Doctor's Perception Research Articles

Medical doctor's perception of artificial intelligence during the COVID-19 era: A mixed methods study.

Artificial intelligence (AI) has led to the development of various opportunities during the COVID-19 pandemic. An abundant number of applications have surfaced responding to the pandemic, while some other applications were futile. The present study aimed to assess the perception and opportunities of AI used during the COVID-19 pandemic and to explore the perception of medical data analysts about the inclusion of AI in medical education. This study adopted a mixed-method research design conducted among medical doctors for the quantitative part while including medical data analysts for the qualitative interview. The study reveals that nearly 64.8% of professionals were working in high COVID-19 patient-load settings and had significantly more acceptance of AI tools compared to others (P < 0.05). The learning barrier like engaging in new skills and working under a non-medical hierarchy led to dissatisfaction among medical data analysts. There was widespread recognition of their work after the COVID-19 pandemic. Notwithstanding that the majority of professionals are aware that public health emergency creates a significant strain on doctors, the majority still have to work in extremely high case load setting to demand solutions. AI applications are still not being integrated into medicine as fast as technology has been advancing. Sensitization workshops can be conducted among specialists to develop interest which will encourage them to identify problem statements in their fields, and along with AI experts, they can create AI-enabled algorithms to address the problems. A lack of educational opportunities about AI in formal medical curriculum was identified.

AN OVERVIEW OF THE INTERESTS AND PERCEPTIONS OF EARLY-STAGE RESIDENT DOCTORS TOWARDS ETHICS AND MEDICO-LEGAL TEACHING METHODS IN A FACULTY OF MEDICINE

Background: Ethics and medico-legal (EM) teaching must be carried out in a fun way so that resident doctors can more easily understand the material being taught. Conventional lecture methods are considered monotonous, so efforts are needed to find the best method that is most in demand by early-stage resident doctors so that learning objectives are achieved optimally. This study aims to describe the interests and perceptions of early-stage resident doctors toward EM teaching methods at the Faculty of Medicine, Universitas Syiah Kuala.Methods: This was an interventional study with a cross-sectional design conducted among early state resident doctors (n=54) with a self-administered online questionnaire. The participants of this study were early-stage resident doctors who had passed the EM courses. The participants were collected using the total sampling method. The participants were tested for seven teaching methods for seven EM materials. After all teaching methods were carried out, participants were asked to fill out a questionnaire.Results: A total of 54 participants were involved in this study. All resident doctors have a high interest and positive perception of all EM teaching methods. The respondent chose the film/video clipping method as the most interesting, followed by CBL, role play, MCD, jigsaw technique, conventional lecture, and narrative writing. The resident doctor's perception of the CBL teaching method was considered the most positive, followed by the film/video clip method, moral case deliberation, role play, jigsaw technique, conventional lecture, and finally narrative writing.Conclusion: The CBL method is most in demand by resident doctors because it directly discusses cases in educational settings, but the resident doctor considers the film/video clipping method to be the most enjoyable. The most favorite teaching method is expected to produce a better understanding of the material than others.

Is there any difference in organizational commitment between general hospitals and specialized hospitals? Empirical evidence from public hospitals in Beijing, China

ObjectiveThe purpose of the study on the one hand is to see different hospital organization commitment have difference, including the overall score and various dimensions, on the other hand, due to the different hospital type, its function orientation is different, the factors of the doctor organization commitment may also exist differences, so the study of another purpose is to determine for different types of hospital doctor organization commitment the focus and key groups, provide reference for the doctor incentive strategy.MethodsA total of 292 doctors in four large public hospitals in Beijing were investigated. Physicians’ perceived organizational commitment was investigated using self-made electronic questionnaires. Data were analyzed by factor analysis, descriptive statistics, t-test, ANOVA, and multiple linear regression.ResultsIn the large public hospital doctor perception of the hospital commitment status, Specialized hospitals had higher overall commitment behavior scores, it is 3.47 ± 0.86; General hospital commitment behavior scored low at 3.39 ± 0.91. In the regression results, department category, working years, administrative position, and entry mode are the influencing factors of the organizational commitment of doctors in general hospitals, while in specialized hospitals, in addition to whether to hold an administrative position, entry mode, and working hours, the influencing factors also include gender, professional title and overseas learning background.ConclusionThere are differences in the perceived organizational commitment by doctors in different types of public hospitals, and different factors influencing their organizational commitment.Hospital type directly influences physicians’ organizational commitment and plays a moderating role in influencing other factors. A possible solution is general hospital specialization, encouraging general hospitals to develop the dominant discipline. These findings can help healthcare service hospital executives or government policymakers understand the impact of hospital specialization strategies and develop more efficient medical staff incentive systems.

Typical and atypical chest pain: an equivocal and dangerous definition

Abstract Background The traditional classification of stable chest pain into typical, atypical and non anginal1 is equivocal and can lead to doctor's decisions and patient's perception that do not correspond to the real importance of the clinical picture. Methods In the last 15 years, 3,588 outpatients, aged &amp;gt;35 years (mean 64±9, female 55%) were evaluated for stable chest pain reported for more than 48 hours. We excluded 290 patients with a history of myocardial infarction or angina pectoris, heart failure, valve diseases or any other major cardiovascular event, or ECG signs of recent ischemia. In the other 3,298 cases we applied the traditional classification of chest pain. All patients were evaluated for the presence of HEART score risk factors² (smoking, obesity, family history of cardiovascular events, hypertension, diabetes, hypercholesterolemia) as well as age. All patients with typical or atypical angina and those with non-anginal pain according to the physician's judgment were evaluated with one or more functional cardiovascular tests (exertion test, nuclear stress tests, stress echo).A follow-up was performed at 6 months and 1 year, for the detection of major cardiovascular events (cardiovascular death, non-fatal heart attack, revascularization, stroke) and non-cardiovascular mortality. Results Table 1 shows the results of chest pain classification and positive functional test. Table 2 shows major events at one year of follow-up stratified according to the initial assessment of chest pain. Table 3 stratifies the events according to the extent of the risk factors and age. It is evident that a positive functional test is also present in 10% of patients with atypical pain and in 4% of those with non-anginal pain. Patients with typical pain undergo revascularization more frequently (39%). The peculiarity of our study is that the prognosis and rate of events do not differ in terms of clinical and ischemic burden among the 3 groups at 1 year of follow-up, except when patients are stratified by risk burden and for age (Table 4). About 1% of patients had a clinical event regardless of the type of pain and the presence of ischemia and 87% of the events involved patients with ≥ 3 risk factors or heavy smokers. Nine percent of all heavy smokers aged &amp;lt;65 years had a major event and are the highest risk group with a peak of 12.5% in those with atypical pain. Conclusions The traditional classification of stable chest pain should be abandoned, as it does not correlate with actual disease burden and prognosis, that appears to be linked to the burden of cardiovascular risk and above all to smoking in patients &amp;lt; 65 years of age, rather than to the clinical and ischemic burden. It will be necessary to evaluate whether the anatomical burden for the search of high-risk coronary lesions improves the prognosis with added value with respect to the treatment of risk factors³.Picture 1Picture 2

Supervision, scheduling, satisfaction and shared working: how experiences of junior doctors relate to excess mortality within the NHS

BackgroundWe sought to explore associations between trainee doctor perception and excess patient mortality. MethodsData from two publicly available databases reflecting mortality and components of trainee satisfaction within 81 NHS healthcare institutions between the years 2012 and 2019 were analysed. Pearson's correlation coefficients were calculated. ResultsAll domains of trainee perception were correlated with excess mortality. Clinical supervision out of hours (R=–0.44; p<0.0001), teamwork (R=–0.36; p<0.0001) and clinical supervision at any time (R=–0.35; p<0.0001) were most strongly correlated. Most associations remained consistent year on year. ConclusionTrainee doctor perceptions of clinical supervision, rota design and teamwork within the NHS are consistently correlated with excess patient mortality. Further exploration of these associations could identify opportunities for interventions to reduce excess patient mortality. Given the clinical significance of our findings, organisations should consider rapid implementation of evidence-based interventions where they exist.

The impact of integrating a compulsory community-oriented research program within undergraduate medical curriculum on graduates' scientific publications: perspectives from Arabian Gulf University

PurposeMedical schools aspire to graduate doctors who are competent in interpreting, conducting and publishing scientific research. Hence, the purpose of the paper is explore the impact of a structured compulsory community-oriented, project-based research program in the undergraduate medical curriculum on medical graduates’ future careers, publications and motivation for scientific research.Design/methodology/approachAn online questionnaire was sent through the Alumni Association of the Arabian Gulf University (AGU) to medical graduates who have valid email addresses, seeking information on their scientific productivity along with demographic and current employment data. Responses were collated and analyzed using a standard statistical software package. The chi-square test and p-value were calculated. P-value &lt;0.05 was considered statistically significant.FindingsCompleted forms were received from 91 medical graduates. In this sample, almost a quarter of the respondents have published a research paper out of their undergraduate research project, and about 50% have published at least one paper (as main or co-author) after graduation. Both demographic and medical specialty was not related to the doctor's perception of the benefits they have attained from the compulsory undergraduate research program. However, medical graduates who are at senior levels in their medical careers and those who are employed in secondary healthcare are significantly more likely to publish research papers.Originality/valueThe compulsory community-oriented, project-based research program in AGU has positively contributed to the research productivity of graduates, and it would be worthwhile to include such programs as an integral part of the undergraduate medical curriculum.

Three-dimensional representation of triple spectral line imaging data as an option for noncontact skin diagnostics

.Significance Skin malformations in dermatology are mostly evaluated subjectively, based on a doctor’s experience and visual perception; an option for objective quantitative skin assessment is camera-based spectrally selective diagnostics. Multispectral imaging is a technique capable to provide information about concentrations of the absorbing chromophores and their distribution over the malformation in a noncontact way. Conversion of spectral images into distribution maps of chromophores can be performed by means of the modified Beer–Lambert law. However, such distribution maps represent only single specific cases, therefore, some extensive method for data comparison is needed.Aim This study aims to develop a more informative approach for identification and characterization of skin malformations using three-dimensional (3D) representation of triple spectral line imaging data.Approach The 3D-representation method is experimentally tested on eight different skin pathology types, including both benign and malignant pathologies; an imaging device ensuring uniform three laser line (448, 532, and 659 nm) illumination is used. Three spectral line images are extracted from a single snapshot RGB image data, with subsequent calculation of attenuation coefficients for each working wavelength at every image pixel and represented as 3D graphs. Skin chromophore content variations in malformations are represented in a similar way.ResultsClinical measurement results for 99 skin pathologies, including basal cell carcinomas, melanoma, dermal nevi, combined nevi, junctional nevi, blue nevi, seborrheic keratosis, and hemangiomas. They are presented as 3D spectral attenuation maps exhibiting specific individual features for each group of pathologies. Along with intensity attenuation maps, 3D maps for content variations of three main skin chromophores (melanin, oxyhemoglobin, and deoxyhemoglobin), calculated in frame of a model based on modified Beer–Lambert law, are also presented. Advantages and disadvantages of the proposed data representation method are discussed.ConclusionsThe described 3D-representation method of triple spectral line imaging data shows promising potential for objective quantitative noncontact diagnosis of skin pathologies.

The roles of primary care doctors in the COVID-19 pandemic: consistency and influencing factors of doctor's perception and actions and nominal definitions

BackgroundAt the end of 2019, the Coronavirus Disease 2019 (COVID-19) pandemic broke out. As front-line health professionals, primary care doctors play a significant role in screening SARS-CoV-2 infection and transferring suspected cases. However, the performance of primary care doctors is influenced by their knowledge and role perception. A web-based cross-sectional survey was conducted to assess the consistency and influencing factors of primary care doctor's role perception and expert advice in the guidelines (regulatory definition).MethodsWe designed the questionnaire using “Wenjuanxing” platform, distributed and collected the questionnaire through WeChat social platform, and surveyed 1758 primary care doctors from 11 community health service stations, community health service centers and primary hospitals in Zhejiang Province, China. After the questionnaire was collected, descriptive statistics were made on the characteristics of participants, and univariate analysis and multivariate analysis were used to determine the relevant factors affecting their role cognition.ResultsIn the reporting and referral suspected cases and patients receiving treatment, most participants’ cognition of their roles were consistent with the requirements of guidelines. However, 49.54% and 61.43% of participant doctors were not in line with the government guidelines for diagnosing and classifying COVID-19 and treating suspected cases, respectively. Having a middle or senior professional title and participating in front-line COVID-19 prevention and control work is beneficial to the accurate role perception of diagnosis and classification of COVID-19, the reporting and transfer of suspected cases, and the treatment of suspected cases.ConclusionsPrimary care doctors’ role perceptions in the COVID-19 pandemic are not always consistent with government guidelines in some aspects, such as transferring and diagnosing suspected cases. Therefore, it is essential to guide primary care doctors in performing their duties, especially those with lower professional titles.

Anxiety, Depression and Barriers to Mental Health Services among patients with Neurological disorders

There is high prevalence of psychological distress in patients diagnosed with neurological disorders. A cross-sectional study was done among inpatients from the department of neurology in a tertiary care centre in South India to assess prevalence of anxiety, depression, and barriers to mental health-care utilization. Anxiety and depression were estimated using the Hospital Anxiety and Depression Scale (HADS). There is a high prevalence of psychological distress among the study participants. Proactive inquiry and screening of distress by the treating team may help identify psychological distress. Patients are more conforming and open to treating doctor. Barriers to mental health-care utilization included stigma, patient perception regarding treating doctor's attitude, patients' perception regarding distress, and doctor's perception regarding patient distress. There is a need for measures to alleviate stigma.

Peak Moments im Ärzt*innen-Patient*innen-Kontakt der hausärztlichen Praxis–eine qualitative Studie mit Allgemeinmediziner*innen in Deutschland

BackgroundSuccessful therapy is influenced by successful communication and a relationship built on trust. Physician empathy and listening skills appear particularly relevant. Based on their empirical experience, general practitioners report special moments in their patients during their medical consultations. Abraham Maslow coined the term “peak experience” for these special moments, which are rare and deeply moving. The present study examines “peak moments” in terms of existence, origin, characterization, doctor perception, and the overall effect on the doctor-patient relationship. MethodA qualitative study design was chosen. Interviews with family practitioners were conducted and analyzed using qualitative content analysis by Kuckartz. In order to collect socio-demographic information the participants were asked to complete a short questionnaire. ResultsThe study participants (n=17) confirmed the existence of peak moments in doctor-patient interactions in their GP practices. These moments came about spontaneously, facilitated by specific communication strategies and intervention measures to support a situation in which peak moments become possible. To bring about a peak moment in patients, specific requirements need to be met on the part of both doctors and patients. Primary care physicians participating agreed that a peak moment led to relaxation and a stronger trust in the relationship between doctor and patient. ConclusionsFamily physicians perceive peak moments to be an important element to build trust between themselves and their patients, for the patients' increased “self-awareness”, and to improve the chances of treatment success. To enable peak moment conditions for general practitioners, a framework of health policy measures such as education and training is recommended, along with an assessment of the time needed for doctor-patient interactions.

Mid-facial soft tissue re-suspension following skeletal fixation after maxillofacial trauma-a prospective case series study.

Open reduction and internal fixation (ORIF) is used for reduction and stabilization of facial fractures. Despite perfect anatomic skeletal reduction, subtle asymmetries are seen in facial appearance as mid-facial soft tissue often reattaches to the respective facial bones in an aberrant, mostly lower in position. Thus, the present study evaluates the effectiveness of mid-facial soft tissue re-suspension procedure to prevent changes in mid-facial soft tissue profile after ORIF of maxillo-facial fractures. Fifteen patients with maxillo-facial fractures requiring ORIF were included. After ORIF, mid-facial soft tissue resuspension (STRP) was done by suspending the soft tissue and periosteum over cheek region from temporal fascia by polydioxanone suture material. The results were analyzed by patient satisfaction survey and doctor perspective form on photographs by three surgeons 6months postoperatively. All patients were male in the age range of 18-60years. STRP was done unilaterally in 7 cases and bilaterally in 8 cases, with average time ranging from 10.6 to 20.5min. The patient satisfaction survey revealed that 86.6% were pleased with their appearance and 93% said that there was no abnormal change in the esthetics postoperatively. The doctor perception form revealed almost 80% agreement, that there was minimal change in the appearance of cheek mound, nasolabial fold, corner of the mouth, and lateral canthus postoperatively. STRP is a simple technique to perform with fewer complications, and helps in restoring facial esthetics, same as prior to facial trauma; as it prevents soft tissue sagging after degloving incisions for fracture reduction and fixation.

Machine Learning Approaches for Predicting Hypertension and Its Associated Factors Using Population-Level Data From Three South Asian Countries

BackgroundHypertension is the most common modifiable risk factor for cardiovascular diseases in South Asia. Machine learning (ML) models have been shown to outperform clinical risk predictions compared to statistical methods, but studies using ML to predict hypertension at the population level are lacking. This study used ML approaches in a dataset of three South Asian countries to predict hypertension and its associated factors and compared the model's performances.MethodsWe conducted a retrospective study using ML analyses to detect hypertension using population-based surveys. We created a single dataset by harmonizing individual-level data from the most recent nationally representative Demographic and Health Survey in Bangladesh, Nepal, and India. The variables included blood pressure (BP), sociodemographic and economic factors, height, weight, hemoglobin, and random blood glucose. Hypertension was defined based on JNC-7 criteria. We applied six common ML-based classifiers: decision tree (DT), random forest (RF), gradient boosting machine (GBM), extreme gradient boosting (XGBoost), logistic regression (LR), and linear discriminant analysis (LDA) to predict hypertension and its risk factors.ResultsOf the 8,18,603 participants, 82,748 (10.11%) had hypertension. ML models showed that significant factors for hypertension were age and BMI. Ever measured BP, education, taking medicine to lower BP, and doctor's perception of high BP was also significant but comparatively lower than age and BMI. XGBoost, GBM, LR, and LDA showed the highest accuracy score of 90%, RF and DT achieved 89 and 83%, respectively, to predict hypertension. DT achieved the precision value of 91%, and the rest performed with 90%. XGBoost, GBM, LR, and LDA achieved a recall value of 100%, RF scored 99%, and DT scored 90%. In F1-score, XGBoost, GBM, LR, and LDA scored 95%, while RF scored 94%, and DT scored 90%. All the algorithms performed with good and small log loss values <6%.ConclusionML models performed well to predict hypertension and its associated factors in South Asians. When employed on an open-source platform, these models are scalable to millions of people and might help individuals self-screen for hypertension at an early stage. Future studies incorporating biochemical markers are needed to improve the ML algorithms and evaluate them in real life.

Evaluation of Doctor's Perception About the Role of the Pharmacy in Pharmaceutical Services in Tengku Rafi'an Siak Hospital and Dr. Rasidin Padang Hospital

Evaluation of Doctor's Perception About the Role of the Pharmacy in Pharmaceutical Services in Tengku Rafi'an Siak Hospital and Dr. Rasidin Padang Hospital

Doctor's Awareness and Perception of Medical Library Resources and Services

The study is an investigation of doctor awareness and perception of the information resources and services in the Delta State University Teaching Hospital (DELSUTH), Oghara. The descriptive survey method has been employed for the study. Also, with the aid of a questionnaire, data has been collected from doctors (academic staff) at DELSUTH, and analysed using a simple percentage. Findings reveal that the doctors are mostly aware of the availability of textbooks and reprographic services in the Medical Library. However, there is a perception of inadequacy of the information resources and services. The study also observes that although the doctors perceive information to be of clinical value and provide new knowledge, the information is not always relevant, accurate and current.

Perception About Doctors in Turkish Culture Through Music

Giriş: Sözlü müzik, insanların duygularını ve düşüncelerini yansıtan önemli araçlardan biridir. Müzik, ayrıca duyguları harekete geçirerek insanı ve toplumu etkileme gücüne de sahiptir. Bireylerin, doktora bakışı ve doktordan beklentileri de o kültüre ait olan müzik içerisinde kendini gösterir. Öte yandan, topluma veya halk kültürüne mal olmuş bir müzik eseri içerisinde yer alan ifadeler ise toplumun doktora bakışını etkileyebilir.Amaç: Bu çalışmada Türkiye’de toplumsal kültürün önemli bir parçası olan şarkı ve türküler içerisinde Doktor, Hekim ve Tabip sözcükleri bulunan müzik eserleri incelenerek, bu eserlere doğrudan veya dolaylı olarak yansıtılmış olan hasta-hekim ilişkisinin niteliğinin araştırılması amaçlanmıştır.Gereç ve Yöntem: Bu çalışma tanımlayıcı tipte bir araştırmadır. Doktor, Hekim ve Tabip kelimelerinin yer aldığı şarkı/türküler belirlenmiş ve kategorize edilmiştir.Bulgular: İncelenen 190 eserde Doktor, Hekim ve Tabip kelimelerinin yer aldığı ifadeler çare bulamayan/tedavi edemeyen ve çare bulması/tedavi etmesi beklenen şeklinde ana iki kategoriye ayrılmıştır. Bu iki grup dışında kalan yirmi iki eser ise diğer grup olarak değerlendirilmiştir.Sonuç: Müzik eserlerinin ve içerisinde yer alan sözlerin, zamanın süzgecinden damıtılarak yıllar içerisinde oluşan bir birikimle meydana gelen toplumsal kolektif bilinci yansıttığı dikkate alınacak olursa, türkülerde yer alan hekim algısının, sağlık politikaları ve sosyal medyanın saman alevi gibi hareketlilik gösteren gündeminden etkilenen anlık bir bakıştan ziyade, o halkın kültüründeki uzun süreli ve kalıcı hekim algısını daha gerçekçi bir şekilde yansıttığı düşünülebilir.

Faktor - Faktor yang Mempengaruhi Komitmen Dokter di Puskesmas untuk Tidak Merujuk Kasus Non-Spesialistik Pasien BPJS di Kota Semarang

Patients who should be able to be treated at the health center (puskesmas) but because of some matters referred to and handled in a hospital, it is a waste of health costs. Hence, BPJS will pay more according to INA CBG's tariff. 3 Advanced Health Facilities, in this case a hospital, is also object to having to deal with non-specialist cases, while the case can actually be completed at the first health facility. Handling non-specialist cases in hospitals leads to health services being less well targeted. The hospital will be very busy handling patients who are not supposed to, while patients who really need treatment in the hospital can be neglected. 2 This study aims to analyze factors which influence the commitment of doctors not to refer to non-specialist cases in health centers in the city of Semarang The study was conducted with a cross sectional quantitative research design. The data were collected by calculating the total results of the questionnaire measurements on each variable with a Likert scale on 73 doctors in 37 health centers spread across the city of Semarang. The study was conducted during March to May 2018. The results showed that the number of non-specialist cases of BPJS Health participant patients was still relatively high. This has to do with the commitment of doctors at the health center not to refer to non-specialist cases. The most influence factor to the commitment of doctors not to refer to non-specialist cases was the doctor's perception of the completeness of facilities and infrastructure and the doctor's perception of his competence

Inercia clínica en el tratamiento con insulina en el primer nivel de atención.

Refusal of physicians to prescribe insulin to their patients has been scarcely evaluated; the delay in treatment intensification hinders adequate and quality care. To identify the perception of primary care physicians about barriers to initiate insulin treatment in patients with diabetes. Using the Smith Index and multivariate analysis, the relevance and grouping of concepts related to barriers to insulin prescription were assessed in 81 family doctors. Only 35.8% of physicians showed confidence for prescribing insulin; almost half of them rated treatment intensification between moderately and little important (39.5% and 6.2%). Barriers were related to the physician (39.5%), the patient (37%), insulin treatment (11.1%) and the institution (6.2%); 6.2 % of physicians did not perceive any barrier. The barriers were grouped in 5 factors that explained 62.48% of the variance: patient cultural level, lack of medical skills, fear of adverse events, insecurity and lack of training. Clinical inertia was not the result of a complex medical condition or patient comorbidities, but of doctor's perception and confidence in his/her clinical and communication skills.

Health Services Management in Turkey: Failure or Success?

Background:The unfair distribution and delivery of health-care resources have been recognized as a problem in the worldwide. In the past 18 years, Turkey has undergone rapid social, cultural, and economic changes. The lifestyle and dietary habits of its people have also been changing, and the rates of diabetes, obesity, cancer, and other chronic diseases have increased dramatically over the past two decades. The health transformation program (HTP) has improved the Turkish health-care system since 2003. The main goal of HTP was to progress government, to provide equality between citizens, to give satisfaction to users and providers, and to subsidise the health-care system in Turkey.Aim:The aim of this study is to assess health-care services and health care quality delivery in the Republic of Turkey with special emphasis on governmental hospitals, university hospitals, primary healthcare centers (PHC) and to make comparison with low-, medium- and high-income countries.Methods:This is a retrospective, descriptive study. The ministry of health Annual Reports, websites of the Central Intelligence Agency (CIA), The World Fact Book, organization for economic cooperation and development report, Compendium of Health Statistics, the Google engine, and PubMed were searched for information about Turkey's health-care system and its history. Papers and websites in English were evaluated. There was no restriction on types of articles and sources.Results:Turkey has made outstanding reforms in health status in the last two decades, especially after the implementation of the HTP. The doctor's perception has more influence regarding consultation length and visit than the patient’s. The results of consultations in volunteer practices in Istanbul showed that the mean and SD of the consultation length for the whole sample of 360 patients was 7.95 ± 4.38, (with range = 3–25 min). Consultation time has been affected by the patients’ diseases, genders that women got longer consultation time, medical practices at the urban or rural areas, and ages which older patients required longer consultation time. The current study revealed that increasing doctor's workload leads to decrease the length of consultations. Moreover, average life expectancy reached 75.3 for men and 80.7 for women in 2015. The infant mortality rate decreased to 10.7/1000 live births in 2015, down from 117.5 in 1980. The leading causes of death are diseases of the circulatory system followed by cancer.Conclusions:The Turkish health system and health-care delivery have been improved over the last decade. Still far from perfect, there is a particular planning to increase medical workforce in PHC including well-trained staffs for a specific area. An urgent need is to acquire more accurate and reliable data from hospital and PHC centers in Turkey. Additional some attempts should be made to assess quality of healthcare in relation to services and process.

Quality of Life Assessment in Multiple Sclerosis: Different Perception between Patients and Neurologists.

In recent years, neurologists are noticing that evaluation of multiple sclerosis (MS) patients based on combining relapses, disability progression, and magnetic resonance imaging activity may be insufficient to adequately assess suboptimal responses to available therapy. Inclusion of quality of life (QoL) parameters may contribute to breach this gap. To evaluate agreement levels between doctor and patient perception of QoL in MS. A total of 700 MS patients and 300 neurologists were invited to participate in a cross-sectional study by answering an e-mail questionnaire. The survey collected information on demographical data and included the Short Form questionnaire (SF-36). After completing the questionnaire, patients were given a standard written description of each of the subdomains assessed by SF-36 and asked to identify which three were the most important determinants of their overall health-related QoL. A total of 135 neurologists and 380 MS patients responded the survey. Study population mean age was 42.1 ± 10.5 years, with 61% presenting relapsing-remitting MS. SF-36 results were physical function 68.4 ± 30, physical role limitation 56.8 ± 41.7, vitality 47.6 ± 21.4, pain 71.2 ± 26.1, social function 72.6 ± 28.6, emotional role limitation 63.2 ± 39.8, mental health 60 ± 14.1, and general health 55.8 ± 22. Doctors considered physical function (75%) and physical role limitation (70%) as the most important QoL determinants in MS, followed by emotional role limitation (52%). Patients however, assigned significantly different levels of importance to physical function (58%), and physical role limitation (46%) and considered vitality (52%) more important than their physicians (p < 0.001). Important to note, the results of SF-36 questionnaire were highly correlated with the perception gap between patients and neurologists (r = 0.89; p = 0.0004). Concerns on QoL in MS are different for patients and physicians. It is essential to enhance communication in order to better understand actual patient needs.

Asthma Education Delivered in the Emergency Department: Does it Encourage Asthma Self-management?

Background: The rates of optimal asthma control and compliance to treatment in Israel are reportedly low. We postulated that adults attending our emergency department (ED) with asthma exacerbation were not using self-management strategies optimally. Objectives: This pilot study aims to: (a) verify the above hypothesis and, if applicable, (b) determine whether an asthma education intervention (AEI) administered in the ED would encourage post-discharge use of a written asthma action plan (AAP). Methods: Thirty-eight adults (>18 yr.) visiting the ED with asthma exacerbation received a 30-min AEI including a written AAP. Prior asthma education was assessed by questionnaire. Follow-up, carried out by phone ≥ 12 months after discharge, assessed AAP use, asthma control (GINA), and exacerbations in the past year. Results: At baseline, participants denied previous education on asthma selfmanagement and AAP use. Of 27 patients available for follow-up, only 5 (18.5%) were using the AAP, assisted by their care-provider. Eighteen subjects (66.7%) presented uncontrolled asthma while, as a whole, the group reported significantly more exacerbation episodes than at enrolment (mean (SD)=5.1 (6.5) vs. 2.7 (3.0) (p=0.0498)). Finally, compared with AAP non-users (n=22) AAP users (n=5) tended to have better asthma control (60% vs. 18%) and fewer episodes of exacerbations (mean (SD)=2.8 (2.2) vs 5.9 (6.9)) but the differences did not reach significance. Conclusion: Delivery to adults of a short AEI in the ED was of limited efficiency in post-discharge boosting of patient/doctor partnership, resulting in sub-optimal AAP use. Feasibility of the AEI in a crowded ED, however, justifies further research on AEI delivery coupled with alternative follow-up strategies targeting patient and doctor perception of AAPs.