Practice Of Medicine Research Articles

From Detached Concern to Love: Reconsidering Physician-Patient Boundaries

Abstract Developing appropriate professional boundaries is part of becoming a mature clinician. Boundaries help physicians fulfill their duties in relationally complex and emotionally fraught situations. The concept of “detached concern” has been used to characterize physician-patient relationships in which physicians show empathy and concern while maintaining due emotional distance. However, if the default tendency of trainees and clinicians is toward detachment, then emphasis on professional boundaries may do less to promote proper detachment than to diminish human connections with patients, thereby leading to clinician disenchantment and patient dissatisfaction. The authors propose that the physician-patient relationship is better characterized by love—specifically the kind of ordered love described by the fourth- and fifth-century bishop and philosopher Augustine of Hippo. Augustine’s vision of love has influenced many social reformers through the centuries, including, notably, Martin Luther King Jr. Importantly, such love is consistent with safeguards for which professional boundaries in the clinical context are corollaries, including guarding against forms of compassion that interfere with reasonable judgment, acknowledging humans' finite capacity to love, and recognizing potential harms of disordered love. Against a horizon of love, however, such boundaries are transformed from walls that prevent human connection and concern to walls that create spaces for and encourage any human connection that does not hinder healing and the patient’s good. By shifting their emphasis from detached concern to love, medical educators can re-enchant medicine for trainees by encouraging the human connections that make the practice of medicine its own reward.

A neurosurgical nursing training system based on 3D printing models: practice and exploration of precision medicine

A neurosurgical nursing training system based on 3D printing models: practice and exploration of precision medicine

Recommendations for Clinicians, Technologists, and Healthcare Organizations on the Use of Generative Artificial Intelligence in Medicine: A Position Statement from the Society of General Internal Medicine

AbstractGenerative artificial intelligence (generative AI) is a new technology with potentially broad applications across important domains of healthcare, but serious questions remain about how to balance the promise of generative AI against unintended consequences from adoption of these tools. In this position statement, we provide recommendations on behalf of the Society of General Internal Medicine on how clinicians, technologists, and healthcare organizations can approach the use of these tools. We focus on three major domains of medical practice where clinicians and technology experts believe generative AI will have substantial immediate and long-term impacts: clinical decision-making, health systems optimization, and the patient-physician relationship. Additionally, we highlight our most important generative AI ethics and equity considerations for these stakeholders. For clinicians, we recommend approaching generative AI similarly to other important biomedical advancements, critically appraising its evidence and utility and incorporating it thoughtfully into practice. For technologists developing generative AI for healthcare applications, we recommend a major frameshift in thinking away from the expectation that clinicians will “supervise” generative AI. Rather, these organizations and individuals should hold themselves and their technologies to the same set of high standards expected of the clinical workforce and strive to design high-performing, well-studied tools that improve care and foster the therapeutic relationship, not simply those that improve efficiency or market share. We further recommend deep and ongoing partnerships with clinicians and patients as necessary collaborators in this work. And for healthcare organizations, we recommend pursuing a combination of both incremental and transformative change with generative AI, directing resources toward both endeavors, and avoiding the urge to rapidly displace the human clinical workforce with generative AI. We affirm that the practice of medicine remains a fundamentally human endeavor which should be enhanced by technology, not displaced by it.

Use of Prenatal Exome Sequencing: Opinion Statement of the French Federation of Human Genetics Working Group

ABSTRACTObjectivePrenatal whole exome sequencing (pES) is increasingly prescribed for fetuses with ultrasound anomalies. Starting from the local French prenatal medicine practice, healthcare system and legal landscape, we aimed to address the broad medical and ethical issues raised by the use of pES for women and couples as well as for prenatal care providers.MethodThe French Federation of Human Genetics established a working group composed of clinicians and biologists from all over France to discuss pES challenges. A literature review was also performed.ResultsWe emphasize the importance of non‐directive information that helps couples make a decision that is consistent with their personal values and ideas. We address the difficulty of obtaining informed consent that respects the couple's autonomy, despite the complexity of the information and regardless of their level of education and cultural background. We address whether variants of uncertain significance and unsolicited results should be reported. We emphasize the need for national harmonization of access to pES and the need for multidisciplinary meetings in complex situations. We point out that the specific French context of healthcare financing and the French law have a major influence on medical care organization and support for couples. The outcome of the working group is the development of 12 proposals.ConclusionThis opinion statement, dedicated to prenatal care providers worldwide although linked to the French context, will provide food for thought and assist them in understanding the complexity and implications of pES.

Abstract 4126895: Bridging the Gap in San Joaquin Valley LGBTQ+ Cardiovascular Disease and Mental Health Disparities

Introduction: LGBTQ+ adults experience discrimination and violence that lead to stressors in daily life. Homophobia affects the mental health of the growing San Joaquin Valley (SJV) LGBTQ+ community leading to psychological distress and mental health concerns which can further lead to High Blood Pressure (HBP) and cardiovascular disease (CVD). SJV has a growing rate of LGBTQ+ migrants from the Bay Area who may be at risk for psychological distress and CVD. With a diverse community of low income and minority groups, the lack of physicians do not represent the workforce of SJV. Objectives: Trainees conducted Kessler psychological distress tests, HBP and CVD screenings across college campuses and community events to reduce the risk of CVD and spread awareness about mental health, CVD and its implications in the LGBTQ+ population due to environmental racism in the most underserved region for health care, SJV. Methods: I trained and provided mentorship to medically ambitious diverse low-income high school to instill a passion in them to come back after their medical education to practice medicine and promote LGBTQ+ health equity in SJV. Students conducted weekly Kessler psychological distress tests, HBP screenings and serve as a health technology coach. Each student monitored 2 hypertensive and psychological distressed patients. Kessler psychological distress tests and CVD screenings were conducted at college campuses to spread awareness about LGBTQ+ mental health and heart health and track psychological distress and HBP in the LGBTQ+ community. Findings: -About 88% (98 of 112) experienced some form of discrimination from a health care professional -About 57% (64 of 112) of SJV LGBTQ+ population are at risk for CVD -About 14% (16 of 112) of SJV LGBTQ+ population are Stage 1 hypertensive -About 76% (83 of 112) of SJV LGBTQ+ population are at risk for hypertension and are psychologically distressed Direct Outcomes: -Youth learned the value of empathy and service to disadvantaged LGBTQ+ communities through the program and volunteering -LGBTQ+ empowerment and students are determined to pursue medicine and address community concerns -Awareness, education among LGBTQ+ community for better heart and mental health -Better understanding in how to manage and seek referral for mental health and health systems concerns -Students learned about SJV health disparities and applied precision medicine to their own health inequity projects in SJV -Improved LGBTQ+ patient provider trust

THE RELATIONSHIP BETWEEN POLYMORPHISM 1357 G → A OF THE CNTF GENE AND GLY482SER OF THE PPARGC1A GENE WITH MUSCLE STRENGTH

Muscle strength is the process of energy synthesis during certain tasks in muscle fibers. In modern sports and sports medicine, exploring methods to enhance muscle strength through targeted exercises and training programs is a key area of focus. While many athletes can achieve the physical conditioning necessary for competitive performance, the role of genetics in sports has gained attention as it offers insights for optimizing training strategies and enhancing performance based on individual genetic profiles. Among the well-researched genes in muscle strength studies are the ciliary neurotrophic factor gene (CNTF) and the peroxisome proliferator-activated receptor gamma coactivator 1-alpha gene (PPARGC1A). This study investigates the relationship between polymorphisms in these genes and the function of motor units in muscle fibers. The aim of the study is to analyze and explain the mechanisms by which polymorphisms in the CNTF and PPARGC1A genes influence muscle strength. Materials and Methods. Following PRISMA guidelines, a comprehensive literature review was conducted using relevant keywords across leading scientometric databases. Results and Discussion. This article explores the relationship between genetic variants of the CNTF and PPARGC1A genes and muscle strength in adults. Specifically, it examines the impact of the CNTF 1357 G→A and PPARGC1A Gly482Ser polymorphisms on muscle strength gains in response to strength training. The study results indicate that these genetic variations significantly affect individual differences in response to exercise. Notable fluctuations in strength gains and changes in maximal voluntary contraction were observed. The data underscore the need for further research to deepen our understanding of how the CNTF and PPARGC1A genes influence muscle adaptation to training, as well as to assess their roles across different populations and training conditions. It has been found out that the AA genotype of the 1357 G→A variation leads to a functionally inactive neurotrophic factor protein, thereby significantly diminishing its myotrophic effect on skeletal muscles. Regarding the Gly482Ser polymorphism, homozygosity for the T allele is associated with reduced skeletal muscle metabolism and decreased oxidative activity. Conclusions. The results obtained can be applied for developing personalized training programs and improving practice of sports medicine and rehabilitation, thus facilitating the more effective achievement of individual fitness and health goals.

The Role of Forensic Medicine in Modern Criminal Justice: A Review of Current Practices and Innovations

Forensic medicine plays a pivotal role in modern criminal justice by providing scientific insights that aid in solving crimes, identifying victims, and ensuring the accurate administration of justice. This review examines the current practices in forensic medicine, including autopsies, toxicology, DNA analysis, and forensic anthropology, highlighting their applications in various criminal cases. Technological innovations, such as advanced DNA technologies, digital forensics, and forensic imaging, have significantly enhanced the field, improving accuracy and efficiency in investigations. The review also addresses challenges faced by forensic medicine, including issues of accuracy, resource constraints, and ethical considerations surrounding privacy and consent. The integration of artificial intelligence and portable forensic devices is explored as part of the ongoing evolution within the field. By analyzing the impact of these advancements on case resolutions, exonerations, and crime prevention, this article underscores the critical role of forensic medicine in the justice system and discusses future directions for research and practice. The insights presented aim to inform ongoing improvements in forensic methodologies and to foster a justice system that is both scientifically rigorous and ethically responsible.

HERBAL MEDICINE IN DENTISTRY: PAST, PRESENT, AND FUTURE

The treatment of inflammatory diseases of the oral mucosa and inflammatory-dystrophic diseases of the periodontal tissues is a major concern in modern dentistry. The use of herbal medicines is one of the most promising areas of pharmacotherapy, employed both as standalone treatments and as part of comprehensive therapeutic regimens. Currently, nearly 50% of medications in the global pharmacotherapeutic arsenal are derived directly from medicinal plant materials. The high interest in herbal remedies stems from several key factors, including their natural origin, complex structure, pharmacological versatility, cost-effectiveness, and their applicability in treating a wide range of diseases. The development of modern herbal medicine is considered a priority in public health, aimed at preventing acute and chronic diseases and improving quality of life. At the same time, evidence-based approaches to medicinal plants are rooted in the principles of "phytonics," which emphasize the standardized production of herbal medicines at all stages. The aim of thus study is to review the literature on the use of herbal medicines in dental practice. The current range of phytopreparations available on the pharmaceutical market in Ukraine includes both well-established herbal products and new preparations that have undergone experimental testing and now require evidence-based clinical validation. Conclusion. Phytotherapy in dental practice presents a promising approach due to the polytropic effects of herbal medicines. Future research must adhere to the principles of scientific rigor to ensure the effectiveness and safety of these treatments.

Precision Medicine in Anesthesia: Pharmacogenomics and Personalized Care

Precision medicine in anesthesia represents a transformative approach aimed at optimizing anesthetic care by tailoring interventions to individual patient characteristics, particularly their genetic profile. Pharmacogenomics, a cornerstone of precision medicine, explores the genetic factors influencing drug metabolism, efficacy, and adverse reactions. This article delves into the integration of pharmacogenomics in anesthesia, discussing its impact on drug selection, dosage adjustments, and patient outcomes. It also highlights the potential for reducing perioperative complications, enhancing patient safety, and improving recovery through personalized anesthetic care. Challenges such as the need for robust genetic databases, ethical considerations, and the cost-effectiveness of implementing precision medicine in clinical practice are also discussed. The future of anesthesia lies in harnessing pharmacogenomics to provide individualized care, ultimately advancing patient-centric anesthetic management.

QLTI-15. MEDICAL MALPRACTICE AND GLIOMA

Abstract BACKGROUND Medical malpractice affects the practice of medicine in every field and specialty. It is a particular concern in high risk specialties including neurological surgery, which has the greatest risk of malpractice litigation. Treatment of glioma patients is complex and requires diagnosis based on presentation and imaging, followed by the decision of resection versus biopsy to confirm diagnosis and potentially improve prognosis. The possibility of a complication accompanies every procedure and patients generally also go on to receive chemotherapy and radiation. Interdisciplinary care is a hallmark. We explored medical malpractice litigation pertaining to gliomas with a focus on outcomes and the role of the defendants as well as the liabilities prompting litigation. METHODS WestLaw Precision, an established legal database, was queried for all cases relevant to “glioma” occurring since 2000. Cases and settlements, in particular, were considered. Keywords included “glioma” and “medical malpractice” with the date range including all cases after January 1, 2000. Cases were identified and analyzed for variables of interest. RESULTS Fourteen relevant cases were identified and reviewed. There were three plaintiff verdicts, one settlement and ten defense verdicts in favor of the defense. Two cases involved minors, while all others concerned adults. Both cases pertaining to the care of minors with gliomas resulted in findings for the defense. The majority of cases centered on failure to diagnose occurring before surgery or treatment. Defendants included neurosurgeons, pathologists, radiologists, nurses and hospital systems. Although the number of cases considered here is small, jury verdicts in favor of plaintiffs resulted in far higher payouts compared with settlements. CONCLUSIONS Medical malpractice allegations relating to glioma treatment are shown to be rare and infrequent. The majority of cases alleged a failure to appropriately diagnose, before surgery or treatment took place. The great majority of cases reported within WestLaw Precision resulted in jury verdicts for the defense.

Challenges in delivery of Bhutanese Traditional Medicine (Sowa Rigpa) services at Primary Healthcare Centres in Bhutan

Bhutanese Traditional Medicine (Sowa Rigpa) and allopathic medicine are integrated and state-funded in the three-tier healthcare system of Bhutan. Bhutanese Traditional Medicine services are available in all three levels of the healthcare system offering a range of services, from consultations to therapies and drug dispensations. Except for the National Traditional Medicine Hospital in Thimphu, all the centres across the country offer only outpatient services. Out of 81 traditional medicine centres, 55 centres are located at the primary level, serving people in different geographical areas of the country. Despite an increasing number of patients availing the traditional medicine services, the facilities at the primary level continue to face several challenges. The challenges include delayed and disruptive medicine supply chain, lack of an effective and systematic patient referral system, misconceptions and lack of awareness of traditional medicine services and inadequate infrastructure. All of these impede the provision of traditional medicine services in the communities. We recommend a technology-based drug delivery system in addition to resilient production centres, an effective patient referral system in traditional medicine practice by leveraging on the guideline and electronic patient information system, advocacies in the communities to dispel the myths and misconceptions regarding the Bhutanese Traditional Medicine, and adequate and architecturally smart infrastructure. Implementing these solutions could enhance access and utilization of traditional medicine services, leveraging the best use of this important component of the healthcare system.

Evidence‐based veterinary medicine—potential, practice, and pitfalls

AbstractUnderstanding and incorporating evidence‐based veterinary medicine (EBVM) into clinical practice and research continues to pose a challenge for our profession despite over 2 decades of increasing awareness of this concept. Reasons for this include a lack of understanding of its importance to the practice of medicine, veterinary literature that often fails to adhere to evidence‐based standards, inadequate attention to teaching EBVM at the university level, and the inherent reluctance of clinicians to alter historical practice styles. For many practitioners, EBVM continues to be an abstract concept they believe requires advanced training in statistics and epidemiology resulting in them relying on less robust sources for clinical guidance. This unfortunately results in suboptimal care for our patients and delayed medical advancements for our profession. As part of the 20th anniversary of the founding of the Evidence‐Based Veterinary Medicine Association (EBVMA), we are refocusing our efforts to highlight the need for dedicated teaching of EBVM at the university level, for rigorous adherence to established research reporting guidelines, for expansion of EBVM infrastructure, and for the provision of easily accessible tools that permit clinicians to incorporate EBVM into their daily practice. As the quality of veterinary literature improves, so too will development of more effective clinical practice guidelines that ultimately can be widely adopted if they are flexible enough to support the triadic relationship between veterinarians, our clients and our patients. Ultimately, EBVM is not an end unto itself, but rather a means to improve the quality of care we provide our patients.

Evaluating pediatric antimicrobial dosing of β-lactam antibiotics for upper respiratory tract infections in emergency and primary care settings

Abstract Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Pediatric prescribing is often weight and indication specific and has been associated with high rates of error. The aim of this study was to evaluate outpatient β-lactam suspension dosing practices for pediatric upper respiratory tract infections (URIs), to characterize the rate of error and to describe common error types. Methods This retrospective cohort study was conducted at a community health system with 2 emergency departments and 20 outpatient family medicine practices. Pediatric patients treated from these settings with oral suspension formulations of amoxicillin, amoxicillin/clavulanate, cefdinir, or cephalexin for streptococcal pharyngitis or otitis media between June 1, 2020, and May 31, 2023, were eligible for inclusion. Doses were evaluated against indication-specific best-practice guidelines and assessed for guideline concordance. Results Of the 200 patients evaluated, 100 were treated for streptococcal pharyngitis and 100 were treated for otitis media. Of the prescribed β-lactam doses, 32% were discordant with best-practice guideline recommendations. Dosing errors were more common for pharyngitis than for otitis media (47% vs 17%; P < 0.001). Overdosing was the most frequently observed error in pharyngitis prescriptions (93.6% of errors) and most commonly occurred in patients weighing more than the 20-kg weight associated with the dosing maximum (80.9% of overdosing errors). All patients receiving an inappropriate dose for otitis media were underdosed. Conclusion Outpatient pediatric dosing errors for URI indications are common among both emergency medicine and family medicine prescribers. Patients weighing over the weight corresponding to the dosing maximum are at highest risk for error. Antimicrobial stewardship interventions targeting the point of prescribing are urgently needed to provide safe dosing practices for pediatric patients.

Pharmaceutical care for patients with coronary heart disease: transformation of pharmaceutical practice

The implementation of the National Recovery Plan of Ukraine in the field of “Health Care”, namely the restoration of the pharmaceutical sector, improving the population’s access to medicines and their proper use, taking into account the regulatory and legal field harmonized with European legislation, in the context of providing the qualified pharmaceutical care and pharmaceutical services requires application of modern approaches based on evidence-based medicine and implementation in pharmaceutical practice. Patients with cardiovascular diseases, who are provided with medication under the Reimbursement Program and prescriptions from doctors, must be accompanied by pharmaceutical care based on evidence-based medicine to ensure proper use of drugs and rational pharmacotherapy. The aim of the study was to investigate Ukrainian information and scientific databases, scientometric databases, i. e.: Embase, Web of Science, PubMed, and Cochrane Library to identify, generalize, and systematize scientific sources of medical and pharmaceutical data on providing patient-oriented pharmaceutical care to patients with coronary heart disease and predict the future vector of research on the specified topic. Results. The analysis of the main strategies of providing pharmaceutical care to patients with cardiovascular diseases, in particular, coronary heart disease in pharmaceutical practice was carried out; the most researched clusters of providing pharmaceutical care were identified; modern trends and tendencies in the provision of pharmaceutical care to patients with coronary heart disease were summarized. Conclusions. The development of providing qualified pharmaceutical care to patients with cardiovascular diseases is based on the principles of patient-oriented pharmacy and evidence-based medicine, which requires the design and implementation into the pharmaceutical practice of a sustainable conceptual model of providing patient-oriented pharmaceutical care by clinical pharmacists and pharmacists of pharmacy institutions with the expansion of the main roles, respectively the standards of Good Pharmacy Practice.

Incorporating Lifestyle Medicine into Occupational Medicine Practice - ACOEM Guidance Statement.

Lifestyle Medicine (LM) utilizes evidence-based therapeutic lifestyle changes to address lifestyle factors that impact health, performance, and injury risk and recovery. By integrating LM principles into clinical care, workplace policies, and programs, along with other evidence-based methods, occupational and environmental medicine clinicians and medical directors can enhance worker health and performance, manage chronic disease, and facilitate faster recovery from injury and illness. This guidance addresses approaches that can be used in the clinic and workplace to address tobacco, substance misuse, nutrition, physical activity, overweight/ obesity, sleep, mental well-being, and social connectedness.

Therapeutic resources used by traditional communities of the Brazilian Amazon: a scoping review.

The traditional communities of the Brazilian Amazon possess significant knowledge regarding the huge therapeutic arsenal available from natural sources that can be used to care for their health problems. This study aimed to identify, map and synthesize the scientific evidence on the use of traditional medicine as a therapeutic resource when used by traditional communities of the Brazilian Amazon. This is a scoping review, which is a method used to map the main concepts of a research area, the available evidence and its sources. It is developed in five steps: (1) identification of the research question; (2) identification of relevant studies; (3) selection of studies; (4) data analysis; and (5) grouping, synthesis and presentation of data. Medicinal plants, vertebrates and invertebrates, among other medicinal products, are elements that are widely used by traditional populations. Plant stems, bark, leaves, flowers, fruits, seeds, roots, tubers and even the whole plant are prepared in various forms, such as teas, infusions, smoke for rituals, baths, macerations, oils, ointments, concoctions, dressings, incenses and exfoliants, among others. The main structures and forms used from animals are lards, fats, viscera, horns, cocoons, nests, feathers and beaks of birds, eggs and roes. These therapeutic practices are often carried out using endogenous, wild and domesticated natural resources present in the biodiverse environments of traditional populations. They involve magical-religious beliefs to treat all types of illnesses, including cultural syndromes that affect children, young people, adults and the elderly. This scoping review has an important role to disseminate and expand the discussion of traditional medicine practices, inviting readers - whether they are health professionals, community members, managers or decision-makers - to a continuing debate using an intercultural dialogue necessary to improve approaches. From this perspective, it is essential to consider the comprehensive legal and legal framework that guides the public policies of national health systems.

New Ideas in Narrative Practice for Mind and Body Healing: Integrating Acupuncture and Massage with Positive Psychology

Abstract: To enrich the specific methods of narrative clinical practice in Chinese medicine and stimulate the innovation of narrative medicine practice in China, we advise that medical professionals should integrate theories and treatments related to acupuncture, massage and positive psychology into their narrative medicine practice, taking into account the current state of clinical practice of acupuncturists and the importance of positive emotions in the field of psychology. This paper elucidates the value of combining acupuncture, massage, and positive psychology from the perspectives of mechanisms and clinical correlations, highlighting their impacts on patients' physical and mental health. To promote the integration of positive psychology with acupuncture and massage, it is proposed to refine the understanding of the efficacy of acupuncture points anddevelop theories on stimulating positive psychology in acupuncture and massage further more.

Thai Guideline for Nuclear Medicine Investigations of Neurocognitive Disorders: Nuclear Medicine Society of Thailand, the Neurological Society of Thailand, and Thai Medical Physicist Society Collaboration

Nuclear medicine investigations play a significant role in diagnosing dementia, mainly using imaging techniques such as positron emission tomography (PET) and single-photon emission computed tomography (SPECT). By providing functional and molecular data via brain imaging, nuclear medicine investigations offer valuable insights that complement clinical evaluations and structural imaging in the early detection, diagnosis, and differentiation of various types of dementia, leading to more accurate diagnosis and personalized treatment planning. Therefore, the Nuclear Medicine Society of Thailand, the Neurological Society of Thailand, and the Thai Medical Physicist Society have collaborated to establish these practical nuclear medicine investigation guidelines aiming to (1) identify the role of nuclear medicine studies in patients with neurocognitive disorders; (2) assist referrers in requesting the most appropriate procedure for diagnosis of each type of neurocognitive disorders; and (3) identify scientific evidence that is useful to assisting nuclear medicine professionals in recommending, performing, interpreting, and reporting the results of nuclear medicine investigations in patients with neurocognitive disorders.

"Where are you really from?": a qualitative study of Asian American medical provider experiences.

The COVID-19 pandemic highlighted how racially minoritized patients and clinicians have suffered racial discrimination. It also made visible the ways in which Asians across the globe experience racial hate and illuminated that the experiences of Asians in medicine are not often spotlighted. In the United States specifically, Asian Americans are not viewed as minoritized in medicine, yet their professional experiences are rarely highlighted. Informed by the discourses of the model minority, the forever foreigner, and ethnic lumping, we used Asian critical theory to explore how Asian American medical providers in Utah understand racial and ethnic identity and how these identities and experiences of racialization inform their professional identities. Using a case study approach, we identified and interviewed 23 physicians, physician assistants, and nurse practitioners (during spring 2022) who live in and practice medicine in Utah. Transcribed interviews were coded using reflective thematic analysis. Findings were organized into three themes: (1) feeling different, (2) experiences with discrimination, and (3) wrestling with the model minority myth. While Asian American medical providers experience not belonging, they also have the agency to disrupt discrimination and stereotypes. Asian American medical providers' racial and ethnic identities influence their professional interactions. Understanding the intersections of their social and professional identities are important to providing support for Asian medical providers, within the United States and beyond.

Systematic Review: The Impact of Traditional Medicine Combined with Standard Diabetes Management versus Standard Management Alone on HbA1c Levels in Type 2 Diabetic Patients

The management of Type 2 diabetes requires a multifaceted approach to achieve optimal glycemic control. This systematic review examines the impact of combining traditional medicine practices, such as herbal remedies, dietary supplements, traditional Chinese exercises, and plant-based diets, with standard diabetes management on HbA1c levels in adults with Type 2 diabetes. A total of 10 studies, including randomized controlled trials, systematic reviews, and meta-analyses, were analyzed. The findings indicate that most traditional medicine interventions, when combined with standard care, resulted in significant reductions in HbA1c levels, suggesting enhanced glycemic control. The most effective interventions included the Mediterranean diet, traditional Chinese exercises, and specific herbal remedies like cinnamon and ginseng. However, one study utilizing the chronic care model showed no significant improvement. This review highlights the potential of integrating traditional medicine practices into conventional diabetes management protocols for improved outcomes. Further large-scale, long-term studies are recommended to validate these findings and explore the mechanisms underlying the observed benefits.