Family medicine in times of 'COVID-19': A generalists' voice.

The novel coronavirus epidemic is transforming the world in which we live. This pandemic will bring sweeping changes everywhere, not least in the field of primary care medicine. Like one of our colleagues said: ‘after this crisis, perhaps even our calendar needs to be redefined. From now on, “BC” might stand for “Before Coronavirus”’. This quote puts into perspective just how significant the current times are for our profession. In this editorial, we will discuss challenges and tasks the COVID-19 crisis presents for family medicine

¿Cuál es la actitud de los médicos hacia el actual modelo de atención primaria?

ObjetivoDeterminar cómo es la actitud de los médicos hacia el actual modelo de atención primaria de salud y estimar su relación con variables de tipo sociodemográfico y/o laboral.DiseñoEstudio multicéntrico, transversal.EmplazamientoCentros de salud del Área II de la Región de Murcia.ParticipantesTotalidad de médicos generales, de familia y pediatras de los centros de salud mencionados (54 en total).Mediciones principalesComo instrumento de evaluación se utiliza la «Escala de actitudes hacia los contenidos de atención primaria de salud», de Ballesteros et al. Esta escala proporciona una puntuación total, así como una puntuación específica para cada una de las 7 dimensiones que la componen.ResultadosEn general, la actitud de los médicos es favorable (4,1 puntos de media sobre 5). En la dimensión «Inclusión de los profesionales del segundo nivel en atención primaria» es donde hemos encontrado una actitud menos favorable, siendo los médicos de familia los que se muestran más de acuerdo. En cuanto a las demás variables asociadas, los profesionales que trabajan en centros periféricos y en situación de interinidad muestran una actitud más positiva hacia el actual modelo.ConclusionesEl conocimiento de las actitudes de los profesionales, así como de las variables relacionadas, puede servir de base para diseñar posibles estrategias de intervención dirigidas a la mejora de la calidad asistencial en atención primaria y para una evolución positiva de los profesionales que prestan sus servicios.ObjectivesTo determine the attitude of doctors towards the current model of primary care and to calculate its relationship with social and demographic and/or work variables.DesignMulti-centre cross-sectional study.SettingHealth centres in Area II of the Murcia region.ParticipantsAll general practitioners, family doctors and paediatricians in the health centres mentioned (54 in all).Main measurementsThe «Scale of attitudes towards the contents of primary health care» by Ballesteros et al. was used as the tool of evaluation. This scale provides both a total score and a specific score for each of its 7 dimensions.ResultsIn general, doctors´ attitudes were favourable (4.1 points average out of 5). We found a less favourable attitude in the dimension «Inclusion of second-level professionals in primary care», with family doctors most in agreement. The professionals working in centres on the periphery and those without tenure had a more positive attitude towards the current model, for the remaining variables.ConclusionsUnderstanding professionals´ attitudes and the variables related to them may serve as a basis for designing intervention strategies aimed at improving the quality of primary care and for the positive evolution of professionals working in PC

A systematic literature review and meta-analysis of community pharmacist-led interventions to optimise the use of antibiotics.

AIMS: The aim of this systematic review is to assess the effects of community pharmacist-led interventions to optimise the use of antibiotics and identify which interventions are most effective. METHODS: This review was conducted according to the PRISMA guidelines (PROSPERO: CRD42020188552). PubMed, EMBASE and the Cochrane Central Register of Controlled Trials were searched for (randomised) controlled trials. Included interventions were required to target antibiotic use, be set in the community pharmacy context, and be pharmacist-led. Primary outcomes were quality of antibiotic supply and adverse effects while secondary outcomes included patient-reported outcomes. Risk of bias was assessed using the 'Cochrane suggested risk of bias criteria' and narrative synthesis of primary outcomes conducted. RESULTS: Seventeen studies were included covering in total 3822 patients (mean age 45.6 years, 61.9% female). Most studies used educational interventions. Three studies reported on primary outcomes, 12 on secondary outcomes and two on both. Three studies reported improvements in quality of dispensing, interventions led to more intensive symptom assessment (up to 30% more advice given) and a reduction of over-the-counter supply up to 53%. Three studies led to higher consumer satisfaction, effects on adherence from nine studies were mixed (risk difference 0.04 [-0.02, 0.10]). All studies had unclear or high risks of bias across at least one domain, with large heterogeneity between studies. CONCLUSIONS: Our review suggests some positive results from pharmacist-led interventions, but the interventions do not seem sufficiently effective as currently implemented. This review should be interpreted as exploratory research, as more high-quality research is needed

TFAP2E Methylation and Expression Status Does Not Predict Response to 5-FU-based Chemotherapy in Colorectal Cancer

Purpose: A recent study reported that 5-fluorouracil (5-FU)- based chemotherapy is less effective in treating patients with advanced colorectal cancer demonstrating hypermethylation of the TFAP2E gene. The aim of our study was to confirm and validate these findings in large, uniformly treated, wellcharacterized patient cohorts. Experimental Design: Two cohorts of 783 patients with colorectal cancer: 532 from a population-based, multicenter cohort (EPICOLON I) and 251 patients from a clinic-based trial were used to study the effectiveness of TFAP2E methylation and expression as a predictor of response of colorectal cancer patients to 5-FU–based chemotherapy. DNA methylation status of the TFAP2E gene in patients with colorectal cancer was assessed by quantitative bisulfite pyrosequencing analysis. IHC analysis of the TFAP2E protein expression was also performed. Results: Correlation between TFAP2E methylation status and IHC staining was performed in 607 colorectal cancer samples. Among 357 hypermethylated tumors, only 141 (39.6%) exhibited loss of protein expression. Survival was not affected by TFAP2E hypermethylation in stage IV patients [HR, 1.21; 95% confidence interval (CI), 0.79–1.87; log-rank P¼ 0.6]. In stage II– III cases, disease-free survival was not influenced by TFAP2E hypermethylation status in 5-FU–treated (HR, 0.91; 95% CI, 0.52–1.59; log-rank P ¼ 0.9) as well as in nontreated patients (HR, 0.88; 95% CI, 0.5–1.54; log-rank P ¼ 0.7). Conclusions: TFAP2E hypermethylation does not correlate with loss of its protein expression. Our large, systematic, and comprehensive study indicates that TFAP2E methylation and expression may not play a major role in predicting response to 5- FU–based chemotherapy in patients with colorectal cancer