Family practice
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Collectively, rare diseases are common, affecting approximately 8% of the population in Canada and the USA. Therefore, the majority of primary care (PC) clinicians will care for patients who are affected or at risk for a genetic disease. Considering the increasing ways in which genetics is being implemented into all areas of healthcare, one way to address these needs and expand the capacity of the PC workforce is through the integration of genetic counselors (GCs) into PC multidisciplinary teams. ⋯ Complex tasks related to genetics, such as pre- and post-test counseling, genetic test selection, and results interpretation, are conducted by GCs, which, in turn, allows physicians, nurse practitioners, and other PC providers to work at the top of their scope of practice. Quality genetics services provided by GCs improve clinical outcomes for patients and their families; the simultaneous provision of genetic education and psychological support by a GC is associated with an increase in patient knowledge, perceived personal control, decrease in distress, and can lead to positive health behavior changes, all of which are aligned with the goals of primary healthcare. With their extensive training in clinical care, medical communication, and psychotherapeutic counseling, integrating GCs into PC care teams will improve the care patients receive and allow PC clinicians to ensure their patients are at the forefront of the personalized medicine revolution.
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Meta Analysis
The benefits and harms of oral iron supplementation in non-anaemic pregnant women: a systematic review and meta-analysis.
Iron deficiency during pregnancy poses a significant risk to both maternal and foetal health. Current international guidelines provide discrepant advice on antenatal iron supplementation for non-anaemic women. ⋯ Prophylactic iron supplementation likely results in a large reduction in maternal anaemia during pregnancy. Future research should qualify the impact of this benefit on women's quality of life and determine which subpopulations benefit most. Evidence surrounding the harms of iron supplementation in the non-anaemic population is poor quality and inconsistent. Randomized controlled trials quantifying the risk of gastrointestinal (GI) disturbance and iron overload are essential to inform iron supplement use and reduce unwarranted variations in international guidelines.
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To understand the implementation of the family doctor contract service system in China from the perspective of resident demand. ⋯ The current state of implementation of China's family doctor contract service system is far from the goals set out in the "Guidance on Promoting High-Quality Development of Family Doctor Contract Services". Inadequate promotion of the system and subpar service quality post-contract have led to low public trust and satisfaction. The construction of family doctor teams and the contract service guarantee mechanism remain underdeveloped.
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The lack of an adequate primary care physician workforce has been a decades-long challenge facing the delivery of healthcare in the United States of America (USA). Previous research has highlighted how strengthening the nation's primary care infrastructure is a critical part of improving the nation's health. ⋯ But, little attention has been focused on how the primary care workforce may affect health disparities. This commentary highlights the importance of the provision of primary care services for populations that experience health disparities, ways that the primary care workforce shortage affects these populations, and potential solutions to expand the reach of the current workforce and to build a diverse workforce to meet the growing needs of the increasingly diverse US population.