In this editorial,we comment on the article by Nagamine et al,published in the World Journal of Clinical Cases.The authors suggest that virtual reality technology has potential in alleviating pain by enhancing brain n...In this editorial,we comment on the article by Nagamine et al,published in the World Journal of Clinical Cases.The authors suggest that virtual reality technology has potential in alleviating pain by enhancing brain network functionality.Alongside virtual reality,various treatment methods are used to effectively manage musculoskeletal pain.One such method is the use of orthoses,which are applied in clinical settings.We emphasize the need for collaboration between pain physicians and orthotists when applying orthoses for pain management.The efficacy of orthoses is maximized when customized to the physical characteristics of each patient,type of disease,and location of pain.Orthoses are designed to restore anatomical alignment and biomechanical function;however,their success depends on the expertise of trained orthotists,who should effectively communicate with physicians and understand the mechanical principles of musculoskeletal alignment.The professional knowledge of orthotists is critical in ensuring that orthoses are appropriately designed and applied to achieve therapeutic efficacy.Since no single treatment modality typically offers sufficient relief for musculoskeletal pain,effective collaboration between pain physicians and orthotists is crucial to optimize the use of orthoses in the management of pain.展开更多
BACKGROUND:In-flight medical emergencies(IMEs)present significant challenges to healthcare professionals,particularly those with limited training or experience in managing such situations.The objective of this study w...BACKGROUND:In-flight medical emergencies(IMEs)present significant challenges to healthcare professionals,particularly those with limited training or experience in managing such situations.The objective of this study was to evaluate the level of knowledge,attitudes,and behaviors of licensed doctors in Saudi Arabia concerning IMEs,and to identify the demographic factors influencing their preparedness.METHODS:A cross-sectional study was conducted with a sample of 383 licensed physicians across five regions of Saudi Arabia.Participants completed a self-administered questionnaire assessing demographics,knowledge of IMEs,attitudes towards providing assistance,and previous experience with in-flight emergencies.Data were analyzed using SPSS 26,with statistical significance set at P<0.05.RESULTS:The results revealed a predominantly young(75.8% aged 25-34 years)and male(69.6%)participant pool.While 76.6% of respondents recognized the impact of cabin pressure on oxygen,only 45.4% correctly identified air travel risks for asthmatic patients.Although 66.8% felt confident assisting in IMEs,20.9% cited medicolegal concerns.Moreover,area of working within Saudi Arabia(P=0.020),year of experience(P=0.041),prior experience with IMEs(P=0.021),and IMEs training(P<0.001)had a significant association with levels of knowledge.CONCLUSION:The study highlights a critical need for enhanced training programs with a focus on the management of IMEs among healthcare practitioners in Saudi Arabia.展开更多
BACKGROUND Thyroid cancer incidence is rising globally,including the Democratic Republic of Congo(DRC).Despite its increasing incidence,limited data exist on physicians’knowledge of thyroid cancer management in the D...BACKGROUND Thyroid cancer incidence is rising globally,including the Democratic Republic of Congo(DRC).Despite its increasing incidence,limited data exist on physicians’knowledge of thyroid cancer management in the DRC.AIM To evaluate the knowledge levels of Congolese physicians regarding the diagnosis and treatment of thyroid nodules and cancers,and to identify existing gaps and areas for improvement.METHODS A descriptive cross-sectional study was conducted from June to August 2024,involving 369 physicians practicing in healthcare facilities across Kinshasa,DRC.Participants were selected using a multi-stage sampling method.Data were collected via a structured questionnaire covering thyroid cancer epidemiology,diagnostic methods,treatment approaches,and prognosis.Data were analyzed using SPSS version 25,employing descriptive and inferential statistics,with a P value≤0.05 being considered as statistically significant.RESULTS Overall response rate was 96.1%.Of all participants,68%were female and 32%were male physicians.General practitioners constituted 84.8%of respondents,with an average age of 34 years.While 53.7%demonstrated adequate knowledge of hypothyroidism management post-thyroidectomy and 61.2%identified the approach for hypoparathyroidism,only 5.1%recognized the need for radiotherapy in metastatic thyroid cancer cases.Awareness of anaplastic thyroid cancer treatment was limited(6.5%),and 90.2%of physicians were unfamiliar with the surgical complications.Moderate understanding was noted in diagnostic protocols,with 44.2%correctly identifying repeat fine-needle aspiration timing in Bethesda I cases.Knowledge of molecular genetics,recurrence risks,and metastasis patterns was remarkably low.CONCLUSION This study highlights significant knowledge gaps among Congolese physicians regarding thyroid cancer management,especially about advanced treatment modalities and molecular genetics.Targeted educational programs and improved access to diagnostic tools are critical to bridging these deficits.Addressing these gaps can enhance the quality of thyroid cancer care and align clinical practices in the DRC with global standards.展开更多
This manuscript provides a commentary on the article by Zhang et al.Patients with heart and pulmonary failure who do not respond to standard treatment may benefit from extracorporeal membrane oxygenation(ECMO)support....This manuscript provides a commentary on the article by Zhang et al.Patients with heart and pulmonary failure who do not respond to standard treatment may benefit from extracorporeal membrane oxygenation(ECMO)support.Advanced heart failure and transplant cardiology(AHFTC)teams play an essential role in managing patients in cardiogenic shock.To determine whether ECMO patient management outcomes differ based on whether AHFTC physicians assume a direct or consultative role,a retrospective cohort study of 51 patients placed on veno-venous and veno-arterial(VA)ECMO between January 2015 and February 2023 was conducted.Results demonstrated a significantly higher 30-day postdischarge survival rate in the AHFTC direct involvement cohort compared to the consultative group(67%vs 30%)for all ECMO patients.This survival benefit was primarily attributable to VA ECMO patients(64%vs 20%).Direct involvement of AHFTC teams in patient selection and management may enhance survival in patients requiring VA ECMO for cardiogenic shock;however,further research is necessary to confirm these findings.展开更多
With the rapid development of emergency medicine,emergency physicians are working around the clock,[1]including additional workloads due to sudden public health emergencies and disasters.Occupational risks for emergen...With the rapid development of emergency medicine,emergency physicians are working around the clock,[1]including additional workloads due to sudden public health emergencies and disasters.Occupational risks for emergency physicians are significantly high due to an increasing number of patients with acute and severe diseases,an increased workload.展开更多
Objectives: To assess the socio-professional determinants of burnout among the medical staff of Dakar University Hospitals. The aim was to propose effective means of prevention. Material and Methods: This was a cross-...Objectives: To assess the socio-professional determinants of burnout among the medical staff of Dakar University Hospitals. The aim was to propose effective means of prevention. Material and Methods: This was a cross-sectional, descriptive, and analytical study of physicians in permanent contact with patients at the Fann and Aristide Le Dantec teaching hospitals in Dakar, Senegal. Results: A total of 159 doctors were included in the study, with a sex ratio (M/F) of 1.3 in favor of men. The prevalence of burnout was 91.8%. Burnout was significantly associated (p Conclusion: Burnout is a threat to doctors at university hospitals in Senegal. It has several determinants linked above all to work organization. It is essential to set up psychological support units in hospitals and integrate occupational medicine into various organizational processes.展开更多
Nitric acid or qiangshui强水(“strong liquid,”from lat.aqua fortis)was introduced to China multiple times by European missionaries during the Ming and Qing dynasties.Xu Guangqi徐光啟(1562-1633)was the first Chinese t...Nitric acid or qiangshui强水(“strong liquid,”from lat.aqua fortis)was introduced to China multiple times by European missionaries during the Ming and Qing dynasties.Xu Guangqi徐光啟(1562-1633)was the first Chinese to record related knowledge from his communication with Johann Schreck(1576-1630).Johann Adam Schall von Bell(1591-1666),Joachim Bouvet(1656-1730),and Matteo Ripa(1682-1746)independently described the substance to the Chinese in their writings,explaining production methods together with different applications such as separating and assaying of gold and silver,etching of iron or copperplates,and manufacturing of thermometers.This paper focuses on newly discovered Chinese materials,mainly from the Investigations of the Earth’s Interior(Kunyu gezhi坤輿格致,1640)by Schall von Bell and his Chinese collaborators,but also from the Record of Essentials of Inception and Completion(Kaicheng jiyao開成紀要)by Xu Guangqi.It analyzes different aspects of knowledge transmission processes including the identification of useful knowledge,the purpose of transmission,the sources of European knowledge,and the applied methods of translation and explanation.From these analyses we can better understand the reasons of their failure or success.展开更多
Background:We aimed to study physician attitudes toward ultrasound-guided procedures and possible improvements.We hypothesized that the usage of ultrasound in procedures may be limited by a high barrier of entry and t...Background:We aimed to study physician attitudes toward ultrasound-guided procedures and possible improvements.We hypothesized that the usage of ultrasound in procedures may be limited by a high barrier of entry and that most physicians would choose to adopt software that provides real-time image guidance if accessible.Methods:A voluntary,cross-sectional survey of physicians at a single site was conducted using a five-point Likert scale.Data analysis included both descriptive and inferential statistical analyses and stratified by categorical descriptors,including variables of formal training,years of experience,and specialty of practice.Results:One hundred sixteen physicians responded to the survey.The majority disagreed that there was a steep learning curve(57.5%)and that they need more time to identify structures under ultrasound(85.0%).Overall attitudes were mixed about the use of additional software to improve ease of use,but most(55.4%)had positive opinions toward the addition of real-time 3D reconstruction.Respondents without formal training were significantly more likely to agree that additional software would improve ease of ultrasound-guided procedures(p=0.0389).Radiologists were significantly more likely to perceive a steeper learning curve and less likely to advocate for supplemental software compared to emergency medicine physicians,surgeons,or anesthesiologists.Conclusions:Surveyed physicians demonstrated comfort with ultrasound-guided procedures and a mixed stance toward the use of additional software to assist with procedures.Those without formal training had significantly more positive attitudes toward the use of additional technology to augment ultrasound-guided procedures,suggesting a knowledge gap that may benefit from such technology.展开更多
As a crucial assessment tool,the Mini Clinical Evaluation Exercise(Mini-CEX)has gradually garnered attention in the clinical skills training of resident physicians.With the ongoing advancement of medical education ref...As a crucial assessment tool,the Mini Clinical Evaluation Exercise(Mini-CEX)has gradually garnered attention in the clinical skills training of resident physicians.With the ongoing advancement of medical education reform,Mini-CEX not only offers a fresh perspective for evaluating the clinical competence of resident physicians but also establishes a foundation for enhancing their overall quality and professional capabilities.Nonetheless,there are still certain constraints in the application of Mini-CEX,including inconsistent assessment criteria,assessor subjectivity,and inadequate feedback mechanisms.This paper will review relevant domestic and international studies,explore the practical application of Mini-CEX in standardized resident physician training,analyze its strengths and weaknesses in assessing clinical ability,and propose recommendations for future development directions.Through a thorough examination of this field,it aims to provide references and guidance for further optimizing the training model for resident physicians.展开更多
Dear Editor,Barry et al.'s study[1],“Physician Attitudes About Ultrasound‐Guided Procedures,”investigates clinicians'views on ultra-sound‐guided interventions and their openness to technological advancemen...Dear Editor,Barry et al.'s study[1],“Physician Attitudes About Ultrasound‐Guided Procedures,”investigates clinicians'views on ultra-sound‐guided interventions and their openness to technological advancements.The group surveyed 116 physicians and found that a majority(57.5%)disagreed that there was a steep learning curve for ultrasound‐guided procedures,and 85%felt confident in identifying anatomical structures under ultrasound.Attitudes toward supplemental software were mixed,though 55.4%sup-ported real‐time 3D reconstruction.Notably,physicians without formal training were significantly more receptive to additional software(p=0.0389).Radiologists perceived greater procedural complexity and were less enthusiastic about technological aids.These findings highlight a paradox:Ultrasound is perceived as accessible,but untrained clinicians may rely on technology to compensate for skill gaps.The study underscores the impor-tance of addressing training disparities and leveraging innova-tion to enhance procedural safety and efficiency.展开更多
Background:Work engagement(WE)is critical to quality primary healthcare delivery.However,limited research has explored its levels and determinants among healthcare professionals in low-and middle-income countries.This...Background:Work engagement(WE)is critical to quality primary healthcare delivery.However,limited research has explored its levels and determinants among healthcare professionals in low-and middle-income countries.This study assessed the levels and correlates of work engagement among physician assistants(PAs)in Ghana.Methods:A cross-sectional study was conducted among 439 PAs from October to December 2024.Participants were recruited via emails,social media platforms,and posters featuring study links and scannable questionnaire codes.WE was measured using the validated Utrecht Work Engagement Scale questionnaire.Results:Overall,WE levels were average,with similar trends across the three subdomains.In the bootstrapped multivariate linear regression model,anxiety was negatively associated with WE(β=-0.49,95%confidence interval[CI]:-0.77 to-0.21).Conversely,working in an urban area(β=0.36,95%CI:0.05 to 0.67),holding the rank of PA/Senior PA(β=0.27,95%CI:0.03 to 0.52),reporting good self-rated health(β=0.54,95%CI:0.19 to 0.88),and working at health centers(β=0.86,95%CI:0.22 to 1.50)were positively associated with WElevels.Conclusion:WE levels are average in the study sample,highlighting the need for strategic interventions to improve and sustain the healthcare workforce's motivation and performance.Addressing workplace stressors,enhancing professional development opportunities,and fostering supportive work environments could improve engagement among PAs and healthcare professionals in general.Strengthening WE is essential for ensuring resilient quality primary healthcare systems and achieving the goals of universal health coverage.展开更多
Physician mental health(MH)is in crisis,particularly in high-stress areas of medicine such as the emergency roomand the intensive care unit.The high prevalence of burnout and psychiatric illness among critical care ph...Physician mental health(MH)is in crisis,particularly in high-stress areas of medicine such as the emergency roomand the intensive care unit.The high prevalence of burnout and psychiatric illness among critical care physicians,along with delays in seeking psychiatric care,can lead to suicide,ruined careers,damaged relationships,and medical errors.Psychoeducation programs can reduce MH sick leave days,increase empathy,and enhance helpseeking attitudes.The purpose of this brief communication is to demonstrate that physician psychoeducation programs can improve patient care,improve outcomes in physicians with psychiatric illness,and improve burnout rates,and we describe the essential aspects of such a program.展开更多
AIM: To explore Chinese physicians' perceptions towards fecal microbiota transplantation(FMT) and to provide information and an assessment of FMT development in China.METHODS: A self-administered questionnaire was...AIM: To explore Chinese physicians' perceptions towards fecal microbiota transplantation(FMT) and to provide information and an assessment of FMT development in China.METHODS: A self-administered questionnaire was developed according to the FMT practice guidelines and was distributed to physicians in hospitals via Internet Research Electronic Data Capture(REDcap) software and electronic mails to assess their attitudes toward and knowledge of FMT. The questionnaire included a brief introduction of FMT that was followed by 20 questions. The participants were required to respond voluntarily, under the condition of anonymity and without compensation. Except for the fill-in-the-blank questions, all of the other questions were required in the REDcap data collection systems, and the emailed questionnaires were completed based on eligibility.RESULTS: Up to December 9, 2014, 844 eligible questionnaires were received out of the 980 distributed questionnaires, with a response rate of 86.1%. Among the participants, 87.3% were from tertiary hospitals, and there were 647(76.7%) gastroenterologists and 197(23.3%) physicians in other departments(nongastroenterologists). Gastroenterologists' awareness of FMT prior to the survey was much higher than non-gastroenterologists'(54.3 vs 16.5%, P < 0.001); however, acceptance of FMT was not statistically different(92.4 vs 87.1%, P = 0.1603). Major concerns of FMT included the following: acceptability to patients(79.2%), absence of guidelines(56.9%), and administration and ethics(46.5%). On the basis of understanding, the FMT indications preferred byphysicians were recurrent Clostridium difficile infection(86.7%), inflammatory bowel disease combined with Clostridium difficile infection(78.6%), refractory ulcerative colitis(70.9%), ulcerative colitis(65.4%), Crohn's disease(59.4%), chronic constipation(43.7%), irritable bowel syndrome(39.1%), obesity(28.1%) and type 2 diabetes(23.9%). For donor selection, the majority of physicians preferred individuals with a similar gut flora environment to the recipients. 76.6% of physicians chose lower gastrointestinal tract as the administration approach. 69.2% of physicians considered FMT a safe treatment. CONCLUSION: Chinese physicians have awareness and a high acceptance of FMT, especially gastroenterologists, which provides the grounds and conditions for the development of this novel treatment in China. Physicians' greatest concerns were patient acceptability and absence of guidelines.展开更多
Description: The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) jointly developed this guideline to present the evidence and provide clinical recommendations based on the ben...Description: The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) jointly developed this guideline to present the evidence and provide clinical recommendations based on the benefits and harms of higher versus lower blood pressure targets for the treatment of hypertension in adults aged 60 years or older.展开更多
AIM: To investigate Chinese physicians' awareness of the 2010 guidelines on the treatment of chronic hepatitis B virus(HBV) infection.METHODS: This was a quantitative survey that investigated the characteristics a...AIM: To investigate Chinese physicians' awareness of the 2010 guidelines on the treatment of chronic hepatitis B virus(HBV) infection.METHODS: This was a quantitative survey that investigated the characteristics and practices of physicians who were treating patients with hepatitis B, the profile of their patients and physician practices regarding the diagnosis and treatment of HBV at the time of the survey. Participants were randomly selected from available databases of Chinese physicians and requested to complete either an online or paper-based survey. Data from the survey responses were analysed. For data validation and interpretation, qualitative in-depth interviews were conducted with 39 of the respondents.RESULTS: Five-hundred completed surveys, from 663 physicians were available for analysis. A mean of 175 chronic hepatitis B(CHB) patients was seen by each physician every month, of whom 85(49%) were treated in line with therapeutic indications stated in the 2010 guidelines. A total of 444(89%) physicians often(> 60% of the time) adhered to the guidelines. Most physicians used antiviral medications as recommended. For patients with compensated and decompensated cirrhosis, 342(68%) and 336(67%) of physicians, respectively, often followed the recommendation to use potent nucleos(t)ide analogues with a high genetic barrier to resistance, using the appropriate treatment more than 60% of the time. Physicians from infectious disease or liver disease departments were better informed than those from gastrointestinal or other departments.CONCLUSION: The majority of Chinese physicians often adhere to Chinese 2010 CHB guidelines and are well-informed about the use of antiviral medications for hepatitis B.展开更多
Effective communication among healthcare professionals in the intensive care unit (ICU) is a particular imperative,with accurate and efficient interdisciplinary communication being a critical prerequisite for high-qua...Effective communication among healthcare professionals in the intensive care unit (ICU) is a particular imperative,with accurate and efficient interdisciplinary communication being a critical prerequisite for high-quality care.Nurses and physicians are highly important parts of the healthcare system workforce.Thus,identifying strategies that would improve communication between these two groups can provide evidence for practical improvement in the ICU,which will ultimately improve patient outcomes.This integrative literature review aimed to identify interventions that improve communication between nurses and physicians in ICUs.Three databases (Medline,CINAHL,and Science Direct) were searched between September 2014 and June 2016 using 11 search terms,namely,nurse,doctor,physician,resident,clinician,ICU,intensive care unit,communication,teamwork,collaboration,and relationship.A manual search of the reference lists of found papers was also conducted.Eleven articles met the inclusion criteria.These studies reported on the use of communication tools/checklists,team training,multidisciplinary structured work shift evaluation,and electronic situation-background-assessment -recommendation documentation templates to improve communication.Although which intervention strategies are most effective remains unclear,this review suggests that these strategies improve communication to some extent.Future studies should be rigorously designed and outcome measures should be specific and validated to capture and reflect the effects of effective communication.展开更多
BACKGROUND: Emergency physicians have been successful in implementing procedural sedation and analgesia(PSA) to treat emergency department(ED) patients who need to undergo painful procedures.However, 25% of the EDs in...BACKGROUND: Emergency physicians have been successful in implementing procedural sedation and analgesia(PSA) to treat emergency department(ED) patients who need to undergo painful procedures.However, 25% of the EDs in the Netherlands are not staffed by emergency physicians.The aim of this study was to investigate PSA availability and quality in EDs without emergency physicians.METHODS: We performed an exploratory cross-sectional study amongst ED nurses and physicians in all 13 EDs without emergency physicians in the Netherlands.Data were gathered using a standardized questionnaire.RESULTS: The response rate was 34.3%(148/432).Of the respondents, 84/148(56.8%) provided adult PSA and 30/148(20.3%) provided paediatric PSA.Main reasons for not providing PSA were insufficient numbers of trained staff to support PSA in the ED and insufficient training and exposure.The providers agreed significantly stronger when reflecting their PSA competencies in adults compared to paediatric patients.CONCLUSION: The key to improve pain management in the ED-setting may lay in investing in continuous training of ED health care professionals and/or acquiring professionals who are both qualified in PSA and available in the ED.展开更多
Male patients with lower urinary tract symptoms(LUTS)and benign prostatic hyperplasia(BPH)are increasingly seen by family physicians worldwide due to ageing demographics.A systematic way to stratify patients who can b...Male patients with lower urinary tract symptoms(LUTS)and benign prostatic hyperplasia(BPH)are increasingly seen by family physicians worldwide due to ageing demographics.A systematic way to stratify patients who can be managed in the community and those who need to be referred to the urologist is thus very useful.Good history taking,physical examination,targeted blood or urine tests,and knowing the red flags for referral are the mainstay of stratifying these patients.Case selection is always key in clinical practice and in the setting of the family physician.The best patient to manage is one above 40 years of age,symptomatic with nocturia,slower stream and sensation of incomplete voiding,has a normal prostatespecific antigen level,no palpable bladder,and no haematuria or pyuria on the labstix.The roles of α blockers,5-α reductase inhibitors,and antibiotics in a primary care setting to manage this condition are also discussed.展开更多
The aim of this study was to determine the association of depressive symptoms with dietary habits among physicians working in hospitals in Japan. We mailed an anonymous questionnaire with the Quick Inventory of Depres...The aim of this study was to determine the association of depressive symptoms with dietary habits among physicians working in hospitals in Japan. We mailed an anonymous questionnaire with the Quick Inventory of Depressive Symptomatology and items about dietary habits to 10,000 randomly selected physicians. Logistic regression analysis was used to explore the association of depressive symptoms with dietary habits. The participants comprised 3862 physicians (3025 men and 837 women). Among the respondents, 252 (8.3%) men and 88 (10.5%) women were determined to be in depressive symptoms. For men, “never eat a balanced diet” (Odds ratio;95% confidence interval, 2.54;1.70 - 3.80), and for women “eat quite small meals” (3.81;1.14 - 13.1), “always eat until full” (4.40;1.48 - 13.1), and “never eat a balanced diet” (3.05;1.49 - 6.23) were associated with depressive symptoms. For men, “do not eat too much” (0.57;0.39 - 0.83) was associated with prevention of depression. Physicians should recognize the important role of healthy dietary habits in good mental health. Hospitals should intervene to help physicians address depressive symptoms and dietary habits.展开更多
Prior studies have not explored physician’s attitudes toward, and behavior and willingness to accept an e-health care system. However, physicians can induce demand for their services. The development of the high-tech...Prior studies have not explored physician’s attitudes toward, and behavior and willingness to accept an e-health care system. However, physicians can induce demand for their services. The development of the high-tech asthma care mobile service (ACMS) in Taiwan provided a means of exploring key factors in a physician’s choice of using an ACMS. The study was based on the technology acceptance model (TAM) and integrated “subjective norm,” “innovativeness,” and “managerial support” to understand and predict physicians’ attitudes and behavioral intentions toward adopting high-tech healthcare systems such as the ACMS. Of 700 questionnaires distributed to physicians with experience using ACMS, 504 completed returns were received (a 72% response rate). The data were analyzed using the structural equation modeling (SEM) method. The results of the study showed that the model selected to explain and predict utilization of the ACMS had high explanatory power and was a good-fit model. The most critical factor that affected behavioral intentions related to ACMS was user attitude, followed by perceived usefulness, managerial support, subjective norm, perceived ease of use, and innovativeness.展开更多
文摘In this editorial,we comment on the article by Nagamine et al,published in the World Journal of Clinical Cases.The authors suggest that virtual reality technology has potential in alleviating pain by enhancing brain network functionality.Alongside virtual reality,various treatment methods are used to effectively manage musculoskeletal pain.One such method is the use of orthoses,which are applied in clinical settings.We emphasize the need for collaboration between pain physicians and orthotists when applying orthoses for pain management.The efficacy of orthoses is maximized when customized to the physical characteristics of each patient,type of disease,and location of pain.Orthoses are designed to restore anatomical alignment and biomechanical function;however,their success depends on the expertise of trained orthotists,who should effectively communicate with physicians and understand the mechanical principles of musculoskeletal alignment.The professional knowledge of orthotists is critical in ensuring that orthoses are appropriately designed and applied to achieve therapeutic efficacy.Since no single treatment modality typically offers sufficient relief for musculoskeletal pain,effective collaboration between pain physicians and orthotists is crucial to optimize the use of orthoses in the management of pain.
基金approved by the Regional Research Ethics Committee,Qassim Province,Saudi Arabia.Number(607-45-12634).
文摘BACKGROUND:In-flight medical emergencies(IMEs)present significant challenges to healthcare professionals,particularly those with limited training or experience in managing such situations.The objective of this study was to evaluate the level of knowledge,attitudes,and behaviors of licensed doctors in Saudi Arabia concerning IMEs,and to identify the demographic factors influencing their preparedness.METHODS:A cross-sectional study was conducted with a sample of 383 licensed physicians across five regions of Saudi Arabia.Participants completed a self-administered questionnaire assessing demographics,knowledge of IMEs,attitudes towards providing assistance,and previous experience with in-flight emergencies.Data were analyzed using SPSS 26,with statistical significance set at P<0.05.RESULTS:The results revealed a predominantly young(75.8% aged 25-34 years)and male(69.6%)participant pool.While 76.6% of respondents recognized the impact of cabin pressure on oxygen,only 45.4% correctly identified air travel risks for asthmatic patients.Although 66.8% felt confident assisting in IMEs,20.9% cited medicolegal concerns.Moreover,area of working within Saudi Arabia(P=0.020),year of experience(P=0.041),prior experience with IMEs(P=0.021),and IMEs training(P<0.001)had a significant association with levels of knowledge.CONCLUSION:The study highlights a critical need for enhanced training programs with a focus on the management of IMEs among healthcare practitioners in Saudi Arabia.
文摘BACKGROUND Thyroid cancer incidence is rising globally,including the Democratic Republic of Congo(DRC).Despite its increasing incidence,limited data exist on physicians’knowledge of thyroid cancer management in the DRC.AIM To evaluate the knowledge levels of Congolese physicians regarding the diagnosis and treatment of thyroid nodules and cancers,and to identify existing gaps and areas for improvement.METHODS A descriptive cross-sectional study was conducted from June to August 2024,involving 369 physicians practicing in healthcare facilities across Kinshasa,DRC.Participants were selected using a multi-stage sampling method.Data were collected via a structured questionnaire covering thyroid cancer epidemiology,diagnostic methods,treatment approaches,and prognosis.Data were analyzed using SPSS version 25,employing descriptive and inferential statistics,with a P value≤0.05 being considered as statistically significant.RESULTS Overall response rate was 96.1%.Of all participants,68%were female and 32%were male physicians.General practitioners constituted 84.8%of respondents,with an average age of 34 years.While 53.7%demonstrated adequate knowledge of hypothyroidism management post-thyroidectomy and 61.2%identified the approach for hypoparathyroidism,only 5.1%recognized the need for radiotherapy in metastatic thyroid cancer cases.Awareness of anaplastic thyroid cancer treatment was limited(6.5%),and 90.2%of physicians were unfamiliar with the surgical complications.Moderate understanding was noted in diagnostic protocols,with 44.2%correctly identifying repeat fine-needle aspiration timing in Bethesda I cases.Knowledge of molecular genetics,recurrence risks,and metastasis patterns was remarkably low.CONCLUSION This study highlights significant knowledge gaps among Congolese physicians regarding thyroid cancer management,especially about advanced treatment modalities and molecular genetics.Targeted educational programs and improved access to diagnostic tools are critical to bridging these deficits.Addressing these gaps can enhance the quality of thyroid cancer care and align clinical practices in the DRC with global standards.
文摘This manuscript provides a commentary on the article by Zhang et al.Patients with heart and pulmonary failure who do not respond to standard treatment may benefit from extracorporeal membrane oxygenation(ECMO)support.Advanced heart failure and transplant cardiology(AHFTC)teams play an essential role in managing patients in cardiogenic shock.To determine whether ECMO patient management outcomes differ based on whether AHFTC physicians assume a direct or consultative role,a retrospective cohort study of 51 patients placed on veno-venous and veno-arterial(VA)ECMO between January 2015 and February 2023 was conducted.Results demonstrated a significantly higher 30-day postdischarge survival rate in the AHFTC direct involvement cohort compared to the consultative group(67%vs 30%)for all ECMO patients.This survival benefit was primarily attributable to VA ECMO patients(64%vs 20%).Direct involvement of AHFTC teams in patient selection and management may enhance survival in patients requiring VA ECMO for cardiogenic shock;however,further research is necessary to confirm these findings.
基金Beijing Key Specialized Department for Major Epidemic Prevention and Control (Construction Project)National Major Science and Technology Projects (2017ZX10305501)Beijing Social Science Foundation Planning Project (17SRC019)。
文摘With the rapid development of emergency medicine,emergency physicians are working around the clock,[1]including additional workloads due to sudden public health emergencies and disasters.Occupational risks for emergency physicians are significantly high due to an increasing number of patients with acute and severe diseases,an increased workload.
文摘Objectives: To assess the socio-professional determinants of burnout among the medical staff of Dakar University Hospitals. The aim was to propose effective means of prevention. Material and Methods: This was a cross-sectional, descriptive, and analytical study of physicians in permanent contact with patients at the Fann and Aristide Le Dantec teaching hospitals in Dakar, Senegal. Results: A total of 159 doctors were included in the study, with a sex ratio (M/F) of 1.3 in favor of men. The prevalence of burnout was 91.8%. Burnout was significantly associated (p Conclusion: Burnout is a threat to doctors at university hospitals in Senegal. It has several determinants linked above all to work organization. It is essential to set up psychological support units in hospitals and integrate occupational medicine into various organizational processes.
文摘Nitric acid or qiangshui强水(“strong liquid,”from lat.aqua fortis)was introduced to China multiple times by European missionaries during the Ming and Qing dynasties.Xu Guangqi徐光啟(1562-1633)was the first Chinese to record related knowledge from his communication with Johann Schreck(1576-1630).Johann Adam Schall von Bell(1591-1666),Joachim Bouvet(1656-1730),and Matteo Ripa(1682-1746)independently described the substance to the Chinese in their writings,explaining production methods together with different applications such as separating and assaying of gold and silver,etching of iron or copperplates,and manufacturing of thermometers.This paper focuses on newly discovered Chinese materials,mainly from the Investigations of the Earth’s Interior(Kunyu gezhi坤輿格致,1640)by Schall von Bell and his Chinese collaborators,but also from the Record of Essentials of Inception and Completion(Kaicheng jiyao開成紀要)by Xu Guangqi.It analyzes different aspects of knowledge transmission processes including the identification of useful knowledge,the purpose of transmission,the sources of European knowledge,and the applied methods of translation and explanation.From these analyses we can better understand the reasons of their failure or success.
文摘Background:We aimed to study physician attitudes toward ultrasound-guided procedures and possible improvements.We hypothesized that the usage of ultrasound in procedures may be limited by a high barrier of entry and that most physicians would choose to adopt software that provides real-time image guidance if accessible.Methods:A voluntary,cross-sectional survey of physicians at a single site was conducted using a five-point Likert scale.Data analysis included both descriptive and inferential statistical analyses and stratified by categorical descriptors,including variables of formal training,years of experience,and specialty of practice.Results:One hundred sixteen physicians responded to the survey.The majority disagreed that there was a steep learning curve(57.5%)and that they need more time to identify structures under ultrasound(85.0%).Overall attitudes were mixed about the use of additional software to improve ease of use,but most(55.4%)had positive opinions toward the addition of real-time 3D reconstruction.Respondents without formal training were significantly more likely to agree that additional software would improve ease of ultrasound-guided procedures(p=0.0389).Radiologists were significantly more likely to perceive a steeper learning curve and less likely to advocate for supplemental software compared to emergency medicine physicians,surgeons,or anesthesiologists.Conclusions:Surveyed physicians demonstrated comfort with ultrasound-guided procedures and a mixed stance toward the use of additional software to assist with procedures.Those without formal training had significantly more positive attitudes toward the use of additional technology to augment ultrasound-guided procedures,suggesting a knowledge gap that may benefit from such technology.
基金Scientific Research Fund Project of China Three Gorges University(Project No.:2022kj008)Special Scientific Research Fund Project of China Three Gorges University(Project No.:2023kjzx001)。
文摘As a crucial assessment tool,the Mini Clinical Evaluation Exercise(Mini-CEX)has gradually garnered attention in the clinical skills training of resident physicians.With the ongoing advancement of medical education reform,Mini-CEX not only offers a fresh perspective for evaluating the clinical competence of resident physicians but also establishes a foundation for enhancing their overall quality and professional capabilities.Nonetheless,there are still certain constraints in the application of Mini-CEX,including inconsistent assessment criteria,assessor subjectivity,and inadequate feedback mechanisms.This paper will review relevant domestic and international studies,explore the practical application of Mini-CEX in standardized resident physician training,analyze its strengths and weaknesses in assessing clinical ability,and propose recommendations for future development directions.Through a thorough examination of this field,it aims to provide references and guidance for further optimizing the training model for resident physicians.
文摘Dear Editor,Barry et al.'s study[1],“Physician Attitudes About Ultrasound‐Guided Procedures,”investigates clinicians'views on ultra-sound‐guided interventions and their openness to technological advancements.The group surveyed 116 physicians and found that a majority(57.5%)disagreed that there was a steep learning curve for ultrasound‐guided procedures,and 85%felt confident in identifying anatomical structures under ultrasound.Attitudes toward supplemental software were mixed,though 55.4%sup-ported real‐time 3D reconstruction.Notably,physicians without formal training were significantly more receptive to additional software(p=0.0389).Radiologists perceived greater procedural complexity and were less enthusiastic about technological aids.These findings highlight a paradox:Ultrasound is perceived as accessible,but untrained clinicians may rely on technology to compensate for skill gaps.The study underscores the impor-tance of addressing training disparities and leveraging innova-tion to enhance procedural safety and efficiency.
文摘Background:Work engagement(WE)is critical to quality primary healthcare delivery.However,limited research has explored its levels and determinants among healthcare professionals in low-and middle-income countries.This study assessed the levels and correlates of work engagement among physician assistants(PAs)in Ghana.Methods:A cross-sectional study was conducted among 439 PAs from October to December 2024.Participants were recruited via emails,social media platforms,and posters featuring study links and scannable questionnaire codes.WE was measured using the validated Utrecht Work Engagement Scale questionnaire.Results:Overall,WE levels were average,with similar trends across the three subdomains.In the bootstrapped multivariate linear regression model,anxiety was negatively associated with WE(β=-0.49,95%confidence interval[CI]:-0.77 to-0.21).Conversely,working in an urban area(β=0.36,95%CI:0.05 to 0.67),holding the rank of PA/Senior PA(β=0.27,95%CI:0.03 to 0.52),reporting good self-rated health(β=0.54,95%CI:0.19 to 0.88),and working at health centers(β=0.86,95%CI:0.22 to 1.50)were positively associated with WElevels.Conclusion:WE levels are average in the study sample,highlighting the need for strategic interventions to improve and sustain the healthcare workforce's motivation and performance.Addressing workplace stressors,enhancing professional development opportunities,and fostering supportive work environments could improve engagement among PAs and healthcare professionals in general.Strengthening WE is essential for ensuring resilient quality primary healthcare systems and achieving the goals of universal health coverage.
文摘Physician mental health(MH)is in crisis,particularly in high-stress areas of medicine such as the emergency roomand the intensive care unit.The high prevalence of burnout and psychiatric illness among critical care physicians,along with delays in seeking psychiatric care,can lead to suicide,ruined careers,damaged relationships,and medical errors.Psychoeducation programs can reduce MH sick leave days,increase empathy,and enhance helpseeking attitudes.The purpose of this brief communication is to demonstrate that physician psychoeducation programs can improve patient care,improve outcomes in physicians with psychiatric illness,and improve burnout rates,and we describe the essential aspects of such a program.
基金Supported by Chinese PLA General Hospital,No.2014FCTSYS-2001 and No.2013FC-TSYS-1009National High-tech Research and Development Projects(863),No.2015AA020702National Natural Science Foundation of China,No.81402345
文摘AIM: To explore Chinese physicians' perceptions towards fecal microbiota transplantation(FMT) and to provide information and an assessment of FMT development in China.METHODS: A self-administered questionnaire was developed according to the FMT practice guidelines and was distributed to physicians in hospitals via Internet Research Electronic Data Capture(REDcap) software and electronic mails to assess their attitudes toward and knowledge of FMT. The questionnaire included a brief introduction of FMT that was followed by 20 questions. The participants were required to respond voluntarily, under the condition of anonymity and without compensation. Except for the fill-in-the-blank questions, all of the other questions were required in the REDcap data collection systems, and the emailed questionnaires were completed based on eligibility.RESULTS: Up to December 9, 2014, 844 eligible questionnaires were received out of the 980 distributed questionnaires, with a response rate of 86.1%. Among the participants, 87.3% were from tertiary hospitals, and there were 647(76.7%) gastroenterologists and 197(23.3%) physicians in other departments(nongastroenterologists). Gastroenterologists' awareness of FMT prior to the survey was much higher than non-gastroenterologists'(54.3 vs 16.5%, P < 0.001); however, acceptance of FMT was not statistically different(92.4 vs 87.1%, P = 0.1603). Major concerns of FMT included the following: acceptability to patients(79.2%), absence of guidelines(56.9%), and administration and ethics(46.5%). On the basis of understanding, the FMT indications preferred byphysicians were recurrent Clostridium difficile infection(86.7%), inflammatory bowel disease combined with Clostridium difficile infection(78.6%), refractory ulcerative colitis(70.9%), ulcerative colitis(65.4%), Crohn's disease(59.4%), chronic constipation(43.7%), irritable bowel syndrome(39.1%), obesity(28.1%) and type 2 diabetes(23.9%). For donor selection, the majority of physicians preferred individuals with a similar gut flora environment to the recipients. 76.6% of physicians chose lower gastrointestinal tract as the administration approach. 69.2% of physicians considered FMT a safe treatment. CONCLUSION: Chinese physicians have awareness and a high acceptance of FMT, especially gastroenterologists, which provides the grounds and conditions for the development of this novel treatment in China. Physicians' greatest concerns were patient acceptability and absence of guidelines.
文摘Description: The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) jointly developed this guideline to present the evidence and provide clinical recommendations based on the benefits and harms of higher versus lower blood pressure targets for the treatment of hypertension in adults aged 60 years or older.
文摘AIM: To investigate Chinese physicians' awareness of the 2010 guidelines on the treatment of chronic hepatitis B virus(HBV) infection.METHODS: This was a quantitative survey that investigated the characteristics and practices of physicians who were treating patients with hepatitis B, the profile of their patients and physician practices regarding the diagnosis and treatment of HBV at the time of the survey. Participants were randomly selected from available databases of Chinese physicians and requested to complete either an online or paper-based survey. Data from the survey responses were analysed. For data validation and interpretation, qualitative in-depth interviews were conducted with 39 of the respondents.RESULTS: Five-hundred completed surveys, from 663 physicians were available for analysis. A mean of 175 chronic hepatitis B(CHB) patients was seen by each physician every month, of whom 85(49%) were treated in line with therapeutic indications stated in the 2010 guidelines. A total of 444(89%) physicians often(> 60% of the time) adhered to the guidelines. Most physicians used antiviral medications as recommended. For patients with compensated and decompensated cirrhosis, 342(68%) and 336(67%) of physicians, respectively, often followed the recommendation to use potent nucleos(t)ide analogues with a high genetic barrier to resistance, using the appropriate treatment more than 60% of the time. Physicians from infectious disease or liver disease departments were better informed than those from gastrointestinal or other departments.CONCLUSION: The majority of Chinese physicians often adhere to Chinese 2010 CHB guidelines and are well-informed about the use of antiviral medications for hepatitis B.
文摘Effective communication among healthcare professionals in the intensive care unit (ICU) is a particular imperative,with accurate and efficient interdisciplinary communication being a critical prerequisite for high-quality care.Nurses and physicians are highly important parts of the healthcare system workforce.Thus,identifying strategies that would improve communication between these two groups can provide evidence for practical improvement in the ICU,which will ultimately improve patient outcomes.This integrative literature review aimed to identify interventions that improve communication between nurses and physicians in ICUs.Three databases (Medline,CINAHL,and Science Direct) were searched between September 2014 and June 2016 using 11 search terms,namely,nurse,doctor,physician,resident,clinician,ICU,intensive care unit,communication,teamwork,collaboration,and relationship.A manual search of the reference lists of found papers was also conducted.Eleven articles met the inclusion criteria.These studies reported on the use of communication tools/checklists,team training,multidisciplinary structured work shift evaluation,and electronic situation-background-assessment -recommendation documentation templates to improve communication.Although which intervention strategies are most effective remains unclear,this review suggests that these strategies improve communication to some extent.Future studies should be rigorously designed and outcome measures should be specific and validated to capture and reflect the effects of effective communication.
文摘BACKGROUND: Emergency physicians have been successful in implementing procedural sedation and analgesia(PSA) to treat emergency department(ED) patients who need to undergo painful procedures.However, 25% of the EDs in the Netherlands are not staffed by emergency physicians.The aim of this study was to investigate PSA availability and quality in EDs without emergency physicians.METHODS: We performed an exploratory cross-sectional study amongst ED nurses and physicians in all 13 EDs without emergency physicians in the Netherlands.Data were gathered using a standardized questionnaire.RESULTS: The response rate was 34.3%(148/432).Of the respondents, 84/148(56.8%) provided adult PSA and 30/148(20.3%) provided paediatric PSA.Main reasons for not providing PSA were insufficient numbers of trained staff to support PSA in the ED and insufficient training and exposure.The providers agreed significantly stronger when reflecting their PSA competencies in adults compared to paediatric patients.CONCLUSION: The key to improve pain management in the ED-setting may lay in investing in continuous training of ED health care professionals and/or acquiring professionals who are both qualified in PSA and available in the ED.
文摘Male patients with lower urinary tract symptoms(LUTS)and benign prostatic hyperplasia(BPH)are increasingly seen by family physicians worldwide due to ageing demographics.A systematic way to stratify patients who can be managed in the community and those who need to be referred to the urologist is thus very useful.Good history taking,physical examination,targeted blood or urine tests,and knowing the red flags for referral are the mainstay of stratifying these patients.Case selection is always key in clinical practice and in the setting of the family physician.The best patient to manage is one above 40 years of age,symptomatic with nocturia,slower stream and sensation of incomplete voiding,has a normal prostatespecific antigen level,no palpable bladder,and no haematuria or pyuria on the labstix.The roles of α blockers,5-α reductase inhibitors,and antibiotics in a primary care setting to manage this condition are also discussed.
文摘The aim of this study was to determine the association of depressive symptoms with dietary habits among physicians working in hospitals in Japan. We mailed an anonymous questionnaire with the Quick Inventory of Depressive Symptomatology and items about dietary habits to 10,000 randomly selected physicians. Logistic regression analysis was used to explore the association of depressive symptoms with dietary habits. The participants comprised 3862 physicians (3025 men and 837 women). Among the respondents, 252 (8.3%) men and 88 (10.5%) women were determined to be in depressive symptoms. For men, “never eat a balanced diet” (Odds ratio;95% confidence interval, 2.54;1.70 - 3.80), and for women “eat quite small meals” (3.81;1.14 - 13.1), “always eat until full” (4.40;1.48 - 13.1), and “never eat a balanced diet” (3.05;1.49 - 6.23) were associated with depressive symptoms. For men, “do not eat too much” (0.57;0.39 - 0.83) was associated with prevention of depression. Physicians should recognize the important role of healthy dietary habits in good mental health. Hospitals should intervene to help physicians address depressive symptoms and dietary habits.
文摘Prior studies have not explored physician’s attitudes toward, and behavior and willingness to accept an e-health care system. However, physicians can induce demand for their services. The development of the high-tech asthma care mobile service (ACMS) in Taiwan provided a means of exploring key factors in a physician’s choice of using an ACMS. The study was based on the technology acceptance model (TAM) and integrated “subjective norm,” “innovativeness,” and “managerial support” to understand and predict physicians’ attitudes and behavioral intentions toward adopting high-tech healthcare systems such as the ACMS. Of 700 questionnaires distributed to physicians with experience using ACMS, 504 completed returns were received (a 72% response rate). The data were analyzed using the structural equation modeling (SEM) method. The results of the study showed that the model selected to explain and predict utilization of the ACMS had high explanatory power and was a good-fit model. The most critical factor that affected behavioral intentions related to ACMS was user attitude, followed by perceived usefulness, managerial support, subjective norm, perceived ease of use, and innovativeness.
