Physician Attitudes Research Articles

Exploring the osteoporosis treatment gap after fragility hip fracture at a Tertiary University Medical Center in Thailand

Background(1) To evaluate the prescription rate of anti-osteoporosis medication, and (2) to identify factors associated with patients not receiving anti-osteoporosis medication or, when prescribed, not persisting with medication 1 year after hip fracture treatment.MethodsWe retrospectively reviewed the medical records of all fragility hip fracture patients admitted to the orthopedic unit of the Faculty of Medicine Siriraj Hospital, Mahidol University, between July 1, 2016, and December 31, 2019. We identified patients who did not receive anti-osteoporosis medication both 6 months and 1 year after fracture treatment. Patients who did not receive the medication 1 year after their treatment were enrolled and interviewed using a no-treatment questionnaire.ResultsIn total, 530 patients with fragility hip fractures were eligible (mean age, 79.0 years), and most (74.5%) were women. Only 148 patients (31.6%) received anti-osteoporosis medication 1 year after hip fracture. Logistic regression analysis identified predictors for not receiving the medication: male sex (OR 1.8; 95% CI 1.1–3.0), Charlson comorbidity index score ≥ 5 (OR 1.5; 95% CI 1.0–2.3), and secondary school education or below (OR 2.0; 95% CI 1.2–3.3). The main reason for not receiving the medication was that healthcare providers neither discussed nor initiated pharmacological treatment for osteoporosis (48.2%). When the medication was prescribed, non-persistence primarily stemmed from transportation difficulties that resulted in patients missing follow-ups (50.0%).ConclusionsImproved physician attitudes toward anti-osteoporosis medications might enhance the treatment rate. Developing a follow-up team and facilitating access to medications (eg, courier delivery to patients) would promote therapy compliance.Trial registrationsThe protocol for the first phase and second phase was approved by the Siriraj Institutional Review Board of the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (COA no. Si 180/2021) and for the second phase, patients-informed consent forms used in the cross-sectional component were approved by the Siriraj Institutional Review Board of the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (COA no. Si 180/2021). The research was registered with the Thai Clinical Trials Registry (TCTR number: 20210824002). The study was conducted in accordance with the Declaration of Helsinki. Each patient (or a relative/caregiver) provided informed consent in writing or by telephone to participate in this second study phase.

Canadian Health Care Professionals' Familiarity with Chronic Cough Guidelines and Experiences with Diagnosis and Management: A Cross-Sectional Survey.

Educational programs on chronic cough may improve patient care, but little is known about how Canadian physicians manage this common debilitating condition. We aimed to investigate Canadian physicians' perceptions, attitudes, and knowledge of chronic cough. We administered a 10-min anonymous, online, cross-sectional survey to 3321 Canadian physicians in the Leger Opinion Panel who managed adult patients with chronic cough and had been in practice for > 2years. Between July 30 and September 22, 2021, 179 physicians (101 general practitioners [GPs] and 78 specialists [25 allergists, 28 respirologists, and 25 ear/nose/throat specialists]) completed the survey (response rate: 5.4%). In a month, GPs saw a mean of 27 patients with chronic cough, whereas specialists saw 46. About one-third of physicians appropriately identified a duration of > 8weeks as the definition for chronic cough. Many physicians reported not using international chronic cough management guidelines. Patient referrals and care pathways varied considerably, and patients frequently experienced lost to follow-up. While physicians endorsed nasal and inhaled corticosteroids as common treatments for chronic cough, they rarely used other guideline-recommended treatments. Both GPs and specialists expressed high interest in education on chronic cough. This survey of Canadian physicians demonstrates low uptake of recent advances in chronic cough diagnosis, disease categorization, and pharmacologic management. Canadian physicians also report unfamiliarity with guideline-recommended therapies, including centrally acting neuromodulators for refractory or unexplained chronic cough. This data highlights the need for educational programs and collaborative care models on chronic cough in primary and specialist care.

Telemedicine Usage of Physicians and Views on Telemedicine

Background: With the Covid-19 pandemic, those who care about working online from home office, computer and / or phone. it is aimed to pay attention to the use of telemedicine in the field of health and the attitudes of specialist physicians.
 Methods: 85 specialist physicians participated in our research. The collected selection analysis was performed with the SPSS 22.0 program.
 Results: Physicians working in internal sciences constituted 76.47% (n=65) of the study group. Among the matched branches, 24% (n=16) of clinical sciences consisted of pediatricians and their sub-branch physicians. 84.70% (n=72) of the physicians participating in the study did not perform video examination with telemedicine. Since it was only reviewed with telemedicine during working hours; 90.58% (n=77) of our study group stated that patients with at least 29 and below can be treated. During both face-to-face and telemedicine visual examinations, 83.52% (n=71) of our study group stated that a maximum of 9 patients could be treated by telemedicine. 85.88% of our study (percussion, palpation, auscultation) thought that telemedicine might be insufficient in evaluating the inspection user physical examination components. As for what precautions should be taken before telemedicine applications are popularized by the public, 83% of our physicians were supporters of the insurance company that wanted to intervene in helping the malpractice police. It should be considered as 76.47% (n=65) of our study group.
 Conclusions: It is thought that telemedicine will facilitate the work of specialist physicians. However, more studies and data are needed before it can be used.

Knowledge, attitude, and practice regarding child maltreatment amongst Iranian medical students through internship course: an 18-month longitudinal study

BackgroundChild maltreatment has been a major worldwide problem and has remained a persistent public health challenge in all countries. Physicians have a significant role in the prevention and intervention of child maltreatment. An educated physician that can effectively identify and report child maltreatment can fill one of the most significant gaps in reducing child abuse.This study was performed to examine the knowledge, attitude, and practice regarding child maltreatment among Iranian medical students through an internship course.MethodAll the medical students (235 students) of the Iran University of Medical Sciences who passed the internship entrance exam in the 2019–2020 academic year participated in this study. The participants completed a 49-item scale questionnaire built by combining three other validated questionnaires that evaluate their attitude, knowledge, and practice skills in the first month of their internship course and then completed the same questionnaire 18 months later, at the end-point of the internship period.ResultsOne-hundred thirty nine (59.1%) participants were female, and 96 (40.9%) were male. The mean age of the subjects was 24.35 ± 0.76. Only 7 (3%) of them formerly received any education about child maltreatment. There was a significant improvement in scores of the knowledge of prevention (p-value = 0.001), the practice of prevention (p-value < 0.001) and the general subscale of the practice section (p-value < 0.001) during the internship course. However, the performance of participants decreased significantly in the subscales of the attitude towards diagnosis (p-value = 0.001) and the attitude towards reporting (p-value < 0.001) of child maltreatment. At the end of the study, the result of graduated physicians was: The total knowledge and attitude of participants were satisfactory, and the majority were at reasonable levels. Although in the practice subscale, 70.6% of the participants didn’t identify, 84.7% didn’t refer, and 86.4% didn’t report a child abuse case in the past year.ConclusionThe knowledge and attitude of Iranian physicians regarding child maltreatment are at a satisfactory level. Although, the practice level has deficiencies. In addition, our findings show that Iranian interns have a shallow experience regarding child maltreatment, particularly despite the higher scores in attitude and knowledge, which can be the reason for deficiencies in the practice level.

Attitudes Towards Artificial Intelligence Among Dermatologists Working in Saudi Arabia.

Artificial intelligence (AI) and its applications are among the most discussed modern technologies today. Despite the rapidly expanding use of AI in medicine, and specifically in dermatology, only a few studies have studied the attitude of physicians toward AI. To recognize the attitudes towards AI among dermatologists in the Kingdom of Saudi Arabia. A cross-sectional survey was done among dermatologists in Saudi Arabia. Questionnaires were distributed through several online channels. Overall, 103 dermatologists filled out the survey. The majority saw very strong or strong potential for AI in the automated detection of skin diseases based on dermatological clinical images (50.9%), dermoscopic images (66.6%) and within dermatopathology (66.6%). In regard to results of attitudes towards AI, 56.6% and 52. 8% agreed that AI will revolutionize medicine and dermatology, respectively. However, many of the respondents disagreed that AI will replace physicians (41.5%) and human dermatologists (39.6%) in the future. Age did not impact the overall attitude of dermatologists. Dermatologists in Saudi Arabia showed an optimistic attitude towards AI in dermatology and medicine. However, dermatologists believe that AI will not replace humans in the future.

Emergency Medicine Physician Attitudes in the Treatment of Heart Failure (EMPATH)

Half of emergency department (ED) to hospital admission for acute heart failure may be unnecessary. Methods for ED risk stratification has improved in recent years, but their implementation has been questioned under the presumption that most acute heart failure (AHF) patients have higher risks of short-term adverse events than physicians will tolerate. There is a lack of modern data on emergency physician risk attitudes in heart failure despite this presumption, so our objective was to assess modern emergency physician risk attitudes and how they compare historical assumptions and modern risk stratification tools.&#x0D; Emergency physicians representing 9 emergency departments across Indiana were surveyed. Participants were board certified in emergency medicine and participation was voluntary. Each physician was asked to identify risk thresholds of outpatient treatment as opposed to admission for both 30-day mortality and 30-day adverse events in patients with AHF. For these risk thresholds, a range of choices was offered from 0-&lt;15%. Bayesian analysis was performed, and results were compared to risk thresholds of both literature suggest values and lowest risk score values.&#x0D; The response rate to the survey was 97.3% (73/75) physicians. The mean emergency physician risk tolerance for 30 day death and 30-day major adverse events were 3.8% (95% CI: 3.3%-4.4%) and 4.3% (3.8%-5.0%) respectively. Risk tolerance distribution is multimodal, with physician subpopulations who tolerate as high as 5-15% risk rates for outpatient disposition. Subgroups of risk tolerance differed only by race demographics.&#x0D; Current emergency medicine physicians are more risk tolerant than previously thought with risk tolerances not even reaching the average of prior values. Compared to historical literature, current risk tolerance more closely aligns with modern risk stratification tool values that were not available when past studies were performed. For reasons not fully understood there appears to be three distinct groups of risk tolerances among emergency physicians.

Community physicians’ attitudes towards meetings with representatives of pharmaceutical companies: a pilot study

BackgroundMarketing by pharmaceutical companies has become an increasingly controversial issue for the medical community and the public. This controversy stems from the potential influence that pharmaceutical companies can wield through marketing on the medical community. This study assesses community physicians’ attitudes towards pharmaceutical companies and their representatives to get a better understanding of how their activities affect daily work in community clinics.MethodsA cross-sectional anonymous questionnaire-based study of 170 community physicians in southern Israel was conducted via convenience sampling. The questionnaire was designed to assess physicians’ attitudes about the nature of their relationships with representatives of pharmaceutical companies and possible associations with physicians’ demographic and professional profiles. The questionnaire was distributed, at weekly staff meetings in the study clinics, to a convenience sample of physicians, who agreed to participate in the study.ResultsMost physicians did not have an extreme attitude on interactions with representatives of pharmaceutical companies. Interestingly, while they thought that pharmaceutical companies play an important role in medical progress, they did express concern regarding the risk of misleading information. While they believed that interactions between physicians and representatives of pharmaceutical companies had a negative effect on the clinic workflow, they were not in favor of prohibiting such interactions. Physicians who graduated from medical schools in Israel held a less sympathetic position towards these interactions.ConclusionThe anticipated heterogeneous attitudes of community-based physicians on interactions with representatives of pharmaceutical companies reflect an inherent complex relationship, with aspects that are specific to the Israeli medical field. Interestingly, physicians trained in other countries than Israel also have divergent attitudes, further affecting the socio-cultural impact on practitioner’s attitudes towards this intricate and often politicized topic. Open professional dialogue and targeted educational programs on the physician–pharmaceutical relationship, with more explicit regulation, could potentially ease the discomfort experienced by physicians, especially in the Israeli context and result in a clearer framework of interaction that would leverage the potential advantages while accounting for ethical and regulatory pitfalls.

Physicians’ and Individuals’ Attitudes Toward Digital Mental Health Tools: Protocol for a Web Survey Study With Physician and Stakeholder Interviews

Background Digital transformation is impacting health care delivery and showing great market dynamism, bringing opportunities and concerns alike. Digital health applications are a vibrant segment where regulation is emerging, with Germany paving the way with its DiGA program. Simultaneously, anxiety and depression constitute global health concerns, and their prevalence is expected to worsen due to the COVID-19 pandemic and its containment measures. Portugal and its National Health System may be a useful testbed for digital health interventions seeking to manage anxiety and depression. This research methodology is very relevant in studies on mental health, making the protocol highly reusable. Objective The paper outlines the protocol for a research project on the attitudes of physicians and potential users toward digital mental health apps to improve access to care and patient outcomes and to reduce the burden of disease for anxiety and depression. Methods Web surveys will be conducted to acquire data from main stakeholders (physicians and academic community). Data analysis will replicate studies from Dahlhausen and Borghouts to derive conclusions regarding the relative acceptance and likelihood of successful implementation of digital mental health apps in Portugal. Results The findings of the proposed studies will elicit important information on how physicians and individuals perceive digital mental health apps interventions to improve access to care and patient outcomes and to reduce the burden of disease for anxiety and depression. Conclusions The results of the studies projected in this research protocol will have implications for researchers and academia, industry, and policy makers regarding the adoption and implementation of digital health mental apps and associated interventions. Conflicts of Interest None declared.

Attitudes of Canadian stroke physicians regarding palliative care for patients with acute severe stroke: A national survey

BackgroundPalliative care (PC) aims to enhance the quality of life for patients and their families when confronted with serious illness. As stroke continues to inflict high morbidity and mortality, the integration of palliative care within acute stroke care remains an important aspect of quality inpatient care. AimThis study aims to investigate the experiences and perceived barriers of PC integration for patients with acute severe stroke in Canadian stroke physicians. MethodsWe conducted an anonymous, descriptive, cross-sectional web-based self-administered survey of stroke physicians in Canada who engage in acute severe stroke care. The questionnaire contained three sections related to stroke physician characteristics, practice attributes, and opinions about palliative care. Descriptive statistics, univariate, and regression analysis were performed to ascertain relations between collected variables. ResultsOf the 132 physician associate members, 120 were surveyed with a response rate of 69 (58%). Stroke physicians reported that PC services were consulted "sometimes" and that PC services were consulted rarely for prognostication and more often for end-of-life care which they agreed was better delivered off the stroke unit. Several barriers for early integration of palliative care services were identified including uncertainty in prognosis. Stroke physicians endorsed education of both families and physicians would be beneficial. ConclusionsThere remain perceived barriers for integration of palliative care within the acute stroke population. Challenges include consultation of PC services, uncertainty around patient prognosis, engagement, and educational barriers. There are opportunities for further integration and collaboration between palliative care physicians and stroke physicians.

Knowledge, attitudes, and behaviors toward fertility preservation in patients with breast cancer: A cross-sectional survey of physicians.

Fertility is an important issue for young women with breast cancer, but studies about physicians' knowledge, attitudes, and practices toward fertility preservation (FP) are largely based on Western populations and do not reflect recent international guidelines for FP. In this international study, we aimed to assess the knowledge, attitudes, and practices of physicians from South Korea, other Asian countries, and Latin America toward FP in young women with breast cancer, and identify the related barriers. The survey was conducted anonymously among physicians from South Korea, other Asian countries, and Latin America involved in breast cancer care between November 2020 and July 2021. Topics included knowledge, attitudes, and perceptions toward FP; practice behaviors; barriers; and participant demographics. We grouped related questions around two main themes-discussion with patients about FP, and consultation and referral to a reproductive endocrinologist. We analyzed the relationships between main questions and other survey items. A total of 151 physicians completed the survey. Most participants' overall knowledge about FP was good. More than half of the participants answered that they discussed FP with their patients in most cases, but that personnel to facilitate discussions about FP and the provision of educational materials were limited. A major barrier was time constraints in the clinic (52.6%). Discussion, consultations, and referrals were more likely to be performed by surgeons who primarily treated patients with operable breast cancer (FP discussion odds ratio [OR]: 2.90; 95% confidence interval [CI]: 1.24-6.79; FP consultation and referral OR: 2.98; 95% CI: 1.14-7.74). Participants' knowledge and attitudes about FP were significantly associated with discussion, consultations, and referrals. Physicians from South Korea, other Asian countries, and Latin America are knowledgeable about FP and most perform practice behaviors toward FP well. Physicians' knowledge and favorable attitudes are significantly related to discussion with patients, as well as consultation with and referral to reproductive endocrinologists. However, there are also barriers, such as limitations to human resources and materials, suggesting a need for a systematic approach to improve FP for young women with breast cancer.

Physician's Knowledge and Attitude towards Mental Health in Pakistan

Physician's Knowledge and Attitude towards Mental Health in Pakistan

Attitudes toward COVID-19 Vaccine Uptake: A Qualitative Study of Mostly Immigrant Racial/Ethnic Minority Older Adults.

(1) Background: Few qualitative studies address diverse older adults' perceptions of COVID-19 vaccination in the United States, including non-English speakers and immigrant populations. This study aims to understand the attitudes of diverse, primarily immigrant older adults in the U.S. toward the COVID-19 vaccine and its influences on their vaccination decision-making. (2) Methods: The research team conducted semi-structured interviews (N = 100) in 2021 focused on understanding ethnically/racially diverse older adults' perceptions of the COVID-19 vaccine. Interviews were recorded, coded, and analyzed using a thematic analysis approach. (3) Results: Thematic analyses identified three themes. (1) Older adults showed mixed attitudes toward the COVID-19 vaccine associated with information consumed and trust in healthcare systems; (2) health concerns and underlying medical conditions were the most influential factors of vaccine uptake; and (3) systemic barriers and trusted figures impacted vaccination decision-making of older adults. (4) Conclusions: Accessible information in diverse languages tailored to the community's fears is needed to combat vaccine mistrust. Vaccine rollout programs need to tackle the fear of vaccine side effects. Attitudes of religious leaders, family members, and physicians considerably influenced vaccine uptake, suggesting their role as trusted members for vaccine messaging for older, primarily immigrant adults. Systemic barriers, namely lack of transportation and inaccessible vaccination sites, contributed to vaccine deterrence.

Postoperative Pain Management Outcomes at a Chinese Hospital: A Cross-Sectional Survey

PurposePostoperative pain is one of the most common postoperative complications, and improper management not only adds to patient suffering but also affects patients' recovery. In this study, we measured patients' postoperative pain to understand the status of patients after surgery and to identify factors influencing postoperative pain. DesignA descriptive and cross-sectional study MethodsThis survey was conducted at a large tertiary hospital in Chengdu, Sichuan Province. A total of 655 postoperative inpatients were included. The survey was conducted using the Chinese version of the Houston Pain Outcome Instrument. General patient data, pain management-related factors, and the pain management index were used to survey risk factors. We used t-tests and ANOVA for univariate analysis of each pain outcome category to explore the association with the predictor variables. Then, those variables with a significance level of 0.05 on univariate analysis were entered into multivariable regression analysis to identify parsimonious subsets of independent risk factors. FindingsIn this survey, 58.7% of patients experienced moderate to severe pain in the 24-hour postoperative period, and 33.6% of patients had moderate to severe average pain over the 24-hour postoperative period. The postoperative pain impact scores on patient mood, somatic function, patient satisfaction with postoperative pain management, and pain education were 3.5 ± 2.1, 4.3 ± 3.1, 8.9 ± 1.4 and 8.2 ± 1.8, respectively. The pain management index, surgery type, insurance, and pain assessment of nurse were influential factors of postoperative pain intensity. Age, ethnicity, insurance, surgery type, patents' knowledge of pain, and pain assessment of the nurse affected the patients' postoperative physiological function (F = 3.822, R2 = 0.065, P = .000). In addition, area of residence and physician attitudes affected the outcomes of patient satisfaction with pain management (F = 26.652, R2 = 0.259, P = .000). ConclusionsThe incidence of moderate to severe pain in post-surgical patients remains high, and postoperative pain affects patients physically and psychologically. Special attention should be given to patients with lower income and literacy levels.

Knowledge, Attitude and Practice of Pediatric Physicians toward APGAR Score in Al-Qassim Region, Saudi Arabia

Background: Apgar score is a scoring system developed by Virginia Apgar in 1952 to assess newborns&amp;apos; health status. This study aimed to assess the knowledge, attitude and practice of physicians covering delivery rooms toward APGAR score at the Ministry of Health Hospitals in Al-Qassim Province, Saudi Arabia. Methods: A cross-sectional study was conducted among pediatric physicians at different Ministry of Health Hospitals in Qassim province, Saudi Arabia. A self-administered questionnaire was distributed among the targeted physicians using an online survey. The questionnaire includes socio-demographic data, a questionnaire that assesses knowledge toward APGAR score, and a questionnaire that measures the attitude and practice of APGAR score. Results: Among the 138 pediatric physicians involved in the study, 63% were males, and 38.4% were aged between 36 to 45 years old. The mean knowledge score was 6.04 (SD 1.17) out of 7 points. For attitude, the overall mean attitude score was 48.5 (SD 1.72) out of 60 points, with nearly all physicians (88.4%) estimated to have a positive attitude, and the rest were neutral (11.6%). Factors associated with increased knowledge were being more experienced, educated, and a consultant, while being a resident was associated with an improved attitude. Conclusion: The knowledge and attitude of pediatric physicians toward the APGAR score were sufficient. Older physicians with higher education and years of experience were likelier to demonstrate better knowledge. However, the attitude and practices toward the APGAR scores were more likely demonstrated by the resident physicians. More research is needed to shed more light on the knowledge and attitude of pediatric physicians in our region.

Attitudes of primary care physicians towards antimicrobial stewardship and the impact of a multi-part training course - a pilot study.

A plethora of antimicrobial stewardship (AMS) programs has been initiated during the past years, focusing on hospital settings. Primary-care physicians have seldom been addressed, although the majority of antibiotic prescriptions are issued for outpatients. We sought to investigate attitudes of primary-care physicians and the impact of a customized training course. Primary-care physicians in southwest Germany were invited to a multi-part training course on AMS in the primary-care setting. Participants were asked to answer a questionnaire about their attitude and factors that hinder them from implementing AMS or enable them to perform AMS. In addition, a knowledge assessment exam at the beginning and end of the training was conducted on selected infectious diseases/syndromes. In total, 36 primary-care physicians participated in the training course. The predominant age group was 51-60 years old (36%; 13/36). The majority, 23/35 (66%), indicated never having had AMS training, while 22/35 (63%) acknowledged partly implementing AMS activities in their daily routine. The primary barrier was lack of expertise, while the main motives were reducing antimicrobial resistance and optimizing patient care. The provision of guidelines was regarded as more important than feedback on their prescription behavior. Exam performance improved from the initial to the final exam on all topics. Customized AMS training courses are a feasible and potentially complimentary tool to address antibiotic misuse in the primary-care setting.

Perception and attitude of emergency department and primary care physicians towards subarachnoid hemorrhage in Al-Hasa, Saudi Arabia: a cross-sectional study

Objective: This study examined the perception and attitude of emergency department (ED) and primary care physicians (PCPs) toward subarachnoid hemorrhage (SAH) in Al-Hasa, Saudi Arabia, and identified challenges in its management. Methods: A cross-sectional research design was employed in this study. A self-administered structured questionnaire with 17 validated questions was distributed electronically via email and social media to 103 eligible ED and PCPs residing in Al-Ahsa city, Saudi Arabia. The sample represented physicians from different settings. Results: Results showed physicians had moderate SAH knowledge, with age being the most important in determining patient prognosis. Limited access to specialized care and trained staff were the biggest management challenges. Additional staff training and increased specialized care access were suggested to improve SAH management. Conclusion: SAH is a potentially life-threatening condition requiring immediate attention. ED and PCPs play a crucial SAH management role, so understanding their perception and attitude is important. Providing extra staff training and specialized care access might improve SAH management.

'Some of my patients only come to renew their prescriptions. They are not interested in any additional advice or support'. Physicians' perceptions on their roles in cardiovascular diseases risk reduction and management in Fiji.

Primary health care (PHC) physicians' perceptions are vital to understand as they are the first-line health care providers in cardiovascular diseases (CVD) risk assessment and management. This study aims to explore PHC physicians' perceptions on their roles and their perceptions on management and risk reduction approaches on CVD risk reduction and management in Fiji. This is a qualitative study conducted in the Suva Medical area among 7 health centers from 1 August to 31 September, 2021. Purposive sampling was used to recruit physicians who worked in the Suva medical area as PHC physicians with at least 6 months' experience in the Special Outpatients Department clinics. In-depth interview were conducted using a semi-structured questionnaire over the telephone and recorded on a tablet device application. The interview content was then transcribed, and thematic analysis was done. This study included 25 PHC physicians. From the thematic analysis, 2 major themes emerged with 6 subthemes. Theme 1 was CVD management skills with 3 subthemes including education, experience and trainings, beliefs and attitudes of physicians, self-confidence and effectiveness in CVD risk reduction and management. Theme 2 was roles and expectations with 3 subthemes including perceptions of effective treatment, perceptions of physicians' roles and perceptions of patients' expectations. Physicians generally see their role as central and imperative. They perceive to be important and leading toward combating CVDs. Physicians' perceptions on their commitment to prevention and management of CVDs through their skills and knowledge, beliefs and motivation should be acknowledged. It is recommended that the physicians are updated on the current evidence-based medicine. Limitations include results that may not be the reflection of the entire physician and multidisciplinary community and the difficulties in face-to-face interviews due to the coronavirus diseases of 2019 pandemic.

Physicians' Knowledge, Attitudes, and Perception Toward Pediatric Palliative Care in Saudi Arabia: A National Exploratory Survey.

Pediatric palliative care (PPC) helps maintain the quality of life for both children and their families. It has been identified as an important goal within the global health agenda. In Saudi Arabia, the discipline remains in its infancy, as illustrated by the absence of PPC programs in academic and health care institutions. The aim was to conduct a pilot study assessing physicians' knowledge, attitudes, and perceptions toward PPC. Data were gathered through a self-administered questionnaire sent to physicians working in Saudi Arabia. One hundred twelve completed the survey (male 54.2%, n = 50). A total of 40.8% (n = 42) had 20 years or more of experience, 42.9% (n = 48) were from the hematology-oncology specialty, and 68.5% (n = 74) received no training in PPC. Half suggested that children should be informed of their condition but mostly when reaching 12 or 15 years of age. Various physicians reported that the most appropriate time to discuss a transition to palliative care goals is when diagnosing an incurable condition or when despite all efforts, a condition continues to progress and death is expected. Multiple gaps were identified. PPC basic concepts should be included in the formal medical curriculum (e.g., pain management, communication, and ethical considerations at the end of life). There is also a significant need to develop further both primary and specialized palliative care.

Routine Preoperative Tests in Low-Risk Surgery. What About Adherence to Clinical Guidelines?

In 2002, the American Heart Association guidelines established that routinary preoperative studies in low-risk patients (ASA I and II) are unnecessary. This fact has been supported by many other publications after that. However, the medical adherence to these recommendations in clinical practice is low. The aim of this review is to identify the reasons associated with a poor guideline’s adherence. Articles published between 2002 and 2022 reporting data on “preoperative test”, “routine preoperative test”, and “low-risk surgery” were identified through a computerized literature research using Pubmed, Scopus, Medigraphic and Cochrane databases and by selecting all of the articles related to adherence to clinical guidelines. The full text of relevant articles was reviewed by all authors. This review found that some of the causes of the limited adherence to clinical guidelines are: lack of awareness regarding current recommendations or lack of familiarity with them; physician attitudes about the guidelines (including outcome expectancy, lack of agreement, poor motivation to modify previous practice, question efficacy); and environmental labor factors of medical institutions, including lack of communication among the consultants involved in the perioperative care, and medicolegal concerns and fear of litigation. Hence, in order to propose effective alternatives to improve guidelines adherence, this review discuss some of the main reasons why in clinical practice there is still a poor compliance to surgical preoperative guidelines, even when more than 20 years have passed since the concept of routinary preoperative studies in low risk patients was eliminated by a myriad of clinical guidelines and medical associations.

Evaluation of Attitudes of Family Physicians toward Occupational Health and Occupational Diseases in T&amp;#252;rkiye

Evaluation of Attitudes of Family Physicians toward Occupational Health and Occupational Diseases in T&amp;#252;rkiye