Physician Involvement Research Articles

The Impact of Family Medicine on Diabetic Eye Care, Screening Programs, Referral Patterns, and Outcomes

Diabetes mellitus is a long-lasting metabolic disease with a complex etiology. It is characterized by elevated blood sugar levels, which are marked by anomalies in insulin secretion, action, or both. Long-term hyperglycemia causes diverse microvascular and macrovascular diabetic complications, which are primarily responsible for the high morbidity and mortality associated with diabetes. Diabetes leads to significant ophthalmological complications among which diabetic retinopathy is thought to be the most frequent cause of blindness in people of working age, with diabetic macular oedema being the most frequent cause of impaired visual acuity among diabetics. The findings of several research studies suggest that the best way to prevent diabetic retinopathy from leading to blindness is through regular assessment and screening so any complications can be addressed as soon as possible. Furthermore, since early diabetic eye disease stages are asymptomatic, screening people with diabetes is essential. As a result, the primary care physician's involvement is essential for enabling an early diagnosis of this condition. Family physicians play an essential role in the early identification and prevention of diabetic retinopathy. They serve as the initial line of contact for managing diabetes and as referral sources when complications arise. The purpose of this research is to review the impact of family medicine on diabetic eye care, screening programs, referral patterns, and outcomes.

Social Media Depictions of Cochlear Implants: An Instagram and TikTok Analysis.

To identify populations of authors who post about cochlear implants (CIs) on Instagram and TikTok, to illustrate the content of these posts, and to elucidate factors that might help surgeons better educate CI patients. Qualitative study. Instagram and TikTok social media platforms. All public social media posts identified with the search terms below. Posts were excluded if unrelated to CIs or if written in a non-English language. Instagram and TikTok were searched for posts from March 2021 through September 2021 with the search terms #cochlearimplant, #cochlearimplants, #cochlearimplantkids, #cochlearkids, and #cochlearfamily. Posts were subclassified and analyzed for content including topics of posts, authorship, timeframe of posts, depiction of CIs, and popularity. Of 1,942 posts included in the final analysis, 1,400 were found on Instagram and 542 on TikTok. Authors were mostly patients (n = 771, 39.7%), companies (n = 568, 29.2%), and patients' family members (n = 482, 24.8%). Only 21 posts were made by physicians (1.1%). Out of 379 total educational posts examined, patients themselves were the most common authors (n = 219, 57.8%) followed by patients' family members (n = 139, 36.7%). Physicians authored only a small fraction of all educational posts (n = 19, 5.0%). This study showed minimal physician involvement in the CI social media spheres of Instagram and TikTok. In addition, there were few educational posts on either platform, revealing ample opportunity for physicians to become more involved with CI social media.

Going local: Evaluating guideline adherence and appropriateness of antibiotic prescribing in patients with febrile neutropenia at an academic teaching hospital.

Febrile neutropenia (FN) is a medical emergency with significant morbidity and mortality for oncology patients, requiring comprehensive workup and timely antibiotic administration. We evaluated concordance with locally developed FN guidelines and outcomes of cancer patients admitted to general internal medicine at an academic teaching hospital. We conducted a retrospective observational cohort study of patients admitted between July 1, 2016, and June 30, 2017, for FN. Patients were classified as having low-risk or high-risk FN according to their malignancy and chemotherapy. Primary outcome was the proportion of patients receiving guideline-concordant antibiotics within 48 hours of admission to general internal medicine. Secondary outcomes were the proportion of patients in whom empirical antibiotics were active against pathogens isolated, rate of antibiotic-associated adverse events, and in-hospital mortality. We used logistic regression to model relationship between FN risk and guideline-concordant antibiotics. Among 100 patients included, 34 (34%) were low-risk FN and 66 (66%) were high-risk. Proportion of guideline-concordant empirical antibiotics was significantly lower among low-risk FN patients than high-risk patients: 12 (35%) of 34 versus 47 (71%) of 66 (P = .001). Empirical antibiotics were active against 17 (94%) of 18 isolated pathogens. The mortality rate was 3%, and 16% of patients experienced antibiotic-associated adverse events. Hematological malignancy and infectious diseases-trained physician involvement were associated with guideline-concordant prescribing, with adjusted odds ratios of 3.76 (95% CI, 1.46-9.70; P = .006) and 3.71 (95% CI, 1.49-9.23; P = .005), respectively. Guideline concordance was low compared to published reports. Factors influencing appropriate antimicrobial prescribing in patients with FN warrant further exploration.

Characteristics promoting behaviour change: physician experience with a coalition-led quality improvement initiative to reduce excessive laboratory test ordering

BackgroundAttempts have been made to reduce excessive laboratory test ordering; however, the problem persists and barriers to physician involvement in quality improvement (QI) remain. We sought to understand physician participation...

Current state of mobile health apps in endourology: a review of mobile platforms in marketplaces and literature.

Several mobile healthcare (mHealth) apps are available in various marketplaces, but there is still concern about their accuracy, data safety, and regulation. The goal of this review was to critically analyze the mobile apps created for education, diagnosis, and medical and surgical treatment of patients with kidney stone disease (KSD), as well as to assess the level of data security, the contribution of physicians in their development and adherence to the Food and Drug Administration (FDA) and Medical Device Regulation (MDR) guidance. A comprehensive literature search was performed using PubMed (September 2022), in the Apple App Store and Google Play store using relevant keywords and inclusion criteria. Information was extracted for the name of the app, primary and additional functionalities, release and last update, number of downloads, number of marks and average rating, Android/iOS compatibility, initial and in-app payments, data safety statement, physician involvement statement, and FDA/MDR guidance. A total of 986 apps and 222 articles were reviewed, of which based on the inclusion, 83 apps were finally analyzed. The apps were allocated to six categories about their primary purpose: education (n = 8), fluid trackers (n = 54), food content description and calculators (n = 11), diagnosis (n = 3), pre- and intra-operative application (n = 4), and stent trackers (n = 2). Of these apps, the number of apps supported for Android, iOS, and both of them were 36, 23, and 23, respectively. Despite a wide range of apps available for KSD, the participation of doctors in their development, data security, and functionality remains insufficient. Further development of mHealth should be carried out properly under the supervision of urological associations involving patient support groups, and these apps must be regularly updated for their content and data security.

Novel options in diagnosis and treatment of endophthalmitis

AbstractEndophthalmitis remains the most vision‐threatening condition that in most severe cases can result in a loss of an eye and systemic spreading of the infection. It is defined as an acute inflammation of the inner tissues of the eyeball and is usually caused by intraocular contamination and colonization of infectious agents with exudation within intraocular space. The development of endophthalmitis as well as its clinical presentation and functional and anatomical outcomes is predefined by its type, kind of infection and therapy applied. There is a risk of progression of endophthalmitis to panophthalmitis, which could end up with evisceration or enucleation. The involvement of the general physician and other medical specialists into the treatment of the patients with endophthalmitis shall be always considered and should not be underestimated. As one of the most severe emergencies in ophthalmology, this condition requires urgent therapeutical or/and surgical intervention. Numerous studies compare the efficacy of the first line treatment for different types of endophthalmitis. Since decades the management of endophthalmitis is based on prompt recognition of infectious agents, immediate intraocular antimicrobial therapy and removal of the purulent exudate form the eye. Novel diagnostic options for endophthalmitis shall be considered in order to increase the precision of to treat patients with endophthalmitis. Improvement of the surgical techniques with the development of the new less traumatic instruments and he novel antimicrobial drugs can stablish a new standards of endophthalmitis care.

The Physician Leader and the Clinical Integration of the Supply Chain

Physician leaders have an important place in healthcare today, and the COVID-19 pandemic accentuated the need for physician involvement and leadership within the supply chain. A physician leader informed of the fundamentals and complexities of the healthcare supply chain can be a strategic asset in building resiliency and mitigating disruption within the supply chain.

Educational roles impact burnout in paediatric undergraduate medical educators.

Physician burnout impacts all levels of medical education and has a relatively unknown impact on those responsible for medical student education, particularly in paediatrics. This study examines the prevalence of burnout among paediatric undergraduate medical educators and explores the impact of roles in medical education on medical educator burnout. This cross-sectional mixed-methods study utilised a binational survey of paediatricians involved in undergraduate medical education. Respondents answered demographics, standardised questions about burnout and attitudes towards students, and an open-ended probe about interactions between medical student education and wellness. Of 445 possible, 120 (26.9%) responded to demographic and burnout questions. Of these, 23.3% endorsed burnout, 21.7% high emotional exhaustion (EE) and 10.8% high depersonalisation (DP). High levels of student-related burnout symptoms were reported by fewer than 5% of respondents and were correlated with overall EE and DP. Content analysis revealed four emergent themes: positive effect of student-related role, need to balance medical education and clinical roles, impact of protected time and medical education-related autonomy on educator well-being, and the burden of the administrative portion of educational roles. Participating paediatric educators had low rates of burnout compared with paediatricians as a whole in prior studies. The vast majority found working with students rewarding and described the overall positive impact of their medical education role on wellness. Physician involvement in rewarding non-clinical activities may improve their overall well-being. Providing dedicated time for these activities may ameliorate the difficulty that many medical educators described in balancing their clinical and educational roles. Future studies should continue to explore how we can better support medical educators and the impact of this support on burnout.

Assessment of Oncology Advanced Practice Professional Willingness to Participate in Medical Aid in Dying

In 2021, New Mexico passed legislation allowing nurse practitioners and physician assistants (referred to herein as advanced practice professionals [APPs]) to prescribe medications for medical aid in dying (MAID). Other US states with existing MAID laws (eg, Washington) are also considering expanding MAID prescribing authority to APPs. There is a lack of research exploring APP knowledge of, willingness to, and comfort with acting as a prescribing or consulting clinician for MAID. To assess perspectives of oncology APPs regarding MAID, including their willingness to prescribe and/or consult for MAID and factors associated with willingness. This cross-sectional, self-report survey study used data collected from APPs working at a comprehensive cancer center in Washington State in fall 2021. The primary survey question was whether APPs would be willing to participate in death with dignity, the term used for MAID in Washington. Survey questions evaluated how influential specific factors were on APP views on MAID as well as respondents' knowledge of and comfort with aspects of the MAID process. Of 167 eligible APPs, 77 (46.1%) responded to the survey. Most respondents (68 [88.3%]) reported their race and ethnicity as White; 72 (93.5%) identified as a woman. Medical oncology (28 [36.4%]) was the most common field of practice, and 21 respondents (27.3%) reported having practiced as an APP for 6 to 10 years. Of all respondents, 61 (79.2%) reported having at least 1 patient who inquired about MAID; depending on the question, less than a third of respondents (5.0%-27.0%) endorsed feeling knowledgeable or very knowledgeable about any aspect of the MAID process. In this study, 39 APPs (50.6%) endorsed being willing to participate in MAID either as a consulting or prescribing clinician, whereas 31 (40.3%) were uncertain of whether they would participate. Willingness to participate was associated with having had more patients pursue MAID (33 of the 39 willing participants [84.6%] vs 15 of the 31 unsure participants [48.4%] reported having 1 or more patients pursue MAID). Higher knowledge and comfort scores were both significantly associated with increased odds of being willing to participate (odds ratio, 1.14 per 1-point score increase [95% CI, 1.03-1.27]; P = .01) vs unsure (1.18 [95% CI, 1.07-1.30; P = .001). The results of this survey study suggest that oncology APPs may require preparation for the addition of MAID to their scope of practice. This study also raises questions for future research regarding support for APPs who may be considering participation in MAID but question their role or want physician involvement.

Physician participation in quality improvement work- interest and opportunity: a cross-sectional survey

BackgroundLack of physician involvement in quality improvement threatens the success and sustainability of quality improvement measures. It is therefore important to assess physicians´ interests and opportunities to be involved in quality improvement and their experiences of such participation, both in hospital and general practice.MethodsA cross-sectional postal survey was conducted on a representative sample of physicians in different job positions in Norway in 2019.ResultsThe response rate was 72.6% (1513 of 2085). A large proportion (85.7%) of the physicians wanted to participate in quality improvement, and 68.6% had actively done so in the last year. Physicians’ interest in quality improvement and their active participation was significantly related to the designated time for quality improvement in their work-hour schedule (p < 0.001). Only 16.7% reported time designated for quality improvement in their own work hours. When time was designated, 86.6% of the physicians reported participation in quality improvement, compared to 63.7% when time was not specially designated.ConclusionsThis study shows that physicians want to participate in quality improvement, but only a few have designated time to allow continuous involvement. Physicians with designated time participate significantly more. Future quality programs should involve physicians more actively by explicitly designating their time to participate in quality improvement work. We need further studies to explore why managers do not facilitate physicians´ participation in quality improvement.

Familial hypercholesterolemia. Perspectives on FH registry systems

Familial Hypercholesterolemia (FH) is a genetic cause of premature Cardiovascular Disease (CVD) which is the leading cause of morbidity and mortality worldwide. In Greece, it is estimated that 90% of patients remain undiagnosed. Patients with FH are at high risk for cardiovascular events, peripheral arterial disease, stroke and death at a young age. Therefore, early detection of these is important for the implementation of appropriate preventive measures. Patient medical records are a powerful tool for recording and monitoring the disease and promoting clinical practices, thus helping to improve outcomes and reduce the cost of healthcare. Simultaneously with the registers, patient-centered management, multidisciplinary teamwork, involvement of primary care physicians, patient networks and support teams are required. Of most importance is the Greek online register system of people with familial hypercholesterolemia, by the Hellenic Atherosclerosis Society in collaboration with major hospital centers and the Hellenic College of Atherosclerosis Treatment registration system in the community. The purpose is to find people who are suffering from FH, to diagnose, to educate them and to put them under treatment and follow-up. In conclusion, effective care of patients with dyslipidemia requires: a) detailed evaluation of medical history, b) clinical and laboratory tests, and c) patient education programs regarding lifestyle changes and disease management. The above strategies of care will help reduce time and cost of medical treatment, obtain better clinical outcome and improve patients’ quality of life.

Descriptive Analysis of Clinical Encounters by Emergency Medical Services Physicians Using the RE-AIM Framework.

Emergency medical services (EMS) medicine continues to expand and mature as a recognized subspeciality within emergency medicine. In the United States, EMS physicians historically supported training, protocol development, and EMS clinician credentialing. In the past, only limited programs existed in which prehospital physicians were engaged in the direct and routine care of prehospital patients; however, a growing number of EMS programs are recognizing the value and impact of direct EMS physician involvement in prehospital patient care. A large suburban, volunteer-based EMS agency implemented a volunteer prehospital physician program where providers routinely responded to emergency calls for service. Beginning in November 2019, a cadre of board-certified physicians completed a field preceptorship and local protocol orientation. Once complete, the physicians were released to function and respond independently to high acuity emergency calls or any call at their discretion. Prehospital physicians were authorized to utilize their full scope of practice and expected to provide field mentorship to traditional prehospital clinicians. This study systematically evaluated a prehospital physician program for public health relevance, sustainability, and population health impact using the RE-AIM framework. A retrospective descriptive analysis was performed on the role and responses by a cohort of prehospital physicians using dispatch data and electronic medical records. Over the 17-month study period, 9 prehospital physicians responded to 482 calls, predominately cardiac arrests, traumatic injuries, and cardiac/chest pain. The physicians performed 99 procedures and administered 113 medications. Ultimately, the program added physician-level care to the prehospital setting in an ongoing and sustainable way. The routine placement of physicians in the prehospital environment can help benefit patients by enhancing access to advanced clinical knowledge and skills, while also benefiting EMS clinicians through opportunities for enhanced patient-side training, education, and medical control.

Strategies for enabling physician leadership and involvement in quality improvement: a scoping review

Background: The importance of physician advocacy and leadership in quality improvement (QI) in health care is well recognized, but achieving physician involvement is challenging. The purpose of this scoping review was to describe strategies used in physician-led QI models/approaches that include learning about the science of improvement and may enable physician QI capability, participation, and leadership. Methods: Articles were identified through electronic searches of MEDLINE, Embase, CINAHL, and Scopus, and reference lists were reviewed. For each model/approach, descriptions of strategies were extracted and the frequency of each strategy was determined. Thematic analysis was conducted. Results: Eleven articles representing nine unique models/approaches were included. From these, 20 enabler strategies were identified, and eight themes emerged: dedicated support staff; operational alignment and leader support; evidence-informed care; sharing QI to encourage QI; financial investment; formal QI leader role and responsibility; physician mentorship; and QI capability. No model/approach included all the strategies, and the number of strategies aligned with each theme varied. Heterogeneity in reporting physician-led QI approaches and broad use of the term “physician-led” increased search complexity. Conclusion: Comprehensive models/approaches that encourage physicians to participate in and lead QI while learning the science of improvement have not yet been developed. Research on physician QI participation and strategy evaluation, including effectiveness, is required. This review offers a road map of enabler strategies that can be used to support future models.

Unterschiede zwischen Rettungsdiensteinsätzen mit und ohne Patiententransport

ZusammenfassungHintergrundDie Inanspruchnahme des Rettungsdienstes in Bayern steigt seit Jahren an. Wir haben die Hypothese aufgestellt, dass Notfalleinsätze ohne Patiententransport (RoT) häufig Ausdruck einer unzureichenden Alarmierungsplanung sind. Das Ziel der Studie war es, für solche Einsätze die Unterschiede zwischen den Integrierten Leitstellen (ILS) in Bezug auf die Merkmale Transportquoten und Spannweiten nach Einsatzgrund sowie Uhrzeiten und Wochentage zu beschreiben.MethodeRetrospektive Querschnittstudie der Daten aller 26 ILS des Freistaats Bayern im Jahr 2018. Transportquoten für wesentliche Einsatzgründe bei Notfalleinsätzen ohne Notarztbeteiligung wurden in Abhängigkeit von Leitstellenbereich, Tageszeit und Wochentag vergleichend analysiert. Einsätze wurden kategorisiert als RoT oder TP (Rettungswageneinsatz mit Transport).ErgebnisseVon 510.145 Einsätzen waren 147.621 (28,9 %) RoT und 362.524 (71,1 %) TP. Für alle untersuchten Einsatzgründe zeigten sich deutliche regionale Unterschiede in der Transportquote. Die höchste Spannweite unter den ILS ergab sich für die Einsatzgründe „Brandmeldeanlage“ (16,8 Prozentpunkte), „Hausnotruf aktiver Alarm“ (16,1) sowie „Herz/Kreislauf“ (14,6). In den Morgenstunden sinkt das Einsatzaufkommen bei steigenden TP. Die wenigsten RoT fanden zwischen 8 und 10 Uhr statt. Die Analyse der Wochentage ergab kleine Unterschiede in der Häufigkeit von RoT an Montagen sowie an Wochenenden ohne planerische Relevanz.SchlussfolgerungWir haben deutliche Unterschiede in den Spannweiten festgestellt. Dies könnte auf örtlich unterschiedliche Alarmierungsplanungsvorgaben oder Dispositionsentscheidungen der ILS hindeuten. Die Leitstellen weisen hier wahrscheinlich ein erhebliches Potenzial zur Steuerung und Verbesserung der Ressourcenallokation auf.

Toward a comparative history of medical genetics as a medical specialty in North America.

Much of what has been written about the history of medical genetics in North America has focused on physician involvement in eugenics and the transition from heredity counseling to genetic counseling in the United States. What are typically missing in these accounts are details concerning the formation of a new medical specialty, i.e., medical genetics, and Canada's involvement in specialty formation. Accordingly, this paper begins to fill in gaps by investigating, on the one hand, the history of American and Canadian geneticists working together to support the creation of examining and teaching positions in human genetics in North American medical schools and, on the other, working independently of one another to monitor the rate and direction of workloads and patient access to local genetic counseling and laboratory services and, subsequently, achieve recognition for medical genetics as a medical specialty at the national level.

Impact of Faculty Training in Health Systems Science on Scholarly Presentation of Resident Physician and Fellow Quality Improvement Projects.

The objective was to evaluate whether faculty participation in a Health Systems Science training program was associated with increased presentation and publication of quality improvement (QI) projects involving resident physicians and fellows at 1 institution. The authors evaluated annual, department-level counts of QI projects with resident physician or fellow involvement, presented locally or published, according to residency or fellowship program director and faculty participation in Teachers of Quality Academy. Ten clinical departments had 82 presentations and 2 publications. Each additional faculty member's participation in Teachers of Quality Academy increased the annual count of published or presented QI projects by 9% (P < 0.001). At this institution, participation in a Health Systems Science training program among clinical faculty improved engagement of resident physicians and fellows in local presentation of QI projects.

Evaluating Information About Osteochondritis Dissecans Shared Across Social Media Platforms.

With the rise of social media, patients are using a variety of online resources to gather information about medical conditions and connect with others for support. Osteochondritis dissecans (OCD) occurs most commonly among children and adolescents, necessitating early diagnosis and management. The purpose of this study is to evaluate content on social media about OCD to quantify the reach of information shared and themes of discussion surrounding this condition. A search was performed across Facebook, Instagram, YouTube, and TikTok using the term "osteochondritis dissecans" to identify information shared related to this topic which was then analyzed based on engagement using number of followers, posts, and/or views. Facebook groups provided a forum for online support and information sharing among patients with OCD and their families. The 4 identified groups had a cumulative following of over 4000 people with posts that shared personal recovery stories, solicited treatment advice, and provided updates on patient progress. Review of related Instagram hashtags revealed over 4500 posts, many of which shared personal accounts of living with OCD. The top 5 most viewed YouTube videos collectively had over 189,000 views and were focused on educational information about OCD, relevant surgical techniques, and pertinent anatomy. The top 3 OCD-related TikTok hashtags had over 4 million total views centered on factual knowledge and sharing changes before and after surgical treatment. Patients with OCD and their families seek information about their condition and treatment on online sources including social media. Although social media provides a supportive community to share and receive advice, the quality of information shared in these groups is a subject for concern. Increasing physician involvement and awareness of the information shared across social media platforms may improve accuracy of information and content available to patients. It is important for physicians treating patients with OCD to be aware of all sources of information and support, including content shared on social media as these platforms allow for the sharing of personal stories, recommendations for treatment, and educational content.

Reach in a pragmatic hypertension trial: A critical RE-AIM component

BackgroundHypertension control is falling in the US yet efficacious interventions exist. Poor patient reach has limited the ability of pragmatic trials to demonstrate effectiveness. This paper uses quantitative and qualitative data to understand factors influencing reach in Hyperlink 3, a pragmatic hypertension trial testing an efficacious pharmacist-led Telehealth Care intervention in comparison to a physician-led Clinic-based Care intervention. Referrals to both interventions were ordered by physicians. MethodsA sequential-explanatory mixed methods approach was used to understand barriers and facilitators to reach. Reach was assessed quantitatively using EHR data, defined as the proportion of eligible patients attending intended follow-up hypertension care and qualitatively, via semi-structured interviews with patients who were and were not reached. Quantitative data were analyzed using descriptive and inferential statistics. Qualitative data were analyzed via combined deductive and inductive content analysis. ResultsOf those eligible, 27% of Clinic-based (n = 532/1945) and 21% of Telehealth patients (n = 385/1849) were reached. In both arms, the largest drop was between physician-signed orders and patients attending initial intended follow-up care. Qualitative analyses uncovered patient barriers related to motivation, capability, and opportunity to attend follow-up care. ConclusionsAlthough the proportion of eligible patients with signed orders was high in both arms, the proportion ultimately reached was lower. Patients described barriers related to the influence of one's own personal beliefs or priorities, decision making processes, logistics, and patient perceptions on physician involvement on reach. Addressing these barriers in the design of pragmatic interventions is critical for future effectiveness.Trial Registration: NCT02996565

ABOUT CONNECTION AUTOIMMUNE THYROIDITIS WITH MANIFESTATION OF IRON DEFICIENCY ANEMIA IN A CONDITION OF HYPOTHYROIDISM IN GENERAL CLINICAL PRACTICE. CLINICAL CASE

Summary: Anemia is a global public health problem that needs to be identified. When determining the algorithms for examination and treatment of anemic syndrome, it is necessary to carefully study the risk factors for its development, taking into account comorbidity. Carrying out of diagnostic search in several directions will allow to specify mechanisms of development of an anemic syndrome which at a combination worsen a clinical condition.&#x0D; Special attention should be paid to patients with manifestations of anemic syndrome on the background of endocrine pathology, namely autoimmune thyroiditis in hypothyroidism, as the incidence rate among women of childbearing age has increased significantly, which determines the direction of research and aim of this publication.&#x0D; The article presents a clinical case of observation and treatment of a patient with chronic autoimmune thyroiditis in a state of hypothyroidism and adenomyosis, accompanied by abnormal uterine bleeding, which was complicated by iron deficiency anemia. Because the patient initially considered uterine bleeding to be the main problem, she was observed by a gynecologist; at the same time changes of indicators of the general analysis of blood in favor of anemia are established. Treatment of endometriosis and the appointment of iron supplements led to improvement with the normalization of laboratory parameters. For 6 months the patient did not consult a doctor, no laboratory control was performed. If she felt worse, the patient consulted a family doctor. Careful examination with the involvement of an endocrinologist allowed to diagnose chronic autoimmune thyroiditis in a state of hypothyroidism and prescribe adequate therapy, which helped to normalize the patient's condition.&#x0D; Conclusion. Manifestations of anemic syndrome require determining the causes of its occurrence with the development of algorithms for examination and monitoring of treatment. The general practice physician should be the main coordinator in studying the causes of anemia and the management of patients in the outpatient phase with the involvement of physicians of other specialties.

Effect of outpatient physician involvement on the physician orders for life-sustaining treatment completed by hospitalists: a cross-sectional study.

Hospitalists are becoming increasingly involved in end-of-life (EOL) care decision making. They participate in the completion of physician orders for life-sustaining treatment (POLST) for patients who have not yet decided whether to proceed with life-sustaining treatment (LST) at the EOL. However, hospitalists are not physicians who have continuously treated patients in outpatient settings; hence, the continuity of care may be poor. We aimed to analyze the effect of outpatient physician involvement on the POLST completed by hospitalists. A retrospective cohort study was conducted in patients aged 18 years or older treated by hospitalists who completed POLST at Seoul National University Bundang Hospital from February 2018 to March 2020. The clinical and sociodemographic data were obtained through a medical chart review, and the differences in the characteristics of POLST were analyzed depending on the status of outpatient physician involvement. A total of 3,533 POLST forms were written, of which 175 (5.22%) were completed by the hospitalists. The proportion of POLSTs completed by hospitalists gradually increased from 2.53% in 2018 to 4.58% in 2019 and 15.9% in 2020. A total of 144 (82.3%) patients had malignancies, while 31 (17.7%) patients had non-cancer illnesses. In 47.4% of the patients, outpatient physicians were involved in completing physician's orders for LST. When the outpatient physicians were involved, more patients signed the POLST form themselves (P=0.02) and chose comfort measures only when asked to determine their preferred LST type (P=0.00). The completion of POLST by hospitalists is gradually increasing. LST was reduced when the outpatient physicians participated in the completion of POLST. Using measures to increase the involvement of outpatient providers in goal care discussions, the quality and goal concordance of EOL care can be improved.