 2021 00:00:00 GMT
       
  • The perspective of Canadian health care professionals on abortion service
           during the COVID-19 pandemic

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      Authors: Ennis M; Wahl K, Jeong D, et al.
      Abstract: AbstractBackgroundThe COVID-19 pandemic and pandemic response created novel challenges for abortion services. Canada was uniquely positioned to transition to telemedicine because internationally common restrictions on abortion medication were removed before the pandemic.ObjectiveWe sought to characterize the experiences of abortion health care professionals in Canada during the COVID-19 pandemic and the impact of the pandemic response on abortion services.MethodsWe conducted a sequential mixed methods study between July 2020 and January 2021. We invited physicians, nurse practitioners and administrators to participate in a cross-sectional survey containing an open-ended question about the impact of the pandemic response on abortion care. We employed an inductive codebook thematic analysis, which informed the development of a second, primarily quantitative survey.ResultsOur initial survey had 307 respondents and our second had 78. Fifty-three percent were family physicians. Our first survey found respondents considered abortion access essential. We identified three key topicss: access to abortion care was often maintained despite pandemic-related challenges (e.g. difficulty obtaining tests, additional costs); change of practice to low-touch medication abortion care and provider perceptions of patient experience, including shifting demand, telemedicine acceptability and increased rural access. The second survey indicated uptake of telemedicine medication abortion among 89% of participants except in Quebec, where regulations meant procedures were nearly exclusively surgical. Restrictions did not delay care according to 76% of participants.ConclusionsCanadian health care professionals report their facilities deemed abortion an essential service. Provinces and territories, except Quebec, described a robust pandemic transition to telemedicine to ensure access to services.PodcastAn accompanying podcast is available in the Supplementary Data, in which the authors Dr Madeleine Ennis and Kate Wahl discuss their research on how family planning care and access to abortion services have changed during the COVID-19 pandemic.
      PubDate: Mon, 23 Aug 2021 00:00:00 GMT
       
  • ‘I was scared I will end up in another abortion’: a mixed-methods
           study assessing the impact of COVID-19 pandemic and lockdown on the
           antenatal care of pregnant women in Puducherry, South India

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      Authors: Ulaganeethi R; Dorairajan G, Ramaswamy G, et al.
      Abstract: AbstractBackgroundAs a mitigation measure for COVID-19 pandemic, lockdown was implemented in India for a period of 2 months (24 March–31 May 2020). Disruption in antenatal care (ANC) provisions during lockdown is expected due to diversion of public health facilities on pandemic.ObjectiveTo assess the proportion of pregnant women who had not completed the ideal number of antenatal visits, availability of iron–folic acid (IFA) supplements and challenges in availing health services during the period of lockdown.MethodsA concurrent mixed-methods study was conducted among pregnant women in Puducherry, India. Information on obstetric characteristics and details regarding antenatal visits were collected through telephonic interviews. In-depth interviews were conducted to understand the perceived challenges in availing health services during the lockdown period.ResultsOut of 150 pregnant women, 62 [41.3%; 95% confidence interval (CI) 33.6–49.3] did not complete the ideal number of visits and 61 (40.7%, 95% CI 32.7–49.0) developed health problems. Out of 44 women who received medical care for health problems, 11 (25%) used teleconsultation. Of all the women, 13 (8.7%, 95% CI 4.9–14.0) had not taken the IFA supplements as prescribed by the health provider. Economic hardship, restricted mobility, lack of information about the health system changes and psychological stress due to the fear of COVID were the challenges in accessing care.ConclusionsTwo out of five pregnant women did not complete the ideal number of visits and developed health problems during the lockdown period.
      PubDate: Fri, 25 Jun 2021 00:00:00 GMT
       
 
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