Black hairy tongue (BHT) is a benign medical condition characterized by elongated filiform lingual papillae with typical carpet-like appearance of the dorsum of the tongue. Its prevalence varies geographically, typically ranging from 0.6% to 11.3%. Known predisposing factors include smoking, excessive coffee/black tea consumption, poor oral hygiene, trigeminal neuralgia, general debilitation, xerostomia, and medication use. Clinical presentation varies but is typically asymptomatic, although aesthetic concerns are common. Differential diagnosis includes pseudo-BHT, acanthosis nigricans, oral hairy leukoplakia, pigmented fungiform papillae of the tongue, and congenital melanocytic/melanotic nevi/macules. Clinical diagnosis relies on visual observation, detailed history taking, and occasionally microscopic evaluation. Treatment involves identification and discontinuation of the offending agent, modifications of chronic predisposing factors, patient's re-assurance to the benign nature of the condition, and maintenance of adequate oral hygiene with gentle debridement to promote desquamation. Complications of BHT (burning mouth syndrome, halitosis, nausea, gagging, dysgeusia) typically respond to therapy. Prognosis is excellent with treatment of underlying medical conditions. BHT remains an important medical condition which may result in additional burden on the patient and health care system and requires appropriate prevention, recognition and treatment.

Burning mouth syndrome is a debilitating medical condition affecting nearly 1.3 million of Americans. Its common features include a burning painful sensation in the mouth, often associated with dysgeusia and xerostomia, despite normal salivation. Classically, symptoms are better in the morning, worsen during the day and typically subside at night. Its etiology is largely multifactorial, and associated medical conditions may include gastrointestinal, urogenital, psychiatric, neurologic and metabolic disorders, as well as drug reactions. BMS has clear predisposition to peri-/post menopausal females. Its pathophysiology has not been fully elucidated and involves peripheral and central neuropathic pathways. Clinical diagnosis relies on careful history taking, physical examination and laboratory analysis. Treatment is often tedious and is aimed at correction of underlying medical conditions, supportive therapy, and behavioral feedback. Drug therapy with alpha lipoic acid, clonazepam, capsaicin, and antidepressants may provide symptom relief. Psychotherapy may be helpful. Short term follow up data is promising, however, long term prognosis with treatment is lacking. BMS remains an important medical condition which often places a recognizable burden on the patient and health care system and requires appropriate recognition and treatment.

Objectives: Examine the extent to which financial assistance, in the form of subsidies for life-extending treatments (LETs) or cash pay-outs, distorts the demand for end-of-life treatments. Methods: A discrete choice experiment was administered to 290 cancer patients in Singapore to elicit preferences for LETs and palliative care (PC) only. Responses were fitted to a latent class conditional logistic regression model. We also quantified patients' willingness to pay to avoid and willingness to accept a less effective LETor PC only. We then simulated the effects of various LET subsidy and cash pay-out policies on treatment choices. Results: We identified 3 classes of patients according to their preferences. The first class (26.1% of sample) has a strong preference for PC and are willing to give up life expectancy gains and even pay for receiving only PC. The second class (29.8% of sample) has a strong preference for LETs and prefers to extend life regardless of cost or quality of life. The final class (44.1% of sample) prefers LETs to PC, but actively trades off costs, length and quality of life when making end-of-life treatment choices. Policy simulations show that LETsubsidies increase demand for LETs at the expense of demand for PC, but an equivalent cash payout was not shown to distort demand. Conclusions: Cancer patients have heterogeneous end-of-life preferences. LET subsidies and cash payouts have differing effects on the utilization of LETs. Policymakers should be mindful of these differences when designing healthcare financing schemes for patients with life-limiting illnesses.

Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches1, while maintaining proven prevention measures using a vaccines-plus approach2 that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities3 in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.

Background: Although patient-centred care has become increasingly important across all medical specialties, when it comes to end of life care, research has shown that treatments ordered are not often concordant with people's expressed preferences. Patient and family engagement in Advance Care Planning (ACP) in the primary care setting could improve the concordance between patients' wishes and the healthcare received when patients cannot speak for themselves. The aim of this study was to better understand the barriers faced by older patients regarding talking to their family members and family physicians about ACP. Methods: In this multi-site cross-sectional study, three free text questions regarding reasons patients found it difficult to discuss ACP with their families or their family physicians were part of a self-administered questionnaire about patients' knowledge of and engagement in ACP. The questionnaire, which included closed ended questions followed by three probing open ended questions, was distributed in 20 family practices across 3 provinces in Canada. The free text responses were analyzed using thematic analysis and form the basis of this paper. Results: One hundred two participants provided an analyzable response to the survey when asked why they haven't talked to someone about ACP. Two hundred fifty-four answered the question about talking to their physician and 340 answered the question about talking to family members. Eight distinct themes emerged from the free text response analysis: 1. They were too young for ACP; 2. The topic is too emotional; 3. The Medical Doctor (MD) should be responsible for bringing up ACP 4. A fear of negatively impacting the patient-physician relationship; 5. Not enough time in appointments; 6. Concern about family dynamics; 7. It's not a priority; and 8. A lack of knowledge about ACP. Conclusions: Patients in our sample described many barriers to ACP discussions, including concerns about the effect these discussions may have on relationships with both family members and family physicians, and issues relating to patients' knowledge and interpretation of the importance, responsibility for, or relevance of ACP itself. Family physicians may be uniquely placed to leverage the longitudinal, person-centred relationship they have with patients to mitigate some of these barriers.