Renaissance is the term used for the societal movement that marked the end of the Middle Ages. With the development of science came the rediscovery of the works and values of ancient scholars. This ...brought enormous development in all areas of society, including education. Man became the measure of all things, humanism became important again, and there was a blossoming of science and art.
The ‘renaissance of family medicine’ took place approximately 50 years ago as a response to over-technical (even inhumane) medicine. Family medicine focused on the patient and was, as such, rediscovered and developed as a scientific discipline.
In 2022 Wonca Europe launched a new document that set out the core values of family medicine, initiating a discussion about the ‘new’ renaissance of family medicine. The idea implies that, due to the changes brought about by rapid technical advances and recent global events, family medicine will develop further. However, the really intriguing question is whether these rapid and dramatic changes will actually result in a new renaissance of family medicine or whether they will result in its decline.
A suitable definition of primary care to capture the variety of prevailing international organisation and service-delivery models is lacking.
Evaluation of strength of primary care in Europe.
...International comparative cross-sectional study performed in 2009-2010, involving 27 EU member states, plus Iceland, Norway, Switzerland, and Turkey.
Outcome measures covered three dimensions of primary care structure: primary care governance, economic conditions of primary care, and primary care workforce development; and four dimensions of primary care service-delivery process: accessibility, comprehensiveness, continuity, and coordination of primary care. The primary care dimensions were operationalised by a total of 77 indicators for which data were collected in 31 countries. Data sources included national and international literature, governmental publications, statistical databases, and experts' consultations.
Countries with relatively strong primary care are Belgium, Denmark, Estonia, Finland, Lithuania, the Netherlands, Portugal, Slovenia, Spain, and the UK. Countries either have many primary care policies and regulations in place, combined with good financial coverage and resources, and adequate primary care workforce conditions, or have consistently only few of these primary care structures in place. There is no correlation between the access, continuity, coordination, and comprehensiveness of primary care of countries.
Variation is shown in the strength of primary care across Europe, indicating a discrepancy in the responsibility given to primary care in national and international policy initiatives and the needed investments in primary care to solve, for example, future shortages of workforce. Countries are consistent in their primary care focus on all important structure dimensions. Countries need to improve their primary care information infrastructure to facilitate primary care performance management.
The high burden of heart failure in nursing-home populations is due to advanced age and comorbidities. Heart failure is often undiagnosed or misdiagnosed in this population and therefore remains ...untreated. We review the use of natriuretic peptide biomarkers for screening heart failure in nursing-home residents. The study was performed in accordance with recommendations from the Cochrane Collaboration using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) and is registered in PROSPERO Register of Systematic Reviews. Databases PubMed, Embase, and Trip were searched from 2000 to March 2019, supplemented by hand-searching of references. Studies investigating the nursing-home population were included. The prevalence of heart failure among nursing-home residents was higher than in the general population of comparable age (23% vs 10%, respectively). The rate of misdiagnosis in nursing homes ranged from 25 to 76%. NT-proBNP was the most commonly used natriuretic peptide biomarker for heart failure screening. The mean value of NT-proBNP was significantly higher in residents with heart failure than in residents overall (pooled means of 2409 pg/mL vs 1074 pg/mL, respectively). In comparison with current guidelines, the proposed cut-off values for ruling out heart failure were higher in the analyzed studies, with ranges of 230–760 pg/mL for NT-proBNP and 50–115 pg/mL for BNP. NT-proBNP and BNP are used for screening heart failure in the nursing-home population. The current screening cut-off values are probably too low for use in nursing homes. Our most conservative estimation for ruling out heart failure is an NT-proBNP cut-off value of 230 pg/mL.
We live in an age of information revolution, where trends in informing physicians and the lay public bring new challenges that must be faced by healthcare professionals. Predatory journals and fake ...conferences are common. Social media is full of false information, which results in serious public health damage. Therefore, it is important that health professionals communicate properly with the public and patients and that they address the education of both the public and other health professionals.
The COVID-19 pandemic has led to a surge in scientific publications, some of which have bypassed the usual peer-review processes, leading to an increase in unsupported claims being referenced. ...Therefore, the need for references in scientific articles is increasingly being questioned. The practice of relying solely on quantitative measures, such as impact factor, is also considered inadequate by many experts. This can lead to researchers choosing research ideas that are likely to generate favourable metrics instead of interesting and important topics. Evaluating the quality and scientific value of articles requires a rethinking of current approaches, with a move away from purely quantitative methods.
Artificial intelligence (AI)-based tools are making scientific writing easier and less time-consuming, which is likely to further increase the number of scientific publications, potentially leading to higher quality articles.
AI tools for searching, analysing, synthesizing, evaluating and writing scientific literature are increasingly being developed. These tools deeply analyse the content of articles, consider their scientific impact, and prioritize the retrieved literature based on this information, presenting it in simple visual graphs. They also help authors to quickly and easily analyse and synthesize knowledge from the literature, prepare summaries of key information, aid in organizing references, and improve manuscript language. The language model ChatGPT has already greatly changed the way people communicate with computers, bringing it closer to human communication. However, while AI tools are helpful, they must be used carefully and ethically.
In summary, AI has already changed the way we write articles, and its use in scientific publishing will continue to enhance and streamline the process.
Values are deeply held views that act as guiding beliefs for individuals and organizations. They state what is important in a profession. The aims of this study were to determine whether European ...countries have already developed (or are developing) documents on core values in family medicine; to gather the lists of core values already developed in countries; and to gather the opinions of participants on what the core family values in their countries are.
This was a qualitative study. The questionnaire was distributed as an e-survey
email to present and former members of the European Society for Quality and Safety in Family Practice (EQuiP), and other family medicine experts in Europe. The questionnaire included six items concerning core values in family medicine in the respondent's country: the process of defining core values, present core values, the respondents' suggestions for core values, and current challenges of core values.
Core values in family medicine were defined or in a process of being defined in several European countries. The most common core values already defined were the doctor-patient relationship, continuity, comprehensiveness and holistic care, community orientation, and professionalism. Some countries expressed the need for an update of the current core values' list. Most respondents felt the core values of their discipline were challenged in today's world. The main values challenged were continuity, patient-centered care/the doctor-patient relationship and comprehensive and holistic care, but also prioritization, equity, and community orientation and cooperation. These were challenged by digital health, workload/lack of family physicians, fragmentation of care, interdisciplinary care, and societal trends and commercial interests.
We managed to identify suggestions for core values of family medicine at the European level. There is a clear need to adopt a definition of a value and tailor the discussion and actions on the family medicine core values accordingly. There is also a need to identify the core values of family medicine in European countries. This could strengthen the profession, promote its development and research, improve education, and help European countries to advocate for the profession.
Unemployment is known to be associated with poor mental health, but it is not clear how strongly unemployment leads to onset of diagnosed clinical depression (causation), or if depression raises the ...risks of becoming unemployed (health selection), or indeed if both pathways operate. We therefore investigate the direction of associations between clinical depression and unemployment in a cross-cultural prospective cohort study. 10,059 consecutive general practice attendees (18–75 years) were recruited from six European countries and Chile between 2003 and 2004 and followed up at six, 12 and (in a subset) 24 months. The analysis sample was restricted to 3969 men and women who were employed or unemployed and seeking employment and had data on depression measures. The outcomes were depressive episodes, assessed using the Depression Section of the Composite International Diagnostic Interview (CIDI) and self-reported employment status. Among 3969 men and women with complete data on depression and unemployment, 10% (
n = 393) had depression symptoms and a further 6% (
n = 221) had major depression at 12 months. 11% (
n = 423) of the sample were unemployed by 6 months. Participants who became unemployed between baseline and 6 months compared to those employed at both times had an adjusted relative risk ratio for 12-month depression of 1.58 (95% Confidence Interval 0.76, 3.27). Participants with depression at baseline and 6 months compared to neither time had an odds ratio for 6-month unemployment of 1.58 (95% Confidence Interval 0.97, 2.58). We found evidence that causation and (to a lesser extent) health selection raise the prevalence of depression in the unemployed. Unemployed adults are at particular risk for onset of major clinical depression and should be offered extra services or screened. Given the trend for adults with depression to perhaps be at greater risk of subsequent unemployment, employees with depressive symptoms should also be supported at work as a precautionary principle.
► The unemployed have poorer mental health than the employed, yet there is little evidence about diagnosed clinical depression. ► We study both direct causal pathways and health selection in a prospective international cohort study. ► Becoming unemployed raised risk of depression symptoms 12 months later, whereas gaining employment reduced risk of symptoms. ► Depression at baseline and 6 months may result in raised risk of subsequent unemployment, more so in men than women. ► We found more evidence for causation than health selection: both the unemployed and employees with depressive symptoms need extra support.
Heart failure is common in the nursing home population and presents many diagnostic and therapeutic challenges. Point-of-care ultrasonography is a bedside method that can be used to assess volume ...status more reliably than clinical examination. This trial was conceived to test whether point-of-care ultrasonography-guided management improves heart failure outcomes among nursing home residents.
Nursing home residents with heart failure will be enrolled in a multi-centre, prospective, randomised controlled trial. Residents will first be screened for heart failure. Patients with heart failure will be randomised in 1:1 fashion into two groups. Nursing home physicians will adjust diuretic therapy according to volume status for six months. Point-of-care ultrasonography will be used in the test group and clinical examination in the control group. The primary endpoint will be heart failure deterioration, defined as a composite of any of the following four events: the need for an intravenous diuretic application, the need for an emergency service intervention, the need for unplanned hospitalisation for non-injury causes, or death from whatever cause.
The expected prevalence of heart failure among nursing home residents is above 10%. Point-of-care ultrasonography-guided heart failure management will reduce the number of deteriorations of heart failure in the nursing home population.
This study will explore the usefulness of point-of-care ultrasonography for heart failure management in the nursing home population.
ABSTRACT
After decades of developing family medicine, one can see that it has been successful in defining its principles and in proving the importance of its contribution using quantitative measures ...of quality that are prevailing today. But if family medicine needs to make a real contribution to society, it needs not to forget that using only rationalistic approach is not enough to define its quality and that caring for a fellow being is as important as science.
Our contribution to changing the world for the better should be in constantly reminding that personal care is essential for every doctor regardless the speciality. This largely neglected feature of medicine can be best taught and researched in the context of family medicine, because it represents the very essence of the discipline.
This implies that we must often take a different path from other disciplines when we address the issues of policy, research and education and use every opportunity to stress the importance of personal care.
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