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Objective To identify and summarize the evidence about the extent of overuse of medications in low- and middle- income countries, its drivers, consequences and potential solutions. Methods We conducted a scoping review by searching the databases PubMed[R], Embase[R], APA PsycINFO[R] and Global Index Medicus using a combination of MeSH terms and free text words around overuse of medications and overtreatment. We included studies in any language published before 25 October 2021 that reported on the extent of overuse, its drivers, consequences and solutions. Findings We screened 3489 unique records and included 367 studies reporting on over 5.1 million prescriptions across 80 low- and middle-income countries--with studies from 58.6% (17/29) of all low-, 62.0% (31/50) of all lower-middle- and 60.0% (33/55) of all upper-middle-income countries. Of the included studies, 307 (83.7%) reported on the extent of overuse of medications, with estimates ranging from 7.3% to 98.2% (interquartile range: 30.2-64.5). Commonly overused classes included antimicrobials, psychotropic drugs, proton pump inhibitors and antihypertensive drugs. Drivers included limited knowledge of harms of overuse, polypharmacy, poor regulation and financial influences. Consequences were patient harm and cost. Only 11.4% (42/367) of studies evaluated solutions, which included regulatory reforms, educational, deprescribing and audit-feedback initiatives. Conclusion Growing evidence suggests overuse of medications is widespread within low- and middle-income countries, across multiple drug classes, with few data of solutions from randomized trials. Opportunities exist to build collaborations to rigorously develop and evaluate potential solutions to reduce overuse of medications. Objectif Identifier et resumer les donnees demontrant l'ampleur de la surconsommation de medicaments dans les pays a revenu faible et intermediaire, mais aussi les causes de cette surconsommation, ses consequences et les pistes de solution. Methodes Nous avons mene une analyse exploratoire en effectuant une recherche dans les bases de donnees PubMed[R], Embase[R], APA PsycINFO[R] et l'Index Medicus mondial a l'aide d'une combinaison de termes MeSH et de mots en texte libre lies a la surconsommation de medicaments et aux surtraitements. Nous avons inclus des etudes redigees dans toutes les langues et publiees avant le 25 octobre 2021, qui mentionnaient l'ampleur de la surconsommation, ses causes, ses consequences et les pistes de solution. Resultats Nous avons passe en revue 3489 documents uniques et conserve 367 etudes faisant etat de plus de 5,1 millions d'ordonnances dans 80 pays a revenu faible et intermediaire--ces etudes concernaient 58,6% (17/29) des pays a revenu faible, 62,0 % (31/50) de ceux a revenu intermediaire de la tranche inferieure et 60,0% (33/55) de ceux a revenu intermediaire de la tranche superieure. Sur l'ensemble des etudes reprises, 307 (83,7%) signalaient l'ampleur de la surconsommation de medicaments, avec des estimations comprises entre 7,3% et 98,2% (ecart interquartile: 30,2-64,5). Cette surconsommation s'observait principalement dans des categories telles que les antimicrobiens, les substances psychotropes, les inhibiteurs de la pompe a protons et les antihypertenseurs. Plusieurs causes etaient evoquees: meconnaissance des degats lies a une surconsommation, polypharmacie, mauvaise reglementation et influences economiques. Les consequences etaient surtout nefastes pour la sante des patients et les couts engendres. A peine 11,4% (42/367) des etudes examinaient des solutions, parmi lesquelles des reformes reglementaires, ainsi que des initiatives de sensibilisation, de deprescription et d'audit-feedback. Conclusion Un faisceau croissant de preuves indique que la surconsommation de medicaments est largement repandue dans les pays a revenu faible et intermediaire, dans de nombreuses categories de substances, et peu d'informations circulent quant aux solutions issues des essais randomises. Il existe neanmoins des opportunites de collaboration qui permettraient de developper et d'evaluer rigoureusement des pistes de solution pour lutter contre la surconsommation de medicaments. Objetivo Identificar y resumir la evidencia sobre el grado del uso excesivo de medicamentos en los paises de ingresos bajos y medios, sus causas, consecuencias y posibles soluciones. Metodos Se realizo una revision exploratoria mediante busquedas en las bases de datos PubMed[R], Embase[R], APA PsycINFO[R] y Global Index Medicus a partir de una combinacion de terminos MeSH y palabras de texto libre sobre el uso excesivo de medicamentos y el sobretratamiento. Se incluyeron estudios en cualquier idioma publicados antes del 25 de octubre de 2021 y que informaran sobre el grado del uso excesivo, sus causas, consecuencias y soluciones. Resultados Se examinaron 3489 registros unicos y se incluyeron 367 estudios que informaron sobre mas de 5,1 millones de recetas en 80 paises de ingresos bajos y medios, con estudios del 58,6 % (17/29) de todos los paises de ingresos bajos, el 62,0 % (31/50) de todos los paises de ingresos medios bajos y el 60,0 % (33/55) de los paises de ingresos medios altos. De los estudios incluidos, 307 (83,7 %) informaron sobre el grado de uso excesivo de medicamentos, con estimaciones que oscilaban entre el 7,3 % y el 98,2 % (rango intercuartil: 30,2-64,5). Las clases mas usadas en exceso incluian los antimicrobianos, los psicofarmacos, los inhibidores de la bomba de protones y los antihipertensores. Los factores causantes incluyeron el conocimiento limitado de los danos del uso excesivo, la polifarmacia, la falta de regulacion y las influencias financieras. Las consecuencias incluian el dano a los pacientes y el coste. Solo el 11,4 % (42/367) de los estudios evaluaron las soluciones, entre las que se encontraban las reformas normativas, las iniciativas de educacion, de desprescripcion y de retroalimentacion de auditorias. Conclusion Cada vez hay mas evidencias de que el uso excesivo de medicamentos esta muy extendido en los paises de ingresos bajos y medios, en multiples clases de medicamentos, y se dispone de datos insuficientes sobre soluciones procedentes de ensayos aleatorizados. Hay oportunidades de crear colaboraciones para desarrollar y evaluar con rigor posibles soluciones para reducir el uso excesivo de los medicamentos., Introduction Overuse in health care is broadly defined as tests or treatments that are inappropriate, unnecessary or of low value and are likely to cause people more harm than benefit. [...]

Background In a therapeutic partnership, physicians rely on patients to describe their health conditions, join in shared decision-making, and engage with supported self-management activities. In shared care, the patient, primary care, and specialist services partner together using agreed processes and outputs for the patient to be placed at the centre of their care. However, few empirical studies have explored physicians' trust in patients and its implications for shared care models. Aim To explore trust in patients amongst general practitioners (GPs), and the impacts of trust on GPs' willingness to engage in new models of care, such as colorectal cancer shared care. Methods GP participants were recruited through professional networks for semi-structured interviews. Transcripts were integrity checked, coded inductively, and themes developed iteratively. Results Twenty-five interviews were analysed. Some GPs view trust as a responsibility of the physician and have a high propensity for trusting patients. For other GPs, trust in patients is developed over successive consultations based on patient characteristics such as honesty, reliability, and proactivity in self-care. GPs were more willing to engage in colorectal cancer shared care with patients with whom they have a developed, trusting relationship. Conclusions Trust plays a significant role in the patient's access to shared care. The implementation of shared care should consider the relational dynamics between the patient and health care providers. [ABSTRACT FROM AUTHOR]

Background Research suggests that a high proportion of melanoma in situ (MIS) may be overdiagnosed, potentially contributing to overtreatment, patient harm and inflated costs for individuals and healthcare systems. However, Australia-wide estimates of the magnitude of melanoma overdiagnosis are potentially outdated and there has been no estimation of the cost to the healthcare system. Objectives To estimate the magnitude and cost of overdiagnosed MIS and thin invasive melanomas in Australia. Methods Using two different methods to calculate lifetime risk, we used routinely collected national-level data to estimate overdiagnosed MIS and thin invasive melanomas (stage IA) in Australia in 2017 and 2021, separately for men and women. We multiplied the number of overdiagnosed melanomas by the estimated annual cost of a MIS or thin invasive melanoma, to quantify the financial burden of melanoma overdiagnosis to the Australian healthcare system in the year following diagnosis. Results We estimated that 67–70% of MIS were overdiagnosed in 2017, rising to 71–76% in 2021, contributing to between 19 829 [95% confidence interval (CI) 19 553–20 105] and 20 811 (95% CI 20 528–21 094) cases of overdiagnosed MIS. In 2021, the estimated costs in Australia ranged between $17.7 million Australian dollars (AUD; 95% CI 17.4–17.9 million) and AUD$18.6 million (95% CI 18.3–18.8 million). We estimated that 22–29% of thin invasive melanomas were overdiagnosed in 2017, rising to 28–34% in 2021, contributing to between 2831 (95% CI 2726–2935) and 3168 (95% CI 3058–3279) overdiagnosed thin invasive melanomas. In 2021, the estimated costs from thin invasive melanoma overdiagnoses ranged between AUD$2.5 million (95% CI 2.4–2.6 million) and AUD$2.8 million (95% CI 2.7–2.9 million). Conclusions Melanoma overdiagnosis is a growing clinical and public health problem in Australia, producing significant economic costs in the year following overdiagnosis. Limiting melanoma overdiagnosis may prevent unnecessary healthcare resource use and improve financial sustainability within the Australian healthcare system. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the proportion of cancer diagnoses in Australia that might reasonably be attributed to overdiagnosis by comparing current and past lifetime risks of cancer.Design, Setting, and Participants: Routinely collected Australian Institute of Health and Welfare national data were analysed to estimate recent (2012) and historical (1982) lifetime risks (adjusted for competing risk of death and changes in risk factors) of diagnoses with five cancers: prostate, breast, renal, thyroid cancers, and melanoma.Main Outcome Measure: Difference in lifetime risks of cancer diagnosis between 1982 and 2012, interpreted as probable overdiagnosis.Results: For women, absolute lifetime risk increased by 3.4 percentage points for breast cancer (invasive cancers, 1.7 percentage points), 0.6 percentage point for renal cancer, 1.0 percentage point for thyroid cancer, and 5.1 percentage points for melanoma (invasive melanoma, 0.7 percentage point). An estimated 22% of breast cancers (invasive cancers, 13%), 58% of renal cancers, 73% of thyroid cancers, and 54% of melanomas (invasive melanoma, 15%) were overdiagnosed, or 18% of all cancer diagnoses (8% of invasive cancer diagnoses). For men, absolute lifetime risk increased by 8.2 percentage points for prostate cancer, 0.8 percentage point for renal cancer, 0.4 percentage point for thyroid cancer, and 8.0 percentage points for melanoma (invasive melanoma, 1.5 percentage points). An estimated 42% of prostate cancers, 42% of renal cancers, 73% of thyroid cancers, and 58% of melanomas (invasive melanomas, 22%) were overdiagnosed, or 24% of all cancer diagnoses (16% of invasive cancer diagnoses). Alternative assumptions slightly modified the estimates for overdiagnosis of breast cancer and melanoma.Conclusions: About 11 000 cancers in women and 18 000 in men may be overdiagnosed each year. Rates of overdiagnosis need to be reduced and health services should monitor emerging areas of overdiagnosis. [ABSTRACT FROM AUTHOR]

Objectives: To calculate lifetime risks of cancer diagnosis and cancer-specific death, adjusted for competing mortality, and to compare these estimates with the corresponding risks published by the Australian Institute of Health and Welfare (AIHW).Design, Setting: Analysis of publicly available annual AIHW data on age-specific cancer incidence and mortality - for breast cancer, colorectal cancer, prostate cancer, melanoma of the skin, and lung cancer - and all-cause mortality in Australia, 1982-2013.Outcome Measures: Lifetime risks of cancer diagnosis and mortality (to age 85), adjusted for competing mortality.Results: During 1982-2013, AIHW estimates were consistently higher than our competing mortality-adjusted estimates of lifetime risks of diagnosis and death for all five cancers. Differences between AIHW and adjusted estimates declined with time for breast cancer, prostate cancer, colorectal cancer, and lung cancer (for men only), but remained steady for lung cancer (women only) and melanoma of the skin. In 2013, the respective estimated lifetime risks of diagnosis (AIHW and adjusted) were 12.7% and 12.1% for breast cancer, 18.7% and 16.2% for prostate cancer, 9.0% and 7.0% (men) and 6.4% and 5.5% (women) for colorectal cancer, 7.5% and 6.0% (men) and 4.4% and 4.0% (women) for melanoma of the skin, and 7.6% and 5.8% (men) and 4.5% and 3.9% (women) for lung cancer.Conclusion: The method employed in Australia to calculate the lifetime risks of cancer diagnosis and mortality overestimates these risks, especially for men. [ABSTRACT FROM AUTHOR]

In humans, the spleen is the body's largest secondary lymphoid organ and flterer of blood. The trabeculated structure of the spleen, which is formed in its early embryonic development, provides its three-dimensional framework designed to remove senescent erythrocytes and eliminate blood-borne microorganisms and/or dubious antigens. At a later date this lobulated framework can develop into notches which usually manifest along its anterior (superior) border. This study addresses the clinical signifcance and developmental basis of both numerous notches and multiple accessory spleens observed in a male human cadaver. The nine notches were all observed on the anterior and inferior borders, whilst the accessory spleens numbered four, with two localized at the splenic hilum and the other two upon the splenorenal and splenocolic ligaments respectively. In the present study, we propose an aetiological origin for the anomalous multi-notches and accessory spleens, which will provide primary beneft for surgeons and radiologists because of clinical signifcance. [ABSTRACT FROM AUTHOR]

Competing Interests: Competing interests: None declared.

Competing Interests: Competing interests: YW's spouse works for BMJ China. JT is the clinical research editor of the BMJ.