International challenges without borders: a descriptive study of family physicians' educational needs in the field of diabetes

<p>Abstract</p> <p>Background</p> <p>The optimal care of persons with diabetes by general practitioners and family physicians (GP/FP) is complex and requires multiple competencies. This is a fairly unrecognized key challenge in the healthcare systems. In some cases, local and national Continuous Professional Development (CPD) initiatives target these challenges; however there have been few international initiatives, possibly because challenges emerging from different studies have not been linked across national boundaries. In this context, the authors have compiled data about gaps and/or barriers inherent to GP/FP care of persons with type 2 diabetes from Austria, Canada, Germany and the United Kingdom.</p> <p>Methods</p> <p>Secondary analyzes of pre-existing studies were conducted to identify challenges in the care of patients with type 2 diabetes as faced by GPs/FPs. Two sources of data were reviewed: unpublished research data from collaborating organizations and articles from a literature search (in English and German). Articles retrieved were scanned by the research team for relevance to the study objectives and to extract existing gaps and barriers. The identified challenges were then categorized along three major axes: (1) phase of the continuum of care {from screening to management}; (2) learning domain {knowledge, skills, attitudes, behavior, context}; and (3) by country/region. Compilation and categorization were performed by qualitative researchers and discrepancies were resolved through discussion until concordance was achieved.</p> <p>Results and discussion</p> <p>Thirteen challenges faced by GPs/FPs in the care for patients with type 2 diabetes were common in at least 3 of the 4 targeted countries/regions. These issues were found across the entire continuum of care and included: pathophysiology of diabetes, diagnostic criteria, treatment targets assessment, drugs' modes of action, decision-making in therapies, treatment guidelines, insulin therapy, adherence, management of complications, lifestyle changes, team integration, bureaucracy and third-party payers. The issues reported were not restricted to the physicians' knowledge, but also related to their skills, attitudes, behaviours and context.</p> <p>Conclusions</p> <p>This study revealed challenges faced by GPs/FPs when caring for patients with diabetes, which were similar across international and health system borders. Common issues might be addressed more efficiently through international educational designs, adapted to each country's healthcare system, helping develop and maintain physicians' competencies.</p

Las comisiones de la verdad en la batalla de la memoria: usos y efectos disputados de la verdad extrajudicial en Chile

Abstract: Objective/context: Based on the framework of the battle of memory, this article examines the dispute (2014-2018) regarding the state embargo of documentation and information from 2004 from Chile's National Commission on Political Prisoners and Torture and its resistance to a collective that can question the embargo, triggering a legislative discussion. Methodology: In this article, we apply a procedural and pragmatic focus to a body of qualitatively analyzed multi-referential data. We take an in-depth look at the performative approach developed by the literature on truth commissions, but shift the examination of the framework of transitional justice to the terrain of the battle of memory supported by societies when dealing with these violent pasts. Conclusions: our analysis shows that the trajectory of the battle for truth and for the construction of collective memory on the past is not incremental and is subject to setbacks. The silence regarding the documentation of the Valech Commission triggered the involvement of new actors in the battle of memory that is no longer solely configured by the State-victim dyad. Originality/value: This article examines the truth commissions (TC) from a not frequently studied perspective: the document and information archive produced by these commissions and their impact on the collaboration with justice and the uncovering of the truth. To observe the dispute over the secret of the document and information archive of the commission from the terrain of the battle of memory allows us to extend the temporal reference framework, examining the TC beyond the effects and uses contemplated by the mandating State, including other actors, and leading the commissions to talk to each other and to other management devices and artifacts of such atrocities.Resumo: Objetivo/contexto: este artigo analisa, a partir do campo da batalha da memória, a disputa (2014-2018) sobre o embargo estatal da documentação e informação da Comissão Nacional sobre Prisão Política e Tortura de 2004, no Chile, e a sua resistência por um coletivo que interpela o embargo, desatando uma discussão legislativa. Metodologia: neste artigo, aplica-se uma abordagem pragmática e processual em um corpus de dados multirreferenciais, analisados qualitativamente. Aprofunda-se a abordagem performativa desenvolvida pela literatura sobre as comissões da verdade, mas mudamos sua análise do âmbito da justiça transicional para o campo da batalha da memória que as sociedades mantêm ao enfrentar esses passados violentos. Conclusões: nossa análise mostra que a trajetória da batalha pela verdade e pela construção de uma memória coletiva sobre o passado não sofre aumento e retrocede. O silenciamento sobre a documentação da Comissão Valech desencadeou o envolvimento de novos atores na batalha da memória, que já não é mais configurada apenas pela díade estado-vítima. Originalidade: este artigo examina as comissões da verdade (CV) de um ângulo menos estudado: o acervo documental e informacional produzido por essas comissões e seu impacto na colaboração com a justiça e no esclarecimento da verdade. Observar a disputa pelo segredo do acervo documental e informacional da comissão a partir do terreno da batalha da memória possibilita ampliar o quadro temporal de referência, examinar as CV mais além dos efeitos e usos contemplados pelo Estado mandatário, incluir outros atores e colocar as comissões em diálogo entre si e com outros dispositivos e artefatos de gestão desse tipo de atrocidades.Resumen: Objetivo/contexto: El artículo analiza, a partir del marco de la batalla de la memoria, la disputa (2014-2018) sobre el embargo estatal de la documentación e información de la Comisión Nacional sobre Prisión Política y Tortura de 2004 de Chile y su resistencia por un colectivo que interpela el embargo, desatando una discusión legislativa. Metodología: En este artículo aplicamos enfoque procesual y pragmático a un corpus de datos multirreferencial, analizado cualitativamente. Profundizamos la aproximación performativa desarrollada por la literatura sobre las comisiones de verdad, pero desplazamos su examen del marco de la justicia transicional al terreno de la batalla de la memoria que sostienen las sociedades al enfrentar estos pasados violentos. Conclusiones: Nuestro análisis demuestra que la trayectoria de la batalla por la verdad y por la construcción de una memoria colectiva sobre el pasado no es incremental y sufre reveses. El silenciamiento sobre la documentación de la Valech I gatilló el involucramiento de nuevos actores en la batalla de la memoria, que ya no se configura únicamente por la díada Estado-víctima. Originalidad: Este artículo examina las comisiones de verdad (CV) desde un ángulo menos estudiado: el acervo documental e informacional producido por estas comisiones y su impacto en la colaboración con la justicia y el esclarecimiento de la verdad. Observar la disputa por el secreto del acervo documental e informacional de la comisión desde el terreno de la batalla de la memoria permite ampliar el marco temporal de referencia, examinar las CV más allá de los efectos y usos contemplados por el Estado mandante, incluir otros actores y poner a las comisiones en diálogo entre sí y con otros dispositivos y artefactos de gestión de este tipo de atrocidades

Erratum: Allogeneic non-adherent bone marrow cells facilitate hematopoietic recovery but do not lead to allogeneic engraftment

Erratum: Allogeneic non-adherent bone marrow cells facilitate hematopoietic recovery but do not lead to allogeneic engraftmen