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
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
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 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
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
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
Background: Standard precautions (SPs) are the minimum infection prevention practices that aim to protect Health care workers (HCWs) including physicians and prevent them from transmitting the infections to their pati...Background: Standard precautions (SPs) are the minimum infection prevention practices that aim to protect Health care workers (HCWs) including physicians and prevent them from transmitting the infections to their patients. Purpose: To assess the level of compliance of physicians with standard precautions of handling patients with infectious respiratory disease. Method: A cross sectional questionnaire-based study was conducted in two tertiary level hospitals named M Abdur Rahim Medical College and Hospital, Dinajpur, Bangladesh and Rajshahi Medical College and Hospital, Rajshahi, Bangladesh to assess the level of compliance of physicians with standard precautions. Purposive sampling technique was applied as per inclusion criteria and data was collected by face to face interview from 285 physicians. Statistical analysis of the results was done by SPSS and a p value less than 0.05 was considered as significant. Result: The study revealed that maximum physicians (76.5%) handling patients with infectious respiratory disease had a moderate level of compliance with standard precautions. 78.6% of the physicians had moderate level of awareness about standard precautions. Only 20.35% of the physicians had training on infection control. 94.4% of the respondents didn’t know the component of standard precaution and most of the physicians were not aware of the sequence of wearing and removing the different components of PPEs. Conclusion: The study result implies that with increased awareness, the compliance of the physicians with standard precautions increased. The main reasons of non-compliance with standard precautions were found to be lack of resources, lack of regular training and excess workload.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 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
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
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
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
A cross-sectional online survey was conducted.A high proportion of the Chinese breast cancer(BC)physician respondents(n=77)would prescribe extended adjuvant endocrine therapy(AET)with aromatase inhibitors(AI)beyond 5 ...A cross-sectional online survey was conducted.A high proportion of the Chinese breast cancer(BC)physician respondents(n=77)would prescribe extended adjuvant endocrine therapy(AET)with aromatase inhibitors(AI)beyond 5 years for postmenopausal females with BC,especially those with higher risk.Respondents with≥15 years of clinical experience were more likely to prescribe a longer duration of AET for low-risk patients.Half of the respondents considered intermittent letrozole as an acceptable option.Most respondents would prescribe adjuvant chemotherapy to genomic high-intermediate risk[Oncotype DX recurrence score(RS)21-25]females aged≤50 years regardless of the clinical risk classification.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
Background: The availability of an anesthesiologist is often a limiting factor in the number of operations that can be performed by International Medical Surgical Response Teams (IMSuRT). Because emergency physicians ...Background: The availability of an anesthesiologist is often a limiting factor in the number of operations that can be performed by International Medical Surgical Response Teams (IMSuRT). Because emergency physicians (EPs) possess skills in airway control, management of moderate and deep sedation, and ventilator management, we propose that with proper training in general anesthesia, EPs can serve as anesthetists for IMSuRT with anesthesiologist supervision. Methods: During a 10-week period, a board-certified EP administered general anesthesia to 60 patients prior to a surgical medical mission trip. The breakdown of surgical cases was: 11 orthopedic, 2 genitourinary, 20 ear, nose, and throat, 8 obstetrics and gynecological, 13 general surgery, and 6 vascular. A simplified protocol for induction, maintenance, and emergence was adhered to for all cases. Results: Fourteen orthopedic cases using general anesthesia were performed in a one-week period in Haiti. These cases involved open reduction and internal fixation (ORIF), hemiarthoplasty, hardware removal, tendon transfer and external fixation of fractured bone. Conclusion: We demonstrate the feasibility of a model curriculum to train EPs in the basics of anesthesia. The EP can safely and effectively deliver general anesthesia for major cases on surgical medical mission trips under the auspices of an anesthesiologist in an austere environment.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
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
The present study aims to investigate the perceptions and experience of physicians regarding the clinical role of the pharmacists. This is an observational study that was conducted during the period of September 2013 ...The present study aims to investigate the perceptions and experience of physicians regarding the clinical role of the pharmacists. This is an observational study that was conducted during the period of September 2013 through March 2014. A self-administered questionnaire was designed to be distributed by personal interview to the physicians. The questionnaire population consisted of randomly selected physicians practicing in UAE. The questionnaire was piloted by 10 physicians for face and understandability. Demographic data, frequencies and cross tabulation between different variables were calculated. The Chi-square test was used to determine the significance of association between categorical variables (gender, length of medical practice, and specialty) and the perception of physicians. A total of 285 filled questionnaires were returned representing 285 physicians, with a male dominance (65.3%). The average age of the physician screened was 32.4 (SD = 10.38) years with a minimum one year experience and up to 24 years. General practitioners consumed the widest sector (21.8%) followed by cardiologists (15.8%), then internal medicine (10.1%). In the current study, two thirds of the physicians believed that pharmacists could act as a reliable source of general drug information and play an important role in discovering clinical related problems. It was found that the physicians who had fewer years in practice (less than 10 years) and recently graduated had more acceptances to the clinical role of the pharmacist and believed that there should be a clinical pharmacy services in their hospitals (p-value < 0.05). No other statistically significant differences were found from analyzing the data. In conclusion, results suggest that physicians in UAE appear comfortable with pharmacists providing the broad range of services but appear somewhat less comfortable with pharmacists’ provision of direct patient care.展开更多
Occupational stress presents a major public health problem. It is the subject of many works in Morocco and in the world. Our work focuses on the study of stress resistance among nurses and physicians working in servic...Occupational stress presents a major public health problem. It is the subject of many works in Morocco and in the world. Our work focuses on the study of stress resistance among nurses and physicians working in services at Ibn Sina Hospital in Rabat, Morocco. The aim of this study is to analyze the relationship between resistance status, burnout and level of psychological distress. A self-questionnaire is provided to all respondents. It includes questions about socio-demographic and professional, clinical, also neuropsychological tests such as the stress resistance test (CTRS), the burnout scale (MBI) and the general health questionnaire (GHQ12). This study shows that 42% of nurses and physicians have a high level of emotional exhaustion, high level of depersonalization affects 49% of nurses and physicians and subjects with low professional achievement account for 67% and 54% of nurses and physicians suffer from psychological distress. The stress test reveals that 88% of subjects have a low or moderate level of stress resistance and only 12% have good resistance. Thus, our study sheds new light on the understanding of stress at work by using new measurement and evaluation methods such as TRS, with the aim of reducing or eliminating the impact of occupational stress in hospitals.展开更多
Doctors who request imaging must be well trained in deciding whether diagnostic imaging is indicated and have an accurate knowledge of the associated risks. Although radiological doses are low and the chance of late e...Doctors who request imaging must be well trained in deciding whether diagnostic imaging is indicated and have an accurate knowledge of the associated risks. Although radiological doses are low and the chance of late effect is minimal, it should be kept as low as reasonably achievable. This cannot be achieved without a proper knowledge and adherence to safe practices. This cross-sectional study investigates the level of physicians’ knowledge about radiation safety and their attitude towards radiation protection. A self-administered questionnaire, for radiation safety was sent to a purposive sample of 120 physicians at Suez Canal University Hospital. Eighty questionnaires were filled by participants (response rate;66.7%). The sample included 22 radiologists, 15 oncologists, 25 surgeons and 18 orthopedists. Most participants did not receive any radiation safety-related training (88.8%). Radiologists and oncologists were exposed to ionizing radiation more frequently;however, their knowledge was as low as that of other physicians. The overall knowledge score ranged from 40% - 60% (mean;56.5 ± 15.2), with a low score among surgeons and orthopedics. The most deficient knowledge was in the dose of background radiation and the radiation dose received by patients in each type of radiation procedure. Adherence to safe radiation practices was violated by most of participants, especially surgeons and orthopedics, but they attributed it to the poor applicability of the protective measures during performing the procedures. This study concluded that physicians at the Suez Canal University Hospital had deficient knowledge, unsafe practices and negative attitude towards radiation safety policies & precautions.展开更多
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.
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.
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Background: Standard precautions (SPs) are the minimum infection prevention practices that aim to protect Health care workers (HCWs) including physicians and prevent them from transmitting the infections to their patients. Purpose: To assess the level of compliance of physicians with standard precautions of handling patients with infectious respiratory disease. Method: A cross sectional questionnaire-based study was conducted in two tertiary level hospitals named M Abdur Rahim Medical College and Hospital, Dinajpur, Bangladesh and Rajshahi Medical College and Hospital, Rajshahi, Bangladesh to assess the level of compliance of physicians with standard precautions. Purposive sampling technique was applied as per inclusion criteria and data was collected by face to face interview from 285 physicians. Statistical analysis of the results was done by SPSS and a p value less than 0.05 was considered as significant. Result: The study revealed that maximum physicians (76.5%) handling patients with infectious respiratory disease had a moderate level of compliance with standard precautions. 78.6% of the physicians had moderate level of awareness about standard precautions. Only 20.35% of the physicians had training on infection control. 94.4% of the respondents didn’t know the component of standard precaution and most of the physicians were not aware of the sequence of wearing and removing the different components of PPEs. Conclusion: The study result implies that with increased awareness, the compliance of the physicians with standard precautions increased. The main reasons of non-compliance with standard precautions were found to be lack of resources, lack of regular training and excess workload.
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.
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A cross-sectional online survey was conducted.A high proportion of the Chinese breast cancer(BC)physician respondents(n=77)would prescribe extended adjuvant endocrine therapy(AET)with aromatase inhibitors(AI)beyond 5 years for postmenopausal females with BC,especially those with higher risk.Respondents with≥15 years of clinical experience were more likely to prescribe a longer duration of AET for low-risk patients.Half of the respondents considered intermittent letrozole as an acceptable option.Most respondents would prescribe adjuvant chemotherapy to genomic high-intermediate risk[Oncotype DX recurrence score(RS)21-25]females aged≤50 years regardless of the clinical risk classification.
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Background: The availability of an anesthesiologist is often a limiting factor in the number of operations that can be performed by International Medical Surgical Response Teams (IMSuRT). Because emergency physicians (EPs) possess skills in airway control, management of moderate and deep sedation, and ventilator management, we propose that with proper training in general anesthesia, EPs can serve as anesthetists for IMSuRT with anesthesiologist supervision. Methods: During a 10-week period, a board-certified EP administered general anesthesia to 60 patients prior to a surgical medical mission trip. The breakdown of surgical cases was: 11 orthopedic, 2 genitourinary, 20 ear, nose, and throat, 8 obstetrics and gynecological, 13 general surgery, and 6 vascular. A simplified protocol for induction, maintenance, and emergence was adhered to for all cases. Results: Fourteen orthopedic cases using general anesthesia were performed in a one-week period in Haiti. These cases involved open reduction and internal fixation (ORIF), hemiarthoplasty, hardware removal, tendon transfer and external fixation of fractured bone. Conclusion: We demonstrate the feasibility of a model curriculum to train EPs in the basics of anesthesia. The EP can safely and effectively deliver general anesthesia for major cases on surgical medical mission trips under the auspices of an anesthesiologist in an austere environment.
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.
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The present study aims to investigate the perceptions and experience of physicians regarding the clinical role of the pharmacists. This is an observational study that was conducted during the period of September 2013 through March 2014. A self-administered questionnaire was designed to be distributed by personal interview to the physicians. The questionnaire population consisted of randomly selected physicians practicing in UAE. The questionnaire was piloted by 10 physicians for face and understandability. Demographic data, frequencies and cross tabulation between different variables were calculated. The Chi-square test was used to determine the significance of association between categorical variables (gender, length of medical practice, and specialty) and the perception of physicians. A total of 285 filled questionnaires were returned representing 285 physicians, with a male dominance (65.3%). The average age of the physician screened was 32.4 (SD = 10.38) years with a minimum one year experience and up to 24 years. General practitioners consumed the widest sector (21.8%) followed by cardiologists (15.8%), then internal medicine (10.1%). In the current study, two thirds of the physicians believed that pharmacists could act as a reliable source of general drug information and play an important role in discovering clinical related problems. It was found that the physicians who had fewer years in practice (less than 10 years) and recently graduated had more acceptances to the clinical role of the pharmacist and believed that there should be a clinical pharmacy services in their hospitals (p-value < 0.05). No other statistically significant differences were found from analyzing the data. In conclusion, results suggest that physicians in UAE appear comfortable with pharmacists providing the broad range of services but appear somewhat less comfortable with pharmacists’ provision of direct patient care.
文摘Occupational stress presents a major public health problem. It is the subject of many works in Morocco and in the world. Our work focuses on the study of stress resistance among nurses and physicians working in services at Ibn Sina Hospital in Rabat, Morocco. The aim of this study is to analyze the relationship between resistance status, burnout and level of psychological distress. A self-questionnaire is provided to all respondents. It includes questions about socio-demographic and professional, clinical, also neuropsychological tests such as the stress resistance test (CTRS), the burnout scale (MBI) and the general health questionnaire (GHQ12). This study shows that 42% of nurses and physicians have a high level of emotional exhaustion, high level of depersonalization affects 49% of nurses and physicians and subjects with low professional achievement account for 67% and 54% of nurses and physicians suffer from psychological distress. The stress test reveals that 88% of subjects have a low or moderate level of stress resistance and only 12% have good resistance. Thus, our study sheds new light on the understanding of stress at work by using new measurement and evaluation methods such as TRS, with the aim of reducing or eliminating the impact of occupational stress in hospitals.
文摘Doctors who request imaging must be well trained in deciding whether diagnostic imaging is indicated and have an accurate knowledge of the associated risks. Although radiological doses are low and the chance of late effect is minimal, it should be kept as low as reasonably achievable. This cannot be achieved without a proper knowledge and adherence to safe practices. This cross-sectional study investigates the level of physicians’ knowledge about radiation safety and their attitude towards radiation protection. A self-administered questionnaire, for radiation safety was sent to a purposive sample of 120 physicians at Suez Canal University Hospital. Eighty questionnaires were filled by participants (response rate;66.7%). The sample included 22 radiologists, 15 oncologists, 25 surgeons and 18 orthopedists. Most participants did not receive any radiation safety-related training (88.8%). Radiologists and oncologists were exposed to ionizing radiation more frequently;however, their knowledge was as low as that of other physicians. The overall knowledge score ranged from 40% - 60% (mean;56.5 ± 15.2), with a low score among surgeons and orthopedics. The most deficient knowledge was in the dose of background radiation and the radiation dose received by patients in each type of radiation procedure. Adherence to safe radiation practices was violated by most of participants, especially surgeons and orthopedics, but they attributed it to the poor applicability of the protective measures during performing the procedures. This study concluded that physicians at the Suez Canal University Hospital had deficient knowledge, unsafe practices and negative attitude towards radiation safety policies & precautions.
