Marc Jamoulle

Beyond diagnosis: rising to the multimorbidity challenge

Urgently needs radical shifts in research, evidence based guidance, and healthcare

Primary Care Physicians’ Action Plans for Responding to Results of Screening Tests Based on the Concept of Quaternary Prevention

Since noncommunicable diseases (NCDs) are generally controllable rather than curable, more emphasis is placed on prevention than on treatment. For the early detection of diseases, primary care physicians (PCPs), as well as general practitioners and family physicians, should interpret screening results accurately and provide screenees with appropriate information about prevention and treatment, including potential harms. The concept of quaternary prevention (QP), which was introduced by Jamoulle and Roland in 1995, has been applied to screening results. This article summarizes situations that PCPs encounter during screening tests according to the concept of QP, and suggests measures to face such situations. It is suggested that screening tests be customized to fit individual characteristics instead of being performed based on general guidelines. Since screening tests should not be carried out in some circumstances, further studies based on the concept of prevention levels proposed by Jamoulle and Roland are required for the development of strategies to prevent NCDs, including cancers. Thus, applying the concept of QP helps PCPs gain better insights into screening tests aimed at preventing NCDs and also helps improve the doctor-patient relationship by helping screenees understand medical uncertainties.

Prevenção Quaternária e limites em medicina

The concept of Quaternary Prevention, a questioning upon the basis of medical action, was born from the articulation of the doctor-patient relationship. It refers to all medical activities being an important tool for family medicine. It is an ethical question about the excesses of too much and too little medicine which provides some answers.

Mapping French terms in a Belgian guideline on heart failure to international classifications and nomenclatures: the devil is in the detail

INTRODUCTION With growing sophistication of eHealth platforms, medical information is increasingly shared across patients, health care providers, institutions and across borders. This implies more stringent demands on the quality of data entry at the point-of-care. Non-native English-speaking general practitioners (GPs) experience difficulties in interacting with international classification systems and nomenclatures to facilitate the secondary use of their data and to ensure semantic interoperability. AIM To identify words and phrases pertaining to the heart failure domain and to explore the difficulties in mapping to corresponding concepts in ICPC-2, ICD-10, SNOMED-CT and UMLS. METHODS The medical concepts in a Belgian guideline for GPs in its French version were extracted manually and coded first in ICPC-2, then ICD-10 by a physician, an expert in classification systems. In addition, mappings were sought with SNOMED-CT and UMLS concepts, using the UMLS SNOMED-CT browser. RESULTS We identified 143 words and phrases, of which 128 referred to a single concept (1-to-1 mapping), while 15 referred to two or more concepts (1-to-n mapping to ICPC rubrics or to the other nomenclatures). In the guideline, words or phrases were often too general for specific mapping to a code or term. Marked discrepancy between semantic tags and types was found. CONCLUSION This article shows the variability of the various international classifications and nomenclatures, the need for structured guidelines with more attention to precise wording and the need for classification expertise embedded in sophisticated terminological resources. End users need support to perform their clinical work in their own language, while still assuring standardised and semantic interoperable medical registration. Collaboration between computational linguists, knowledge engineers, health informaticians and domain experts is needed.

Equity in healthcare: status, barriers, and challenges

(1) Waris Qidwai Department of Family medicine, Aga Khan University E-mail: waris.qidwai@aku.edu (2) Tabinda Ashfaq Department of Family Medicine Aga Khan University E-mail: tabinda.ashfaq@aku.edu (3) Tawfik A M Khoja Director General, Executive Board, Health Ministers’ Council for Cooperation Council States Email: sgh@sgh.org.sa (4) Ketki Merchant Consultant, Mumbai, India E-mail: ketkimerchant@hotmail.com

Development, dissemination, and applications of a new terminological resource the Q-Code taxonomy for professional aspects of General Practice / Family Medicine.

Abstract Background: While documentation of clinical aspects of General Practice/Family Medicine (GP/FM) is assured by the International Classification of Primary Care (ICPC), there is no taxonomy for the professional aspects (context and management) of GP/FM. Objectives: To present the development, dissemination, applications, and resulting face validity of the Q-Codes taxonomy specifically designed to describe contextual features of GP/FM, proposed as an extension to the ICPC. Development: The Q-Codes taxonomy was developed from Lamberts’ seminal idea for indexing contextual content (1987) by a multi-disciplinary team of knowledge engineers, linguists and general practitioners, through a qualitative and iterative analysis of 1702 abstracts from six GP/FM conferences using Atlas.ti software. A total of 182 concepts, called Q-Codes, representing professional aspects of GP/FM were identified and organized in a taxonomy. Dissemination: The taxonomy is published as an online terminological resource, using semantic web techniques and web ontology language (OWL) (http://www.hetop.eu/Q). Each Q-Code is identified with a unique resource identifier (URI), and provided with preferred terms, and scope notes in ten languages (Portuguese, Spanish, English, French, Dutch, Korean, Vietnamese, Turkish, Georgian, German) and search filters for MEDLINE and web searches. Applications: This taxonomy has already been used to support queries in bibliographic databases (e.g., MEDLINE), to facilitate indexing of grey literature in GP/FM as congress abstracts, master theses, websites and as an educational tool in vocational teaching, Conclusions: The rapidly growing list of practical applications provides face-validity for the usefulness of this freely available new terminological resource.

A Comment on “Quaternary Prevention in Public Health” by Dr. Jong-Myon Bae

CONFLICT OF INTEREST The author has no conflicts of interest with associated the material presented in this paper.

New 2016 MeSH Addressing Information Gap, Poverty, Violence and Danger of Medicine Set the Tone for Policy-Makers in Patient Care

In their interesting article on Collaboration and Co-Production of Knowledge in Healthcare, Rycroft-Malone and colleagues make the following point: “there are some general transferable qualities that might be embodied in researchers, such as being: able to wear more than one hat (being generalists), comfortable in the field, tolerant of messiness, a good communicator with different audiences, able to go with the flow and be adaptable whilst maintaining the standards of research rigor, able to manage conflict, be tenacious and creative (to name a few).”