General Practitioner’s Knowledge about Bariatric Surgery Is Associated with Referral Practice to Bariatric Surgery Centers

(1) Background: Patients seeking treatment for obesity and related diseases often contact general practitioners (GPs) first. The aim of this study was to evaluate GPs’ knowledge about weight loss surgery (WLS) and potential stereotypes towards obese patients. (2) Methods: For this prospective cohort study, 204 GPs in the region of the bariatric surgery center at the University Hospital Aachen were included. The participants filled out a questionnaire comprising general treatment of obese patients, stigmatization towards obese patients (1–5 points) as well as knowledge regarding WLS (1–5 points). (3) Results: The mean age of the GPs was 54 years; 41% were female. Mean score for self-reported knowledge was 3.6 points out of 5. For stigma-related items, the mean score was 3.3 points out of 5. A total of 60% of the participants recognized bariatric surgery as being useful. Knowledge about bariatric surgery significantly correlated with the number of referrals to bariatric surgery centers (p < 0.001). No significant correlation was found between stigma and referral to surgery (p = 0.057). (4) Conclusions: The more GPs subjectively know about bariatric surgery, the more often they refer patients to bariatric surgery specialists—regardless of potentially present stereotypes. Therefore, GPs should be well informed about indications and opportunities of WLS.

Evaluating the Need for Integrated Pediatric Palliative Care Services in a Pediatric Oncology Setting: A Retrospective Audit

Objectives: Early integrated palliative care has shown to improve the quality of life in patients with cancer. During the past decade, pediatric palliative care has become an established area of medical expertise, however due to scant information available regarding the triggers for referral and referral practice very few children receive a formal palliative care consult. Materials and Methods: A retrospective audit of medical case records of pediatric oncology patients over a period of 1 year from September 30, 2019, to September 30, 2020, was conducted. Demographic details, diagnosis, staging, clinical parameters, reason for referral, and palliative care plan were captured in a predesigned pro forma. Results: Among 126 children with cancer, 27 (21.4%) patients were referred to palliative care. Majority 21 (77%) referrals were inpatient consults. Symptom management 17 (44.7%) was the most common trigger for referral followed by referrals for psychosocial support 12 (14.4%). Children with solid tumors 16 (59%) were more often referred than hematological malignancies. Among those needing end of life care, 8 (88.8%) out of 9 families preferred home than hospital. Conclusion: Low incidence of palliative care referral and presence of symptoms as a trigger for palliative care referral suggests gaps in the integrated approach. The study findings prompt a review of palliative care referral criteria and referral practice in a pediatric oncology setting.

Otitis externa: a roundtable discussion

Otitis externa is a common problem in both primary care and referral practice. A wide range of factors contribute to the successful management of disease. A logical approach and investigation are important and should always include an appreciation of underlying primary causes, predisposing and perpetuating factors, and secondary infection. Cytology is essential to help choose appropriate therapy and represents an opportunity to use the expertise of the nurses within the veterinary team. COVID-19 has forced many veterinary professionals to use remote consultation techniques to provide care for patients and it may be that some of the lessons we have learned during lockdown can be applied to our working practices to improve the level of veterinary care in the future. The selection of appropriate topical anti-microbial and anti-inflammatory drugs is, of course, important but without good levels of owner compliance even the best therapy is ineffective. This article presents the outcome of a workshop in which a group of experts discussed many of these topics.

Personalized Approach to the Management of Barrett’s Esophagus, Perspectives from Gastroenterology

Despite the rich literature and large number of guideline and consensus statements the management of patients with Barrett’s Esophagus (BE) remains controversial and demands careful thought when face-to-face with a patient. The approach to screening, individualized risk assessment and treatment depends on the scope of your practice, your access to technology, pathology and a multidisciplinary team. I am an interventional endoscopist with a specialized referral practice in foregut disease. In this article I discuss how I approach a patient with suspected or known Barrett’s Esophagus.

Isolation of dermatophytes from dogs and cats in the South of England between 1991 and 2017

BackgroundSince the epidemiology of canine and feline dermatophytosis might evolve in response to chronological, sociological and ecological factors, the authors studied the occurrence of dermatophyte pathogens over 27 years subsequent to the last major UK survey.MethodsDermatophyte culture submission records from dogs and cats to the Royal Veterinary College Diagnostic Laboratory in England between 1991 and 2017 were reviewed. Samples were routinely cultured aerobically at 26°C for up to four weeks on Sabouraud’s dextrose agar containing cycloheximide and chloramphenicol; dermatophytes were identified using conventional phenotypic methods.ResultsProportional isolation from cats (15.9 per cent of 1389) exceeded that of dogs (8.1 per cent of 2193) (P<0.001). Together, Microsporum canis and Trichophyton mentagrophytes accounted for 91.9 per cent (n=203) and 80.2 per cent (n=142) of isolations from cats and dogs, respectively. M canis was more frequently (P<0.001) isolated from cats and dogs under two years of age. Dermatophytes were more frequent (P≤0.001) in samples from first-opinion rather than referral practice, and from Jack Russell and Yorkshire terriers and from Persian and chinchilla cats (P≤0.002).ConclusionsM canis and T mentagrophytes remain the most common agents of canine and feline dermatophytosis in the South of England; continued clinical vigilance is required.

The Catalysing Effect of the Rome Statute in Africa: Positive Complementarity and Self-Referrals

The International Criminal Court’s (ICC) policy and practice of self-referrals has attracted some degree of academic criticism. This has been due partly because the procedure itself was, according to some opinions, never quite envisaged in the original Rome Statute, and partly because the concept of a State self-referral appears to contradict the Rome Statute objective of the ICC as a Court of complementarity. Following Gabon’s self-referral in 2016, and in view of the recent termination of the ICC Prosecutor’s Preliminary Examinations in Gabon, this paper argues that African States’ self-referral practice continues to represent a step backwards for African local justice and accountability. The fact that in this particular situation the necessary threshold was not met is actually not relevant for the argument put forward in this paper, namely that this practice should now be put under scrutiny rather than accepting, at face value, a self-referral whenever an (African) State proposes it. The strengthening of local accountability and the transformation of the local justice landscape should be considered as the ICC long-term objectives, and more dialogue (as well as political pressure) should be contemplated in order to gently coerce States to take on investigations and prosecutions of international crimes.