Development of a blended communication training program for managing medically unexplained symptoms in primary care using the intervention mapping approach

Background: General practice (GP) training in how to communicate with patients with medically unexplained symptoms (MUS) is limited. Objective: Development, implementation and evaluation of an evidence-based communication training program for GP residents focused on patients with MUS in primary care. Methods: We used the intervention mapping (IM) framework to systematically develop the MUS training program. We conducted a needs assessment to formulate change objectives and identified teaching methods for a MUS communication training program. Next, we developed, implemented and evaluated the training program with 46 residents by assessing their self-efficacy and by exploring their experiences with the training. Results: The resulting program is a blended training with an online course and two training days. After attending the training program, GP residents reported significantly higher self-efficacy for communication with patients with MUS at four weeks follow up compared to baseline. Furthermore, GP residents experienced the training program as useful and valued the combination of the online course and training days. Conclusion and practice implications: We developed an evidence-based communication training program for the management of patients with MUS in primary care. Future research should examine the effect of the training on GP residents' communication skills in MUS consultations in daily practice. (C) 2021 The Author(s). Published by Elsevier B.V

Simultaneous X-ray and radio observations of the transitional millisecond pulsar candidate CXOU J110926.4-650224: The discovery of a variable radio counterpart

We present the results of simultaneous observations of the transitional millisecond pulsar (tMSP) candidate CXOU J110926.4-650224 with the XMM-Newton satellite and the MeerKAT telescope. The source was found at an average X-ray luminosity of LX 7 × 1033 erg s-1 over the 0.3-10 keV band (assuming a distance of 4 kpc) and displayed a peculiar variability pattern in the X-ray emission, switching between high, low and flaring modes on timescales of tens of seconds. A radio counterpart was detected at a significance of 7.9σ with an average flux density of 33 μJy at 1.28 GHz. It showed variability over the course of hours and emitted a 10-min long flare just a few minutes after a brief sequence of multiple X-ray flares. No clear evidence for a significant correlated or anticorrelated variability pattern was found between the X-ray and radio emissions over timescales of tens of minutes and longer. CXOU J110926.4-650224 was undetected at higher radio frequencies in subsequent observations performed with the Australia Telescope Compact Array, when the source was still in the same X-ray sub-luminous state observed before, down to a flux density upper limit of 15 μJy at 7.25 GHz (at 3σ). We compare the radio emission properties of CXOU J110926.4-650224 with those observed in known and candidate tMSPs and discuss physical scenarios that may account for its persistent and flaring radio emissions

TRAPUM discovery of thirteen new pulsars in NGC 1851 using MeerKAT

We report the discovery of 13 new pulsars in the globular cluster NGC 1851 by the TRAPUM Large Survey Project using the MeerKAT radio telescope. The discoveries consist of six isolated millisecond pulsars (MSPs) and seven binary pulsars, of which six are MSPs and one is mildly recycled. For all the pulsars, we present the basic kinematic, astrometric, and orbital parameters, where applicable, as well as their polarimetric properties, when these are measurable. Two of the binary MSPs (PSR J0514-4002D and PSR J0514-4002E) are in wide and extremely eccentric (e > 0.7) orbits with a heavy white dwarf and a neutron star as their companion, respectively. With these discoveries, NGC 1851 is now tied with M28 as the cluster with the third largest number of known pulsars (14). Its pulsar population shows remarkable similarities with that of M28, Terzan 5 and other clusters with comparable structural parameters. The newly-found pulsars are all located in the innermost regions of NGC 1851 and will likely enable, among other things, detailed studies of the cluster structure and dynamics

Revival of the magnetar PSR J1622-4950: observations with MeerKAT, Parkes, XMM-Newton, Swift, Chandra, and NuSTAR

New radio (MeerKAT and Parkes) and X-ray (XMM-Newton, Swift, Chandra, and NuSTAR) observations of PSR J1622-4950 indicate that the magnetar, in a quiescent state since at least early 2015, reactivated between 2017 March 19 and April 5. The radio flux density, while variable, is approximately 100x larger than during its dormant state. The X-ray flux one month after reactivation was at least 800x larger than during quiescence, and has been decaying exponentially on a 111+/-19 day timescale. This high-flux state, together with a radio-derived rotational ephemeris, enabled for the first time the detection of X-ray pulsations for this magnetar. At 5%, the 0.3-6 keV pulsed fraction is comparable to the smallest observed for magnetars. The overall pulsar geometry inferred from polarized radio emission appears to be broadly consistent with that determined 6-8 years earlier. However, rotating vector model fits suggest that we are now seeing radio emission from a different location in the magnetosphere than previously. This indicates a novel way in which radio emission from magnetars can differ from that of ordinary pulsars. The torque on the neutron star is varying rapidly and unsteadily, as is common for magnetars following outburst, having changed by a factor of 7 within six months of reactivation.Comment: Published in ApJ (2018 April 5); 13 pages, 4 figure

The MeerKAT telescope as a pulsar facility: System verification and early science results from MeerTime

We describe system verification tests and early science results from the pulsar processor (PTUSE) developed for the newly commissioned 64-dish SARAO MeerKAT radio telescope in South Africa. MeerKAT is a high-gain ( ) low-system temperature ( ) radio array that currently operates at 580–1 670 MHz and can produce tied-array beams suitable for pulsar observations. This paper presents results from the MeerTime Large Survey Project and commissioning tests with PTUSE. Highlights include observations of the double pulsar , pulse profiles from 34 millisecond pulsars (MSPs) from a single 2.5-h observation of the Globular cluster Terzan 5, the rotation measure of Ter5O, a 420-sigma giant pulse from the Large Magellanic Cloud pulsar PSR , and nulling identified in the slow pulsar PSR J0633–2015. One of the key design specifications for MeerKAT was absolute timing errors of less than 5 ns using their novel precise time system. Our timing of two bright MSPs confirm that MeerKAT delivers exceptional timing. PSR exhibits a jitter limit of whilst timing of PSR over almost 11 months yields an rms residual of 66 ns with only 4 min integrations. Our results confirm that the MeerKAT is an exceptional pulsar telescope. The array can be split into four separate sub-arrays to time over 1 000 pulsars per day and the future deployment of S-band (1 750–3 500 MHz) receivers will further enhance its capabilities

Hoe en wanneer herkennen huisartsen SOLK?

Huisartsen interpreteren symptomen al vroeg in het consult als somatisch onvoldoende verklaarde lichamelijke klachten (SOLK). Signalen die op SOLK kunnen wijzen zijn de manier waarop de patiënt de symptomen presenteert, symptomen die niet in een specifiek patroon passen en symptoomattributie door de patiënt zelf. De snelheid waarmee huisartsen symptomen als SOLK duiden suggereert dat de niet-analytische redeneerwijze een centrale rol speelt in het denkproces

Hoe en wanneer herkennen huisartsen SOLK?

Huisartsen interpreteren symptomen al vroeg in het consult als somatisch onvoldoende verklaarde lichamelijke klachten (SOLK). Signalen die op SOLK kunnen wijzen zijn de manier waarop de patiënt de symptomen presenteert, symptomen die niet in een specifiek patroon passen en symptoomattributie door de patiënt zelf. De snelheid waarmee huisartsen symptomen als SOLK duiden suggereert dat de niet-analytische redeneerwijze een centrale rol speelt in het denkproces

Which difficulties do GPs experience in consultations with patients with unexplained symptoms: a qualitative study

Background Many general practitioners (GPs) struggle with the communication with patients with medically unexplained symptoms (MUS). This study aims to identify GPs’ difficulties in communication during MUS consultations. Methods We video-recorded consultations and asked GPs immediately after the consultation whether MUS were presented. GPs and patients were then asked to reflect separately on the consultation in a semi-structured interview while watching the consultation. We selected the comments where GPs experienced difficulties or indicated they should have done something else and analysed these qualitatively according to the principles of constant comparative analysis. Next, we selected those video-recorded transcripts in which the patient also experienced difficulties; we analysed these to identify problems in the physician-patient communication. Results Twenty GPs participated, of whom two did not identify any MUS consultations. Eighteen GPs commented on 39 MUS consultations. In 11 consultations, GPs did not experience any difficulties. In the remaining 28 consultations, GPs provided 84 comments on 60 fragments where they experienced difficulties. We identified three issues for improvement in the GPs’ communication: psychosocial exploration, structure of the consultation (more attention to summaries, shared agenda setting) and person-centredness (more attention to the reason for the appointment, the patient’s story, the quality of the contact and sharing decisions). Analysis of the patients’ views on the fragments where the GP experienced difficulties showed that in the majority of these fragments (n = 42) the patients’ comments were positive. The video-recorded transcripts (n = 9) where the patient experienced problems too were characterised by the absence of a dialogue (the GP being engaged in exploring his/her own concepts, asking closed questions and interrupting the patient). Conclusion GPs were aware of the importance of good communication. According to them, they could improve their communication further by paying more attention to psychosocial exploration, the structure of the consultation and communicating in a more person-centred way. The transcripts where the patient experienced problems too, were characterised by an absence of dialogue (focussing on his/her own concept, asking closed questions and frequently interrupting the patient)