Experience Of Medical Practice Research Articles

Perspectives of Family Medicine Providers on Nutrition of Maternal-Infant by Group Care Visits: A Cross-Sectional Study.

Group care in child welfare and primary care settings has evolved, becoming a popular approach for maternal and infant health care. This study focuses on the perspectives of family medicine providers on group care visits for maternal and infant nutrition, a crucial aspect of primary healthcare. Hence, this study aimed to explore current practices and opinions regarding the efficacy of group care models in delivering nutrition education to mother-infant dyads. A quantitative, cross-sectional study was conducted among family physicians in Buraydah, Saudi Arabia, from June to August 2023. Participants were recruited using a randomized sampling method from primary healthcare centers. Data were collected through a well-structured, self-administered questionnaire. The total participant count was 60. Statistical analyses were conducted using descriptive and inferential methods. The majority of participants were men (n=32, 53.3%), under 30 years of age (n=31, 51.7%), and had 0 to five years of experience in medical practice (n=32, 53.4%). A high weekly volume of infant and maternal clinic visits was reported (n=44, 73.3%) but predominantly conducted individual nutrition education sessions (n=60, 100%). A significant majority (n=41, 68.3%) expressed a positive potential for group care in nutrition education. The study revealed a positive inclination among family medicine providers towards group care models for maternal and infant nutrition education. However, current practices largely involved one-on-one sessions, indicating a gap between the recognition and implementation of group care models. It underscores the need for enhanced integration of group care approaches into clinical practice, highlighting their perceived benefits in efficiency and comprehensiveness. Future steps include implementing group care programs addressing participant concerns and assessing their efficacy in educating mothers on infant nutrition.

Is There Such a Thing as Theological Medicine?

The idea that science must be understood in existential contradiction to religion and even theology is more of a conviction than a philosophical or experiential necessity. Indeed, we may now propose "Theological Medicine" as a new terminology for a perennial reality: that most physicians, health care providers, patients, and their caretakers experience the reality of illness within a theological framework, at least for those who have some degree of spiritual or religious belief. Developing a curriculum in Theological Medicine could develop a mechanism to offer appropriate training to healthcare providers. Such a course would have to be created and delivered by experienced physicians and nursing staff, spiritual advisors, clergy representatives such as pastors or priests from different churches or faith communities, bioethicists, psychologists, social workers, psychotherapists, patient support group members, members of institutional review boards, researchers, and even legal advisors, if available. Continuing professional education requirements also create an opportunity to introduce and evaluate competency in theological medicine, an emerging discipline that could add significant value to the lived experience of medical practice which remains based on the uniquely rich relationship between physician and patient.

Are we aware of radiation: A study about necessity of diagnostic X-ray exposure.

BACKGROUNDTotal exposure to ionizing radiation has nearly doubled in the last two decades. This increase is primarily due to increased computed tomography (CT) exposure. Concerns have been raised about the risks associated with patients' exposure to medical imaging radiation, which can increase a person's lifetime risk of developing cancer. Preventing unnecessary examinations becomes critical at this point. To avoid unnecessary examinations, it is necessary to understand the demanding process. AIMTo ascertain clinicians' awareness of and reasons for requesting a CT examination. METHODSWe developed an online questionnaire that included 20 questions about clinicians' awareness of radiation safety and their reasons for requesting a CT examination, as well as demographic information such as age, gender, and year of medical practice experience. Additionally, we asked participants the number of CT scans requested in a month, the patients' questions and approaches about the imaging method, the effect of the patient's previous imaging history on the current imaging request, whether they believed that they had sufficient information about radiation doses, and whether they requested CT without an indication. We administered the questionnaire to clinicians from a variety of different professions in four different cities. RESULTSA total of 195 clinicians participated. Internal medicine specialists were the most crowded group (38/195, 19.5%). Mean age of the population was 33.66 ± 5.92 years. Mean year of experience was 9.01 ± 5.96. Mean number of requested CT scans in a month was 36.88 ± 5.86. Forty-five (23.1%) participants stated that they requested CT scans without clinical indication. The most common reasons for CT scan requests were work load, fear of malpractice, and patient demand/insistence. CONCLUSIONCT scan requests are influenced by a variety of factors, both internal and external to the doctors and patients. Raising awareness of radiation safety and reducing fear of malpractice by limiting the number of patients per physician may result in a reduction in unnecessary CT examinations and ionizing radiation exposure.

Assessment of the need for the use of digital medical decision support system in the diagnosis of diseases of the oral mucosa

Aim. To substantiate the need for the use of digital systems to support medical decision-making in the diagnosis of diseases of the oral mucosa.Materials and Methods. The study was conducted by the method of anonymous questionnaires, dedicated to the evaluation of the use of digital systems to support medical decision-making in the diagnosis of diseases of the oral mucosa, on the basis of the Institute of Dentistry I.M. Sechenov First Moscow State Medical University (Sechenov University). The study analyzed 200 questionnaires of doctors aged 20 to 70 years. The main methods used in the study: statistical method using the Kruskal-Wallis test, followed by pairwise comparison using the Mann-Whitney-Wilcoxon test (with Benjamin-Hochberg correction for multiple comparisons), questionnaire.Results. It was revealed that dentists with a long experience of medical practice from 15 to 20 years (77,8%) more often detect manifestations of diseases of the oral mucosa at a medical appointment. When analyzing the diagnosis of oral mucosa diseases, depending on the specialization of the dentist, it was found that this group of pathologies is more often determined by orthodontists(68,8%). At the same time, for the majority of specialists (59%), the diagnosis of diseases of the oral mucosa is difficult. Dentists of various specializations in most cases noted difficulties in determining a presumptive diagnosis (59.5%). At the same time, most specialists associated this with a lack of knowledge and experience in working with patients with diseases of the oral mucosa (66.5%) and with a large variety forms of diseases of the oral mucosa (54%) and resorted to the use of additional sources of information from textbooks, manuals, information articles, as well as the help of colleagues (64.5%). However, at clinical appointments, many doctors faced a lack of time to use reference literature (48.5%). As a result of the survey, it was also revealed that the majority of respondents (64,5%) would like to use the medical decision support system integrated into the medical information system of a medical institution.

Practical aspects of the electronic system functioning in the field of medicine of the future (Pakistan)

This article focused on “Practical aspects of the electronic system functioning in the field of medicine of the future in Pakistan” Aims: To explore the practical aspects of the electronic systems functioning in the field of medicine of the future, the challenges and opportunities of implementing these systems, and the potential solutions for optimising and enhancing their impact on outcomes in Pakistan. Methodology: A descriptive cross-sectional study design was used. A sample of 323 was selected through non-random convenient method. Data collected through interview. Chi square test was applied. Results: The results on telemedicine showed, out of 323 participants who practiced telemedicine, 52% had 19-24 months of medical practice experience. Among the doctors, 19.3% used laptops, 22.7% used mobile phones to search information online, while 41.1% connected with their patients through WhatsApp and 16.9% through Facebook. 80% of the doctors agreed that telemedicine was beneficial for saving money, time, effort, and for the patients. Among the group with experience above 24 months, 59% were practicing EHR systems and 41% were not utilising them. When it came to CDS Systems, 64.2% of the more experienced group were using the system, while 35.8% were not. In addition, 71.2% of the more experienced group were practicing Digital Medical Imaging. During the COVID-19 pandemic, all medical institutes taught, assigned tasks, and evaluated students through online mechanisms. However, after the pandemic, 100% of the institutes returned to traditional teaching methods. Interestingly, 60% of the participants favoured online education, considering it an easier, more effective and efficient way of learning. Scientific Novelty: Examines Pakistan's computerised healthcare system and its impacts. Conclusion: Improved infrastructure, healthcare education, patient computer literacy, privacy and data security rules may have the largest impact on healthcare outcomes. An international help is needed to reach global electronic health care standards. Note: Review paper may have different types of subsections.

The Effect of Requester Training on the Relevance of Lumbar Spine X-Ray Request for Low Back Pain in Adults at Yaounde

Background: Despite the availability of guidelines, the requests for medical imaging examinations for the exploration of low back pain remain irrelevant in the majority of cases. Objective: To assess the impact of requester training on the justification of lumbar spine X-rays for low back pain in adults in Yaounde. Materials and Methods: We carried out an interventional study from December 2017 to April 2018 in Yaounde (Cameroon). We analyzed the relevance of the prescription of X-rays for low back pain before and after an interactive training of the requesters. Results: Among the 16 requesters who were trained, the proportion of irrelevant requests dropped from 58.22% (46/79) before training to 44.44% (20/45) after training, representing a decrease of 13.78% (p = 0.012). The highest drop in the proportion of irrelevant requests was found among general practitioners (-21.98%) and requesters having less than 10 years of experience in medical practice (-31.8%). Conclusion: The training of requesters moderately reduces the rate of irrelevant examinations. Other factors of irrelevant prescription must be investigated and corrected for this decrease to be more significant.

Classical Hodgkin Lymphoma; Real-World Observations from Physicians, Patients, and Caregivers on the Disease and Its Treatment (CONNECT): Physician First-Line Treatment Preferences for Stage III or IV Classical Hodgkin Lymphoma

BackgroundMainstay therapies for patients with stage III or IV classical Hodgkin lymphoma (cHL) include several multiagent chemotherapy regimens. A combination of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) is commonly administered in the first-line (1L) setting; however, ~30% of patients with stage III or IV cHL will be refractory to or relapse following ABVD treatment. Brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine (A+AVD), a novel targeted therapy in combination with a standard chemotherapy regimen, is another option for 1L treatment of stage III or IV cHL. In the 5-year update of the ECHELON-1 trial (Straus, 2021), patients with stage III or IV cHL randomized to 1L A+AVD compared with ABVD continued to demonstrate progression-free survival (PFS) improvement with a 32% reduction in the risk of progression or death (HR=0.681, nominal P=0.002). To understand the decision-making process when selecting a 1L cHL treatment regimen for stage III or IV cHL, we surveyed physicians to gain insights into their preferred regimens and factors that influence their treatment choices as part of CONNECT, the first real-world observational survey in cHL that includes physicians, patients, and caregivers.MethodsPhysicians in the United States who treat patients with cHL were recruited to participate in an Institutional Review Board-approved, online anonymous survey from October 19, 2020-November 16, 2020. Eligible participants were medical oncologists, hematologist/oncologists, or hematologists with ≥2 years medical practice experience who, within the past 12 months, had treated ≥1 adult (aged ≥18 years) with stage III or IV cHL and ≥1 adult in the 1L setting.ResultsOf participating physicians (N=301), 62% were community-based and 80% identified themselves as a hematologist/oncologist, reporting a median of 15 years of experience. Participants saw a median (interquartile range) of 16 (7-40) patients with active, newly diagnosed cHL and 15 (8-40) cHL survivors in the 12 months preceding survey participation. The most important considerations (ranked 1 or 2) for cHL treatments were clinical trial efficacy and safety data (60%) and official guideline recommendations (58%). Specifically, efficacy attributes including overall survival (OS; 91%), long-term PFS (86%), curative potential (85%), and complete response (81%) were rated highest or as having the most essential impact. In contrast, patient personal goals (6%), treatment costs (4%), and patient financial support programs (4%) were endorsed by <10% of participants. When asked about acceptable long-term toxicity trade-offs for increased efficacy in patients with stage III or IV cHL, participants stated that an additional median of 8 months of OS and 6 months of PFS were worth the potential for downstream toxicity. Fifty percent of participants reported that disease stage was the most important patient characteristic to consider when deciding on 1L cHL treatment. In patients with newly diagnosed stage III or IV cHL, 37% to 50% of participants selected A+AVD as their first-choice regimen across various populations (Figure); no significant differences in preferences were noted between community and academic practice settings. Participants reported selecting intensive treatment regimens based on OS and PFS and less intensive regimens (e.g., AVD) based on age, comorbidities, and patient quality of life.ConclusionsEfficacy attributes, including OS and PFS; quality of life; and patient age were top reasons cited by surveyed participants for selecting a specific 1L treatment regimen in stage III or IV cHL. Treatment preferences for newly diagnosed stage III or IV cHL varied based on patient characteristics including presence of bulky mediastinal disease, disease stage, perceived risk of relapse, age, and comorbidities. [Display omitted] DisclosuresYu: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Liu: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Kumar: Seagen, Inc: Consultancy. Fanale: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Flora: Seagen, Inc: Research Funding. Parsons: SeaGen: Consultancy.

Marvels of Medicine: Literature and Scientific Enquiry in Early Colonial Spanish America

Yarí Pérez Marín's examination of sixteenth- and seventeenth-century medical works aims to contextualize the literary and scientific contributions of Spanish writers with experiences in early colonial Spanish America. The work includes analysis of four medical practitioners with varying levels of education and training: Pedro Arias de Benavides, Alonso López de Hinojosos, Agustín Farfán, and Juan de Cárdenas. Studying these authors helps to counter teleological narratives of supremacy in knowledge production. Pérez Marín argues that these practitioners viewed themselves as “voices within a larger conversation on health and the human body” who “contest[ed] the supremacy of emerging marginalising colonial structures” (p. 6). Frustratingly, the imperial motherland failed to see these contributions in the same light.Drawing from extensive primary source material and in-depth historiographical analysis, Pérez Marín offers a contextual interpretation of colonial and imperial discourses that shaped the acceptance, rejection, or ambivalence toward works of science and medicine produced in the New World. The author emphasizes the narrative of civilizational superiority as inhibiting dissemination and cultural acceptance of New World scientific works. Such contributions were so often written off as “local ‘practices’ or ‘traditions’” and thus inherently “unscientific” (p. 10). Pérez Marín analyzes the role of race in the construction of differences between humans; she combines methodologies of both literary and cultural analysis to determine whether these New World works “chose to advance racialised models of human anatomy and physiology” (p. 14).Pérez Marín detects in the work of Pedro Arias de Benavides a growing displeasure with European exclusion of practitioners engaged in empirical work overseas. Benavides's Secretos de Chirurgia (Secrets of surgery), a hybrid surgical manual and book of secrets, offers life-size surgical illustrations and descriptive techniques to detail his myriad treatment of ailments in Honduras and later in Mexico. Benavides strongly emphasizes the role of experience in medical practice, arguing that importing samples of materia medica from the New World to Spain failed to satisfy epistemological standards. As Pérez Marín summarizes Benavides's argument, “In order to know or to speak of new worlds, one had to have lived in them” (p. 25).Pérez Marín's side-by-side comparison of Alonso López de Hinojosos's Svmma, y recopilacion de chirvgia (Surgical compendium) and Juan de Cárdenas's Primera parte de los problemas y secretos marauillosos de las Indias (First part of problems and marvelous secrets of the Indies) analyzes the colonial paradox of anatomy and physiology. Where anatomy emphasized a bodily template essentially free from influence of racial or ethnic background, physiology sought to determine measurable differences between ethnic compositions. The two disciplines diverged against the backdrop of growing mixed-race populations throughout the viceroyalties.Drawing from the colonial paradox established with López de Hinojosos and Cárdenas, Pérez Marín next brings gender and femininity into the discussion. From Agustín Farfán's Tractado breve de anothomia y chirvgia, y de algvnas enfermedades, que mas comunmente suelen hauer en esta Nueua España (Brief treatise on anatomy and surgery, and on some common illnesses found in this New Spain), Pérez Marín traces physiological interpretations of gestational processes that were thought to result in appearances that did not align with notions of femininity or masculinity. Ultimately, Pérez Marín determines that while Farfán's work did not drastically change anatomical or physiological interpretations of the body, it did create a place for women's voices in relation to their health, detailed at length in the Tractado.Finally, Pérez Marín looks more broadly at knowledge circulation between Spain and its empire, citing Cárdenas's critiques of scientific rigor. Like Benavides before him, Cárdenas questioned the superiority of European scientific endeavors that relied on imported specimens. This research from afar could not possibly replace the value of research conducted in situ. Questioning geographical and cultural identity rather than a criollo/peninsular designator, Cárdenas diverged from the narrative of superiority based on birthplace.Pérez Marín's work offers a valuable, rich interdisciplinary analysis of early colonial medical texts and their authors. The author's literary and historical contextualization of political, scientific, and cultural discourses that determined the fate of these men and their work is thorough and engaging. This book will be especially useful for scholars interested in viceregal medicine and circulation of knowledge.

Naval hygienist Zun Andrey Vadimovich: professionalism, erudition and fidelity to traditions

We are considering the main aspects of the professional activity of an outstanding naval hygienist, alumnus of the Faculty of residency training for the Naval Service of Military Medical Academy named after S.M. Kirov (1964), Candidate of Medical Sciences (1971), Higher Senior Officer (graduate education hygiene) of the Scientific Research Center of the Academy (1975), Associate Professor at the Department of Naval and Radiation Hygiene (2004), retired Colonel of the Medical Service Zun Andrey Vadimovich. Having gained a unique experience in medical practice as the Head of the medical service of a diesel-electric submarine of the Baltic Fleet and having completed his postgraduate studies at the Department of Naval and Radiation Hygiene (Military Medical Academy named after S.M. Kirov), Andrey Vadimovich successfully defended his thesis for the degree of Candidate of Medical Sciences (graduate education hygiene) on the topic "Hygienic characteristics of the working conditions of specialists working on the fleet shore installations of the Naval Service, working with components of rocket fuel". After this more than 45 years of his professional activity were devoted specifically to the preventive medicine trend hygiene. The main professional achievements of Andrey Vadimovich undoubtedly include the study of the physiological effect of negative air ions in closed premises with conditions of oxygen deficiency, the study of the workplace hygiene of coastal missile systems specialists, as well as the hygienic characteristics of military clothing. Andrey Vadimovich has been also teaching such academic disciplines as naval and radiation hygiene, as well as medical ecology for all categories of Academy students. He is a veteran of the Armed Forces and Military Medical Academy named after S.M. Kirov. Andrey Vadimovich considers the success of his son and grandson as the main achievement of his life. His son Sergey followed the path taken by his father and graduated from the Faculty of Residency Training for the Naval Service of Military Medical Academy named after S.M. Kirov, also he deployed downrange on submarines, and then became an Associate Professor of the Psychiatry Department at the Academy. The grandson of Andrey Vadimovich, Pavel, graduated from the University of Information Technologies, Mechanics and Optics. After he completed his postgraduate studies at the same University, his area of expertise is computer modeling of the circulatory system.

Історія розвитку науки з організації медичного забезпечення військ в Україні (ХV—XIX ст.)

The article, based on historical and modern historical and medical bibliography and archival materials, considers issues related to the history of science in the organization of medical support of troops in Ukraine in the late XV in the first half of the XIX centuries. The article describes in chronological and historical order the influence of the military doctor, doctor of medical sciences, professor, born in Ukraine Yakym Charukovsky on the creation and development of science. He singled out military-medical issues from them and creatively worked on it, using his own practical experience in medical practice. At that time it was the first and only systemic military medical publication of its kind, which still has not lost its relevance, or is undeservedly forgotten in military medical practice today.

Shared decision-making in gout treatment: a national study of rheumatology provider opinion and practice.

To assess rheumatologists' views and practices related to shared decision-making (SDM) in gout treatment. We performed a cross-sectional electronic survey of rheumatologists at U.S. Veterans Affairs (VA) medical centers, assessing views and practices related to SDM in gout. Of the 154 VA rheumatology providers eligible, 90 responded (response rate, 58%). Fifty-eight percent were female, the mean age was 51 years (standard deviation, 9.6), 42% had > 20 years of experience in medical practice. Rheumatologists reported routinely offering a choice to their patients for (1) starting urate-lowering therapy (ULT) for gout vs. doing nothing (70%); (2) choosing NSAIDs, corticosteroids, or colchicine for the treatment of acute flares (67%); and (3) choosing NSAIDs, corticosteroids, or colchicine for anti-inflammatory prophylaxis when starting ULT (51%). Very few rheumatologists offered choice regarding (4) choosing allopurinol vs. febuxostat as the first ULT (16%) and (5) taking daily ULT long-term vs. intermittently (15%). Rheumatologists perceived that a large proportion of patients were often or sometimes unsure of the best choice for these five decisions, 34%, 76%, 76%, 52%, and 54%, respectively. Similar proportions of rheumatologists felt that patients were uninformed about both medication benefits and risks, unclear about the personal importance of the benefits and risks, and unsupported in decision-making. For the five decisions respectively, rheumatologists supported SDM with patients in 76%, 56%, 58%, 27%, and 25%. The majority of VA rheumatologists incorporated SDM in several gout treatment decisions. Rheumatologists also recognized that patients need better support to participate in SDM in gout. Key Points: • Rheumatologists offered shared decision-making to gout patients for 3 key treatment decisions. • Rheumatologists perceived that many patients were unsure of the best choice for these decisions. • Rheumatologists felt that patients were uninformed about medication benefits/risks and unsupported in decision-making.

Narrative Representation of Medical Student Periodicals

The relevance of the study is due to the need to research medical student periodicals as a source of narrative medicine. The aim of the study is to find out the features of the narratives of medical student periodicals. Research methodology.To achieve the goal of the research the method of narrative analysis was applied, according to the method an analysis was carried out, monitoring of medical student publications for the presence of narratives, classification of their types, and separation of structural units have been done. Using the methods of correlation and synthesis, the thematic section of the available narratives and their correlation with the performed functions have been clarified. Having applied the method of sociological survey, in particular, by conducting the focus group survey of interns of different specialties, the positions of the respondents on the expediency of acquiring and applying the narrative competence by future doctors and creative cooperation with the student periodicals have been focused.Results. Monitoring and the narrative analysis have shown that student medical publications represent several types of narratives. These narratives are distinguished by the specific thematic sections, functionality and structural units. Not only does biographical narrative tell the story of eminent scientists, doctors, students, and the professional development of a person in the medical field, but also sets a pattern for imitation, serves as a source of deepening medical knowledge and motivation for successful professional activity. The presence of authoritative subjectivism, the incorporation of the quotations of the described people helps to establish an identity between the narrative hero, his author and the reader. Narrative stories about the disease in the context of current events contribute to the generalized knowledge, information, and experience of a particular disease treating, serve as a reminder for patients in preventing such a disease. The main purpose of narratives — case stories — is to represent an algorithm of action for medical students, interns, and other physicians in the case of similar life and professional experience.Novelty. The narratological potential and functionality of texts of periodicals of medical students have been studied. It has been found out that reading narratives helps the future specialists in the practice of gaining medical education, gaining experience of medical practice, diagnosis, widening their horizons. The narrators themselves are helped by narrators as a therapeutic process of joint reflection of a problem, a clinical case, constitution of their experience, awareness of themselves as specialists.The practical significance of the study. The results of the study will comple-ment to the scientific research on general narratology, medical narratives in general, and rethinking the phenomenon of student periodicals in particular.

Experiential knowledge in clinical medicine: use and justification.

Within the evidence-based medicine (EBM) construct, clinical expertise is acknowledged to be both derived from primary experience and necessary for optimal medical practice. Primary experience in medical practice, however, remains undervalued. Clinicians' primary experience tends to be dismissed by EBM as unsystematic or anecdotal, a source of bias rather than knowledge, never serving as the "best" evidence to support a clinical decision. The position that clinical expertise is necessary but that primary experience is untrustworthy in clinical decision-making is epistemically incoherent. Here we argue for the value and utility of knowledge gained from primary experience for the practice of medicine. Primary experience provides knowledge necessary to diagnose, treat, and assess response in individual patients. Hierarchies of evidence, when advanced as guides for clinical decisions, mistake the relationship between propositional and experiential knowledge. We argue that primary experience represents a kind of medical knowledge distinct from the propositional knowledge produced by clinical research, both of which are crucial to determining the best diagnosis and course of action for particular patients.

Analysis of Patient-Physician Concordance in the Understanding of Chemotherapy Treatment Plans Among Patients With Cancer

The treatment plans of patients with cancer involve multiple modalities that oncologists need to explain to patients. One such modality is chemotherapy, in which information about the goals, duration, and expected complications of therapy are considered fundamental to achieving optimal patient understanding. Therefore, effective communication between patients and their treating physicians is important to ensure patient adherence to treatment and achieve better outcomes. To investigate the concordance in the understanding of chemotherapy treatment plans between patients and their treating oncologists and to identify the potential factors associated with concordance. A cross-sectional study was conducted among adult patients (aged >18 years) with cancer who consented to receive chemotherapy between October 4, 2017, and November 8, 2018. The study also included the treating oncologists of patients receiving chemotherapy. An interview-based structured questionnaire was administered in both inpatient and outpatient settings at the Princess Noorah Oncology Center in Jeddah, Saudi Arabia. The demographic data of patients and physicians were obtained from the ARIA Oncology Information System, a chemotherapy-prescribing software database used at the center. Patients who had a personal history of cancer or were unwilling to be involved in the decision-making process were excluded. Data were analyzed from November 15 to December 20, 2018. Patients' comprehension and concordance with their treating physicians regarding the aspects of the intended treatment plan. The main outcomes measured were the patient-physician concordance level in the understanding of treatment plans and the identification of patient-related and physician-related factors associated with the level of concordance. A total of 151 adult patients (77 men [51.0%] and 74 women [49.0%]) were interviewed. Of those, 144 patients (75.5%) were younger than 60 years, and 52 patients (34.4%) had a college or advanced degree. A total of 20 treating oncologists were interviewed, of whom 14 (70.0%) were men and 6 (30.0%) were women. Arabic was the primary language of 19 oncologists (95.0%), and 19 oncologists (95.0%) had medical practice experience outside of Saudi Arabia. Only 20 patients (13.7%) had full concordance with their physicians regarding the aspects of their treatment plans. The remaining 131 patients (86.2%) had discordance with 1 or more aspect of their treatment plans. The most common aspect of discordance was the planned duration of the chemotherapy regimen, with 104 patients (68.4%) having full discordance. Full patient-physician concordance was more likely among patients with college or advanced degrees (χ21 = 17.73; P < .001) and patients with a family history of cancer (χ21 = 15.88; P < .001). In addition, older physicians (>40 years) compared with younger physicians (aged 30-40 years) were more likely to achieve higher rates of full patient-physician concordance, whereas older patients (>60 years) were associated with only partial concordance compared with patients younger than 60 years (χ21 = 5.84; P = .008), with an AR of 2.7. Most patients showed suboptimal understanding of aspects of their chemotherapy treatment plans. More effort and time should be dedicated to enhancing the understanding of chemotherapy plans among patients with lower educational levels. In addition, self-report surveys that evaluate patients' understanding of their chemotherapy treatment plans should be developed and added to the informed consent process to objectively assess how much a patient understands and to develop a stepwise patient education program that targets patients with the lowest levels of understanding.

Knowledge of coronavirus disease 2019 (COVID-19) among healthcare providers: A cross-sectional study in Indonesia

Objective: To assess healthcare workers’ knowledge of novel coronavirus disease 2019 (COVID-19) in the early phase of the outbreak in Indonesia.Methods: A cross-sectional survey was conducted in 12 hospitals in Indonesia from March 6 to March 25, 2020. Healthcare workers’ knowledge on COVID-19 was assessed, and demographic data, workplace characteristics, and medical professional characteristics as well as the current local situation of COVID-19 were collected. To characterize determinants associated with knowledge, a logistic regression analysis was employed.Results: Out of 288 healthcare workers who completed the interview-assisted questionnaire, 149 (51.7%) respondents had a good knowledge. Nurses and other types of healthcare workers had lower odds of having good knowledge compared to doctors: adjusted odds ratio (aOR): 0.38; 95% CI: 0.20-0.72 and aOR: 0.31; 95% CI: 0.13-0.73, respectively. Compared to healthcare workers who had medical practice experience less than 5 years, those who had worked for more than 10 years had lower knowledge (aOR: 0.43; 95% CI: 0.20-0.90). Healthcare workers who worked in the infection department had higher knowledge compared to those in the emergency room (aOR: 14.33; 95% CI: 3.67-55.88). Conclusions: The knowledge of COVID-19 among surveyed healthcare workers was relatively low. The COVID-19 response in Indonesia will require further education and enhancement of the capacity of healthcare workers in the emergency room where COVID-19 patients may be treated the earliest.

Self-reported confidence with ocular examination and management of eye diseases by general medical practitioners.

The aim of the study is to determine the confidence of general practitioners (GPs) with ophthalmic exam and management of eye diseases. Using self-administered questionnaire, information on sociodemographics, medical practice experience, confidence with eye exam, and management of eye diseases was obtained from GP at the General Outpatient Department. Responses on level of confidence were ranked with Likert scale and analyzed with the Statistical Package for Social Science, version 23. Twenty-two GPs with mean medical practice experience of 17.4 ± 8.5 years participated. Twelve (54.5%) GPs routinely examined patients' eyes. Pen torch assessment of ocular surface was most commonly performed eye exam, 1 (4.6%) did visual acuity, while none performed ophthalmoscopy. Seventeen (77.3%) GPs rated themselves average or higher in interpreting pen torch examination of ocular surface. Expressed diagnostic confidence was highest for pterygium, 19 (86.4%), and low for interpreting visual acuity, 8 (36.4%); 13 (59.1%) were confident with diagnosing cataract. While all GPs (100.0%) were not confident with diagnosing and managing posterior segment diseases, 19 (86.4%) felt that they could confidently manage allergic and bacterial conjunctivitis, respectively. Seventeen (77.3%) GPs thought their undergraduate exposure in ophthalmology was inadequate and 21 (95.5%) felt that update courses in ophthalmology were necessary. Half of the GPs performed eye examination. Self-reported confidence in ophthalmoscopy, diagnosis, and management of posterior segment diseases was low among GPs. Diagnostic confidence was highest for pterygium. Continuing ophthalmic education and provision of basic ophthalmic equipment are recommended to improve confidence of GP in management of ocular disorders.

Physicians' knowledge, attitudes and practices towards Zika virus infection in Jordan.

Zika virus (ZIKAV) disease is a public health problem of international concern. Recent evidence has documented imported ZIKAV cases into the Middle East and the existence of ZIKAV-transmitting mosquitoes in Jordan. However, limited data exist on the role of physicians in public awareness in this regard. This study aimed to assess ZIKAV knowledge, attitudes and counseling practices (KAP) of general physicians and gynecologists in Amman, Jordan. In this cross-sectional study, a structured paper-based questionnaire was completed by 119 participants during 2016-2017. Only 4.2% of the physicians correctly addressed ZIKAV-complication questions. A misconception of considering direct contact between individuals and breastfeeding as modes of ZIKAV transmission was observed. Only one participant correctly recognized that isolation of infected or exposed persons is not recommended. Having at least five years of experience in medical practice was the only factor that was significantly associated with a high knowledge score (P-value=0.011). Although prevention measures are the sole method to control ZIKAV spread, only 50% of participants believed in the efficacy of such measures. Despite a quarter of participants perceiving ZIKAV as a threat to their patients, none of them have counseled a patient in this regard before. The presence of an evidence of ZIKAV in Jordan and health authorities' recommendations were the most important predictors for adoption of counseling practice. General physicians and gynecologists in Jordan had several gaps in knowledge of key aspects of ZIKAV disease, and there is a need for specific training programs of physicians and gynecologists.

The history of the treatment of animals in Lviv

During the XV – first half of the XVII century, Lviv was the artisan, educational and cultural center of Ukraine due to the fact that it stood at the intersection of major European roads and was a well-known market center for sales, exchange and commodity production in Central and Southern Europe. The first schools for the training of medical specialists were family, that is, family schools. Later, the schools became known as workshops. In the 14th century the workshops were independent higher educational institutions and were not part of the universities, even in Europe, as it was regulated by the statutes of universities. Ukrainian workshops later started out academies and universities and had the attributes of higher educational institutions: statute, flag, seal, ciches, icons, which testified the place and importance of the school (shop) in the life of the country. The prince (king) gave the certificate of the opening of the school. The statute of the work shop was extended to members of the association: a student, an apprentice and a master. Workshops statutes were legal documents and often were not changed much for centuries. Medieval archival documents of the XIV – first half of the XVII century (workshops statutes, books on current affairs, books of the city authorities) quite fully reflect the Lviv workshop structure not only quantitatively but also professionally. The two oldest statutes of the blacksmith shop in 1529 and 1558 are stored in the Lviv State Historical Archives. In the future, the blacksmiths-conquerors were engaged in the treatment of not only horses but other animals. Particularly in the fight against poisonous animal diseases, they enriched the experience of medical practice, which was passed on to subsequent generations. However, all of these were educational institutions, in which a small number of qualified medical specialists trained, and the majority of the population and animals were served by healers, bloodshed, blacksmiths, and veterinary doctors. Diagnosis of diseases at that time was based mainly on using only their senses: it was investigated the movement of animals, body temperature, eye color, condition of the tongue, nasal mirror, mouth and nasal cavity, removing sweat, urine, breath, nostrils and so on. In countries that were under the care of Austria, Hungary, Poland and other countries of Western Europe, has acted veterinary service structure of relevant states. Already in the XII – XIII centuries laws have been enacted and the measures were developed, aimed at preventing the emergence and spread of diseases (quarantine disposal of dead animals, compliance with sanitary regulations, etc.). Great attention was paid to protecting people from infectious diseases. Opening of veterinary school and horses forging was the result of the rise of trade and economic, cultural and educational ties in the medieval city, which was contributed to the birth and development of the work shop structure that gave the beginning of a medical case, and later – the birth of veterinary education in Galicia.

Association between emergency physician self-reported empathy and patient satisfaction.

BackgroundHigher physician self-reported empathy has been associated with higher overall patient satisfaction. However, more evidence-based research is needed to determine such association in an emergent care setting.ObjectiveTo evaluate the association between physician self-reported empathy and after-care instant patient-to-provider satisfaction among Emergency Department (ED) healthcare providers with varying years of medical practice experience.Research designA prospective observational study conducted in a tertiary care hospital ED.MethodsForty-one providers interacted with 1,308 patients across 1,572 encounters from July 1 through October 31, 2016. The Jefferson Scale of Empathy (JSE) was used to assess provider empathy. An after-care instant patient satisfaction survey, with questionnaires regarding patient-to-provider satisfaction specifically, was conducted prior to the patient moving out of the ED. The relation between physician empathy and patient satisfaction was estimated using risk ratios (RR) and their corresponding 95% confidence limits (CL) from log-binomial regression models.ResultsEmergency Medicine (EM) residents had the lowest JSE scores (median 111; interquartile range [IQR]: 107–122) and senior physicians had the highest scores (median 119.5; IQR: 111–129). Similarly, EM residents had the lowest percentage of “very satisfied” responses (65%) and senior physicians had the highest reported percentage of “very satisfied” responses (69%). There was a modest positive association between JSE and satisfaction (RR = 1.04; 95% CL: 1.00, 1.07).ConclusionThis study provides evidence of a positive association between ED provider self-reported empathy and after-care instant patient-to-provider satisfaction. Overall higher empathy scores were associated with higher patient satisfaction, though minor heterogeneity occurred between different provider characteristics.

Pedagogical Preparation for Physicians and their Performance in the Medical Course

ABSTRACT Qualifying the medical profile to meet the population’s main health needs is a challenge for contemporary medical schools. In this process, the medical professor has a prominent place, since medical teaching practice is based on the production of models considered valid, previously learned, and the experience of medical practice. One questions, thus, the physician’s pedagogical aptitude to teach, since the professor-academic relationship occurs differently from the physician-patient relationship, starting from the need to understand which ways professors seek to acquire the teaching-specific skills. Objective To carry out an integrative review on the pedagogical training of physicians in the teaching context. Methods This is a non-observational, descriptive integrative review of the literature. Initially, we searched the databases at the Scientific Electronic Library Online (SciELO), Latin American and Caribbean Literature in Health Sciences (Lilacs), the US National Library of Medicine and the National Institutes of Health (PubMed) and the Cochrane Library with the help of the Boolean operator and the following descriptors: Health Human Resource Training; Faculty, Medical and Education, Medical, Continuing. The inclusion criteria were free, complete articles, published from 2012 to 2016, in Portuguese, Spanish and English. Results The search resulted in 24 articles those discuss the research theme. After exhaustive reading of the articles found, only five converged and answered the guiding question raised in the initial reflection. Teaching strategies and methodologies, as well as the evaluation of clinical supervision processes to construct the students’ technical knowledge appear as important topics on learning and teaching. In addition, these discussions raise professors’ need for continuing education programs, as well as the construction of evaluation tools for professors, tutors and preceptors. Conclusions This study highlights the continuous improvement in the professors’ pedagogical training and the development of permanent education programs and improvement of the faculty by the school.