Unemployment is associated with a diminished mental health. Interventions to improve mental health for the unemployed exist. However, there is no clear overview with respect to the content and effectiveness of these interventions. A systematic search was conducted and, included studies that targeted unemployed adults, described an intervention and reported mental health as an outcome measure. After screening, 24 studies remained, which contained 21 different interventions. These interventions could be classified into three categories: occupational skills training interventions, psychological interventions and combined interventions. The majority of the studies reported significant short-term effects on mental health, but in most cases evidence of sustained effects was lacking or not assessed. There is promising evidence that interventions combining occupational skills and resilience training are effective in promoting mental health. However, there is a need for high-quality research on the intervention effects on the mental health of the (long-term) unemployed.

We aimed to gain insight into the barriers and facilitators to fall risk screening of older adults visiting the hospital as experienced by patients and healthcare professionals, and to examine the differences between chronic- and acute-care patients. We invited patients (≥ 70 years) attending the nephrology and emergency department to participate in the screening. Patients and their healthcare professionals were asked to complete a self-administered questionnaire based on the “Barriers and Facilitators Assessment Instrument”. Differences in barriers and facilitators between acute- and chronic-care patients were examined with chi-square tests. A total of 216 patients were screened, and 103 completed the questionnaire. They considered many factors as facilitators, and none as barriers. Acute-care patients were more positive than chronic-care patients about healthcare worker characteristics, such as knowledge and skills. After screening, patients were more open to receiving advice regarding fall prevention. The 36 healthcare professionals considered program characteristics to be facilitators and mainly factors regarding healthcare worker characteristics as barriers to implementation. For patients, the outpatient setting seemed to be a good place to be screened for fall risk. Healthcare professionals also suggested that program characteristics could enhance implementation. However, healthcare professionals’ mindsets and the changing of routines are barriers that have to be addressed first.

Background Non-contrast computed tomography (CT) scanning allows for reliable coronary calcium score (CCS) calculation at a low radiation dose and has been well established as marker to assess the future risk of coronary artery disease (CAD) events in asymptomatic individuals. However, the diagnostic and prognostic value in symptomatic patients remains a matter of debate. This narrative review focuses on the available evidence for CCS in patients with stable chest pain complaints. Method PubMed, Embase, and Web of Science were searched for literature using search terms related to three overarching categories: CT, symptomatic chest pain patients, and coronary calcium. The search resulted in 42 articles fulfilling the inclusion and exclusion criteria: 27 articles (n = 38 137 patients) focused on diagnostic value and 23 articles (n = 44 683 patients) on prognostic value of CCS. Of these, 10 articles (n = 21 208 patients) focused on both the diagnostic and prognostic value of CCS. Results Between 22 and 10 037 patients were included in the studies on the diagnostic and prognostic value of CCS, including 43 % and 51 % patients with CCS 0. The most evidence is available for patients with a low and intermediate pre-test probability (PTP) of CAD. Overall, the prevalence of obstructive CAD (OCAD, defined as a luminal stenosis of ≥ 50 % in any of the coronary arteries) as determined with CT coronary angiography in CCS 0 patients, was 4.4 % (n = 703/16 074) with a range of 0–26 % in individual studies. The event rate for major adverse cardiac events (MACE) ranged from 0 % to 2.1 % during a follow-up of 1.6 to 6.8 years, resulting in a high negative predictive value for MACE between 98 % and 100 % in CCS 0 patients. At increasing CCS, the OCAD probability and MACE risk increased. OCAD was present in 58.3 % (n = 617/1058) of CCS > 400 patients with percentages ranging from 20 % to 94 % and MACE occurred in 16.7 % (n = 175/1048) of these patients with percentages ranging from 6.9 % to 50 %. Conclusion Accumulating evidence shows that OCAD is unlikely and the MACE risk is very low in symptomatic patients with CCS 0, especially in those with low and intermediate PTPs. This suggests a role of CCS as a gatekeeper for additional diagnostic testing. Increasing CCS is related to an increasing probability of OCAD and risk of cardiac events. Additional research is needed to assess the value of CCS in women and patient management in a primary healthcare setting. Key Points: Citation Format

Introduction Identifying and excluding coronary artery disease (CAD) in patients with atypical angina pectoris (AP) and non-specific thoracic complaints is a challenge for general practitioners (GPs). A diagnostic and prognostic tool could help GPs in determining the likelihood of CAD and guide patient management. Studies in outpatient settings have shown that the CT-based coronary calcium score (CCS) has high accuracy for diagnosis and exclusion of CAD. However, the CT CCS test has not been tested in a primary care setting. In the COroNary Calcium scoring as fiRst-linE Test to dEtect and exclude coronary artery disease in GPs patients with stable chest pain (CONCRETE) study, the impact of direct access of GPs to CT CCS will be investigated. We hypothesise that this will allow for early diagnosis of CAD and treatment, more efficient referral to the cardiologist and a reduction of healthcare-related costs. Methods and analysis CONCRETE is a pragmatic multicentre trial with a cluster randomised design, in which direct GP access to the CT CCS test is compared with standard of care. In both arms, at least 40 GP offices, and circa 800 patients with atypical AP and non-specific thoracic complaints will be included. To determine the increase in detection and treatment rate of CAD in GP offices, the CVRM registration rate is derived from the GPs electronic registration system. Individual patients’ data regarding cardiovascular risk factors, expressed chest pain complaints, quality of life, downstream testing and CAD diagnosis will be collected through questionnaires and the electronic GP dossier. Ethics and dissemination CONCRETE has been approved by the Medical Ethical Committee of the University Medical Center of Groningen. Trial registration number NTR 7475; Pre-results.

Experience with simulated clinical cases is a relevant component in the development of clinical reasoning (CR). Generating and vetting cases that are locally relevant is, however, a complex and time-consuming process. We propose the use of generative artificial intelligence (AI) to create synthetic patients (SyP), in the form of narratives, based on real-world data describing patients' symptoms. We pilot tested this solution with self-reported questionnaires of patients with chest discomfort using a chatbot. Automatically creating vetted clinical narratives that are locally relevant would amplify the teaching of CR, allowing for a larger exposure of students to clinical cases. We synthesized SyP from narrative data that retained the initial diagnostic hypothesis of the original patients as defined by a general practitioner. Our results indicate that a more efficient process of generating cases for educational purposes mediated by AI is feasible. We plan to fine-tune the process to improve the narratives while preserving confidentiality. In the future, the process could be used on a large scale for the development of diagnostic abilities and communication skills.

In this short report, the challenges and lessons learned from implementing scientific research in primary care are discussed. It highlights the complexities of conducting studies in primary care, where ‘Lasagna’s Law’ rules too often. Using the CONCRETE trial – a pragmatic multicenter implementation trial – as an example, eight key elements are identified as important factors for successfully conducting scientific research in primary care, such as optimizing digital processes and improving engagement.