Permanent Physician Research Articles

ChatGPT for use in technology-enhanced learning in anesthesiology and emergency medicine and potential clinical application of AI language models : Between hype and reality around artificial intelligence in medical use

The utilization of AI language models in education and academia is currently asubject of research, and applications in clinical settings are also being tested. Studies conducted by various research groups have demonstrated that language models can answer questions related to medical board examinations, and there are potential applications of these models in medical education as well. This study aims to investigate the extent to which current version language models prove effective for addressing medical inquiries, their potential utility in medical education, and the challenges that still exist in the functioning of AI language models. The program ChatGPT, based on GPT3.5, had to answer 1025 questions from the second part (M2) of the medical board examination. The study examined whether any errors and what types of errors occurred. Additionally, the language model was asked to generate essays on the learning objectives outlined in the standard curriculum for specialist training in anesthesiology and the supplementary qualification in emergency medicine. These essays were analyzed afterwards and checked for errors and anomalies. The findings indicated that ChatGPT was able to correctly answer the questions with an accuracy rate exceeding 69%, even when the questions included references to visual aids. This represented an improvement in the accuracy of answering board examination questions compared to astudy conducted in March; however, when it came to generating essays ahigh error rate was observed. Considering the current pace of ongoing improvements in AI language models, widespread clinical implementation, especially in emergency departments as well as emergency and intensive care medicine with the assistance of medical trainees, is aplausible scenario. These models can provide insights to support medical professionals in their work, without relying solely on the language model. Although the use of these models in education holds promise, it currently requires asignificant amount of supervision. Due to hallucinations caused by inadequate training environments for the language model, the generated texts might deviate from the current state of scientific knowledge. Direct deployment in patient care settings without permanent physician supervision does not yet appear to be achievable at present.

Gender differences in academic productivity, educational positions, and leadership appointments of physicians in the U.S.

Promotions in academic medicine are frequently based on number of publications and leadership positions held. While prior study has established women publish less than men, many evaluations are limited to individual specialties and do not evaluate involvement with educational activities. To compare gender differences in academic output, intramural leadership positions, and educational leadership positions of academic physicians. The curriculum vitae and de-identified demographic data of all permanent physicians employed at a multi-site academic medical center were reviewed from April to May 2020. Multivariable logistic and Poisson regressions evaluated leadership positions and number of publications. Of 3,359 physicians in the demographic database, 32.3% (n = 1,087) were women and 72.5% were white (n = 2,510). Of the 3,015 physicians in the curriculum vitae database, 32% (n = 962) were women. Women were more likely (p < 0.001) to be assistant professor (54% vs. 42.7%) and less likely to be associate (18.1% vs. 20.3%) or full professor (14.6% vs. 29.1%). Women assistant professors published 22% fewer articles (ratio estimate = 0.78, p < 0.001), associate professors 18% less (coefficient = 0.82, p < 0.001), and full professors 23% less (coefficient = 0.77, p < 0.001). Fewer women were program directors for residencies (1.6% vs. 2.9%, p = 0.02) or fellowships (5.4% vs. 7.4%, p = 0.04), and held fewer division or department leadership positions (OR 0.8, 95% CI as [0.6, 1.0], p = 0.03). Women physicians do not outperform men across any education, leadership, or publication category. A cultural shift is needed to redefine traditional metrics for leadership appointments if academic medicine hopes to achieve equity.

A survey on the practice of bronchoscopy in county-level hospitals of China

Objective: To investigate the bronchoscopy resource allocation and technology application in county-level hospitals in China. Methods: A cross-sectional survey was conducted. In 2021, 12 provinces were sampled from all provinces in China according to the regional Gross Domestic Product (GDP) and the number of counties, in which a total of 291 county-level hospitals were randomly enrolled. Two county-level hospitals which carried out bronchoscopy technology in each province were randomly sampled to investigate the status of bronchoscopy resources, technical application, decontamination and anesthesia by using questionnaires. Independent sample t test or two related sample nonparametric test were used for comparison between groups. Spearman correlation analysis was used to explore the correlation. Bilateral P<0.05 was considered statistically significant. Results: According to the sampling results, it was estimated that in the county-level hospitals, the proportion of those performing bronchoscopy was 11.4% (9.9%, 13.8%), which was significantly correlated with the population in the province (r=0.64, P=0.025) and the regional GDP (r=0.65, P=0.025).The 24 county-level hospitals interviewed were equipped with (1.6±1.0) bronchoscopes on average, and the number of hospitals with electronic bronchoscopes and fiberoptic bronchoscopes was 22 (91.7%) and 6 (25.0%), respectively. Six (25.0%) hospitals performed bronchoscopy every working day. Twelve (50.0%) hospitals had relatively permanent physicians and nurses. All operating doctors had received special training. There was a significant increase in the number of bronchoscopy cases per hospital in 2020 compared to 2019 [140(70, 335) vs. 100(29, 254), P=0.001]. All hospitals used standard cleaning and sterilization workbenches, cleaning agents and disinfectants. Surface anesthesia was available in 24 hospitals, and bronchoscopy techniques under sedation and analgesia were performed in 10 (41.7%) hospitals. Atropine was still used to prevent airway secretions in 2 (8.3%) hospitals,although not recommended by guidelines. Conclusions: There was a large gap between the current status of bronchoscopy technology in county-level hospitals and the standards of the National Health Commission, together with regional disparities. Bronchoscopist training in the standardization and the decontamination work met the requirements. In some hospitals, the use of complementary medicines was not standardized or the sedatives were not given routinely according to the guidelines. We should promote the popularization and standardization of bronchoscopy technology, and strengthen the allocation of related resources in China's county hospitals.

Prevalence of Common Diseases in Indigenous People in Colombia.

The Indigenous tribe called the Wiwa lives retracted in the Sierra Nevada de Santa Marta, Colombia. Little is known about their health status and whether the health care system in place covers their needs. In 2017 and 2018, a permanent physician was in charge for the Wiwa. Diseases and complaints were registered, ranked, and classified with the ICD-10 coding. Datasets from the Indigenous health care provider Dusakawi, collected from local health points and health brigades travelling sporadically into the fields for short visits, were compared. Furthermore, a list of provided medication was evaluated regarding the recorded needs. The most common complaints found were respiratory, infectious and parasitic, and digestive diseases. The top ten diagnoses collected in the health points and in the health brigade datasets were similar, although with a different ranking. The available medication showed a basic coverage only, with a critical lack of treatment for many severe, chronic, and life-threatening diseases. Most of the detected diseases in the Indigenous population are avoidable by an improvement in health care access, an expansion of the provided medication, and an increase in knowledge, hygiene, and life standards.

Clinical features and medical care factors associated with mortality in French nursing homes during the COVID-19 outbreak

ObjectivesThis study aimed to identify demographic, clinical and medical care factors associated with mortality in three nursing homes in France. MethodsTwo nursing homes were hospital-dependent, had connections with infection prevention and control departments, and had permanent physicians. A third nursing home had no direct connection with a general hospital, no infection control practitioner, and no permanent physician. The main outcome was death. ResultsDuring the first 3 months of the outbreak, 224 of 375 (59.7%) residents were classified as COVID-19 cases and 57 of 375 (15.2%) died. The hospital-dependent nursing homes had lower COVID-19 case fatality rates in comparison with the non-hospital-dependent nursing home (15 [6.6%] vs 38 [25.8%], OR 0.20 [0.11–0.38], p = 0.001). During the first 3 weeks of the outbreak, mortality in COVID-19 patients decreased if they had a daily clinical examination (OR: 0.09 [0.03–0.35], p = 0.01), three vital signs measurement per day (OR: 0.06 [0.01–0.30], p = 0.001) and prophylactic anticoagulation (OR: 0 [0.00–0.24], p = 0.001). ConclusionsThis study suggested that high mortality rates in some nursing homes during the COVID-19 outbreak might have been contributed by a lack of medical care management. Increasing human and material resources, encouraging presence of nursing home physicians and establishing a connection with general hospitals should be considered to deal with present and future health disasters in nursing homes.

Fill the gap between traditional and new era: The medical educational reform in Taiwan.

The 7-year medical education program in Taiwan has been established since 1949. More than 60 years later, many medical professionals have observed and voiced its deficiencies following the outbreak of severe acute respiratory syndrome. The deficiencies are three-fold: (1) specialties are excessively institutionalized, (2) students engage in passive learning and memorization, and (3) passing one written national examination serves as the means of granting permanent physician qualification. The situation has aroused concerns and discussions among medical professionals and educators for a new medical education program. Authorized by the Conference of Deans of Medical Schools in Taiwan, Prof. Chyi-Her Lin assembled a team for planning medical curricular reform. Subsequently, Prof. Shan-Chwen Chang organized a task force team which has been monitoring the new 6-year program since 2013. The aims of medical reform by Prof. Lin are (1) to eliminate the specialty training part, (2) to use innovative teaching methods to motivate students to learn proactively, and (3) to implement competency-based medical education. Now, the first class of physicians will enter the workplace in 2019, subject to various clinical challenges.

A hundred and thirty five years of egzistance of Cuprija general hospital and introduction into the fiftieth anniversary of pathology and forensic medicine department founding in general hospital Cuprija

When Serbia got a new constitution in December 1838. work on the organization of medical services immediately started. Cuprija, as a Head office of Cuprija county 1835. Have had the privilege to has its permanent physician that worked and performed the supervision of health services throughout the County of Cuprija (Province Despotovac, Paracin and Resavica). In early year of 1839 Dr. Karl Belon was appointed as a doctor of Cuprija cavalry garrison, who established a small garrison hospital in the same year of his arrival. The State commission, in 1879 and 1881 with dr Acimom Medovic as the president, (who was also the president of the Serbian Medical Society) adopted 'The law on the regulation of the medical profession and the preservation of public health'. Dr Mladen Jankovic, the inspector of Medical institutes, acting on previous orders, came in Cuprija on August the 26th 1881 and in the Vašarište found the shed. After its renovation and furnishing, it was able to accommodate 20 patients. Opening of the District Hospital in Cuprija was performed on August the 7th 1881(Julian calendar). Later, at a new location, the main hospital building was constructed. Official moving into it took place on October 29th 1906. Department of Pathology, patho-histology and forensic medicine in Cuprija hospital was founded in 1968, and was accommodated in the former premises of the Department for pediatrics. Founder of the section was Dr Bratislav Glavicic, the first specialist of pathology for the whole Pomoravlje district.

Evaluation the Role of Clinical Pharmacist on Prevents or Reduced the Medication Error in Emergency Department

Objective: To identify the role and importance of the clinical pharmacist in the Emergency Department on preventor reduced the medication error.Methodology: We collected the medical file of 3400 patients, 1400 patient's file in (A) hospital, and 1000 patient'sfile in each of (B and C) hospital, who admitted to the ED, at primary weekdays between 8 am to 2 pm, andrecorded all the intervention made by clinical pharmacist through an active search in clinical charts, with analysisof the daily medical prescription. The potential severity of harm of the medication error judged by two reviewers,a permanent emergency physician, and clinical pharmacist based on the National Coordinating Council (NCC) ofMedication Error Reporting and Prevention error classification system.Results: Four of intervention that have the greatest incidence which represent the majority of the cases, and theywere related to: dosage 500 (38.7%), route of administration 300 (23.2%), frequency 100 (7.7%), andincompatibility 120 (9.3%). The severity of medication errors that was judged as potentially life threatening (67;5.1%), serious (135; 10.4%), significant (634; 49.1%), and insignificant (454; 35.1%). The acceptance to thepresence and intervention of pharmacist was as follow: senior physicians 75%, permanent physicians 20%, residentphysicians 77%, and nurses 30%.Recommendation: Hospitals should contemplate assigning well-trained knowledgeable, efficient and skilled EDclinical pharmacists to prospectively review medication orders whenever clinically possible. It is also recommendedthat each hospital performs acquainted analysis of medication errors occurring in its ED, in order to determinetheir origin and then establish the necessary ED-based clinical pharmacy services. The sets of actions needed toprovide such services, as well as the skills, which their ED pharmacists must possess or acquire in order to becapable of producing desired outcomes

How aware are Belgian permanent and resident emergency physicians of common medical costs and radiation doses?

To establish how aware Belgian emergency physicians are of common treatment costs and radiation doses. Using a questionnaire survey on a voluntary basis, 60 emergency physicians from four universities and four district hospitals were asked to estimate treatment costs and radiation doses involved in the management of a patient with pulmonary embolism. The responses of permanent and resident physicians were then compared with actual data defined by the Belgian legislation. Physicians' error was calculated as a percentage of the real value using the formula [(real-estimated)/real]×100. Fifty questionnaires were fully completed and analysed. Estimated costs of diagnostic procedures (chest radiograph, ECG, pulmonary-computed tomography, Doppler legs, cardiac ultrasound, ventilation/perfusion scintigraphy), laboratory tests (standard, D-dimers, arterial blood gases), drugs (alteplase, enoxiparine, acenocoumarol) and hospitalization (emergency department, intensive care and pneumology units) were within 25% of real costs for 38, 14, 18 and 30%, respectively, of permanent physicians and 31, 12, 8 and 27% of resident physicians. Drug prices were generally largely overestimated.Mean error of the physicians' estimates of the radiation dose of imaging modalities (chest radiograph, computed tomography and scintigraphy) was 1805% for permanent physicians versus 4997% for resident physicians. There was no significant difference between the two groups for the different items studied. Emergency doctors, whether permanent physicians or resident physicians, have a limited knowledge of both costs and radiation doses of investigations and treatments they prescribe every day.

Physicians’ perception of CPOE implementation

To identify perceptions held by physicians of the benefits of computerized physician order entry (CPOE) and factors influencing its successful implementation in the context of the increased presence of a clinical pharmacist on ward. A 2000-bed University Hospital. A cross-section opinion survey was conducted of all permanent physicians of the hospital to determine their perception on the benefits, or otherwise, of CPOE. Questionnaires, built upon the analysis of 10 preliminary semi-structured interviews with physicians, were sent to physicians by electronic and paper mail. It comprised three sections with a 4 level Likert scale: general perception of CPOE benefits (items 1.1-1.8); opinion on the introduction of the CPOE system in the hospital (item 2); opinion on the presence of a pharmacist on ward (item 3). A fourth section recorded the respondent's profile. Level of agreement on the items describing the general perception of CPOE benefits; opinion on the introduction of a CPOE system in the hospital; and opinion on the pharmacist's presence on ward. A Principal Component Analysis (PCA) was conducted on sections one and two. Analysis of this PCA representation in terms of the respondents' profile was performed. One hundred and one physicians (18%) participated in the survey. Most (83%) physicians favoured the implementation of a CPOE (item 2). Among the advantages of CPOE, the greatest agreement concerned items related to safety and regulatory issues (from 80 to 76% agreement). Other items related to management issues were perceived as less tangible benefits (from 50 to 67% agreement). The increased presence of a pharmacist on the ward was supported by 94% of physicians. The PCA representation using profile items produced a 2-factor solution, accounting for 68% of the variance, with former experience of collaboration with a pharmacist (P = 0.002) and senior physician status (P = 0.013) positively influencing the perception of the CPOE. Endorsement by senior physicians and the presence of a clinical pharmacist on ward promote a positive attitude towards CPOE and facilitate its implementation.

La educación popular en salud salva: proyecto freireano en tiempos del neoliberalismo

Desde la antigüedad el "pequeño resto" que persiste con fe en la vida, es protección frente al caos. El desarrollo local es la respuesta. Paulo Freire dice: "Mi experiencia junto con otras experiencias son la base de la esperanza". La educación popular en salud orienta para hacer un proyecto productivo con identidad. Este ejemplo es el de Balsa Las Perlas, un conglomerado a orillas del Rio Limay de la provincia de Rio Negro, Argentina. Personas que se radican y transforman un territorio de clima desfavorable en una comunidad demandante de sus derechos. Sólo con los intereses de la misma población, logran un centro de salud nivel II, un médico permanente, capacitación de una enfermera y una agente sanitaria, comunicación radial en red hospitalaria y las puertas abiertas a la participación de la gente, que rindió posteriormente sus frutos, haciendo de este paraje un lugar imposible de olvidar a la hora de asignar recursos estatales.

Always on call

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Physician–nurse attitudes toward collaboration in Istanbul's public hospitals

The need for greater collaboration between nurses and physicians in clinical practice is essential to improve patient care and worker satisfaction. This study used t-tests and logistic regression to test four research hypotheses concerning attitudes toward physician–nurse collaboration in Istanbul, Turkey. The study found that nurses express more positive attitudes toward collaboration than physicians. Noteworthy was the finding that male physicians expressed more positive attitudes toward collaboration than female physicians. Residents and those employed in secondary institutions were also more likely to express more positive attitudes toward collaboration than permanent physicians and those employed in tertiary hospitals.

Good continuity of care may improve quality of life in Type 2 diabetes

Some features of diabetes care and diabetes treatment regimen which may have an impact on health-related quality of life (HRQOL) in people with diabetes were studied cross-sectionally using the SF-20 questionnaire. Of the 381 subjects with Type 2 diabetes aged under 65 years, 260 (68%) participated in the study. On univariate analysis, HRQOL was associated with regular clinical review (check-up at least twice a year) and continuity of care (the same GP for at least 2 years), education by a diabetes nurse, and satisfaction with diabetes education. No associations were found between the HRQOL dimensions and home glucose monitoring, participation in educational courses, or satisfaction with care. On logistic regression analysis only good continuity of care was significantly associated with the better well-being dimensions of the SF 20 (ORs 2.5–6.0). However, good continuity of care was also associated with less satisfactory glucose control (HbA 1c 8.9±2.0 (±SD) vs 8.3±2.0%, P=0.04). It is concluded that a permanent physician–patient relationship may improve HRQOL in subjects with Type 2 diabetes, but further prospective studies are needed to confirm this finding.

A Comparative Study of the Psychiatric Care between Locum Tenens and Staff Physicians in a State Hospltal

Artificial neural networks (ANNs) were used to measure the quality of care (Q) at two admission units in a state psychiatric hospital, each unit having two treatment teams, one led by a permanent (PM) staff physician, and one led by various locum tenens (LT) physicians. An LT physician's tour of duty (TOD) averaged approximately 30 days. Over nearly a 2 1/2-year period the four treatment teams received 744 admissions. Our previous research has reported measuring Q using percent accurate prediction of hospital length-of-stay (LOS), divided by a measure of severity of patient illness. We calculated Q for each treatment team's test set of patients using a trained ANN for each team. All the teams' test sets were run through each of the trained ANNs resulting in a set of four Q values for each ANN. We defined the standard deviation of Qs resulting from a single team's test set run through it own as well as the other three teams' ANNs as representative of the "diversity" of the patients in that test set. We defined the reciprocal of the standard deviation of the Qs resulting from each of the teams' test sets run through a single team's ANN as that team's "robustness." The product of "robustness" times "diversity" was defined as the value (V) of the treatment team. The V of the PM physician-led teams was 1.9 times that of the LT physician-led teams. We normalized V for patient entropy (uncertainty) with a metric called the "risk ratio" (RR), derived from Boltzmann's law. This resulted in the V/RR of one PM physician-led team as superior, despite treating patients with the highest risk. The LT physician-led teams, despite having fewer patients afflicted with the more problematic diagnosis of schizophrenia, were handicapped by not having preexisting therapeutic relationships with their patients, giving both LT teams low robustness. There was no statistically significant difference in patient LOS between the teams. Because the greatest change in team composition was due to LT physicians, we assumed that the differences in V/RR were due to the short (30-day) TOD and not to any skill deficits in the LT physicians. This article explores a new paradigm which compares the value of patient care in separate delivery systems despite differences in severity of illness, case-mix, and uncertainty associated with an imperfect therapeutic environment.

Local health knowledge and universal primary health care: a behavioral case from Costa Rica.

This paper describes a group of rural people living in 2 communities in the Atlantic lowlands of Costa Rica and the health options available to them namely health posts clinics and hospital services private physicians and the traditional health system (bush medicine). The health posts are part of a comprehensive rural health program initiated by the Ministry of Health to offer basic health services to communities. The major barriers to the functioning of the PHC program are administrative: poor transportation scheduling and lack of personnel. People said their reason for not using the health posts is lack of confidence in their reliability. The peoples perspective about the solution to the problems of the health care system demonstrates some understanding of their own problems. The most frequently suggested change in the system is to have a permanent physician in the communities followed by the suggestion to have a permanent nurse and more medicines at the health post. All their suggestions involve the health post the most underutilized health resource in the community. Other suggestions involve the community level and the overall health delivery system and general improvement of living especially economic conditions. Health seeking strategies demonstrate a utilization patterns are: perceived seriousness of the illness; cost of services and methods of payment; perceived efficacy of the provider and treatment; accessibility and transportation. Consultations with family and friends praying and using bush medicines were reported for almost all illness episodes. The people of the 2 communities are active participants in their health care and in the health care system. The majority assume that there are limited health resources and that they must utilize all the alternatives. Preventive medicine is practiced by most of the people by keeping the body in balance through proper use of diet drinking bush teas avoiding certain behaviors and/or situations and using doctors medicines. The major factors that motivate their health seeking behavior are based on a combination of bush and Western knowledge in a pragmatic framework. There is a negotiation process between bush and scientific medicine in the cognitive processes of the people. A participatory model for PHC in which the micro and macro systems become interdependent is suggested. Health planners should ask whether the program will have access to people an answer to which is possible through knowledge of the culture i.e. the clients perspective. The planner should also pay attention to the factors that motivate people to seek health care and policies should involve community people in the planning process. Local participation in PHC is crucial in integrating the various levels in the health system. PHC must begin at the local level and with community involvement in planning. The specifics of the policies and plans however must be left open to negotiation depending on the culture and structure of the involved communities.

Where there is a doctor: strategies to increase productivity at lower costs. The economics of rural health care in the Dominican Republic.

The study of a rural health district in the Dominican Republic found relatively high levels of public and out-of-pocket primary health expenditures and poor quality of care. The inefficient use of public resources and low efficacy were attributed to: (1) underutilization of health services, (2) low productivity of human and physical resources, which in turn were caused by poor managerial practices, shortages of medicines, dispersion of the population and the compulsory 1-year rural social service required from all graduating physicians (known as pasantía in some Latin American countries and medicatura rural in others). Out-of-pocket health expenditures responded to unnecessary self-referrals and excessive self-medications. The findings suggest that the quality of care can be improved and the public and out-of-pocket expenditures reduced by: (1) the replacement of the social service (pasantía) by permanent physicians, (2) the organization of communal pharmacies and (3) the establishment of outreach health posts. It is argued that today in the Dominican Republic as in many other Latin American countries unemployed or underemployed physicians are willing to take permanent positions in rural areas. The study suggests that rural physicians need and will be willing to accept the fact that much of their medical training has no applicability to the rural setting. The retraining or recycling of rural physicians for their new health roles is discussed also.

Symptom prevalence in hypertensive patients.

The influence of blood pressure levels on the prevalence of symptoms was studied in a group of 1771 untreated hypertensive patients referred to the Saint-Joseph Hypertension Clinic in Paris. Information on symptoms was obtained from a standardized physician-conducted interview during the patient's first visit at the outpatient clinic. The most frequent symptoms were headache (40.5%), palpitation (28.5%), nocturia (20.4%), dizzines (20.8%) and tinnitus (13.8%). Except for nocturia, symptom prevalence was higher in females than in males. In males as well as in females, no correlation was found between blood pressure levels and the presence of headaches, dizziness, palpitation and tinnitus when results were adjusted for age. In contrast, the relationship between two behavioural characteristics, anxiety and lack of regular physical activity, and symptom prevalence was more pronounced than the relationship with the blood pressure level itself. Moreover, the symptom prevalence reported differed significantly between the five permanent physicians of the clinic; comparison of results obtained by physician conducted interview and self-administered questionnaire indicated that differences between physicians were not due to differences in patient's characteristics but to differences in physician behaviour.

Parents' experiences of child health centers. A study in the urban district of Uppsala.

Improved techniques for counselling parents can be achieved through a knowledge of the parents' experience of existing child health care. The author has studied the parents' experience of child health centers with regard to contact with the staff, information received, and general organization. A questionnaire was sent to one-third, 478, of all parents in the urban district of Uppsala with children 1/2–1 1/2 years old. The children were registered at 14 separate child health centers. The results showed that the essential prerequisites for good contact with the staff were, a limited number of children registered, and the presence of a permanent physician at the health center. The level of information concerning measures undertaken in child health care was mainly related to social grouping. One or more behavior problems were noted to have existed in 21% of the cases. About 60% of all parents concerned had sought advice at the child health center with varying degrees of success for different kinds of problems. An important objective in the child health care system would be to study the clients' attitudes. This would be the method to identify information problems and conditions influencing the contact between parents and staff. A constructive parental attitude to the staff is in fact necessary for successful guidance and psycho-social care, tasks of great significance for child health care in our type of community.