Physician Attitudes Research Articles

Perspectives of telemedicine: a cross-sectional study among health care personnel

Background: Telemedicine is the remote delivery of medical services. There has yet to be sufficient data in our community on perspectives on telemedicine. Therefore, this study aimed to evaluate the perception and attitude of physicians and medical students in Bisha region toward telemedicine. Methods: A cross-sectional study was conducted among physicians in ten hospitals and primary health care centers in Bisha and medical students at the College of Medicine, University of Bisha, Saudi Arabia. A structured, self-administered online questionnaire with optional participation was distributed. Results: 239 responses were received with diverse distribution among different ages, genders, nationalities, occupations, and frequencies of daily technology use. The participants showed 60.3% acceptance of telemedicine, especially its helpfulness in transferring information among sectors. Various sociodemographic-dependent debates were retrieved regarding the viability of telemedicine approach, its integration ability, time and money saving, and flexibility. The frequency of personal computer use correlated positively with the participants’ perceptions and attitudes (p=0.001 and 0.003). A positive attitude was retrieved from 79.1% of participants, with readiness to obtain telemedicine training for better professional growth, especially in non-Saudi personnel. The lack of suitable equipment, patient satisfaction and compliance, weakness of the doctor-patient relationship, familiarity with technology, and extra load for physicians were the most prominent barriers mentioned by the participants. Conclusions: Meetings, training, and orientation programs still need to be scheduled for the general population, healthcare personnel, and information technologists to override the weaknesses in community awareness and telemedicine deficiencies and to get the benefit of this technology.

European Nephrologists’ Attitudes toward the Application of Artificial Intelligence in Clinical Practice: A Comprehensive Survey

Introduction: The rapid advancement of artificial intelligence and big data analytics, including descriptive, diagnostic, predictive, and prescriptive analytics, has the potential to revolutionize many areas of medicine, including nephrology and dialysis. Artificial intelligence and big data analytics can be used to analyze large amounts of patient medical records, including laboratory results and imaging studies, to improve the accuracy of diagnosis, enhance early detection, identify patterns and trends, and personalize treatment plans for patients with kidney disease. Additionally, artificial intelligence and big data analytics can be used to identify patients’ treatment who are not receiving adequate care, highlighting care inefficiencies in the dialysis provider, optimizing patient outcomes, reducing healthcare costs, and consequently creating values for all the involved stakeholders. Objectives: We present the results of a comprehensive survey aimed at exploring the attitudes of European physicians from eight countries working within a major hemodialysis network (Fresenius Medical Care NephroCare) toward the application of artificial intelligence in clinical practice. Methods: An electronic survey on the implementation of artificial intelligence in hemodialysis clinics was distributed to 1,067 physicians. Of the 1,067 individuals invited to participate in the study, 404 (37.9%) professionals agreed to participate in the survey. Results: The survey showed that a substantial proportion of respondents believe that artificial intelligence has the potential to support physicians in reducing medical malpractice or mistakes. Conclusion: While artificial intelligence’s potential benefits are recognized in reducing medical errors and improving decision-making, concerns about treatment plan consistency, personalization, privacy, and the human aspects of patient care persist. Addressing these concerns will be crucial for successfully integrating artificial intelligence solutions in nephrology practice.

Emergency Department Buprenorphine Quality Improvement and Emergency Physician Knowledge, Attitudes, and Self-Efficacy.

Buprenorphine is an evidence-based treatment for opioid use disorder that is underused in the emergency department (ED). In this study we evaluated changes in emergency physician knowledge, confidence, and self-efficacy regarding buprenorphine prescribing and working with patients who use drugs after implementation of an ED buprenorphine quality improvement (QI) initiative. An anonymous, online survey was administered to emergency physicians staffing four EDs in New England in 2019 and 2020 before and after an ED QI initiative. Survey questions included novel and previously validated questions to assess confidence, knowledge, self-efficacy, and attitudes about buprenorphine and working with patients who use drugs. Confidence, self-efficacy, and attitude responses were assessed on a Likert scale. Participants received a gift card for survey completion. We analyzed pre- and post- survey responses descriptively and compared them using t-tests. Using logistic regression we evaluated the factors associated with buprenorphine prescribing. Of 95 emergency physicians, 56 (58.9% response rate) completed the pre-intervention survey and 60 (63.2%) completed the post-survey. There was an increase in the number of X-waivered adult emergency physicians and ED buprenorphine prescribing after program implementation. Physician confidence increased from a mean of 3.4 (SD 0.8) to 3.9 (SD 0.7; scale 1-5, p < 0.01). Knowledge about buprenorphine increased from a mean score of 1.4 (SD 0.7) to 1.7 (SD 0.5, p < 0.01). Physician attitudes and self-efficacy did not change. Post-initiative, increased confidence was associated with higher odds of buprenorphine prescribing (odds ratio 4.4; 95% confidence interval 1.07-18.4). After an ED QI initiative, buprenorphine prescribing in the ED increased, as did both physician confidence in working with patients who use drugs and their knowledge of buprenorphine. Increased confidence was associated with higher odds of buprenorphine prescribing and should be a focus of future, buprenorphine implementation strategies in the ED.

The stability of physicians’ risk attitudes across time and domains

Risk attitude is known to influence physicians' decision-making under uncertainty. Research on the risk attitudes of physicians is therefore important in facilitating a better understanding of physicians' decisions. However, little is known about the stability of physicians' risk attitudes across domains. Using five waves of data from a prospective panel study of Australian physicians from 2013 to 2017, we explored the stability of risk attitudes over a four-year period and examined the association between negative life events and risk attitudes among 4417 physicians. Further, we tested the stability of risk attitude across three domains most relevant to a physician's career and clinical decision-making (financial, career and clinical). The results showed that risk attitude was stable over time at both the mean and individual levels but the correlation between domains was modest. There were no significant associations between negative life events and risk attitude changes in all three domains. These findings suggest that risk attitude can be assumed to be constant but domain-specificity needs to be considered in analyses of physician decision-making.

Abstract 11638: Physician Attitudes Toward Beta Blocker and Antiplatelet Therapy in Spontaneous Coronary Artery Dissection Patients

Background: Spontaneous Coronary Artery Dissection (SCAD) primarily affects younger women and is a cause of acute coronary syndrome for which medical management guidelines and clinical trial data are lacking. Our study assessed physician attitudes toward beta blocker (BB) and antiplatelet therapy (APT) in SCAD. Methods: We conducted an online survey among 165 physicians who treat SCAD. Data were collected about their demographics, BB and APT prescribing practices in hypothetical SCAD patients each with one key difference from the base case, and willingness to randomize patients to BB or no BB and to dual APT [DAPT] (12 months of aspirin and P2Y12 inhibitor, then only aspirin) or single APT [SAPT] (3 months of aspirin, then no APT). Results were analyzed with descriptive statistics and chi-squared test. Results (Table): Of the respondents, 163 (99%) were cardiologists, and 64 (39%) were women. When considering BB at discharge, 88% of physicians would prescribe BB in the base case of an otherwise healthy 49-year-old woman with SCAD, with higher likelihood of prescribing BB in a patient with hypertension or ejection fraction (EF) &lt; 50%. Most physicians (95%) were willing to randomize the base case to BB or no BB. Respondents expressed uncertainty about the benefit of BB use, particularly in patients with normal blood pressure or with EF &gt; 50%. When considering APT at discharge, 38% of physicians would prescribe DAPT, 46% would prescribe SAPT, and 16% would prescribe no APT in the base case. Most physicians (92%) were willing to randomize the base case to the DAPT or SAPT strategies. Physicians expressed concern about inadequate and excessive APT, indicating a range of opinions. Conclusion: Most physicians would prescribe BB and APT at discharge after SCAD, with the type of APT varying widely. Nearly all were willing to randomize patients to BB or no BB and to DAPT or SAPT. Our results suggest clinical equipoise exists for BB and APT use in SCAD and point to the need for clinical trial data.

Perceived cost-conscious attitudes of physicians sensitized by the Choosing Wisely campaign during the undergraduate phase: A longitudinal study

IntroductionThe rational use of health resources has awakened us to the importance of including this theme in the curriculum of medical schools. This research aims to compare the perception of cost-conscious attitudes of medical students before and after the implementation of the CW campaign and after 1 year of medical practice. Material and methodsLongitudinal study conducted with students and physicians, who answered a questionnaire on cost-conscious perception at 3 moments: before the implementation of the CW campaign during the undergraduate phase; immediately after the campaign; and after 1 year of medical practice. In order to make the comparison among the different moments, the T-test for paired samples was used. ResultsIn the first 2 moments, 98 students participated, of which 80 also participated in the third moment, already as physicians. Most students disagreed that physicians should not think about cost when making therapeutic decisions, with a change after the educational actions (P = .001). There was agreement by the students on the items that refer to the physicians’ posture regarding science and responsibility to contain costs and discuss treatment options with patients. Comparing the answers after the campaign and at 1 year of practice, it was observed that the perception of cost-conscious attitudes was maintained. ConclusionsStudents showed high perception of cost-consciousness, even before the implementation of the campaign. Nevertheless, after the educational actions, an increase in this perception was observed; and, after 1 year of medical practice, this perception was maintained.

Standard-of-Care Bortezomib Dosing in Multiple Myeloma: An International Survey of Physicians

Background: Bortezomib (Velcade), a mainstay of treatment regimens for newly diagnosed multiple myeloma (MM), is often dosed twice-weekly in trials (i.e., Days 1, 4, 8, 11 in 21-day cycles). However, several analyses have shown that once-weekly bortezomib performs comparably and is associated with less peripheral neuropathy (Sidana PLoS One 2017, Mateos L&amp;L 2020, Cook AJH 2021). Many centers thus use once-weekly bortezomib in MM induction regimens regardless of transplant eligibility, e.g. modified VRd or Dara-VRd in 28-day cycles with once-weekly subcutaneous (SC) bortezomib 1.3 mg/m 2 (McCaughan BJH 2022). Physician attitudes and perceptions regarding how bortezomib should be dosed, an important step toward establishing a global standard of care in MM, have not been investigated. Methods: We conducted a global online survey of hematologists/oncologists who had treated ≥1 patient with MM in the past 12 months. The survey was distributed via social media platforms as well as targeted emails to MM physicians, IMWG members, and outreach through professional societies. The survey comprised 14 questions including usage of once- vs twice-weekly bortezomib, usage of SC vs IV bortezomib, attitudinal questions about potential benefits/disadvantages of each approach, and perceived barriers to using once-weekly bortezomib. Statistics were analyzed descriptively with Wilcoxon rank-sum and signed-rank tests. Results: Of 317 webpage visits, 205 responses were recorded (65% completion rate).Most respondents were from US academic practices (25%, n=52), US community practices (22%, n=46), or Australian academic practices (6%, n=13); however, responses were recorded from 38 countries including 22 low- or middle-income countries (LMICs: 29% of responses, n=60).Over a third of respondents (37%, n=76) practiced in community settings, and most respondents (58%, n=119) reported &amp;gt;20 patients with MM under their personal care . 93 respondents (45%) had previously helped write institutional or societal guidelines, including 21 IMWG members.Respondents reported using once-weekly bortezomib most of the time (median 95% of patients, IQR 80%-100%) and almost always used SC bortezomib (IQR 100%-100%).There were no significant differences in bortezomib frequency or route based on academic vs community practice, experience with MM, US vs non-US, or LMIC vs non-LMIC. Large majorities of respondents (Table 1) felt that once-weekly bortezomib is preferred by patients (94%), associated with comparable durations of response (79%), and associated with less peripheral neuropathy (89%). Conversely, 61% of respondents felt that twice-weekly bortezomib in superior in newly diagnosed MM with acute cast nephropathy.Physician estimates of the incidence of any-grade peripheral neuropathy were significantly lower with once-weekly bortezomib (median 30%, IQR 20-43%) vs twice-weekly bortezomib (median 50%, IQR 40-73%). Similarly, Grade 3+ neuropathy estimates were significantly lower with once-weekly (median 10%, IQR 5-17%) vs twice-weekly bortezomib (median 25%, IQR 15-38%), with p&amp;lt;0.001 in all cases . The most common cited barriers to ordering once-weekly bortezomib (Table 2) were perceived lack of prospective data (31%), difficulty modifying treatment orders (24%), and resistance from pharmacist colleagues who prefer adhering to trial-studied regimens (13%). Discussion: In our survey of over 200 MM-treating physicians from 38 countries (including 22 LMICs), once-weekly subcutaneous bortezomib was overwhelmingly preferred regardless of practice setting or country. The only exception was acute cast nephropathy, where twice-weekly bortezomib may expedite renal recovery and is reasonable to use initially. Neuropathy estimates were similar to published incidences (32% with once-weekly bortezomib vs 47% with twice-weekly bortezomib) from prospective data collected from the ALCYONE, GIMEMA-QW, and VISTA randomized trials (Mateos L&amp;L 2020). Our findings highlight the widening mismatch between what physicians routinely prescribe to patients versus what registrational trials typically require. Given that &amp;gt;90% of physicians personally prefer once-weekly bortezomib and that &amp;gt;90% report that their patients feel similarly, once-weekly bortezomib appears to have become the global standard of care. This consensus should be taken into consideration for clinical trial design in the future.

Physician practices and attitudes towards atopic dermatitis in Latin America: A cross-sectional study

BackgroundThe prevalence of atopic dermatitis (AD) is increasing in developing countries. Different worldwide guidelines have been proposed, but their applicability for AD specialists in Latin American (LA) countries is unknown. ObjectiveThe objective of this study was to explore the medical approach to treating AD in LA countries. MethodsThe study population comprised AD specialists (allergists and dermatologists). They completed an electronic survey containing questions about the health system, diagnostic criteria, and pharmacotherapy approach to treating AD. The survey was constructed and validated by the Atopic Dermatitis Committee of the Latin American Society of Allergy Asthma and Immunology (SLAAI) in Spanish and Portuguese. Each member was responsible for distributing the questionnaire through different networks in their respective countries. ResultsA total of 284 AD specialists from 13 LA countries completed the questionnaire; among them, 67% were allergists and 33% were dermatologists. Less than 50% of the AD specialists strictly followed guideline recommendations. Among the AD specialists, the European and North American guidelines were more frequently used, and only 16% followed LA guidelines. Dermatologists used the local guidelines less frequently than allergists. Most physicians did not routinely use AD assessment tools (55%). The frequency of the diagnostic tests depends on symptom severity. The availability of some systemic treatments, such as biologics and Janus Kinase (JAK) inhibitors, is not universal in all LA countries. ConclusionThere were marked differences between the specialists, and these differences seemed to be affected by their specialty and each country's healthcare system. New AD education strategies that consider the particularities of the region could allow patients to be more accurately managed. AD assessment tools may provide a way to enhance AD treatment and allow for shared decision-making, patient empowerment, and standardized care.

Evaluation of family physicians’ attitude towards primary healthcare consultations

Abstract Background The quality of services in the health care system is very important for both patients’ health and health care providers. In the past decade, good service ratings from the patient's perspective have become crucial in evaluating the work of medical professionals and health care institutions. However, it is also important to consider the opinions of health care specialists, especially when it comes to medical consultation, which is one of the most important components of primary health care (PHC) chain. Aim To evaluate the attitude of family physicians (FP) towards consultations provided in PHC. Methods The study was conducted in 2022. December - 2023 in February. The research contingent is FP of Lithuania. Research method - quantitative momentary research, anonymous questionnaire survey, 206 subjects were interviewed. Calculated chi-square (χ2) and z-criterion. Results The majority of FP indicated that they involve the patient in the decision-making process (68.0%), those working in private institutions said so more often than those working in public institutions (p &amp;lt; 0.05). 89.3% of the subjects stated that the consultation time with the patient is not enough, and 70.4% respondents receive many unregistered patient visits per day. E-health makes it difficult for 81.1%, 86.4% of the respondents indicated that there is too much of a workload and this was mostly said by respondents working in public institutions (p &amp;lt; 0.05). Remote consultations facilitate the workflow (76.2%). The older age of the respondents and greater work experience lead to lower self-confidence during remote consultation, longer consultation time and less belief in the benefits of remote consultation (p &amp;lt; 0.05). Conclusions Most FP positively evaluate the consultation they provide, but they also said that the consultation time is insufficient, they must consult a number of unregistered patients, e-health complicates the work. Remote consultations facilitate the workflow. Key messages • The consultation time is insufficient. • Remote consultations facilitate the workflow.

A critical issue for primary care practice: knowledge and attitudes of family physicians regarding levothyroxine use

Objective: Accurate management of hypothyroidism, which is one of the common reasons for referral to primary care, is critically important issue. This study aims to measure the knowledge and attitudes of family physicians (FPs) regarding the use of levothyroxine, which is the main pharmacological agent in the treatment of hypothyroidism.&#x0D; Methods: This prospective and descriptive study was performed on 102 physicians from family health centers in Şanlıurfa province central districts. The researchers created a questionnaire consisting of eight questions; seven of which were multiple choices and one was open-ended, by scanning the guidelines and literature. Data were obtained by face-to-face interview technique. &#x0D; Results: Of the participants, 21 (20.6%) were female and 81 (79.4%) male physicians, and the mean age of the participants was 36.9±8.0 (28-66) years. The work duration as a FP was 6.1±3.3 years. Sixteen (15.7%) of the participants reported that they had never prescribed levothyroxine. Two-thirds of them correctly answered the relationship between levothyroxine absorption and food intake, and 36.3% correctly answered that there would be a difference in absorption between different levothyroxine formulations. However, the rate of correct answers to the question of how to start hypothyroidism treatment in patients over 60 years of age or with coronary artery disease was quite low.&#x0D; Conclusions: The results of this study revealed that FPs in Sanliurfa central districts do not have adequate knowledge about the use of levothyroxine for treatment of hypothyroidism, and they need effective training on this vital issue.&#x0D; duyduklarını ortaya koymuştur.

Assessment of Knowledge, Attitude, and Practice Patterns in Pulmonary Arterial Hypertension among Cardiologists and Pulmonologists: Evidence from Turkey.

Background and Objectives: Pulmonary arterial hypertension (PAH) is a rare chronic disease of the small pulmonary arteries that causes right heart failure and death. Accurate management of PAH is necessary to decrease morbidity and mortality. Understanding current practices and perspectives on PAH is important. For this purpose, we intended to determine physicians' knowledge, attitudes, and practice patterns in adult pulmonary arterial hypertension (PAH) in Turkey. Materials and Methods: Between January and February 2022, an online questionnaire was sent via e-mail to all cardiologists and pulmonologists who were members of the Turkish Society of Cardiology (TSC) and the Turkish Thoracic Society (TTS). Results: A total of 200 physicians (122 pulmonologists and 78 cardiologists) responded to the questionnaire. Cardiologists were more frequently involved in the primary diagnosis and treatment of PAH than pulmonologists (37.2% vs. 23.8%, p = 0.042). More than half of the physicians had access to right heart catheterization. In mild/moderate PAH patients with a negative vasoreactivity test, the monotherapy option was most preferred (82.8%) and endothelin receptor antagonists (ERAs) were the most preferred group in these patients (73%). ERAs plus phosphodiesterase-5 inhibitors (PDE-5 INH) were the most preferred (69%) combination therapy, and prostacyclin analogues plus PDE-5 INH was preferred by only pulmonologists. Conclusions: Overall, clinical management of patients with PAH complied with guideline recommendations. Effective clinical management of PAH in specialized centers that having right heart catheterization achieve better outcomes.

Nitrous oxide use in Canadian pediatric emergency departments: a survey of physician's knowledge, attitudes, and practices.

Nitrous oxide (N2O) is an inhaled analgesic/ anxiolytic gas with evidence supporting its safety and efficacy for distressing procedures in children. Despite this, its use is not consistent across Canadian pediatric emergency departments (EDs). We aimed to characterize a) physicians' knowledge and practices with N2O and b) site-specific N2O protocols in Canadian pediatric EDs to help optimize its use nationally. This cross-sectional survey was distributed to physician members of Pediatric Emergency Research Canada (PERC) in early 2021. Survey items addressed practice patterns, clinician comfort, and perceived barriers/ facilitators to use. Further, a representative from each ED completed a site-specific inventory of N2O policies and procedures. N2O was available in 40.0% of 15 pediatric EDs, with 83.3% of these sites having written policies in place. Of 230 distributed surveys, 67.8% were completed with mean (SD) attending experience of 14.7 (8.6) years and 70.1% having pediatric emergency subspecialty training. Of the 156 respondents, 48.7% used N2O in their clinical practice. The most common indications for use were digit fracture/ dislocation reduction (69.7%), wound closure (60.5%), and incision & drainage (59.2%). Commonly perceived facilitators were N2O equipment availability (73.0% of 156) and previous clinical experience (71.7% of 156). Of the 51.3% of physicians who reported not using N2O, 93.7% did not have availability at their site; importantly, the majority indicated a desire to acquire access. They identified concerns about ventilation/ scavenging systems (71.2% of 80) and unfamiliarity with equipment (52.5% of 80) as the most common barriers to use. Despite evidence to support its use, only half of Canadian pediatric ED physicians surveyed use N2O in their clinical practice for treating procedure-related pain and distress. Increased availability of N2O equipment, protocols, and training may improve clinicians' abilities to better manage pediatric acute pain and distress in the ED.

Why is naloxone prescription not more common in emergency departments? A survey of physician practices and attitudes.

Emergency physicians (EPs) have a singular opportunity to prescribe naloxone and decrease fatal overdoses in opioid users. We surveyed EPs patterns of naloxone prescription and identified barriers to prescribing naloxone. Surveys were conducted at an emergency medicine conference from 2018 to 2019. We used a Likert scale for all questions and a chi-square or chi-square for trend tests to determine statistical significance. Emergency medicine conferences and emergency departments. Forty-one EPs were surveyed. Oral survey. Prevalence of naloxone prescription and EP attitude toward naloxone. 65.0 percent of residents and 33.3 percent of attending physicians had never prescribed naloxone to patients. 90.2 percent believed ED naloxone prescription is safe, 82.9 percent did not refrain from prescribing due to ethical concerns, and 73.2 percent believed it is not a waste of resources. Many resident physicians had never prescribed naloxone despite agreeing it was safe, ethical, and a productive use of resources. The time needed to counsel patients on naloxone use was a barrier to prescription, and various interventions are needed to make this practice more common.

Psychological Attitudes of Physicians in Seeking Help and Associated Factors.

Physician suicides have been increasing in recent years, and this shows that the psychological state of physicians is a subject that needs research and intervention. We think that the factors affecting the behavior of physicians to seek medical help due to their psychiatric disorders should be addressed. Therefore, we conducted a study examining the relationship between the anxiety, depression and stress levels of physicians, their attitudes toward seeking psychological help, and the degree of self-stigma related to seeking help. One hundred sixty-six physicians who accessed online platforms were included in the study, and data were collected using self-report forms. The Depression Anxiety Stress Scale, the Attitudes Toward Seeking Professional Psychological Help Scale, and the Self-Stigma in Seeking Help Scale were used as assessment instruments. A positive correlation was found between negative attitudes toward seeking psychological help and depression, anxiety, and stress, whereas a negative association was found between positive attitudes and depression, anxiety, and stress. A significant association was found between age and depression and anxiety scores. Physicians with high levels of depression, anxiety, and stress are more likely to exhibit negative attitudes toward seeking psychological help, and interventions are needed to improve attitudes toward seeking help.

A review of pharmacogenomics studies assessing the knowledge and attitudes of physicians and pharmacists across the Arab and Middle Eastern Region

A review of pharmacogenomics studies assessing the knowledge and attitudes of physicians and pharmacists across the Arab and Middle Eastern Region

Using a Quality Improvement Approach to Implement Measurement-Based Care (MBC) in Outpatient General Psychiatry.

Measurement-based care (MBC) is the clinical practice of using patient-reported symptom measurement to inform treatment decisions. MBC has been shown to improve patient outcomes and quality of care in outpatient psychiatry. Despite these benefits, MBC is not routinely used in most psychiatric outpatient settings. This quality improvement (QI) project aimed to achieve 75% completion of symptom scales using an online MBC platform in a general psychiatry clinic in Toronto, Canada, by June 2022. The QI team used the Model for Improvement methodology. The main outcome measure was completion of symptom scales using an online MBC platform. Process measures included counts of invitations to join the MBC platform, counts of online MBC account creation, and counts of symptom scale assignment by clinicians. Balancing measures included administrative task completion and physician workload assessment. Stakeholder interviews explored barriers and facilitators to MBC utilization. Completion of symptom scales increased from 7/65 (10.8%) preintervention to 40/70 (57.1%) during the 26-week intervention. Clinician reminders and coaching clinicians about how to incorporate MBC into the care process facilitated uptake of MBC. Stakeholders identified several barriers to implementation, particularly physician attitudes toward MBC and perceived administrative burden. Completion of symptom scales increased over the course of this QI initiative. Successful implementation of MBC in general psychiatry outpatient settings requires the availability of a broad range of measurement scales given the diversity of mental health diagnoses. Implementation must also consider health equity, including access to technology and availability of symptom scales in multiple languages.

Attitudes of primary care physicians toward bariatric surgery: a free word association networks analysis.

Primary care physicians (PCPs) hold major responsibility in referring patients with obesity eligible for bariatric surgery (BS). The aim was to explore PCPs' mental representation of BS in order to identify barriers and catalysts of BS referral practices. Switzerland. A total of 3526 PCPs were invited to participate in an online survey. PCPs were asked to write the first 5 words that came to their mind about the term "bariatric surgery." Additionally, they had to pick 2 emotions that best described each provided association. Demographic data and obesity-related referral patterns were collected. Mental representation network was constructed based on co-occurrence of associations, using validated data-driven methodology. In all, 216 PCPs completed the study (response rate: 6.13%). Respondents were aged 55 ± 9.8 years, had an equal sex distribution, and practiced mainly in urban settings. Three mental representations of BS emerged: indication-focused (most frequent associations: "obesity," "diabetes"), treatment-focused ("gastric bypass," "weight loss"), and outcome-focused ("complications," "challenging follow-up"). The emotional label "interested" was used significantly more frequently in the treatment-focused group. Comparison of PCPs among mental modules showed that those with a treatment-focused mindset referred patients for BS most frequently and were significantly more willing to follow up with postbariatric patients (χ2 = 17.8, P = .022). PCPs think about BS along 3 mental representations, and the treatment-focused attitude was coupled with the highest willingness to refer eligible patients for BS. Confidence in performing postbariatric follow-up was identified as catalyst of BS referral. Access to optimal care for patients with obesity may be improved accordingly.

Assessment of Physician Knowledge, Attitude and Safety Practice Towards Radiation Safety

Background: Radiations plays an important role in various diagnostic and therapeutic procedures within health facilities, but its use poses inherent risks to both healthcare professionals and patients. Understanding the knowledge, attitude, and safety practices of physicians in relation to radiation safety is paramount for ensuring the well-being of all stakeholders involved. Physicians, as key decision-makers in medical procedures involving radiation, need to be well-informed about the associated risks and safety measures. Objective: To determine the physician knowledge, attitude and safety practice towards radiation safety. Study Design: Cross-sectional study. Settings: Pakistan Institute of Medical Sciences, Islamabad Pakistan. Duration: March 2020 to February 2021. Methods: All the physician relevant to exposure to ionizing radiation, such as radiology, nuclear medicine, interventional cardiology, and oncology, having minimum one year or more experience in radiological field of either age and gender were included. Data collection was carried out through a structured questionnaire, specifically designed to evaluate participants' understanding of radiation safety principles, their attitudes towards adherence to safety protocols, and their day-to-day practices in radiological procedures. The collected data was analyzed using appropriate statistical methods SPSS version 26. Results: Majority of participants experience medical radiation exposure less than once per week (42.1%), with a significant portion having exposure more than three times per week (40.8%). 90.8% of participants have never undergone a radiation protection course, despite 73.7% expressing willingness to participate in such a course if provided by their institution. 52.7% strongly disagreed that radiation significantly affects childbearing, while 39.5% believe they are safe within 1 meter of radiation exposure. On a positive note, 86.8% of participants correctly identified the ALARA principle for radiation protection. Regarding the implementation of safety protocols, only 28.9% were more likely to wear a lead apron, and 22.4% never wore it. Conclusion: Health care professionals lacks adequate knowledge, training and attitude regarding radiation safety protocols. Lack of adequate knowledge and training leads to poor utilization of radiation safety equipment and it is a source of health hazard for both medical professionals and the patients.

The Red and Yellow Flag Awareness Level of Family Physicians in Low Back Pain

Aim: This study aims to determine the level of attitude and awareness of family physicians about red and yellow flags in patients with low back pain. Methods: A total of 395 family physicians were included in the study between February 2022 and April 2022. A questionnaire that evaluates the physicians’ non-mechanical causes of low back pain, red flag symptoms and findings, yellow flag signs, and the rate of questioning them in clinical practice was created and used. Results: Although 70.1% of the participants specified cauda equina symptoms, 65.3% non-mechanical nature of pain, 63.5% systemic illness findings, 62.5% history of severe trauma and malignancy as red flag symptoms and findings, 71.1% the presence of catastrophic thoughts as a yellow flag sign in low back pain, they could not achieve the same success in other red and yellow flag signs. The rate of questioning red and yellow flags in patients who applied to family physicians with low back pain was 60.7% and 34.5%, respectively. Conclusion: The results of our study show that family physicians have a deficiency in questioning the red and yellow flags. When it is considered that patients with low back pain consult family physicians frequently, we think that training family physicians on red and yellow flags may help to the quick determination of non-mechanical causes of low back pain and to prevent low back pain from becoming chronic. Keywords: low back pain, awareness, physicians, family

Isaaq Ibn Imran, A Physician of North Africa with a Look at His First Independent Work "Fi al-Mālikholiā" (Melancholy)

Medical knowledge has gone through many ups and downs in its historical background. The formation of medical schools existed in different areas of Islamic territory. The purpose of this research is to introduce the character of Isaaq Ibn Imran and the impact of his works on the evolution of medical knowledge in North Africa. The present paper was written with a descriptive-analytical approach and a library method. After collecting relevant information, historical sources were analyzed and classified. To get more information, many articles were read and a search was made in electronic databases. The knowledge and attitude of Muslim physicians were different according to the climatic characteristics. Social and political conditions were effective in the production of various works as well. Isaaq Ibn Imran (d. 892) was one of the physicians born in Baghdad, who played an important role in the expansion of medical knowledge and philosophy in North Africa. The results of the research indicate that Ibn Imran is considered sheikh al-Attiba and a specialist physician, a pioneer of the school of medicine and pharmacy in North Africa. From all the works and writings that have been remembered by him in the field of medicine, he can be mentioned as a specialist in mental diseases among Muslims. His most important writing is the treatise "Fi al-Mālikholiā" among the first works on the treatment of mental disorders and the description of its therapeutic drugs, which there was no history of writing such a book by Muslim physicians.