Physician Awareness Research Articles

Viral Etiology Associated With Acute Respiratory Tract Infection Patients in Bangkok, Thailand.

Background Acute respiratory infections (ARIs) are a significant public health concern globally. After the relaxation of COVID-19 containment measures, there has been an increase in respiratory tract infections. However, the epidemiological data on circulating respiratory pathogens after the COVID-19 pandemic in Bangkok, Thailand are interesting. We conducted a study on the respiratory pathogens detected in patients with ARIs in 2023. Methodology This retrospective study utilizes archived nasopharyngeal swab samples from patients with ARIs of all ages at Bangpakok 9 Hospital between January and December 2023. These samples were collected when physicians ordered multiplex polymerase chain reaction testing as part of the diagnostic investigation. All samples were tested for 23 types of respiratory viruses and bacteria using multiplex reverse transcription-polymerase chain reaction (QIAstat-Dx, Qiagen) testing. Results Of 321 patients, viral pathogens were found in 78.5% of cases, with 21.5% remaining unidentified. Most patients (47%) were aged between two months to five years.The most common pathogen identified was rhino/enterovirus (28.0%), followed by human parainfluenza virus (15.1%), influenza virus (12.0%), respiratory syncytial virus (9.9%), human metapneumovirus (9.5%), adenovirus (9.2%), bocavirus (8.0%), and coronavirus (5.5%). Interestingly, the prevalence of SARS-CoV-2 infection was relatively low at 2.8%. Moreover, viral co-infection was observed in 25% of cases. Monthly distribution revealed the fluctuating prevalence of detected respiratory pathogens co-circulation throughout the year. In addition, the proportion of identified pathogens varied among patients across all age groups. Conclusions Our study reported the high prevalence of respiratory pathogens in ARI patients of all ages after the COVID-19 pandemic. The most prevalent respiratory pathogens among ARI cases were viruses, particularly rhino/enterovirus. The data hold significance for physician awareness regarding diagnosis, treatment, and the implementation of infection control strategies in cases of ARIs.

Higher prevalence of dupilumab-induced ocular adverse events in atopic dermatitis compared to asthma: A daily practice analysis.

Dupilumab has been shown to be an effective treatment in moderate-to-severe atopic dermatitis (AD) and severe asthma (SA). However, comparative real-world analyses of adverse events (AE), particularly dupilumab-associated ocular surface disease (DAOSD), are lacking. This is the first real-world study to provide insight into the prevalence of AEs associated with dupilumab in AD compared with SA. Secondary objectives were to assess the prevalence, onset and therapeutic strategies of DAOSD and evaluate dupilumab discontinuation rates. Data from two daily practice registries including AD and SA patients receiving dupilumab treatment were analyzed. Adverse events, including DAOSD, were evaluated. In total, 322 AD and 148 SA patients were included. Headaches (23.6%), injection site reactions (10.1%), and influenza-like symptoms (13.5%) were more prevalent in SA patients. Interestingly, ocular AEs were significantly more prevalent in AD patients (62.1%, p<0.001), including conjunctivitis (17.1%, p=0.004). 88% AD and 47% SA patients with ocular AEs received one or more ophthalmic treatment(s). Additionally, 20% of AD and 17.6% of SA patients discontinued dupilumab treatment due to ocular AEs, while only 65% of these AD and none of these SA patients were referred to an ophthalmologist. The higher incidence of DAOSD in AD patients compared with SA patients in this real-world study highlights the importance of physician awareness, especially when prescribing dupilumab to AD patients. Conversely, the findings of this study help alleviate potential concerns about ocular AEs in patients with SA who do not have comorbid AD. Furthermore, the effective management of most ocular AEs with ophthalmic treatments suggests favorable tolerability of dupilumab in daily practice, and multidisciplinary collaboration is essential to proactively manage ocular AEs before discontinuing dupilumab.

An Overview of Cardiovascular Risk in Pituitary Disorders.

Cardiovascular comorbidities owing to hormonal excess or deficiency are the main cause of mortality in patients with pituitary disorders. In patients with Cushing's Disease, there is an increased prevalence of cardiovascular diseases and/or risk factors including visceral obesity, insulin resistance, atherosclerosis, arterial hypertension, dyslipidaemia, hypercoagulability as well as structural and functional changes in the heart, like cardiac hypertrophy and left ventricle (LV) dysfunction. Notably, these demonstrate limited reversibility even after remission. Furthermore, patients with acromegaly may manifest insulin resistance but also structural and functional heart changes, also known as "acromegalic cardiomyopathy". Patients with prolactinomas demonstrate an aggravation of metabolic parameters, obesity, dysregulation of glucose and lipid metabolism as well as endothelial dysfunction. Hypopituitarism and conventional hormonal replacement therapy may also contribute to an unhealthy metabolic status, which promotes atherosclerosis and may lead to premature mortality. This review discusses the literature on cardiovascular risk in patients with pituitary disorders to increase physician awareness regarding this aspect of management in patients with pituitary disorders.

Comparison of Physicians' Attitudes and Practice Regarding Vaccination during Pregnancy in Turkey.

This study aimed to investigate the knowledge, attitudes, and behaviors of family physicians (FPs), pediatricians (PPs), and obstetricians and gynecologists (OGs) regarding vaccine administration during pregnancy in Turkey as factors that contribute to decision-making. The survey was distributed among FPs, OGs, and PPs, and participants were asked to rate their knowledge on specific topics using a five-point scale ranging from "Not Effective" to "Effective". The tetanus and diphtheria (Td) vaccine was highly recommended by 94.9% of physicians and considered very effective. Among the physicians surveyed, 80% of PPs and 66.0% of OGs were aware of the disease burden of pertussis. We also found that 74.5% of FPs and 77.2% of PPs believed they needed more information about vaccination during pregnancy. All physicians surveyed agreed or strongly agreed that explaining the disease risks and benefits of vaccination increases the vaccine acceptance rate. The results of this survey study indicate that the knowledge and awareness of physicians need to be improved to increase vaccination rates during pregnancy in Turkey, and it is essential to incorporate influenza and tetanus, diphtheria, and pertussis (TdaP) vaccines into the standard maternal immunization schedule for newborns.

The Place and Approaches of Family Medicine Doctors in the Health Management of CBRN Events: The Case of Türkiye

In this study, it was aimed to determine the level of knowledge of Family Medicine residents about Chemical, Biological, Radiological and Nuclear (CBRN) events, their risk assessments and their thoughts on the roles that CBRN events can play in healthcare services. As a multi-center and cross-sectional analytical study, 444 family medicine residents at the national level were included in the study via an online survey application method. The data form included a total of 25 questions prepared to evaluate the sociodemographic information of the participants and their evaluation, awareness, knowledge level, approach to events and general opinions regarding CBRN event risks. 91.7% of physicians evaluated their knowledge level as "very little" or "little" and 95.7% evaluated their preparation level as "very little" or "little". 77.3% of physicians think that family physicians should have a role in CBRN incidents. For a possible CBRN event in the next 5 years, physicians predict biological events as the highest risk and nuclear events as the lowest risk. The rate of physicians who stated that they had previously received CBRN training was 17.8%, and the rate of those who participated in the CBRN drill was only 0.9%. While 89.9% of the participants wanted to receive training on health management in CBRN incidents; 80.2% want the training to be included in the specialty curriculum. While the participants' level of knowledge about the symptoms that may develop after a CBRN event is high, when asked about the awareness of CBRN risks around their institutions, 79.3% of physicians stated that they were not aware. It was determined that the level of knowledge, preparation, training, practice and awareness of family physicians regarding CBRN events was low. On the other hand, their willingness to receive training and their belief that they had a role in CBRN incidents were found to be high. According to the data of our study, we evaluate that there is a need for institutional structuring against CBRN risks, including primary health care services, and we suggest that CBRN training modules should be included in specialty curricula, starting from medical faculties.

Registry of patients with autoimmune liver diseases in St. Petersburg: clinical and epidemiological data

BACKGROUND: The problem of autoimmune liver diseases, which include autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis and their overlap syndromes is an urgent problem of modern medicine. This is associated with an increase in the incidence and prevalence of these nosologies in different regions of the world. Absence of an established etiological factor, prolonged asymptomatic or low-symptomatic course, lack of pathognomonic clinical picture, imperfect diagnostic criteria, insufficient awareness of physicians lead to late diagnosis of autoimmune liver diseases and, accordingly, untimely initiation of treatment, which often reduces its effectiveness, affecting the further prognosis and survival rate for this group of patients. Patients with autoimmune liver diseases require long-term, often lifelong therapy and dispensary observation. Epidemiological registries along with autoimmune liver diseases registries, including various nosologies of autoimmune liver diseases, form an important database on the incidence, clinical features, development and course of the disease, variants of therapy and response to therapy, presence of extrahepatic manifestations as well as allow analysis of all data in dynamics. AIM: To analize data on various nosologies of autoimmune liver diseases, demographics, clinical symptoms, timing of the first symptoms, timing of diagnosis, and the nature of extrahepatic manifestations. MATERIALS AND METHODS: This article presents data from the autoimmune liver diseases Register of the North-West Hepatology Centre (North-West Autoimmune Liver Diseases Register) of the North-Western State Medical University named after I.I. Mechnikov. RESULTS: The study obtained data on the nosological structure, demographic characteristics, timing of diagnosis verification, clinical symptoms and extrahepatic manifestations of autoimmune liver diseases. CONCLUSIONS: Establishing registers of autoimmune liver diseases, providing information about patients with these diseases, will help to assess the effectiveness of examination and treatment methods, factors affecting the course and prognosis of the disease. Analysis of the data obtained will help to develop screening programs, diagnostic algorithms and differential diagnostics of autoimmune liver diseases, which, in turn, will facilitate the diagnostic process, shorten the time of diagnosis, make it possible to start therapy earlier and, consequently, improve the prognosis and survival rate for this group of patients.

Cross-sectional study on evaluation of diagnostic interval in children with newly diagnosed paediatric cancers and factors affecting it

BackgroundDiagnostic interval/delay (DI) denotes the duration between first presentations to healthcare provider to the definitive diagnosis of cancer. Prolonged DI is a major contributor to deaths among children with malignancies in low-middle-income countries (LMICs). The data on DI and factors affecting it are limited from LMIC. MethodsThis cross-sectional study enrolled patients/children<12 years with proven/suspected malignancies. Children already on definitive chemotherapy, who died before a definitive diagnosis and with benign tumours were excluded. The parents or caregivers were interviewed individually using a customized questionnaire. Various intervals in referral chain like patient interval/delay (PI), DI and treatment interval/delay (TI) and factors affecting DI were evaluated. ResultsOut of 120 eligible children; 79 with median age 43 months (interquartile range [IQR]: 28–81) were analyzed. Haematological malignancies (n = 40) and non-haematological malignancies (n = 39) were equally distributed. Median total delay was 74 days (14–88 days). Median DI was 17 days (IQR: 8–54). The main contributor to delay was due to referral delay by primary and secondary physician (p < 0.05). The median PI was 2 day (IQR: 0–7.5) and median TI was 1 day (IQR: 0–4). Prolonged DI (DI > 30 days) was seen in 33 (41.8%) children. Trial of alternative medicine was the only significant factor associated with prolonged DI in univariate and multivariate analysis with odds ratio of 6.24. Other demographic, socioeconomic, health-seeking journey and disease-related factors were not found to be associated with prolonged DI. ConclusionsSignificant delay exists in paediatric cancer management in LMIC. Augmentation of physician and parental awareness is the key to decrease these delays.

Physician and Patient Preferences for Treatment of Anemia Associated with Chronic Kidney Disease in Japan: A Survey Including Best-Worst Scaling.

Several treatment options are available for anemia associated with chronic kidney disease (CKD); however, there remains a lack of awareness of physician and patient preferences regarding these treatments. We aimed to explore physicians' and patients' perceptions and preferences regarding the management of anemia of CKD in Japan. A web-based survey, including best-worst scaling (BWS), was conducted with physicians who had treated ≥1 patient with anemia of CKD in the preceding year, and with patients with CKD who self-reported a clinical diagnosis of anemia of CKD or low hemoglobin levels. A three-step approach was used comprising cognitive interviews, a pilot survey, and a main survey. The BWS survey results were analyzed using multinomial logit and hierarchical Bayesian models. The survey was completed by 906 participants: 103 patients (average age 60.6 years; 77.7% male) and 803 physicians (166 nephrologists, 214 cardiologists, 137 diabetologists, and 286 general internists). Almost all (96.0%) physicians surveyed considered anemia of CKD to be an important condition to treat. Hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitors had the highest treatment satisfaction among physicians, whereas patients had the highest satisfaction with both erythropoietin-stimulating agent therapy and HIF-PH inhibitors. Approximately one-third (35.9%) of patients surveyed indicated that they were receiving treatment. When comparing the relative importance of attributes and levels, physicians favored efficacy (particularly improvement in hemoglobin levels), whereas patients favored safety (particularly a lower rate of severe adverse events). Although a majority of physicians consider treatment of CKD-related anemia important, differences in the perceptions and usage of medications exist between medical specialties. Preferences for the management of anemia of CKD vary between physicians and patients; therefore, patient involvement in treatment decisions may help optimize outcomes.

Physician Prescribing Behavior of Medicines in Developed and Developing Countries: A Systematic Review

ABSTRACT A physician’s prescribing decision is a complex process, as it calls for the contribution of multiple stakeholders across the value chain. Physicians’ prescribing behavior constitutes elements such as product-related characteristics, product-promotional efforts, physician’s professional characteristics, and physician personality traits. Collaborative efforts involving government agencies, physician societies, and pharmaceutical organizations can enhance physician awareness and improve prescribing practices, leading to better disease management with improved patient quality of life. Based on existing studies in these economies, this systematic review explored physicians’ prescribing behavior in developed and developing countries. The ultimate goal of this systematic review is to empower physicians to make better prescribing decisions, ensuring patient safety and faster recovery. Using relevant keywords, the search was conducted with Scopus and Google Scholar databases from 2011 to 2024, with cross-sectional and longitudinal studies, and reviews were included, whereas narrative reviews, case reports, opinion polls, and letters to the editor were excluded from the study. All three reviewers independently extracted data based on study design, year, country, participant characteristics, setting, and other details for conducting qualitative analysis based on the central tendency to study year-on-year publication trends and demographics characteristics were analyzed. Our review demonstrated that various promotional tools positively impacted prescribing behavior in developed and developing economies. However, physicians in developing countries expressed concerns about the value provided by pharmaceutical representatives, indicating a need for better knowledge dissemination about the product. Physicians prefer branded drugs for quality and efficacy, supported by health-care infrastructure and insurance in developed countries, but in developing countries, physicians prefer branded generics over branded drugs due to cost considerations.

Awareness, Practice, and Views of Pediatricians, General Physicians, and Pharmacists about Prescribing Off-label Medication in Pediatric Patients in Eastern Province, Saudi Arabia.

An off-label medication involves the use of an approved drug for an unapproved indication, population, route of administration, or dosage.The physiological state of children differs from that of adults, making the adult formulation potentially dangerous to children. Off-label prescribing is quite common in children due to challenges in the development of pediatric formulations. The current study was conducted to determine the awareness, practice, and views of pediatricians, general physicians, and pharmacists about prescribing Off-label medication to pediatric patients in Eastern Province, Saudi Arabia. A cross-sectional study based on a questionnaire was conducted among pediatricians, general physicians, and pharmacists (clinical and community) in Eastern Province, Saudi Arabia. Statistical analysis was conducted using the data exported from Google Forms (Mountain View, California, USA) and Microsoft Excel (Version 2016) and then exported into Statistical Package for Social Sciences (SPSS) version 26.0 (IBM, Inc., Armonk, NY, USA). Chi-square was deemed suitable. The level of significance was set at 0.05. Among the study participants, 53(35.09%) were pharmacists, followed by 24(15.89%) others, 22(14.565) pediatricians, 19(12.58%) other specialists, 17(11.25%) general physicians, and 16(10.59%) were clinical pharmacist. About 73(48.34%) described the definition of off-label correctly. About 114(75.49%) believed that parents and guardians must be informed about off-label medicine prescribed to their children. About 52(34.43%) had concerns about the safety of the medication, and 98(64.90%) believed they should be tested in pediatrics during clinical trials. Further, 97(64.23%) considered themselves not enough knowledgeable about off-label medications. The barriers reported by the participants were as follows: 89(58.945%) said lack of information resources, 71(47.01%) said lack of training, 56(37.08%) said lack of information on the safety of excipients used in pediatrics, 47(31.12%) said lack of formulary, 44(29.13%) said lack of guidelines, and 58(5.29%) said lack of information related to the safety of excipient concentration in pediatrics. The proportion of healthcare professionals who agreed that excipients in adult medication may be harmful to pediatrics was 103(68.21%). The drugs most often prescribed as off-label were paracetamol 54(21.68%), followed by Phenobarbital 35(14%), and Amoxicillin 33(13.25%). There are a considerable number of healthcare professionals unaware of the description of off-label medication. The majority have concerns over the safety and efficacy of the off-label drugs and believe that most frequently used off-label drugs in pediatrics must be tested in pediatrics during clinical trials. In addition, excipient safety data are of considerable importance to ensure off-label drug safety in pediatrics, who believe their knowledge is inadequate and need proper guidelines and training on this issue.

Physicians' perceptions and awareness of adverse effects of proton pump inhibitors and impact on prescribing patterns.

Background: Heightened scrutiny surrounds the inappropriate use of proton pump inhibitors (PPIs) due to concerns regarding potential serious adverse effects (AEs). Understanding the impact of these AEs on real-world practice is crucial. This study aimed to assess physicians' perceptions, experiences, awareness, and beliefs regarding published data on potential AEs associated with PPIs. Additionally, it sought to determine alterations in PPI prescribing patterns resulting from these AEs, explore attitudes towards PPI use, and ascertain recommendations for PPI use in clinical scenarios with varying levels of risk for upper gastrointestinal bleeding (UGIB). Method: A quantitative, cross-sectional study utilized a self-administered questionnaire, inviting 282 physicians from 55 primary healthcare centers and 334 internal medicine physicians from seven governmental hospitals to participate. Results: With a response rate of 87.8% (541/616), 74% (95% CI: 70.2-77.7) of respondents were somewhat or very familiar with published data on PPI AEs. Among the familiar, 69.5% (CI: 65.2-73.5) had somewhat or very much changed their PPI prescribing patterns. General concerns about AEs when prescribing PPIs were reported by 62% (CI: 56.7-65.1). Respondents displayed awareness of a median (IQR) of 15 (9) different AEs associated with long-term PPI use, including osteoporosis or osteopenia (90.2%), hypomagnesemia (81.5%), vitamin B12 deficiency (80.6%), and bone fracture (80.0%). Respondents believed that PPIs elevate the risk for a median (IQR) of 7 (6) different AEs, with osteoporosis or osteopenia (81.8%) being the most common, followed by hypomagnesemia (67.1%), and vitamin B12 deficiency (62.3%). The most common strategies for PPI de-escalation were PPI discontinuation (61%) and using PPI on-demand/as-needed (57.9%). The majority (87.4%) agreed or strongly agreed that PPI overuse is prevalent in Kuwait and 78.2% emphasized the necessity for large-scale education on rational PPI use for medical staff and the public. In the UGIB prevention scenarios, 43.6% recommended appropriately the PPI discontinuation in the minimal-risk scenario, while 56% recommended appropriately the PPI continuation in the high-risk scenario. Associations and comparative analyses revealed predictors influencing physicians' practices and attitudes toward PPI usage. Conclusion: These findings lay the foundation for future research and targeted interventions aimed at optimizing PPI prescribing practices and ensuring patient safety.

Features of the course of pollen allergy in children in the Nizhny Novgorod region

Due to its widespread distribution, the problem of pollen allergy does not lose its relevance for practical healthcare: the variety of clinical forms, the possibility of polyvalent sensitization and pathogenetic treatment in the form of allergen-specific immunotherapy determine the importance of studying its clinical and epidemiological features.Materials and methods. A retrospective analysis of 119 discharge summaries of children with diagnoses of “Allergic rhinoconjunctivitis”, “Bronchial asthma”, “Atopic dermatitis”, occurring with clinically significant pollen sensitization, was carried out in the period 2015–2022. The prevalence, clinical features, prevailing symptoms and atopic comorbidity of patients with pollen allergy living in the Nizhny Novgorod region were assessed.Results. Pollen allergy is characterized by a variety of clinical manifestations, which are mainly represented by allergic rhinoconjunctivitis, bronchial asthma, and oral allergic syndrome. In the study, in the majority of patients, polyvalent sensitization was combined with a pronounced variety of products that provoke oral allergic syndrome. Manifestations of pollen allergies requiring seeking medical help are equally distributed among residents of Nizhny Novgorod and the region’s villages.Conclusions. Clinical and epidemiological features of the course of pollen allergy are of great interest to the practicing physician. The variety of manifestations of pollen allergies determines the need for a clinically effective treatment method, which today is ASIT. One of the needs of modern healthcare is to increase the awareness of primary care physicians about atopic diseases, incl. pollen allergy, with the aim of timely referral of patients to a specialist. Currently, allergen-specific immunotherapy is the most effective method of treating manifestations of pollen allergies.

LMIC-14. MAPPING THE REFERRAL PATH - HURDLES IN PEDIATRIC BRAIN TUMOR DIAGNOSIS: A PERSPECTIVE FROM TERTIARY CANCER CARE CENTRE IN A LOW MIDDLE-INCOME COUNTRY

Abstract BACKGROUND Delayed referral remains leads to worse outcomes for children with cancer in low- and middle-income countries (LMIC), especially for patients with brain tumors. Delay in treatment could be due to the ignorance from the families to seek health care advice or lack of awareness of primary care physician. METHODS A retrospective study was conducted to delineate the referral path of children with brain tumors who presented to our institution. Patients &amp;lt;18 years with brain tumors registered from June 2022-December 2023 were included. Patients with relapsed disease, second opinion, or partially treated in an outside institute prior to referral were excluded. Data were captured using a proforma after obtaining permission from Institutional ethics committee. RESULTS Thirty-one children were enrolled with a median age of 5 years (range: 0-17) with M: F ratio of 1.58:1. The most common diagnosis in this cohort was medulloblastoma in 13(42%) followed by high grade glioma in 7(22%) and low-grade glioma in 4 patients (13%). Twenty-four (77%) belonged to low socio-economic strata defined by Modified Kuppuswamy classification, of which 22 (71%) were hailing from rural area with median distance from cancer center being 121 miles (range: 4.34 -242). Median of 3 (range: 1-6) consultations were sought prior to being referred to us and about 11 (35%) had visited alternative system of medicine before consulting us. Mean delay from symptom onset to diagnosis was 52 days (range: 2-530) with healthcare seeking delay of 5.4 days (Range: 0-30) and health system delay of 46 days (range: 1-500). The factors influencing delay included rural background (p=0.04) and lower socioeconomic strata (p=0.03). CONCLUSIONS Health system delay was a major cause of delayed referral in our study. By improving awareness of the primary care physicians about symptomatology of pediatric brain tumors, the referral pathway can be expedited thereby improving the outcomes of these children.

Cannabis use by individuals with spinal cord injury in the UK: a call for improved patient education and physician awareness for pain and spasticity management

Study designProspective observational qualitative study.ObjectiveCannabis is used by patients for the treatment of chronic pain, spasticity, sleep issues or mood disorders such as anxiety and depression. Since 2018, it has been authorised in the United Kingdom for medical use as an unlicensed medicine. This study aims to determine if patients are using cannabis for the management of symptoms related to spinal cord injury, and if so, whether they are using medical or illicit cannabis.MethodsSpinal cord injury patients from the Yorkshire Regional Spinal Injuries Centre and SPINE Community in the United Kingdom were surveyed. Participants were sent a 7-point electronic survey. All results were anonymous, and confidentiality was maintained throughout the process.ResultsIn total, 223 patients completed the survey. Not all patients answered every question. Of those who responded 65.35% (n = 132) were paraplegic and 34.65% (n = 70) were tetraplegic. Patients were suffering from chronic pain (longer than 3 months), spasticity, loss of/difficulty in sleeping or anxiety/depression. Almost 15% (14.93%, n = 33 out of 221) used cannabis to manage their symptoms, out of those the majority used street cannabis (79.41%, n = 27 out of 34) were using street cannabis.ConclusionThis study demonstrates that there are spinal cord injury patients in the UK using cannabis to treat their symptoms. A majority appear to be using illicit cannabis. Given that cannabis can interact with other medications, and that the quality and content of illicit cannabis can be highly variable and at times dangerous, it is important for physicians to discuss cannabis use with their patients. This can inform prescribing and allow them to educate patients on the dangers of medical cannabis and potential alternatives.

Assessing Moroccan physician knowledge and practices regarding maternal obesity's impact on childhood obesity: Implications for prevention and intervention.

Childhood obesity is a growing global concern with far-reaching health implications. This study focuses on evaluating the knowledge and practices of physicians in Morocco regarding the link between maternal obesity and childhood obesity. Despite the increasing prevalence of childhood obesity worldwide, this issue remains inadequately addressed in the Moroccan context. To assess the awareness and practices of physicians in Morocco concerning the connection between maternal obesity and childhood obesity. The research encompasses a comprehensive survey of practicing physicians, revealing significant gaps in awareness and practices related to maternal obesity. Notably, a significant portion of doctors do not provide adequate guidance to overweight pregnant women, highlighting the urgency for targeted educational programs. In conclusion, this research illuminates critical areas for improvement in tackling childhood obesity in Morocco. By addressing these gaps, fostering awareness, and enhancing medical practices, the healthcare system can contribute significantly to preventing childhood obesity and improving the overall health of future generations.

Multidisciplinary PAIN management features of pediatric oncology patients in a pediatric cancer center in Turkiye: A developing country experience.

e22002 Background: Pain is one of the most important problems that affects more than half of cancer patients at any stage of the disease and disrupts the quality of life of patients. The aim should be to relieve pain as soon as possible and prevent its recurrence. In this study, we aimed to evaluate the clinical characteristics of our patients who were followed up with a diagnosis of cancer in our clinic and whose pain management was planned in a multidisciplinary manner with the department of Algology. The clinic where the study was conducted is the reference center of a middle income developing country. Therefore, the data obtained will represent the characteristics of developing countries. Methods: In this retrospective descriptive study, patients followed up with diagnosis of cancer at Ankara University Faculty of Medicine, Department of Pediatric Oncology between 2018 and 2023 and consulted to Department of Algology for pain management were included. Patients whose file information could not be accessed from the hospital information system were excluded from the study. Demographic and clinical parameters of the patients were recorded. The data were evaluated with descriptive statistical methods appropriate to distribution. Results: A total of 33 patients, 19 girls and 14 boys, aged between 2.2 and 23.5 (median 14.4) were evaluated in the study. For each case, a median of 2 (1-16) consultations were made. The most frequent cancer diagnosis was bone tumors with 42% (n:14). Nociceptive pain was present in 25 of the patients, nociceptive and neuropathic pain were present together in 8 patients. It was determined that the most commonly used treatment for pain management was paracetamol, which was used in all patients. Other agents used, in order of frequency: Fentanyl in 19 (57.6%) of the patients, NSAID in 13 (39.4%), gabapentin in 9 (27.3%), oxycodone in 12 (36.4%), 7 (3%) 21.2) were tramadol, 4 (12.5%) were morphine, and 1 (3%) was codeine-paracetamol. Intravenous patient-controlled analgesia (PCA) was used in one patient. Side effects were observed in 3 patients. Fentanyl-related constipation was observed in 1 patient, fentanyl-related globe vesicale was observed in 1 patient, and thrombocytopenia was observed in 1 patient due to gabapentin. Conclusions: Pain is an important factor affecting the quality of life and treatment compliance of children with cancer. Therefore, it is important to ensure effective treatment and to raise the awareness of physicians and care providers by keeping it constantly on the agenda especially in developing countries. Prospective studies will be most useful guide for clinicians.

Effect of real-time data-driven physician engagement on appropriate precision oncology testing.

11168 Background: Precision medicine is a paradigm shift in healthcare: 24% of all FDA approvals are precision medicines, with 67% of new approvals relying on companion or complementary testing or on diagnostics prior to clinical use. Yet a recent publication indicates that approximately 64% of potentially eligible patients could be lost due to various clinical practice gaps along patient journey (Sadik et al JCO 2022). Low prevalence biomarker testing is proven to be one of the critical determinants of missed therapy, potentially due to poor physician awareness. The increasingly advanced machine learning (ML) and natural language processing (NLP)-based ability to label, analyze, and segment data can be utilized to monitor and influence testing behavior in real-time. We hypothesize that a real-time data-driven physician-targeted digital engagement can increase biomarker testing rate and in turn enhance patient identification for precision therapies. Methods: Unstructured real-world, real-time biomarker testing reports were collected from 494 laboratories across the US. These testing reports were first curated, labeled and extracted via ML and NLP-based technologies to allow data analysis and reveal testing behavior. Suboptimal testing behavior was defined as no requisition of the selected novel biomarker as part of the diagnostic workups. Physicians who identified as having suboptimal testing behavior were selected as candidates to receive a personalized digital engagement over a 4-week period. The digital engagement's purpose was to raise clinical awareness towards the novel biomarker testing. The follow-up testing behavior was analyzed again over laboratory reports collected from 26-weeks’ time after the initial engagement. Results: 822 physicians were identified with suboptimal testing behavior and selected to receive 4 weeks' follow-up digital engagement. 271 out of 822 (33%) recipients were successfully engaged shown as open and read the digital communication. 42 (~15%) physicians reacted to the communications and ordered the new test at least once during this period. The initial 4 weeks' engagement was observed to be the most impactful, when 23 out of the 42 (~55%) physicians ordered the novel biomarker test for the first time.71 new therapy-eligible patients were identified via data-driven targeted physician digital engagement during the 26 weeks’ follow-up period. Conclusions: This study illustrates the value of data in influencing or reinforcing testing behaviors and emphasizes the value of data-driven physician-targeted digital engagement in addressing clinical practice gaps which in turn, drive patient identification to match potential eligible precision therapies.

Early evidence of pancreatic enzyme insufficiency in patients with gastric neoplasia.

e16037 Background: The incidence and association of Exocrine Pancreatic Insufficiency (EPI) in patients with gastric neoplasms has not been well reported. Malnutrition and cachexia occur commonly in patients with advanced gastric cancer (AGC), significantly affecting the quality of life and prognosis in these patients. EPI is one of the factors associated with malnutrition and can cause increased morbidity and mortality. ( [1] ) While an association between pancreatic tumors and EPI has been well established, such an association has not been well studied with gastric tumors. Methods: We queried the HERON database for the number of patients diagnosed with Malignant neoplasms of the stomach using International Classification of Disease (ICD) code C16 who then developed EPI, represented by ICD codes K87, K86.6, and K89.9. We conducted a comparative analysis involving individuals diagnosed with gastric neoplasia but lacking a preceding diagnosis of EPI. Specifically, we examined two distinct groups within this cohort: those individuals who were subsequently diagnosed with EPI and those who were not. Additionally, our study incorporated a comparison with the broader general population, utilizing the same database. We used CHI squared testing, odds ratio, and Cramer’s V for statistical analysis. Results: We identified ICD codes in the whole database of 1566102 patients from the database inception to Jan 1, 2024. Out of these, 1609 patients had the diagnosis of gastric neoplasms in the database. 21 patients had the diagnosis of PEI occurring following the diagnosis of gastric neoplasm. 3148 patients developed EPI without gastric neoplasms. The association was statistically significant with a p-value of &lt; / = .001. The odds ratio reported was 6.58 (95% CI = 4.27-10.13). The Cramer’s V was 0.007. Conclusions: The findings reveal preliminary evidence within our cohort of a significant association between the diagnosis of gastric malignant neoplasm and subsequent development of EPI. However, the strength of this association, as indicated by Cramer’s V, is comparatively low. This could be attributed to various factors, including possible missed diagnosis related to limited physician awareness. To delve deeper into this early evidence, a prospective study should be initiated, and physician should pay special attention to this underreported condition. The study should also investigate subgroup variables such as the patient's age, gender, carcinoma stage at diagnosis, nutritional status before and after treatment, as well as the type and duration of treatment, including chemotherapy and radiotherapy. ( [2] ).

Gamification of emergency medicine cost awareness education.

Despite rising costs of health care, physician awareness of costs remains poor. Educational initiatives to remedy this have shown promise, with gamification specifically having success, but actual improvements in physician estimation capabilities have yet to be evaluated. The objective of the study was to assess a gamified educational session for emergency medicine residents that improved their ability to estimate the costs of tests or services commonly performed in their department. Participants completed an anonymous presession survey consisting of demographic data, self-analysis on cost awareness, and a 10-item cost estimation list. This was followed by a 1-h interactive gamified education session utilizing rules from the television show The Price is Right. During this session, only three of the survey items had their cost directly discussed such that the remaining seven were able to be assessed solely on estimation improvement instead of short-term knowledge retention. Participants then completed the same survey to assess for improvement in cost awareness. Sixteen residents at the PGY-2 or PGY-3 level completed the surveys and education session. All self-analysis questions showed significant improvement in the postsession survey. Eight out of the 10 items had significant differences in cost estimation. A gamified teaching session using The Price is Right rules can improve a resident's estimation capabilities, even on items not directly taught during the session.

P.007 Role of neuroimaging in headache management; are we following the guidelines?

Background: Healthcare systems incur a significant financial burden through unnecessary neuroimaging, which globally, is in the order of the billions of dollars. Current recommendations suggest avoiding neuroimaging in patients with stable headaches, particularly those meeting the criteria for migraine. Methods: We conducted a retrospective chart review of 100 headache patients in an outpatient neurology clinic. We evaluated the use of CT and MRI imaging and the impact of neuroimaging on clinical management. Results: 55% of patients had a history of migraine. Overall, 74 of 100 patients had either CT or MRI imaging. Imaging was largely normal or identified non-specific, clinically irrelevant findings. There was 1 case of a cerebellopontine angle epidermoid tumor and another of suspected MS. Neuroimaging did not alter headache management. Conclusions: The data is consistent with current guidelines suggesting that neuroimaging is not necessary in patients with stable headaches, particularly migraine. Neuroimaging overuse might reflect lack of awareness of guideline recommendations, insecurity over diagnoses, medicolegal concerns, as well as patients and primary practitioners’ expectations. Resources to help improve public and physician awareness regarding neuroimaging use in patients with stable headache may help reduce unwarranted imaging studies and could have significant financial savings for healthcare systems.