Internal Medicine Doctors Research Articles

Physicians’ knowledge and preferences regarding pharmacotherapy of pregnant women with respiratory tract infections: research PIKAP

Introduction. The most common extragenital pathology during pregnancy includes upper and lower respiratory tract infections (URTI and LRTI), which, if left untreated, leading to obstetric and perinatal pathology. It is relevant to conduct pharmacoepidemiological studies assessing the preferences of specialists regarding the treatment of pregnant women and attitudes towards vaccination in real clinical practice.Aim. To analyze approaches to pharmacotherapy of URTI and LRTI in pregnant women, evaluate the compliance of prescribed drugs with current clinical recommendations and treatment standards.Materials and methods. The study was conducted from 2018 to 2022 using an anonymous questionnaire method in seven regions of Russia.Results and discussion. A total of 227 physicians from seven regions of Russia were surveyed, with 66.8% being internal medicine doctors and 33.2% obstetrician-gynecologists. This study revealed that physicians’ knowledge regarding the rational use of antimicrobial drugs (AMD) in pregnant women is insufficient. Respondents showed better results in the use of AMD in the treatment of pneumonia, with 78.7% of surveys indicating correct tactics. The worst results were observed in answering the question about the appropriateness of prescribing AMD for URTI, tracheitis, and bronchitis (40.3% to 67.7% of respondents made incorrect choices). Overall, 57.7% of respondents understand the importance of vaccination among pregnant women.Conclusion. The results of the conducted study indicate that the choice of drugs for the therapy of URTI and LRTI, especially AMD, for outpatient treatment of pregnant women in some situations does not fully correspond to the current clinical recommendations in our country. Moreover, it is particularly concerning that some physicians prescribe drugs that are unsafe for pregnant women or lack the necessary evidence base or indications for use.

MULTIDISCIPLINARY APPROACH TO A DIFFICULT CASE OF ACUTE HEART FAILURE DUE TO POSSIBILE ISOLATED CARDIAC SARCOIDOSIS

Abstract Background Cardiac sarcoidosis (CS) is a rare, infiltrative cardiomyopathy that results from granulomatous inflammation affecting the heart with high morbidity and mortality. It is usually associated with a systemic (i.e. pulmonary) involvement, but lone heart involvement has been described. Even with extensive multidisciplinary evaluation making a firm diagnosis is difficult, especially in case of isolated CS where the endomyocardial biopsy (EBM) diagnostic yield is low (20–30%). Case Description A 71–year–old patient, heavy smoker with no previously known diseases, was admitted with a 3–month history of dyspnea. On admission he showed typical features of heart failure with reduced ejection fraction (HFrEF). A coronary angiography excluded coronary artery disease, while echocardiography (TTE), cardiac magnetic resonance (CMR), and positron emission tomography (FDG–PET) showed a pattern consistent with a non–ischemic dilated cardiomyopathy with reduction in systolic function, and signs of active inflammation (highly suspected CS). Two electroanatomic mapping driven EBM were made but no clear histological signs of CS (i.e., granulomatous inflammation) were detected. The patient was treated with corticosteroids and HFrEF optimal medical therapy (sacubitril/valsartan, mineralocorticoid receptor antagonists, beta–blockers, dapagliflozin) and a temporary wearable defibrillator (LifeVest) was applied. At 2–month follow–up, despite a moderate improvement in the systolic function and HF symptoms, after a multidisciplinary discussion, considering the extensive left ventricle scar, inflammatory involvement, and the presence of multiple non–sustained ventricular tachycardia, a permanent cardioverter–defibrillator (ICD) was implanted. Conclusion This case highlights how, even with (repeated) extensive multidisciplinary evaluation (TTE, CRM, FGD–PET, EBM), a definitive diagnosis of isolated CS often remains presumptive. The presence of an experienced cardiomyopathy team (HF specialists, cardiac imager, electrophysiologists, internal medicine doctor) can help in the diagnostic–therapeutic management of these patients with inflammatory heart disease.

The impact of doctors' facial attractiveness on users' choices in online health communities: A stereotype content and social role perspective

This study examines the impact of doctors' facial attractiveness on users' choices in online health communities (OHCs). We conducted a field study using a sample of 14,897 doctors registered on a Chinese OHC. The results indicate a significant negative relationship between the facial attractiveness of doctors and the number of visits to their homepage by users. However, this relationship only holds true for male surgeons and female internal medicine doctors, not for female surgeons or male internal medicine doctors. These findings suggest the possible presence of gender-specialty bias in the influence of facial attractiveness on patients' decision-making. To further investigate how facial attractiveness influences users' inclination to choose a particular doctor, we develop our research model drawing upon the stereotype content and social role perspective. Through a laboratory experiment, we found that OHC users' perceptions of doctors' warmth and competence act as mediating factors in the relationship between facial attractiveness and user choice. Additionally, this relationship is influenced by stereotypical gender-specialty fit.

Drug Optimization in Patients with Mild-to-Moderate Ulcerative Colitis: A Global Survey.

Background/Objectives: The treatment of patients with mild-to-moderate ulcerative colitis (UC) is challenging. Although there are commonly used guidelines, therapy optimization is not standardized. We conducted a survey to investigate the management and treatment of patients with mild-to-moderate UC. Methods: Physicians with experience in treating inflammatory bowel diseases (IBD) were invited to participate in an anonymous, multiple-choice survey between June and July 2023. The survey addressed various issues of patient care such as patient monitoring, treatment optimization, follow-up, treatment decision making, and therapy de-escalation. Results: The survey included 222 physicians (59.9% men; mean age = 50.4 years) from 66 countries worldwide. Gastroenterologists were the most represented specialists (89.6%), followed by surgeons (3.2%), and internal medicine doctors (2.7%). Two-thirds of the participants (66.7%) had >10 years of experience in the field of IBD. The combination of oral (≥4 g/day) and rectal 5-aminosalicylic acid (5-ASA) was the preferred choice when optimizing therapy. Budesonide MMX (41.8%) and systemic steroids (39.9%) were preferred in patients who failed 5-ASA. Treatment decisions were predominantly based on endoscopic (99.0%) or clinical (59.8%) activity. A significant percentage of clinicians did not optimize therapy in the case of increased fecal calprotectin alone (45.1%) or radiological/ultrasound activity (39.8%) alone. Conclusions: The guidelines for the management of mild-to-moderate UC are well accepted in clinical practice. Endoscopic remission remains the main therapeutic target, followed by clinical remission. Fecal calprotectin and intestinal ultrasound still elicit complaints from physicians.

Addiction Patient’s Relationship to Self and Predictions on the Estimated Hospitalization Duration

Addictions are physical and/or psychological dependency disorders characterized by repetitive and compulsive behaviours in which the individual has difficulty controlling impulses. In this study, behaviours are defined as chronic alcohol or substance use. Thus, compulsions will generate negative consequences on a person's quality of life. Among the causes of addiction are genetic and biological factors, environmental factors, trauma, abuse, lack of emotional support, stress, social pressures, poor coping mechanisms, social and cultural factors.
 Material and method
 In this study, part of a larger study, 81 patients diagnosed with toxic-nutritional liver cirrhosis, chronic alcohol users, aged between 32 and 68 years were included. The study period was of two years, and anamnestic data (number of hospitalization days, hospitalization frequency) were collected for the period 2015-2022. In order to carry out the linear research, SPSS statistical software was used. Patients, after obtaining consent, were administered a psychological questionnaire designed to assess unconditional self-acceptance, based on the hypothesis that low self-tolerance generates self-destructive behaviours, i.e. addictions.
 
 Results 
 The necessary statistical steps were followed in order to check the database and it was possible to obtain correlations between the number of hospitalization days, the hospitalization frequency and the scores obtained in the questionnaire. Finally, it was possible to generate a simple linear regression prediction with the number of hospitalisation days /inpatient frequency as the dependent variable and the test score as the independent variable.
 The results showed that as unconditional self-acceptance decreases (decreasing score), the hospitalization duration or the number of patient presentations to the doctor increases.
 Conclusions 
 Unconditional self-acceptance, environmental tolerance, coping mechanisms have a major impact on the patient's well-being and compliance with treatment. Psychosomatic disorders accompany the addiction patient to a much greater extent than the diagnosis made by clinicians. This demonstrates the need for a diagnostic tool, the lack of collaboration with the psychiatrist, ultimately generating costs on the health system and reducing the quality of the patient’s life.
 In order to optimise the diagnosis, a tool within the clinician's reach (internal medicine doctor, gastroenterologist, etc.) and a real collaboration with the psychiatrist or clinical psychologist is necessary.

Follow-up of Patients with Hereditary Metabolic Diseases during the 3 Years of the Pandemic in the Reference Center for Hereditary Metabolism Diseases of the Centro Hospitalar Universitário Lisboa Norte

Introduction:: The adult unit of the Reference Center for Hereditary Metabolism Diseases of the Centro Hospitalar Universitário Lisboa Norte was created in 2002. The team that supports this unit is made up of several specialists, including 2 Internal Medicine Doctors and 2 Nutritionists. The unit carries out its activity mainly in an outpatient clinic on Fridays. Between March 2020 and December 2022, the team adapted the support given to this unit, transforming some external appointments into non-face-to-face appointments in order to maintain contact with patients and reduce the deslocation to the CHULN. Methods:: The analysis reported below reflects the activity in face-to-face and non-face-to-face appointment of the medical team and nutrition team in the critical period. Results/Case Report:: A total of 220 patients were evaluated, 56.4% female and 43.6% male. Regarding the evaluated pathologies, these were divided into 3 groups: aminoacidopathies – 40%, organic aciduria – 6.5% and other metabolic diseases – 53.5%. During these three years a total of 580 nutrition appointments were scheduled, 457 face-to-face and 123 non-face-to-face. 32% of patients scheduled did not attend the appointments or it was not possible to make telephone contact. This percentage is divided into 90% face-to-face appointments and 10% nonface- to-face appointments. Regarding medical appointments, the total was 797, 667 of which were face-to-face and 130 non-face-to-face. 16.8% of absences were registered in face-to-face and non-face-to-face appointments. 98.5% of absences concern non-face-to-face appointments. Conclusion:: Despite the troubled period worldwide, support for these patients was always ensured, both by the Medical team and the Nutrition team. Despite the solutions found to keep patients safe, in this specific period, the % of absences from the outpatient clinic is quite high, and one of the main justifications presented by the patients is related to the fact that they are afraid to go to the hospital. With regard to absences recorded in non-face-to-face appointments, there were several situations in which patients reported not being able to answer the phone during their working hours.

Expert consensus on clinical application of Lixuwang~® Xuesaitong Soft Capsules

Lixuwang~® Xuesaitong Soft Capsules(referred to as "Xuesaitong Soft Capsules") have the effects of promoting blood circulation, resolving blood stasis, and dredging meridians and collaterals. They are widely used in the prevention and treatment of cardiovascular and cerebrovascular diseases in clinical practice. Through years of clinical observation, they have shown significant efficacy in ischemic stroke, coronary heart disease, and other diseases, and have been recommended by multiple guidelines, consensus statements, and monographs. Based on the summary of clinical application experience by doctors and existing evidence-based research, following the Technical Specifications for Consensus Development of Chinese Patent Medicine by Clinical Experts issued by Standardization Office of the Chinese Association of Traditional Chinese Medicine, a nominal group method was used to reach 19 recommended opinions/consensus suggestions. This document proposes the timing of medication, syndrome differentiation for medication, therapeutic effects, dosage and administration, treatment duration, economic considerations, and safety considerations in the use of Xuesaitong Soft Capsules for the treatment of ischemic stroke and angina pectoris in coronary heart disease. It is intended for doctors in internal medicine, encephalopathy(neurology), cardiovascular medicine, geriatrics, emergency medicine, general practice, and traditional Chinese medicine departments of various medical institutions, as well as pharmacists in hospitals and pharmacies, as a medication reference when using Xuesaitong Soft Capsules. It is hoped that the widespread application of this consensus can improve the clinical efficacy of Xuesaitong Soft Capsules in the treatment of ischemic stroke and coronary heart disease, promote rational drug use, and reduce medication risks. This consensus has been reviewed and published by the China Association of Traditional Chinese Medicine, with the identification number GS/CACM 323-2023.

O.4.1-4 Integrated geriatric care - a community approach to preventing falls and frailty of elderly Slovenian

Abstract Purpose The need for geriatric treatment is increasing with the aging of the population. Multimorbid patients with social care problems and increased need for rehabilitation and paliative care are more common. Mortality of the elderly, due to falls is 2.5 times higher in Slovenia than in the other EU countries. Until the national regulation of integrated geriatric care in Slovenian health system and in other relevant environments (community, long-term care, social care) and the establishment of appropriate, licensed postgraduate training for health professionals, it is necessary to start educating wider range of health and social care personnel, for most common geriatric syndromes such as frailty, falls and NCDs. Establishing a community approach to health is one effective way to address vulnerability of elderly population. Project description Project Integration of geriatric care for the elderly is implementing the existing commitment from WHO Decade of healthy ageing and the Slovenian Health Care Plan until 2025. With planned activities, it will ensure equal access to quality and safe health services, integrated and comprehensive treatment and will contribute to the deinstitutionalization of the Slovenian eldest population. It will develop a unified set of tools, for the systematic identification of elderly needs, new digital tools for optimization and better communication between different levels of providers and training a wider range of new and already employed health and social care personnel, for optimal health care. Evaluation of new competency models for health care personnel, training methods and proposed clinical pathways will be carried out at the end of the project. Based on final proposals, we will establish a new approach to the system level of integrated geriatric care and bring the treatment closer to the patient's home. Conclusions Project will also contribute to upgrading competences of physiotherapists, kinesiologists, standard health teams in Health Promotion Centers, community nurses, family medicine and internal medicine doctors and social care workers for the integrated geriatric care for the elderly. It will address especially treatment of the physical component in geriatric syndrome, such as decreased muscle strength, balance, impaired walking and frailty, at different levels of health care and communities.

К 225 - ЛЕТИЮ ВИДНОГО ОТЕЧЕСТВЕННОГО ВРАЧА ТЕРАПЕВТА КАРЛА КАРЛОВИЧА ЗЕЙДЛИЦА

Introduction. 2023 marks the 225th anniversary of the birth of Karl Karlovich Seidlitz, a prominent Russian scientist, internal medicine doctor, professor of the Medical and Surgical Academy, one of the reformers of medical education and the founder of the clinical and anatomical method in Russian medicine, the founder of the department of the Faculty academic therapeutic Clinic, a close friend and biographer of the poet V.A. Zhukovsky. Аim. Is to show the role of K.K. Seidlitz in the development of clinical medicine and education in the Russian Empire. The appeal to his memory in the jubilee year allows us to preserve the continuity of generations. Material and methods. The study uses general methodological approaches for historical and medical research. The analysis of literary sources on the history of medicine is carried out, articles and materials revealing the priority and importance of the works of K.K. Seidlitz for medical science and the history of culture of Russia are studied. Results and discussion. The contribution of K.K. Seidlitz to the fight against infectious diseases in the Russian Empire is analyzed. K.K. Seidlitz was one of the first to describe the clinic and epidemiology of leptospirosis. Having headed the therapeutic clinic of the St. Petersburg Medical and Surgical (now Military Medical) Academy, he was one of the first in Russia to introduce differential diagnostics, methods of physical research, created an outpatient clinic and a laboratory at the clinic for conducting research using microscopes discharged from Paris, introduced pathoanatomical studies of deceased patients, etc. Conclusion. In modern literature, the name of K.K. Seidlitz is primarily associated with the first detailed in modern literature, the name of K.K. Seidlitz is primarily associated with the first detailed systematized biography of the poet V.A. Zhukovsky written by him. However, K.K. Seidlitz has great merits in the field of the development of clinical medicine in Russia and its teaching, which the reader should be reminded of.

The perceptions of healthcare practitioners on obesity management in Peninsular Malaysia: a cross-sectional survey

BackgroundPractitioners’ perceptions of patients with obesity and obesity management shape their engagement in obesity care delivery. This study aims to describe practitioners’ perceptions, experiences and needs in managing patients with obesity, determine the extent of weight stigma among health practitioners, and identify the factors associated with negative judgment towards patients with obesity.MethodsA cross-sectional online survey was conducted from May to August 2022 with health practitioners commonly involved in obesity management in Peninsular Malaysia, including doctors in primary care, internal medicine and bariatric surgery, and allied health practitioners. The survey explored practitioners’ perceptions, barriers and needs in managing obesity, and evaluated weight stigma using the Universal Measures of Bias – Fat (UMB Fat) questionnaire. Multiple linear regression analysis was used to identify demographic and clinical-related factors associated with higher negative judgment towards patients with obesity.ResultsA total of 209 participants completed the survey (completion rate of 55.4%). The majority (n = 196, 94.3%) agreed that obesity is a chronic disease, perceived a responsibility to provide care (n = 176, 84.2%) and were motivated to help patients to lose weight (n = 160, 76.6%). However, only 22% (n = 46) thought their patients were motivated to lose weight. The most frequently reported barriers to obesity discussions were short consultation time, patients’ lack of motivation, and having other, more important, concerns to discuss. Practitioners needed support with access to multi-disciplinary care, advanced obesity training, financing, comprehensive obesity management guidelines and access to obesity medications. The mean (SD) of the UMB Fat summary score was 2.99 (0.87), with the mean (SD) domain scores ranging between 2.21 and 4.36 (1.06 to 1.45). No demographic and clinical-related factors were significantly associated with negative judgment from the multiple linear regression analyses.ConclusionPractitioners in this study considered obesity a chronic disease. While they had the motivation and capacity to engage in obesity management, physical and social opportunities were the reasons for not discussing obesity with their patients. Practitioners needed more support to enhance their capability and opportunity to engage with obesity management. Weight stigma in healthcare settings in Malaysia should be addressed, given the possibility of hindering weight discussions with patients.

#3008 SERENDIPITY OF SGLT2 INHIBITION – DIABETIC AND NON DIABETIC CKD

Abstract Background and Aims Ever since their therapeutic introduction, SGLT2 inhibition class of medicaments did impress physicians of related fields, nephrologists, internal medicine doctors, endocrinologists etc. Their natriuretic and glucoretic effects besides lowering the plasma glucose does produce a important effect on lowering intraglomerular pressure, this became an added value and a strong point to recommend these drugs on all CKD population irregardles the main cause of the disease. Method Observational retrospective study on 125 patients, three groups: G1 50 pt with diabetic nephropathy treated with empagliflozine vs control group G2 50 pt with diabetic nephropathy treated with other glucose lowering agents, and G3 25 nondiabetic pt with CKD and proteinuria treated with SGLT2i. Inclusion criteria was proteinuria and T2D for G1 and G2, and patients with proteinuria and CKD for G3. Patients with T1D and eGFR > 20 where excluded. Intervention - the SGLT2i drugs where started, median follow up 18 months. We followed on four periods creatinine levels, 24 hour proteinuria in g/24 h, HbA1c, cholesterol level, BMI. Results In our study the G1 showed a decrease in proteinuria average – 811 mg/24 h, serum creatinine showed increase on the first three months and it did get back to baseline afterwards, the eGFR increased + 15.44 ml/min; HbA1c decreased with -1.41%, levels, the reduction BMI – 0.9 kg/m2 and LDL cholesterol -1.11 mmol/l. G2 results decrease on 24 hour proteinuria with – 121 mg/24 hours, a drop on eGFR with - 3.3 ml/min, a drop on HbA1C – 1.45 %, - 0.3 mmol/l decrease on cholesterol level and average increase on BMI with + 0.8 kg/m2; G3 results on patients without T2D but with CKD different causes and proteinuria where: - 690 decrease proteinuria, + 14.4 increase on eGFR, HbA1C NA, we did have 2 cases that experienced hypoglycemic symptoms, both of them where improved with dose reduction, a – 0.9 decrease on cholesterol level and 0.3 kg/m2 was registered on our G3. Conclusion In our observation the 18 month follow up showed remarkable improve in kidney function tests, other benefits were noted such as optimal glycemic control, total body cholesterol lowering and a significant reduce of body weight expressed on BMI. Treatment with SGLT2i drugs does present a safe and efficient treatment modality for diabetic nephropathy and for all other CKD with proteinuria.

Algorithms for the management of patients with anxiety in the internist’s practice

The development of guidelines for the detection and further management of patients with anxiety for outpatient physicians is relevant due to the high incidence of anxiety disorders in patients with non-communicable diseases, including cardiovascular diseases, deterioration in quality of life and an increase in adverse outcomes in patients with anxiety. In addition, there is an insufficient awareness of outpatient doctors about the importance of diagnosing and treating anxiety disorders. The aim was to present original "Algorithms for the Management of Patients with Anxiety in the Internist’s Practice" for the detection and timely treatment of anxiety disorders in the routine practice of an internal medicine doctor. The algorithms are intended for internal medicine specialists working in primary outpatient healthcare, as well as for residents.

7-yi Makmasterskyi mizhnarodnyi ohliadovyi kurs z vnutrishnoi medytsyny (7th McMaster International Review Course in Internal Medicine - MIRCIM) - 29.09-01.10.2022 (Krakiv, Respublika Polshcha)

On September 28 – October 1, 2022, the 7th MIRCIM 2022 international conference was held in Krakow (Poland). The conference, which brought together internal medicine doctors, family doctors, narrow specialists of a therapeutic profile, had eight sections corresponding to eight main sections of internal medicine – cardiology, endocrinology, pulmonology, nephrology, rheumatology, gastroenterology, hematology, chronic infections. Professors with international recognition from the USA, Canada, Germany, France, Great Britain, Israel, India, and Mexico had the lectures. In the endocrinological section, the determination of the content of thyroid hormone, the diabetes mellitus treatment new possibilities, the experience of diagnosis and treatment of glucocorticosteroid-induced adrenal insufficiency were discussed. In the section of cardiovascular diseases, the speakers proposed to discuss the issue of acute heart failure, differences in the occurrence and course of cardiovascular diseases in women and men. In the pulmonology session, the lectures on the modern treatment of asthma, the use of nonsteroidal anti-inflammatory drugs in patients with respiratory diseases exacerbations, and the issue of the chronic obstructive pulmonary disease severity course reducing were presented. The nephrology section was presented by the reports on the topics: “Infections and kidneys”, “Optimal nephroprotection in patients with chronic kidney disease”. Professor Tracy Balboni emphasized the importance of spiritual care in the treatment of the critically ill patients and the role of spirituality in medicine and health care in general. The gastroenterology block of reports was devoted to the tactics of management and treatment of helicobacter pylori infection, intestinal polyps and non-alcoholic fatty liver disease. As part of the hematology unit, Professor Andreas Greinacher spoke about heparin-induced, vaccine-induced and other immune thrombocytopenias. At the rheumatology section.

Factors related to Japanese internal medicine doctors’ retention or migration to rural areas: a nationwide retrospective cohort study

Internal medicine (IM) doctors in Japan play the role of primary care physicians; however, the shortage of rural physicians continues. This study aims to elucidate the association of age, sex, board certification, type of work, and main clinical work with the retention or migration of IM doctors to rural areas. This retrospective cohort study included 82,363 IM doctors in 2010, extracted from the national census data of medical doctors. The explanatory variables were age, sex, type of work, primary clinical work, and changes in board certification status. The outcome was retention or migration to rural areas. The first tertile of population density (PD) of municipalities defined as rural area. After stratifying the baseline ruralities as rural or non-rural areas, the odds ratios (ORs) of the explanatory variables were calculated using generalized estimation equations. The analyses were also performed after age stratification (<39, 40-59, ≥60 years old). Among the rural areas, women had a significantly higher OR for retention, but obtaining board certification of IM subspecialties had a significantly lower OR. Among the non-rural areas, physicians who answered that their main work was IM without specific subspecialty and general had a significantly higher OR, but obtaining and maintaining board certification for IM subspecialties had a significantly lower OR for migration to rural areas. After age stratification, the higher OR of women for rural retention was significant only among those aged 40-59 years. Those aged under 40 and 40-59 years in the non-rural areas, who answered that their main work was IM without specific subspecialty had a significantly higher OR for migration to rural areas, and those aged 40-59 years in the rural areas who answered the same had a higher OR for rural retention. Obtaining and maintaining board certification of IM subspecialties are possible inhibiting factors for rural work, and IM doctors whose main work involves subspecialties tend to work in non-rural areas. Once rural work begins, more middle-aged female IM doctors continued rural work compared to male doctors.

Screening for existing anxiety-depressive disorder among internal medicine doctors in the Southern region of Ukraine

Screening for existing anxiety-depressive disorder among internal medicine doctors in the Southern region of Ukraine

Empijem pleure kao komplikacija Kovid 19 pneumonije kod pacijenta sa destroyed lung sindromom

Introduction. Destroyed lung syndrome is a severe destruction of the pleural parenchyma due to lung infection, mostly caused by tuberculosis. Besides tuberculosis, necrotizing pneumonia may also lead to this disease complication. Pleural empyema is a frequent consequence of the destroyed lung syndrome. Pleural empyema may occur during the COVID-19 infection and is negatively correlated with a favorable disease outcome. Case report. A male 50 y/o showed up during the on-call shift during the winter COVID-19 wave with a medical report from the Internal medicine clinic. His personal history is significant for his pneumonectomy in 2016. In the past two months, he had been treated for pneumonia and COVID-19 infection with antibiotics and corticosteroid therapy. Due to prolonged malaise and tachycardia his GP referred him to yet another chest X-ray and lab work. The chest X-ray showed pleural effusion, so he was promptly referred to an on-call hospital. The on-call physician, after looking into the hospital reports, consulted an internal medicine doctor and it was decided to refer the patient to a thoracic surgeon. He was hospitalized for pleural empyema and treated with thoracic drainage using the system of active aspiration. A year later, he feels well, and he regained his appetite, and body mass, with occasional leaking from the thoracic fistule. Conclusion. This case report shows a recurrence of pleural empyema in a patient with pneumonectomy due to necrotizing pneumonia and destroyed lung syndrome, complicated by COVID-19 infection. We aimed to draw the attention of GPs to diseases and disease complications that are rarely met in GP practice and are not otherwise treated on the primary healthcare level.

Assessment of doctor-pharmacist collaboration in the treatment of diabetes mellitus patients at Airlangga University Hospital Surabaya from the pharmacist's perspective

Background: Collaboration between doctors and pharmacists is needed in treating Diabetes Mellitus (DM) patients to optimise treatment regimens. Collaboration between healthcare professionals illustrates teamwork in solving the problem of DM patients. Methods: This study is observational with a cross-sectional design. Respondents were all Internal Medicine doctors and pharmacists of the Universitas Airlangga Hospital. The observed variables were individual, context, and exchange characteristics that affect collaborative practice in dealing with DM patients from the pharmacist's perspective. Results: The results showed that the communication pharmacists-doctors rarely occurred. The pharmacist-doctor collaborative practice was quite effective, according to the pharmacist's perspective. The multiple linear regression test of the exchange characteristics and practice collaboration showed that the trust domain was significant. Conclusion: The communication between pharmacists and doctors is rare. The collaborative practice is in sufficient category. Trust significantly affects this practice.

THE TOTAL POWER OF THE HEART AS A PROMISING PARAMETER FOR ASSESSING THE FUNCTIONAL STATE OF THE PATIENT DURING AN OBJECTIVE STRUCTURED CLINICAL EXAMINATION: GNOSEOLOGY, CLINICAL SIGNIFICANCE

This study reveals the clinical value of the parameter of the total power of the heart in assessing the functional state of the patient. The article is devoted to the expediency of using the method of short recording of heart rhythm variability in Objective Structured Clinical Examination.&#x0D; The purpose of the study was to investigate the total power in patients with noncommunicable diseases based on the results of recording a short record of heart rhythm variability as a promising parameter for assessing the functional state during an Objective Structured Clinical Examination.&#x0D; Materials and methods. An analysis of the total power was carried out based on the data of the short record of heart rhythm variability in 229 people. 43 persons were comorbid patients with coronary heart disease, 111 persons were young functionally healthy non-athletes, 75 persons were professional young athletes.&#x0D; Results. The diagnostic value of the parameter of the total power of the heart was proved. 23% and 21% of patients with non-stationary heart rhythm in the background and orthostatic modes were found. A decrease in total power of various degrees was established in patients, in contrast to control groups.&#x0D; Conclusions. 1) The total power of cardiac activity is a promising, diagnostically valuable parameter for assessing the patient's functional state during an Objective Structured Clinical Examination. 2) Now all the conditions have been formed for the widespread introduction of the method of short recording of heart rhythm variability in the practice of internal medicine doctors.3) The method of short recording of heart rhythm variability can be recommended for use in the clinical examination of patients as a device for improving the individual work of a doctor in order to determine the individual characteristics of the functioning of the heart, determine the risk of cardiac death, and early preclinical diagnosis of emerging pathology.

Postgraduate oncological training: Developing an adaptive oncology-focused teaching programme for central doctors rotating to the Christie NHS Foundation Trust

Background: Junior doctors (FY2 and internal medicine doctors) will be involved in the care of patients with cancer in whichever specialty they choose and yet less than half receive dedicated oncology training. Improving exposure to oncology patient management can develop confidence and engagement and encourage a career in oncology. We aimed to identify stimulating ways to encourage doctors to enjoy and pursue an interest in oncology during their rotation at a tertiary cancer centre.

Trends in secure mobile communication technology use among hospitalists in North America, 2016–2021

ObjectivesStructured communication is essential for hospital-based clinicians to effectively coordinate patient care. However, traditional one-way paging systems are an inefficient means of information transfer. In response to the limitations of paging systems, vendors have developed secure text messaging systems (STMS) that provide asynchronous, multi-way messaging between mobile devices. In 2016 we conducted a cross-sectional survey of a nationally representative cohort of hospitalists and showed that pagers were used more frequently than STMS for patient care-related communication. Despite the potential benefits of STMS, we know little about the degree of STMS adoption since that time. The objective of this study was to quantify how STMS use has changed over time. MethodsWe re-administered our secure communication survey to the original cohort of hospitalists who responded to our initial survey, with a response rate of 25.4%. We used paired hypothesis tests to assess how hospitalist use and organizational adoption of STMS have changed since 2016. ResultsIn 2021, more respondents received messages primarily via STMS than they did in 2016 (n = 36 vs n = 14, difference in proportions 0.23, 95% CI 0.13–0.34, P<.001). Conversely, fewer respondents received messages via pager in 2021 than they did in 2016 (n = 21 vs n = 47, difference in proportions -0.27, 95% CI -0.38 to -0.17, P<.001). ConclusionsWe found that STMS has overtaken paging as the most frequently used technology for patient care-related communication. In addition, many hospitalists use both STMS and paging systems, placing them at risk for communication overload. Public Interest SummaryDoctors working in hospitals still use pagers to communicate. However, paging (receiving a message on a pager and having to call someone back) is slow and can lead to errors. New text messaging apps have been developed to let doctors send secure texts on their smartphones, but when we surveyed hospital-based internal medicine doctors (“hospitalists”) back in 2016, there was very little use of this technology. Because there seem to be benefits to using secure texting over paging, we wanted to show how trends in use of secure paging are changing over time. Here, we repeated our initial survey on the same group of hospitalists. We show that secure texting is now more common than paging, but many hospitalists have access to both. We caution that having too many communication options could lead to communication overload, and we suggest that best practices to prevent this should be studied.