Introduction This study aimed to either identify or develop and validate a patient-reported outcome measure(PROM)to assess treatment burden related to general practice for patients with multimorbidity,which can be use...Introduction This study aimed to either identify or develop and validate a patient-reported outcome measure(PROM)to assess treatment burden related to general practice for patients with multimorbidity,which can be used alongside the MultiMorbidity Questionnaire part 1(MMQ1)without overwhelming the target population with redundant items.Methods We conducted a systematic literature review to identify all existing PROMs measuring treatment burden.If no suitable PROM was found,our plan was to:(1)develop a draft PROM using items from existing instruments,(2)carry out group and individual interviews with patients with multimorbidity to ensure the PROM’s understandability,clarity,completeness and relevance and(3)undertake psychometric validation with a diverse sample of primary care patients with chronic conditions.Results We did not identify an eligible PROM in the literature review.The draft PROM consisted of 30 items divided into six domains;Information about treatment,Challenges with medication,Medical appointments,Self-monitoring,Health behaviour and Challenges in the contact to the health system.In the psychometric validation,neither these domains nor any other theoretical constellation of items had adequate psychometric properties.Individual items had good criterion validity and sensitivity to change.Conclusions In this study,we developed a 30-item PROM with high content validity where various individual items showed adequate criterion validity and sensitivity to change,making these items useful as a supplemental measure to the MMQ1.Trial registration number NCT05676541 Registration Date:16 December 2022.展开更多
Objective This study describes acceptance and attitudes towards genetic cancer testing among German primary care patients.Design Cross-sectional survey.Setting Primary care.Participant Systematically recruited patient...Objective This study describes acceptance and attitudes towards genetic cancer testing among German primary care patients.Design Cross-sectional survey.Setting Primary care.Participant Systematically recruited patients aged≥18 years from six general practices in Mecklenburg-Western Pomerania participated in an anonymous self-administered survey on familial cancer prevention(n=479 and 67.0%participation rate).Those with complete data were analysed(n=424;mean age 53.7,SD 16.6 years;men 34.4%).Linear regression analyses were used to examine potential disparities in general acceptance of genetic testing and attitudes towards genetic cancer testing according to sociodemographics and familial cancer knowledge.Result General acceptance of genetic testing was high,particularly among younger,higher-educated individuals and those with a family history of cancer and higher familial cancer knowledge.For example,83.3%either agreed or strongly agreed that it should be available to anybody.The most important benefits of genetic cancer testing were to guide check-up frequency(81.4%),to inform medical decision-making(80.2%)and to understand children’s risk(75.2%).The most important concerns included the potential burden on the family(44.6%)and the belief that cancer cannot be prevented(39.2%).More favourable attitudes were found among younger,higher-educated individuals,those with a personal history of cancer and those with fewer children or no partner.For example,higher age was linked to lower benefit(regression coefficient(RC)−0.01,95%CI−0.01 to−0.001)and higher concern ratings(RC 0.01,95%CI 0.002 to 0.01).About a third(34.7%)rated not wanting to know about genetic alterations that increase their cancer risk as a(very)important reason against testing.Information avoidance was higher among older individuals(RC 0.02,95%CI 0.01 to 0.02),women(RC 0.40,95%CI 0.11 to 0.69),those with lower education(RC−0.64,95%CI−0.91 to−0.36)and those with more children(RC 0.21,95%CI 0.09 to 0.33).Conclusion Acceptance of genetic testing was high,but barriers remain,particularly among older adults,women,the less educated and those with more children.Targeted educational efforts to improve health literacy,emphasise the preventive potential of genetic testing and emotional support through genetic counselling are essential to overcome these barriers and promote informed decision-making.展开更多
In more recent times, health-related quality of life (HRQOL) measurements have formed an important part of as- sessing the quality of routine care in general practice. For a measure to have clinical usefulness it must...In more recent times, health-related quality of life (HRQOL) measurements have formed an important part of as- sessing the quality of routine care in general practice. For a measure to have clinical usefulness it must not only be valid, appro- priate, reliable, responsive, and capable of being interpreted, but it must also be simple, fast to complete, easy to score, and provide useful clinical data. The Two-step method of choosing appropriate measures is introduced. Then through comparison of generic instruments with disease-specific instruments, we can conclude that sometimes a combination of generic and disease-specific HRQOL measures may be more appropriate for monitoring changes in a patient’s health status due to an intervention.展开更多
Otitis media is a frequent problem in preschool children and one of the most common reasons for treatment with antibiotics in children. The exact diagnosis is important for proper management. The diagnosis of otitis m...Otitis media is a frequent problem in preschool children and one of the most common reasons for treatment with antibiotics in children. The exact diagnosis is important for proper management. The diagnosis of otitis media is often difficult. Pneumatic otoscopy, otomicroscopy, and tympanometry can improve the diagnostic quality by indicating fluid or no fluid in the middle ear and thus improve the quality of treatment. The aim of this review is to explain why and how tympanometry can improve the diagnostic quality in otitis media, and to identify some barriers and difficulties encountered when using tympanometry in daily practice. The current literature on tympanometry and own experiences during 38 years are used to elucidate the aim. Tympanometry is difficult to understand and use, when the procedure is not properly trained. The problems are both of a technical nature, and it is difficult to understand and use the information from the curve and the figures on the display. If the use of tympanometry in general practice is increased, the diagnostic quality will improve and hopefully antibiotics will be prescribed on more appropriate indications and less frequently. More demand on tympanometry will hopefully reduce the price of the tympanometer, making it more accessible for GPs. First in that situation the use will be nearly as common as the use of the otoscope.展开更多
It is challenging for general practitioners to make a more correct diagnosis with the least instrument examination. How to make an effective diagnosis has always been an issue. In order to achieve this goal, a clinica...It is challenging for general practitioners to make a more correct diagnosis with the least instrument examination. How to make an effective diagnosis has always been an issue. In order to achieve this goal, a clinical symptom-oriented modular diagnosis scheme based on the concept of the process thinking and Murtaghs General Practice was developed for general practitioners. Five key steps according to the workflow of real reception patients by a general practitioner were promulgated in this design of a modular scheme, which is in line with the actual clinical setting. This thinking concept of diagnosis should help prevent missed and erroneous diagnoses and meet the actual needs of general practitioners.展开更多
Background: Flow FL-100 is a transcranial direct current stimulation (tDCS) device self-administered by a patient at home in combination with a software application delivered wellbeing behaviour therapy training. tDCS...Background: Flow FL-100 is a transcranial direct current stimulation (tDCS) device self-administered by a patient at home in combination with a software application delivered wellbeing behaviour therapy training. tDCS has evidence of effectiveness in treating symptoms of depression. Purpose/Aim: This post marketing study evaluated the effect of Flow on depression for primary care general practice patients with depression symptoms. Methods: Open-label patient cohort design with no control group. Inclusion criteria were aged 18 years or over and reporting depression symptoms. Participants self-administered five 30 minute tDCS sessions per week for the first three weeks, and then 3 sessions per week following this. Three, six and ten week assessment with participant self-report measure: Montgomery- Åsberg Depression Rating Scale (MADRS-S). Results: MADRS-S remission rates were between 29% - 30% at three weeks, 33% - 34% at six-weeks and 50% at 10-weeks treatment. There was a significant improvement in MADRS-S with large effect sizes at all time points. Conclusions: Flow tDCS can be delivered through a primary healthcare general practice service and patients will choose to use. Flow tDCS provides an effective depression treatment in addition and as an alternative to antidepressants and psychotherapy. tDCS has evidence as an effective depression treatment, and the widespread availability of tDCS in primary care general practice should be considered.展开更多
Purpose:Strong primary health care(PHC)systems require well‐established PHC education systems to enhance the skills of general practitioners(GPs).However,the literature on the experiences of international collaborati...Purpose:Strong primary health care(PHC)systems require well‐established PHC education systems to enhance the skills of general practitioners(GPs).However,the literature on the experiences of international collaboration in primary care education in low‐and middle‐income countries remains limited.The purpose of this study was to evaluate the implementation and perceived impact of the McGill‐Tongji Blended Education Program for Teacher Leaders in General Practice(referred to as the“Tongji Program”).Methods:In 2020–2021,the McGill Department of Family Medicine(Montreal,Canada)and Tongji University School of Medicine(TUSM,Shanghai,China)jointly implemented the Tongji Program in Shanghai,China to improve the teaching capacity of PHC teachers.We conducted an exploratory longitudinal case study with a mixed methods design for the evaluation.Quantitative(QUAN)data was collected through questionnaire surveys and qualitative(QUAL)data was collected through focus group discussions.Results:The evaluation showed that learners in Tongji Program were primarily female GPs(21/22,95%)with less than 4 years of experience in teaching(16/22,73%).This program was considered a successful learning experience by most participants(19/22,86%)with higher order learning tasks such as critical thinking and problem‐solving.They also agreed that this program helped them feel more prepared to teach(21/22,95%),and developed a positive attitude toward primary care(21/22,95%).The QUAL interview revealed that both the Tongji and McGill organizers noted that TUSM showed strong leadership in organization,education,and coordination.Both students and teachers agreed that by adapting training content into contextualized delivery formats and settings,the Tongji Program successfully overcame language and technology barriers.Conclusions:Committed partnerships and contextualization were key to the success of the Tongji Program.Future research should focus on how international primary care education programs affect learners'behavior in their practice settings,and explore barriers and facilitators to change.展开更多
AIM To explore primary care physicians' perspectives on possible barriers to the use of insulin.METHODS This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Me...AIM To explore primary care physicians' perspectives on possible barriers to the use of insulin.METHODS This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight electronic databases were searched(between January 1, 1994 and August 31, 2014) for relevant studies. A search for grey literature and a review of the references in the retrieved studies were also conducted. Studies that focused on healthcare providers' perspectives on possible barriers to insulin initiation with type 2 diabetic patients were included, as well as articles suggesting solutions for these barriers. Review articles and studies that only considered patients' perspectives were excluded. RESULTS A total of 19 studies met the inclusion criteria and were therefore included in this study: 10 of these studies used qualitative methods, 8 used quantitative methods and 1 used mixed methods. Studies included a range of different health care settings. The findings are reported under four broad categories: The perceptions of primary care physicians about the barriers to initiate insulin therapy for type 2 diabetes patients, how primary care physicians assess patients prior to initiating insulin, professional roles and possible solutions to overcome these barriers. The barriers described were many and covered doctor, patient, system and technological aspects. Interventions that focused on doctor training and support, or IT-based decision support were few, and did not result in significant improvement. CONCLUSION Primary care physicians' known delay in insulin initiation is multifactorial. Published reports of attempts to find solutions for these barriers were limited in number.展开更多
This article provides insight into the status of general practice in Pakistan and challenges to its health care system. The country ranked 122nd on the overall health system attainment and ranked 7th in the world on d...This article provides insight into the status of general practice in Pakistan and challenges to its health care system. The country ranked 122nd on the overall health system attainment and ranked 7th in the world on diabetes prevalence. The public sector health care system in Pakistan is encountered with many problems such as structural fragmentation, resource scarcity, inefficiency and lack of functional specificity, gender insensitivity and inaccessibility. The general practice status in Pakistan requires immediate attention to face the challenges created by chronic diseases in the country. Of particular mention are the patient-doctor interaction, healthcare system delivery, access to the doctors and better utilization of primary health care services.展开更多
General practice as a discipline has largely evolved over the past 30 years in the field of primary health care. It originated in the 18th century m Europe. It was established in the United States in the 1960s and int...General practice as a discipline has largely evolved over the past 30 years in the field of primary health care. It originated in the 18th century m Europe. It was established in the United States in the 1960s and introduced to China in the late 1980s. In earlier times, medicine was not specialized, and general physicians dominated the medical field. At the end of the 19th century, with the development of basic medical disciplines, such as biology and anatomy, the development of more specialized medical practices began.展开更多
Our small group of expert GP academic trainers from Monash University and the University of Melbourne have been collaborating over the last decade to develop a GP model training program based in Luohu,Shenzhen,that de...Our small group of expert GP academic trainers from Monash University and the University of Melbourne have been collaborating over the last decade to develop a GP model training program based in Luohu,Shenzhen,that deeply engages Chinese GPs and seeks to provide personal and professional development of the GPs.The program is closely linked to continuing offshore GP education in Australia,with many trainees of the program having attended intensive training hosted by Monash University in Australia.展开更多
Objective To understand general practice(GP)residents’attitudes about their residency training in China.Design Mixed methods survey administered cross-sectionally.Setting Two GP training programmes similar in most re...Objective To understand general practice(GP)residents’attitudes about their residency training in China.Design Mixed methods survey administered cross-sectionally.Setting Two GP training programmes similar in most regards according to current GP training policy of 5 years’undergraduate degree in medicine and 3 years of postgraduate GP residency training-but differing as the Beijing programme has adopted educational innovations beyond the nationally prescribed standard curriculum used by the second Shenzhen programme.Participants 105(85%)of eligible GP trainees,35(90%)in the innovative Beijing programme and 70(83%)in the standard training Shenzhen programme.Results Overall,residents felt discrimination because of specialty choice,and that they lacked competency as a general practitioner.Many residents commented faculty had negative teaching attitudes.Beijing residents were more satisfied than Shenzhen residents with their training(p=0.001),and felt teaching faculty had sufficient knowledge(p<0.001),and appropriate attitudes towards teaching(p=0.004).Beijing residents more strongly agreed on five items about good future job prospects(all p<0.05).Conclusion These Chinese GP residents identify areas for improvement in their training as well as strengths.Higher satisfaction with faculty teaching and job optimism in Beijing where GP residents receive training from specifically qualified faculty,and can earn special certification,suggest that the educational innovations enhance training and promote positivity about job prospects.These findings imply that GP residents in China face many training challenges that are similar to other international reports,while also implicating benefits of using an innovative curricular approach.展开更多
Objective To examine general practitioners’(GPs)referral patterns to allied health services for people with dementia compared with those without dementia across two large Australian Primary Health Networks(PHNs).Desi...Objective To examine general practitioners’(GPs)referral patterns to allied health services for people with dementia compared with those without dementia across two large Australian Primary Health Networks(PHNs).Design A retrospective cohort study using routinely collected general practice data.Logistic regression was used to compare odds of allied health referrals,adjusting for age,sex and socioeconomic status.Setting De-identified patient and episode activity data from 537 GP practices across two PHNs in Australia between 2018 and 2023.Participants Data from 1153304 patients and 28667517 GP episodes of care were analysed.After merging records,693328 unique patients were identified,including 16610 patients with dementia.Subcohorts included patients with dementia,stroke,Parkinson’s disease and combinations of these conditions.Results The dementia cohort(n=16610)had a similar overall allied health referral rate(36.1%)to the control cohort(n=48977)(35.4%).Patients with dementia only were significantly less likely to receive any allied health referral compared with those with stroke(adjusted OR(aOR)0.76,95%CI 0.72 to 0.80;p<0.001)or Parkinson’s disease(aOR 0.72,95%CI 0.66 to 0.78;p<0.001).Those with dementia and stroke were also less likely to receive referrals than those with stroke only(aOR 0.71,95%CI 0.61 to 0.82;p<0.001).No significant difference was found between dementia with Parkinson’s and Parkinson’s only groups(p=0.48).Patients with dementia were consistently less likely to be referred to key allied health services(p<0.05).Conclusion Despite strong evidence supporting allied health interventions for dementia,referral rates remain comparatively low.Enhancing GP referral resources and education,integrating dementia-specific care pathways and implementing supportive policy changes are needed to improve access and equity in dementia care.展开更多
Transitions are a period and a process,through which there is a longitudinal adaptation in response to changing circumstances in clinical practice and responsibilities.While the experience of the transition in medical...Transitions are a period and a process,through which there is a longitudinal adaptation in response to changing circumstances in clinical practice and responsibilities.While the experience of the transition in medical student learning and in hospital-based specialty training programmes are well described and researched,the experience of the transition in community-based postgraduate general practitioner(GP)training has not been described comprehensively.Objective We aimed to identify,and categorise,the formative experiences of transitions in GP training and their impacts on personal and professional development.Design We adopted Levac et al’s scoping review methodology.Of 1543 retrieved records,76 were selected for data extraction.Based on a combined model of the socioecological and multiple and multi-dimensional theories of transitions,data relating to the experiences of transitions were organised into contextual themes:being physical,psychosocial,organisational culture and chronological.Eligibility criteria Empirical studies focused on general practice trainees or training,that discussed the transitions experienced in general practice training and that were published in English were included.Information sources PubMed,MEDLINE and Web of Science databases were searched in January 2024 with no date limits for empirical studies on the transition experiences of GP into,and through,training.Results Our findings describe context-dependent formative experiences which advance,or impede,learning and development.Time is a significant modulator of the factors contributing to more negative experiences,with some initially adverse experiences becoming more positive.Identification of the inflection point that represents a shift from initially adverse to more positive experiences of transitions may help moderate expectations for learning and performance at different stages of training.Conclusion Challenges in training can either advance development and contribute positively to professional identity formation and clinical competency,or detract from learning and potentially contribute to burnout and attrition from training programmes.These findings will assist future research in identifying predictive factors of positive and adverse experiences of transitions and may strengthen existing and nascent GP training programmes.The findings are transferable to other community-based specialty training programmes.展开更多
Objective:Chronic nonspecific musculoskeletal pain(CNMP)is a complex idiopathic condi-tion that causes significant disruption to patients’lives,their relationships,and functionality.The cause of CNMP is not fully und...Objective:Chronic nonspecific musculoskeletal pain(CNMP)is a complex idiopathic condi-tion that causes significant disruption to patients’lives,their relationships,and functionality.The cause of CNMP is not fully understood,which makes diagnosis and management challenging.As general practitioners(GPs)are central to the management of chronic pain,their perspectives on managing CNMP are important.Purpose:To explore the clinical reasoning GPs use when diagnosing and managing CNMP.Methods:A qualitative study design using focus group discussion was conducted with Australian GPs.Five focus group discussion were conducted across Adelaide.All focus group discussions were audio-recorded,and transcripts were coded and analyzed thematically with the program NVivo.Results:The main themes remained consistent across the five focus group discussion’s:the ambiguous cause of CNMP;sex differences;developing the“right strategy”;patient-centered care;and verifying vitamin D levels.Conclusion:The findings show that GPs use a patient-centered approach tailored to indi-vidual patients’medical history,physical examination findings,and psychosocial health.There was general concern about low levels of vitamin D in patients with CNMP,and vitamin D supplements were recommended if indicated by a patient’s history.展开更多
Background: Diabetes Mellitus results in several serious complications and among them foot problem is one of the commonly ignored complications. This study is an attempt to find out the level of patient’s awareness a...Background: Diabetes Mellitus results in several serious complications and among them foot problem is one of the commonly ignored complications. This study is an attempt to find out the level of patient’s awareness and practice in Nepalese context. Objective: The aim of this study is to determine the knowledge and practice of foot care among patients with diabetes in Nepal. Methods: This is a six-month long cross-sectional study done in the General Practice Clinic of Tribhuvan University Teaching Hospital. Diabetic patients were given structure questionnaires on knowledge, foot care practices, and demographic information. Results: Illiteracy was found be significantly associated with poor knowledge and practice of foot care. Those who have no education are more likely to have poor knowledge and foot care practice. The odds of having poor knowledge is 6.414 (3.075, 13.379) in those who have no education/primary education compared to those who have education and the odds of poor foot care practice is 4.5180 (2.077, 8.411) in those who have no education/primary education compared to those who have education with significance of Conclusion: This study has highlighted the need of appropriate education intervention for the patients with diabetes who have no education background to prevent from foot complications. Health education materials such as graphics, photos are needed to make them comprehensible for the illiterate patients.展开更多
Objectives To evaluate the capacity of general practice(GP)electronic medical record(EMR)data to assess risk factor detection,disease diagnostic testing,diagnosis,monitoring and pharmacotherapy for the interrelated ch...Objectives To evaluate the capacity of general practice(GP)electronic medical record(EMR)data to assess risk factor detection,disease diagnostic testing,diagnosis,monitoring and pharmacotherapy for the interrelated chronic vascular diseases-chronic kidney disease(CKD),type 2 diabetes(T2D)and cardiovascular disease.Design Cross-sectional analysis of data extracted on a single date for each practice between 12 April 2017 and 18 April 2017 incorporating data from any time on or before data extraction,using baseline data from the Chronic Disease early detection and Improved Management in PrimAry Care ProjecT.Deidentified data were extracted from GP EMRs using the Pen Computer Systems Clinical Audit Tool and descriptive statistics used to describe the study population.Setting Eight GPs in Victoria,Australia.Participants Patients were≥18 years and attended GP≥3 times within 24 months.37946 patients were included.Results Risk factor and disease testing/monitoring/treatment were assessed as per Australian guidelines(or US guidelines if none available),with guidelines simplified due to limitations in data availability where required.Risk factor assessment in those requiring it:30%of patients had body mass index and 46%blood pressure within guideline recommended timeframes.Diagnostic testing in at-risk population:17%had diagnostic testing as per recommendations for CKD and 37%for T2D.Possible undiagnosed disease:Pathology tests indicating possible disease with no diagnosis already coded were present in 6.7%for CKD,1.6%for T2D and 0.33%familial hypercholesterolaemia.Overall prevalence:Coded diagnoses were recorded in 3.8%for CKD,6.6%for T2D,4.2%for ischaemic heart disease,1%for heart failure,1.7%for ischaemic stroke,0.46%for peripheral vascular disease,0.06%for familial hypercholesterolaemia and 2%for atrial fibrillation.Pharmaceutical prescriptions:the proportion of patients prescribed guideline-recommended medications ranged from 44%(beta blockers for patients for some conditions.These baseline data highlight the utility of GP EMR data for potential use in epidemiological studies and by individual practices to guide targeted quality improvement.It also highlighted some of the challenges of using GP EMR data.展开更多
Background and objective The WHO emphasises the importance of integrating advice on physical activity(PA)into primary care of patients with chronic ischaemic heart disease(IHD).Similarly,the German treatment guideline...Background and objective The WHO emphasises the importance of integrating advice on physical activity(PA)into primary care of patients with chronic ischaemic heart disease(IHD).Similarly,the German treatment guideline‘Chronic Coronary Heart Disease’recommends that general practitioners(GPs)provide advice on PA to IHD patients.However,the provision of PA advice seems to be inadequately implemented in general practice.One reason is the lack of medical training in providing PA advice effectively and efficiently.International guidelines recommend such training for health professionals.This study aims to explore experiences,perceptions and attitudes,including barriers and facilitators of GPs towards the routine delivery of PA advice to IHD patients.Methods Between March and June 2023,12 face-to-face problem-centred interviews and six focus group discussions(n=37)with GPs were conducted.Interview and discussion guides were developed and pilot tested by the multi-professional study team.We used a purposive sampling strategy,and data were collected in an iterative process.Audio-recorded data were transcribed verbatim and analysed using a content structuring procedure(deductive and inductive approach).GPs were involved throughout the entire research process,for example,in multi-professional analysis groups.Results Although GPs are mostly aware of the health benefits of PA for patients with IHD,PA advice is not routinely provided.Conversations on PA tend to be rather unstructured,and advice is often addressed more generally than customised to the patients’needs and preferences.Priority is given to other lifestyle issues,such as smoking cessation.PA advice is perceived as time-consuming and rather ineffective with regard to the target behaviour.GPs frequently express frustration in this context.GPs express a lack of and simultaneously a need for communication strategies(structure and tools)that can be integrated into everyday GP practice to motivate patients to PA.Conclusion The results provide relevant insights into the current practice of GPs with regard to their attitudes on,experiences with,and requirements for the provision of PA advice to IHD patients.These results are helpful to inform the development of appropriate GP training in the provision of very brief PA advice to IHD patients.展开更多
Objectives:Electronic health records(EHRs)offer valuable real-world data(RWD)for Chinese medicine research.However,significant methodological challenges remain in developing integrative Chinese-Western medicine(ICWM)d...Objectives:Electronic health records(EHRs)offer valuable real-world data(RWD)for Chinese medicine research.However,significant methodological challenges remain in developing integrative Chinese-Western medicine(ICWM)databases.This study aims to establish a best-practice methodological framework,referred to as BRIDGE,to guide the construction of ICWM databases using EHRs.Methods:We developed the methodological framework through a comprehensive process,including systematic literature review,synthesis of empirical experiences,thematic expert discussions,and consultation with an external panel to reach consensus.Results:The BRIDGE framework outlines 6 core components for ICWM-EHR database development:Overall design,database architecture,data extraction and linkage,data governance,data verification,and data quality evaluation.Key data elements include variables related to study population,treatment or exposure,outcomes,and confounders.These databases support various research applications,particularly in evaluating the effectiveness and safety of integrative therapies.To demonstrate its practical value,we developed an ICWM-EHR database on women’s reproductive lifespan,encompassing 2,064,482 patients.This database captures women’s health conditions across the life course,from reproductive age to older adulthood.Conclusions:The BRIDGE methodological framework provides a standardized approach to building high-quality ICWM-EHR databases.It offers a unique opportunity to strengthen the methodological rigor and real-world relevance of Chinese medicine research in integrated healthcare settings.展开更多
Recent evidence suggests that ferroptosis plays a crucial role in the occurrence and development of white matter lesions.However,the mechanisms and regulatory pathways involved in ferroptosis within white matter lesio...Recent evidence suggests that ferroptosis plays a crucial role in the occurrence and development of white matter lesions.However,the mechanisms and regulatory pathways involved in ferroptosis within white matter lesions remain unclear.Long non-coding RNAs(lnc RNAs)have been shown to influence the occurrence and development of these lesions.We previously identified lnc_011797 as a biomarker of white matter lesions by high-throughput sequencing.To investigate the mechanism by which lnc_011797 regulates white matter lesions,we established subjected human umbilical vein endothelial cells to oxygenglucose deprivation to simulate conditions associated with white matter lesions.The cells were transfected with lnc_011797 overexpression or knockdown lentiviruses.Our findings indicate that lnc_011797 promoted ferroptosis in these cells,leading to the formation of white matter lesions.Furthermore,lnc_011797 functioned as a competitive endogenous RNA(ce RNA)for mi R-193b-3p,thereby regulating the expression of WNK1 and its downstream ferroptosis-related proteins.To validate the role of lnc_011797 in vivo,we established a mouse model of white matter lesions through bilateral common carotid artery stenosis.The results from this model confirmed that lnc_011797 regulates ferroptosis via WNK1 and promotes the development of white matter lesions.These findings clarify the mechanism by which lnc RNAs regulate white matter lesions,providing a new target for the diagnosis and treatment of white matter lesions.展开更多
基金supported by the public agreement between the Danish Regions and the General Practitioners’Organization 2022–2024.
文摘Introduction This study aimed to either identify or develop and validate a patient-reported outcome measure(PROM)to assess treatment burden related to general practice for patients with multimorbidity,which can be used alongside the MultiMorbidity Questionnaire part 1(MMQ1)without overwhelming the target population with redundant items.Methods We conducted a systematic literature review to identify all existing PROMs measuring treatment burden.If no suitable PROM was found,our plan was to:(1)develop a draft PROM using items from existing instruments,(2)carry out group and individual interviews with patients with multimorbidity to ensure the PROM’s understandability,clarity,completeness and relevance and(3)undertake psychometric validation with a diverse sample of primary care patients with chronic conditions.Results We did not identify an eligible PROM in the literature review.The draft PROM consisted of 30 items divided into six domains;Information about treatment,Challenges with medication,Medical appointments,Self-monitoring,Health behaviour and Challenges in the contact to the health system.In the psychometric validation,neither these domains nor any other theoretical constellation of items had adequate psychometric properties.Individual items had good criterion validity and sensitivity to change.Conclusions In this study,we developed a 30-item PROM with high content validity where various individual items showed adequate criterion validity and sensitivity to change,making these items useful as a supplemental measure to the MMQ1.Trial registration number NCT05676541 Registration Date:16 December 2022.
基金supported by the research networks Community Medicine,Molecular Medicine,GANI_MED and Digital Health Lab of the University Medicine Greifswald(grant number FOVB-2024-04).
文摘Objective This study describes acceptance and attitudes towards genetic cancer testing among German primary care patients.Design Cross-sectional survey.Setting Primary care.Participant Systematically recruited patients aged≥18 years from six general practices in Mecklenburg-Western Pomerania participated in an anonymous self-administered survey on familial cancer prevention(n=479 and 67.0%participation rate).Those with complete data were analysed(n=424;mean age 53.7,SD 16.6 years;men 34.4%).Linear regression analyses were used to examine potential disparities in general acceptance of genetic testing and attitudes towards genetic cancer testing according to sociodemographics and familial cancer knowledge.Result General acceptance of genetic testing was high,particularly among younger,higher-educated individuals and those with a family history of cancer and higher familial cancer knowledge.For example,83.3%either agreed or strongly agreed that it should be available to anybody.The most important benefits of genetic cancer testing were to guide check-up frequency(81.4%),to inform medical decision-making(80.2%)and to understand children’s risk(75.2%).The most important concerns included the potential burden on the family(44.6%)and the belief that cancer cannot be prevented(39.2%).More favourable attitudes were found among younger,higher-educated individuals,those with a personal history of cancer and those with fewer children or no partner.For example,higher age was linked to lower benefit(regression coefficient(RC)−0.01,95%CI−0.01 to−0.001)and higher concern ratings(RC 0.01,95%CI 0.002 to 0.01).About a third(34.7%)rated not wanting to know about genetic alterations that increase their cancer risk as a(very)important reason against testing.Information avoidance was higher among older individuals(RC 0.02,95%CI 0.01 to 0.02),women(RC 0.40,95%CI 0.11 to 0.69),those with lower education(RC−0.64,95%CI−0.91 to−0.36)and those with more children(RC 0.21,95%CI 0.09 to 0.33).Conclusion Acceptance of genetic testing was high,but barriers remain,particularly among older adults,women,the less educated and those with more children.Targeted educational efforts to improve health literacy,emphasise the preventive potential of genetic testing and emotional support through genetic counselling are essential to overcome these barriers and promote informed decision-making.
文摘In more recent times, health-related quality of life (HRQOL) measurements have formed an important part of as- sessing the quality of routine care in general practice. For a measure to have clinical usefulness it must not only be valid, appro- priate, reliable, responsive, and capable of being interpreted, but it must also be simple, fast to complete, easy to score, and provide useful clinical data. The Two-step method of choosing appropriate measures is introduced. Then through comparison of generic instruments with disease-specific instruments, we can conclude that sometimes a combination of generic and disease-specific HRQOL measures may be more appropriate for monitoring changes in a patient’s health status due to an intervention.
文摘Otitis media is a frequent problem in preschool children and one of the most common reasons for treatment with antibiotics in children. The exact diagnosis is important for proper management. The diagnosis of otitis media is often difficult. Pneumatic otoscopy, otomicroscopy, and tympanometry can improve the diagnostic quality by indicating fluid or no fluid in the middle ear and thus improve the quality of treatment. The aim of this review is to explain why and how tympanometry can improve the diagnostic quality in otitis media, and to identify some barriers and difficulties encountered when using tympanometry in daily practice. The current literature on tympanometry and own experiences during 38 years are used to elucidate the aim. Tympanometry is difficult to understand and use, when the procedure is not properly trained. The problems are both of a technical nature, and it is difficult to understand and use the information from the curve and the figures on the display. If the use of tympanometry in general practice is increased, the diagnostic quality will improve and hopefully antibiotics will be prescribed on more appropriate indications and less frequently. More demand on tympanometry will hopefully reduce the price of the tympanometer, making it more accessible for GPs. First in that situation the use will be nearly as common as the use of the otoscope.
文摘It is challenging for general practitioners to make a more correct diagnosis with the least instrument examination. How to make an effective diagnosis has always been an issue. In order to achieve this goal, a clinical symptom-oriented modular diagnosis scheme based on the concept of the process thinking and Murtaghs General Practice was developed for general practitioners. Five key steps according to the workflow of real reception patients by a general practitioner were promulgated in this design of a modular scheme, which is in line with the actual clinical setting. This thinking concept of diagnosis should help prevent missed and erroneous diagnoses and meet the actual needs of general practitioners.
文摘Background: Flow FL-100 is a transcranial direct current stimulation (tDCS) device self-administered by a patient at home in combination with a software application delivered wellbeing behaviour therapy training. tDCS has evidence of effectiveness in treating symptoms of depression. Purpose/Aim: This post marketing study evaluated the effect of Flow on depression for primary care general practice patients with depression symptoms. Methods: Open-label patient cohort design with no control group. Inclusion criteria were aged 18 years or over and reporting depression symptoms. Participants self-administered five 30 minute tDCS sessions per week for the first three weeks, and then 3 sessions per week following this. Three, six and ten week assessment with participant self-report measure: Montgomery- Åsberg Depression Rating Scale (MADRS-S). Results: MADRS-S remission rates were between 29% - 30% at three weeks, 33% - 34% at six-weeks and 50% at 10-weeks treatment. There was a significant improvement in MADRS-S with large effect sizes at all time points. Conclusions: Flow tDCS can be delivered through a primary healthcare general practice service and patients will choose to use. Flow tDCS provides an effective depression treatment in addition and as an alternative to antidepressants and psychotherapy. tDCS has evidence as an effective depression treatment, and the widespread availability of tDCS in primary care general practice should be considered.
基金China Scholarship Council,Grant/Award Number:202000610047McGill University+4 种基金Fonds de recherche du Québec–Santé,Grant/Award Number:315852Québec Ministry of HealthCanadian Institutes for Health Research,Strategy for Patient‐Oriented Research Mentorship ChairGlobal Health Scholars ProgramFonds de recherche du Québec‐Santé,Grant/Award Number:311200。
文摘Purpose:Strong primary health care(PHC)systems require well‐established PHC education systems to enhance the skills of general practitioners(GPs).However,the literature on the experiences of international collaboration in primary care education in low‐and middle‐income countries remains limited.The purpose of this study was to evaluate the implementation and perceived impact of the McGill‐Tongji Blended Education Program for Teacher Leaders in General Practice(referred to as the“Tongji Program”).Methods:In 2020–2021,the McGill Department of Family Medicine(Montreal,Canada)and Tongji University School of Medicine(TUSM,Shanghai,China)jointly implemented the Tongji Program in Shanghai,China to improve the teaching capacity of PHC teachers.We conducted an exploratory longitudinal case study with a mixed methods design for the evaluation.Quantitative(QUAN)data was collected through questionnaire surveys and qualitative(QUAL)data was collected through focus group discussions.Results:The evaluation showed that learners in Tongji Program were primarily female GPs(21/22,95%)with less than 4 years of experience in teaching(16/22,73%).This program was considered a successful learning experience by most participants(19/22,86%)with higher order learning tasks such as critical thinking and problem‐solving.They also agreed that this program helped them feel more prepared to teach(21/22,95%),and developed a positive attitude toward primary care(21/22,95%).The QUAL interview revealed that both the Tongji and McGill organizers noted that TUSM showed strong leadership in organization,education,and coordination.Both students and teachers agreed that by adapting training content into contextualized delivery formats and settings,the Tongji Program successfully overcame language and technology barriers.Conclusions:Committed partnerships and contextualization were key to the success of the Tongji Program.Future research should focus on how international primary care education programs affect learners'behavior in their practice settings,and explore barriers and facilitators to change.
文摘AIM To explore primary care physicians' perspectives on possible barriers to the use of insulin.METHODS This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight electronic databases were searched(between January 1, 1994 and August 31, 2014) for relevant studies. A search for grey literature and a review of the references in the retrieved studies were also conducted. Studies that focused on healthcare providers' perspectives on possible barriers to insulin initiation with type 2 diabetic patients were included, as well as articles suggesting solutions for these barriers. Review articles and studies that only considered patients' perspectives were excluded. RESULTS A total of 19 studies met the inclusion criteria and were therefore included in this study: 10 of these studies used qualitative methods, 8 used quantitative methods and 1 used mixed methods. Studies included a range of different health care settings. The findings are reported under four broad categories: The perceptions of primary care physicians about the barriers to initiate insulin therapy for type 2 diabetes patients, how primary care physicians assess patients prior to initiating insulin, professional roles and possible solutions to overcome these barriers. The barriers described were many and covered doctor, patient, system and technological aspects. Interventions that focused on doctor training and support, or IT-based decision support were few, and did not result in significant improvement. CONCLUSION Primary care physicians' known delay in insulin initiation is multifactorial. Published reports of attempts to find solutions for these barriers were limited in number.
文摘This article provides insight into the status of general practice in Pakistan and challenges to its health care system. The country ranked 122nd on the overall health system attainment and ranked 7th in the world on diabetes prevalence. The public sector health care system in Pakistan is encountered with many problems such as structural fragmentation, resource scarcity, inefficiency and lack of functional specificity, gender insensitivity and inaccessibility. The general practice status in Pakistan requires immediate attention to face the challenges created by chronic diseases in the country. Of particular mention are the patient-doctor interaction, healthcare system delivery, access to the doctors and better utilization of primary health care services.
文摘General practice as a discipline has largely evolved over the past 30 years in the field of primary health care. It originated in the 18th century m Europe. It was established in the United States in the 1960s and introduced to China in the late 1980s. In earlier times, medicine was not specialized, and general physicians dominated the medical field. At the end of the 19th century, with the development of basic medical disciplines, such as biology and anatomy, the development of more specialized medical practices began.
文摘Our small group of expert GP academic trainers from Monash University and the University of Melbourne have been collaborating over the last decade to develop a GP model training program based in Luohu,Shenzhen,that deeply engages Chinese GPs and seeks to provide personal and professional development of the GPs.The program is closely linked to continuing offshore GP education in Australia,with many trainees of the program having attended intensive training hosted by Monash University in Australia.
基金This study was funded by University of Michigan Medical School.
文摘Objective To understand general practice(GP)residents’attitudes about their residency training in China.Design Mixed methods survey administered cross-sectionally.Setting Two GP training programmes similar in most regards according to current GP training policy of 5 years’undergraduate degree in medicine and 3 years of postgraduate GP residency training-but differing as the Beijing programme has adopted educational innovations beyond the nationally prescribed standard curriculum used by the second Shenzhen programme.Participants 105(85%)of eligible GP trainees,35(90%)in the innovative Beijing programme and 70(83%)in the standard training Shenzhen programme.Results Overall,residents felt discrimination because of specialty choice,and that they lacked competency as a general practitioner.Many residents commented faculty had negative teaching attitudes.Beijing residents were more satisfied than Shenzhen residents with their training(p=0.001),and felt teaching faculty had sufficient knowledge(p<0.001),and appropriate attitudes towards teaching(p=0.004).Beijing residents more strongly agreed on five items about good future job prospects(all p<0.05).Conclusion These Chinese GP residents identify areas for improvement in their training as well as strengths.Higher satisfaction with faculty teaching and job optimism in Beijing where GP residents receive training from specifically qualified faculty,and can earn special certification,suggest that the educational innovations enhance training and promote positivity about job prospects.These findings imply that GP residents in China face many training challenges that are similar to other international reports,while also implicating benefits of using an innovative curricular approach.
基金funded by the Australian Government Medical Research Future Fund(MRFF),Grant number 2015947.
文摘Objective To examine general practitioners’(GPs)referral patterns to allied health services for people with dementia compared with those without dementia across two large Australian Primary Health Networks(PHNs).Design A retrospective cohort study using routinely collected general practice data.Logistic regression was used to compare odds of allied health referrals,adjusting for age,sex and socioeconomic status.Setting De-identified patient and episode activity data from 537 GP practices across two PHNs in Australia between 2018 and 2023.Participants Data from 1153304 patients and 28667517 GP episodes of care were analysed.After merging records,693328 unique patients were identified,including 16610 patients with dementia.Subcohorts included patients with dementia,stroke,Parkinson’s disease and combinations of these conditions.Results The dementia cohort(n=16610)had a similar overall allied health referral rate(36.1%)to the control cohort(n=48977)(35.4%).Patients with dementia only were significantly less likely to receive any allied health referral compared with those with stroke(adjusted OR(aOR)0.76,95%CI 0.72 to 0.80;p<0.001)or Parkinson’s disease(aOR 0.72,95%CI 0.66 to 0.78;p<0.001).Those with dementia and stroke were also less likely to receive referrals than those with stroke only(aOR 0.71,95%CI 0.61 to 0.82;p<0.001).No significant difference was found between dementia with Parkinson’s and Parkinson’s only groups(p=0.48).Patients with dementia were consistently less likely to be referred to key allied health services(p<0.05).Conclusion Despite strong evidence supporting allied health interventions for dementia,referral rates remain comparatively low.Enhancing GP referral resources and education,integrating dementia-specific care pathways and implementing supportive policy changes are needed to improve access and equity in dementia care.
文摘Transitions are a period and a process,through which there is a longitudinal adaptation in response to changing circumstances in clinical practice and responsibilities.While the experience of the transition in medical student learning and in hospital-based specialty training programmes are well described and researched,the experience of the transition in community-based postgraduate general practitioner(GP)training has not been described comprehensively.Objective We aimed to identify,and categorise,the formative experiences of transitions in GP training and their impacts on personal and professional development.Design We adopted Levac et al’s scoping review methodology.Of 1543 retrieved records,76 were selected for data extraction.Based on a combined model of the socioecological and multiple and multi-dimensional theories of transitions,data relating to the experiences of transitions were organised into contextual themes:being physical,psychosocial,organisational culture and chronological.Eligibility criteria Empirical studies focused on general practice trainees or training,that discussed the transitions experienced in general practice training and that were published in English were included.Information sources PubMed,MEDLINE and Web of Science databases were searched in January 2024 with no date limits for empirical studies on the transition experiences of GP into,and through,training.Results Our findings describe context-dependent formative experiences which advance,or impede,learning and development.Time is a significant modulator of the factors contributing to more negative experiences,with some initially adverse experiences becoming more positive.Identification of the inflection point that represents a shift from initially adverse to more positive experiences of transitions may help moderate expectations for learning and performance at different stages of training.Conclusion Challenges in training can either advance development and contribute positively to professional identity formation and clinical competency,or detract from learning and potentially contribute to burnout and attrition from training programmes.These findings will assist future research in identifying predictive factors of positive and adverse experiences of transitions and may strengthen existing and nascent GP training programmes.The findings are transferable to other community-based specialty training programmes.
文摘Objective:Chronic nonspecific musculoskeletal pain(CNMP)is a complex idiopathic condi-tion that causes significant disruption to patients’lives,their relationships,and functionality.The cause of CNMP is not fully understood,which makes diagnosis and management challenging.As general practitioners(GPs)are central to the management of chronic pain,their perspectives on managing CNMP are important.Purpose:To explore the clinical reasoning GPs use when diagnosing and managing CNMP.Methods:A qualitative study design using focus group discussion was conducted with Australian GPs.Five focus group discussion were conducted across Adelaide.All focus group discussions were audio-recorded,and transcripts were coded and analyzed thematically with the program NVivo.Results:The main themes remained consistent across the five focus group discussion’s:the ambiguous cause of CNMP;sex differences;developing the“right strategy”;patient-centered care;and verifying vitamin D levels.Conclusion:The findings show that GPs use a patient-centered approach tailored to indi-vidual patients’medical history,physical examination findings,and psychosocial health.There was general concern about low levels of vitamin D in patients with CNMP,and vitamin D supplements were recommended if indicated by a patient’s history.
文摘Background: Diabetes Mellitus results in several serious complications and among them foot problem is one of the commonly ignored complications. This study is an attempt to find out the level of patient’s awareness and practice in Nepalese context. Objective: The aim of this study is to determine the knowledge and practice of foot care among patients with diabetes in Nepal. Methods: This is a six-month long cross-sectional study done in the General Practice Clinic of Tribhuvan University Teaching Hospital. Diabetic patients were given structure questionnaires on knowledge, foot care practices, and demographic information. Results: Illiteracy was found be significantly associated with poor knowledge and practice of foot care. Those who have no education are more likely to have poor knowledge and foot care practice. The odds of having poor knowledge is 6.414 (3.075, 13.379) in those who have no education/primary education compared to those who have education and the odds of poor foot care practice is 4.5180 (2.077, 8.411) in those who have no education/primary education compared to those who have education with significance of Conclusion: This study has highlighted the need of appropriate education intervention for the patients with diabetes who have no education background to prevent from foot complications. Health education materials such as graphics, photos are needed to make them comprehensible for the illiterate patients.
基金This project received funding from Macedon Ranges and North West Melbourne Medicare Local and from Better Care Victoria,there was no award/grant number.
文摘Objectives To evaluate the capacity of general practice(GP)electronic medical record(EMR)data to assess risk factor detection,disease diagnostic testing,diagnosis,monitoring and pharmacotherapy for the interrelated chronic vascular diseases-chronic kidney disease(CKD),type 2 diabetes(T2D)and cardiovascular disease.Design Cross-sectional analysis of data extracted on a single date for each practice between 12 April 2017 and 18 April 2017 incorporating data from any time on or before data extraction,using baseline data from the Chronic Disease early detection and Improved Management in PrimAry Care ProjecT.Deidentified data were extracted from GP EMRs using the Pen Computer Systems Clinical Audit Tool and descriptive statistics used to describe the study population.Setting Eight GPs in Victoria,Australia.Participants Patients were≥18 years and attended GP≥3 times within 24 months.37946 patients were included.Results Risk factor and disease testing/monitoring/treatment were assessed as per Australian guidelines(or US guidelines if none available),with guidelines simplified due to limitations in data availability where required.Risk factor assessment in those requiring it:30%of patients had body mass index and 46%blood pressure within guideline recommended timeframes.Diagnostic testing in at-risk population:17%had diagnostic testing as per recommendations for CKD and 37%for T2D.Possible undiagnosed disease:Pathology tests indicating possible disease with no diagnosis already coded were present in 6.7%for CKD,1.6%for T2D and 0.33%familial hypercholesterolaemia.Overall prevalence:Coded diagnoses were recorded in 3.8%for CKD,6.6%for T2D,4.2%for ischaemic heart disease,1%for heart failure,1.7%for ischaemic stroke,0.46%for peripheral vascular disease,0.06%for familial hypercholesterolaemia and 2%for atrial fibrillation.Pharmaceutical prescriptions:the proportion of patients prescribed guideline-recommended medications ranged from 44%(beta blockers for patients for some conditions.These baseline data highlight the utility of GP EMR data for potential use in epidemiological studies and by individual practices to guide targeted quality improvement.It also highlighted some of the challenges of using GP EMR data.
基金funded as a junior research group in health services research by the German Ministry of Education and Research(BMBF)(funding period:05/2022-04/2027,grant number:01GY2103).
文摘Background and objective The WHO emphasises the importance of integrating advice on physical activity(PA)into primary care of patients with chronic ischaemic heart disease(IHD).Similarly,the German treatment guideline‘Chronic Coronary Heart Disease’recommends that general practitioners(GPs)provide advice on PA to IHD patients.However,the provision of PA advice seems to be inadequately implemented in general practice.One reason is the lack of medical training in providing PA advice effectively and efficiently.International guidelines recommend such training for health professionals.This study aims to explore experiences,perceptions and attitudes,including barriers and facilitators of GPs towards the routine delivery of PA advice to IHD patients.Methods Between March and June 2023,12 face-to-face problem-centred interviews and six focus group discussions(n=37)with GPs were conducted.Interview and discussion guides were developed and pilot tested by the multi-professional study team.We used a purposive sampling strategy,and data were collected in an iterative process.Audio-recorded data were transcribed verbatim and analysed using a content structuring procedure(deductive and inductive approach).GPs were involved throughout the entire research process,for example,in multi-professional analysis groups.Results Although GPs are mostly aware of the health benefits of PA for patients with IHD,PA advice is not routinely provided.Conversations on PA tend to be rather unstructured,and advice is often addressed more generally than customised to the patients’needs and preferences.Priority is given to other lifestyle issues,such as smoking cessation.PA advice is perceived as time-consuming and rather ineffective with regard to the target behaviour.GPs frequently express frustration in this context.GPs express a lack of and simultaneously a need for communication strategies(structure and tools)that can be integrated into everyday GP practice to motivate patients to PA.Conclusion The results provide relevant insights into the current practice of GPs with regard to their attitudes on,experiences with,and requirements for the provision of PA advice to IHD patients.These results are helpful to inform the development of appropriate GP training in the provision of very brief PA advice to IHD patients.
基金supported by the National Key Research&Development Program of China(No.2024YFC3505800)the National Natural Science Foundation of China(Nos.82474334,82474335 and 72174132)+3 种基金National Science Fund for Distinguished Young Scholars(No.82225049)the Key Research&Development Projects of Sichuan Provincial Department of Science and Technology(Nos.2024YFFK0174 and 2024YFFK0152)1.3.5 Project for Disciplines of Excellence,West China Hospital,Sichuan University(Nos.ZYYC24010 and ZYGD23004)the Special Fund for Traditional Chinese Medicine of Sichuan Provincial Administration of Traditional Chinese Medicine(No.2024zd023).
文摘Objectives:Electronic health records(EHRs)offer valuable real-world data(RWD)for Chinese medicine research.However,significant methodological challenges remain in developing integrative Chinese-Western medicine(ICWM)databases.This study aims to establish a best-practice methodological framework,referred to as BRIDGE,to guide the construction of ICWM databases using EHRs.Methods:We developed the methodological framework through a comprehensive process,including systematic literature review,synthesis of empirical experiences,thematic expert discussions,and consultation with an external panel to reach consensus.Results:The BRIDGE framework outlines 6 core components for ICWM-EHR database development:Overall design,database architecture,data extraction and linkage,data governance,data verification,and data quality evaluation.Key data elements include variables related to study population,treatment or exposure,outcomes,and confounders.These databases support various research applications,particularly in evaluating the effectiveness and safety of integrative therapies.To demonstrate its practical value,we developed an ICWM-EHR database on women’s reproductive lifespan,encompassing 2,064,482 patients.This database captures women’s health conditions across the life course,from reproductive age to older adulthood.Conclusions:The BRIDGE methodological framework provides a standardized approach to building high-quality ICWM-EHR databases.It offers a unique opportunity to strengthen the methodological rigor and real-world relevance of Chinese medicine research in integrated healthcare settings.
基金supported by the Qingdao Medical Health Research Project,No.2023-WJZD212(to XX)。
文摘Recent evidence suggests that ferroptosis plays a crucial role in the occurrence and development of white matter lesions.However,the mechanisms and regulatory pathways involved in ferroptosis within white matter lesions remain unclear.Long non-coding RNAs(lnc RNAs)have been shown to influence the occurrence and development of these lesions.We previously identified lnc_011797 as a biomarker of white matter lesions by high-throughput sequencing.To investigate the mechanism by which lnc_011797 regulates white matter lesions,we established subjected human umbilical vein endothelial cells to oxygenglucose deprivation to simulate conditions associated with white matter lesions.The cells were transfected with lnc_011797 overexpression or knockdown lentiviruses.Our findings indicate that lnc_011797 promoted ferroptosis in these cells,leading to the formation of white matter lesions.Furthermore,lnc_011797 functioned as a competitive endogenous RNA(ce RNA)for mi R-193b-3p,thereby regulating the expression of WNK1 and its downstream ferroptosis-related proteins.To validate the role of lnc_011797 in vivo,we established a mouse model of white matter lesions through bilateral common carotid artery stenosis.The results from this model confirmed that lnc_011797 regulates ferroptosis via WNK1 and promotes the development of white matter lesions.These findings clarify the mechanism by which lnc RNAs regulate white matter lesions,providing a new target for the diagnosis and treatment of white matter lesions.
