integrity of physicians

BACKGROUND: Limited evidence on utilisation of health care by recently arrived asylum seekers and refugees in high-income countries is available. This study aims to describe the implementation of an integrated care facility (ICF) in an initial reception centre and measure the utilisation of care and the influence of operational parameters. METHODS: In a retrospective cohort study design, using medical records, we followed inhabitants of a reception centre in Germany between 11...

INTRODUCTION: This study aims to reduce potentially inappropriate prescribing (PIP) of statins and foster healthy lifestyle promotion in cardiovascular disease (CVD) primary prevention in low-risk patients. To this end, we will compare the effectiveness and feasibility of several de-implementation strategies developed following the structured design process of the Behaviour Change Wheel targeting key determinants of the clinical decision-making process in CVD prevention. METHODS AND ANALYSIS: A cluster randomised implementation trial, with an additional control group, will be launched, involving family physicians (FPs) from 13 Integrated Healthcare Organisations (IHOs) of Osakidetza-Basque Health Service with non-zero incidence rates of PIP of statins in 2021...

BACKGROUND: Racial and ethnic disparities have been well-described among surgical specialties, however, variations in underrepresented minority (URiM) representation between these specialties have not previously been quantified. METHODS: Data collected from Accreditation Council for Graduate Medical Education (ACGME) annual reports were used to derive the Diversity of Surgical Trainee Index (DoSTI) metric, which was calculated as the proportion of URiM resident and fellow physicians within a given surgical specialty, relative to the overall proportion of URiM trainees within all surgical and non-surgical ACGME-accredited programs in the same academic year...

During the 14th century CE, a pivotal shift took place in the world of medicine as its epicenter transitioned from the Middle East to Europe. The emergence of the European Renaissance sparked skepticism regarding the significance of Avicenna's contributions to the advancement of medicine. This paper explores how the rise of secularization and the Renaissance in Europe marked significant cultural transformations, fostering the spread of literacy. These societal shifts influenced the trajectory of medical thought, and Avicenna's "Canon of Medicine" received both praise and condemnation amidst the evolving intellectual landscape...

The popularity of electronic cigarettes among young people in Switzerland has been increasing since the introduction of puffs to the market. According to recent epidemiological data, more than half of 14-25 year olds have tried these devices, potentially exposing themselves to nicotine and substances with little-known long-term effects. This phenomenon raises concerns regarding health risks and the developmental phase during which these consumptions occur. Primary care physicians have a crucial role to play in managing these consumptions through an integrated approach...

OBJECTIVE: Describe the implementation of a digital diagnostic and territorial monitoring tool in primary healthcare. METHODS: Quantitative and qualitative study, developed in 14 basic healthcare units in São Paulo, with community health workers, coordinators, nurses, and physicians. Data collection occurred in four phases: analysis of the instruments used by the team for territory management; development of the digital tool; training and implementation; and evaluation after 90 days using focus groups...

INTRODUCTION: Integrating climate change and health into a medical school curriculum is critical for future physicians who will manage health crises caused by a rapidly changing climate. Although medical schools have increasingly included climate change in the curriculum, there remains a need to address the link between the climate crisis, environmental justice, and historical policies that shape environmental health disparities in local communities. METHODS: In academic years 2021-2022 (AY22) and 2022-2023 (AY23), second-year medical students participated in a 2...

PURPOSE: Management reasoning is a distinct subset of clinical reasoning. We sought to explore features to be considered when designing assessments of management reasoning. METHODS: This is a hybrid empirical research study, narrative review, and expert perspective. In 2021, we reviewed and discussed 10 videos of simulated (staged) physician-patient encounters, actively seeking actions that offered insights into assessment of management reasoning. We analyzed our own observations in conjunction with literature on clinical reasoning assessment, using a constant comparative qualitative approach...

BACKGROUND: Though there has been considerable effort to implement machine learning (ML) methods for health care, clinical implementation has lagged. Incorporating explainable machine learning (XML) methods through the development of a decision support tool using a design thinking approach is expected to lead to greater uptake of such tools. OBJECTIVE: This work aimed to explore how constant engagement of clinician end users can address the lack of adoption of ML tools in clinical contexts due to their lack of transparency and address challenges related to presenting explainability in a decision support interface...

The Flow Diverter is a self-expandable braided stent that has helped improve the effectiveness of cerebral aneurysm treatment during the last decade. The Flow Diverter's efficiency heavily relies on proper decision-making during the pre-operative phase, which is currently based on static measurements that fail to account for vessel or tissue deformation. In the context of providing realistic measurements, a biomechanical computational method is designed to aid physicians in predicting patient-specific treatment outcomes...

The CPD landscape is rapidly evolving and may be affecting patient outcomes. This also poses challenges to healthcare professionals, some of whom are experiencing a lot of stress leading to burnout. Medical and residency training are very structured and the importance of CPD occurring in a non-structured setting to prevent professional stagnation cannot be overemphasized. The need for lifelong learning post- residency, which encompasses a much longer period until retirement, is underscored hence the need for a cultural shift...

IMPORTANCE: Timely tests are warranted to assess the association between generative artificial intelligence (GenAI) use and physicians' work efforts. OBJECTIVE: To investigate the association between GenAI-drafted replies for patient messages and physician time spent on answering messages and the length of replies. DESIGN, SETTING, AND PARTICIPANTS: Randomized waiting list quality improvement (QI) study from June to August 2023 in an academic health system...

PURPOSE: The expanding capabilities of surgical systems bring with them increasing complexity in the interfaces that humans use to control them. Robotic C-arm X-ray imaging systems, for instance, often require manipulation of independent axes via joysticks, while higher-level control options hide inside device-specific menus. The complexity of these interfaces hinder "ready-to-hand" use of high-level functions. Natural language offers a flexible, familiar interface for surgeons to express their desired outcome rather than remembering the steps necessary to achieve it, enabling direct access to task-aware, patient-specific C-arm functionality...

PROBLEM: In the United States, physician bias is exhibited early in medical training and contributes to systemic inequities within the field of medicine. A lack of diversity, equity, inclusion, and antiracism (DEI-AR) content within medical curricula drives critical gaps in knowledge and deficiencies when preparing medical students to serve patients of diverse backgrounds. At the Mayo Clinic Alix School of Medicine (MCASOM), student-led curricular reviews between 2017 to 2018 and 2020 to 2021 revealed opportunities to improve DEI-AR content within preclinical courses...

This case report describes an atypical small bowel obstruction in a 71- years old cannabis user and how point-of-care of ultrasound (PoCUS) helped to its management by further orientating the physician toward the bowel obstruction etiology, namely intussusception. Intussusception is the invagination of an intestinal segment into the adjacent segment. The acute clinical presentation of intussusception often has non-specific symptoms, and the diagnosis can be challenging. While the most common etiology is neoplasm, intussusception also occurs in bowel motility disorder such as after cannabis use...

BACKGROUND: Deceased organ donation rates are extremely low in India. As future physicians, medical students can advocate organ donation in society. However, their knowledge, attitudes, and practices regarding organ donation remain understudied in India. Therefore, the present study aimed to assess the knowledge, attitudes, and practices related to deceased organ donation among undergraduate medical students in India using a mixed methods approach. MATERIALS AND METHODS: This is a mixed-method study with a cross-sectional survey conducted among 400 randomly selected medical students at a medical college in India using a pretested questionnaire...

BACKGROUND: The prevalence of lung cancer in the Middle East and Africa (MEA) region has steadily increased in recent years and is generally associated with a poor prognosis due to the late detection of most of the cases. We explored the factors leading to delayed diagnoses, as well as the challenges and gaps in the early screening, detection, and referral framework for lung cancer in the MEA. METHODS: A steering committee meeting was convened in October 2022, attended by a panel of ten key external experts in the field of oncology from the Kingdom of Saudi Arabia, United Arab Emirates, South Africa, Egypt, Lebanon, Jordan, and Turkey, who critically and extensively analyzed the current unmet needs and challenges in the screening and early diagnosis of lung cancer in the region...

We present two cases of cricoid chondronecrosis treated with hyperbaric oxygen (HBO2 ) therapy. Both patients presented with biphasic stridor and dyspnea several weeks after an intubation event. Tracheostomy was ultimately performed for airway protection, followed by antibiotic treatment and outpatient HBO2 therapy. Both patients were decannulated within six months of presentation and after at least 20 HBO2 therapy sessions. Despite a small sample size, our findings are consistent with data supporting HBO2 therapy's effects on tissue edema, neovascularization, and HBO2 potentiation of antibiotic treatment and leukocyte function...

BACKGROUND: People experiencing homelessness frequently die young, from preventable and treatable conditions. They experience significant barriers to healthcare and are often critically ill when admitted to hospital. A hospital admission is an opportunity to intervene and prevent premature mortality by providing compassionate care and facilitating access to safe onward accommodation and support. METHODS: To quantify needs, a cross-sectional audit of inpatients experiencing homelessness across 15 acute hospital teams in London, was undertaken in February 2022...

Obesity is associated with respiratory dysfunction. It is a key risk and contributory factor in the sleep related breathing disorders, obstructive sleep apnoea/hypopnoea syndrome (OSAHS) and obesity hypoventilation syndrome (OHS). Weight management is an integral part of the management of these disorders, in addition to continuous positive airways pressure (CPAP) and non-invasive ventilation (NIV). Untreated, these conditions are associated with a high disease burden and as treatment is effective, early recognition and referral is critical...