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Background High-risk human papillomavirus (HR-HPV) is a known cause of cervical cancer (CC). Latvia has a high incidence of CC compared with the average incidence in the European Union. This study aims to fill the data gap on the HR-HPV burden in Latvia, providing information on its prevalence and associated factors. Methods The cross-sectional study was conducted from February 2021 to April 2022. Participants 25–70 years old visiting a general practitioner (general population) or those referred to a colposcopy clinic with changes in their cervical cytology (colposcopy population) collected vaginal self-sample and completed a paper-based questionnaire. Samples were analyzed with Cobas 6800 System (Roche) for HPV16, HPV18 and other HR-HPV (HPV31/33/35/39/45/51/52/56/58/59/66/68). Descriptive statistics for categorical variables were performed. The Chi-square test was used to determine for the statistical significance of differences in the proportions of the dependent variable between subgroups of the independent variable. Univariate and multivariate binary logistic regression were used to identify factors associated with positive HR-HPV status. Results were considered statistically significant at P  < 0.05. Results A total of 1274 participants provided a valid sample. The prevalence of any HR-HPV infection was 66.8% in the colposcopy group and 11.0% in the general population. Factors associated with positive HR-HPV status were marital status single/divorced/widowed (vs. married/cohabiting) [adjusted OR (aOR) 2.6; P  = 0.003], higher number of lifetime sex partners [aOR 5.1 (P  < 0.001) and 4.0 (P  = 0.001)] for six or more and three to five partners in the general population; in the colposcopy group, the statistical significance remained only for Latvian ethnicity (vs. other) (aOR 1.8; P  = 0.008) and current smoking (vs. never) (aOR 1.9; P  = 0.01). Conclusion We documented a comparison to European Union HR-HPV infection burden in Latvia. Any HR-HPV positivity was significantly associated with sexual and other health behavior. [ABSTRACT FROM AUTHOR]

Patient journey mapping is an emerging field of research that uses various methods to map and report evidence relating to patient experiences and interactions with healthcare providers, services, and systems. This research often involves the development of visual, narrative, and descriptive maps or tables, which describe patient journeys and transitions into, through, and out of health services. This methods corner paper presents an overview of how patient journey mapping has been conducted within the health sector, providing cardiovascular examples. It introduces six key steps for conducting patient journey mapping and describes the opportunities and benefits of using patient journey mapping and future implications of using this approach. [ABSTRACT FROM AUTHOR]

A correction is presented to the article "ANZCA Annual Scientific Meeting (ASM) Faculty of Pain Medicine (FPM) Best Free Paper Award Session Abstracts" published in November 29, 2022 issue.

Background The Acute Medical Ambulatory Centre (AMAC) was established with the goals of facilitating early discharge and preventing avoidable medical admissions. 12 months post its introduction, the service was inefficient and operating under capacity. A project aimed to improve the AMAC referral processes and increase the centre's overall efficiency was undertaken. Methods Western Australia Department of Health Clinical Service Redesign methodology (a blend of Lean and Six Sigma methodologies) was used to complete the project. This involved process mapping, root cause analysis and solutions sessions with stakeholders, as well as a semi-structured phone interview with patients. Results Transition from a paper-based to an electronic referral system. Creation of an 'AMAC Quick Reference Guide' for doctors. Production of an AMAC contact card to be given to patients on discharge if they   have AMAC follow up. Letters detailing the patient review are forwarded on the day of the appointment facilitating timely feedback to GPs. An AMAC information flyer for GPs is now available on the hospital website. Conclusion Redesigning the referral process to the AMAC has improved workflow and efficiency with significant improvements in staff satisfaction. The institution is aiming to become paperless and this redesign project has led to the elimination of another paper form. The success of the project is testament to the engagement of the staff involved and demonstrates the need for doctors to not only engage their medical colleagues, but also nursing and clerical staff. The redesign project has helped refocus hospital priorities and should hopefully see further support for the centre; developing the ambulatory model of care as an integral part of the service provided. Other centres can learn valuable lessons from our experience and develop similar strategies to cope with the ever-increasing demands on the public healthcare system. [ABSTRACT FROM AUTHOR]

Background: The Scottish Intercollegiate Guidelines Network (SIGN) developed guidelines for the management of sore throat and indications for tonsillectomy in 1999 to address concerns of unnecessary surgery. Emergency admissions to hospital for tonsillitis have since increased. Adults experience an average of 27 episodes of tonsillitis before undergoing tonsillectomy. We wished to explore the appropriateness of the guidance and/or its implementation in primary care.Aim: To explore the attitudes of GPs to the referral criteria they use when managing adults presenting with acute tonsillitis.Design: Secondary analysis of qualitative data from the NAtional Trial of Tonsillectomy IN Adults (NATTINA) feasibility and process evaluation.Participants and Setting: Twenty-one GPs from practices throughout the UK.Method: In-depth interviews with GPs concerning both the feasibility and process evaluation phases of NATTINA. Analysis was conducted using the framework method.Results: GPs felt it was rarely necessary to refer patients. They were aware of guidelines and would refer if requested by a patient who fulfilled the guidelines criteria and/or who were missing considerable amounts of work.Conclusion: The introduction of the guidelines appears to coincide with what some may have hoped to be a desired effect of reducing adult sore throat referrals and subsequent tonsillectomies by increasing the number of episodes a patient must suffer before the referral threshold is met. GPs may find equipoise for tonsillectomy referral challenging as many patients express a strong preference for surgery. We believe this paper reinforces GP professionalism and patient-centred consultations, and challenges the role of clinical guidelines. [ABSTRACT FROM AUTHOR]

A number of controversies and challenges exist for the management of OA in health care. This paper describes the challenges and gaps in OA care, particularly in relation to population health management, complex interventions and outcomes. It sets this in the context of competing health priorities and multimorbidity, access to high quality conservative care, non-pharmacological therapies, resource limitations and models of care. The overuse of some therapies and neglect of others are discussed, as well as the potential for self-management. The roles of patient and public involvement and the healthcare team are highlighted in enhancing best care for OA and providing solutions for closing the evidence-to-practice gap. Implementation of models of care offer one solution to the challenges and progress of such implementation is described. Areas for further research are highlighted. [ABSTRACT FROM AUTHOR]

Background: Perinatal anxiety and depression are widespread, with up to 20% of women affected during pregnancy and after birth. In the UK, management of perinatal mental health falls under the remit of general practitioners (GPs). We reviewed the literature on GPs' routine recognition, diagnosis and management of anxiety and depression in the perinatal period.Method: A systematic search of Embase, Medline, PsycInfo, Pubmed, Scopus and Web of Science was conducted. Studies were eligible if they reported quantitative measures of GPs' or Family Physicians' assessment, recognition and management of anxiety or depression in pregnancy or post-partum.Results: Thirteen papers, reporting 10 studies, were identified from the United States, Australia, UK, Netherlands and Canada. All reported on depression; two included anxiety disorders. Reported awareness and ability to diagnose perinatal depression among GPs was high. GPs knew about and used screening tools in the UK but less so in US settings. Antidepressants were the first line of treatment, with various SSRIs considered safest. Counseling by GPs and referrals to specialists were common in the post-natal period, less so in pregnancy. Treatment choices were determined by resources, attitudes, knowledge and training.Conclusions: Data on GPs' awareness and management of perinatal depression were sparse and unlikely to be generalizable. Future directions for research are proposed; such as exploring the management of anxiety disorders which are largely missing from the literature, and understanding more about barriers to disclosure and recognition in primary care. More standardized training could help to improve recognition and management practices. [ABSTRACT FROM AUTHOR]

Background: In 2005, the UK Department of Health recommended that a new role, the arrhythmia care coordinator (ACC), be created to guide patients through the diagnosis and treatment for arrhythmia. The belief was that this would improve the efficiency of care and improve their quality of life. The British Heart Foundation provided funding for 32 such posts, all of which were filled by arrhythmia specialist nurses, and commissioned an evaluation of the new service to assess its impact on patients. Aims: This paper focuses on the impact of the ACCs on their patients’ levels of anxiety and depression, hospital readmissions and costs to the National Health Service (NHS). Methods: From 2008 to 2010, using questionnaires, we conducted a longitudinal audit of the psychological status of the patients referred to the ACCs; we also assessed the ACCs’ impact on readmissions and cost benefits to the NHS using UK Hospital Episode Statistics. Results: We found high levels of anxiety and depression amongst patients. Nearly one-third were at the ‘borderline’ or ‘clinically anxious’ and 18% were at the ‘borderline’ or ‘clinically depressed’ level at their first assessment with small changes at follow-up. In arrhythmia specialist nurse sites, readmission rates were reduced by half. After deducting the cost of the ACCs and their support, the estimated annual saving was £29,357 per ACC. Conclusion: This evaluation has shown that the NHS saves £29,357 per year over and above the costs of employing a British Heart Foundation ACC and that all arrhythmia centres should be encouraged to employ an appropriate number of such specialists. [ABSTRACT FROM AUTHOR]

Presents several abstracts of research papers related to dermatology published in the July 2004 issue of "British Journal of Dermatology." "Consent and Patient Understanding in Minor Surgery," by M. Connolly, K. Wathen and D. A. R. De Berker; "Can Nurses Perform Minor Skin Surgery As Well As Doctors?," by G. E. Elston, R. Jones, M. Benjamin and A. Bedlow; "Is the 2-Week Skin Cancer Referral Route Being Used Appropriately and Effectively?," by G. E. Elston, M. D. Catterall and S. M. Khorshid.

Background: The general practitioner is usually the first health care contact for mental problems. The position of a general practitioner may vary between health care systems, depending on the referral system (gatekeepers versus directly accessible specialists), presence of fixed lists and the payment system. This may influence patients' expectations and requests for help and GPs' performance. In this paper the effects of working in different health care systems on demand and supply for psychological help were examined. Methods: Data were collected in six European countries with different health care system characteristics (Belgium, Germany, the Netherlands, Spain, Switzerland and the UK). For 15 consecutive contacts with 190 GPs in the six countries, each patient completed questionnaires concerning reason for visit and expectations (before) and evaluation (after consultation). General practitioners completed registration forms on each consultation, indicating familiarity with the patient and diagnosis. General practitioners completed a general questionnaire about their personal and professional characteristics as well. Results: Practices in different countries differed considerably in the proportion of psychological reasons for the visit by the patient and psychological diagnoses by the GP. Agreement between patients' self-rated problems and GPs' diagnoses also varied. Patients in different countries evaluated their GPs' psychological performance differently as well, but evaluation was not correlated with agreement between request for help and diagosis. In gatekeeping countries, patients had more psycho-social requests, GPs made more psychological diagnoses and agreement between both was relatively high. Evaluation, however, was more positive in non-gatekeeping countries. Individual characteristics of doctors and patients explained only a relatively small part of variance. Conclusions: Health care system characteristic. [ABSTRACT FROM AUTHOR]

Carpal tunnel syndrome is an extremely common upper limb nerve compression syndrome, widely distributed in the community. There are a variety of treatment options which may be applied to the syndrome, depending on the severity of symptoms. Some options are available in a primary care setting, others require secondary referral. This paper is a detailed review of the available literature and provides a protocol that could be used to assist in the referral of patients from primary care. [ABSTRACT FROM AUTHOR]

Social prescribing is seen as a mechanism for addressing the social determinants of health, preventing exacerbation of preexisting diseases, reducing attendance in primary and emergency care and improving general population health and well-being. Social prescribing involves individuals being referred/self-referring to non-medical interventions run by a third-party organisation. Social prescribing has received widespread attention internationally; however, the evidence base to support social prescribing lacks rigour, and gaps remain. The complexity of social prescribing, in that it involves multiple referral routes, partners, pathways and outcomes, poses challenges for its evaluation and research. Researchers across Europe have developed different projects of research to address the challenges associated with evaluating social prescribing. Development of the evidence base for social prescribing is crucial in informing policy and public health systems to deliver effective interventions that contribute to individual, community and systemic outcomes. This workshop aims to share different approaches that have been taken across Europe to address issues in producing evidence base and share learning about the challenges and solutions that researchers have developed, specifically regarding research about implementation and evaluation of social prescribing. The workshop will be structured in a first part of presentations and the second part of open discussion with presenters and the audience. This workshop will present five papers which will address two key questions: 1. What have we learned about developing the evidence in social prescribing?; 2. What challenges have we experienced, and what solutions have we come up with? The short presentations will cover examples of social prescribing initiatives based on implementation and evaluation studies conducted in diverse European countries. Learning shared with the audience through the presentations will stimulate discussions around challenges with implementing and evaluating social prescribing. This workshop will inform the development of an overarching guidance on implementing social prescribing interventions, as well as identify parallel challenges in other areas of public health. Key messages: • Interactive session to discuss strategies for successful social prescribing projects addressing complex health issues that are relevant to stakeholders and for research to inform practice and policy. • Collaboration with interdisciplinary stakeholders is crucial in developing the evidence base for social prescribing. [ABSTRACT FROM AUTHOR]

The authors discuss a report about the original Hoffmann method that used normal probability paper to plot cumulative percentages against the measurement values.

The paper summarises current knowledge on ganglia of the wrist including the views of patients and doctors. The efficacy of available treatment options are discussed. Summary points are derived from the available knowledge with a referral protocol from primary care. [ABSTRACT FROM AUTHOR]

This article provides an update on the H5N1 virus and the role of the clinical microbiology laboratory in the diagnosis of H5N1 influenza. Although overshadowed recently by the influenza A H1N1 2009 pandemic, the influenza A H5N1 virus continues to circulate among avian species and cause morbidity and mortality in man. The H5N1 virus is evolving, creating the potential for a new strain that is efficiently transmitted from person to person, while remaining highly lethal. Surveillance is essential to detect the spread of, and changes in, the virus. Laboratory testing is an important element of surveillance and patient management. The clinical microbiology laboratory has a number of diagnostic tools for detecting influenza viruses, including antigen detection, serology, virus culture, and nucleic acid amplification. The relative performance characteristics of these tests vary significantly. In addition, the sensitivity of tests may differ between influenza strains, including H5N1. [ABSTRACT FROM AUTHOR]

Presents an abstract of the research paper 'An Audit of Wart Referrals from GPs—a Way to Cut Waiting Lists?,' by S.J. Beswick, H.M. Ramsay, L.A. Pemberton and N. Hardwick presented during the annual meeting of the British Association of Dermatologists in Edinburgh, Scotland.

Presents an abstract of the research paper 'Does Advising GPs of Their Referral Rates Affect Subsequent Practice?,' by J.M. Mahood presented during the annual meeting of the British Association of Dermatologists in Edinburgh, Scotland.