Practice Of Doctors Research Articles

Keratodermas in the practice of a family doctor

Keratodermas are a heterogeneous group of dermatological diseases characterized by thickening of the stratum corneum of the epidermis on the palms and soles. This article discusses the main forms of keratodermas, their hereditary characteristics, clinical manifestations, methods of diagnosis and treatment, as well as important aspects of patient monitoring. Keratoderma is divided into diffuse and focal forms, each of which has its own clinical characteristics and types of inheritance (autosomal dominant and autosomal recessive). In particular, diseases such as Unna-Thost keratoderma, Meleda disease, and Papillon — Lefèvre syndrome are mentioned. The main symptoms and morphological changes of the skin in various forms of keratoderma, as well as diagnostic methods, including clinical studies and histology, are described. Treatment of keratoderma is based on the use of retinol preparations and keratolytic agents; the need for an individual approach depending on the form of the disease is emphasized. The criterion for the effectiveness of treatment is a significant reduction in the severity of clinical manifestations. Attention is paid to side effects and complications associated with therapy, as well as the importance of consultation with specialists to prevent secondary diseases such as periodontal disease. Keratoderma is a complex disease that requires an integrated approach to diagnosis and treatment. The prognosis for patients is most often unfavorable, and complete cure is impossible. It is necessary to ensure careful monitoring of the patient's health status and evaluate the efficacy of the treatment used to reduce clinical manifestations. The text provides relevant information for dermatologists and other medical professionals involved in the diagnosis and treatment of skin diseases.

Resilience of primary healthcare facilities: Experiences from 16 European countries during the COVID-19 pandemic. A mixed-methods study conducted by EURIPA.

The role of primary healthcare (PHC) during a pandemic varies across European countries. The coronavirus disease 2019 (COVID-19) pandemic has altered the working practices of family medicine doctors and impacted the resilience of healthcare systems. This study aimed to examine European healthcare system responses to the pandemic, focusing on rural and urban differences. This cross-sectional, mixed-methods study used a semi-structured online questionnaire with 68 questions, including 21 free-text comments. Data were collected from May 2020 to January 2021. Key informants from 16 European Rural and Isolated Practitioners Association (EURIPA) member countries distributed questionnaires to 406 PHC doctors. Data were analyzed using descriptive statistics and nonparametric tests (χ2, Kruskal-Wallis, Mann-Whitney U) with a significance threshold of 0.05. A statistically significant difference was found between rural (36.4%, 55/151), semirural (19.4%, 24/124) and urban populations (29.8%, 39/131) regarding medicine shortages (χ2 = 9.91, degrees of freedom (df) = 4, p = 0.042). The semirural setting showed a statistically significant difference from the other settings (p = 0.004 in post hoc χ2 test). Significant differences were found between countries in resilience features including, effectiveness of triage, adapting to the rapidly changing requirements, government help, existence of a community resilience group, improved interprofessional collaboration, medicine shortage, and general practitioners (GPs) involvement in palliative care. Medicine shortage was more prevalent in rural and urban areas compared to semirural areas. Differences were observed between countries in their responses to the pandemic, particularly in adapting to the rapidly changing requirements, effectiveness of triage, government help, and the existence of a community resilience group. These differences were confirmed with qualitative analysis. The results emphasize the need for tailored approaches considering diverse contexts in shaping effective healthcare system resilience.

The main scientific and practical results of the study at the Military Medical Academy of combat pathology during the Special Military operation

The development of problems of combat pathology is a constant focus of scientific interests of scientists of the S.M. Kirov Military Medical Academy. With the beginning of a Special military operation, it received a new impetus for development both due to the large clinical material and due to changes in the structure and nature of modern combat pathology. The relevant teams have joined forces to develop the most priority tasks. Based on the analysis of the mortality of wounded on the battlefield, the principles of “tactical medicine” were developed and implemented in practice, aimed at combating the most common causes of death at the pre-hospital stage, and training cycles for instructors for the whole country were organized in the established Center for Tactical Medicine. Principles of anesthesia and shock control at the stages of medical evacuation have been developed. Based on the study of the structure of combat surgical pathology, the tactics of screening diagnosis of hidden injuries during medical triage are proposed, the principles of staged surgical treatment of wounds (the principle of damage control) are clarified, an integrated system of treatment of wounded with injuries of the musculoskeletal system is developed. At the hospital stage, improved methods for the prevention of thromboembolic complications, treatment of phantom pain syndrome, and stress-associated mental disorders are proposed. The spectrum of wound infection pathogens and existing antibiotic resistance has been studied, new wound dressings have been developed. A prototype of the system of professional psychological selection and support of operators of unmanned aerial vehicles has been formed. Guidelines on military field surgery and military field therapy have been developed, more than 50 methodological recommendations on the most in-demand issues of organization and provision of medical care. Thus, in a little more than 900 days, the scientists of the S.M. Kirov Military Medical Academy has carried out a huge amount of work only in scientific terms, introducing the results into the practice of military doctors. This makes it possible to achieve the best performance indicators of the medical service of the Armed Forces of the Russian Federation in comparison with previous conflicts.

Digital transformation of primary health care in Moscow

The modern appearance of the Moscow digital clinic was mainly set in 2011 in the context of complex changes in the city management system, which subsequently took the form of the Moscow city development concept “Smart City – 2030”. The initial goals for changing primary health care included providing Muscovites with access to information and communication technologies in medical organizations, eliminating fragmentation and duplication of functions, and ensuring compatibility of data used in various information systems. Aim. To identify and describe step-by-step changes in the organization of primary health care in Moscow, related to the introduction of digital technologies and aimed at improving the organizational forms and methods of operation of public medical institutions in the capital, improving the access of the urban population to timely and high-quality medical care. Materials and methods. An analysis of regulatory legal acts and scientific literature was carried out in the “manual search” mode for the period 2011–2024. Results. Informatization of key processes in primary healthcare in the capital has reduced the waiting time for patients to receive an appointment. The number of people waiting 4 days or more to see a therapist has dropped to 2 %. An AIDS based on artificial intelligence was introduced into the practice of primary care doctors, available in all adult clinics in Moscow. Telemedicine services were provided for patients with COVID-19, which were subsequently expanded to other categories of patients. Conclusion. A review of data related to the digitalization of healthcare shows that changes in the work of clinics of the Moscow public health system are best practices that correspond to the practices of leading foreign countries, partly surpassing them in the systematicity of urban management issues.

Doctors' knowledge, practices, challenges, and limitations regarding disclosure of bad news: A multicentre study from Pakistan.

Breaking bad news is one of the most difficult tasks for practicing doctors, especially for those working in health care specialties where life-threatening diseases are diagnosed and managed routinely. Our aim was to elicit the knowledge and practices of doctors and identify barriers faced by them in disclosure of bad news across the provinces of Pakistan. Cross-sectional, multi-centered study supported by an external grant in 15 Government and Private Hospitals across Pakistan. A total of 1185 doctors were surveyed. Responses were compared across provinces. 80% of doctors across all specialties considered life-threatening diagnoses like cancer and stroke as equivalent to bad news, whereas less than 50% perceived conditions like malaria and typhoid as bad news. Regarding the level of difficulty encountered in giving bad news on a scale of 0 to 6, over 57% doctors rated it 4 and above. The reasons identified were lack of confidentiality, lack of privacy, lack of time, lack of training, fear of patients' and family reactions, not wanting to hurt the patient or causing more distress, concern of having failed the patient, and their own reactions among others. Technical proficiency, training, good patient-centered communication, and incorporating socio-cultural aspects are essential for effective disclosure of bad news.

Healthcare ethics and artificial intelligence: a UK doctor survey

ObjectivesTo survey UK doctors on their uses of artificial intelligence (AI) and of their views on the ethics and regulation of AI in healthcare.DesignAnonymous cross-sectional e-survey.SettingAn online survey of UK...

Pendekatan Fuzzy Servqual Untuk Mengevaluasi Tingkat Kepuasan Pasien di Praktik Dokter Karunia

Measuring patient satisfaction is one of the main indicators of measuring the quality of service in health facilities. Health service providers have difficulty measuring patient satisfaction, problems that are often complained about based on patient perceptions include late arrival of doctors at the clinic, lack of toilet cleanliness, long examination times, and the attitude of some nurses who are not friendly. The purpose of the study was to evaluate the level of satisfaction of patients who were treated at the Karunia Doctor's Practice using the Fuzzy Servqual method. Service quality was analyzed through five dimensions in the Servqual framework, namely tangible evidence, reliability, responsiveness, assurance, and empathy. The results of the study showed that the gap value of the five dimensions was negative, indicating that the quality of service provided did not meet the expectations of patients who were treated at the Karunia Doctor's Practice. The dimension with the highest gap value was tangible evidence with a value of -0.77, while the lowest gap value was in the reliability dimension. Thus, it can be concluded that the tangible evidence dimension requires special attention to improve service quality.

The Criminal Law Enforcement Against the Use of Fake Identities as Doctors in Carrying Out Medical Practices

This study aims to analyze criminal law enforcement against the use of fake identities as doctors. The type of research used is empirical legal research. There are 2 types of data obtained, namely the first primary data obtained through interviews, the second secondary data, namely laws, books and journals. The research locations were centered at the Makassar District Court, the South Sulawesi High Prosecutor's Office, the South Sulawesi Regional Police and the Makassar City Branch of the Indonesian Doctors' Association. The results of the data that have been obtained were analyzed qualitatively and presented descriptively. The results of the study show that: Criminal Law enforcement against the use of false identities as doctors in carrying out medical practices has not been maximized, while the influencing factors are law enforcement factors where law enforcement officials do not understand and master the regulations, community factors are the community ignore to report practice of fake doctors.

Sensitivity of the hospital anxiety and depression scale HADS in stroke patients

Introduction. The validated Hospital Anxiety and Depression Scale HADS is recommended for screening symptoms of anxiety and depression in the routine practice of somatic doctors; it is also recommended by experts for use in rehabilitation medicine and frequently used in scientific research to assess the emotional state of stroke patients. At the same time, the literature provides various contradictory data on the sensitivity of this scale for stroke patients. Aim. To evaluate the detectability of emotional disorders in stroke patients using the HADS scale in comparison with the author’s computer program for studying the actual emotional state of the patient. Materials and methods. 60 stroke patients underwent inpatient rehabilitation in the National Medical Research Center for Rehabilitation and Balneology were randomly divided into 2 groups. 30 patients of Group 1 received a basic rehabilitation complex (aimed at correcting motor disorders); 30 patients of Group 2 received a basic rehabilitation complex in combination with a course of cognitive behavioral psychotherapy (CBT). To assess the emotional state at the beginning and at the end of rehabilitation, the HADS scale and the author’s computer program were used to study the actual emotional state of the patient. Statistical analysis was carried out using the Statistica-10 program. Results. The study groups were comparable in gender, age and clinical parameters. Initially, in patients of both groups, the median values of anxiety and depression on the HADS Scale corresponded to the norm, while the median values of the author’s methodology corresponded to a low level of comfort, the presence of fatigue, high levels of anxiety and depression. At the end of rehabilitation, according to the HADS Scale, significant positive dynamics was revealed in both groups, both for depression and anxiety (p 0.05), without significant intergroup differences. Whereas with the help of the author’s methodology, significant intergroup differences (p 0.05) were revealed, indicating a better positive dynamics of the emotional state in group 2, additionally receiving CBT. Conclusion. In comparison with the author’s program in stroke patients, the HADS scale is significantly less sensitive in the diagnosis of anxiety and depression, and does not reflect the established intergroup difference in the dynamics of emotional state after the use of the basic complex and its combination with CBT.

Legal Consequences of Medical Accidents and Medical Malpractice in Indonesia

Medical malpractice, which refers to errors or negligence committed by doctors and medical personnel when treating patients. This malpractice can have serious consequences, such as worsening the patient's health condition or even causing death. This act of malpractice has legal consequences, and therefore, it is important to have a clear legal system in the health sector. The research conducted is of a normative juridical nature, using various approaches to understand this problem. The results of the study indicate that the criminal law governing medical malpractice is contained in the Criminal Code, which includes elements of negligence. To increase legal certainty for patients who are harmed, there are special laws, namely Law No. 36 of 2009 concerning Health and Law No. 36 of 2014 concerning Health Workers, which regulate law enforcement related to malpractice. Overall, this text emphasizes the importance of legal protection for patients and the responsibility of doctors in medical practice.

Chronic kidney disease in a doctor's practice

The article discusses the etiology, risk factors for development, stages, clinical symptoms, clinical and laboratory markers, approaches to the diagnosis and treatment of chronic kidney disease (CKD). The modern classification and diagnostic features of CKD are presented, as well as approaches to treatment at different stages of the disease.

Exploring Korean Medicine professions' perspectives on the applicability of ChatGPT in facial palsy practice: A web-based survey

IntroductionSince November 2022, when Chat Generative Pre-trained Transformer (ChatGPT) was released, studies have been conducted to explore its potential use in various text-based areas. In the field of Korean Medicine (KM), studies evaluating the feasibility of ChatGPT are mainly focused on the educational domain. This study aimed to 1) identify the current level of ChatGPT-generated responses in answering questions from patients and KM practitioners, specifically exemplified by facial palsy and 2) explore the potential applicability of ChatGPT in KM practice through a perception survey of experts. MethodsThis study evaluates the applicability of ChatGPT concerning facial palsy through a survey of board-certified acupuncturists. The survey comprises two parts: assessing response quality for patients and for KM doctors in clinical practice. Ethical approval was obtained, and a 36-item questionnaire was administered online to 33 participants. Responses were analyzed for quality, relevance, and applicability using a combination of Likert scales and a standardized assessment tool. ResultsAmong 33 eligible participants, 30 board-certified acupuncturists agreed to participate (response rate: 90.9 %). Survey results showed that the applicability of ChatGPT was lower for specialized KM practitioner inquiries than for general patient inquiries. Although the responses were considered useful to the readers (part 1: 96.7 %, part 2: 63.3 %) and understandable (part 1: 66.7 %, part 2: 60 %), the proportion of positive evaluations was relatively low in the domains assessing reliability and sufficiency. ConclusionsThough ChatGPT is generally viewed positively for its potential utility, its direct application in KM clinical practice treating facial palsy at its current level seems challenging. To improve reliability, the information generated by ChatGPT should be critically reviewed by qualified expert medical personnel. To enhance sufficiency, further training of the artificial intelligence model with additional KM information is required.

Self-care practices of foundation year doctors in Malta

ABSTRACT Several studies have shown high rates of mental health problems amongst doctors in training worldwide. Self-care has been shown to be protective against burnout and increases subjective wellbeing. This study aims to investigate the self-care practices of foundation year doctors (FYs) in Malta. All doctors enrolled in Foundation Programme Malta in 2022 were invited to participate in an online questionnaire containing the Mindful Self-Care Scale (MSCS). Confirmatory factor analysis confirmed the 6-factor model described in literature. The independent sample t-test and Mann–Whitney U-test were used to check for relationships between total scores and variables of interest and means and medians for each group were compared. A total of 122 doctors answered the questionnaire out of 264 (46%). The median score for our FY cohort was 68, indicating moderate levels of self-care. Almost 40% of participants rarely or never experienced a sense of meaning at work. Working for long hours under stressful conditions means that self-care must be one of the top priorities for new doctors. However, very few FYs working in Malta regularly care for their physical and mental health. Strategies to improve trainee wellbeing must first focus on systemic factors to allow the individual factors to be addressed.

Modern concepts of chronic fatigue syndrome: diagnosis and differential diagnosis with other variants of asthenic syndrome

Chronic fatigue is one of the most common syndromes in the clinical practice of medical doctors of various specialties. However, issues of criteria for distinguishing chronic fatigue from physiological fatigue, differential diagnosis of reactive asthenia, secondary fatigue syndrome and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) as a distinct nosological form can be challenging for physicians. The provision of care to patients with ME/CFS is negatively impacted by the lack of accurate and up-to-date knowledge about the disease among healthcare professionals. Even if doctors are compassionate, they often do not know how to make a diagnosis or what can be done to improve the well-being of patients. Currently, this problem is especially relevant due to the increased risk of developing ME/CFS after suffering from a new coronavirus infection, COVID-19. This article presents a modern approach to the diagnosis of ME/CFS, set out in consensus recommendations that were developed in 2021 independently by groups of experts on the diagnosis and treatment of this disease in European countries and the USA, and taking into account the recommendations of domestic specialists.

Stigmas of dysembryogenesis of undifferentiated connective tissue dysplasia in bronchial asthma

Connective tissue dysplasia is a disturbance of its development during embryogenesis and the postnatal period due to genetically altered fibrillogenesis of the extracellular matrix. Undifferentiated connective tissue dysplasia (UCTD) includes a set of phenotypic characteristics that do not fit into any already known dysplastic syndrome or phenotype. It is this pathology of connective tissue that is widespread and is constantly encountered in the practice of doctors of various profiles, serving as the basis for the formation of various chronic diseases. As for bronchial asthma (BA), it is quite natural that studies have appeared to identify the characteristics of the course of BA with connective tissue dysplasia, primarily in children. It has been shown that asthma in children associated with connective tissue dysplasia has a number of clinical features: an earlier onset of the disease, a higher incidence of concomitant diseases, and a more severe course. The features of the course of bronchial asthma associated with connective tissue dysplasia in adults have been practically not studied. Our very first results from a study of adult patients with BA showed that in patients with a mild course of the disease, up to 3 stigmas of disembryogenesis were recorded, in patients with a moderate course - from 2 to 4, and in patients with a severe course - from 1 to 8 stigmas. Correlation analysis (the data was obtained on a small material, therefore we do not consider it statistically significant) provides a distinct basis for continuing the study. Thus, negative correlations have been identified between the presence of stigmas (myopia, dolichostenomelia, joint hypermobility, wide atrophic scars, varicose veins) and such an important characteristic of the disease as its controllability.

Oncofertility in primary health care: the role of the Portuguese family doctor

Abstract Background The increasing number of cancer cases diagnosed at young ages and the impact of the disease and treatments on reproductive function have led to the development of Oncofertility. While oncologists typically lead these discussions, family doctors, as primary care providers, also play a crucial role. This study aims to assess family doctors’ knowledge, attitudes, and practices regarding fertility preservation in cancer patients. Methods This cross-sectional study, conducted between April 2023 and March 2024, surveyed 351 General and Family Medicine doctors from the Portuguese Northern Regional Health Administration. The questionnaire, consisting of 15 questions, assessed sociodemographic profiles, knowledge, attitudes, and practices. Data were analyzed using descriptive statistics and multivariate logistic regression. Results Most participants were female (80.5%) and under 40 years old. The majority (91.5%) had treated fewer than 10 cancer patients under 40 in the past two years. Key barriers included lack of knowledge (63.3%), time constraints (57.0%), and patient age (18.5%). Male physicians were more likely to address specific fertility concerns (OR 2.239) and less likely to view patient age as a barrier (OR 0.459). Physicians aged 31-35 were less likely to discuss fertility preservation (OR 0.553) but more likely to address it in the first consultation (OR 2.969). Urban-based physicians were less likely to discuss fertility preservation (OR 2.099). Only 9.1% always discussed fertility preservation before treatment, 27.6% did so sometimes, and 63.3% never discussed it. Conclusions There are significant gaps in the knowledge and practices of family doctors regarding fertility preservation for cancer patients. Targeted training and resources are urgently needed to support family doctors in effectively discussing fertility preservation, crucial for improving the quality of life of young cancer patients wishing to preserve their fertility. Key messages • Empowering Portuguese family doctors to address fertility concerns in cancer patients contributes to comprehensive oncofertility care, improving patient outcomes and quality of life. • Integrating oncofertility support with Portuguese family doctors strengthens primary care, ensuring discussion of fertility preservation is considered as part of cancer treatment planning.

Non-steroid anti-inflammatory drugs: recommendations and precautions for safe use in a multidisciplinary surgical department

Aim of the study. Conducting a safety analysis of the use of non-steroidal anti-inflammatory drugs in order to develop informed recommendations and precautions for medical practice.Materials and methods. A retrospective analysis of inpatient medical records of 250 patients in the multidisciplinary surgery department was conducted for the period from December 2023 to February 2024.Results and discussion. Based on the results of the analysis of inpatient medical records, such criteria as the presence of indications for the prescription of non-steroidal anti-inflammatory drugs (according to the diagnosis, clinical pain syndrome and according to pain assessment scales), compliance of the choice of non-steroidal anti-inflammatory drugs with national protocols/international recommendations, compliance with age, the patient's physiological/ pathological condition and allergy history for the prescription of non-steroidal anti-inflammatory drugs were 100%. The indicator for compliance of a single therapeutic dose, route of administration, frequency, duration and an appropriate diluent of non-steroidal anti-inflammatory drugs with instructions for use was 86%, where medication errors were mainly made in the frequency of use of drugs. The percentage of polypharmacy was 20%. The criterion for assessing drug-drug interactions between drugs taken by patients showed that interactions of high clinical significance (major) were 8%, while those of moderate clinical significance (moderate) were 40%.Conclusions. Nonsteroidal anti-inflammatory drugs are convenient and affordable drugs that are widely used in the treatment of diseases of various organs and systems. Therefore, to ensure the rational and safe use of drugs in this group, it is necessary to introduce effective recommendations and precautions:1. Timely completion of pain assessment scales and diary records in the Damumed medical information system;2. Development in the Damumed medical information system of divisions of appointments into planned and pro re nata (as necessary), introduction into the system of accurately recording the time of execution of doctors’ prescriptions by nursing staff for strict compliance with the intervals between doses of non-steroidal anti-inflammatory drugs allowed by the instructions.3. Introduction into the practice of doctors the use of tools to combat polypharmacy in patients ≥65 years old: Beers criteria;4. Conducting educational activities, covering both medical personnel and patients, in order to increase the level of registration of unwanted adverse reactions.

Chronic stress and mild depressive disorders in the practice of a family doctor: new possibilities of combined pharmacological agents

The problem of depression today is relevant on a global medical scale, and especially in Ukraine, where the main factor of mental distress is a full-scale war. Therefore, there is an urgent need to develop an adequate strategy of pharmacotherapy and non-drug effects. The result of scientific research was the appearance on the pharmaceutical market of Ukraine of the innovative domestic combined product Gammavital, which has a thymostabilizing, anxiolytic and mild antidepressant effect.

Psychologists' Opportunities for Fostering Leadership Skills in Academic Medicine: The Rothenberger Leadership Academy.

Healthcare leaders must increasingly attend to the monumental challenges facing their organizations (Angood and Falcone, American Association for Physician Leadership, 2023). As such, leadership in healthcare settings demands new skills sets amongst healthcare professionals that transcend the technical skills of any given profession. Academic health center psychologists are well-positioned to contribute to the leadership of academic health centers due to knowledge, skills, and attitudes fostered in doctoral psychology education, practice, and research through the focus on Profession-Wide Competencies. This article calls for psychologists to pursue more leadership opportunities within academic health centers.The article starts by identifying parallels between psychology's Profession-Wide Competencies and needed leadership skills/concepts for healthcare leaders. An example of an academic health center psychologist's leadership in a cohort-based physician leadership program illustrates how Profession-Wide Competencies were used in three structural elements of the leadership program. The article identifies particular leadership opportunities for psychologists within academic health centers.

Autoimmune gastritis: relationship between endoscopic, morphological and laboratory data

This article presents notes from the practice of doctors of the Stavropol Regional Clinical Consultative and Diagnostic Center in the diagnosis of autoimmune gastritis. The authors noted that in the presence of endoscopic and morphological signs of autoimmune gastritis in a group of patients, there is no serological confirmation of the diagnosis.