Physicians Research Articles

Multi-label semantic segmentation of magnetic resonance images of the prostate gland

Prostate segmentation is a substantial factor in the diagnostic pathway of suspicious prostate lesions. Medical doctors are assisted by computer-aided detection and diagnosis systems systems and methods derived from artificial intelligence deep learning-based systems have to be trained on existing data. Especially freely available labeled prostate magnetic resonance imaging data is rare. With regard to this problem, we show a method to combine two existing small datasets to form a bigger one. We present a data processing pipeline consisting of a cascaded network architecture that is able to perform multi-label semantic segmentation, hence, capable of classifying each pixel in a T2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\ extrm{T}_{2}$$\\end{document}-weighted image not only to one class but to a subset of the prostate zones and classes of interest. This delivers richer information such as overlapping zones that are key to medical radiological examination. Additionally, we describe how to integrate expert knowledge in our deep learning system. To increase data variety for training and evaluation we use image augmentation on our two datasets—a freely available dataset and our new open-source dataset. To combine the datasets we denoise the contourings in our dataset by using an effective yet simple algorithm based on standard computer vision methods only. The performance of the presented methodology is compared and evaluated using the dice score metric and 5-fold cross-validation on all datasets. Although we trained on tiny datasets our method achieves excellent segmentation quality and is even able to detect prostate cancer. Our method to combine the two datasets reduces segmentation errors and increases data variety. The proposed architecture significantly improves performance by including expert knowledge via feature-map concatenation. On the initiative for collaborative computer vision benchmarking dataset we achieve on average dice scores of approximately 91% for the whole prostate gland, 67% for the peripheral zone and 75% for the prostate central gland. We find that image augmentation except contrast limited adaptive histogram equalisation did not have much influence on the segmentation quality. Derived and enhanced from existing methods we present an approach that is able to deliver multi-label semantic segmentation results for prostate magnetic resonance imaging. This approach is simple and could be applied to other applications of deep learning as well. It improves the segmentation results by a large margin. Once tweaked to the data, our denoising and combination algorithm delivers robust and accurate results even on data with segmentation errors.

A-184 Evidence-based Test Utilization: Test Ordering Patterns in Functional Medicine and Community Clinics, and Implications for Laboratory Stewardship

Abstract Background Functional Medicine Physicians (FMPs) use a holistic approach to identify and address “the root cause of a disease”. These physicians routinely order laboratory tests that are not supported by clinical suspicion and practice guidelines (i.e., Centers for Disease Control and Prevention Laboratory Medicine Best Practices, and local diagnostic algorithms) and are unnecessarily duplicative, with inappropriate testing patterns. Ordering unnecessary tests does not improve diagnosis; indeed, 5% of disease-free patients falsely test positive for a given diagnostic test. Test overutilization increases the rate of false positives, leading to unnecessary medical follow-ups, compromised patient care, and financial constraints on the healthcare system. The objective of this study is to: 1) Compare test ordering patterns between FMPs and General Practitioners (GPs) to identify disparities and opportunities for laboratory stewardship improvements. 2) Analyze the potential factors impacting test utilization in areas served by FMPs, 3) investigate the proper approach to improve test utilization. Methods Using our laboratory’s information system, we conducted a retrospective study spanning from January 2022 to December 2022 to assess testing patterns by 15 FMPs in Southern Alberta, comparing them to those of randomly selected community GPs within the same geographical region. A query was executed to retrieve data on the top 50 chemistry tests ordered by functional medicine clinics and community clinics. These tests were further categorized into six groups: general chemistry, endocrinology, immunology, trace elements, toxic metals, and vitamins. Data analysis included determining the geographical locations of functional medicine clinics and assessing the socioeconomic status of their patient populations. Additionally, the percentage of abnormal test results were calculated for both functional medicine clinic and community clinics. Furthermore, the average cost of tests per patient, per physician, and per clinic was computed to evaluate the financial implications of testing practices. Results Our preliminary results showed significant variability in test ordering practices among FMPs, with potential implications for patient care and healthcare costs. Most tests ordered by FMPs were normal (94%), suggesting a need for further scrutiny regarding the necessity and appropriateness of these tests. A notable trend observed was the disproportionate preference of FMPs for expensive tests, including hormones, vitamins, and toxic metals. Our analysis reveals that the cost per reportable test from FMPs was four times higher compared to the tests ordered by GPs. Furthermore, on average, functional medicine clinics in urban areas ordered around 60% more tests annually compared to their rural counterparts. Conclusions Our preliminary findings clearly show a need to monitor the testing behavior more carefully by the functional medicine clinics. The data from this study will be shared with the physicians practicing functional medicine in Alberta. Strategies to improve the test utilization and patient care include educating the functional medicine doctors and provincial healthcare authorities about the appropriate test utilization and the impact of inappropriate use of lab on patient care. In addition, using algorithms for test ordering will be used if the pattern of inappropriate testing continues.

An Empirical Correlation Between Work Stress and Occupational Performance Among Medical Practitioners: A Case Study

The modern age of professional competition and the post-COVID-19 situation led to the birth of stressful life. The lifestyle of medical practitioners becomes hectic and disturbing, affecting not only their profession but also their personal lives. This study identifies the factors like Role Overload & Responsibility (ROR), Lifestyle Variations (LV), Family Disruptions (FD), and Stringent Working Conditions (SWC) affecting the occupational performance of doctors. This was exploratory research that identified and validated antecedent work stress factors for the occupational performance of medical professionals in the national capital region. The factors were measured through a self-adapted questionnaire based on the five-point Likert scale. The validation of the factors was verified through the hypothesized model by using structural equation modeling (SEM) on their occupational performance. The study identifies that ROR and SWC affect the National Capital Region (NCR) medical practitioners' occupational performance. Moreover, this study has specific implications for medical professionals and provides the theoretical and practical basis for health issues during the job that severely impacts the employees' personal and professional lives. This study decodes the work stress buster factors that manipulated the effective occupational performance of the employees.

Health care providers' perceptions of burnout and moral distress during the COVID-19 pandemic: A qualitative study from Saskatchewan, Canada.

This study sought to describe feelings and perceptions of burnout and moral distress experienced by health care providers in the Canadian province of Saskatchewan during the COVID-19 pandemic. This study was part of a larger mixed methods project, and we here report on the qualitative results relating to burnout and moral distress experienced by medical doctors, registered nurses and respiratory therapists. We used an exploratory, qualitative descriptive design involving one-one-one interviews with 24 health care providers. Interview data were analysed using a reflexive thematic analysis approach. We identified three overarching themes each for health care provider burnout and moral distress. Interviews revealed that providers experienced burnout through (i) increased expectations and (ii) unfavourable work environments, which led most of them to recognise (iii) a need to step back. Regarding moral distress, key themes were: (i) a sense of compromised care, (ii) feelings of bumping heads with authorities and patient families, and (iii) seeing patients make difficult decisions. Our study found that medical doctors, registered nurses and respiratory therapists working during the COVID-19 pandemic experienced and continue to experience significant burnout and moral distress. This was often driven by both institution- and system-level factors. There is a need for sustained investment to build and support a motivated health care workforce to prepare for future pandemics and health emergencies.

Bioactive Compounds in Phyllanthus Amarus Leaf Extract and its Toxicity in the Treatment of Newcastle Disease

Background: Using extracts from medicinal plants to cure sicknesses and enfeebling diseases remains a major practice for traditional healers and medical practitioners. This research aimed to elucidate the significance and potential composition of n-Hexane extract of Phyllanthus amarus leaf and also establish its safety for use in potential medicinal preparations. Methods: Bioactive compounds from an extract of Phyllanthus amarus leaf were used in the treatment of Newcastle Disease (ND) in broiler chickens. It was characterised using gas chromatography-mass spectrometry (GCMS) and its biosafety effect on selected biochemical markers in chickens was observed. Results: The results showed the presence of over 15 bioactive compounds including phytol, phenol, and vitamin E. The constituents did not have a toxic effect on the selected biochemical markers of the chickens. Conclusion: This study demonstrated that Phyllanthus amarus may be considered safe and contains numerous active constituents which could be further explored for probable novel drugs sourced from natural plants for the treatment of animal or human diseases.

Scalpel and strife: Assessing the impact of Sudan's ongoing civil war on surgical practice and healthcare delivery

BackgroundThis study aims to shed light on the profound ramifications of the military conflict that started in April 2023 on surgical practice in Sudan. MethodsThis is a survey-based study. The survey link was disseminated to Sudanese medical practitioners via various social media (WhatsApp, Telegram, X (previously twitter) and Facebook) channels. We included only responses from medical practitioners working in the surgical specialities. ResultsA total of 90 responses have been collected. All participants were working in surgical service provision institutes. Sixty per cent of the responses were from the age group 25–35 years old, and two-thirds of the total cohort either left Sudan or was internally displaced because of the conflict. Moreover, 51% are no longer practising because they had to flee the conflict area (75%) or because the hospital is out of service (20%). There was a significant drop in the average number of emergency and elective lists. ConclusionThe military conflict affected Sudan's already strained health system. There was a significant drop in the average number of emergency and elective lists with surgeons out of practice because they had to flee the conflict area and hospitals were out of service.

A Retrospective Analysis of 190 Patients With Scoliosis Referred to a Private Australian Clinical Advisory Service Between 2017 and 2020

ObjectiveThe aim of this study was to describe the demographic and clinical characteristics of patients with scoliosis from Australian primary care practices. MethodsA retrospective review of 190 patient records from August 2017 to April 2020 from a private Australian clinical advisory service database was performed. Deidentified demographic and clinical data were collated and analyzed, along with information regarding the referring practitioners and any accompanying clinical or paraclinical information. Numerical data were summarized with median and IQR, while categorical data were summarized with counts and percentages. Salient qualitative data from the advisory service records were also collated, coded, and summarized. ResultsPatients were aged between 3 and 87 years; the majority (71%) of patients were female, with a median age of 16 years (IQR, 13; range, 3-87 years). The most common type of spinal deformity seen in the sample was scoliosis (92%), with hyperkyphosis (7%) and other deformity (1%) making up the remaining cases. There was a wide variety of scoliosis presentations; however, curves were commonly (45%) located in the thoracic region of the spine. Observed scoliosis cases were of moderate severity with a median Cobb angle measuring 26.5° (IQR, 20°). Reports of pain were in the lower trunk/pelvis (46%), the middle trunk (16%), or throughout multiple bodily regions (27%). Alterations in normal spinal anatomy (eg, hemivertebrae) were common (55% of cases). The majority (86%) of patient cases came from chiropractors, whereas 9% were from osteopaths, 4% from physiotherapists, and 1% from other types of practitioners (eg, medical practitioners). ConclusionThe findings from this study suggest that patients presenting to practitioners in primary care settings in Australia present with a range of scoliosis and related spinal deformity presentations.

Projected health workforce requirements and shortage for addressing the disease burden in the WHO Africa Region, 2022–2030: a needs-based modelling study

IntroductionAn adequate health workforce (HWF) is essential to achieving the targets of the Sustainable Development Goals (SDG), including universal health coverage. However, weak HWF planning and constrained fiscal space for...

Evaluating ExpandED: Evaluating the effectiveness of a serious game expansion pack in teaching health professional students about interprofessional care.

The emergency department (ED) is a challenging fast-paced environment with high-acuity, undifferentiated patients who often require extensive interdisciplinary care. This paper introduces ExpandED, an expansion pack to the serious board game GridlockED, designed to enhance players' understanding of interprofessional collaboration in the ED and the diverse scope of practice of different ED professionals including physicians, residents, registered nurses, registered practical nurses, social workers, occupational therapists, and physiotherapists. This investigation evaluates the effectiveness of ExpandED as a teaching tool for medical and allied health professions students about interprofessional collaboration in the ED. A program evaluation harnessing a playtest framework was employed. Participants completed pre- and postgame surveys including quantitative measures (e.g., Likert scales) and qualitative free-text feedback that focused on participant familiarity with ED functioning, valuation of interprofessional collaboration before and after playing, and feedback on game usability and effectiveness. Recruitment was open to students in all health care and allied health professional programs at the institution. Forty-five participants were recruited from medical doctor, nursing, physiotherapy, and speech language pathology programs. ExpandED enhances participants' understanding of ED workflow (p < 0.001) and provides an enjoyable playing experience. However, participants' valuation of interdisciplinary teamwork did not change significantly before and after game play (p = 0.17). Participants expressed satisfaction with the game's accuracy in simulating the ED environment and appreciated the opportunity to collaborate with peers from different disciplines. Challenges reported included some tension among players, potential biases, and limitations of fidelity to a real-life ED. While this study has limitations regarding participant sampling and duration of gameplay sessions, it highlights the potential of ExpandED for teaching interprofessional collaboration in the ED. These findings will guide further development to optimize the expansion pack's effectiveness and its implementation into health care curricula.

Telemetry discontinuation education for Nurse Practitioners decreases hospital costs-A quality-improvement project.

Despite updated American Heart Association guidelines, interventions designed to reduce telemetry misuse are uncommon. There was a systemic failure within the institution to adopt the most recent guidelines, resulting in poor use of resources and downstream costs. Case-control. Pre-post educational intervention, quality-improvement (QI) project in an urban academic cancer institution. Baseline telemetry usage was observed in 2,984 nonintensive inpatients in 21 hospital services over 6 months. Outcome measures were weekly telemetry usage in total minutes and cost savings based on a cost-predicted algorithm. Performance was compared between the intervention group and a control group for 3 months. Measures were compared using QI control charts and inferential statistics. Three high-using telemetry services primarily staffed by certified nurse practitioners (CNPs) were provided with a telemetry education intervention. The intervention consisted of four ten-minute educational sessions over 2 weeks delivered to the highest three telemetry using services. Forty-five providers received the educational intervention (78% CNPs and physician assistants [PAs] and 22% medical doctors [MDs]) and 272 did not (57% CNPs and PAs and 43% MDs). Only the educational intervention group showed measurable decreases shown by shifts in QI control charts. Decreased usage in the intervention group produced greater cost savings per patient when compared with the control group ($71.98 vs. $60.68), resulting in an estimated total annual cost savings of $94,740. Educational interventions for inpatient CNPs that reinforce national policies for telemetry discontinuation improve practice efficiency and potentially decrease health care costs.

Biomedical waste management among healthcare workers in a Primary Health Centre in Sikkim, India—A KAP study

BACKGROUND: “Biomedical waste (BMW) is the waste generated during the diagnosis, treatment or immunization of human beings or animals or research activities pertaining thereto or in the production or testing of biologicals” (Management and Handling Rules, 1998 of India). As it is a source of dangerous diseases, the handlers need to have adequate knowledge about the same. MATERIALS AND METHODS: This study assessed the knowledge, attitude, and practice of biomedical waste management among healthcare workers in a Primary Health Centre and tested the association between KAP and selected variables. For this study, one PHC among six in Sikkim was purposively selected and all health providers attached with the PHC were assessed for KAP toward BMW Management. Data was summarized using SPSS version 27. Pearson’s Chi-square test (or Fisher’s exact test) was applied to find the association between KAP and selected variables (P &lt; 0.05 was considered significant). Bivariate and multivariate logistic regression analysis was performed for the significant variables. RESULTS: The mean age of the study participants ranged from 36.42 ± 8.983 years. 66%, 66%, and 60% of healthcare workers had adequate knowledge scores, favorable attitude scores, and good practice scores in BMWM, respectively. CONCLUSION: A knowledge gap was observed among the supportive medical staff as there was a lack of formal training in BMWM. Training of not only medical officers but also for waste handlers should be conducted at the time of appointment as well as refresher trainings should be done for the overall health and safety of all waste handlers.

Geographical Distribution and Trends Analysis of Osteopathic General Surgery Residents.

In recent years, the number of Doctor of Osteopathic Medicine (DO) residents entering general surgery has increased. As DOs continue to solidify their role within the surgical domain, understanding their distribution, preferences, and the dynamics of their integration into residency programs becomes crucial for general surgery applicants. Publicly available data were gathered for each DO general surgery resident from residency programs across the nation, including details such as post-graduate year, degrees held, and residency program location. A comprehensive cross-sectional analysis was conducted to determine the geographical distribution and match trends of DO residents in these residency programs. Analysis revealed a significant rise in the number of DOs entering general surgery residencies, from 153 DO trainees beginning their residency training in 2019 to 274 DO trainees beginning their residency training in 2024. This upward trend indicates a growing presence of DOs in surgical practice. Examination of the geographical locations of programs for which DO applicants have matched showed variations nationwide. This analysis allows for a deeper understanding of the evolving match trends for DOs in surgery. It highlights the importance of addressing disparities in access to surgical training opportunities for osteopathic physicians nationwide.

Normothermic Regional Perfusion Experience of Organ Procurement Organizations in the US

Despite the unmet need for donor organs, organ use from donation after circulatory determination of death (DCD) donors has been limited by inferior transplant outcomes. Normothermic regional perfusion (NRP) improves recipient outcomes and organ utilization from DCD donors. There is variability in NRP policies and experience among US organ procurement organizations (OPOs). To determine OPO experience, identify operational inconsistencies, and explore needs related to NRP. This survey study included 55 OPOs in the US that had recovered DCD organs and completed a survey on operational, administrative, and educational components related to NRP in November to December 2023. Data analysis was performed from February to April 2024. The primary outcome was the number of OPOs participating in and/or anticipating NRP participation. Secondary outcomes were NRP implementation barriers, OPO education practices, and future needs regarding consensus NRP recommendations and standards. Of 55 respondents, 11 (20%) were chief executive officers, 8 (15%) were chief operating officers, and 36 (65%) were medical directors or chief clinical officers. Forty-nine OPOs facilitated NRP cases: 26 OPOs (53%) facilitated both thoracoabdominal NRP (TA-NRP) and abdominal NRP (A-NRP) cases, 16 OPOs (33%) facilitated only TA-NRP, and 7 OPOs (14%) facilitated only A-NRP. OPOs reported 606 NRP cases (421 TA-NRP [69%], 185 A-NRP [31%]); median (range) case experience was 8 (1-52). Fifty-two of 55 OPOs (95%) thought standardized guidance documents would be helpful. All 49 OPOs facilitated NRP at a transplant center's request; 39 (80%) had NRP initiated by a nonlocal transplant center. Twenty-three of 49 OPOs (47%) participated in NRP without a policy and without a policy pending approval. Positive donor hospital feedback was received by 29 OPOs (59%), primarily focused on increased organs transplanted and prerecovery communication. Allocation challenges were experienced by 21 OPOs (43%); their median (range) case volume was higher than those with no reported allocation challenges (11 [3-52] vs 6.5 [1-29]; P = .03). Eleven OPOs (22%) had incorporated NRP into general donor hospital education. In this survey study of US OPOs, wide variation existed with respect to NRP experience and practice. Allocation challenges occurred more frequently with increased NRP experience. NRP guidelines and standardization were desired by most OPOs to decrease allocation challenges and maximize the gift of organ donation.

Bullying within specialist medical training in Australia: Analysis of the medical training survey, 2020-2023.

Bullying is common in medical specialist training in Australia. To understand bullying rates across medical specialist training programs, we analyse the recent Medical Training Survey, administered by the Medical Board of Australia to all registered medical practitioners. Medical Training Survey data were extracted and averaged from 2020 to 2023. Many speciality trainees reported personally experiencing or witnessing bullying. This was lowest in general practice (13% personally experienced and 15% witnessed) and highest in obstetrics and gynaecology (27% and 41%). The highest rate of bullying by supervisors was in surgery: 60% of surgical trainees stated that when they were bullied it was by their supervisor. Within psychiatry, 22% of trainees had personally experienced bullying and 32% of trainees had witnessed bullying. When they were bullied, the perpetrator was less commonly a supervisor (40%). In all specialities, there was a very low percentage of bullying which was reported, and was identified as having a satisfactory outcome: the most satisfactory outcomes (13%) were in general practice. Current rates of bullying for medical specialist trainees, the reluctance to report, as well as the lack of satisfactory outcomes, is of grave concern for Australian healthcare. This requires urgent attention at a systems level.

Efficacy of urokinase in maintaining patency of hemodialysis catheters: Ameta-analysis.

Catheter malfunctions are associated with reduced blood flow and interrupted dialysis during hemodialysis. This meta-analysis aimed to determine whether the use of urokinase to lock hemodialysis catheters can maintain their patency and prevent catheter-related bloodstream infections (CRBSIs). The PubMed, Cochrane Library, Web of Science, Embase, and Chinese medical databases were searched for controlled trials of hemodialysis catheter locking using urokinase from database inception until July 15, 2021. The primary outcome was catheter malfunction, and the secondary outcomes were the peak catheter blood flow rate (Qb) and CRBSIs. Across 16 trials, 1,041 patients were randomized to receive either urokinase/urokinase mixture (treated) or heparin (control) locks once or thrice a week. Locking with urokinase alone or in combination with another substance significantly prevented catheter malfunction. The effect on Qb was significant, with that in the treated group being better than in the control group. Similarly, the incidence of CRBSIs in the treated group was lower. Urokinase locking maintains catheter patency more effectively than heparin. Prophylactic locking with urokinase or urokinase mixtures reduces incidences of catheter malfunction, which ensures the smooth progression of hemodialysis and reduces patient medical costs. The results of this study have important clinical implications and will provide guidance to medical practitioners globally.

Health and healthcare use of homeless population: Evaluation study of joint social work and healthcare provision

BackgroundHomelessness as an extreme form of poverty perpetuates and exacerbates health inequalities. People experiencing homelessness face a mortality rate 10 times higher than that of the general population, with an average age of death at 45. There is a significant disconnect between the mainstream healthcare system and the specific health needs of people experiencing homelessness, leading to substantial human and economic costs. ObjectiveThe objective of this evaluation study is to assess the impact of an intervention in nurse-led healthcare outreach services to people experiencing homelessness on their utilization of healthcare services. DesignThis study is a part of research program aimed at assuring health equity of most vulnerable members of a society. Detailed understanding of barriers to care is a necessary precondition for improvements in healthcare use. DataThe study analyzes data on hospitalization and emergency department visits by people experiencing homelessness across three cities in Czechia from 2014 to 2021. MethodsA quantitative difference-in-differences approach is complemented by insights from field studies in these three cities. ResultsThe intervention in people experiencing homelessness outreach led to a reduction in both hospital admissions and the emergency visits by people experiencing homelessness, alleviating pressure on health service capacity and reducing associated healthcare costs. Enhanced primary nurse-led healthcare outreach, along with cross-sectoral integration and activation, has lowered the barriers to accessing essential healthcare services. ConclusionA pivotal policy outcome of this study is the establishment of an insurance provision that allows medical doctors to claim additional costs incurred in treating people experiencing homelessness from a public insurance system.

WISE: Efficient WSI Selection for Active Learning in Histopathology

Deep neural network (DNN) models have been applied to a wide variety of medical image analysis tasks, often with the successful performance outcomes that match those of medical doctors. However, given that even minor errors in a model can impact patients’ life, it is critical that these models are continuously improved. Hence, active learning (AL) has garnered attention as an effective and sustainable strategy for enhancing DNN models for the medical domain. Extant AL research in histopathology has primarily focused on patch datasets derived from whole-slide images (WSIs), a standard form of cancer diagnostic images obtained from a high-resolution scanner. However, this approach has failed to address the selection of WSIs, which can impede the performance improvement of deep learning models and increase the number of WSIs needed to achieve the target performance.This study introduces a WSI-level AL method, termed WSI-informative selection (WISE). WISE is designed to select informative WSIs using a newly formulated WSI-level class distance metric. This method aims to identify diverse and uncertain cases of WSIs, thereby contributing to model performance enhancement. WISE demonstrates state-of-the-art performance across the Colon and Stomach datasets, collected in the real world, as well as the public DigestPath dataset, significantly reducing the required number of WSIs by more than threefold compared to the one-pool dataset setting, which has been dominantly used in the field.

Medical Liability for Omission under the Portuguese Criminal Law: A Critical Eye on Portuguese Jurisprudence

In the Portuguese legal system, criminal liability for omission can be conducted by the legal category that criminalises omission in itself, regardless of the result, or operate by equating omission with action. This is enshrined in section 10 of the Penal Code, as long as the omitting person has a personal legal duty to act as guarantor (section 10, no. 2). In medical criminal liability, the framework for a hypothetical omission by an on-duty doctor in emergency services has been controversial. In our legal system, section 284 of the Penal Code expressly stipulates that a doctor’s refusal to administer care be punishable conduct. On the other hand, it is possible that the doctor on duty in the emergency room of a hospital has a personal legal duty to act as a guarantor, arising from the contract that binds him/her to the hospital. Thus, it is necessary to affirm a subsidiarity relation between the mechanism of equating omission with action resulting from section 10 of the Penal Code and incrimination under section 284 of the Penal Code. However, this has not been the major understanding of the jurisprudence of the Portuguese courts on this subject. For instance, when the refusal of assistance by a doctor causes the death of a patient, instead of convicting the doctor for homicide by omission (section 131 of the Portuguese Penal Code, ex vi section 10, numbers 1 and 2), courts are convicting as per section 284 – refusal of the medical doctor to provide medical assistance. The present work aims to critically present this jurisprudence, state the legal and doctrinal foundations that justify the inclusion of these hypotheses within the scope of crimes committed by omission and point out the practical importance of choosing this solution. Keywords: Omission; Committed by omission; Medical liability; Duty to act as guarantor.

Transforming science communication through storytelling.

Science communication is an important skill. It is easier for nonacademic audiences to remember stories that resonate with their imagination rather than facts and figures. To help early-career researchers develop their skills, the EU-LIFE Science Communications Working Group (SCWG) developed a training course based on the experience from previous workshops held at a research institute in Denmark. The stories crafted in the workshops proved impactful, with some integrated into broader campaigns and featured in science magazines. The initiative holds potential for transformative change, helping researchers promote their findings and increasing awareness of emerging research topics among the public. Recently, the initiative has been customized for a summer school aimed at medical doctors pursuing a PhD, marking a step forward in the SCWG's mission to equip researchers with essential communication skills.

Chinese expert consensus on blood lipid management in patients with diabetes (2024 edition).

Diabetes is a significant independent risk factor for atherosclerotic cardiovascular disease (ASCVD), with dyslipidemia playing a critical role in the initiation and progression of ASCVD in diabetic patients. In China, the current prevalence of dyslipidemia in diabetes is high, but the control rate remains low. Therefore, to enhance lipid management in patients with diabetes, the Endocrinology and Metabolism Physician Branch of the Chinese Medical Doctor Association, in collaboration with the Experts' Committee of the National Society of Cardiometabolic Medicine, has convened experts to develop a consensus on the management of dyslipidemia in patients with type 1 or type 2 diabetes. The development of this consensus is informed by existing practices in lipid management among Chinese diabetic patients, incorporating contemporary evidence-based findings and guidelines from national and international sources. The consensus encompasses lipid profile characteristics, the current epidemiological status of dyslipidemia, ASCVD risk stratification, and lipid management procedures in diabetic patients. For the first time, both low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol have been recommended as primary targets for lipid intervention in diabetic patients. The consensus also includes a summary and recommendations for lipid management strategies in special diabetic populations, including children and adolescents, individuals aged 75 years and older, patients with chronic kidney disease, metabolic-associated fatty liver disease, and those who are pregnant. This comprehensive consensus aims to improve cardiovascular outcomes in diabetic patients by contributing to the dissemination of key clinical advancements and guiding clinical practice.