Opinions Of Physicians Research Articles

Clinical, laboratory and instrumental predictors of the effectiveness of anti-inflammatory therapy in COVID-19

BACKGROUND: Anti-inflammatory therapy is a leading method of pathogenetic treatment of moderate and severe forms of COVID-19. The drugs used during anti-inflammatory therapy, in particular, dexamethasone, olokizumab, tocilizumab, and baricitinib, are still actually prescribed in off-label mode. Of course, their use is justified by the Russian and international clinical guidelines, practical experience, expert opinions. However, the opinion of an attending physician, based on the assessment of the risk/benefit ratio for each patient, is fundamental in determining a drug for anti-inflammatory therapy. Determination of clinical and laboratory predictors of anti-inflammatory therapy effectiveness in moderate and severe forms of COVID-19 will facilitate a decision-making process when identifying risk groups for developing an adverse outcome during anti-inflammatory therapy, as well as determining an optimal drug for an anti-inflammatory therapy, taking into account the identified criteria.
 AIM: To compare the effectiveness of preemptive anti-inflammatory therapy with anticytokine drugs (tocilizumab, olokizumab, baricitinib, dexamethasone) in the patients with moderate and severe COVID-19 to identify clinical, laboratory and instrumental predictors of anti-inflammatory therapy outcome.
 MATERIALS AND METHODS: A retrospective analysis of 229 cases of severe and moderate COVID-19 disease requiring various types of anti-inflammatory therapy at the Hospital of War Veterans, including the Lenexpo site.
 RESULTS: The study has identified the main (significantly affecting the outcome) and additional (significant) predictors of the effectiveness of anti-inflammatory therapy in moderate and severe forms of COVID-19. The main ones include: the level of oxygen support, the period from the onset of clinical manifestations, the level of C-reactive protein, D-dimer. The additional, but significant factors include: the amount of damage to the lung tissue according to the computed tomography data, the presence and degree of compensation of concomitant pathology, the presence of therapy for concomitant pathology, as well as the level of leukocytes and neutrophils in the clinical blood test.
 CONCLUSIONS: The presence of additional oxygen support is a leading predictor of the effectiveness of an anti-inflammatory therapy, and its administration as early as possible, if indicated, can significantly increase the chances of a favorable outcome for a patient with moderate to severe COVID-19. Important prognostic markers also include C-reactive protein and D-dimer. The presence of concomitant diseases in anamnesis, as well as the degree of lung damage according to computer tomography data, are significant factors; however, they should be compared with other clinical and laboratory data and the objective status of the patient in order to predict the outcome of an anti-inflammatory therapy.

Correlation Amongst Scoring of Various Frailty Tools in Myeloma Patients Undergoing Autologous Stem Cell Transplantation

Introduction: With the growing array of treatment options for multiple myeloma (MM) patients, it is important to individualize the approach at each point in the patient's treatment journey. Frailty scores such as the Revised Myeloma Comorbidity Index (R-MCI) can help match therapeutic intensity to patient fitness, particularly important in the elderly. The R-MCI has been prospectively validated in transplant patients and found to be predictive for PFS and OS outcomes. At our centre, we are enrolling patients deemed transplant-eligible by standard institutional criteria into a prospective study applying a variety of frailty tools, including objective measures of comorbidity/function and subjective measures based on patient self-assessment and physician opinion. These tools are applied at time of transplant clearance, not at diagnosis as previously studied, to take into consideration changes in frailty that occur during the initial treatment phase. The primary objective is to identify normative frailty scores at this timepoint and correlate with severity of transplant-related toxicity. In this analysis, we present data on the first 101 enrolled patients, reporting the various frailty scores and their inter-correlation. Patients and Methods: The first 101 consecutive MM patients preparing for autologous transplant (ASCT) and consented for the frailty study were included. Patients underwent comprehensive frailty assessments including: 1) objective measures of fitness [hand grip strength, 6-min walk test (6MWT), Timed Up and Go (TUG), 2) subjective measures of function (abbreviated Fried Frailty Phenotype Score (FFP), Rockwood Clinical Frailty Score, KPS, ECOG, HSCT-CI, ESAS), 3) scoring systems integrating both objective and subjective measures (R-MCI, International Myeloma Working Group geriatric assessment tool (IMWG-GAT), and 4) routine screening for organ function (creatinine clearance, serum albumin, hemoglobin, BNP, PFT, and cardiac imaging). Demographics including disease and treatment details were obtained from electronic medical records. Measures were evaluated with Chi-square/Fischer's exact test/Kruskal-Wallis test to assess the association between the various frailty scores. In addition, frailty scores were compared against R-MCI as baseline. All p values were 2-sided and p≥0.05 was considered statistically significant. Results: From Feb 2020 to July 2022, 101 patients consented for the frailty study and were included in this analysis. Patient characteristics and frailty scores are summarised in Table 1. ASCT was part of upfront treatment in 87 patients (86%), with 14 patients (14%) receiving salvage transplant at relapse. Median age was 63 years (35-75), with 9(9%) age 70 and above. In general, our transplant-eligible population tested well on most frailty scores, mostly falling within the fit or intermediate-fit categories, as expected. Notable exceptions were significantly poorer handgrip strength and 6MWT than observed in the literature. Only 2 of 101 patients in our analysis were able to walk >400 metres, a threshold for fitness cited in prior transplant studies. Most scoring systems in our analysis correlated in designating our cohort as "fit” or "intermediate fit". When using the transplant-validated R-MCI scores as our gold standard, we observed correlations with the IMWG-GAT and Rockwood scores (p=0.0014 and <0.0001 respectively). The simple-to-perform ECOG and HCT-CI indices also correlated highly with R-MCI.(Table 2) That said, the R-MCI lacked discrimination in our patient population, with almost all patients clustered into the fit or pre-fit categories (98/101; 98%). Conclusions: In this analysis of various frailty assessments applied at ASCT for MM, we report that most scoring systems correlated but generally lacked discrimination in this relatively fit cohort. Even the widely cited R-MCI which is validated in both myeloma and transplant, has limited utility in discriminating within this more homogeneously fit population. We will hence focus next on identifying scoring systems or individual tools that can further define the less fit or mildly frail within the "fit” category, allowing us to identify subgroups for medical optimization pre-ASCT. We also note that physical function testing such as handgrip and 6MWT may have limited utility in myeloma where disease-related disability may prevent full engagement. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Position paper from the Endocrine Task Force of the European Organisation for Research and Treatment of Cancer (EORTC) on the management and shared decision making in patients with low-risk micro papillary thyroid carcinoma

The incidence of differentiated thyroid cancer (DTC) has been increasing worldwide, mostly, as an increase in the incidental detection of micro papillary thyroid carcinomas (microPTCs), many of which are potentially overtreated, as suggested by the unchanged mortality. Several international guidelines have suggested a less aggressive approach. More recently, it has been shown that active surveillance or minimally invasive treatments (MIT) are good alternatives for the management of these patients. In this context, patient participation in the decision-making process is paramount. The Endocrine Task Force of the European Organisation for Research and Treatment of Cancer (EORTC) has undertaken the task to establish consensus and define its position based on the scientific evidence concerning, 1) the current state of diagnostic and management options in microPTCs, including the current opinion of physicians about shared decision making (SDM), 2) the available evidence concerning patients' needs and the available decision instruments, and 3) to provide practical suggestions for implementation of SDM in this context. To improve SDM and patients' participation, knowledge gaps and research directions were highlighted.

Comparative analysis of the opinion of physicians and patients of the obstetric and gynecological clinics on communication issues

IntroductionThe article presents the results of the study of communicative patterns that have developed in everyday obstetric and gynecological practice, as well as a comparative analysis of the representation of patients and doctors about them. The purpose of the study was to study and compare the opinions of doctors and patients of obstetric and gynecological profile on communication issues.Materials and methods. A total of 491 obstetrician-gynecologists and 975 patients treated in obstetrician-gynecological hospitals and antenatal clinics were interviewed. The data were statistically processed using the SPSS v 24.0 software package. Qualitative data were expressed as fractions (%), for which the 95 % confidence interval (95 % CI) was calculated by the Wilson method. Significance of differences between groups with nominal variables was assessed using the χ2 test (differences were considered significant if p ≤ 0.05).Results. It was revealed that 3.1 % of patients and 25.3 % of physicians always face communication difficulties. In the case of patients, 67.5 % of patients and only 8.8 % of doctors were in favor of greater involvement in the decision-making process regarding treatment tactics. Physicians experience communication difficulties much more often than patients, and rarely satisfy patients' need to receive information about their health condition in full.Discussion. Patients nowadays increasingly want to participate in discussions about their diagnosis and treatment tactics on an equal footing with their physician. The novelty of this study is the comparison of responses to the same questions from patients and physicians, which allows us to assess the two perspectives of communication participants.Conclusion. Physicians are more likely to have difficulty communicating with patients and are unable to meet patients' need for full information about their health status. More widespread implementation of modern technologies in the communication process is needed, and the identified communication patterns and opinions of the main participants in the communication process should be the basis for the development of measures aimed at improving its effectiveness.

A CASE REPORT ON: MANAGEMENT AND COMPLICATION OF HANGING

Background: The process of breathing, or the exchange of air between the atmosphere and the lungs' alveoli, is impaired in cases of hanging by a neck rope, which results in asphyxia and death. Main symptoms and important findings: A 27-year-old male was admitted to a rural hospital with complaints of hanging from a fan at home after a fight with his wife, with unconscious state, and one episode of seizure associated with up rolling off the eyeball, frothing from the mouth, and tonic-clonic movement. There was previous deliberate self-harm. Given low GCS, the patient was immediately intubated with ET TUBE 7.5 and taken on mechanical ventilation on volume control mode with peep 5, RR 16, Spo2 100%, TV 360 ml. rapid antigen test was done which came out to be negative and ECG done and show sign of tachycardia. Chest and spine X-RAY was done. CT brain done and the finding was normal. EEG was done and show the finding was beta activity and no epileptiform changes. An orthopedic physician's opinion was taken and to continue Philadelphia collar for 4 weeks was advised. The main diagnosis, therapeutic interventions, and outcomes: After a physical examination and investigations doctor diagnosed a case of hanging with depression. Medical management was provided with Inj. Ceftriaxone 1 gm intravenous twice a day for 9 days, Inj. Pan 40 mg intravenous once a day, Inj. Emset 4 mg three times a day, Inj. Levipril 500 mg twice a day, Inj. Dexa 6 mg once a day for 5 days, Nebulization With Duolin And Budecort three times a day, intravenous fluids given. Now his outcomes were good. His complications were reduced. Conclusion: Hanging is a complicated case and produces more complications but early diagnosis management can secure the life of a patient and reduce the complication of hanging.

Attitudes of Polish Doctors towards Brain Death.

Brain death has been one of the most controversial issues in the medical and bioethical debate globally for more than fifty years. There is no unanimous acceptance of the understanding of brain death, and a single set of neurological criteria for the determination of human death that is accepted worldwide has yet to be established. Physicians from different specialisations understand brain death differently. Therefore, research is needed to understand and typologically classify their points of views as regards brain death. In Poland, this research is particularly important, as the views of anaesthesiologists, neurologists and transplantologists, who fully accept and support brain death as being synonymous with biological human death, have dominated the scholarly debate on this issue. This study presents the opinions of Polish physicians with various medical specialisations in relation to brain death. Free-form interviews with 28 doctors were conducted. Participants expressed their personal views on brain death, while exhibiting at the same time various emotions. We discuss our findings in relation to the existing framework of knowledge and debate concerning brain death and the Polish legal regulation in force when the interviews were carried out. Although participants had different beliefs with regard to brain death, the research team managed to classify their statements and opinions into five attitudes, taking into account what for them were the most important, namely: the escapist-protective attitude, the scientistic-medical attitude, the accepting-critical attitude, the ignorant-agnostic attitude, and the ambiguous attitude.

Ethics of Resident Involvement in Surgical Training

INTRODUCTION: An attending surgeon must maintain a balance between allowing appropriate resident independence while ensuring safe medical management of the patient. This pilot investigation aims to characterize these conflicts within an ethical framework by qualitative analysis of opinions of active teaching physicians and residents in the field. We hypothesize that the ethical principles of patient autonomy, physician beneficence, and justice/equal opportunity can be applied to organizing the themes and opinions that will be provided by study participants. METHODS: After IRB approval, attending physicians and residents from 3 Accreditation Council for Graduate Medical Education–approved institutions were invited to participate in our pilot study. Participation involves completion of an anonymous, peer-revised online survey, structured to characterize the ethical foundations of surgical teaching from the perspective of both teachers and trainees. The survey answers and general demographics are transcribed and coded for quantitative and qualitative analysis. RESULTS: This study is currently ongoing. In preliminary findings, we have identified particular reluctance in providing autonomy to residents when caring for vulnerable populations (ie children, oncology). The importance of disclosure and informed consent has also been a recurring theme. CONCLUSION: Although surgical residents may measure the success of their training on their level of intraoperative independence, we have identified that intraoperative autonomy afforded to the resident does not only depend on their objective skill or experience. There are complex ethical considerations that the attending surgeon must navigate as they decide on appropriate, effective teaching and safe surgical management, which is especially relevant when vulnerable patient populations are involved.

Physicians’ beliefs about brain surgery for drug-resistant epilepsy: A global survey

PurposeTo investigate the opinions of physicians about brain surgery for drug-resistant epilepsy worldwide. MethodsPracticing neurologists, psychiatrists, and neurosurgeons from around the world were invited to participate in an online survey. The survey anonymously collected data about demographics, years in clinical practice, discipline, nation, work setting, and answers to the questions about beliefs and attitudes about brain surgery for drug-resistant epilepsy. ResultsIn total, 1410 physicians from 20 countries and different world regions participated. The propensity to discuss brain surgery with patients, who have drug-resistant seizures, was higher among men (versus women) [Odds Ratio (OR) 1.67, 95% CI 1.20–2.31; p = 0.002]. In comparison to neurologists, psychiatrists were less likely (OR 0.28, 95% CI 0.17–0.47; p < 0.001) and neurosurgeons were more likely (OR 2.00, 95% CI 1.08–3.72; p = 0.028) to discuss about it. Survey participants working in Africa, Asia, the Middle East, and the Former Union of Soviet Socialist Republics showed a lower propensity to discuss epilepsy surgery with patients. ConclusionThis study showed that on an international level, there is still a knowledge gap concerning epilepsy surgery and much needs to be done to identify and overcome barriers to epilepsy surgery for patients with drug-resistant seizures worldwide.

Perceptions on basilar artery occlusion management in China versus other countries: Analysis of the after the BEST of BASICS (ABBA) survey

IntroductionUncertainty remains on the optimal management of basilar artery occlusion (BAO). Two large randomized controlled trials (RCTs) in 2019 and 2021 demonstrated neutral results with respect to the use of endovascular therapy (EVT) for BAO. This study aimed to understand regional variation in physicians' perceptions towards the treatment of BAO as stratified by physician respondents from China versus outside China, prior to the publication of studies demonstrating a benefit of EVT for BAO. MethodsAn international online survey was conducted of stroke neurologists and neurointerventionalists from January to March 2022. Survey questions evaluated physician opinions toward the use of EVT in BAO, as well as the clinical and imaging features underlying treatment decisions. Respondents were dichotomized as either from China or from other countries and differences between groups were analyzed. ResultsThere were 1245 physician respondents across 73 countries of which 295 (23.7%) were from China. Compared to respondents from the rest of the world, respondents from China were more likely to be interventionalists (71.5% vs 35.0%; p < 0.0001). Overall, more than 95% of respondents believed that EVT was superior to medical therapy under certain circumstances. Chinese respondents were more likely to believe that further RCTs were necessary than respondents from other countries (93.6% vs 76.2%; p < 0.0001). Chinese respondents were more likely to use advanced imaging in later time windows and use a premorbid mRS threshold of ≤2 for BAO selection to EVT. ConclusionMost stroke physicians believe EVT is beneficial in selected patients with BAO. Clinical and imaging modality differences were observed in the selection criteria used for EVT. There was greater inclination to enroll all trial eligible patients in a BAO RCT by respondents from China as compared to other parts of the world.

Palliative home care for older patients with respiratory disease in Japan: Practices and opinions of physicians.

Older adults at the end-of-life stage receiving home visits from physicians often experience symptoms such as dyspnea, pain and fatigue, among others. This study aimed to investigate the practices and opinions of physicians providing home visits regarding palliative care for older adults with respiratory symptoms due to non-malignant diseases in Japan. A nationwide questionnaire survey on home palliative care for non-cancer chronic respiratory diseases was sent to 2988 home-care physicians in 2020 through postal mail and/or email. The questions focused on their background, their use of rating scales to evaluate the intensity of dyspnea, and their practices and opinions regarding home palliative care for respiratory diseases or symptoms. Valid responses were collected from 592 physicians (19.8%). A total of 251 participants (43.1%) used a rating scale to evaluate the intensity of dyspnea. While 87.8%, 86.6%, 67.3%, and 60.0% of physicians considered pulmonary rehabilitation, morphine, sedative medications, and non-invasive positive pressure ventilation (NPPV), respectively, as effective in relieving respiratory distress, 73.0%, 66.9%, 57.3%, and 55.2% of those physicians, respectively, used each modality to relieve respiratory distress. Frequently involved physicians in the aforementioned care prescribed morphine or sedative medications and used NPPV more frequently. This study found a discrepancy between the proportion of physicians who considered palliative care as effective and those who prescribed it. Geriatr Gerontol Int 2022; 22: 943-949.

Opinions of Physicians Working in Intensive Care on Telemedicine and Tele-intensive Care

Opinions of Physicians Working in Intensive Care on Telemedicine and Tele-intensive Care

A survey of physician opinions in Russia in the field of pharmacogenetics of cardiovascular disease.

Aims: To study the readiness of Russian physicians with experience and younger physicians undergoing clinical residency and postgraduate education to apply pharmacogenetic testing in their clinical practice. Materials & methods: The sociological study involved physicians (n =378) living in different regions of the Russian Federation, as well as residents and graduate students (n =185) of the Russian Medical Academy of Continuing Professional Medical Education. The survey consisted of 35 questions, and 23 were created on the online platform of professional surveys, Testograf.ru. Results: Every second respondent was willing to use pharmacogenetic testing in clinical practice to predict the efficacy and safety of medications in patients with cardiovascular disease (p=0.06). Factors impeding the clinical implementation of pharmacogenetic testing in Russia were identified: physicians' ignorance of pharmacogenetics (p=0.015), a lack of pharmacogenetic testing in clinical guidelines and treatment standards (p=0.175) and a lack of economic justification for using pharmacogenetic testing (p=0.320). Conclusion: Russian physicians have a positive attitude toward pharmacogenetic testing. However, the level of test implementation remains low.

Lost in Communication: Do Family Physicians Provide Patients with Information on Preventing Diet-Related Diseases?

: BackgroundDiet-related diseases remain leading causes of death in most developed countries around the world. The aim of the study was to compare opinions of patients and family physicians on receiving and providing recommendations about physical activity, diet and use of medication. Methods: The questionnaire study was conducted among patients of 36 primary health care clinics in Poland between September 2018 and February 2019. Patients and physicians were interviewed separately by trained researchers. Data from 509 patients and 167 family doctors were analyzed. Results: The median age of patients was 44 years (interquartile range: 29–55) and 70% were women. The majority of physicians were women (59%) and the median age was 37 years (IQR: 31–50). There was a significant difference between physicians’ declarations on providing recommendations on diet (92% vs. 39%) and activity (90% vs. 37%) versus patients’ declarations on receiving them. Conclusions: The results indicate that there is significant room for improvement in providing patients with proper recommendations on diet and physical activity by their family physicians. Primary care physicians should put more emphasis on clear communication of recommendations on diet and physical activity.

Implicações éticas dos testes genéticos de suscetibilidade ao câncer de mama

Abstract Breast cancer is a public health problem because it is the malignant neoplasm with the highest incidence in women worldwide. The hereditary form corresponds to about 5% to 10% of all cases and is directly related to the inheritance of genetic mutations. The main ones occur in the BRCA1 and BRCA2 tumor suppressor genes. The identification of these mutations is extremely important because of the high risk of breast cancer development in this population, allowing differentiated screening strategies and the adoption of risk reduction measures. However, reflections on the ethical aspects related to the indiscriminate use of genetic testing are important and necessary. The objective of this study was to evaluate the knowledge and opinion of physicians of an oncology reference center on the indication of genetic tests for susceptibility to breast cancer given the ethical dilemmas to which they are submitted in medical practice.

Pediatric infectious disease physician perceptions of antimicrobial stewardship programs.

Pediatric antimicrobial stewardship programs (ASPs) improve antibiotic use for hospitalized children. Prescriber surveys indicate acceptance of ASPs, but data on infectious diseases (ID) physician opinions of ASPs are lacking. We conducted a survey of pediatric ID physicians, ASP and non-ASP, and their perceptions of ASP practices and outcomes.

Physicians' Beliefs and Attitudes Toward Hypoactive Delirium in The Last Days of Life.

The perspective toward hypoactive delirium in the last days of life could be different among physicians. To clarify the attitudes, beliefs, and opinions of palliative care physicians and liaison psychiatrists toward hypoactive delirium in the last days of life and to explore the association among these factors. A nationwide cross-sectional questionnaire survey was conducted among 1667 physicians who were either certified palliative care specialists or liaison psychiatrists. Physicians' agreement with the appropriateness of pharmacological management (e.g., antipsychotics) (one item), their beliefs (11 items), and their opinions (four items) were measured. 787 (47%) physicians responded. 481 (62%) agreed to use of medications for hypoactive delirium in the last days of life, whereas 296 (38.1%) disagreed. More than 95% agreed with "hypoactive delirium at the end of life can be considered as a part of natural dying process." Multivariate analysis identified two belief subscales of "hypoactive delirium at the end of life is a natural dying process" and "antipsychotics are futile and harmful in managing hypoactive delirium" had a significant negative correlation with the use of medications. On the other hand, one belief subscale of "hypoactive delirium can be distressing even if patients' consciousness is impaired" had significant positive correlations with the use of medications. Pharmacological management of hypoactive delirium in the last days of life differs depending on physicians' beliefs. Future research is needed to clarify the efficacy and safety of pharmacological management of hypoactive delirium.

Agreement Between Physician Evaluation and the Composite Response Index in Diffuse Cutaneous Systemic Sclerosis.

Diffuse cutaneous systemic sclerosis (SSc) is a highly heterogeneous disease. A provisionally approved Composite Response Index in diffuse cutaneous SSc (CRISS) was developed as a 1-year outcome measure for clinical trials. Our goal was to further validate the CRISS by examining agreement between CRISS definitions for improved/non-improved with physicians' evaluation of disease. Patient profiles from a large observational cohort were created for 50 random diffuse cutaneous SSc patients of <5 years disease duration with improved CRISS scores after 1 year and 50 with non-improved CRISS scores. Profiles described disease features used during the initial CRISS development at baseline and at 1 year. Each profile was independently rated by 3 expert physicians. Majority opinion determined whether a patient was improved or not improved, and kappa agreement with the CRISS cutoff of 0.6 was calculated. Patients had mean ± SD disease duration of 2.2 ± 1.3 years. There was substantial agreement between the physician majority opinion about each case and the CRISS (κ=0.76 [95% confidence interval (95% CI) 0.64-0.88]). The agreement between each individual physician opinion and the CRISS was also substantial (κ=0.70 [95% CI 0.62-0.78]). All CRISS non-improvers were also rated as non-improved by physician majority; however, 12 CRISS improvers were rated as non-improved by physicians. There was substantial agreement between the dichotomous CRISS rating and physician assessment of diffuse cutaneous SSc patients after 1 year. This supports the use of a CRISS cutoff at 0.6 for improvement versus non-improvement, although the CRISS tended to rate more patients as improved than did physicians.

Qualitative Study of Medical Doctors on Their Experiences and Opinions of the Characteristics of Exceptionally Good Doctors.

BackgroundIt is generally accepted that there is a therapist effect in psychotherapy, with master therapists being studied using qualitative methods. There are surgeons with exceptionally positive patients' physical health outcomes, and qualitative research on what makes good doctors. However, characteristics of exceptionally good doctors are less studied and understood.ObjectiveTo qualitatively study the opinions of physicians on exceptionally good doctors.MethodsThirteen semi-structured interviews of English-speaking medical doctors of any specialty were conducted. Recruitment was achieved through the authors’ network; contacting authors of relevant research papers; and Bond University’s General Practitioner recruitment program. Their opinion was sought on what makes an exceptionally good doctor, whether they have met such a person, what was their experience of that person, and whether they consider themselves as exceptionally good doctors.AnalysisA six-phase thematic analysis in an experiential framework, as per Braun and Clarke, was implemented to identify themes and their details in an inductive approach with a realist epistemological position, ie, assuming truthful knowledge on what makes exceptionally good doctors can be obtained.ResultsEach interviewee had met and been inspired by exceptionally good doctors. Descriptions covered six themes: character traits; other characteristics; patient relationships; peer and health care system relations; education; and treatment examples. Exceptionally good doctors were found to have up-to-date extensive medical knowledge and skills, relate well with patients, and have excellent diagnostic abilities. They tend to be humble, approachable, inspiring, and are long-remembered role models. However, they may not always be appreciated by their peers and their health care system because of their exceptional abilities.Discussion and ConclusionExceptional doctors are beneficial for their peers, their patients, and their health care system. Identifying, acknowledging, and making such doctors more accessible to medical students and junior doctors could have a positive impact on medical practice.

Diagnosis of brucellosis disease using data mining: A case study on patients of a hospital in Tehran

BackgroundBrucellosis is a common zoonotic infection of humans from livestock. This bacterial infection is acquired from infected animals and their products. The pathogen of this disease is a genus of bacilli called Brucella, and no effective vaccine has been discovered yet for the prevention of human brucellosis. ObjectivesThe present study is mainly conducted to diagnose brucellosis accurately and timely, using Data Mining techniques. Based on the knowledge discovered with Data Mining and opinions of specialist physicians, this study aims to propose instructions for diagnosing brucellosis. Materials and methodsThe dataset used in this study contains 340 samples and is extracted from the files of patients at Tehran Imam Khomeini Hospital from the years 2010–2020. Attributes of this dataset have been determined based on domain expert opinions, namely specialist physicians. After initial analysis and data pre-processing, various Data Mining techniques have been employed to diagnose brucellosis, including neural networks, Bayesian networks, and decision trees. ResultsAccording to the recorded data, 270 people (approximately 79% of samples) had brucellosis. Some clinical symptoms were more prominent among infected patients, including fever, arthritis, tremor, decreased appetite, and nightly perspiration. Among all employed Data Mining techniques in this study, the decision tree with C5.0 pruning algorithm possessed the highest accuracy in diagnosing patients with brucellosis (approximately 99% accuracy). Based on the obtained final model, the most important factors for diagnosing brucellosis are the Wright test, Coombs Wright test, blood culture test, and living place. Discussion and conclusionAccording to the results of this study, brucellosis can be diagnosed with a high accuracy using Data Mining techniques. Furthermore, the most significant factors for diagnosing brucellosis disease can be identified by Data Mining. Among all investigated techniques in this study, the decision tree with C5.0 pruning algorithm has the most accuracy in diagnosing brucellosis. Given the decision tree created by the C5.0 algorithm and the opinions of specialist physicians, some instructions are proposed based on a decision-making framework to classify referents into patient and non-patient groups. These instructions can accelerate the diagnosis, reduce therapeutic costs, and decrease treatment period.

Acceptance, Barriers, and Facilitators to Implementing Artificial Intelligence-Based Decision Support Systems in Emergency Departments: Quantitative and Qualitative Evaluation.

BackgroundDespite the increasing availability of clinical decision support systems (CDSSs) and rising expectation for CDSSs based on artificial intelligence (AI), little is known about the acceptance of AI-based CDSS by physicians and its barriers and facilitators in emergency care settings.ObjectiveWe aimed to evaluate the acceptance, barriers, and facilitators to implementing AI-based CDSSs in the emergency care setting through the opinions of physicians on our newly developed, real-time AI-based CDSS, which alerts ED physicians by predicting aortic dissection based on numeric and text information from medical charts, by using the Unified Theory of Acceptance and Use of Technology (UTAUT; for quantitative evaluation) and the Consolidated Framework for Implementation Research (CFIR; for qualitative evaluation) frameworks.MethodsThis mixed methods study was performed from March to April 2021. Transitional year residents (n=6), emergency medicine residents (n=5), and emergency physicians (n=3) from two community, tertiary care hospitals in Japan were included. We first developed a real-time CDSS for predicting aortic dissection based on numeric and text information from medical charts (eg, chief complaints, medical history, vital signs) with natural language processing. This system was deployed on the internet, and the participants used the system with clinical vignettes of model cases. Participants were then involved in a mixed methods evaluation consisting of a UTAUT-based questionnaire with a 5-point Likert scale (quantitative) and a CFIR-based semistructured interview (qualitative). Cronbach α was calculated as a reliability estimate for UTAUT subconstructs. Interviews were sampled, transcribed, and analyzed using the MaxQDA software. The framework analysis approach was used during the study to determine the relevance of the CFIR constructs.ResultsAll 14 participants completed the questionnaires and interviews. Quantitative analysis revealed generally positive responses for user acceptance with all scores above the neutral score of 3.0. In addition, the mixed methods analysis identified two significant barriers (System Performance, Compatibility) and two major facilitators (Evidence Strength, Design Quality) for implementation of AI-based CDSSs in emergency care settings.ConclusionsOur mixed methods evaluation based on theoretically grounded frameworks revealed the acceptance, barriers, and facilitators of implementation of AI-based CDSS. Although the concern of system failure and overtrusting of the system could be barriers to implementation, the locality of the system and designing an intuitive user interface could likely facilitate the use of optimal AI-based CDSS. Alleviating and resolving these factors should be key to achieving good user acceptance of AI-based CDSS.