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Abstract Background Otolaryngology-Head and Neck Surgery (OHNS) electives provide medical students opportunities for knowledge acquisition, mentorship, and career exploration. Given the importance of electives on medical student education, this study examines OHNS clinical electives prior to their cancellation in 2020 due to the COVID-19 pandemic. Methods An anonymous 29-question electronic survey was created using the program “Qualtrics.” Themes included elective structure and organization, elective clinical and non-clinical teaching, evaluation of students, and the influence of electives on the Canadian Residency Match (CaRMS). The survey was distributed through the Canadian Society of Otolaryngology e-newsletter and e-mailed to all OHNS undergraduate and postgraduate program directors across Canada. Results Forty-two responses were received. The vast majority of respondents felt that visiting electives were important and should return post-COVID-19 (97.6%). Most said they provide more in-depth or hands-on teaching (52.4% and 59.6%, respectively). However, there was great variability in the feedback, types of teaching and curriculum provided to elective students. It was estimated that 77% of current residents at the postgraduate program that responders were affiliated with participated in an elective at their program. Conclusions Prior to the cancellation of visiting electives in 2020 due to the COVID-19 pandemic, electives played an important role in OHNS undergraduate medical education and career planning for students wishing to pursue a career in OHNS. Electives also provide the opportunity for the evaluation of students by OHNS postgraduate programs.

Background: In recent years, patient advocacy has emerged as a prominent concept within healthcare. How nursing students decide what is best for their patients is not well understood., Objective: The objective is to examine nursing students' views on doing what is best for patients during their clinical experiences and how they seek to establish patient interests when providing care. Research questions guiding the interview were as follows: (1) What are nursing students' perceptions of patient interests? (2) What factors influence nursing students' perceptions of advocating for patient's interests?, Research Design: Qualitative descriptive research using thematic analysis., Participants and Research Context: Data was collected through individual online interviews with nine nursing students with clinical experience., Ethical Considerations: The study was approved by the University Research Ethics Committee. Participants provided digital informed consent., Results: The students asserted that they are able to understand the patients' interests by placing emphasis on the patients' needs. They believe that it is crucial to adopt a collaborative strategy for the provision of care to meet these requirements. In addition, some of them expressed concern over the most effective methods of advocating for the interests of patients. Three themes were identified. (1) Focussing on patient needs first, (2) taking a collective approach, and (3) learning how to advocate., Conclusions: Students understand and value the ethical commitments associated with advocating for the patient's best interest by considering factors such as prioritising the patient's needs, adopting a strategy that involves everyone, and acquiring the ability to undertake the advocacy role. Additionally, nursing education strategies in clinical contexts require additional study to inspire students to do what is in their patient's best interests., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Approximately 7% of children live with food allergy, a condition that requires dietary avoidance to prevent an allergic reaction. In this qualitative study, we aimed to understand food allergy-related experiences, beliefs and learning preferences among children with and without food allergies, to inform a school-based, food allergy education program. Data were analysed thematically. We virtually interviewed children in Kindergarten-Grade 8 in Manitoba, Canada, with (n = 7) and without (n = 9) parent-reported, physician-diagnosed food allergies. We identified three themes: Naive reliance on peers and school staff to assist with food allergy management; Limited food allergy knowledge; and, Recommended food allergy curricula: complementary perspective. Our findings will help inform the development of a school-based, food allergy education program, with a long-term goal of minimizing food allergy-related worries and optimizing safety for children with food allergy. Ongoing, school-based food allergy education is needed., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background and Aims: The purpose of this study is to review the 2020 Substance Abuse and Mental Health Services Administration Guideline for Opioid Use Disorder recommendations to continue buprenorphine perioperatively by evaluating the total morphine milligram equivalents (MME) requirements in the first 24 hours postoperatively of patients who continued their buprenorphine therapy to those who discontinued their buprenorphine therapy perioperatively. Methods: This IRB approved study is a multicenter retrospective chart review of 80 surgical inpatients on buprenorphine prior to admission at participating sites from January 2015 to October 2022. The primary outcome is MME administered 24 hours postoperatively in patients who continued buprenorphine perioperatively versus those who discontinued buprenorphine perioperatively. Secondary efficacy outcomes included MME administered 48 and 72 hours postoperatively and daily average pain scores. Safety outcomes included rate of respiratory depression and mortality. Findings: Patients who continued buprenorphine perioperatively required significantly less MME in the first 24 hours postoperatively compared to those who discontinued buprenorphine perioperatively (median [IQR]; 23.25 [6-74.35] vs 93.38 [49.8-156.26]; P  < .001). Secondary outcomes of MME administered at 48 hours (10.4 [0-40.5] vs 66.15 [27.94-143.5], P  < .001) and 72 hours (0 [0-31.13] vs 66 [22.5-144], P  < .001) postoperatively were also significantly less in those whose buprenorphine was continued versus those whose buprenorphine was discontinued perioperatively. Patients whose buprenorphine was continued perioperatively experienced significantly lower average pain scores at 48 (median [IQR]; 4.74 [2.9-7.08] vs 6 [4.93-7.4], P  = .028) and 72 hours (3.78 [1.78-5.85] vs 5.75 [4.15-7.45], P  = .002) postoperatively. Conclusion: Continuation of buprenorphine in the perioperative setting results in significantly lower utilization of MME in patients whose buprenorphine is continued compared to those whose buprenorphine is discontinued perioperatively., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

The Neurohospitalist Core Competencies comprise a set of competency-based learning objectives that encapsulate the knowledge, skills, and attitudes of neurohospitalitists who specialize in the care of hospitalized patients with neurologic conditions. These competencies serve to characterize the rapidly expanding field of neurohospitalist medicine. The 27 chapters are divided into 3 sections entitled: neurological conditions, clinical interventions and interpretation of ancillary studies, and neurohospitalist role in the healthcare system. Each individual learning objective in the chapters describes a specific concept with an action verb to illustrate the behavior that the neurohospitalist exhibits. The individual neurohospitalist may not exhibit mastery in each of the topics included as individual practices vary in scope and practice pattern. A few examples of how the complete set of competencies may be used include in the creation of curricula for neurohospitalist fellowships, to assist in defining the scope of practice of neurohospitalists for administrative leaders of hospitals and departments, and in influencing the direction of further research and quality improvement in the field., (© The Author(s) 2024.)

The assessment of individual students is not only crucial in the school setting but also at the core of educational research. Although classical test theory focuses on maximizing insights from student responses, the Bayesian perspective incorporates the assessor's prior belief, thereby enriching assessment with knowledge gained from previous interactions with the student or with similar students. We propose and illustrate a formal Bayesian approach that not only allows to form a stronger belief about a student's competency but also offers a more accurate assessment than classical test theory. In addition, we propose a straightforward method for gauging prior beliefs using two specific items and point to the possibility to integrate additional information., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Aim: In the context of mortality, heart failure (HF) represents an intermediate factor and should not be used to describe underlying cause of death (UCoD). We explored the potential educational gradients in use of HF to describe UCoD using national data spanning more than 30 years from Norway., Methods: Using a cross-sectional design, we linked data from the Cause of Death Registry and the National Education Database. Logistic regression models were used to analyze the association between highest attained education and the odds of HF being listed as the UCoD: odds ratios (ORs) and corresponding 95% confidence intervals (CIs) are reported., Results: HF was listed as UCoD in 46,331 (3.7%) of 1,254,249 deaths analyzed. Compared to primary education, secondary and tertiary education were associated with 10% (OR = 0.90, 95% CI: 0.88-0.92) and 17% (OR = 0.83, 95% CI: 0.80-0.86) lower odds of HF incorrectly listed as UCoD, respectively. We observed no significant differences for the association between education and study outcomes between men and women and across place of death categories. However, educational gradients were greater among younger compared to older individuals ( p , = 0.002). Similar educational gradients were observed in the analyses restricted to cardiovascular deaths (OR = 0.93; 95% CI: 0.91-0.94 for secondary vs. primary education, and OR = 0.91; 95% CI: 0.88-0.95 for tertiary vs. primary education).interaction , = 0.002). Similar educational gradients were observed in the analyses restricted to cardiovascular deaths (OR = 0.93; 95% CI: 0.91-0.94 for secondary vs. primary education, and OR = 0.91; 95% CI: 0.88-0.95 for tertiary vs. primary education)., Conclusions: Education was inversely associated with the use of HF to incorrectly describe UCoD. Addressing the observed educational gradients, would improve the quality of mortality data and allow for less biased descriptions of cause-specific mortality., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Stroke is a major cause of morbidity and mortality worldwide. Despite advances in acute treatments, timely intervention remains crucial. This study assessed stroke knowledge in Malta to identify gaps that could contribute to treatment delays., Methods: A mixed methods approach was used, starting with qualitative interviews of stroke patients, relatives, and bystanders, followed by a quantitative survey among the general Maltese population and healthcare workers. The online survey included demographics, stroke knowledge, and stroke response questions. Data were analysed using descriptive and inferential statistics to identify knowledge gaps and influencing factors., Results: The study surveyed 1872 participants, representing the Maltese population. Significant knowledge gaps were found in stroke symptoms, risk factors, and appropriate responses. Younger participants, males, non-Maltese, urban residents, those with higher education, and higher-income individuals showed better stroke knowledge and response. Healthcare workers scored higher than the general public. A strong positive correlation was found between stroke knowledge and appropriate response actions., Conclusions: The study highlights the need for targeted educational interventions to improve stroke awareness and response, especially among older adults, women, rural residents, and lower-income groups. Recommendations include comprehensive public education campaigns, culturally tailored materials, and ongoing professional development for healthcare workers. Addressing these gaps could enhance stroke prevention and management, reducing stroke-related morbidity and mortality., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: As health information systems (HIS) become a critical part of patient care, it is crucial to build an effective education strategy that facilitates the adoption and sustained use of these systems. The COVID-19 pandemic (2019-2023) has contributed to the rapid shift in virtual education and training for healthcare staff., Objective: We sought to evaluate the efficacy and long-term sustainability of virtual training for using a HIS by examining opportunities and challenges., Method: An exploratory, multimethods study was conducted with staff who had taken part in a virtual HIS training program as part of the clinical transformation journey at a large academic health science center in Canada. The study was guided by the Accelerating the Learning Cycle framework. Data were collected through pre- and post-training surveys, as well as semi-structured interviews. An iterative, inductive, constant comparative analysis approach, outlined by Braun and Clarke, was taken to thematically analyse the data., Results: Of the 33 participants in this study, 13 were educational champions, and 20 were end-users. The pre- and post-training surveys yielded a total of 1479 responses in both groups. Three prominent themes emerged from this study: (1) fostering dynamic facilitation techniques to cultivate an inclusive culture and adapt to diverse learning needs; (2) integrating practical learning activities that contribute to knowledge retention; and (3) ensuring training resources are accessible and consistent for an optimal training experience., Conclusion: As HIS continue to be part of the transformation of the healthcare ecosystem, education is vital in preparing healthcare providers to perform their clinical tasks and effectively use these technologies. Findings from this study can be used to inform the development of virtual training that is inclusive and addresses the needs of care providers., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

This commentary explores the 'cost of poverty' for child development, with particular reference to the current UK context. Specifically, it comments on the adverse impacts of poverty on child mental health, education, and maltreatment., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Sharing pathology data is critical for educational and scientific purposes. Since most pharmaceutical or (agro)chemical companies outsource nonclinical safety assessment studies to contract research organizations (CROs), the pathology data of those studies are not owned by the investigator but is the legal property of the respective company sponsoring the work. Although some companies have installed policies that govern sharing of pathology data, many companies generally do not allow the external use of data by either the CRO-based study pathologist or the sponsor pathologist. Policies for governing the external use of data vary significantly. In this article, we present an overview of the different approaches taken across different companies (CROs, pharmaceutical/chemical companies, or other institutes) for sharing pathology material for educational and/or scientific purposes. The results of a survey and interviews with legal departments of different companies will be presented (anonymously) and discussed. In addition, the importance of sharing pathology data is addressed, as well as the challenges and opportunities this presents. Suggestions will be provided regarding what material should be made available and what will be needed to achieve agreement for this to happen., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: The study aimed to evaluate the effect of education given to immigrant mothers on breastfeeding success of mothers., Method: The randomized-controlled, single-blind study was conducted in a neonatal intensive care unit of a state hospital in Turkey. The Mother-infant information form, Nutrition monitoring form, and LATCH Assessment Tool were used to collect the study data., Results: In the study, the mean LATCH score of the mothers in the experimental group was higher than that of the control group ( P < .05). It was determined that the breastfeeding duration of the mothers in the experimental group was longer, and the number of infants fed exclusively by breastfeeding was higher in the last follow-up ( P < .05)., Discussion: It was found that breastfeeding education positively affected the breastfeeding success of immigrant mothers. This study reveals the positive effects of health education programs designed for immigrants on immigrant health., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Social inequality in life expectancy (LE) and various indicators of health expectancy have received much attention. Mental health expectancy (MHE) has received less attention, although research has shown an increasing prevalence of poor mental health. We aimed to investigate educational differentials in LE in relation to good, moderate, and poor mental health., Methods: Nationwide registry data on education and mortality were linked and combined with data from the Danish National Health Survey for 2017 and 2021 on mental health and education. The sample group consisted of data on Danes aged 30 and over. MHE was estimated by Sullivan's method., Results: From 2017 to 2021, a general decline in the MHE of Danes was observed. Furthermore, the educational inequality in MHE remained substantial between genders, and was larger than the inequality in LE. Changes in MHE differed across educational groups. For Danes with short education, good MHE tended to increase for men, while the increase was statistically significant among women., Conclusions: MHE is associated with educational attainment. Despite the observed changes in educational differential, substantial inequality persists, raising important questions about the underlying causes of social disparity in MHE., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

A fundamental principle of clinical reasoning is that assessment precedes plan; clinicians are taught to base interventions on the presumed etiology of a presentation. A notable exception is in the domain of communication education, where training is focused heavily on tools and interventions, with minimal focus on the assessment that informs which tools or strategies to select with a given patient. The concept of formulation (foundational in psychotherapy education) provides a framework with which to address this gap, enhancing a clinician's ability to be more therapeutically effective with the communication tools at their disposal. Our formulation serves as the compass that guides our decisions around communication, allowing us to conceptualize communication as a therapeutic intervention and align our approach to communication with the broader philosophy of clinical reasoning. This manuscript explores the concept of formulation, the direct relevance and applicability to palliative care, sample cases to underscore the impact of this framework, and high-yield tips for use of formulation in general palliative care practice. Palliative care clinicians and IDTs can readily apply formulation in synergy with the communication tools they already possess, elevating their ability to address patients' psychological needs., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Uterine fibroids, known as leiomyomas, are non-cancerous tumors in women. Uterine fibroids disproportionately affect African American women, as they are more common and severe. Uterine fibroids are the leading cause of hysterectomy in African American women. Over 80% of African American women will receive a uterine fibroids diagnosis before 50. Myomectomies (removal of uterine fibroids) and hysterectomies (removal of the uterus) are more prevalent in African American women due to more significant symptoms. Socioeconomic status, including education and income, influences access to healthcare, with some treatments directly affected by insurance coverage and the cost of the procedure. This review aimed to characterize the socioeconomic disparities and inequities regarding uterine fibroids awareness, perceptions, and treatment and to understand how socioeconomic status impacts knowledge and treatment of uterine fibroids. Recognition of the treatment barriers and decisions due to socioeconomic status is a critical step in ensuring equitable treatment options for women diagnosed with uterine fibroids. A narrative literature review was conducted using PubMed, MedLine, and Google Scholar. A total of 98 articles were returned. After adjusting for the exclusion criteria, 10 articles were included in this review. The review demonstrated the disparities in treatment options based on race and socioeconomic status. Low-income women were more likely to receive more invasive treatment, which resulted in more time off work and increased medical bills. In addition, women in lower-income brackets frequented the emergency department at an increased level. This review underscored the need for additional research to learn about the role of socioeconomic status in uterine fibroid awareness and treatment., (© The Author(s), 2024.)

Purpose. To determine if implementation of an enhanced clinical pharmacy service (ECPS) at a community hospital could improve patient experience as measured by medication-related Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.  Methods. A cohort study of 260 patients at a community hospital was conducted. Patients in the intervention group received additional pharmacy services from the standard of care (SOC) group, including daily medication counseling, pharmacist-driven medication administration, discharge medication reconciliation and education, consistent offers to enroll in a bedside medication delivery program (BMDP), and a telephone call following discharge. The primary outcome of patient experience was assessed through patients' responses to a care transitions HCAHPS survey question regarding understanding of the purpose of taking medications following discharge.  Results. Among patients in the ECPS cohort, 75.8% had a top-box response to the care transitions HCAHPS question, compared to 63.3% of patients in the SOC cohort (OR = 1.81; 95% CI [0.61-5.37]). Top-box responses increased for all assessed HCAHPS questions but were not statistically significant. The HCAHPS survey response rate was 29.3% in the SOC cohort and 29.9% in the ECPS cohort.  Conclusion. Following an ECPS intervention, patient experience as determined by HCAHPS scores increased, but the results did not reach statistical significance. Further, larger studies are needed on this topic., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Objective: Stigma surrounding mental health persists as a significant impediment to adequate support and help-seeking behaviors in Slovenia, despite advancements in psychiatric care and education. This study investigates stigma among first-year medical students at the University of Maribor, Slovenia and how the stigma changes after completing a course in mental health literacy., Participants: Participants were first-year medical students at the University of Maribor in the academic year 2023/2024. A total of 116 students participated in the baseline study, with 66 students participating in the follow-up study., Study Method: The intervention involved implementing the "Transitions" program, aimed at enhancing mental health literacy and reducing stigma. We conducted a baseline study and a follow-up study, then used Wilcoxon signed rank test for repeated measures to compare the differences in ranks before and after implementation of the program., Findings: There was a significant reduction in stigma after intervention (Wilcoxon Z = -3.06, P  < .01), suggesting a positive impact of the educational program. This reduction aligns with findings from similar programs globally, suggesting the efficacy of educational interventions in mitigating mental health stigma., Conclusions: The study emphasizes the importance of integrating mental health education into medical curricula to foster stigma reduction and enhance mental health literacy among future medical doctors., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Social media (SoMe) is now a core part of modern-day life with increased use among both patients and urologists. The interplay of SoMe between these two parties is complex. From a patient perspective, SoMe platforms can serve as educational tools as well as communication portals to support networks and patient communities. However, studies report the educational value of content online is often poor and may contain misinformation. For urologists, SoMe can lead to research collaborations, networking and educational content but areas of concern include the potential negative impact SoMe can have on mental health and sharing of patient images without appropriate consent. This review serves to provide an overview of the interaction between SoMe and urology practice and provide practical guidance to navigating it., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Medical photography has multiple, important roles. The education of medical practitioners, documentation of disease, response to treatment, research, publication, intraoperative recording and trauma documentation all rely on medical photography. Additionally, there are important medicolegal implications pertaining to medical photography across many medical disciplines. Other than specific image use to document cases, there remains a paucity of urological literature regarding the use of medical photography in Urology. The aims of this 6-month study were to document the use of medical photography by a Reconstructive Urological Service in a tertiary referral centre and to assess the range of urological conditions photographed. A secondary aim was to specifically document intraoperative use of the medical photography., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Aims: Studies of the association between self-rated health and persons' income and education have almost invariably shown that people with higher education and incomes report better health. Less is known of the influence of household members' socioeconomic characteristics on individuals' health. This study thus aimed to assess the extent to which the socioeconomic characteristics of partners may contribute to explaining the variation in the respondents' self-rated health (SRH)., Methods: Using an observational design, we analysed cross-sectional Norwegian survey data on SRH (2015 and 2019), linked to register data on education and income for respondents ( N = 7082) and their opposite-sex coresident spouse or partner. We employed logistic regression models to assess the associations between respondents' SRH and the relative income and education of their partner. Average marginal effects were calculated to enable cross-model comparisons., Results: Net of individual characteristics, having a higher-educated partner was positively associated with SRH for both male (OR = 1.56) and female (OR = 1.36) respondents. Having a partner with an above median income (by age and sex) was positively associated with SRH for female (OR = 1.29) respondents only. For education, the positive SRH associations were roughly similar for respondents and partners. For income, the associations were more pronounced for respondents than partners., Conclusions: Our findings suggest that health is affected by the resources (or lack thereof) in one's immediate networks. To reduce social inequalities in health, health personnel might customise interactions to account for household resources. Such knowledge could also be used in health-promoting activities to enhance participation and health competency ., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Aim: To explore how overcrowding affects children's health, environment and schooling., Methods: A qualitative study was conducted with individual interviews among 20 participants with occupational experience from overcrowded Stockholm areas but diverse in professions, locations and employers. The interviews were recorded, transcribed and analysed with Systematic Text Condensation., Results: Almost all participants expressed that overcrowding has a negative impact on children's health, environment and schooling - based on perceptions of precarious and different living conditions for children in overcrowded areas, for example, substandard homes, vulnerability, stress, exclusion, limited resources, lack of learning opportunities, gender differences, confinement, shame, insecurity, conflicts, risk of criminality, and bodily impact, both physical and psychological., Conclusions: Our qualitative evidence suggest that overcrowding has a negative impact on children's health, environment and schooling ., Competing Interests: Declaration of conflicting interestsThe authors have no conflicts of interest to declare.

Background: The Utrecht Symptom Diary-4 Dimensional (USD-4D), an adaptation of the Edmonton Symptom Assessment System, supports healthcare providers (HCPs) in identifying, monitoring, and exploring multidimensional symptoms and needs of patients in the palliative phase. For the USD-4D to be optimally implemented in clinical palliative care, it is essential to know and understand the needs of HCPs when using it., Objective: To identify and interpret the needs of HCPs when using the USD-4D in clinical palliative care, operationalized as perceived facilitators and barriers., Design: An explanatory mixed-methods study with a sequential design., Methods: Data were collected between October 2019 and September 2020. In phase I, quantitative data were collected through a survey targeting Dutch HCPs working in palliative care. Facilitators were identified as items answered positively by ⩾80% of participants, while barriers were identified as items answered negatively by ⩾20% of participants. In phase II, these identified facilitators and barriers were explored in depth through mixed composition focus groups. The Capability-Opportunity-Motivation-Behavior (COM-B) model was utilized to contextualize and interpret the perceived facilitators and barriers., Results: A total of 122 HCPs completed the survey, with 95% of the respondents being women with a mean age of 48 years and 72% being nurses. Additionally, 53% of the respondents had no prior experience with the USD-4D. In phase II, 21 HCPs participated in focus groups. 95% of the participants were women with a mean age of 49 years and 67% being nurses. HCPs pinpointed facilitators primarily related to the potential benefits of the USD-4D for daily patient care. Conversely, the identified barriers included issues related to HCPs' behavior, knowledge gaps, uncertainty regarding their abilities and attitudes toward the USD-4D, and technical obstacles., Conclusion: Facilitators and barriers across all facets of the COM-B model were recognized, with a notable emphasis on motivational barriers. It should be acknowledged that facilitators and barriers can evolve throughout the implementation process, underscoring the importance of viewing implementation and integration as fluid and continuous endeavors. Facilitators and barriers are closely linked to HCPs' reflective capacities, emphasizing the need for tailored intervention strategies that align with different stages of USD-4D implementation., Competing Interests: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors do hereby declare that there are no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s), 2024.)

Background: Ethics education is a basic part of midwifery education program. However, there is no evidence to show that ethics education has been able to meet the educational needs of midwifery students. Purpose: This study aimed to explore the educational needs of students for ethics in midwifery program with a focus on the course of history, ethics, and rules of midwifery. Research design and participants: The present study is qualitative descriptive content analysis research, exploring midwifery students' needs of ethics education in bachelor's degrees. We conducted in-depth semi-structured interviews with 11 undergraduate midwifery students, seven midwives working in hospitals and health centers, and seven midwifery faculty members in Urmia University of Medical Sciences. The participants were selected using a purposeful sampling method and invited to join the study from December 2021 to June 2022. The sampling continued until data saturation. Findings: Content analysis identified four categories and associated subcategories: 1. "The client's rights": respecting the dignity of clients, confidentiality, the client's right to choose and make decisions; 2. "Legal and ethical requirements of fertility": abortion, alternative treatment for infertility, domestic violence; 3. "Communication skills": communication with the client, communication with clients' caregivers and communication with colleagues; and 4. "ethical principles in research": compliance with ethical principles in the research process and ethical principles in publishing research findings. Ethical considerations: The study was approved by the Ethics Committee of Urmia University of Medical Sciences. Before filling the questionnaires, written informed consent was obtained from the participants. The participants were assured of the confidentiality of personal information. Conclusion: The educational needs of midwifery students can be met by providing theoretical and practical training on respecting the pregnant mother, communication skills, legal and ethical aspects of the reproductive period, and incorporating ethical principles in related courses., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The ethical challenges faced by undergraduate nursing students and nurses may lead to moral distress, negatively affecting learning capacity and self-confidence and potentially influencing the quality of patient care. Objective: To examine the state of knowledge regarding the moral distress among undergraduate nursing students during clinical practice. Methods: This scoping review followed JBI guidelines. First, the LILACS, Web of Science, Scopus, CINAHL, PubMed/MEDLINE, PsycINFO, Embase, and ProQuest databases were consulted. Next, the reference lists of the studies included in the sample were checked. Studies exploring moral distress among undergraduate nursing students during clinical practice were included regardless of language or date of publication. Two independent reviewers simultaneously selected the studies. Results: The sample included 12 articles with different research designs. Three conditions that trigger moral distress among undergraduate nursing students emerged: Interpersonal relationships between students and preceptors/supervisors and multidisciplinary teams; interpersonal relationships between students and patients; and the relationship between students and health services. Conclusions: This review identified the various circumstances that lead to moral distress among undergraduate nursing students. Therefore, these results highlight the importance of preventing moral distress in this group through teaching, especially before students begin their clinical practices., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: One of the authors is a member of the Editorial Board.

Objective: A comprehensive understanding of professional and technical terms is essential to achieving practical results in multidisciplinary projects dealing with health informatics and digital health. The medical informatics multilingual ontology (MIMO) initiative has been created through international cooperation. MIMO is continuously updated and comprises over 3700 concepts in 37 languages on the Health Terminology/Ontology Portal (HeTOP). Methods: We conducted case studies to assess the feasibility and impact of integrating MIMO into real-world healthcare projects. In HosmartAI, MIMO is used to index technological tools in a dedicated marketplace and improve partners' communication. Then, in SaNuRN, MIMO supports the development of a "Catalog and Index of Digital Health Teaching Resources" (CIDHR) backing digital health resources retrieval for health and allied health students. Results: In HosmartAI, MIMO facilitates the indexation of technological tools and smooths partners' interactions. In SaNuRN within CIDHR, MIMO ensures that students and practitioners access up-to-date, multilingual, and high-quality resources to enhance their learning endeavors. Conclusion: Integrating MIMO into training in smart hospital projects allows healthcare students and experts worldwide with different mother tongues and knowledge to tackle challenges facing the health informatics and digital health landscape to find innovative solutions improving initial and continuous education., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: The purpose of this article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Methods: Several board-certified nutrition support pharmacists aggregated a list of articles relevant to pharmacy nutrition support published in 2023. The list was compiled into a spreadsheet whereby the authors were asked to assess whether the article was considered important. A culled list of publications was then identified whereby at least 5 out of the 8 author participants considered the article to be important for pharmacists practicing in nutrition support. Guideline and consensus papers, important to practice but not ranked, were also included. Results: A total of 133 articles were identified; 9 from the primary literature were voted by the group to be of high importance. Fourteen guidelines, position, recommendation, or consensus papers were also identified. The top-ranked articles from the primary literature were summarized and a narrative regarding its implications to pharmacy nutrition support practice were provided. Conclusion: We recommend that pharmacists engaged in nutrition support therapy be familiar with these articles as it pertains to their practice., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Drs. Dickerson and Bingham have no conflicts of interest. Dr. Canada is on the speaker’s bureau and consultant for Fresenius Kabi. Dr. Chan is a consultant for Baxter healthcare. Dr. Cober is a consultant for BBraun/CAPS, Baxter, Fresenius-Kabi, and Wolters-Kluwer and speaker for Fresenius-Kabi. Dr. Tucker is a consultant for Up to Date, Inc. Dr. Kumpf is a consultant for Fresenius Kabi, Baxter, and VectivBio., (© The Author(s) 2024.)

Background: Joseph Pancoast (1805-1882), a prominent figure in 19th-century surgery and medical education, introduced several innovative surgical techniques during his career Purpose: While he made significant contributions to various areas of surgery, including plastic surgery and anatomy, his techniques were particularly notable for their precision and efficacy. Results: Some of his surgical innovations are the facial grafting especially in rhinoplasty either by using a forehead graft or by using a graft from the cheeks. He introduced his own operation for Staphyloplasty by dissecting two flaps of mucous membrane having a triangular shape and contributed also in taliacotian operation, blepharoplasty, otoplasty, cheiloplastic operation in case of lip cancer, amputations at the hip-joint, ocular deformities and tongue cancer restoration. In ocular surgery he had produced a fine needle turned into a hook in order to be inserted behind the cornea to cut deeply the soft parts of the lens and withdraw any hardened nucleus., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This review provides a thorough understanding of the developments in the field of interventional neuroradiology (INR). A concise overview of the pioneering past and current state of this field is presented first, followed by a greater emphasis on its future. Five main aspects predicted to undergo significant developments are identified and discussed. These include changes in 'education and training', 'clinical practice and logistics', 'devices and equipment', 'techniques and procedures', and 'relevant diagnostic imaging'. INR is at the crossroads of neuroradiology, neurosurgery, neurology, and the neurosciences. To progress we must value the uniqueness and vitality of this multidisciplinary aspect. While minimal access techniques offer very good anatomical accessibility to treat multiple pathologies of the central nervous system, it is also important to recognise its limitations. Medical, surgical, and radiosurgery modalities retain an important role in the management of some complex neuropathology. This review is certainly not exhaustive of all ongoing and predicted developments, but it is an important update for INR specialists and other interested professionals., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Abstract Background The COVID-19 pandemic has deeply impacted healthcare and education systems, including resident education. The impact of the pandemic on the different types of pedagogical activities, and the displacement of pedagogical activities to online modalities have not yet been quantified. We sought to evaluate the impact of the COVID-19 pandemic on formal pedagogic components of otorhinolaryngology–head and neck surgery (ORL–HNS) residency, the switch to distance learning and program director’s perceptions of the future of teaching and learning. Methods A nationwide online survey was conducted on Canadian ORL–HNS program directors. The use of standard didactic activities in-person and online, before and during the pandemic was rated with Likert scales. Perceptions of the pandemic were described with open-ended questions. Results A total of 11 of the 13 program directors contacted responded. The analysis were conducted using nonparametric statistics. There was a significant drop in overall didactic activities during the pandemic, regardless of the teaching format (3.5 ± 0.2 to 3.1 ± 0.3, p

Background: Disparities in advance care planning (ACP) among older Latinos necessitate targeted interventions to enhance engagement and knowledge in end-of-life care. This study aimed to evaluate the effectiveness of a resource-efficient, culturally tailored educational intervention in improving ACP readiness and knowledge among older Latino adults in the community., Methods: A quasi-experimental pretest-posttest design was used to assess the impact of the intervention. The study involved community-dwelling older Latinos (aged 61-94) in the U.S. attending community wellness centers. Measures included participants' knowledge of ACP, care options, familiarity with hospice and palliative care, and attitudes toward hospice, assessed using pre- and post-intervention surveys., Results: Statistically significant improvements were observed in ACP knowledge, understanding of care options, and attitudes towards hospice and palliative care post-intervention. Demographic factors influenced knowledge scores, with no significant gender differences in the intervention's efficacy., Conclusions: The educational intervention effectively enhanced end-of-life care planning readiness and knowledge among older Latinos. The study highlights the potential for sustainable, accessible, and culturally sensitive educational strategies to reduce disparities in ACP knowledge and possibly engagement., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Current palliative care training in medical school is inadequate in preparing doctors to provide quality palliative care. Little attention is paid to determining effective methods of training., Objective: To assess the use of bite-sized animations in improving the confidence, knowledge and attitudes of medical students towards palliative care., Methods: A mixed methods cohort study was adopted for the study. 50 medical students without prior palliative training completed questionnaires before and after watching a 12-part animated palliative care video series called PowerFacts. Of these participants, 18 underwent semi-structured interviews., Results: The quantitative results showed that animations are effective in improving the confidence ( P < .001) and knowledge ( P < .001), but not the attitudes ( P = .183) of medical students. Confidence, knowledge and attitudes were not correlated. Analysis of follow-up interviews of a convenience sample of participants showed that animations can be effective in teaching knowledge and does fill some gaps in palliative education for medical undergraduates. However, the content delivered as a sole learning tool is inadequate in preparing medical students for clinical practice., Conclusion: All participants achieved level 1 (reaction), some achieved level 2 (learning) but most did not achieve level 3 (behaviour) of the Kirkpatrick's model. There is a need for a multimodal approach in the comprehensive teaching of palliative care in undergraduate medical training to achieve all four levels of the Kirkpatrick Model., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Abstract Background Trainees in Otolaryngology–Head and Neck Surgery must gain proficiency in a variety of challenging temporal bone surgical techniques. Traditional teaching has relied on the use of cadavers; however, this method is resource-intensive and does not allow for repeated practice. Virtual reality surgical training is a growing field that is increasingly being adopted in Otolaryngology. CardinalSim is a virtual reality temporal bone surgical simulator that offers a high-quality, inexpensive adjunct to traditional teaching methods. The objective of this study was to establish the face and content validity of CardinalSim through a national study. Methods Otolaryngologists and resident trainees from across Canada were recruited to evaluate CardinalSim. Ethics approval and informed consent was obtained. A face and content validity questionnaire with questions categorized into 13 domains was distributed to participants following simulator use. Descriptive statistics were used to describe questionnaire results, and either Chi-square or Fishers exact tests were used to compare responses between junior residents, senior residents, and practising surgeons. Results Sixty-two participants from thirteen different Otolaryngology–Head and Neck Surgery programs were included in the study (32 practicing surgeons; 30 resident trainees). Face validity was achieved for 5 out of 7 domains, while content validity was achieved for 5 out of 6 domains. Significant differences between groups (p-value of

Background: Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease which leads to significant morbidity. Formal quantitative swollen and tender joint count and indices like disease activity score 28 (DAS28) and clinical disease activity index (CDAI) are very specific for measuring disease activity. Routine assessment of patient index data 3 (RAPID3) is a patient-reported outcome measure used for the assessment and follow-up of RA which can be completed in 10 s. We aimed to determine the effects of patient educational status and comorbidity on RAPID3 and its correlation with DAS28 and CDAI. Methods: A total of 246 RA patients (80.1% female; mean age: 53.2 years) followed up for 3 years were asked to fill out RAPID3 questionnaires, and DAS28 and CDAI were calculated. Patients were subdivided according to disease severity as Group A (remission-minimal disease activity) and Group B (moderate–severe disease activity). The duration of disease, medications, educational status, comorbidity, and medical history were recorded. Results: The mean duration of disease was 8.44 years. Of the patients, 27.2% were illiterate and the mean education time was 4.9 years. The 47.6% of the patients had a comorbid disease. The correlation of RAPID3 with DAS28 and CDAI scores was statistically significant (P < 0.001). Similarly, educational status and the presence of comorbidity did not affect this correlation (P < 0.001). The kappa analysis showing compliance of RAPID3 with DAS28 and CDAI scores was also significant (P < 0.001). Conclusion: RAPID3 is an index which shows a perfect correlation with DAS28/CDAI and can be used routinely for follow-up of RA patients and for decision-making for treatment. It can provide quantitative data with DAS28/CDAI in busy outpatient clinics not only in patients with different educational levels but also in patients with comorbid diseases.

Medical profession requires extensive knowledge and accuracy from the existing data for improved decision-making. Artificial intelligence (AI) is an appropriate technology used to improve the knowledge, skill, quality of treatment, capability, confidence, and effective decision-making process. It has the capability to revolutionize the healthcare industry. It can identify high-risk patients and their associated treatments and can help train doctors for the understanding of diseases and diagnostic treatment for better patient health. We discuss various advantages and limitations of AI in the context of healthcare sector. Various significant capabilities of AI for decision-making are identified and presented, and its significant capabilities for healthcare education are consolidated herewith. AI is helpful for appropriate planning, diagnosis, and associated activities, such as education, training, research, and development of healthcare. This technology provides some excellent capabilities to notice the changes and predict the disease of the patient. AI is now being applied for developing personal health history, and industry is contemplating a great potential for its implementation. However, cost and privacy issues are yet to be taken care of.

In Sri Lanka, intimate partner violence (IPV) remains a major concern, particularly for married women. Women's education and empowerment are significant contributors to IPV. Despite this, there have been no recent studies exploring the complex relationship between education and multidimensions of empowerment in relation to IPV in Sri Lanka. Therefore, this research addresses this gap by exploring the complex pathways connecting married women's education and multidimensional empowerment to IPV. Using data from the 2019 Sri Lankan Women's Wellbeing Survey, this study included 1,165 married women. A path analysis based on structural equation modeling (SEM) was used to examine the complex interplay between distinct empowerment domains and IPV. The SEM results revealed both direct and indirect effects of women's education and empowerment on IPV experiences. Education is positively linked to age at marriage, employment status, and husbands' educational level, while inversely associated with accepting attitudes toward violence. Age at marriage plays a major role as a mediator, mediating the relationship between women's education and their involvement in decision-making, and the relationship between husbands' education and women's IPV experience. Moreover, the relationship between women's age at marriage and their IPV experiences was fully mediated by their decision-making ability, highlighting the importance of empowerment in decision-making. These findings underscore the need for targeted interventions that address the interconnected factors affecting IPV risk among married women in Sri Lanka, particularly focusing on education, empowerment, and marriage timing., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interests with respect to the authorship and/or publication of this article.

The health of Canadians is already impacted by climate change due to wildfire smoke, heat domes, floods, droughts, and the changing distribution of vector borne disease. The healthcare sector contributes to climate change, accounting for approximately 4.6% of annual greenhouse gas emissions in Canada. Healthcare teams have a responsibility and opportunity to reduce harm by limiting emissions and waste, and engaging the public in understanding the planetary health links between clean air and water, a stable climate, a healthy planet and human health. Transformation of Canadian healthcare to a low carbon, climate resilient system will be enhanced by physician engagement and leadership. Cornerstones to physician participation include knowledge of the anthropogenic etiology of the climate crisis, the human health impacts, and the contribution providing healthcare makes to the climate crisis. Integration of climate change knowledge into the Canadian Radiology educational curricula is essential to position radiologists to lead transformative change in mitigation and adaptation of the healthcare system to the climate crisis. This statement is intended to provide guidelines to optimize education and research for current and future Canadian radiologists, and builds on existing planetary healthcare education publications and the Canadian Association of Radiologists Statement on Environmental Sustainability in Medical Imaging., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: MJB: Co-Chair CAR Environmental Sustainability Working Group; Co-Chair BC Cancer Planetary Health Unit; Member, AUR Sustainability Committee; Member, Canadian Association of Physicians for the Environment. KH: Co-Chair CAR Environmental Sustainability Working Group; Chair, ISMRM Environmental Sustainability Working Group; Deputy Lead Sustainability Joint Department of Medical Imaging.

Introduction: Blended learning is a teaching approach that integrates online self-learning and classroom teaching. It emphasizes students' self-directed learning, actively engaging, as well as communication and collaboration. Blended learning develops the qualities in nursing undergraduate students with problem-solving ability, clinical thinking, and communication skills as nurses have. Currently, learners' experience has become an important factor in determining the success of blended learning., Aim: To learn about the experiences and perceptions of undergraduate nursing students regarding blending learning in pediatric nursing., Methods: A mixed methods design beginning with a quantitative data collection and analysis phase to inform the subsequent qualitative phase was utilized. This study was conducted among undergraduate nursing students at one university in China. In the quantitative study phase, a convenience sample of 59 students completed the online survey while the qualitative study phase included nine students recruited by purposive sampling. The qualitative data were collected using individual semistructured in-depth interviews. Audio data were transcribed and subjected to thematic analysis. The findings from those two phases were integrated into the final analysis., Results: The majority (89.8%) of students reported satisfaction with blended learning. Among various teaching methods, case-based learning (CBL) was the most preferred (98.3%). Regarding the qualitative data, students reported positive experiences with blended learning including well-organized course structure, resourceful course content, and high teacher quality. They stated that blended learning improved the learning outcomes such as improving problem-solving ability and developing clinical thinking. They also provided suggestions for achieving better learning outcomes, including providing stressful learning activities, optimizing online course design, and improving the quality of group learning., Conclusions: The blended learning model of pediatric nursing based on the Community of Inquiry framework provides a positive learning experience for nursing undergraduate students. However, ongoing assessment and improvement of the blended learning process are also needed., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: For almost 60 years, Indian psychiatry literature has called for all medical students to learn psychiatry so that millions of mentally unwell people across India might receive appropriate treatment. Yet for almost 60 years, medical students have disengaged from psychiatry education, resulting in limited learning. The literature has repeatedly cited the solution as one that involves longer exposure on posting and more exam questions, with little impact. This research sought to understand why medical students disengage from psychiatry education so that meaningful change might occur., Methods: The research utilized constructivist grounded theory, initially in one medical college in Mumbai, followed by a quantitative survey to test the findings with a wider group of interns across 10 states of India. An iterative process of data gathering and analysis was undertaken using the constant comparison method and theoretical integration., Results: Findings identified that 98% of interns believe all MBBS (doctors) should "know" psychiatry, with "know" meaning practical skills-how to assess and treat people with mental illness. The majority of students attend psychiatry to learn those skills, but on finding faculty too overworked to teach, they disengage, saying : "there's nothing in it for me ." The findings indicate that more exam questions would not increase engagement., Conclusion: Medical students want to learn skills to help those in mental distress. Faculty do not have time and, arguably, the training to teach them. To address the nation's mental health needs, the government needs to prioritize teaching of psychiatry skills by releasing and enabling psychiatry faculty, alongside the certification of psychiatry skills., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2024 The Author(s).)

Background: The the current views of less-than full-time (LTFT) training by both LTFT and full-time (FT) doctors in training, with regards to health and well-being, clinical and non-clinical opportunities, in addition to associated future workforce implications and challenges, are uncertain., Methods: We performed a cross-sectional study of UK-based doctors in training via an online questionnaire, designed and piloted by the Royal College of Physicians Edinburgh (RCPE) Trainees and Members Committee. Design was informed by prior investigation into LTFT training undertaken amongst similar populations by RCPE in 2019. The survey was distributed from May to September 2023 via email to trainees across the United Kingdom and was open to all specialties and training grades. The survey focused on lived experience of both LTFT and FT training, as well as perceived challenges for the future workforce., Results: There were 648 responses from doctors in training across the United Kingdom, with an even spread of LTFT and FT trainees. Most responses (53%) were from trainees in medical specialties. Most LTFT trainees plan to train at this pace for more than 5 years. LTFT was commonly linked to improved work-life balance and well-being, with FT training perceived to feature high stress and burnout. Concerns around LTFT relate to administrative errors, reduced training opportunities and colleague prejudice. Trainees are concerned about LTFT leading to rota gaps and incoherent workforce planning around training numbers., Conclusion: With ever-increasing popularity in LTFT training, flexible and robust long-term workforce planning is necessary for the system to adapt to a new normal and improve retention of doctors in training., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Background: The rapid advancement of technology-focused strategies in neurorehabilitation has brought optimism to individuals with neurological disorders, caregivers, and physicians while reshaping medical practice and training., Objectives: We critically examine the implications of technology in neurorehabilitation, drawing on discussions from the 2021 and 2024 World Congress for NeuroRehabilitation. While acknowledging the value of technology, it highlights inherent limitations and ethical concerns, particularly regarding the potential overshadowing of humanistic approaches. The integration of technologies such as robotics, artificial intelligence, neuromodulation, and brain-computer interfaces enriches neurorehabilitation by offering interdisciplinary solutions. However, ethical considerations arise regarding the balance between compensation for deficits, accessibility of technologies, and their alignment with fundamental principles of care. Additionally, the pitfalls of relying solely on neuroimaging data are discussed, stressing the necessity for a more comprehensive understanding of individual variability and clinical skills in rehabilitation., Results: From a clinical perspective, the article advocates for realistic solutions that prioritize individual needs, quality of life, and social inclusion over technological allure. It underscores the importance of modesty and honesty in responding to expectations while emphasizing the uniqueness of each individual's experience. Moreover, it argues for the preservation of human-centric approaches alongside technological advancements, recognizing the invaluable role of clinical observation and human interaction in rehabilitation., Conclusion: Ultimately, the article calls for a balanced attitude that integrates both scientific and humanistic perspectives in neurorehabilitation. It highlights the symbiotic relationship between the sciences and humanities, advocating for philosophical questioning to guide the ethical implementation of new technologies and foster interdisciplinary dialogue., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Evidence suggests that involving General Practitioners in the care of patients with palliative care needs may improve patient outcomes., Aim: To evaluate whether a two-tiered intervention involving training in palliative care and a new consultation model in primary care for patients with palliative care needs is feasible and could reduce patients' symptom burden., Design: Before-after study including an internal pilot., Setting/participants: Nine general practitioners working in a health region in Portugal and 53 patients with palliative care needs from their patient lists were recruited. General Practitioners received training in palliative care and used a new primary palliative care consultation model, with medical consultations every 3 weeks for 12 weeks. The primary outcome was physical symptom burden, self-reported using the Integrated Palliative care Outcome Scale (IPOS) patient version (min.0-max.1000). Secondary outcomes included emotional symptoms (min.0-max.400) and communication/practical issues (min.0-max.300)., Results: Of the 35/53 patients completed the 12-week intervention (mean age 72.53 years, SD = 13.45; 54.7% female). All had advanced disease: one third had cancer ( n  = 13), one third had congestive heart failure ( n  = 12); others had chronic kidney disease and chronic obstructive pulmonary disease. After the 12 weeks of intervention, there was a reduction in physical symptom burden [mean difference from baseline of 71.42 (95%CI 37.01-105.85) with a medium-large effect size (0.71], and in emotional symptom burden [mean difference 42.86 (95%CI 16.14-69.58), with a medium effect size (0.55)]. No difference was found for communication/practical issues., Conclusions: Our intervention can be effective in reducing patients' physical and emotional symptoms., Trial Registration: ClinicalTrials.gov ID - NCT05244590. Registration: 14th February 2022., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.