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Abstract: Objective: To study doctor–patient interaction styles in consultations with patients presenting persistent medically unexplained symptoms (MUS) and to study on which stages of the consultation patients and doctors focus within the available time. Methods: exploratory, qualitative analysis of transcripts of 20 videotaped consultations between family physicians (FP) and persistent MUS patients. Results: Patients presented many symptoms in a rather unstructured way. However, FPs hardly used structuring techniques such as agenda setting and summarizing. Patients with persistent MUS got much opportunity to tell their story, but the reasons for encounter, their beliefs and concerns were not discussed in a structured manner. Although consultations were focused on these issues, mostly patients themselves initiated discussion of their ideas, concerns and expectations. FPs’ extensive explanations of the origin of the symptoms often did not take patients’ beliefs and concerns into account. Conclusions: Due to patients’ multiple symptom presentation and the absence of FPs’ structuring techniques, consultations of persistent MUS patients proceed rather unfocused. However, patients got ample opportunity to tell their story. Practice implications: Persistent MUS patients might benefit from structured consultations focused on the exploration of the reason for encounter. [Copyright &y& Elsevier]

The article examines the way family physicians address the diagnosis and management of depression in palliative care patients in the Netherlands. It notes their perception that the diagnosis and management of the condition in those patients is challenging. It mentions their reliance on their clinical judgment and strongly considered context and background factors of the patients. It also emphasizes their suggestions to improve the management of depression in palliative care patients.

Purpose: Depression is highly prevalent in advanced cancer patients, but the diagnosis of depressive disorder in patients with advanced cancer is difficult. Screening instruments could facilitate diagnosing depressive disorder in patients with advanced cancer. The aim of this study was to determine the validity of the Beck Depression Inventory (BDI-II) and a single screening question as screening tools for depressive disorder in advanced cancer patients. Methods: Patients with advanced metastatic disease, visiting the outpatient palliative care department, were asked to fill out a self-questionnaire containing the Beck Depression Inventory (BDI-II) and a single screening question 'Are you feeling depressed?' The mood section of the PRIME-MD was used as a gold standard. Results: Sixty-one patients with advanced metastatic disease were eligible to be included in the study. Complete data were obtained from 46 patients. The area under the curve of the receiver operating characteristics analysis of the BDI-II was 0.82. The optimal cut-off point of the BDI-II was 16 with a sensitivity of 90% and a specificity of 69%. The single screening question showed a sensitivity of 50% and a specificity of 94%. Conclusions: The BDI-II seems an adequate screening tool for a depressive disorder in advanced cancer patients. The sensitivity of a single screening question is poor. [ABSTRACT FROM AUTHOR]

Abstract: Depressive disorder is assumed to be highly prevalent in advanced cancer patients, but the diagnosis of depressive disorder in patients with advanced cancer is difficult. The more robust the assessment instrument to diagnose depressive disorder is, the lower the reported prevalence of depressive disorder in advanced cancer patients. This study confirms a low prevalence of depressive disorder (3%) in 64 advanced cancer outpatients using a robust structured clinical assessment (SCAN 2.1). Furthermore, in this article we discuss possible implications of using predefined psychiatric labeling in the assessment of mood symptoms in advanced cancer patients. [Copyright &y& Elsevier]

Objective: During the COVID-19 pandemic new collaborative-care initiatives were developed for treating and monitoring COVID-19 patients with oxygen at home. Aim was to provide a structured overview focused on differences and similarities of initiatives of acute home-based management in the Netherlands. Methods: Initiatives were eligible for evaluation if (i) COVID-19 patients received oxygen treatment at home; (ii) patients received structured remote monitoring; (iii) it was not an 'early hospital discharge' program; (iv) at least one patient was included. Protocols were screened, and additional information was obtained from involved physicians. Design choices were categorised into: eligible patient group, organization medical care, remote monitoring, nursing care, and devices used. Results: Nine initiatives were screened for eligibility; five were included. Three initiatives included low-risk patients and two were designed specifically for frail patients. Emergency department (ED) visit for an initial diagnostic work-up and evaluation was mandatory in three initiatives before starting home management. Medical responsibility was either assigned to the general practitioner or hospital specialist, most often pulmonologist or internist. Pulse-oximetry was used in all initiatives, with additional monitoring of heart rate and respiratory rate in three initiatives. Remote monitoring staff's qualification and authority varied, and organization and logistics were covered by persons with various backgrounds. All initiatives offered remote monitoring via an application, two also offered a paper diary option. Conclusions: We observed differences in the organization of interprofessional collaboration for acute home management of hypoxemic COVID-19 patients. All initiatives used pulse-oximetry and an app for remote monitoring. Our overview may be of help to healthcare providers and organizations to set up and implement similar acute home management initiatives for critical episodes of COVID-19 (or other acute disorders) that would otherwise require hospital care. [ABSTRACT FROM AUTHOR]

The article presents an overview of fungal nail infection. A discussion of the issues a physician should cover with patients who have fungal nail infection, of the treatments, including topical antifungal treatments and systemic antifungal drugs, that are available for fungal nail infection, and of methods patients can use to prevent further infections, is presented. The proper examinations which should be done on patients suspected of having fungal nail infection and the proper diagnosis of the infection is discussed.

Purpose To evaluate the added value of somatic screening for patients with severe mental illness over regular care. Design and Methods We compared the information on somatic health problems collected by screening with the general practitioner ( GP) files ( n = 118). Findings The mean number of somatic health problems detected with somatic health screening was significantly higher than those noted in GP records ( p < .01). Practice Implications Somatic health screening is an addition to the care provided by the GP. Advanced mental health nurses can play a key role in somatic health screening and initiating further cooperation and communication of GP and mental health care. [ABSTRACT FROM AUTHOR]

The author argues that financial incentives for primary care physicians to treat depression devised by the quality and outcomes framework (QOF) are not a substitute for professional judgment. Particular attention is paid to the results of research in this issue of the journal titled "Management of depression in UK general practice in relation to scores on depression severity questionnaires: analysis of medical record data." It is stressed that a physician's judgment is more valuable than guided care.

The article defines the characteristics of palliative care patient. It is mentioned that for clear descriptions of palliative care patients, design involves a systematic review of medical literature for randomized controlled trials (RCTs). It suggests that elements of the patients' health status and the care delivered to them should be included in the definition of a palliative care patient. It is concluded that published RCTs have no clear definitions of palliative care patients.

Abstract: Objectives: The doctor–patient relationship has been linked to patient satisfaction, treatment adherence, and treatment outcome. Many different instruments have been developed to assess this relationship. The large variety makes it difficult to compare results of different studies and choose an instrument for future research. This review aims to provide an overview of the existing instruments assessing the doctor–patient relationship. Study Design and Setting: We performed a systematic search in PubMed, PsychInfo, EMBASE, and Web of Science for questionnaires measuring the doctor–patient relationship. We appraised each instrument ascertaining the questionnaires focused on the doctor–patient relationship. We compared the content and psychometric characteristics of the instruments. Results: We found 19 instruments assessing the doctor–patient relationship. The instruments assess a variety of dimensions and use diverse conceptual models for the doctor–patient relationship. The instruments found also vary in terms to which they have been psychometrically tested. Conclusion: We have provided an overview of 19 instruments assessing the doctor–patient relationship. The selection of an instrument for future research should be based on the model or conceptual basis of the doctor–patient relationship that is most applicable to the study objectives and the health care field in which it will be applied. [Copyright &y& Elsevier]

Purpose: Internationally, family physicians (FP) are not routinely involved in young adult cancer (YAC) care. In this short report, we would like to make a compelling argument for primary care involvement.Methods: Comparative descriptions and literature review.Results: Cancer among YAs is rare and usually not the first thing that comes into the FP's mind. Youth is sometimes mistakenly regarded as a protective factor. Across the countries, almost all YACs are treated in tertiary health care facilities with specialists providing the majority of care. Health care services are covered by the universal health insurance in Denmark, The Netherlands, and Canada but not in the US. Once the YAC has completed acute treatment and follow-up care, they often return to the care of the FPs who may potentially be expected to deal with and take action upon any possible medical, mental health, and psychosocial issues the YA cancer patient may present with. The role of the FP in follow-up care seems to be very limited.Conclusions: YACs in the western world seem to have comparable medical and psychosocial problems. However, the nature of health insurance is such that it impacts differently on the care of this group of cancer patients. Primary care features such as patient-centered, integrated, and comprehensive care over extended periods of time bring the FP into the unique position to provide follow-up for YAC. However, this will require integrating patient's perspectives on their care, professional continuing medical education (CME) initiatives, and an enhanced cooperative effort between those delivering and coordinating cancer care. [ABSTRACT FROM AUTHOR]

Objective: To summarize current evidence on the effectiveness of different knowledge transfer and change interventions for improving primary and ambulatory anxiety care to provide guidance to professionals and policy-makers in mental health care. Method: We searched electronic medical and psychological databases, conducted correspondence with authors, and checked reference lists. Studies examining the effectiveness of knowledge transfer and interventions targeted at improvement of the recognition or management of anxiety in primary and ambulatory health care settings were included. Methodological details and outcomes were independently extracted and checked by 2 reviewers. Where appropriate, data concerning the impact of interventions on symptoms of anxiety were pooled using metaanalytical procedures. Results: We identified 24 studies that met our inclusion criteria. Seven professional-directed interventions and 17 organizational interventions (including patient-oriented interventions) were identified. The methodological quality of studies was variable. Professional-directed interventions only impact the process and outcome of care when embedded in some sort of organizational intervention. Metaanalysis (n = 8 studies) showed no effect of diverse organizational interventions on patients' anxiety symptoms (effect size, -0.08; 95% confidence interval, -0.31 to 0.15; P = 0.50). Collaborative care interventions proved to be the most effective organizational intervention strategies. Six studies reported economic results: 4 studies showed that intervention had a high probability of being cost-effective. Conclusions: Collaborative care seems to be very promising for improving primary and ambulatory care for anxiety. At the level of management and policy, the results of this review mandate the need to offer fair and reasonable reimbursement for collaborative care programs. [ABSTRACT FROM AUTHOR]