General practitioners' perceptions of using virtual primary care during the COVID-19 pandemic: An international cross-sectional survey study

With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. We explored GPs' perspectives on the main benefits and challenges of using digital virtual care. GPs across 20 countries completed an online questionnaire between June-September 2020. GPs' perceptions of main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. A total of 1,605 respondents participated in our survey. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and accompanying legal frameworks. Main challenges included patients' preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital virtual care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues, and regulatory weaknesses. At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how during the pandemic. Lessons learned can be used to inform the adoption of improved virtual care solutions and support the long-term development of platforms that are more technologically robust and secure.

Evaluating the Impact of COVID-19 on the Adoption of Virtual Care in General Practice in 20 Countries (inSIGHT): Protocol and Rationale Study

BACKGROUND

In recent decades, virtual care has emerged as a promising option to support primary care delivery. However, despite the potential, adoption rates remained low. With the outbreak of COVID-19, it has suddenly been pushed to the forefront of care delivery. As we progress into the second year of the COVID-19 pandemic, there is a need and opportunity to review the impact remote care had in primary care settings and reassess its potential future role.

OBJECTIVE

This study aims to explore the perspectives of general practitioners (GPs) and family doctors on the (1) use of virtual care during the COVID-19 pandemic, (2) perceived impact on quality and safety of care, and (3) essential factors for high-quality and sustainable use of virtual care in the future.

METHODS

This study used an online cross-sectional questionnaire completed by GPs distributed across 20 countries. The survey was hosted in Qualtrics and distributed using email, social media, and the researchers' personal contact networks. GPs were eligible for the survey if they were working mainly in primary care during the period of the COVID-19 pandemic. Descriptive statistical analysis will be performed for quantitative variables, and relationships between the use of virtual care and perceptions on impact on quality and safety of care and participants' characteristics may be explored. Qualitative data (free-text responses) will be analyzed using framework analysis.

RESULTS

Data collection took place from June 2020 to September 2020. As of this manuscript's submission, a total of 1605 GP respondents participated in the questionnaire. Further data analysis is currently ongoing.

CONCLUSIONS

The study will provide a comprehensive overview of the availability of virtual care technologies, perceived impact on quality and safety of care, and essential factors for high-quality future use. In addition, a description of the underlying factors that influence this adoption and perceptions, in both individual GP and family doctor characteristics and the context in which they work, will be provided. While the COVID-19 pandemic may prove the first great stress test of the capabilities, capacity, and robustness of digital systems currently in use, remote care will likely remain an increasingly common approach in the future. There is an imperative to identify the main lessons from this unexpected transformation and use them to inform policy decisions and health service design.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/30099.

Family Physicians' Knowledge about and Attitudes towards COVID-19 - A Cross-sectional Multicentric Study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has affected every country on earth, and family physicians (FPs) have helped patients at every stage. The first objective of our study was to study the FPs' knowledge about COVID-19 and second objective was to assess their attitudes, stress and death anxiety surrounding the current pandemic.

MATERIALS AND METHODS

An online questionnaire was prepared to collect responses from FPs between March-April 2020. A descriptive and correlational design was utilized.

RESULTS

240 FPs from eight countries were evaluated. The majority reported that they received most information from medical journals (77%). Most of the respondents also noted that the most common symptoms were acute respiratory syndrome and fever - with the most effective treatment in most cases consisting of symptomatic treatment (41%). Although FPs generally had a positive attitude, most of them (68%) were concerned about contacting COVID-19 from patients and as a result, they experienced increased stress (64%).

CONCLUSION

The research was conducted during the COVID-19 outbreak while the FPs were working on the frontline of the pandemic. This research revealed that most of the FPs had good knowledge of, and a positive attitude towards COVID-19 treatment. It was observed that participants who tended towards conscientiousness, emotional stability, and openness to experience, and who had higher life satisfaction, and lower levels of death anxiety also reported more positive attitudes towards COVID-19. While the main target population of COVID-19 disease were the older age groups, FPs' attitudes and fear levels were not associated with age, gender, or years of experience.

Leveraging Unmanned Aerial Vehicle Technology to Improve Public Health Practice: Prospects and Barriers

Unmanned aerial vehicle (UAV) is increasingly being used in different sectors, including public health. Common applications of UAVs in public health are delivering logistics in remote areas, transporting biomedical samples, providing community-based health care, and public health surveillance. UAVs have contributed to efficient public health ensuring better health services activities at a lower cost. Across diverse health-care settings, UAVs are used to minimize human labor and physical barriers such as distance or hazards associated with different tasks. This technology has shown notable success in advancing public health in resource-constrained countries. In Rwanda, the use of UAVs has resulted in robust logistic support and improved vaccine coverage. Faster transportation and coordination between points of health services have facilitated the overall health service delivery. Despite these advancements, there are several challenges in using UAVs in public health, which include technical difficulties in operating UAVs, maintenance of devices and systems, regulatory challenges, safety concerns, air traffic congestion, and cost of using UAVs. These challenges should be addressed with empirical research and innovative interventions to leverage UAVs in preventing health-care problems and saving lives around the world.

Where is the patient's chair? Differences in general practitioner consultation room layouts - an exploratory questionnaire

Background: Consultation room design varies from country to country. The layout of a general practitioner’s (GP’s) consulting room may influence the physician’s or patient’s experience. The aim of this study is to explore and investigate the layout of GP’s consulting rooms around the world and to describe any significant differences.

Methods: Between 3rd July and 2nd August 2018, an internet-based questionnaire on Google Docs was distributed by email, social media and WhatsApp platforms to several worldwide rural medicine groups.  Analysis of an internet-based questionnaire to explore possible layouts of consultation rooms within practices was performed. The questionnaire was designed with three distinct sections: first, a GP demographic profile including gender, year of graduation from medical school, country of graduation, and type of practice (private or public); second, questions relating to the office layout; third, a section for questionnaire feedback.  

Results: 502 responses to the questionnaire were received; 65.3% women and 34.7% men.  The most common layout in Europe and America was where the physician and the patient were separated by a desk. The layout where the physician and the patient had a 90º angle facing each other was the most commonly used layout in Asia-Pacific and Africa. For GPs who graduated before 1990 and between 1990-2010, the layout where the table was between the patient and physician was preferred. However, physicians graduating after 2010 preferred a layout with the physician and the patient with a 90º angle facing each other.

Conclusion: The position of the GP’s desk differs between and within countries as well as the gender of the physician and year of graduation. Next steps should focus on gathering an even greater breadth of GP input, as well as comparing and contrasting those to the preferences of our patients and communities.

Association between +45T>G adiponectin polymorphism gene and type 2 diabetes mellitus and metabolic syndrome in a Venezuelan population

Background: Adiponectin (ADIPOQ) is a hormone primarily synthesized by adipocytes and encoded by the ADIPOQ gene, which exerts anti-inflammatory, antiatheratogenic and insulin sensitizing functions. It has been shown that its plasma concentrations are decreased in individuals with metabolic syndrome (MS) and type 2 diabetes mellitus (DM2), which could be due to variations in the gene coding for this protein. The aim of this study was to detect the +45 T>G polymorphism of the ADIPOQ gene in subjects with DM2 and MS in Maracaibo municipality, Zulia state, Venezuela. Methods: A total of 90 subjects who attended the Center for Metabolic Endocrine Research "Dr. Félix Gómez" were enrolled for this study, 46 of which had MS-DM2 and 44 of which were healthy control individuals. Genomic DNA was extracted from blood samples and PCR-restriction fragment length polymorphism analysis was carried out for the promoter region of the ADIPOQ gene. Likewise, the +45 T> G polymorphism was identified and correlated with MS and DM2 in the studied population. Results: The most frequent allele in both groups was the T allele, and the predominant genotype was homozygous T/T (79%). Genotypes with heterozygous T/G and G/G homozygous polymorphism were more frequent in the control group than in the MS-DM2 group. Regarding the individuals with T/G and G/G genotypes, statistically significant lower mean values ​​were found for fasting glucose, total cholesterol, triacylglycerides, abdominal circumference, and for the medians of systolic and diastolic blood pressure. Odds ratio were calculated for the presence or absence of MS and DM2. Conclusions: The results suggested that the presence of the G allele exerts a protective effect on the carrier individuals, thus avoiding the appearance of the aforementioned metabolic alterations.

Balint 2.0: A virtual Balint group for doctors around the world

Objective Balint groups have shown promise in addressing clinician-patient relationships, clinician burnout, referral practices, and psychological mindedness. However, their traditional format of in-person sessions limits their ability to meet the needs of clinicians practicing in locations without trained Balint leaders. We report on a pilot of an international, internet-based Balint group in collaboration between the World Organization of Family Doctors regional Young Doctors Movements and the International Balint Federation. Method Balint 2.0 arose through interest of the Young Doctors Movements leadership, who approached the International Balint Federation for assistance. Initial discussions and some trialing of videoconference platforms led to monthly group meetings over the internet. Surveys evaluated each individual session as well as quarterly progress of the group. Survey items were borrowed from existing surveys in use by the American and German Balint Societies. Results Session surveys demonstrated the effectiveness of the videoconferencing platform for convening a Balint group, with a majority of participants expressing agreement with survey items evaluating each session. Quarterly survey responses were more positive reflecting agreement with outcomes seen from in-person Balint groups. Conclusions The Balint 2.0 pilot has demonstrated the ability of a Balint group to successfully convene over the internet and reach the common outcomes of a Balint group meeting in-person. The Young Doctors Movements and International Balint Federation plan to expand this work based on this successful pilot. We hope that others may also be able to build on this success with the result that Balint groups are available to clinicians in areas where they might not otherwise be accessible.

Meeting report: 'How do I incorporate research into my family practice?': Reflections on experiences of and solutions for young family doctors

Background

Family doctors (FDs) focus on biopsychosocial components of health during consultations. However, much of the evidence employed by these doctors is produced by researchers who are not routinely involved in family practice. Family doctors competent in both clinical practice and research are essential to addressing this gap. With the growing recognition of family medicine as the specialty of choice for many young doctors, there is a scarcity of literature that describes their experiences in combining research and daily family practice.

Aim

Members from Young Doctor Movements (YDMs) under the auspices of the World Organisation of Family Doctors (WONCA) sought to address this knowledge gap by reflecting on their experiences towards becoming researchers. With the assistance of senior doctors, they explored solutions that can help young FDs incorporate research into their family practice.

Methods

Following an online YDM meeting, a summary of the experiences of young FDs as well as strategies useful for incorporating research into their everyday practice as FDs was prepared.

Result

Nine thematic areas were derived, including experiences and motivation towards regular research, culture and environment of practice, relevance and gains of research, teamwork and mentorship.

Conclusion

Family practices can incorporate research by promoting a personal and organisational research culture, highlighting gains and relevance of making it part of the profession and fostering teamwork, supportive networks and mentorship while making it enjoyable.

Dyslipidemia: Genetics, lipoprotein lipase and HindIII polymorphism

The direct link between lipid metabolism alterations and the increase of cardiovascular risk are well documented. Dyslipidemias, including isolated high LDL-c or mixed dyslipidemia, such as those seen in diabetes (hypertriglyceridemia, high LDL-c or low HDL-c), correlate with a significant risk of cardiovascular and cerebrovascular disease worldwide.  This review analyzes the current knowledge concerning the genetic basis of lipid metabolism alterations, emphasizing lipoprotein lipase gene mutations and the HindIII polymorphism, which are associated with decreased levels of triglycerides and LDL-c, as well as higher levels of HDL-c. These patterns would be associated with decreased global morbidity and mortality, providing protection against cardiovascular and cerebrovascular diseases.

Dyslipidemia: Genetics, lipoprotein lipase and HindIII polymorphism

The direct link between lipid metabolism alterations and the increase of cardiovascular risk are well documented. Dyslipidemias, including isolated high LDL-c or mixed dyslipidemia, such as those seen in diabetes (hypertriglyceridemia, high LDL-c or low HDL-c), correlate with a significant risk of cardiovascular and cerebrovascular disease worldwide.  This review analyzes the current knowledge concerning the genetic basis of lipid metabolism alterations, emphasizing lipoprotein lipase gene mutations and the HindIII polymorphism, which are associated with decreased levels of triglycerides and LDL-c, as well as higher levels of HDL-c. These patterns would be associated with decreased global morbidity and mortality, providing protection against cardiovascular and cerebrovascular diseases.

Case Report: An incidentaloma that catches your eye - adrenal myelolipoma

Background: Adrenal incidentaloma refers to the incidental finding of a tumor in the adrenal gland, where nonfunctional forms are the most common variant. Myelolipoma is a rare (0.08-0.4%) occurrence characterized by adipose and hematopoietic tissue. The aim of this case report is to describe the diagnosis and appropriate management of a myelolipoma in an asymptomatic patient, which was originally considered an incidental hepatic hemangioma prior to being identified as a giant adrenal adenoma. Case description: The patient was a 54 year old obese female with a recent diagnosis of diabetes type II and dyslipidemia with recent ultrasound imaging suggestive of a hepatic hemangioma. An MRI was performed revealing a 7x6cm lesion in the right adrenal area indicating a giant adrenal adenoma. An adrenalectomy was performed without complications. The pathology report identified a myelolipoma. Discussion: The incidence of myelolipoma has recently increased due to advances in radiological techniques. Its etiology is unclear and the most accepted theories support a myeloid cell metaplasia in the embryonic stage as a result of stress, infections, or adrenocorticotropic hormone or erythropoietin stimulus. Contributing components may include bone morphogenetic protein 2 and β-catenin, as well as the presence of the chromosomal translocation (3, 21) (q25; p11). Despite its benign nature, the association with other adrenal lipomas must be ruled out. A biochemical evaluation is essential for detecting subclinical states, such as Cushing syndrome and pheochromocytoma. Conclusion: Adrenal myelolipomas are rare benign tumors that are generally asymptomatic. Uncertainty still exists surrounding their etiology. Surgical management depends on hormone production, tumor size, high risk features on imaging and patient consent.  Additional information is needed to better understand myelolipomas, their etiology, and clinical management.  Incidentalomas may confuse the physician and patient. Ensuring proper multidisciplinary management based on the clinical guidelines of endocrinology allowed a satisfactory resolution of this case.

A qualitative study of young Nigerian family physicians’ views of their specialty

Background: In Nigeria, the specialty of family medicine (FM) has endured its own share of identity crises. This study was aimed at generating hypotheses about what describes a practising family physician (FP) and the specialty, according to young Nigerian FPs. Methods: Using the online platform for young African FPs alongside text messages and emails from volunteer research assistants over an eight-week period (March 3 to April 30, 2015), a purposive sample of young Nigerian FPs were asked to describe their favourite aspect of FM in a single word/phrase. Responses were provided in English/individual’s mother tongue. Translation of the words was performed by respondents and additional collaborators fluent in these languages. Thematic analysis using the grounded theory approach was performed. Results: Twenty-four responses were received consisting of four themes: Scope, Family, Skills/Feelings/Values, and Professional Fulfilment. The resulting data portrayed the FP as one who possesses a unique skill-set, enjoys fulfilment in the profession, deals with undifferentiated diseases and is able to provide holistic care for patients (irrespective of age and gender) from a family-centred perspective. When compared with accepted domains of FM for Africa and Europe, roles of the FP in community-oriented care and primary care management were absent. Conclusion: While this showcases the young Nigerian FPs’ acceptance of their role in providing comprehensive primary care, it suggests a lesser acceptance of their role in community-oriented primary care as well as primary care management. This study provides a basis for future, quantitative research describing attitudes and competence in these areas. (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2017; DOI: 10.1080/20786190.2017.1292694

Health care and social media: What patients really understand

Background: Low health literacy is associated with decreased patient compliance and worse outcomes - with clinicians increasingly relying on printed materials to lower such risks. Yet, many of these documents exceed recommended comprehension levels. Furthermore, patients look increasingly to social media (SoMe) to answer healthcare questions. The character limits built into Twitter encourage users to publish small quantities of text, which are more accessible to patients with low health literacy. The present authors hypothesize that SoMe posts are written at lower grade levels than traditional medical sources, improving patient health literacy. Methods: The data sample consisted of the first 100 original tweets from three trending medical hashtags, leading to a total of 300 tweets. The Flesch-Kincaid Readability Formula (FKRF) was used to derive grade level of the tweets. Data was analyzed via descriptive and inferential statistics. Results: The readability scores for the data sample had a mean grade level of 9.45. A notable 47.6% of tweets were above ninth grade reading level. An independent-sample t-test comparing FKRF mean scores of different hashtags found differences between the means of the following: #hearthealth versus #diabetes (t = 3.15, p = 0.002); #hearthealth versus #migraine (t = 0.09, p = 0.9); and #diabetes versus #migraine (t = 3.4, p = 0.001). Conclusions: Tweets from this data sample were written at a mean grade level of 9.45, signifying a level between the ninth and tenth grades. This is higher than desired, yet still better than traditional sources, which have been previously analyzed. Ultimately, those responsible for health care SoMe posts must continue to improve efforts to reach the recommended reading level (between the sixth and eighth grade), so as to ensure optimal comprehension of patients.

South Africa has joined a global initiative for Family Medicine advocacy

The international #1WordforFamilyMedicine initiative serves to explore the identity of family physicians and allows the international Family Medicine community to collaborate on advocating the discipline. South African family physicians provided 42 responses via a social media and online survey. Two “word cloud” images were created based on two icons recognised as being truly South African around the world – the national flag and former president Nelson Mandela. The #1WorldforFamilyMedicine initiative was promoted by the World Organization of Family Doctors across the globe to help celebrate World Family Doctor Day on 19 May 2015. To date, over 70 images have been created in 50 different countries on six continents. The images represent family physicians’ love for their profession and the community they serve. It is hoped that this initiative will help to inspire current and future Family Medicine and primary care providers.

New Zealand among global social media initiative leaders for primary care advocacy

Abstract The international ‘#1WordforFamilyMedicine’ initiative explores the identity of General Practitioners (GPs) and Family Physicians (FPs) by allowing the international Family Medicine community to collaborate on advocating for the discipline via social media. The New Zealand version attracted 83 responses on social media. Thematic analysis was performed on the responses and a ‘word cloud’ image was created based on an image identifying the country around the world - that of the silver fern. The ‘#1WorldforFamilyMedicine’ project was promoted by WONCA (World Organisation of Family Doctors) globally to help celebrate World Family Doctor Day on 19 May 2015. To date, over 80 images have been created in 60 different countries on six continents. The images represent GPs’ love for their profession and the community they serve. We hope that this initiative will help inspire current and future Family Medicine and Primary Care providers.

[#1 Word for Family Medicine: ideas beyond words]

Social media has proven to be a powerful method in which ideas can be formed and shared publicly. Within the global family medicine community, the #1 Word for Family Medicine project has gained widespread popularity with participation in over 30 countries on 5 continents. With over 3000 responses - and counting - this idea has crossed the globe to engage both the general public and medical community at an exponential rate. Further exploration into the use of social media for the benefit of our profession should continue as patients and physicians become increasing connected to the internet.

Young Doctor Movements: motives for membership among aspiring and young family physicians

Background:

Over the past decade, young doctor movements (YDMs) have gained recognition for their efforts in promoting the discipline of family medicine. With growth and expansion comes the need for an inquiry into the membership motives of current/intending members.

Aim and Objectives:

This study was aimed at determining the main reasons why young and aspiring family physicians (FPs) joined their regional YDM. It was also concerned with determining the main factors that will make non-members want to join a YDM as well as assessing for differences in the responses within YDM members on the one hand, and between YDM members and non-members on the other.

Materials and Methods:

This was a cross-sectional web-based study. Using a list of 11 items generated following a series of discussions and feedback among selected FPs and FP trainees, respondents annotated levels of agreement on reasons for current or desired YDM membership. The Mann–Whitney U test was used to determine the distribution and differences in the mean of rank scores of the responses from YDM and non-YDM members while the Kruskal–Wallis test was used to describe same for the various YDMs.

Results:

The total number of respondents was 200, out of which 102 (51.0%) were current YDM members, 97 (48.5%) were non-members and 1 (0.5%) respondent did not state his/her membership status. Non-YDM members indicated a predominantly academic/professional motive for membership while YDM members indicated the opportunity to socialise with FPs abroad and in their country as their foremost reasons for membership. A mixture of academic, professional and social motives was observed for respondents from Vasco da Gama; predominantly academic and professional motives for respondents from Spice route.

Conclusions:

While gaining recognition and improving one's practice may be the ultimate goal of an aspiring FP, socialising within a network of like-minded professionals maybe the young FP's way of coping with demands of the discipline.

Military-specific application of nutritional supplements: a brief overview

The Soldiers of America's military endure numerous physical and mental challenges that demand strict physical fitness regimens, extreme mental agility, and a perpetual readiness to deploy at a moment's notice. The chronicity of these stressors has the potential to dramatically reduce performance - both directly and indirectly.  Because of this risk, many Soldiers turn to nutritional supplements with hopes of optimizing performance. Increasing amounts of research have demonstrated that various supplements may enhance overall physical prowess, health, and offer quicker recovery in the face of corporal or psychological extremes. Most individuals, including many medical and nutrition professionals, possess only an elementary comprehension of nutritional supplements and their effect on Soldiers in training or combat environments. Nevertheless, a grasp of these details is required for safety and optimal benefits. Various compounds have been evaluated - to include evidence within the military setting - and found to augment endurance, increase cognitive function, decrease knee pain, or offer hearing or lung protection in the face of high-energy impulses. These efficacious outcomes may serve to augment the health and longevity of these Soldiers; however, continued research is needed for efficacy and long-term safety within specific environments.

A rare case of moyamoya disease in a 20-year-old Puerto Rican female U.S. soldier

Moyamoya disease is a progressive, occlusive pathology involving the cerebral vasculature with particular involvement of the circle of Willis and its tributaries. The cause of moyamoya disease is unknown, but is believed to be hereditary. Females 20 to 39 years old with moyamoya represent 0.5% of all acute cerebral ischemia and infarcts with risk factors including smoking, estrogen-containing birth control use, coagulopathy, neoplasm, and congenital malformation. This case reports on a 20-year-old Puerto Rican female U.S. soldier with a 1-year history of migraine headaches with worsening right retro-orbital pain, blurred vision, and photophobia. The patient had minimal unilateral neurological deficits despite evidence of significant cerebral infarction on non-contrast computed tomography. Other neuroimaging findings were consistent with moyamoya disease with confirmation via cerebral angiography. This case details the process of diagnosis and treatment as well as discussing its incidence, identification, and treatment options.

The effects of military deployment on early child development

PURPOSE

The purpose of this observational, point prevalence study is to determine if parental deployment affects the cognitive, social and emotional development of preschool age children in the military family.

METHODS

Demographic information was collected and an age-appropriate Ages and Stages Questionnaire (ASQ-3) and Ages and Stages Social-Emotional Inventory (ASQ:SE) were administered. The primary outcome measure was the failure rates on the developmental instruments.

RESULTS

We identified 151 parents of eligible children; 95 children had a parent that deployed during their lifetime. We found a significant difference in ASQ-3 failure rates for children in the deployed group compared to those in the nondeployed group. Children of deployed parents were at least twice as often to fail the ASQ-3 or ASQ:SE developmental screen compared to children whose parents did not deploy. 30.5% of children in the deployed group failed the ASQ-3 screen while 12.5% of children who did not have a deployed parent failed (P=.009). On the ASQ:SE developmental screen, 16.8% of children who had a parent deploy failed versus 5.4% of children who did not have a parent deploy (P=.031).

CONCLUSIONS

This study suggests that parental deployment is related to adverse risk for developmental delays in children in military families. The psychological burden on military children could be life-long or require significant resources to address. These adverse outcomes could be possibly mitigated by early detection of developmental delay and firm attention to aggressive screening techniques in military communities.

Increase in residency scholarly activity as a result of resident-led initiative

BACKGROUND AND OBJECTIVES

Scholarly activity (SA) is a fundamental component of family medicine residency training. Despite the variety of SA options, the output of resident presentations and publications remains disappointingly low, and many residents voice frustration with fulfilling the research requirements. A resident-driven process improvement project was undertaken with the goal of achieving a 100% increase of peer-reviewed publications and scholarly presentations by residents with secondary goals of doubling the involvement of staff, residents, and visiting medical or physician assistant students.

METHODS

This project involves (1) increasing awareness of conferences for scholarly submission, (2) assignment of residents in a resident research team to lead efforts, (3) pairing of interns/students with senior mentors with similar interests, (4) faculty to include one resident on all projects, and (5) monthly SA meetings to track research progress, share ideas, and troubleshoot areas of difficulty. Scholarly totals were compared between the 2011--2012 and 2012--2013 academic years.

RESULTS

The SA goals were achieved on all fronts. The number of resident presentations increased from three to 28 (seven regional, 10 national, and 11 international presentations), and resident peer-reviewed publications increased from two to six when compared to the previous year. Scholarly participation doubled at all levels.

CONCLUSIONS

The authors recommend that other residencies consider promoting increased resident-to-resident scholarly mentorship, early planning with scheduled timeline, and increasing awareness of SA opportunities yearly.

Megaloblastic hematopoiesis in a 20 year old pregnant female

Background:

Nitrous oxide can cause disordered blood cell proliferation and lead to pancytopenia and altered immune function.

Case Report:

A young pregnant female patient presented after binge nitrous oxide abuse with altered mental status and abnormal vital signs. From her initial assessment she was noted to have pancytopenia and was found to have megaloblastic, hyper-cellular changes in a subsequent bone marrow biopsy. This presentation was determined to be secondary to toxic effects after heavy use of nitrous oxide.

Conclusions:

Nitrous oxide exposure, including use as an inhalant, over 12 hours can lead to bone marrow abnormalities such as megaloblastic hematopoiesis.