General Medical Management Research Articles

Accuracy and Readability of Kidney Stone Patient Information Materials Generated by a Large Language Model Compared to Official Urologic Organizations

ObjectiveTo compare the readability and accuracy of large language model generated patient information materials (PIMs) to those supplied by the American Urological Association (AUA), Canadian Urological Association (CUA), and European Association of Urology (EAU) for kidney stones. MethodsPIMs from AUA, CUA, and EAU related to nephrolithiasis were obtained and categorized. The most frequent patient questions related to kidney stones were identified from an internet query and input into GPT-3.5 and GPT-4. PIMs and ChatGPT outputs were assessed for accuracy and readability using previously published indexes. We also assessed changes in ChatGPT outputs when a reading level was specified (grade 6). ResultsReadability scores were better for PIMs from the CUA (Grade level 10 – 12), AUA (8 – 10), or EAU (9 -11) compared to the chatbot. GPT-3.5 had the worst readability scores at Grade 13-14 and GPT-4 was likewise less readable than urologic organization PIMs with scores of 11-13. While organizational PIMs were deemed to be accurate, the chatbot had high accuracy with minor details omitted. GPT-4 was more accurate in general stone information, dietary and medical management of kidney stones topics in comparison to GPT-3.5, while both models had the same accuracy in the surgical management of nephrolithiasis topics. ConclusionsCurrent PIMs from major urologic organizations for kidney stones remain more readable than publicly available GPT outputs, but they are still higher than the reading ability of the general population. Of the available PIMs for kidney stones, those from the AUA are the most readable. Although Chatbot outputs for common kidney stone patient queries have a high degree of accuracy with minor omitted details, it is important for clinicians to understand their strengths and limitations.

Pharmacology Knowledge Among Nurses Working in Nursing Homes in Norway: A Cross-Sectional Study.

The administration of drugs is an important part of nurses' professional practice. A basic knowledge of pharmacological principles is required to make accurate decisions about drug management and conduct patient medication education. However, several studies have suggested that nurses have inadequate knowledge of pharmacology and medication management. To explore the level of knowledge in pharmacology and medication management among nurses working in nursing homes (NHs). We conducted a cross-sectional study at 24 NHs in Norway. The nurses took a multiple-choice test in pharmacology with 35 questions at their workplace. Each question had four alternative answers with one answer being correct. One point was awarded for a correct answer and zero for a wrong answer. The test included categories in general pharmacology, clinical pharmacology, and medication management. In total, 145 nurses completed the questionnaire. In the range of 0-35 correct responses, the mean score for the sum of all questions was 22.5, which equates to 66% of responses being correct. Linear multiple regression showed no association regarding gender, age distribution among the nurses, years since completing basic education in nursing, years of work experience in NHs, postgraduate education, and knowledge of pharmacology and medication management. Knowledge was better in the category medication management (p < 0.001) than in the category's general pharmacology and clinical pharmacology. When evaluating specific test questions, 38.9% of the nurses answered a question on opioids correct, 64.1% a question on anticoagulants correct, 33.5% knew the prerequisites for generic substitution, and 45.5% did not know the difference between agonists and antagonists. Our results are in line with previous findings. The participating nurses working in the NHs have insufficient knowledge in pharmacology and medication management. This may cause harm and undermine patient safety.

Role of patient education &amp; counseling while treating superficial fungal infection

The prevalence of superficial fungal infection has ascended in India over the past 6–7 years. Chronic, recurrent, relapse and steroid‑modified tinea (tinea incognito) with nonresponse to the conventional treatment regimens are being commonly reported. Poor adherence to general measures, and non-compliance to treatment are important factors affecting the spread of infection and clinical presentation. The management of superficial fungal infection depends on general measures and medical management. Treatment strategies involve the use of systemic antifungals and/or topical antifungal agents. Treatment guidelines must be followed appropriately. Regular patient counselling and patient education are the deciding parameters for successful treatment of superficial fungal infection. Patients should be well educated about personal hygiene, clothing, skin care, corticosteroid abuse, adherence to general measures and compliance with treatment to ensure a successful treatment outcome.

Management of Post-Myocardial Infarction Right Ventricular Failure.

Right ventricular failure (RVF) due to an acute myocardial infarction (MI) has been associated with high morbidity and mortality. Initial treatment is guided by early recognition and prompt revascularization. Current management of post-MI RVF is built upon expert consensus and is also informed by RVF from other etiologies, including massive pulmonary embolism, left ventricular assist device-associated right ventricular dysfunction, postcardiotomy shock, etc.; this speaks to the limited data available on the specific management of RVF in acute MI. The goal of this review is to discuss the current literature on the pathophysiology, general management considerations, interventional management, hemodynamic monitoring, medical management, and mechanical circulatory support of MI-induced RVF.

Eating Disorders.

Eating disorders are common behavioral disorders associated with substantial psychological and physical morbidity and mortality. Persons with eating disorders frequently present to primary care providers, who may also be responsible for their general medical management. This article reviews the diagnosis, medical assessment, and treatment of the most common eating disorders.

General Surgery Clinical Information Management System Based on Intelligent Data Management.

In order to improve the effect of surgical clinical information management, this paper combines the intelligent data management technology to construct the general surgery clinical information management system. Based on the design and development of general surgery clinical medical case information management system, this paper studies the mutual conversion between XML data and relational data, and designs a clinical medical case information management system based on the design idea of layered architecture. The clinical medical case information management system mainly adopts the modular design idea and adopts a digital microscopic image storage mode based on HDFS architecture. After building the system function structure, the system effect is verified by simulation test. From the experimental statistical results, it can be seen that the general surgery clinical information management system based on intelligent data management proposed in this paper has a good effect.

UK trainee perspectives on leadership in the COVID-19 pandemic

There has been redeployment, ‘up-skilling’, halted rotations and an earlier than planned start to work for many new foundation year-1 (F1) doctors, to name just a few of the events impacting trainees in the UK during these ‘unprecedented times’. At times of crisis we look to leaders for guidance and support; but it is not only in these times that leadership plays a pivotal role – note the General Medical Council (GMC) leadership and management guidance. This snapshot survey was designed to explore trainee experience of leadership during the COVID-19 pandemic in the UK. An online survey …

Evaluation of Smoking as a Modifying Factor in Chronic Rhinosinusitis

The negative association of smoking with the respiratory tract is well known; however, the association between smoking and chronic rhinosinusitis (CRS) has not been well characterized. To analyze whether active smoking was a risk factor for CRS development, smoking was associated with disease-specific quality of life, and smokers experience an increased symptom burden than nonsmokers. This subanalysis of the Chronic Rhinosinusitis Epidemiology Study (CRES), a prospective, questionnaire-based case-control study conducted between October 2007 and September 2013 was conducted across 30 UK tertiary/secondary care sites. Participants were identified at ear, nose, and throat outpatient clinics and classified into CRS phenotypes as per European Position Paper on Rhinosinusitis and Nasal Polyps 2012 criteria. The overall response rate of those identified to take part in the study was 66%. A total of 1535 questionnaires were returned, with 1470 considered eligible for inclusion. Data analysis was conducted in January 2020. The CRES was designed to distinguish differences in socioeconomic status, geography, medical comorbidities, lifestyle, and quality of life between patients with CRS and healthy controls. A total of 1450 patients completed the smoking question, comprising 219 controls (15.1%; mean [SD] age, 47.3 [14.9] years; 143 women [68%]), 546 participants with CRS (37.7%; mean [SD] age, 51.8 [15.3] years; 259 women [53%]) without nasal polyps (CRSsNPs), and 685 participants (47.2%; mean [SD] age, 56.0 [14.5] years; 204 women [33%]) with CRS and nasal polyps/allergic fungal rhinosinusitis (CRSwNPs+). The mean age was similar, with a greater female preponderance in the control group and male in the CRSwNP group. The greatest number of active smokers was found among control participants (33 [15%]), with a lower rate of smokers in the patients with CRSwNPs+ (9.9%) and CRSsNPs (13.9%), respectively. We found a clinically significant difference in the mean difference in Sino-nasal Outcome Test (SNOT-22) scores between active smokers and nonsmokers for both CRS phenotypes (4.49, 12.25). In both CRS subgroups active smokers had significantly worse SNOT-22 scores than nonsmokers by a mean (SD) magnitude of 10 (18.99, 24.14) points. Nonsmokers also demonstrated a higher percentage of surgical procedures (1 or more), although this was not clinically or statistically different (0.34, 1.10). This questionnaire-based case-control study demonstrated a clinically significant symptom burden associated with active cigarette smoking, with worse SNOT-22 scores in the smoking cohort by a mean magnitude of 10 points. We could find no demonstrable evidence that smoking increases the likelihood of need for revision sinus surgery. Clinicians should encourage smoking cessation alongside general CRS medical management.

English

Asthma is a chronic respiratory disease that adversely influences the quality of life of many South Africans. The medical management of asthma includes identification, education, medical and pharmaceutical treatment. Literature has inequitably demonstrated that habitual structured exercise therapy can be a beneficial adjunct to general medical and pharmaceutical management strategies. This clinical commentary aims to increase awareness regarding the salutogenic effect of structured exercise on asthma. There is need for asthmatic management strategies that are not influenced by financial cost, and which, consequently, have the ability to reach more patients. This study recommends the adoption of regular structured exercise rehabilitation as an adjunct to popular asthmatic treatment protocols. Key words: Asthma, benefits, exercise, risks

The Diagnostic Role of Brain MRI in Detection of Multiple Sclerosis Related Cognitive Impairment

Background: Cognitive impairment (CI) is a common manifestation of multiple sclerosis (MS), which can severely affect patients’ and their families’ life. Early suspicion and detection of CI can improve general medical management of MS patients. Objectives: To correlate MS related CI to cortical brain lesions using brain magnetic resonance imaging (MRI). Materials and Methods: Cognitive impairment was detected using mini mental state examination (MMSE); Neurological examination and brain MRI were performed for all patients. Correlation was calculated between disease cortical burden detected by MRI and CI. Results: Fifty-three patients with proven MS were scanned by brain MRI; 69.8% of them had cognitive impairment diagnosed with MMSE. The presence and severity of cognitive impairment was correlated to cortical brain lesion. Cognitive impairment was not correlated with non-cortical brain lesions or neurological physical disability measured by Expanded Disability Status Scale (EDSS). Conclusions: Presence of brain frontal cortical lesions detected by MRI in MS patients can predict subsequent development of MS-related CI.

Design of standard system framework for hospital quality and safety management in China

A comprehensive literature review on medical quality and safety at home and abroad in recent years, rounded up cases of medical risks, quality defects and medical injuries faced by medical institutions. With reference to domestic and overseas experiences on standardization, the authors created the Hospital Quality and Safety Management of Chinese Hospitals Association, as institutional standard system framework and a system table. These contents comprise four parts and 62 sections, including general principles, patient service, medical support and medical management. Key words: Quality of health care; Patient safety; Medical quality; Management standards; Framework system

Retrospective Study of The Corticosteroids Administration in Glioblastoma Patients as A Prognostic Factor in The Disease

Background: Glioblastoma multiforme (GBM) is the most common and most malignant of the glial tumors. Optimum management consists of maximal safe surgical resection, followed by concurrent chemo-radiotherapy treatment then adjuvant chemotherapy with temozolomide. A considerable part from the care of patients with GBM involves general medical management, containing corticosteroids. Despite steroids common use, there is experimental and clinical evidence that corticosteroids have direct effects on tumor cell proliferation and apoptosis. Aim of the Work: was to discuss the clinical relation between corticosteroids usage in Glioblastoma Multiforme (GBM) patients and quality of life as well as the disease progression free survival according to the recorded data from the joined hospitals. Patients and Methods: Retrospective analysis of 66 adult patients diagnosed with GBM by surgery or imaging criteria. In order to assess the relation between corticosteroid dependence and the survival, patients were recruited into two groups (arms) according to dependency. Arm (A) was steroid dependent (34 patients) and arm (B) was steroid non-dependent (32 patients). Results: Corticosteroids dependency was statistically significant correlated to both Overall Survival (OS)(median 2.5 in arm (A) vs. 13.1 months in the arm (B), p < 0.001), and Progression-free survival ratio (PFS)(median 2.3 in arm (A) vs. 9.4 months in arm (B), p = 0.035). Also, steroid dependency was independent prognostic factor by doing the COX regression analysis. Conclusion: Dependence on corticosteroids during course of treatment is identified as a poor prognostic factor.

Retrospective Study of The Corticosteroids Administration in Glioblastoma Patients as A Prognostic Factor in The Disease

Background: Glioblastoma multiforme (GBM) is the most common and most malignant of the glial tumors. Optimum management consists of maximal safe surgical resection, followed by concurrent chemo-radiotherapy treatment then adjuvant chemotherapy with temozolomide. A considerable part from the care of patients with GBM involves general medical management, containing corticosteroids. Despite steroids common use, there is experimental and clinical evidence that corticosteroids have direct effects on tumor cell proliferation and apoptosis. Aim of the Work: was to discuss the clinical relation between corticosteroids usage in Glioblastoma Multiforme (GBM) patients and quality of life as well as the disease progression free survival according to the recorded data from the joined hospitals. Patients and Methods: Retrospective analysis of 66 adult patients diagnosed with GBM by surgery or imaging criteria. In order to assess the relation between corticosteroid dependence and the survival, patients were recruited into two groups (arms) according to dependency. Arm (A) was steroid dependent (34 patients) and arm (B) was steroid non-dependent (32 patients). Results: Corticosteroids dependency was statistically significant correlated to both Overall Survival (OS)(median 2.5 in arm (A) vs. 13.1 months in the arm (B), p < 0.001), and Progression-free survival ratio (PFS)(median 2.3 in arm (A) vs. 9.4 months in arm (B), p = 0.035). Also, steroid dependency was independent prognostic factor by doing the COX regression analysis. Conclusion: Dependence on corticosteroids during course of treatment is identified as a poor prognostic factor.

Consequences of non-medical switch among patients with type 2 diabetes

Objective: This study aimed to describe real-world experiences following a non-medical switch among adults with type 2 diabetes mellitus (T2DM) in the United States.Methods: For this cross-sectional study, patients with T2DM (N = 451) provided data on demographics, and how a non-medical switch of their anti-hyperglycemic agent (AHA) affected their general health, HbA1c levels and medication management, via an Internet-based survey. Patients self-reported their level of satisfaction with the original medication and emotional reactions to the non-medical switch. Patients who recently experienced a non-medical switch of their AHA(s) (n = 379) were asked about the consequences of switching and their satisfaction with the switch (vs. the original) medication.Results: Patients most frequently reported feeling very/extremely frustrated, surprised, upset and angry in reaction to a non-medical switch. Patients were somewhat satisfied with their original medication. Between 20% and 30% of patients reported the non-medical switch had a moderate/major effect on their general health, diabetes, mental well-being and control over their health. The blood glucose levels of recent switchers were somewhat/much worse (20.7%) and medication management was somewhat/much worse (12.9%) on the switch (vs. the original) medication. Some recent switchers reported old symptoms returning (7.7%) and experiencing new side-effects (14.2%).Conclusions: Approximately one in five patients reported a moderate/major negative impact on their blood glucose level, diabetes, mental well-being, general health and control over their health following a non-medical switch. Findings suggest that a non-medical switch may have unintended negative health consequences and results in considerable burden across multiple domains for a sizeable minority of patients with T2DM.

Management of Common Medical Conditions by Office-Based Psychiatrists.

This study examined the extent of psychiatrists' involvement in general medical management activities for their patients. With data from the 2006-2013 U.S. National Ambulatory Medical Survey-an annual cross-sectional survey of visits in a random week to office-based physicians-general medical management activities in 11,046 visits to psychiatrists, 66,267 to general medical physicians (general and family physicians and internists), and 158,933 to other physicians were compared. General medical management activities included recordings of hypertension, hyperlipidemia, diabetes, or obesity; prescriptions of medications for hypertension, hyperlipidemia, or diabetes; blood pressure or weight measurements; ordering glucose, glycohemoglobin (HbA1c), lipids, or cholesterol laboratory tests; and education or counseling for weight, exercise, diet and nutrition, or tobacco use. Any of the target general medical management activities were provided in 37.0% of visits to psychiatrists, compared with 98.0% of visits to general medical physicians and 78.4% to other physicians. Differences between psychiatrists and all other physician groups were smaller for health education and counseling. For each general medical management activity, many of the psychiatrists did not engage in the activity in any of their sampled visits. The most consistent predictors of general medical management activities in each psychiatrist visit were the extent of these activities in other visits to the same psychiatrist and having recorded other types of general medical management activities in the same visit. Efforts to expand psychiatric practice to general medical management activities require better understanding of barriers to such expansion, better characterization of conditions under which such expansion is feasible, and continuing medication education.

Improving medication practices for persons with intellectual and developmental disability: Educating direct support staff using simulation, debriefing, and reflection.

Direct support professionals (DSPs) are increasingly active in medication administration for people with intellectual and developmental disabilities, thus supplementing nursing and family caretakers. Providing workplace training for DSPs is often the duty of nursing personnel. This article presents empirical data and design suggestions for including simulations, debriefing, and written reflective practice during in-service training for DSPs in order to improve DSPs' skills and confidence related to medication administration. Quantitative study results demonstrate that DSPs acknowledge that their skill level and confidence rose significantly after hands-on simulations. The skill-level effect was statistically significant for general medication management -4.5 (p < 0.001) and gastrointestinal medication management -4.4 (p < 0.001). Qualitative findings show a deep desire by DSPs to not just be "pill poppers" but to understand the medical processes, causalities, and consequences of their medication administration. On the basis of our results, the authors make recommendations regarding how to combine DSP workplace simulations and debriefing with written reflective practice in DSP continuing education.

Combined acute inhalation of hydrofluoric acid and nitric acid: a case report and literature review

We describe a nonlethal, delayed onset case of combined acute inhalation of hydrofluoric acid (HFA) and nitric acid (NA) together with a review of the literature. Our patient was exposed to fumes of a 12% HFA and 22% NA solution in a closed environment and suffered during several months after the incident from exertional dyspnoea but recovered completely. Since HFA and NA are dangerous and widely used substances, preparedness for exposure is mandatory. After inhalational exposure, the principles of decontamination with attention to treatment of the skin for HFA burns together with general medical incident management should be applied. The severity of combined NA and HFA intoxication depends on the concentration, the nature of the contact and the duration of exposure but other factors may also be involved. Therapy resistant hypoxia and death have been reported in the literature. Inhalation injury from HFA alone is rare but systemic toxicity should be anticipated. Calcium is advocated as the cornerstone of local and systemic therapy. NA inhalation alone is very rare and causes heavy pulmonary irritation. Massive pulmonary secretions seem a sign of very severe intoxication and treatment appears to be mainly supportive.

Implementing an elective toxicology course through integration of emergency medicine resident physicians into didactic lectures

ObjectivesTo design, implement, and evaluate an elective clinical toxicology course through the integration of emergency medicine physicians into case-based lectures to pharmacy students. DesignAn introductory clinical toxicology course with an emphasis on overdose prevention, overdose patient diagnosis/assessment, and general medical management approaches was developed. Interprofessional interaction opportunity for pharmacy students was provided through integration of emergency medicine resident physicians into didactic lectures. Case-based lectures were created and delivered throughout the course to illustrate the application of the general toxicology knowledge to patient care. AssessmentThe outcome of the course design and implementation were assessed through students’ self-assessment survey, standard course evaluation, and overall course grades from class students. ConclusionStudents perceived the integration of emergency medicine resident physicians as beneficial. The course design promoted students to value different viewpoints, and the method of content delivery helped them to develop real world professional skills through interprofessional interactions. The course survey, evaluations, and overall course grades demonstrated that the course met its predefined educational outcome.

BE ACTIVE: an Education Program for Chinese Cancer Survivors in Canada.

The needs of cancer survivors have been well documented and tend to be higher in immigrant populations. In order to help address unmet needs of Chinese-speaking cancer survivors, we have developed a structured psycho-educational program for this group. The program development was informed by both cultural values of the population and published recommendations for cancer survivorship education and support. The program, entitled BE ACTIVE, includes topics related to key domains in cancer survivorship: psychosocial aspects, general medical management and follow up for late effects, complementary medicine, and lifestyle management through fitness and nutrition. We studied the program delivery in 2012 and 2013, where a total of 124 individuals took part. Participants reported high satisfaction, learning gains, and the willingness to recommend the program to others; they rated their understanding of the behaviors needed for wellness and their motivation for change as high. A facilitator toolkit, which includes topic content development guides and presentation examples, was developed to assist with delivery of the program by other centers. This type of program can improve access and delivery to underserved populations with unmet needs and may also benefit cancer survivors in other jurisdictions with similar concerns.

Identification of Stroke Etiology May Contribute to Improve the Outcome in Dedicated Units

The purpose of our study is to investigate whether stroke unit (SU) care and the utilization of Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria may contribute to reduce death and disability in hospitalized patients after a first-ever ischemic stroke (IS). Data included in the present study were derived from our previous study on the incidence and outcome of cerebrovascular diseases in the district of Udine, performed from April 1, 2007, to March 31,2009. We identified 429 hospitalized first-ever IS cases, 297 of 429 (69.2%) patients were admitted to a dedicated SU and 132 of 429 (30.8%) to a general medical ward. According to the TOAST criteria, 101 of 132 first-ever ISs (76.5%) admitted to general medical wards were of undetermined (UND) etiology, whereas in only 105 of 297 (35.4%) patients admitted to the SU, the diagnosis remained UND. Multivariable analysis after propensity score matching showed that compared with general medical wards, SU care was associated with a reduced probability of being dead or highly disabled (P=.025) at the end of follow-up. Moreover, patients with an UND diagnosis had a worse 6-month case fatality (P<.0001) and also higher risk of being dead or highly disabled (P<.0001). Our study provides real-world evidence that accurate etiologic subtype classification of ISs according to TOAST criteria and SU care as opposed to general medical ward management are associatedwith reduction of the proportion of poor outcomes in first-ever IS patients.