Education can improve clinician confidence in information sharing and willingness to refer to stem cell clinical trials for cerebral palsy

To progress stem cell therapies for cerebral palsy, clinicians need to openly engage with patients about emerging evidence and be willing to refer to relevant clinical trials, if and when appropriate. To assess whether education can change clinicians’ confidence in information sharing and willingness to refer to relevant clinical trials, an online questionnaire was distributed at a scientific conference before and after a professional workshop on cell therapies for cerebral palsy. Of the 42 participants who completed the survey, 26 self-identified as clinicians. Of these, 81% had had patients ask about stem cells, yet in the pre-workshop questionnaire indicated they were not confident answering questions about cell therapies. Clinicians were most commonly asked about stem cell treatments provided by private clinics, stem cell research and current evidence. Post-workshop, knowledge and confidence regarding stem cells, as well as likelihood to refer to clinical trials using therapies with a strong evidence base (eg, umbilical cord blood/placental cells), significantly increased (p<0.001). This study highlights that by offering resources and education, clinician confidence and willingness to refer to cell therapy trials can improve; this may help drive the stem cell research landscape and support patient decision-making.

Self-identification, mode of diagnosis and treatment, and perceptions of relationships with medical providers of South African Xhosa-speaking traditional healers

There is widespread use of traditional medicine in treating common mental disorders in South Africa. We aimed to (i) explore the self-identification of traditional healers (THs; how they refer to themselves, e.g., as healer, spiritualist, sangoma, etc.); (ii) determine if different types of THs treat different conditions (physical/psychological) or use different modes of diagnosis and treatment; (iii) identify factors that influence the willingness of THs to refer patients to biomedical hospitals; and (iv) compare TH practices between two provinces. Participants included Xhosa-speaking THs (mean age = 54.10, SD = 13.57 years) from the Western ( n = 50) and Eastern ( n = 68) Cape provinces. Participants completed a questionnaire regarding self-identification, mode of diagnosis/treatment, relationship with biomedical hospitals, type of condition(s) treated, and a Patient Health Questionnaire. There were significant associations between the type of TH (as self-identified) and (i) mode of diagnosis, (ii) mode of treatment, and (iii) type of condition(s) treated. Spiritualists, male THs, and THs who had previously been hospitalised for a mental disorder were more likely to treat mental disorders. THs who had previously been hospitalised for mental disorders were more likely to report a willingness to refer patients to biomedical hospitals. Findings highlight the complex practices of Xhosa-speaking THs. Collaboration between THs and mental health care professionals could be facilitated by focusing on male THs, spiritualists, and THs who have previously been hospitalised for mental illness. Future research should provide clearer operational definitions of the type of TH included.

Primary care physicians’ knowledge, attitudes and concerns about bariatric surgery and the association with referral patterns: a Swedish survey study

Background Obesity prevalence is increasing globally. Bariatric surgery is an effective treatment for severe and complex obesity resulting in significant and sustained weight loss. In Sweden, most bariatric surgery patients are referred by primary care physicians. We aimed to explore barriers for physicians to refer patients with severe and complex obesity for bariatric surgery. Methods A questionnaire survey was in 2019 emailed to 1100 primary care physicians in the Skåne and Kronoberg regions in south Sweden. The survey focused on referral patterns, knowledge and attitudes towards bariatric surgery and concerns about postoperative complications. We created different statistical indices for referral patterns, knowledge, attitudes and concerns about bariatric surgery. To analyze the correlation between these indices, we did Spearman’s correlations and regression analyses. Results Of 1100 email respondents, we received 157 (14%) completed surveys. Among 157 physician respondents, 73% answered that they had good knowledge about the referral criteria for bariatric surgery, whereas 55 and 60% answered correctly to two items on criteria for bariatric surgery. A majority of respondents (84%) stated that their patients initiated referral to bariatric surgery. Half of the respondents had concerns about postoperative medical and surgical complications, but another half had a positive attitude to bariatric surgery as a treatment for obesity comorbidities. Almost half of the respondents (44%) answered that they needed to learn more about bariatric surgery. We found significant positive correlations between high knowledge and referral patterns (r = 0.292, p < 0.001) and positive attitudes (r = 0.235, p < 0.001) respectively. We found significant reverse correlations between concerns and referral patterns (r = − 0.355, p < 0.001) and between positive attitudes and concerns (r = − 0.294, p < 0.001). In logistic regression high levels of concerns explained low willingness to refer for bariatric surgery (Odds Ratio 0.2, 95% confidence interval 0.1–0.7). Conclusion According to this Swedish survey among primary care physicians, high levels of concerns about bariatric surgery among physicians seemed to be a barrier to refer patients with severe and complex obesity for bariatric surgery. Since high knowledge about obesity and bariatric surgery correlated negatively to concerns and positively to favorable attitudes to bariatric surgery, more knowledge about obesity and bariatric surgery is warranted.

Willingness of medical students to refer patients to a physician associate or a doctor based on clinical scenarios when time is a trade-off

Background: The Physician Associate (PA) role was introduced in Ireland in 2015 in an effort to bolster medical services. From the perspective of the patient and staff they have been well received. However, the attitude of medical students about PAs is not known.Objective: To investigate the willingness of medical students to refer patients to a PA or a doctor.Methods: A quantitative study was undertaken using an online survey with a sample of 1,909 undergraduate and graduate entry medical students. Based on three outpatient scenarios, they were asked, in their role as future intern (PGY1), to choose a referral to a PA or a doctor, with six time trade-off options offered. Year of study, country of residence and working or treatment experience with PAs and Nurse Practitioners were recorded. Descriptive statistics, and logistic regression models were used.Results: In 2019, in Dublin, 177 medical students took part in the survey. Those surveyed were international and domestic nationals. Overall the PA option was chosen where the patient’s wait time was shorter and the clinical condition was perceived more serious. The doctor option was selected more readily when the wait time difference was less significant. Respondents from countries with established PA roles may have had experience to choose PAs than naïve ones.Conclusion: This study confirms that medical students’ willingness to refer a patient is influenced by familiarity with the PA role and severity of the medical condition. In addition wait time is a primary motivator for selecting the PA over doctor option. These findings suggest a need to improve communication about the PA role among Irish medical students.

Hyperbaric oxygen therapy awareness within a doctor population

Hyperbaric medicine is a relatively young specialty that remains in the blind spot of most doctors’ awareness. This study endeavors to identify the level of awareness of the indications for hyperbaric oxygen (HBO2) therapy among a doctor population in a developed country and factors which may improve referral rates. An anonymized questionnaire was distributed to doctors licensed to practice in Malta. Questions included physician specialty, demographics and previous exposure to diving and/or hyperbaric medicine. Moreover, two scoring systems were used to score subjects on HBO2-related topics. Binomial logistic regression models and generalized linear models were used in the statistical analysis. A total of 152 full replies were obtained and analyzed. Respondents who had visited a hyperbaric unit (HBU) (p=0.002) or attended a lecture on HBO2 (p=0.006) scored better than their counterparts, indicating better awareness of HBO2 indications and local chamber location. A previous HBU visit (p=0.001), being a hospital-based doctor (p=0.027) and a history of scuba diving (p=0.03) were associated with willingness to refer patients for HBO2 in the future. Encouraging visits to an HBU has been shown to be associated with multiple factors, which are expected to result in improved referral rates. Targeted educational sessions to doctors and medical students are likely to be beneficial in improving correct referral of patients for HBO2. The findings from this study may prove useful in improving appropriate referral rates of patients who may benefit from this useful treatment modality.

Investigating the Effect of Gift-Giving on Patient's Behavior in the Pediatric Clinic of Dr. Sheikh Hospital of Mashhad

Objective The aim of this study was to investigate the effect of gift-giving on the patient's behavior. We hypothesized that it is possible to improve the relationship between a doctor and a patient by giving the visiting patient gifts as such gesture may boost her confidence in the doctor, help built personable relationship, and thereby facilitate examination. Materials and Methods For this study, we selected pediatric patients aged 3 to 12 years, who visited pediatric clinic of Dr. Sheikh Hospital of Mashhad. Patients were divided into two groups. One group received a gift (stickers) after examination and prescription. The criterion for evaluating patients' behavior was parental opinion, and the questionnaire was completed in two stages. The Chi-square test was used to compare the behavior of the patients, and data were analyzed by SPSS software. Results In total, 194 people participated that included 74 boys and 120 girls. There was a significant difference at the 99% level between the control and intervention groups in the variables of stress, the desire to go to the doctor, fear reduction between visits, regular use of the drug, cooperation with the doctor, the desire for re-referral, and insistence on referring to the same physician after receiving the gift. There was also a significant difference at the 95% level between two groups in terms of the expression of physical problems by kids. However, there was no significant difference in the level of stress before the receipt of the gift, the desire and willingness to refer to the doctor before receiving the gift, and the waiting time tolerance to enter the doctor's room. Conclusion We found that gifts motivate more appropriate behaviors in kids when referring to a doctor.

Why do lower courts refer in the absence of a legal obligation? Irish eagerness and Dutch disinclination

The majority of requests for a preliminary ruling from the EU Court of Justice comes from lower national courts. This is surprising because such courts are, contrary to the highest national courts, not obliged to refer on the basis of Article 267 TFEU. This article examines why Dutch and Irish lower courts have decided to refer or not in the absence of such a legal obligation. It does so on the basis of an analysis of court decisions complemented with 45 interviews with judges and legal secretaries. The article shows that there is a wide variety of reasons (not) to refer, including pragmatic and practical considerations. Politico-strategic reasons play a smaller role than one would expect on the basis of the literature to date. The most important factor affecting the courts’ willingness to refer is the way in which lower court judges see their role in relation to the highest court(s). This factor also explains the difference between Ireland and the Netherlands. While most Irish references are made by lower courts, around two thirds of the references in the Netherlands stem from the highest courts. Most Irish judges adopted a ‘better sooner than later’ logic, while the majority of Dutch judges emphasized that the highest courts have more time and expertise.

Predictors of Patient Satisfaction in Hand and Upper Extremity Clinics

Introduction Patient satisfaction is an important clinical marker for hand/upper extremity patients. Few studies have investigated the predictors of patient satisfaction in the clinic setting. Our objective was to analyze patient satisfaction surveys to explore factors that influence patient satisfaction. Materials and Methods We conducted a retrospective analysis assessing patient satisfaction in the hand/upper extremity clinics at our university medical center between 2012 and 2018. Patient satisfaction was assessed via Press Ganey Hospital Consumer Assessment of Healthcare Providers and Systems surveys. Patient demographics, satisfaction scores, and clinic experience questionnaire responses were evaluated. Statistical analysis was conducted to identify significant trends. Results Between 2012 and 2018, 102 surveys were completed. Scores ranged from 5 to 10 with an average provider rating of 9.56. We found six factors significantly influenced patient satisfaction: adequate time was spent with the provider, provider showed respect, patient was seen by provider within 15 minutes of appointment time, provider listened sufficiently, patient received understandable medical instructions, and understandable medical explanations (p < 0.05). Conclusion Achieving patient satisfaction is an important clinical marker in hand/upper extremity clinics. Patient satisfaction has defined predictors wherein various clinical factors can influence patient satisfaction and willingness to refer their provider to other patients.

General practitioner referral of older patients to Improving Access to Psychological Therapies (IAPT): an exploratory qualitative study

Aims and methodTo understand general practitioner (GP) reticence to refer older patients to a local Improving Access to Psychological Therapies (IAPT) service providing mostly cognitive–behavioural therapy (CBT)-based interventions. Semi-structured, hour-long interviews were conducted with eight GPs and then analysed by modified grounded theory and thematic analysis.ResultsGP views regarding the treatability of older adults with CBT influenced their willingness to refer to a CBT-based IAPT service. Perceptions of local IAPT assessment processes being distressing and onerous to older patients also motivated referral inaction. GPs expressed a preference to treat depressed older patients themselves (with medication and psychological approaches such as watchful waiting).Clinical implicationsAny strategy to increase referral rates of older adults to CBT-based IAPT services should address local GP concerns regarding assessment processes and the effectiveness of offered treatments.Declaration of interestNone.

Willingness of private general practitioners to refer suspected tuberculosis patients in Badung District

Background and purpose: The national tuberculosis (TB) prevalence study showed that between 2013 and 2014 there was significant proportion of pulmonary TB patients received treatment from private healthcare facilities. Data from Bali Province and Badung District Health Offices revealed that of all suspected TB patients only a few were referred by their private general practitioner. A reward system was created in 2012 by providing credit points to every referral made by the private general practitioner. This study aims to examine association between the reward system, national health insurance scheme and willingness to refer suspected TB patients.Methods: A cross-sectional study was conducted from February to April 2017. A total of 111 private general practitioners who practice at Badung District were interviewed. In addition, medical record from these private general practitioners were also examined.Results: Our study found that as many as 55 (45.95%) of private general practitioners had ever referred suspected TB patients over the last year. The total suspected TB patient being reffered in the last year was 132 cases. A cross checking with the laboratory data revealed that only 47 cases (35.61%) presented at referral laboratory facilities. Multivariate analysis showed that the willingness of private general practitioners to refer suspected TB patient was associated to reward system (AOR=4.62; 95%CI: 1.23-17.32) and supervision from TB officials (AOR=13.07; 95%CI: 3.78-45.13). The enrollment of private general practitioners as a primary healthcare facility under the national insurance scheme was not associated with the willingness to refer suspected TB patients.Conclusions: About half of the private general practitioners have ever referred a suspected TB patient. Supervision from TB officials and a reward system in terms of credit points were associated with the willingness to refer suspected TB patients. Ongoing supervision, providing credit points, and improving referral systems are required to improve case findings and referral of suspected TB patients by private general practitioners.