Internal Medicine Research Articles

Assessment of renal response in Tunisian patients with proliferative lupus nephritis under three different induction immunosuppressive agents: A prognostic retrospective study.

The aim of our study was to evaluate the renal response (RR) of three immunosuppressive protocols in the induction treatment of proliferative lupus nephritis (PLN) in a Tunisian population. We performed a retrospective prognostic cohort study in the Internal Medicine Department of the Habib Thameur University Hospital in Tunis from January 2000 to December 2023, and included kidney biopsy proven proliferative lupus nephritis patients. Three induction treatments were compared: High CYP regimen: glucocorticoids (GC) + IV cyclophosphamide (CYP) in monthly pulses of 0.7g/m2 for 6 months; Low CYP regimen: GC + IV CYP in biweekly pulses of 500mg for 3 months; and MMF regimen: GC + oral MMF 1.5g twice daily for 6 months. The primary endpoint was the incidence of RR (complete and partial remission) at one year post-diagnosis. The additional outcomes were end-stage kidney disease (ESKD), severe adverse events (AEs) and death. Our study included 78 PLN patients (High CYP: 17, Low CYP: 40, MMF: 21). The study found that 94.1% of patients receiving High CYP achieved the primary endpoint, RR, compared to 67.5% of those receiving Low CYP and 61.9% in the MMF group. For the additional outcomes, there were 3 cases of ESKD, all in the Low CYP group, 5 cases of death (4 in the Low CYP group and 1 in the MMF group), and 20 cases of severe AEs, all of which were severe infections (5 in the High CYP group, 12 in the Low CYP group, and 3 in the MMF group). Multivariate analysis showed that the High CYP regimen was more associated with RR than the MMF regimen, with an adjusted OR of 9.846 (95% CI: 1.087-98.210); p = 0.042. Multivariate analysis did not show statistically significant differences between the High CYP regimen and the Low CYP regimen in terms of RR. As an induction treatment for PLN, the High CYP regimen was strongly associated with a higher rate of RR than the MMF regimen. There were no statistically significant differences between the High CYP regimen and the Low CYP regimen in terms of RR.

Mechanisms of functional asymmetry of the face formation in patients with dysfunctional condition of temporomandibular joint

Objective. To give a detailed description of clinical manifestations, diagnosis and treatment of functional asymmetry of the face in patients with dysfunctional condition of temporomandibular joint (TMJ). Materials and methods. A complete examination of 34 (25 %) patients with symptomatic facial asymmetry of the 3rd type according to H.S. Hwang classification was carried out. The group consisted of 5 males (14,71 %) and 29 females (85,29 %). Screening protocol included standard dental care, cone beam computer tomography of both jaws and TMJ, MRI of TMJ with functional load. Results. 24 patients (70.59 %) completed complex dental treatment; 10 (29.41 %) people stopped treatment for various reasons and were excluded from further study. Complete restoration of facial symmetry was achieved in 21 people (87.5 %), partial restoration in 3 (12.5 %) patients. The height of the lower facial part and the synchrony of occlusal contacts were restored in all patients. Noise in the joint area persisted in 3 (8.8 %) cases, which is associated with arthrosis in the articular heads. In patients with unreducible dislocations, the intensity of the clicks decreased, and there was no pain at the end of treatment. It should be noted that all patients of this group refused subsequent surgical treatment. Conclusion. Functional asymmetry of the face results from multifactorial impact on the human organism and is multimorbid by nature. This condition is accompanied by complicated dental pathology, such as increased hard tooth tissues attrition, functional overload with traumatic nodes formation, disturbance of muscles and TMJ functions. It requires following diagnostic and treatment algorithm under the supervision of internal medicine specialists to correct sleep, postural stability, impaired psychoneurological status.

What does current diabetes and endocrine speciality outpatient training look like and what will change? Observations from a single training region in England

Introduction: Diabetes and endocrine speciality training in the UK has traditionally been lasted five years but moved to a four- year model in 2021 with the introduction of the Internal Medical Training (IMT)3 year programme. Here we aim to review the case mix of outpatients seen by a single diabetes and endocrinology Specialty Registrar (SpR) during clinical training and offer insights into the range of patients seen. We will also review the NHS ePortfolio entries for Diabetes and Endocrinology and for General Internal Medicine to establish how many self-entered forms, assessments (completed and expired) and summary assessments are typically undertaken before certification of completion of training (CCT). Methods: A diabetes and endocrinology registrar (JD) kept an anonymised log of all outpatient consultations from starting speciality training as an ST3 in August 2017 up until his CCT was awarded in May 2023. Duration of training was extended because JD was a less than full time trainee (LFTT), with a period of shared parental leave. Non-patient-identifiable data included diagnosis or presenting complaint of patient seen, type of clinic and date of clinic between August 2017 and May 2023. Following CCT, NHS ePortfolio data were reviewed to establish NHS ePortfolio entries, including the number of requested assessments and number of completions. Results: For the last 18 months of training, approximately 40% of JD’s working time was spent on general medicine and 60% on diabetes and endocrinology. Over the total time of training from 2017 to 2023 JD had a total of 4,150 consultations in outpatient clinics. There were 1,347 consultations in the endocrine clinic and 2,803 consultations in the diabetes clinic. There were 472 ePortfolio entries: 158 of these were self-entered, 284 requested assessments completed and 30 summary or progression assessments. 130 requested assessments expired before completion, giving a response rate of 68.5%. Conclusion: Observations from a single training region in England show that five years of diabetes and endocrinology registrar training provided a broad mix and depth of outpatient experience. The greater number of patients seen in diabetes clinic represents the requirement for service delivery in the area and subspecialist interest being developed. The change to four years’ speciality training is likely to represent around 800 fewer consultations as a speciality trainee in diabetes and endocrinology. The reduction in training opportunities could be addressed through having more protected time for specialist teaching clinics, particularly pump and technology clinics. A large amount of evidence from both the trainee and assessors is required in NHS ePortfolio to achieve CCT in diabetes and endocrinology and general internal medicine. Although the data come only from one trainee and one region, they can provide a point of reference for future analysis of the effect of four years’ speciality specific training on the breadth of training and a stimulus for other trainees and other region to reflect and analyse their rota and data.

The Organization of Academic General Internal Medicine Practice at the Top Primary Care Schools.

While prior studies have explored staffing infrastructure for primary care practices in general, little is known about the range of academic primary care practice models and supports available for academic general internists. To characterize the range of practice arrangements and expectations for attending academic physicians in general internal medicine (GIM) practices at the top 22 medical schools across the USA. Cross-sectional survey administered electronically between October 30, 2022, and December 28, 2022. Clinical leaders in GIM at the top 22 primary care medical schools, as identified by the 2023 US News and World Report Rankings. Clinical load, productivity expectations, cross-coverage, and team-based care models. Twenty-two leaders responded, representing 68% (15/22) of medical schools surveyed. The practices were mostly in urban locations (18/22, 82%) and 86% (19/22) included residents. Practices ranged from 7 to 200 PCPs and from 3 to 112 clinical FTEs. A full-time (1.0 FTE) clinical role for academic attending GIM physicians entailed a median of 9 (IQR 8, 10) weekly half-day clinic sessions, with a median panel size expectation of 1600 (IQR 1450, 1850) patients and a median yearly RVU expectation of 5200 (IQR 4161, 5891) yearly RVUs generated. Staff support was most commonly present for prescription refills and patient portal message checks. It was less commonly available for time sensitive form completion. Occasional clinical coverage for other physicians was an expectation at all practices. In this study, we characterize the organization of and supports available in academic GIM practices affiliated with the top primary care medical schools. Our findings provide comparative information for leaders of academic GIM practices seeking to enhance primary care delivery for their faculty and trainees. They also highlight areas where standardization may be beneficial across academic GIM.

Quantitative Blood Serum IVDr NMR Spectroscopy in Clinical Metabolomics of Cancer, Neurodegeneration, and Internal Medicine.

Despite more than two decades of metabolomics having joined the "omics" scenery, to date only a few novel blood metabolite biomarkers have found their way into the clinic. This is changing now by massive large-scale population metabolic phenotyping for both healthy and disease cohorts. Here, nuclear magnetic resonance (NMR) spectroscopy is a method of choice, as typical blood serum markers can be easily quantified and by knowledge of precise reference concentrations, more and more NMR-amenable biomarkers are established, moving NMR from research to clinical application. Besides customized approaches, to date two major commercial platforms have evolved based on either 600MHz (14.1 Tesla) or 500MHz (11.7 Tesla) high-field NMR systems. This chapter provides an introduction into the field of quantitative in vitro diagnostics research (IVDr) NMR at 600 MHzand its application within clinical research of cancer, neurodegeneration, and internal medicine.

Adherence to Mediterranean Diet and Biomarkers of Redox Balance and Inflammation in Old Patients Hospitalized in Internal Medicine.

We have previously described that low adherence to the Mediterranean diet (MD) in elderly patients admitted in internal medicine wards is linked to poorer clinical outcomes. This investigation was designed to explore whether adherence to the MD is related to circulating markers of redox balance and inflammation in this clinical scenario. A cross-sectional study was performed on 306 acute old patients hospitalized in internal medicine wards. Adherence to the MD was estimated by the Italian Mediterranean Index (IMI). The circulating markers of redox balance were assessed in serum and erythrocytes and correlated with inflammatory markers across different MD adherence groups. Compared to the patients with high adherence, those with low adherence to the MD exhibited severely impaired redox balance, as evidenced by a higher GSSG/GSH ratio and increased serum hydroxynonenal/malondialdehyde-protein adducts. No modifications were described in the expression of antioxidant enzymes in peripheral blood mononuclear cells. Patients with low adherence to the MD exhibited a higher neutrophil-to-lymphocyte ratio and markers of systemic inflammation, as well as raised levels of interleukin-6 and tumor necrosis factor, compared to those with high MD adherence. A strong association was observed between the circulating markers of redox balance and inflammation/immune response, with the highest regression coefficients found in the low adherence group. Old patients admitted to internal medicine wards with low adherence to the MD display unfavorable profiles of the circulating markers of redox balance and inflammation. It is conceivable that such effects on redox balance can be linked to the high polyphenol content of MD. This study supports the rationale for intervention trials that attest to the effectiveness of MD as a nutritional strategy for disease prevention.

B-198 Rapid Molecular Detection of Respiratory Infections in Brazilian Hospitals and Outpatient Units: Insights from the Diagnostic Medicine and Health Network

Abstract Background Diagnosing agents causing respiratory infections remains a global challenge due to the numerous coexisting agents and similar symptoms. This study evaluates the epidemiology of viral and bacterial agents responsible for major respiratory infections through molecular detection in patients across various Brazilian hospital units served by a clinical diagnostic and health laboratory. Understanding the distribution and prevalence of these pathogens is crucial for effective diagnosis, treatment, and prevention strategies in the face of evolving epidemiological landscapes. Methods Utilizing an internal database, we conducted a comprehensive analysis of tests performed on the FilmArray® system. This system employs multiplex PCR technology, capable of simultaneously identifying 21 respiratory agents in a single sample obtained from nasopharyngeal and bronchial lavage specimens collected from diverse geographical regions across Brazil. The data for the examination of patient samples with respect to gender, age group, geographical regions, and the prevalence of various agents between January 2021 and April 2023 were retrieved from the database and analyzed. To ensure privacy, sensitive and individual data from all patients were meticulously preserved throughout the study. Results The analysis encompassed a diverse sample of 477 patients, originating from 26 cities across 11 Brazilian states, including Goiás, Minas Gerais, Mato Grosso, Pará, Paraná, Rio de Janeiro, São Paulo, Tocantins, Amazonas, Bahia, and Distrito Federal. The distribution of patients was nearly split between hospital settings (39.8%) and outpatient units, with hospital patients predominantly from departments such as internal medicine, cardiology, and nephrology. In contrast, outpatient samples were primarily requested by specialists in pulmonology and infectious diseases. The demographic profile revealed an average age of 36 years, with a majority male representation (54%). However, a notable shift occurred in the first four months of 2023, where females constituted 60.8% of the sample. The overall test positivity rate stood at 42.3%, with a significant detection of 71% (15 out of 21) of the surveyed respiratory agents at some point during the study period. The most frequently identified pathogens were Rhinovirus, Enterovirus, and SARS-CoV-2, collectively accounting for 55.1% of the positive findings. Additionally, mixed infections were observed in 29 (6%) of the patients, with combinations such as SARS-CoV-2 and Rhinovirus, SARS-CoV-2 and H3N2, and SARS-CoV-2 and RSV, among others, highlighting the complexity of respiratory infections. Conclusions The findings from this study underscore the critical role of advanced molecular diagnostics in the Brazilian clinical-laboratory landscape. The utilization of multiplex PCR technology has proven to be a pivotal tool in accurately identifying a wide array of respiratory pathogens, thereby enhancing the precision of diagnosis and treatment strategies. The detection of a high prevalence of agents such as Rhinovirus, Enterovirus, and SARS-CoV-2, along with the identification of mixed infections, highlights the complexity of respiratory infections and the necessity for robust diagnostic tools. This study not only contributes to the understanding of the epidemiology of respiratory infections in Brazil but also emphasizes the importance of continuous advancements in molecular diagnostics for better patient care and public health management.

A Systematic Review of Metabolic Syndrome: Key Correlated Pathologies and Non-Invasive Diagnostic Approaches.

Background and Objectives: Metabolic syndrome (MetS) is a condition marked by a complex array of physiological, biochemical, and metabolic abnormalities, including central obesity, insulin resistance, high blood pressure, and dyslipidemia (characterized by elevated triglycerides and reduced levels of high-density lipoproteins). The pathogenesis develops from the accumulation of lipid droplets in the hepatocyte (steatosis). This accumulation, in genetically predisposed subjects and with other external stimuli (intestinal dysbiosis, high caloric diet, physical inactivity, stress), activates the production of pro-inflammatory molecules, alter autophagy, and turn on the activity of hepatic stellate cells (HSCs), provoking the low grade chronic inflammation and the fibrosis. This syndrome is associated with a significantly increased risk of developing type 2 diabetes mellitus (T2D), cardiovascular diseases (CVD), vascular, renal, pneumologic, rheumatological, sexual, cutaneous syndromes and overall mortality, with the risk rising five- to seven-fold for T2DM, three-fold for CVD, and one and a half-fold for all-cause mortality. The purpose of this narrative review is to examine metabolic syndrome as a "systemic disease" and its interaction with major internal medicine conditions such as CVD, diabetes, renal failure, and respiratory failure. It is essential for internal medicine practitioners to approach this widespread condition in a "holistic" rather than a fragmented manner, particularly in Western countries. Additionally, it is important to be aware of the non-invasive tools available for assessing this condition. Materials and Methods: We conducted an exhaustive search on PubMed up to July 2024, focusing on terms related to metabolic syndrome and other pathologies (heart, Lung (COPD, asthma, pulmonary hypertension, OSAS) and kidney failure, vascular, rheumatological (osteoarthritis, rheumatoid arthritis), endocrinological, sexual pathologies and neoplastic risks. The review was managed in accordance with the PRISMA statement. Finally, we selected 300 studies (233 papers for the first search strategy and 67 for the second one). Our review included studies that provided insights into metabolic syndrome and non-invasive techniques for evaluating liver fibrosis and steatosis. Studies that were not conducted on humans, were published in languages other than English, or did not assess changes related to heart failure were excluded. Results: The findings revealed a clear correlation between metabolic syndrome and all the pathologies above described, indicating that non-invasive assessments of hepatic fibrosis and steatosis could potentially serve as markers for the severity and progression of the diseases. Conclusions: Metabolic syndrome is a multisystem disorder that impacts organs beyond the liver and disrupts the functioning of various organs. Notably, it is linked to a higher incidence of cardiovascular diseases, independent of traditional cardiovascular risk factors. Non-invasive assessments of hepatic fibrosis and fibrosis allow clinicians to evaluate cardiovascular risk. Additionally, the ability to assess liver steatosis may open new diagnostic, therapeutic, and prognostic avenues for managing metabolic syndrome and its complications, particularly cardiovascular disease, which is the leading cause of death in these patients.

Formative processes in nursing intervention in palliative care in internal medicine service patients

The purpose of the research project was to determine the nursing intervention in palliative care in patients of the Internal Medicine service of the Alfredo Noboa Montenegro Hospital during the period October 2023- February 2024, since nursing professionals are exposed to social, health and service changes, whose deficiency or lack of knowledge can limit an integral, personalized and quality intervention that allows care from individuality, flexibility, continuity, accessibility and polyvalence. A descriptive, cross-sectional, bibliographic and field method was applied with a quantitative approach, whose research design was non-experimental and cross-sectional, applying a sample by convenience with a total of 17 nursing professionals working in the internal medicine service, in addition, a survey of 29 questions distributed in four dimensions was used to collect the information; actions, education, psycho-emotional support, spiritual and grief. According to the results, it was possible to demonstrate the deficiencies of nursing professionals, especially in the identification of palliative needs, symptom assessment, intervention processes, use of tools to assess psychoemotional and spiritual needs, pharmacological approach and information on bereavement, which made it necessary to establish a palliative care guide focused on nursing professionals, to be subsequently socialized with all personnel.

Assessing Attitudes and Confidence in Managing Erectile Dysfunction Among Urology, Internal Medicine, and Family Medicine Providers

ObjectiveTo assess and contrast attitudes and confidence regarding erectile dysfunction (ED) treatment among urologists (GU) and primary care providers (PCPs), identifying areas for collaboration, practice improvement, and additional training to enhance men's healthcare (MH) quality and access. MethodsAn anonymous survey with 25 questions on ED treatment, rated on a 5-point Likert scale, was conducted among our institution's providers in GU, internal medicine (IM), and family medicine (FM). Data were analyzed using descriptive statistics and Fisher’s exact test. Results138 providers responded, including 58 IM, 47 FM, and 33 GU. FM and IM responses generally overlapped with some differences. IM were more positive regarding vacuum erection device (VED) and inflatable penile prosthesis (IPP) satisfaction and risk.Comparing GU to FM + IM, GU displayed greater confidence and knowledge about ED. Notably, 63% of GU used the validated International Index of Erectile Function (IIEF) compared to 3% of FM + IM. Additionally, 100% of GU strongly/agreed that good options remained after pills failed vs 83% of FM + IM.Significant differences in GU vs FM + IM perspectives on IPP included patient willingness to undergo surgery for ED (67% vs. 12%), patient satisfaction (91% vs. 28%), partner satisfaction (79% vs. 26%) and willingness to recommend/repeat surgery (82% vs. 17%). Notably, 82% of GU vs 10% of FM + IM were aware that Medicare covered implants. ConclusionThis survey reveals significant knowledge gaps in ED treatment between GU and PCPs. Targeted provider education, particularly about penile prostheses, could optimize patient care.

Long-term trends of cardiometabolic risk factors in adolescents aged 14–18 years in Novosibirsk (1989–2024)

High prevalence of cardiovascular morbidity and mortality in the Russian population dictates the need to identify and prevent risk factors for these diseases from adolescence. Objective: to study the prevalence and long-term trends in cardiometabolic risk factors in an adolescent population sample of Novosibirsk (1989–2024).Methods. In 1989–2024, cross-sectional population studies of random representative samples of schoolchildren aged 14–18 of both sexes were conducted in Novosibirsk with an interval of 5 years. 8 screenings were conducted. A total of 5106 adolescents (43–46 % boys) were examined. Approval was received from the Local Ethics Committee of the Research Institute of Preventive and Internal Medicine – Branch of the Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences; all children and their parents signed informed consent for the examination. The program was uniform for all screenings and included a survey using a standard questionnaire, 2-fold measurement of blood pressure, anthropometry (height, body weight, chest, waist and hip circumferences), and a biochemical blood test for lipid profile. The levels of cardiometabolic risk factors were assessed in accordance with the latest Russian and international recommendations. Statistical data processing was performed using the SPSS for Windows 13 package.Results. The prevalence of hypercholesterolemia in adolescents in Novosibirsk over 35 years decreased from 22.3 to 3.0 % in boys and from 31.8 to 10.6 % in girls (p < 0.001). The highest prevalence of hypertension in adolescents was observed in 1989, then by 1994 its levels decreased and remained relatively stable until a decrease in 2014 with a subsequent increase, especially among boys, the prevalence of hypertension among whom in 2024 reached the 1989 level (17.3 % and 16.9 %, respectively). The greatest decrease in the frequency of excessive weight in adolescents relative to 1989 was observed in 1999: in boys – 2.7 times, in girls – 3.2 times. Since 2003, there has been a consistent increase in the prevalence of overweight among adolescents, primarily among boys, and by 2014 it exceeded the baseline values of the 1989 screening by 8 % in boys (21.6 versus 13.9 % (p < 0.01)) and by 3 % in girls (14.3 versus 11.5 % (p = 0.05)). At subsequent screenings, the frequency of overweight remained unchanged. The frequency of smoking among adolescents of both sexes decreased almost 10-fold from 1989 to 2024: from 45 % in 1989 to 5.5 % in 2024 among boys, and from 19 % to 2% among girls (p < 0.01), however, an increase in electronic smoking was noted. Over the past 5 years (2019–2024), the use of electronic cigarettes and gadgets among boys has doubled (from 6 up to 12 %) and three times among girls (from 3 to 9 %). The prevalence of reduced physical activity among adolescents remained high throughout the period, but in the last 15 years it has clearly decreased among boys (62 % in 2009 versus 37 % in 2024 (p < 0.01). Since 2009, screen time has increased: from 18 hours/week in 2009 for boys and 15 for girls to 30 hours/week in 2014 and remained at the same level in 2019. In 2024, screen time of the computer decreased, but phone time increased, which in total did not exceed the figures for 2014 and 2019 (33–35 hours/ week).Conclusions. Based on population screening of adolescents conducted in Novosibirsk over 35 years, the prevalence and long-term trends of cardiometabolic risk factors (arterial hypertension, dyslipoproteinemia, overweight and obesity, smoking and low physical activity) were identified.

Association of Physicians of India: National Expert Opinion and Clinical Practice Recommendations for Primary Care Cough Management in India.

Pathological cough in primary care is a significant concern. With a prevalence ranging from 5 to 10% in India, cough is the second most common symptom seen by general practitioners (GPs). The existing algorithms and tools that are available are generally meant for cough categorization in specialized fields; their limited adoption by GPs results in insufficient screening and categorization of cough, which results in the use of irrational fixed drug combination formulations. Formulation of recommendations for GPs to enable them to appropriately screen and categorize cough for efficient management and avoid irrational treatments. An expert panel (seven experts specializing in pulmonology and internal medicine) held a virtual discussion to assess the necessity for cough categorization and develop user-friendly tools, along with a simplified format for history taking in cough evaluation and management. Panel discussions were based on a questionnaire that contained items related to the categorization of cough, assessment tools, and approaches to treating cough. After deliberations, simplified clinical practice recommendations and assessment tools were developed by the experts to facilitate the categorization of cough into wet or dry categories, thereby helping in the symptom-based management of cough. By adhering to these principles and using assessment tools, primary care practitioners can optimize cough management, avoid irrational drug combinations, minimize potential risks, and improve patient well-being.

Assessment and improvement of goals of care discussion by internal medicine residents.

191 Background: End-of-life goals and quality of life are intrinsically connected, focusing on providing care that maximizes comfort, dignity, and personal satisfaction during the final stages of life. Residents are primarily involved in Goals of care (GOC) discussion in hospitalized patients it is an integral component in Internal Medicine (IM) resident education. Literature has shown improved outcomes in delivering bad news by residents and oncology fellows after workshops, lectures, and courses. We aimed to improve Residents' competency in effective GOC discussion. Methods: We devised a questionnaire with the help of palliative care specialists and distributed it via a Google survey to the IM residents. After the survey, a palliative care specialist lectured about understanding the POLST form and components of Code Status Discussions. The same questionnaire was sent again. Five survey questions were used as post-lecture improvement parameters, and residents were stratified among three different classes: Interns, Year 2, and Year 3. Results: Before the lecture, residents were asked about their comfort level on a scale from 1-10, with 10 being the most comfortable conducting GOC discussions with the patient or the patient's family. As per the combined survey of all three classes, 50% of residents scored seven or above. Post lecture, 69.3% of intern year residents and 100% of 2nd and 3rd-year residents scored seven and above, which showed significant improvement in residents' comfort level while conducting GOC discussions. The parameters analyzed were the ability to explain SPIKES protocol for 'Breaking Bad News. Initially, 58.3% of the residents were comfortable explaining it, while 41.7 % answered negatively. After the survey, 84.6% from the intern year, 92.3% in 2nd year, and 77.8% of 3rd-year residents stated being comfortable with explaining SPIKES protocol. Another evaluated paradigm was the residents' ability to determine the patient's prognosis using any given scale/score (like the UCSF prognosis calculator). 33.3 % of the residents said 'yes' while 30.6% answered 'maybe.' Post-intervention, 100% of 3rd-year residents and 61.5% of 2nd-year residents, while 30.8% of intern-year residents said 'yes.' The cumulative mean of all three combined classes was 64.1%, which showed significant improvement compared to pre-intervention 33.3%. Conclusions: The results show that residents' comfort level of conducting GOC discussions improved with a single lecture on the topic. Further interventions and mentorship are needed. Intern-year residents were found to have a lower level of subjective comfort in conducting these discussions, which can be explained by their being relatively new to the work environment. A more integrated approach at the beginning of the residency training regarding GOC discussion training can improve interns' confidence and comfort for ensuing such discussions.

Transfusion Camp: The UK experience and its value in improving knowledge of transfusion medicine among postgraduate trainees.

To report the UK experience of rolling out Transfusion Camp. Transfusion Camp is a structured education programme developed in Toronto, with the aim of reducing knowledge gaps in transfusion medicine in postgraduate trainees. It consists of didactic lectures viewed online by the participants, then interactive, locally delivered seminars. Since 2015, it has been rolled out in the United Kingdom, and is now available in four centres. Here, we report the UK experience of Transfusion Camp and outcomes. Trainees are recruited via the training programme directors in each region. Pre- and post-course assessments are administered using the validated BEST (Biomedical Excellence for Safer Transfusion) test, with possible scores 0-20, and confidence measured on an A-E Likert scale. Since 2015, 130 trainees have participated in Transfusion Camp in the United Kingdom. Trainees from all specialties significantly improved their BEST-test scores after attending the course (mean score 11.6/20 before the course, compared with 14.3/20 after the course), and confidence in managing transfusion-related issues was also significantly improved. We recommend that all centres consider offering Transfusion Camp to trainees in haematology and other specialties that frequently use blood transfusions, such as anaesthesia/ICU, Internal Medicine and others.

Neuropsychiatric symptoms of patients two years after experiencing severe COVID-19: A mixed observational study

BackgroundThe impact of SARS-CoV-2 infection (COVID-19) on mental health has not been extensively studied in the medium and long term. This study assessed how clinical, biological, and social factors affect mental health in patients who recovered from severe COVID-19. The evaluation was done 90 days after hospital discharge and followed up at 12 and 24 months. MethodsA retrospective-prospective cohort mixed observational study was conducted on patients over 18 years of age who required hospitalization in Internal Medicine or ICU for severe COVID-19 pneumonia during 2020 and 2021. Demographic information, clinical variables, and data for the scales were obtained from electronic medical records and telephone interviews. For comparisons of the different variables in each clinical variable (insomnia, depression, anxiety), the Student's t-test for independent samples has been used (normal distribution); otherwise, the Mann–Whitney test will be used. All tests and intervals will be performed with a confidence level of 95. Fisher's exact or Pearson's Chi-square test has been used as appropriate for qualitative variables. Results201 patients were recruited. 37.3% presented insomnia, 22.4% anxiety, and 21.4% depressive symptoms. A direct association was established between female sex and depressive symptoms. Psychotropic history, fatigue, and C-reactive protein levels (CRP) were correlated with depression. Anosmia and ageusia, CRP, cognitive symptoms, and dyspnea predicted insomnia. Sex, orotracheal intubation (OTI), pain, fatigue, mental health history, and academic level were independent predictors of anxiety. High percentages of depressive, anxiety, and insomnia symptoms were detected in the second month after discharge and persisted at 12 and 24 months. The fatigue variable maintained a significant relationship with depressive symptoms at 2, 12 and 24 months. A possible limitation could be recall bias in retrospective data collection. ConclusionsThis is a novel study to follow up on mental health for two years in patients with severe COVID-19. Clinical, biological, and psychosocial variables could be predictors of depressive symptoms, anxiety, and insomnia. The psychiatric symptoms persisted throughout the 2-year follow-up. These findings are critical for the follow-up of these patients and open the possibility of further studies in the medium and long term.

Duties, Tasks, Knowledge and Skills of an Obesity Medicine Physician: A Practice Analysis

BackgroundGiven the evolving nature of obesity medicine, periodic evaluation of its clinical practice is needed to ensure that certification requirements address real-world experience. Practice analysis is a systematic approach to define a field’s body of knowledge, and its results can inform the content outline and examination blueprint for a certification examination. This study describes the 2023 practice analysis conducted by the American Board of Obesity Medicine (ABOM). MethodsInitially, 14 obesity medicine physicians participated in a practice analysis panel, resulting in 3 duties and 30 tasks required for competent practice of obesity medicine physicians. Each task included steps, knowledge, skills, and abilities needed to perform the task. ABOM then recruited 645 certified obesity medicine physicians from its database to participate in a validation survey to rate the frequency [scale: never (0) to very frequently (5)] and importance [scale: not important (0) to very important (3)] of each task. Survey participants could also provide open-ended comments. ResultsAmong validation survey participants (n=645), the most common primary medical specialties reported were internal medicine (46.0%), family medicine (33.8%), and pediatrics (11.2%). Years practicing obesity medicine varied with 45.3% reporting 1-4 years, 26.0% 5-9 years, and 28.7% ≥10 years in practice. Most tasks were performed frequently (mean score ≥4.0) and rated as important (mean score ≥2.0). All tasks were retained based on the frequency and importance ratings. Survey results informed the weighting in the examination blueprint. ConclusionThere was consensus among practicing ABOM-certified physicians who participated in the validation survey in the tasks required for competent obesity medicine practice. Our practice analysis approach was a structured process that engaged obesity medicine physicians and captured the breadth and depth of knowledge required for obesity medicine. The new content outline and examination blueprint developed will be implemented with the 2025 ABOM certification exam administration.

"Doctor ChatGPT, Can You Help Me?" The Patient's Perspective: Cross-Sectional Study.

Artificial intelligence and the language models derived from it, such as ChatGPT, offer immense possibilities, particularly in the field of medicine. It is already evident that ChatGPT can provide adequate and, in some cases, expert-level responses to health-related queries and advice for patients. However, it is currently unknown how patients perceive these capabilities, whether they can derive benefit from them, and whether potential risks, such as harmful suggestions, are detected by patients. This study aims to clarify whether patients can get useful and safe health care advice from an artificial intelligence chatbot assistant. This cross-sectional study was conducted using 100 publicly available health-related questions from 5 medical specialties (trauma, general surgery, otolaryngology, pediatrics, and internal medicine) from a web-based platform for patients. Responses generated by ChatGPT-4.0 and by an expert panel (EP) of experienced physicians from the aforementioned web-based platform were packed into 10 sets consisting of 10 questions each. The blinded evaluation was carried out by patients regarding empathy and usefulness (assessed through the question: "Would this answer have helped you?") on a scale from 1 to 5. As a control, evaluation was also performed by 3 physicians in each respective medical specialty, who were additionally asked about the potential harm of the response and its correctness. In total, 200 sets of questions were submitted by 64 patients (mean 45.7, SD 15.9 years; 29/64, 45.3% male), resulting in 2000 evaluated answers of ChatGPT and the EP each. ChatGPT scored higher in terms of empathy (4.18 vs 2.7; P<.001) and usefulness (4.04 vs 2.98; P<.001). Subanalysis revealed a small bias in terms of levels of empathy given by women in comparison with men (4.46 vs 4.14; P=.049). Ratings of ChatGPT were high regardless of the participant's age. The same highly significant results were observed in the evaluation of the respective specialist physicians. ChatGPT outperformed significantly in correctness (4.51 vs 3.55; P<.001). Specialists rated the usefulness (3.93 vs 4.59) and correctness (4.62 vs 3.84) significantly lower in potentially harmful responses from ChatGPT (P<.001). This was not the case among patients. The results indicate that ChatGPT is capable of supporting patients in health-related queries better than physicians, at least in terms of written advice through a web-based platform. In this study, ChatGPT's responses had a lower percentage of potentially harmful advice than the web-based EP. However, it is crucial to note that this finding is based on a specific study design and may not generalize to all health care settings. Alarmingly, patients are not able to independently recognize these potential dangers.

Physician-dentist dual referral model concept for coordinated bone anabolic therapy

BackgroundBone anabolic drugs used for the pharmacologic treatment of osteoporosis have the potential to enhance alveolar bone regeneration to improve implant success. There are no US Food and Drug Administration–approved drugs indicated to improve oral bone density around teeth or implants. MethodsThe authors summarized expert opinions on a novel coordinated treatment approach leveraging the effects of systemic bone anabolic drugs to enhance dental implant therapy in patients with osteoporosis and a dual referral model for physicians and dentists to address the clinical needs of patients with osteoporosis from a comprehensive perspective of oral-systemic health. Interviews of key opinion leaders were conducted with a bone health specialist group consisting of specialists in orthopedic surgery, internal medicine, geriatrics, endocrinology, and clinical densitometry and a surgical dental specialist group consisting of periodontists and oral surgeons. ResultsOverall, both groups shared positive feedback on the idea of strategically timing administration of anabolic osteoporosis drugs with dental treatment. Both groups expressed interest in the dual referral model. ConclusionsThe feedback of key opinion leaders supported the coordinated bone anabolic therapy concept and identified a need for improved interdisciplinary collaboration, education, and communication to realize the synergies of physician-dentist clinical cooperation. Practical ImplicationsStrategic timing of osteoporosis therapy could improve skeletal bone health and reduce fracture risk while offering adjunctive dental benefits.

Deprescribing in Older Adults: Attitudes, Awareness, Training, and Clinical Practice Among Portuguese Physicians.

The importance of deprescribing in clinical practice is growing, particularly in aging populations with polypharmacy scenarios, making it a crucial matter in Portugal, one of Europe's most aged nations. The aim of this study was to investigate deprescribing awareness, training, attitudes, and practices among Portuguese physicians to inform future healthcare strategies. A cross-sectional study using an anonymous online questionnaire was disseminated through the Portuguese Medical Association. It gathered sociodemographic and professional data, and insights into deprescribing awareness, attitudes, training, and practices. Descriptive statistics were summarized as frequencies, percentages, medians, and interquartile ranges. For inferential analysis, the Chi-square test and Fisher's exact test were used to evaluate categorical variables, and the Mann-Whitney U test was used for continuous variables. The significance level was set at p < 0.05. A total of 425 valid questionnaires were included. The participants were mostly women (61.6%), with a median age of 45 (IQR 34 - 42). General practice/family medicine (34.1%) and internal medicine (16.2%) were the most common medical specialties. While 81.2% of the respondents were familiar with the term 'deprescribing', 55.4% reported no training. A vast majority (91.9%) reported practicing deprescribing, but a smaller fraction employed specific methodologies to deprescribe (39.8%) and criteria for identifying potentially inappropriate medications (38.7%). Training in deprescribing was significantly associated with higher deprescribing awareness (p < 0.001), the use of specific deprescribing methods (p < 0.001), the use of criteria to identify potentially inappropriate medications (p < 0.001) and having certification in geriatrics by the Portuguese Medical Association (p = 0.006). Family physicians showed higher familiarity with and training in deprescribing than hospital-based specialists (p < 0.001). Deprescribing methodologies were adopted more often by family physicians than by hospital-based specialists (p = 0.004). This study highlights widespread deprescribing awareness among Portuguese physicians, while simultaneously uncovering considerable gaps in training and inconsistencies in its application. These findings highlight the pressing need for targeted educational initiatives that could contribute to medication optimization for older adults in the national healthcare system. Furthermore, these findings emphasize the importance of policy development and medical education in promoting safe deprescribing.

Editorial Comment on “Assessing Attitudes and Confidence in Managing Erectile Dysfunction Among Urology, Internal Medicine, and Family Medicine Providers”

Editorial Comment on “Assessing Attitudes and Confidence in Managing Erectile Dysfunction Among Urology, Internal Medicine, and Family Medicine Providers”