Opinions Of Physicians Research Articles

What influences patients' opinion of remission and low disease activity in psoriatic arthritis? Principal component analysis of an international study.

In PsA, the treatment objective is remission or low disease activity (LDA), but patients' perception of remission is poorly studied. This analysis aimed to identify factors associated with patient-defined remission. This analysis uses ReFlaP data, an international PsA study, with remission defined as 'At this time, is your psoriatic arthritis in remission, if this means: you feel your disease is as good as gone?'. Variables associated with, first, patient-defined remission and, second, LDA were identified using multivariable logistic regression and principal component analysis (PCA) to explore correlated variables. Of 424 patients (50.2% male, mean age 52 years) with established disease, 94 (22.2%) reported themselves as being in remission and 191 (45.0%) as LDA alone. In multivariable analysis pain, psoriasis, impact of disease, physician opinion of symptoms from joint damage and Groll comorbidity index were independent predictors of remission. For LDA, results were similar. Using PCA, variance explained was 74% by five components for men and 80% by six components for women. The key component from PCA for remission was, for both sex, disease impact (Psoriatic Arthritis Impact of Disease, pain and HAQ) explaining 22.2-27.5% of variance. Other factors included musculoskeletal disease activity, chronicity/joint damage, psoriasis, enthesitis and CRP. For LDA, similar factors were identified but the variance explained was lower (64-68%). Many factors impact on patients' opinion of remission, dominated by disease impact. Disease activity in multiple domains, chronicity/age, comorbidities and symptoms due to other conditions contribute to a robust model highlighting that patient-defined remission is multifaceted. Clinicaltrials.gov, http://clinicaltrials.gov, NCT03119805.

The Effect of Music on Heart Rate Variability (Review)

Abstract Music therapy and the use of music in medical practice have now become rapidly advancing and promising areas of non-invasive alternative medicine. However, the opinions of physicians and therapists on the implementation of this complementary therapy, especially in the process of treating the patient, are constantly different. In addition, the effect of music and individual methodological procedures are not uniform and defined in detail. Therefore, this review study summarizes the results and conclusions of some selected high-quality publications over the last decade and makes suggestions for improvement and further research. It focuses mainly on the evaluation of changes in heart rate variability (HRV) as an indicator of the activity of the autonomic nervous system (ANS) in connection with the application of music in the process of passive music therapy.

Attitudes of hospital physicians toward childhood mandatory vaccines in France: A cross-sectional survey

ABSTRACT Background Due to a decades-long crisis of confidence in vaccination, in 2017 France extended the number of mandatory early childhood vaccines from 3 to 11. Aims To describe the opinions of hospital staff physicians (HSPs) regarding this measure, quantify the proportion who would have preferred measures based on education, and study the factors associated with the latter opinion. Methods Cross-sectional nationwide survey with a standardized questionnaire in 2018–2019 among HSPs in 14 French public hospitals. The factors associated with HSPs’ preference for education and persuasion over mandatory vaccination were analyzed with simple and multiple Poisson regressions. Results The analyses included 1,795 HSPs (participation rate of 86%). Among them, 84% considered the extension of mandatory childhood vaccination essential given the epidemiological context at the time; in a later question, 40% would have preferred education and persuasion. Multiple regressions showed that the latter tended to be younger and less trustful of sources of information about vaccination. They were more likely to think that information on the rationale behind the national vaccination policy lacked clarity and that the extension of mandatory vaccines was not essential, even in the current epidemiologic situation. Conclusion Although most HSPs agreed that the extension of mandatory childhood vaccines was essential, some were ambivalent about its coercive philosophy. Further research is necessary to better understand the reasons of this ambivalence. A fraction did not understand the French vaccination strategy well. Efforts to explain its details to HSPs and an overhaul of their initial training on vaccination are still needed.

Physician perspectives on complementary and alternative medicine in hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic and often debilitating inflammatory condition characterized by frequent nodules, abscesses, sinus tracts, and scars impacting the intertriginous areas. Many patients with HS often report limited treatment success and symptom coverage with conventional therapies. Recent studies have reported the widespread use of complementary and alternative medicine (CAM) among patients with HS. In this study, our aim was to examine current physician practice patterns, opinions, and comfort with recommending CAM. Our results indicate that provider comfort and opinions on CAM varied based on the provider's experiences, demographics, and the CAM modality itself. Overall, nearly two-thirds (n = 30, 61.2%) of respondents agreed that CAM and conventional medicine were more effective together than either alone. Meanwhile, 44.9% (n = 22) of respondents routinely recommend CAM while 64.6% (n = 31) of respondents reported that they are routinely asked about CAM. The majority (n = 41, 83.7%) of respondents indicated a lack of scientific evidence in the medical literature as a barrier to recommending CAM along with efficacy concerns (n = 34, 69.4%) and ability to recommend reputable CAM products (n = 32, 65.3%) and practitioners (n = 32, 65.3%). Future investigations are warranted to establish a better understanding of the efficacy and benefit of CAM methods in conjunction with conventional methods.

Contribution of Ultrasonography of Hands and Wrists in Early Rheumatoid Arthritis.

Early diagnosis and management of rheumatoid arthritis (RA) have improved the outcome of patients. In the last decade, musculoskeletal Ultrasonography (MSUS) had demonstrated its superiority over clinical examination in detecting synovitis in RA. We conducted this present study in order to assess the added value of MSUS in diagnosing early RA. A cross-sectional study was conducted, including one hundred patients diagnosed RA based on the physician's opinion and presenting with inflammatory arthralgia or swollen joints for more than 6 weeks and less than 2 years. Patients underwent clinical, laboratory, and radiographic examination. MSUS was performed by a radiologist blinded to clinical findings assessing 22 joints of hands. A US ACR/EULAR 2010 score was calculated by replacing the swollen joints of hands with those expressing synovitis in Greyscale US. Agreement between clinical and US ACR/EULAR score was assessed. Among the 2200 joints scanned by the US, synovitis was detected in 81% of patients, an intra-articular effusion in 36% patients, and PD signals in 51% of patients. Flexor tenosynovitis was present in 55% of patients and extensor tenosynovitis in 59% of patients. Synovitis and PD signals were more often detected in wrists. PD mode was found to be correlated with CRP results (r=0,302, p=0,023). The MSUS assessment has demonstrated synovitis on 71% (N=22) patients who were free of swollen joints on clinical examination. Through 13 patients expressing monoarthritis at clinical examination, 69% (N=9) patients were reclassified with oligo or polyarthritis. By adding US data, a further 13 patients accomplished the ACR/EULAR score. A good level of agreement was found between clinical and US ACR/EULAR criteria (k=0,684, p=0,001). MSUS is an inexpensive and accessible examination tool, which should be considered in patients in the onset of an inflammatory rheumatic disease in order to benefit of the window of opportunity and reach remission.

Complementary and alternative medicine in epilepsy: A global survey of physicians’ opinions

PurposeTo investigate the opinions of physicians on the use of complementary and alternative medicine (CAM) in patients with epilepsy (PWE) worldwide. MethodsOnline survey addressed to neurologists and psychiatrists from different countries. ResultsTotally, 1112 physicians from 25 countries (different world region: Europe, North America, South America, Middle-East, Africa, Former Soviet Union Republics) participated; 804 (72.3%) believed that CAM might be helpful in PWE. The most commonly endorsed CAM included meditation (41%) and yoga (39%). Female sex, psychiatry specialization, and working in North and South America were associated with the belief that CAM is helpful in PWE. Two-hundred and forty five out of 1098 participants (22.3%) used/prescribed CAM to PWE; among them, 174 (71%) people perceived CAM to be less effective and 114 (46.5%) people found CAM to be safer than conventional antiseizure medications (ASMs). The most common reasons to prescribe CAM for PWE were: to satisfy the patient (49.9%), dissatisfaction with the efficacy (35.6%), and dissatisfaction with the adverse effects (31.2%) of conventional therapies. ConclusionAlthough the evidence supporting the use of CAM for the treatment of epilepsy is extremely sparse, most physicians worldwide believe that it could be integrated with the use of conventional ASMs, at least in some patients. High-quality controlled trials are warranted to provide robust evidence on the usefulness of CAM options in PWE.

Opinion of physicians and the general population on the legalization of euthanasia and assisted suicide.

In some countries, particularly Spain, one of the arguments used to justify the legalization of euthanasia is that there is a strong social demand for it. To try to ascertain the truth of this statement, we review different surveys of physicians and the general public, to determine their opinion on whether or not to legalize this practice. We found that the percentage of respondents who approve this practice varies widely from one country to another, with some countries in which approval is close to 80% and others in which it fails to reach even 40%. It has been suggested that this may be because the questions included in the various surveys differ greatly, since not all use the word ″euthanasia″ directly, replacing it with words or phrases of similar meaning. Thus, some respondents may not quite identify them with euthanasia. We conclude that, in the vast majority of countries, there does not seem to be an objective social demand to justify the legalization of euthanasia.

Factors influencing adjuvant treatment decision making among Chinese patients with hepatocellular carcinoma (HCC): Results of a patient survey.

346 Background: This study aimed to understand patient decision-making factors for post-operative adjuvant treatment after resection of hepatocellular carcinoma (HCC) in China. Methods: Patients who had received surgical resection of HCC in the last 2 years at 27 hospitals in China were surveyed using a questionnaire (https://pro.wenjuan.com/t/jUZFU). Feedback was collected by telephone or online. The survey covered three domains: adjuvant treatment decision making, selection of treatment regimen and the influence of recurrence risk on willingness to receive adjuvant treatment. For each domain, participants were asked to identify decision makers and to score decision-making factors from 1 (no influence) to 7 (high influence). All factors with an average score of 6 or 7 points were considered impactful, and those with scores ≤5 were not considered impactful. Descriptive statistics were used to summarize the findings. This study was approved by the ethics committee of Zhongshan hospital and patients provided informed consent. Results: In total, 2,220 valid responses were collected (2,183 patients from Zhongshan Hospital, 37 from 26 other hospitals); 75% of respondents were male, 60% were aged 50-70 years, and 50% had a monthly family income ≤5,000 Chinese Yuan (~$740 USD). Among respondents, 62% had received adjuvant treatment: 56% received systemic therapy (chemotherapy, tyrosine kinase inhibitors, immune therapy and traditional Chinese medicine), 27% transarterial chemoembolization (TACE) plus systemic therapy and 17% TACE alone. The majority of respondents (75%) identified physicians as the decision makers for use of adjuvant therapy and selection of treatment regimen. Of the 38% of respondents who did not receive adjuvant treatment, 90% gave ‘physician recommendation’ as the reason. When patients were the decision makers, factors influencing decisions to use adjuvant treatment and selection of treatment regimen, ranked from most to least influential, were efficacy (for prevention of tumor recurrence), reimbursement status, treatment side effects and cost. Patient willingness to receive adjuvant treatment was influenced by predicted risk of recurrence; among respondents with an estimated 2-year recurrence risk > 10% and > 30%, 40% and 56%, respectively, believed they should receive adjuvant therapy. Conclusions: A majority of patients surveyed received adjuvant therapy, the most common of which were systemic therapy and TACE. Patients who underwent resection had a strong desire to reduce postoperative recurrence by using adjuvant therapy. Physician opinion was identified as the most important factor in treatment decision making, followed by economic factors. When patients were the decision maker, the most influential factors were treatment effectiveness followed by reimbursement status.

Investigating the factors enabling the accurate implementation of the patient-assisted teledermatology model during the pandemic in Turkey: A pilot study.

We aim to investigate the factors enabling the accurate implementation of the patient-assisted teledermatology model during the pandemic in our country. This single-center, a prospective-survey study was enrolled consecutively 468 patients aged 13 years and older. The patients were asked about their attitudes towards teledermatology. After the dermatological examinations, the diagnosis and management of the diseases, and classification of diseases according to lesion locations were recorded. The physician's and the patient's opinions on whether it was possible to manage properly the current medical condition through teledermatology were recorded. The patients stated that 81.2% have been keen to use teledermatology for any complaints during the pandemic. 53.7% of the patients who are positive to use teledermatology expressed that they would never use this method unless it is fully reimbursed. Although it was thought that 49.8% of the current complaints according to the patients and 56.6% to the dermatologists could be resolved appropriately by teledermatology, for 24.8% either the patient's or the physician's opinion was contrary. Being woman, high-income level, and the presence of facial dermatosis favorably affected the patients' and physicians' evaluations regarding the suitability of the complaint to teledermatology. Factors such as low education level, insufficient technical skills to be examined alone, and the necessity of undressing for examination caused patients to consider teledermatology unsuitable for their current complaints. Priority should be given to the development of an appropriate reimbursement system and reducing potential medicolegal risks to encourage patients to participate in high-quality teledermatology.

Validation of a novel causality assessment scale for adverse events in non-small cell lung carcinoma patients treated with platinum and pemetrexed doublet chemotherapy.

Aim:Accurate causality assessment (CA) of adverse events (AEs) is important in clinical research and routine clinical practice. The Naranjo scale (NS) used for CA lacks specificity, leading to a high rate of false positive causal associations. NS is a simple scale for CA; however, its limitations have reduced its popularity in favour of other scales. We therefore attempted to improvise the algorithm by addressing specific lacunae in NS.Methods:We attempted to modify the existing NS by (a) changing the weightage given to certain responses, (b) achieving higher resolution to certain responses for delineating drug related and unrelated AEs and (c) modifying the slabs for classification of association as ‘likely’ and ‘unlikely’. The new scale, named as the Sharma-Nookala-Gota (SNG) algorithm, was evaluated in a training set of 19 AEs in a tertiary care cancer hospital in western India, and further validated in a set of 104 AEs. Consensus of four physician opinion was taken as gold standard for comparison.Results:Of the 19 AEs in the training set, 6 were described by the treating physician as ‘not related’ and 13 as related to the drug. The SNG algorithm had 100% concordance with physician opinion, whereas the NS had only 73.7% concordance. NS showed a tendency to misclassify AEs as ‘related’ when they were indeed ‘not related’. In the validation set of 104 AEs, NS and SNG algorithms misclassified 30 and 2 AEs, respectively, leading to a concordance of 70.2% and 98.1%, respectively, with physician opinion.Conclusion:Decisive modifications of the NS resulted in the SNG scale, with superior specificity while retaining sensitivity against the gold standard.Plain Language Summary SNG algorithm – A novel tool for causality assessment of adverse drug reactions Adverse events (AEs) can cause increased morbidity, hospitalisation, and even death. Hence it is essential to recognise AEs and to establish their correct causal relationship to a drug. Many causality assessment methods, scales and algorithms are available to assess the relationship between an AE and a drug. The Naranjo algorithm is most commonly employed in spite of its many drawbacks as it is simple to use. Concerns have been raised regarding the performance of the scale, and researchers have tried to answer them, but none of them could address all issues satisfactorily. We too experienced many problems while using it in our routine clinical practice and in clinical trials. For instance, the Naranjo scale is non-specific and shows a bias toward implicating the drug as the causal factor for AEs. This improper assessment has often led to drug discontinuation, thereby compromising the efficacy of treatment. Hence, we modified the existing Naranjo scale to a new one (the Sharma-Nookala-Gota – SNG algorithm) to address these shortcomings. We piloted the SNG causality assessment algorithm in patients suffering from AEs due to various drugs. The SNG algorithm was found to have good concordance with the physicians’ assessment of causality. As a next step, we validated the SNG algorithm in patients receiving a standard drug combination of pemetrexed and carboplatin for lung cancer combination. Out of the 104 AEs observed in 65 patients, the SNG causality assessment algorithm showed good concordance (except in two cases) with the physicians’ decision of causality assessment, while the Naranjo algorithm was not so successful. Hence, the SNG algorithm can be a better guide for causality assessment of AEs.

Opinion of primary care physicians regarding prescription of generic drugs: A Cross-sectional study.

Background:Generics are low-cost alternatives of the existing approved branded drugs. The aim of this work was to study knowledge and perception about generic drugs among the doctors practicing in government and private healthcare sectors.Methods:A cross-sectional study was conducted with a prevalidated questionnaire. Physicians working in government and private healthcare sectors were asked to fill the survey form after obtaining written informed consent. Descriptive analysis was used.Results:Of 240, 11.6% of primary care physicians could identify all the correct statements regarding generic drugs and 57% physicians agreed or strongly agreed that doctors should prescribe only generic drugs. Substandard quality (24.4%) and less effectiveness (35.6%) of generics was cited major reason for low use. Majority (76.1%) believed that patients will accept substitution of branded with generics but 21% either did not or rarely inform patients regarding generics. Only 11.7% considered generics has low efficacy as compared to branded drugs but majority (57.4%) denied the interchangeability of generics. Majority were aware about the Jan Aushadhi scheme (79.3%) and Indian Medical Council Act (Professional conduct, Etiquette and Ethics) (76.8%). For personal use, 45.6% preferred generics. Around 44% agreed/strongly agreed for pharmacist's right to substitute branded drugs with generics but private practicing physicians opted against it.Conclusion:Knowledge and acceptance of generic drugs is still low amongst the doctors. Efforts need to be done increase the awareness and acceptability.

Self-Evaluation of The Candidate Physicians Regarding Competences Expected From a Graduate of Medical School

Background: In the context of good medical practices, physicians perform their duty as a role model for their colleagues for the benefit of patients, without any discrimination, by prioritizing professional responsibilities, ethical principles and human values”. In this context, it is important for physicians to receive ethical education based on humanistic and professional values. There are national and international standard setting studies intended to determine the content of ethics education in medicine. The Association for the Evaluation and Accreditation of Medical Education Programs, which continues its efforts to ensure quality assurance, has set a standard for medical faculties related to the professional ethical development of physicians.This study aims to determine opinions of the candidate physicians who are at the graduation stage in medical education on their own competencies against a list of competencies defined in "National Competencies Framework for Medical School Graduates".Methods: This is a cross-sectional study and the target population consists of the candidate physicians who are at the graduation point in the 2019-2020 academic year of Akdeniz University Faculty of Medicine (AUFM) (n=240). A digital data gathering form including two parts was used in the study. In the first part, there were questions about sociodemographic characteristics of the participants. The second part was prepared by the researchers on the basis of the competence list for medical school graduates which is available in the “National Core Curriculum for Undergraduate Medical Education‐2014”. Twenty-four items from the competence list were thought to relevant to ethical issues and used in the study. For each of these 24 items, a five-item likert scale was prepared for the participants to rate themselves on it. The participants filled out the forms online. Results: The self-evaluation scores of the participants did not differ according to their sociodemographic characteristics. Mean and median values for all items are around “4” on the five-point scale. Conclusion: Self- evaluation scores of the participants on ethics related items of the competence list are high which means that they find themselves well-equipped on ethical issues at the graduation point from medical school.

Co-morbidities associated with various ear nose throat conditions of geriatric patients in a tertiary care hospital

<p><strong>Background: </strong>Old age is a sensitive phase in which lack of awareness regarding the changing behavioural patterns leads to major physiological and psychological problems. This emphasizes the need for a study on the co-morbidities associated with ENT conditions among geriatric population presented in a tertiary care hospital.</p><p><strong>Methods</strong>: A discrete study was done among the elder patients (≥65 years) admitted in ENT department. Detailed history was taken regarding their co-morbidities and health problems using questionnaire. Feedback of these patients with respect to their ENT conditions as well as co-morbidities was recorded during hospital stay and subsequent follow-upin ENT outpatient department. Opinion of general physician, neurologist, cardiologist was sought and advices followed for management of co-morbidities. The prevalence of co-morbidities and health problems were subjected to statistical analysis.</p><p><strong>Results</strong>: A total of 141 patients (90 male and 51 female) were included in the study. The most common ENT associated illness for the admission was epistaxis (23/141, 16.3%) and vocal cord pathology (23/141,16.3%). The most common associated co-morbidities were hypertension (54/141, 38.2%) and type 2 diabetes (51/141, 36.17%). Symptomatic improvement and patient satisfaction with treatment offered were higher with adequate management of co-morbidity.</p><p><strong>Conclusions</strong>: The most common ENT associated illness for the admission was epistaxis and vocal cord pathology which was associated with hypertension and type 2 diabetes. Better control of these co-morbidities improves treatment outcome as well as patient satisfaction, trust with medical field.</p>

Working restrictions and disability benefits eligibility in patients with functional (psychogenic) seizures: An international survey of physicians’ opinions

ObjectivesIn this international study, we aimed to investigate the opinions of physicians dealing with patients with functional seizures (FS) worldwide on working restrictions and disability benefits eligibility. MethodsInternational online survey of neurologists/mental health professionals from Argentina, Venezuela, Colombia, Italy, France, Iran, Iraq, United Arab Emirates (UAE), Qatar, Saudi Arabia, Georgia, and Russia. ResultsSix hundred and twenty-seven physicians from 12 countries participated in the study. Working as a neurologist was a predictor to think that patients with FS should not be counseled to avoid performing all jobs or professions as long as they have active disease (OR: 0.46; 95% CI: 0.30 to 0.68; p < 0.001). Having managed more than 200 patients was associated with the opinion that patients should not be counseled to avoid performing any type of work (OR: 2.17; 95% CI: 1.02 to 4.59; p = 0.043). Working as a psychiatrist/psychologist was associated with the idea that patients with FS should be qualified for disability benefits (OR: 1.97; 95% CI: 1.21–3.21; p = 0.006), and receive these benefits lifelong (OR: 0.43; 95% CI: 0.22–0.84; p = 0.014). ConclusionNeurologists and mental health professionals have different attitudes and opinions toward working restrictions and disability benefits for patients with FS. Further studies should investigate the reasons for these differences, and propose solutions to avoid discrimination and unequal access to employment and disability benefits.

Medical Error, Adverse Events, and Complications in Interventional Radiology: Liability or Opportunity?

This review suggests that there is a critical need to renew understanding of adverse events and complications within interventional radiology and to redefine a robust commitment to patient safety a...

Physicians' Perceptions of a Situation Awareness-Oriented Visualization Technology for Viscoelastic Blood Coagulation Management (Visual Clot): Mixed Methods Study.

BackgroundViscoelastic tests enable a time-efficient analysis of coagulation properties. An important limitation of viscoelastic tests is the complicated presentation of their results in the form of abstract graphs with a multitude of numbers. We developed Visual Clot to simplify the interpretation of presented clotting information. This visualization technology applies user-centered design principles to create an animated model of a blood clot during the hemostatic cascade. In a previous simulation study, we found Visual Clot to double diagnostic accuracy, reduce time to decision making and perceived workload, and improve care providers’ confidence.ObjectiveThis study aimed to investigate the opinions of physicians on Visual Clot technology. It further aimed to assess its strengths, limitations, and clinical applicability as a support tool for coagulation management.MethodsThis was a researcher-initiated, international, double-center, mixed qualitative-quantitative study that included the anesthesiologists and intensive care physicians who participated in the previous Visual Clot study. After the participants solved six coagulation scenarios using Visual Clot, we questioned them about the perceived pros and cons of this new tool. Employing qualitative research methods, we identified recurring answer patterns, and derived major topics and subthemes through inductive coding. Based on them, we defined six statements. The study participants later rated their agreement to these statements on five-point Likert scales in an online survey, which represented the quantitative part of this study.ResultsA total of 60 physicians participated in the primary Visual Clot study. Among these, 36 gave an interview and 42 completed the online survey. In total, eight different major topics were derived from the interview field note responses. The three most common topics were “positive design features” (29/36, 81%), “facilitates decision making” (17/36, 47%), and “quantification not made” (17/36, 47%). In the online survey, 93% (39/42) agreed to the statement that Visual Clot is intuitive and easy to learn. Moreover, 90% (38/42) of the participants agreed that they would like the standard result and Visual Clot displayed on the screen side by side. Furthermore, 86% (36/42) indicated that Visual Clot allows them to deal with complex coagulation situations more quickly.ConclusionsA group of anesthesia and intensive care physicians from two university hospitals in central Europe considered Visual Clot technology to be intuitive, easy to learn, and useful for decision making in situations of active bleeding. From the responses of these possible future users, Visual Clot appears to constitute an efficient and well-accepted way to streamline the decision-making process in viscoelastic test–based coagulation management.

Flipped Classrooms in Physician Assistant Education.

This study assessed the impact of flipped classrooms on physician assistant (PA) students' performance and opinions. Students completed quizzes and an opinion survey in Genetics, Human Pathophysiology (HPP), Clinical Medicine (CM) (n = 105) and Physical Exam (PE) (n = 98) courses. In Genetics and PE, the quiz scores were significantly higher for flipped classrooms (Genetics 95.00 ± 6.56; PE 83.09 ± 11.47) compared to the traditional lectures (Genetics 90.00 ± 10.53; PE 55.43 ± 16.66). In HPP, students performed better with traditional lectures (86.54 ± 8.82) compared to the flipped classrooms (75.12 ± 8.54). In CM, students' gain score was significantly higher for flipped classrooms (37.85 ± 16.73) than for traditional lectures (20.97 ± 15.55). The opinion surveys showed that the students surveyed preferred traditional lectures over flipped classrooms in Genetics (4.58 ± 0.46 vs. 2.29 ± 0.71) and HPP (4.14 ± 0.35 vs. 2.09 ± 0.53). Flipped classrooms improved the quality of learning in courses that deliver a hands-on skill or use case-based scenarios. They may not be an ideal choice for courses that require explanation of intricate scientific concepts.

Comparing Physician and Nurse Opinions of Team and Individual Handoffs: Does Role Influence Preference?

Care transitions are key to patient safety and remain a safety issue despite previous research. This study examines how the design of care transitions impacts different health care professions. Twenty-nine physicians and nurses were interviewed about operating room to intensive care unit care transitions. We compared relationships between work system elements in positive and negative opinions about two sociotechnical system designs: including team or individual handoffs. Nurses did not express positive opinions of individual handoffs or negative opinions of team handoffs, while physicians expressed positive and negative opinions of both. Relationships between work system elements varied by profession in the positive opinions about team handoffs and negative opinions about individual handoffs. Professional needs and culture may be related to the different perceptions of each handoff. Future work should continue to examine professional differences when developing a flexibly standardized process to ensure all users are considered.

How accurate is telephone triage in out-of-hours care? An observational trial in real patients

ABSTRACT Objectives Patients in Belgium needing out-of-hours medical care have two options: the emergency department (ED) or a general practitioner (GP) on call. Currently, there is no triage system in Belgium, so patients do not know where they should go. However, patients who could be managed by a GP frequently present themselves at an ED without referral. GPs often organise themselves in a General Practitioners Cooperative (GPC). This study assesses the accuracy of a newly developed telephone triage guideline. Methods Observational real-time simulation: all walk-in patients at two GPCs and three EDs were asked to call a triage telephone number with their current medical problem. The operator handling this call registered an urgency level and a resource (ED, GP or ambulance) to deploy. The treating physician's opinion was used a the gold standard for correct triage. Patients were not informed about the outcome of the triage and continued the standard care path they had chosen. Results The overall sensitivity of the telephone triage for detecting patients who could be managed by a GP was 82% with a specificity of 53%. The correctness of the advice given by the operator according to the physicians was 71%, with 12% underestimation of urgency and 17% overestimation. At the GPC, the sensitivity for detecting patients requiring GP management/care was 91% with a specificity of 36%. At the ED, the sensitivity for detecting GP patients was 67% with a specificity of 48%. Conclusion This study evaluates a new guideline for telephone triage, showing potential overtriage for patients wanting to attend the GPC, with possible inefficiency, and potential undertriage for patients wanting to attend the ED, with possible safety issues.

Primary care quality in Vietnam: Perceptions and opinions of primary care physicians in commune health centers - a mixed-methods study.

IntroductionMeasuring the performance of a primary care system is one of the very first steps to find out whether there is room for improvement. To obtain an objective and comprehensive view, this measurement should come from both the supply and demand sides of the system. Patients’ experiences of primary care have been studied around the world, but much less energy has been invested in researching providers’ perspectives. This research aims to explore how primary care physicians working at commune health centers in Vietnam evaluate their performance and their opinions on how to improve the quality of primary care services.Materials and methodsFirst, a quantitative study was conducted using the validated Vietnamese PCAT questionnaire—provider expanded version (VN PCAT PE) targeting all primary care physicians (PCPs) working at commune health centers in a province of Central Vietnam. Next, a qualitative study was carried out, consisting of in-depth interviews with PCPs, to better understand the results of the quantitative survey and gain insight on barriers of primary care services and how to overcome them.ResultsIn the quantitative portion of our study, 150 PCPs rated the quality of ongoing care and first contact in CHCs as the best (3.09 and 3.11 out of 4, respectively), and coordination as the worst performing core domain (2.53). Twenty-two PCPs also participated in our qualitative research. In regards to challenges that primary care physicians face during their daily practice, three central themes emerged: 1) patient factors such as client attitude and knowledge, 2) provider factors such as the burden of administrative work and lack of training opportunities, and 3) contextual factors such as low income and lack of resources including medicines and diagnostics. Participants recommended more health promotion campaigns in the media, increasing the number of services available at CHCs (such as being able to take blood samples), reducing the workload related to administration for CHC leaders, greater government subsidies, and providing more training courses for PCPs.ConclusionsFindings from this study offer a valuable view from the supply-side of the primary care system, specifically those who directly deliver primary care services. Along with the earlier study on consumers’ evaluation of the Vietnamese primary care system, and literature from other low and middle-income countries, these findings offer emerging evidence for policymakers to improve the quality of primary care in Vietnam.