Medical Judgment Research Articles

Humanizing the Physician-Patient Relationship

Humanizing the Physician-Patient Relationship

Implementation of Combined Machine Learning with the Big Data Model in IoMT Systems for the Prediction of Network Resource Consumption and Improving the Data Delivery.

In recent years, health applications based on the internet of medical things have exploded in popularity in smart cities (IoMT). Many real-time systems help both patients and professionals by allowing remote data access and appropriate responses. The major research problems include making timely medical judgments and efficiently managing massive data utilising IoT-based resources. Furthermore, in many proposed solutions, the dispersed nature of data processing openly raises the risk of information leakage and compromises network integrity. Medical sensors are burdened by such solutions, which reduce the stability of real-time transmission systems. As a result, this study provides a machine-learning approach with SDN-enabled security to forecast network resource usage and enhance sensor data delivery. With a low administration cost, the software define network (SDN) design allows the network to resist dangers among installed sensors. It provides an unsupervised machine learning approach that reduces IoT network communication overheads and uses dynamic measurements to anticipate link status and refines its tactics utilising SDN architecture. Finally, the SDN controller employs a security mechanism to efficiently regulate the consumption of IoT nodes while also protecting them against unidentified events. When the number of nodes and data production rate varies, the suggested approach enhances network speed. As a result, to organise the nodes in a cluster, the suggested model uses an iterative centroid technique. By balancing network demand via durable connections, the multihop transmission technique for routing IoT data improves speed while simultaneously lowering the energy hole problem.

Trust, Brutality, and Human Dignity: How "Partial Birth Abortion" Helps Shape American Biopolitics.

In this Article, I explore how nearly continuous public rhetorical challenges to abortion in the political realm first led the public and the courts to turn away from a particular abortion procedure (intact dilation and extraction, also known as partial-birth abortion) which political agitators labeled as "barbaric" and then to view physicians who performed abortions not as legitimate professionals, but simply as "abortionists," and sometimes as evil "Frankensteins." "Abortionists" use no "medical judgment" and are unworthy of deference by state legislatures, Congress, or the courts when deciding how or when to perform an abortion. The concentration on the welfare of fetuses and the actions of physicians permitted the abortion debate to bypass discussion of both the rights and welfare of pregnant patients, including their right to health, and to virtually never mention that abortion restrictions primarily affect people in poverty who cannot afford to seek reproductive health care, including an abortion, by traveling to a nonrestrictive state. Understanding the power of extreme rhetoric, including the use of social media in political campaigns and the use and misuse of concrete terms such as murder, infanticide, brutality, and dismemberment, and abstract concepts such as "human dignity," can help us plot a post-Dobbs way forward. Perhaps the demise of Roe can lead to a birth of a new rhetoric on abortion, one that concentrates on the right to health of everyone, including the right to make reproductive decisions, and requires moving abortion back into the realm of contemporary medicine, complete with a meaningful doctor-patient relationship protected by privacy and financed in a way that is accessible to all pregnant patients.

A Pilot Study of Modified Mini-Clinical Evaluation Exercises (Mini-CEX) in Rotation Students in the Department of Endocrinology.

BackgroundThe mini-clinical evaluation exercise (mini-CEX) is an excellent tool for assessing the clinical abilities of medical students in intense clinical practice. In this study, the Mini-CEX was adapted to professional questionnaires for Diabetes Mellitus (DM), and examined in medical students completing their clerkship rotation in the department of endocrinology.MethodsFrom January 2021 to January 2022, all rotating medical students at Shanghai Pudong Hospital completed two mini-CEX exams before and following their rotation under the supervision and guidance of six tutors. The mini-CEX form was modified in this study primarily for inpatient management based on our clinical experience and updated DM guidelines of the American Diabetes Association (ADA), the European Association for the Study of Diabetes (EASD), and the Chinese Diabetes Society (CDS). Each component of the mini-CEX assessment, including medical interviews, physical examination, clinical judgment, clinical management, and overall clinical competence was evaluated using a nine-item questionnaire.ResultsOur findings revealed that the second-round performance on the assessments significantly improved, as indicated by higher scores on each component. The Pearson association analysis revealed that the feedback time of the first examination was markedly associated with improved overall scores (r= 0.391, p<0.001). However, no correlations were discovered between patient age, gender, disease severity disparity, or the interval between examinations (p>0.05). Additional regression analysis revealed that the feedback time during the initial examination was the most significant contributor to the increased overall scores (β=0.391, p<0.001).ConclusionThis newly designed mini-CEX form based on current ADA and EASD guidelines may assist trainees in more effectively diagnosing and managing DM in inpatients, particularly those with macrovascular, microvascular, or peripheral nerve neuropathy. This study aims to assess the efficacy of administering a modified mini-CEX form to rotating trainees participating in an endocrine clerkship.

The Making of ADHD: A Comparative Content Analysis of Teachers’ and Doctors’ Worldviews

Abstract Little is known about how teachers and doctors make sense of ADHD. Drawing on a corpus of online accounts, we reconstructed their worldviews with a qualitative analysis. While both professional groups referred to a male troublemaker and to the German literary figure of the Fidgety Phil, they also expressed rival expert claims. Doctors represented the scientific authority in labeling and diagnosing ADHD, whereas teachers attached objective meaning to the medical judgement by pathologizing deviant behavior and justifying measures of control.

Abstract CT248: Design and rationale of a first in human (FIH) phase 1/1b study evaluating KIN-2787, a potent and highly selective pan-RAF inhibitor, in adult patients with BRAF- and NRAS-mutation positive solid tumors

Abstract Background: BRAFV600 alterations (BRAF Class (Cl) I alterations) encode a highly active monomeric oncogenic kinase that can be targeted by approved RAF kinase inhibitors (RAFi) in patients (pts) with melanoma (MEL), NSCLC, colorectal &amp; anaplastic thyroid cancers. Cl II and III represent molecularly distinct BRAF alterations driving dimer-dependent signaling. Cl II alterations include single nucleotide variants (SNVs), indels and gene fusions that induce BRAF homodimer formation, leading to oncogenic kinase activation. Cl III alterations, typically SNVs, are low activity alterations that promote RAF dimerization and RAS-dependent oncogenic MAPK pathway signaling. Approved BRAFi have limited clinical activity in solid tumors driven by BRAF Cl II or III alterations, highlighting the urgency to develop effective targeted therapies for these patients. Combinations of a RAFi and a MEK inhibitor (MEKi) show promising results in early clinical trials. KIN-2787 is a potent, highly selective type II pan-RAFi designed to target both monomeric &amp; dimeric forms of the altered BRAF kinase and minimize paradoxical activation, a liability often observed with other RAFi that can adversely impact tolerability &amp; require addition of a MEKi to suppress pathway activation. KIN-2787 has favorable pharmaceutical properties, achieves substantial systemic exposures in pre-clinical toxicology studies, &amp; induces regressions in human cancer xenograft models driven by BRAF Cl I, II, or III alterations. Combinations of KIN-2787 with a MEKi show promising activity in preclinical models. Methods: This is a FIH, multicenter, non-randomized Ph1 study (NCT04913285) of KIN-2787 in adult pts with BRAF mutant advanced &amp; metastatic solid tumors (AMST). KIN-2787 will be given orally bid continuously in 28-day cycles until drug intolerance or disease progression. Planned sample size is approx. 155 pts in 2 parts: Part A is a dose-escalation to MTD open to pts with AMST driven by either BRAF genomic alterations (Cl I, II or III ) or by NRAS. Part A1 assesses single agent KIN-2787; Part A2 assesses KIN-2787 in combination w/binimetinib. Part B will evaluate a selected dose of KIN-2787 in 3 cohorts of pts (MEL, NSCLC, or other AMST), each driven by BRAF Cl II or III alterations. Standard Ph1 enrollment criteria are required (ECOG PS 0-2, normal organ function, prior receipt of standard treatment or medical judgment that such is not appropriate). Pts may have measurable or evaluable disease. Key exclusion criteria include known active brain metastases, prior BRAF-, MEK-, or MAPK inhibitor therapy (unless for FDA approved indications), HBV/HCV seropositivity. Primary endpoints are safety/tolerability (Part A), and preliminary antitumor activity: objective response rate, disease control rate, duration of response, &amp; duration of stable disease (Part B). Secondary objectives include pharmacokinetic and pharmacodynamic assessments including measures of MAPK signaling inhibition. Enrollment began in August 2022. Trial is open globally. Citation Format: Meredith McKean, Cesar A. Perez, Shumei Kato, Alexander I. Spira, Yan Xing, Hao Xie, Michael Millward, Anthony Olszanski, Ken Kobayashi, Nichol Miller, Paul Severson, Betty Tam, Caro Unger. Design and rationale of a first in human (FIH) phase 1/1b study evaluating KIN-2787, a potent and highly selective pan-RAF inhibitor, in adult patients with BRAF- and NRAS-mutation positive solid tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT248.

The role of stereotypical information on medical judgements for black and white patients

THIS ARTICLE USES WORDS OR LANGUAGE THAT IS CONSIDERED PROFANE, VULGAR, OR OFFENSIVE BY SOME READERS. The new generation of direct-acting antivirals has improved dramatically the rates of cure for chronic hepatitis C. Yet, evidence shows that racial groups are deemed more often ineligible for hepatitis C treatment, despite no clinical evidence supporting differential treatment for Black and White patients. One possible explanation has to do with providers’ racial biases. This investigation sought to explore medical students’ racial stereotypes (Study 1, N = 171) and the role of stereotypical cues on perceptions of medical adherence of Black and White patients (Study 2, N = 208). In Study 1, we first sought to identify health-related aspects that are consistently associated with Blacks as part of a stereotype. In Study 2, we experimentally manipulated racial stereotypes identified in Study 1 by asking participants to read a clinical vignette depicting a patient (Black vs. White) and their medical history (cause of exposure to hepatitis C: unprotected sex vs. non-injectable drugs use). The results show that the impact of stereotypicality on patient perceived compliance varies as a function of medical students’ racial prejudice. Implications for further applied health inequalities research and for medical training are discussed.

Design and rationale of a first-in-human (FIH) phase 1/1b study evaluating KIN-3248, a next-generation, irreversible (irrev), pan-FGFR inhibitor (FGFRi), in adult patients with solid tumors harboring FGFR2 and/or FGFR3 gene alterations (NCT05242822).

TPS9601 Background: FGFR1-4 gene alterations are observed in approximately 7% of all human cancers. There are currently 3 FDA-approved, reversible FGFRi for treatment of patients w/previously treated, locally advanced or metastatic (met) cholangiocarcinoma (CCA) harboring FGFR2 gene fusions/rearrangements (pemigatinib and infigratinib) or met urothelial carcinoma (UC) w/susceptible FGFR2 or FGFR3 genetic alterations (erdafitinib). A major limitation of approved and clinical-stage FGFRi is emergence of secondary, on-target resistance mutations (mutn) that reduce duration of response. Up to 67% of CCA patients treated with either reversible or irrev FGFRi exhibit secondary FGFR2 kinase domain resistance mutn at the time of relapse. KIN-3248 is a next-generation, selective, irrev, small molecule pan-FGFRi, structurally designed to inhibit primary FGFR oncogenic alterations as well as secondary kinase domain mutn associated w/disease progression. Preclinically, KIN-3248 has favorable pharmaceutical properties, is well-tolerated with continuous, daily oral administration in 28d GLP toxicology studies in rats and beagle dogs and is efficacious against primary FGFR2 and FGFR3 oncogenic driver alterations as well as secondary FGFR2 resistance mutn (e.g., gatekeeper and molecular brake) in human cancer cell and PDX models in vitro and in vivo. Methods: This is a FIH, multicenter, non-randomized Ph1 study of KIN-3248 in adult pts with advanced &amp; metastatic solid tumors (AMST) harboring FGFR2 and/or FGFR3 gene alterations. KIN-3248 is given po qd continuously in 28-day cycles until drug intolerance or disease progression. Planned sample size is approx. 120 pts: Part A is a dose-escalation to MTD for pts w/AMST having either FGFR2 and/or FGFR3 alterations. Part A assesses single agent KIN-3248; Part B will evaluate a selected dose of KIN-3248 in 3 cohorts of pts (ICC, UC, or other AMST), each driven by specified FGFR alterations. Standard Ph1 enrollment criteria are required (ECOG PS 0-1, normal organ function, prior receipt of standard treatment or medical judgment that such is not appropriate). Pts may have measurable or evaluable disease. Key exclusion criteria include known active brain metastases and active/uncontrolled HBV/HCV. FGFRi-naïve &amp; -pretreated patients are both eligible. Primary endpoints are safety/tolerability (Part A), and preliminary antitumor activity: objective response rate, disease control rate, duration of response, &amp; duration of stable disease (Part B). Secondary objectives include pharmacokinetic and pharmacodynamic assessments including measures of FGFR pathway modulation. Enrollment is expected to commence in April 2022. Clinical trial information: NCT05242822.

Design Simulation and Assessment of Prediction of Mortality in Intensive Care Unit Using Intelligent Algorithms

Big data in healthcare refers to vast amounts of data generated by the adoption of digital technology that collect patient records and aid in the management of hospital performance, which would otherwise be too large and complex for traditional technologies. We have chosen Mortality Prediction in Hospital ICU for this paper. In recent years, there has been a determined push in hospitals to implement digital health record systems. Between 2008 and 2014, the number of non-federal acute care hospitals in the United States using basic digital systems climbed from 9.4 percent to 75.5 percent. In the near future, the percentage increase in the hospital's digital information will be enormous, and we will need to apply modern big data techniques to analyse those datasets. In the best sense, the future of medical diagnosis and therapy is a combination of medical judgement and an algorithmic diagnostic tool based on large medical information. For our research, we used the MIMIC III database. In this paper, we will go over why Mortality Prediction in ICU is interesting, as well as the method we used to examine and address the problem.

When to Operate on Colleagues? An Unspoken Ethical Dilemma among Aesthetic Plastic Surgeons.

As the demand for aesthetic surgery increases, one must consider the distinct ethical challenges that surgeons face in performing such interventions. Furthermore, the practice of plastic surgeons operating on their own relatives may raise notable concerns, including breach of confidentiality, objective decision-making, patient autonomy, and liability. According to the American Medical Association’s Code of Medical Ethics, “physicians generally should not treat themselves or members of their immediate families” except in cases of emergency, due to the potential “influence [on] his or her professional medical judgment and interference with the care being delivered.”1 While the American Medical Association’s Code of Ethics advises against operating on family, there are no clear guidelines on whether operating on colleagues and subordinates (e.g., medical students and residents) is justifiable. The purpose of this article is to discuss considerations for performing aesthetic procedures on colleagues. Several studies have affirmed that aesthetic surgeons are comfortable with operating on their own families. In fact, Slavin et al. conducted a survey on 465 aesthetic surgeons and determined that 88 percent reported they would operate on a spouse or relative.2 Although surgeons achieved low complication rates and favorable aesthetic results, there are additional considerations that may confound the mere decision to operate. A key concern involves the risk of compromising professional objectivity, which can be detrimental to overall patient care. Another concern lies in the mismanagement of the protocol of informed consent, which may preclude discussion of potential complications and poor clinical outcomes. The situation may, in fact, grow more complex when surgeons consider operating on their colleagues, such as fellow attendings, residents, or medical students. In addition to the aforementioned issues, surgeons may face greater scrutiny when operating on other medical professionals.3 Furthermore, given the professional exposure to surgeons’ skills, medical professionals may be more cognizant and critical of aesthetic and functional results. The Hippocratic Oath states, “To reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required.”4 However, appreciating a teacher or offering assistance does not equate to providing aesthetic surgical care to colleagues.5 This ultimately leaves the discussion open to debate in today’s medical world. We contend that the decision to operate on one’s colleagues is a personal one but requires multiple considerations (Table 1). Furthermore, given our positive experience when treating colleagues and trainees, we provide a series of recommendations that can help the plastic surgeon navigate the decision to operate on a colleague or trainee (Table 1). In relaying this information, we aim to spark an open discussion on this topic to resolve this dilemma. Table 1. - Recommendations for Determining How to Approach Operating on a Medical Colleague Dos Do Nots Intervene if the colleague-physician relationship is considered to be only professional, meaning that it conforms to the expected technical and ethical standards of the medical profession (taking into consideration the principles of informed consent, patient autonomy, and objectivity).Treat the colleague like a lay patient. Intervene if the colleague-physician relationship is considered to be more than professional. Treat the colleague in a preferential manner. Establish a professional boundary and discuss treatment management, concerns, and ethical and financial issues early. Feel pressured to accept every colleague’s request for treatment. Refer the colleague to someone else if you decline to provide treatment.Connect medical professionals with opportunities to gain second opinions for the procedure. Leave the patient without a referral if you decline to provide treatment. Provide medical professionals with the equivalent materials/instruction for the operation, preoperative and postoperative course, and so on. Perform the procedure of informed consent as you would do for any other patient and respect the patient’s final decision regarding the procedure. Carry out an objective history and physical examination in order to ensure the best care possible for the patient. Follow the well-established scheduled clinical visit time course (from preoperative to postoperative timepoints), as you would do for any other patient. In conclusion, performing procedures on colleagues and trainees presents a unique set of challenges for plastic surgeons. In considering the important issues of patient confidentiality, autonomy, objectivity, and liability, we propose a series of recommendations for aesthetic surgeons to guide decisions on how to pursue operating on colleagues. Future studies should elucidate the prevalence of such arrangements and assess the clinical outcomes and satisfaction conferred by such procedures. DISCLOSURE The authors have no commercial associations or financial disclosures that might pose or create a conflict of interest with information presented in this article. No funding was received for this work.

P274 The effect of ixekizumab versus adalimumab on individual components of the ACR composite score, with and without concomitant methotrexate or other conventional synthetic DMARDs, at 52 weeks in patients with psoriatic arthritis

Abstract Background/Aims It is useful to evaluate individual American College of Rheumatology (ACR) components in large trials for active psoriatic arthritis (PsA) because individual patient domains may influence treatment choice. SPIRIT-H2H showed superiority of ixekizumab (IXE) over adalimumab (ADA) in patients with PsA and inadequate response (IR) to conventional synthetic disease modifying antirheumatic drugs (csDMARDs). This analysis describes the effect of IXE and ADA on individual ACR components at week (Wk) 52, with and without concomitant methotrexate (MTX) and csDMARDs. Methods Patients from SPIRIT-H2H (NCT03151551, 52 Wk randomized multicenter study) who met Classification Criteria for Psoriatic Arthritis (CASPAR) (N = 566), were randomized (1:1, stratified by baseline concomitant csDMARDs and moderate-to-severe PsO) to IXE or ADA on-label PsA or PsO dosing. Patients were bDMARD-naïve with IR to csDMARDs, active PsA (≥3 tender joints [TJC] and ≥3 swollen joints [SJC]) and had psoriasis (PsO) ≥3% BSA (body surface area). Patient’s Global Assessment (PtGA) and Physicians Global Assessment (PGA), Health Assessment Questionnaire-Disability Index (HAQ-DI), and joint pain were assessed by visual analog scale, and TJC and SJC as well as C-reactive protein (CRP) were analyzed. All post-hoc analyses were performed on the intent-to-treat (ITT) population. Change from baseline (CFB) in individual ACR components was analyzed using an Analysis of Covariance (ANCOVA) model, for overall as well as with and without concomitant therapies (e.g., MTX or csDMARD). Least square mean (LSM) and standard error (SE) are presented. Missing data were imputed using modified baseline observation carried forward (mBOCF). Nine patients with active PsO and BSA≥3% were assessed as Psoriasis Area and Severity Index (PASI)=0 at baseline, a medical inconsistency that was resolved using medical judgment. These patients were considered PASI100 responders if PASI=0 and BSA=0 at post baseline visits. Results A total of 566 patients received either IXE (N = 283) or ADA (N = 283). Baseline values for individual ACR components were balanced between IXE and ADA. At Wk 52, IXE demonstrated efficacy across all individual ACR components in the ITT population, specifically in PGA, PtGA and Joint Pain; ADA also demonstrated numerical efficacy. Improvements from baseline for IXE were observed across ACR components, with or without MTX or csDMARD. The effect of MTX (with or without) was notably different between IXE and ADA in TJC68, PGA, Joint Pain, and PtGA. Conclusion In this analysis, there was improvement with IXE in all components of the ACR composite score at Wk 52, irrespective of MTX or csDMARD use (with or without). In the ITT population, IXE showed comparable efficacy to ADA at Wk 52 in all components of ACR, demonstrating improvement across musculoskeletal domains. These results may provide further confidence of the clinical benefits of ixekizumab across musculoskeletal domains in patients with PsA, regardless of MTX or csDMARD use. Disclosure A. Kiprianos: None. E. Husni: Consultancies; AbbVie, Amgen, Bristol Myers Squibb, Celgene, Eli Lilly and Company, Janssen, Novartis, and UCB Pharma. S. Kamat: Member of speakers’ bureau; AbbVie, Amgen, Eli Lilly and Company, and Exogen. K. Stenger: Shareholder/stock ownership; Eli Lilly and Company. R. Bolce: Shareholder/stock ownership; Eli Lilly and Company. T. Holzkaemper: Shareholder/stock ownership; Eli Lilly and Company. C.C. Helt: Shareholder/stock ownership; Eli Lilly and Company. S. Park: Shareholder/stock ownership; Eli Lilly and Company. J.R. Lisse: Shareholder/stock ownership; Eli Lilly and Company. L. Idolazzi: Member of speakers’ bureau; AbbVie, Amgen, Eli Lilly and Company, and Janssen.

Application of Quantum Cognition to Judgments for Medical Decisions

The psychology of judgment and decision making can provide useful guidance to the task of medical decision making. More specifically, we describe how a new approach to judgment and decisions, based on quantum probability theory, can shed new light on seemingly irrational judgments, as well as indicate ways to ameliorate these judgment errors. Five different types of probability judgment errors that occur in medical decisions are reviewed. For each one, we provide a simple account using theory from quantum cognition. We conclude by drawing the implications of quantum cognition for ameliorating these common medical probability judgment errors.

Hospital physicians\u2019 experiences and reflections on their work and role in relation to older patients\u2019 pathways - a qualitative study in two Norwegian hospitals

BackgroundOlder patients are the most frequent users of initial hospital admissions and readmissions. Both hospital admission and discharge require communication and coordination between healthcare professionals within the hospital, and between professionals in hospitals and primary healthcare. We have identified few studies exploring hospital physicians’ perspectives on older patients’ pathways in the interface between hospital and primary healthcare services. The aim of this study was to explore hospital physicians’ experiences and reflections on their work and role in relation to older patients’ pathways between hospital and primary healthcare. Specifically, we focused on the challenges they faced and how they dealt with these in relation to admission and discharge, and their suggestions for service improvements that could facilitate older patients’ pathway.MethodsWe used a qualitative approach, conducting individual in-depth interviews with 18 hospital physicians from two hospitals in eastern Norway. Data were analyzed using systematic text condensation, in line with a four-step prosedure developed by Malterud.ResultsThe participants emphasized challenges in the communication about patients across the two service levels. Moreover, they described being in a squeeze between prioritizing patients and trying to ensure a proper flow of patients through the hospital wards, but with restricted possibilities to influence on the admissions. They also described a frustration regarding the lack of influence on the healthcare delivery after discharge. The participants had various suggestions for service improvements which might be beneficial to older patients.ConclusionsThe results demonstrate that the hospital physicians perceived being squeezed between professional autonomy and limited capacity at the hospital, and between their medical judgement as a specialist and their power to decide on hospital admissions for old patients and also on the delivery of health care services to patients after discharge.

The role of the ophthalmologist in forensic medical judgement for videoterminalists.

This work describes what are the regulations in the field of safety and prevention in the workplace, with particular regard to the legal medical aspects of the doctor in charge of Occupational Medicine in correlation with ergophthalmological examinations. The main subjects of this treatment are the employees videoter-minalists. The first part of this work aims to analyze the compliance, as well as laws and legislative decrees governing the obligations and duties of the employer to its employees, regarding the compliance of workplaces and equipment with the instrument that are routinely used by employees videoterminalists. The discussion continues by focusing on the specific aspects of the ergophthalmological examination. It also describes the different phases of the eye examination, starting from the identification of the employee and then to the collection of anamnestic data, which are an integratedpart of the medical-legal act and are also a useful tool for the final diagnosis. The discussion of the various phases of the ergophthalmological examination concludes with a description of indirect ophthalmoscopy with its crucial points, which are important points in any ophthalmo-logical examination. Given the considerable diffusion and the great amount of tech-nological innovations in the field of display screens, we conclude the discussion with a historical overview of the display screens that have been habitually used by employees in their workplace, describing the mechanism that underlie their operation through some hints of Physics.

How to Teach/Learn Praecox Feeling? Through Phenomenology to Medical Education.

BackgroundThe Praecox Feeling (PF) refers to a classical psychopathological concept describing the specific experience of bizarreness arising in the encounter with a person living with schizophrenia spectrum disorders (SSDs). Some studies have shown that experienced psychiatrists take advantage of this experience to perform accurate and rapid diagnostic expertise. It would seem that PF is not contradictory with an operationalized diagnostic approach, but that the PF would intervene at a more tacit level of medical judgment. However, the articulation between the implicit and explicit levels of the psychiatrist's experience in the situation of medical judgment remains little studied, even though it is of crucial importance for structuring the teaching of clinical psychiatry to mental health practitioners. Can diagnostic intuition be learned? Is this experience a kind of “gift” that some may or may not have? Does the PF refer to medical expertise?MethodsTo unfold the complexity of his questions this article proposes to conduct an historical, epistemological and phenomenological analysis of the PF.ResultsWe will first conduct a presentation of historical descriptions of the PF understood as a sensation, intuition and experience, alongside the evolution of the concept of schizophrenia. Then, the article proposes an original phenomenological modelization of the temporal unfolding of the PF.DiscussionThe phenomenological conceptualization, informed from empirical evidence will try to account for the paradox of the PF as both lived evidence and indescribable experience. PF will be described as a complex cognitive and embodied process based upon ante-predicative aesthetic sensing which is secondly apprehended as perceptible evidence thanks to clinical typification. This conceptualization relying on Husserl manuscript on intersubjectivity will help to demystify its experiential structure and discuss its relevance for medical education.

AAOS Appropriate Use Criteria: Management of Rotator Cuff Pathology.

AAOS Appropriate Use Criteria: Management of Rotator Cuff Pathology.

Trapped by a first hypothesis: How rudeness leads to anchoring.

In this article we explore the effect of encounters with rudeness on the tendency to engage in anchoring, one of the most robust and widespread cognitive biases. Integrating the self-immersion framework with the selective accessibility model (SAM), we propose that rudeness-induced negative arousal will narrow individuals' perspectives in a way that will make anchoring more likely. Additionally, we posit that perspective taking and information elaboration will attenuate the effect of rudeness on both negative arousal and subsequent anchoring. Across four experimental studies, we test the impact of exposure to rudeness on anchoring as manifested in a variety of tasks (medical diagnosis, judgment tasks, and negotiation). In a pilot study, we find that rudeness is associated with anchoring among a group of medical students making a medical diagnosis. In Study 1, we show that negative arousal mediates the effect of rudeness on anchoring among medical residents treating a patient, and that perspective taking moderates these effects. Study 2 replicates the results of Study 1 using a common anchoring task, and Study 3 builds on these results by replicating them in a negotiation setting and testing information elaboration as a boundary condition. Across the four studies, we find consistent evidence that rudeness-induced negative arousal leads to anchoring, and that these effects can be mitigated by perspective taking and information elaboration. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Sideline Assessment of Concussion

A concussion is a transient disturbance in neurologic function due to a force absorbed by the head or body which is transmitted to the brain. An athlete who sustains a concussion can experience abnormal cognition, difficulty with balance, vision changes, memory deficits, and a variety of symptoms including headache, irritability, feeling “in a fog,” or just “not feeling right.” Evaluation of a suspected concussion begins with ruling out catastrophic injuries to the head, neck, and brain which would require transport to an emergency department. Once life- and limb-threatening injuries have been excluded, the athlete should undergo a thorough sideline evaluation of their symptoms, cognitive function, neurologic status, balance, and visual system. This is best accomplished using the Sport Concussion Assessment Tool, 5th edition (SCAT5) as well as 1 or 2 additional scales to test the visual system. While these tools provide information about an athlete with suspected concussion, the final diagnosis relies on the health care provider's medical judgment. This chapter will outline the sideline evaluation and early management of sport-related concussion (SRC).

Assessment of medical students’ preparedness and willingness for integration into a war-torn healthcare system: the example of COVID-19 pandemic scenario

ABSTRACT In Syria, medical students were placed on call to provide sufficient human resources during COVID-19 pandemic. This research aimed to explore the ability and willingness of the final-year medical students to assist during COVID-19 in the Syrian war-torn and fragile health-system. Final-year Syrian medical students were approached between 9th-17th April 2020 through an online questionnaire. Students’ COVID-19-related medical knowledge (5-point score), clinical judgement (5-point score), and preparedness and willingness to integrate in healthcare facilities were assessed. A 10-point score was created, and linear regression and Tukey’s HSD test were conducted. 1673 valid responses were received, of which 1199 (71.66%) responses were from the final-year students. Of the latter, 728 (60.71%) scored 4 points or higher in the medical knowledge score (mean 3.69 points), while 298 (24.85%) scored 4 or higher in the clinical judgement score. Final-year students scored significantly higher than the fourth-year students in the clinical judgement score. Finally, 682 (56.88%) of the final-year students expressed willingness to volunteer with healthcare teams. Final-year medical students may provide medical aid, on voluntary basis, by working in fragile health systems during pandemics. However, this should be undertaken in cases of extreme need. Sufficient personal protective measures, intensive training, and adequate supervision should be guaranteed.

Physicians’ perception toward using telephone consultations during the COVID-19 pandemic in Korea

Background: As the world faced a pandemic caused by the coronavirus disease (COVID-19) outbreak in 2019, telemedicine quickly spread and was widely adopted. This was the first instance where telephone consultations were temporarily allowed in Korea. We used data from the 2020 Korean Physician Survey and analyzed the physicians’ perceptions of telephone consultations, the reasons for providing these consultations, and the level of physician satisfaction after providing it.Current Concepts: A total of 6,342 respondents were selected for the final analysis of the research results. Regardless of the COVID-19 pandemic, the data showed that most physicians had a negative perception (77.1%) toward the introduction of the telemedicine system. A third (31.1%) of physicians surveyed had provided medical treatment via telephone consultation. According to the position the physicians held, professors, fellows, self-employed physicians, and public health physicians had the most experience in this method of consultation. The use of telephone consultation was highest in the field of internal medicine (44.5%) treatment. Data also showed that most physicians (83.5%) who provided such consultations experienced difficulties in making a medical judgment that could ensure their patients’ safety.Discussion and Conclusion: The results of this study verified that physicians’ opinions about the telemedicine system differed according to service, area of specialization, region, and type of medical institution. A closer review and establishment of policy alternatives are required to explore the possible expansion of teleconsultations and related medical treatments in the future.