Efforts Of Physicians Research Articles

No pains no gains: understanding the impacts of physician efforts in online reviews on outpatient appointment

PurposeThis study aims to investigate the impact of physician efforts in online reviews on outpatient appointments, while also examining the moderating effect of physician title.Design/methodology/approachThis study employs the heuristic-systematic model (HSM) to analyze the impact of physician efforts on outpatient appointments. Subsequently, a fixed effect model is employed to examine the research model using an 89-week panel dataset (from April 16, 2018 to December 29, 2019) comprising appointment and online review information pertaining to 8,157 physicians from a prominent online health community in China.FindingsThe findings suggest that physicians with lower professional titles exhibit a significantly higher inclination to enhance heuristic information (e.g. attracting helpful votes) compared to those with higher professional title. All physicians can enhance their outpatient appointments by dedicating efforts towards improving systematic review information, but physician title would weaken the relationship. Moreover, the effect of increasing review volume is considerably more substantial than that of increasing review length, which also surpasses the influence of providing managerial response.Originality/valueUnlike previous studies that primarily focus on patients’ perspectives, this paper represents one of the pioneering effects to examine physicians’ engagement in online reviews.

Comparison of RVU Reimbursement in Anterior or Posterior Approach for Single- and Multilevel Cervical Spinal Fusion.

Retrospective database study. This study aims to quantify and compare mean work RVUs (wRVUs), mean operative time (OpTime), and wRVUs/min in single- and multilevel anterior and posterior cervical spine fusions performed between 2011 and 2020. Prior research has demonstrated inconsistencies in technical skill, operative time, and surgical difficulty with reimbursement in various orthopedic subspecialties. Although trends investigating physician effort and reimbursement have been investigated in lumbar spine surgery, less research has examined these relationships with respect to cervical spine procedures. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) was queried for Current Procedural Terminology (CPT) codes reflecting anterior cervical discectomy and fusion (ACDF), posterior cervical decompression and fusion (PCDF), and the number of levels involved. The cohort was stratified into 10 groups: single-level, 2-level, 3-level, 4-level, 5+ level anterior or posterior cervical fusions. Mean operative times, mean wRVUs, and wRVU/min were calculated and compared by Student t test. A total of 100,997 patients met inclusion criteria in this study, of which 79,141 (78.36%) underwent ACDF, whereas 21,836 (21.62%) underwent PCDF. One- and 2-level fusions were most common in both ACDF and PCDF. In 1-, 3-, 4-, and 5+ level fusion, the anterior approach demonstrated significantly lower mean wRVU (P<0.001). In 1-, 2-, and 3-level fusions, the anterior approach had significantly lower operation times (P<0.001). The anterior approach demonstrated significantly higher wRVU/min in 1- and 2- levels (P<0.001) but lower wRVU/min in 3- and 4-level fusions (P<0.001). Clear discrepancies exist between surgical approach and levels of fusion in cervical spine procedures incongruous with markers of surgical difficulty, physician effort, or expertise required. These specific results suggest that the complexity of multi-level anterior cervical fusions are not effectively accounted for by existing RVU measures.

Drug-Drug Interactions of Selective Serotonin Reuptake Inhibitors: A Pharmacovigilance Study on Real-World Evidence from the EudraVigilance Database.

As the most common psychiatric symptom, depression represents a subject of high interest for the medical community. Background/Objectives: International guidelines consider selective serotonin reuptake inhibitors (SSRIs) the first-line treatment of depression. Although having better efficacy and tolerability in comparison to tricyclic antidepressants or monoamine oxidase inhibitors, the diversity and potential severity of adverse effects and interactions manifested by SSRIs, combined with the frequency of prescriptions, lead to the necessity of evaluating real-world data. The aim of this study was to identify and evaluate the drug interactions reported in EudraVigilance (EV) for the six SSRIs representatives that are authorized in Europe: fluoxetine (FXT), fluvoxamine (FVM), citalopram (CIT), escitalopram (ESC), paroxetine (PAR) and sertraline (SER). The entire class of SSRIs was examined as a comparator to identify whether one of the representatives was more prone to reporting. Methods: Descriptive analysis and disproportionality analysis were conducted on data extracted from the EV database. Results: A total of 326,450 adverse reactions (ADRs) were reported for the SSRIs group. Approximately a quarter of these (n = 83,201; 25.46%) were reported for SER and 22.37% (n = 73,131) for PAR. Of the total ADRs reported, 2.12% (n = 6925) represent preferred terms related to drug-drug interactions (DDIs): SER (n = 1474; 22.37%), CIT (n = 1272, 19.86), and FXT (n = 1309, 19.83%). Specific ADRs related to inhibitory activity represent 0.98%, and for potentiating activity, 1.89%. Conclusions: Although representing a small value of the total ADRs, DDIs may be related to severe outcomes. Awareness should be raised for this category of ADRs that can be reduced by the joined efforts of physicians and pharmacists.

A New Method for Scoliosis Screening Incorporating Deep Learning With Back Images.

Retrospective observational study. Scoliosis is commonly observed in adolescents, with a world0wide prevalence of 0.5%. It is prone to be overlooked by parents during its early stages, as it often lacks overt characteristics. As a result, many individuals are not aware that they may have scoliosis until the symptoms become quite severe, significantly affecting the physical and mental well-being of patients. Traditional screening methods for scoliosis demand significant physician effort and require unnecessary radiography exposure; thus, implementing large-scale screening is challenging. The application of deep learning algorithms has the potential to reduce unnecessary radiation risks as well as the costs of scoliosis screening. The data of 247 scoliosis patients observed between 2008 and 2021 were used for training. The dataset included frontal, lateral, and back upright images as well as X-ray images obtained during the same period. We proposed and validated deep learning algorithms for automated scoliosis screening using upright back images. The overall process involved the localization of the back region of interest (ROI), spinal region segmentation, and Cobb angle measurements. The results indicated that the accuracy of the Cobb angle measurement was superior to that of the traditional human visual recognition method, providing a concise and convenient scoliosis screening capability without causing any harm to the human body. The method was automated, accurate, concise, and convenient. It is potentially applicable to a wide range of screening methods for the detection of early scoliosis.

COVID-19 Vaccination Recommendations: Challenges and Strategies for High-Risk Populations

&lt;p&gt;COVID-19（新冠併發重症）大流行對全球，尤其是有潛在醫療狀況的易感染之高風險族群，造成深遠的影響。為因應全球不斷演變的疫情趨勢以及台灣持續增加病例的疫苗防治需求，台灣家庭醫學醫學會建立了針對易感染之高風險族群的COVID-19疫苗接種建議。本研究進行全面性的文獻回顧並經由專家小組討論後，擬定具證據力的建議以作為防疫策略參考。總計提出25項建議，說明糖尿病、肥胖症、慢性腎臟疾病、心血管疾病和呼吸系統疾病病友感染COVID-19後的重症風險為高，因此強調COVID-19 mRNA（訊息核糖核酸）疫苗在這些易感染之高風險族群中的安全性和有效性以及家庭醫師在COVID-19疫情的關鍵作用，包括常規篩檢、衛教、疫苗接種服務的提供和持續的研究。此建議為醫界與政府相關單位在為易感染高風險族群制定疫苗接種計畫時，提供了兼具客觀實證依據與符合臨床實務需求的具體指引，同時強化家庭醫師在防疫工作中的核心角色，透過持續的監測與積極推動疫苗施打，在不斷變化的COVID-19疫情趨勢中發揮重要作用。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;The COVID-19 pandemic has had a profound global impact, particularly on high-risk populations, such as those with underlying medical conditions. In response to the evolving pandemic landscape and the constant surge in the need to vaccinate among vulnerable cases in Taiwan, the Taiwan Association of Family Medicine (TAFM) has developed recommendations on COVID-19 vaccination for high-risk groups. Based on a comprehensive literature review and expert panel discussions, a total of 25 evidence-based recommendations have been developed to serve as a reference for vaccination strategies, highlighting the increased risk of severe COVID-19 outcomes among individuals with complications such as diabetes, obesity, chronic kidney disease, cardiovascular disease, and respiratory illnesses. The recommendations emphasize the safety and effectiveness of COVID-19 vaccines, particularly mRNA vaccines, for the aforementioned high-risk populations and underscore the critical roles of family physicians in response to severe COVID-19 outcomes, including routine screening, health education, vaccine administration, and continuous research to optimize strategies. The TAFM recommendations provide a robust, evidence-based framework that meets clinical practice requirements and provides effective guidelines for physicians, healthcare institutions, and governments in tailoring vaccination efforts to address the unique needs of high-risk groups in Taiwan. Ongoing monitoring and proactive vaccination drives are essential for ensuring the effectiveness of these recommendations in the evolving COVID-19 landscape, while also accentuating the continuous efforts of family physicians in preventing endemic diseases.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Medicaid Reimbursement for Common Orthopedic Trauma Procedures is 16.0% Less Compared to Medicare with Substantial Variability Between States.

This study seeks to evaluate the variability of Medicaid reimbursement and compare it to Medicare reimbursement using the 20 most commonly billed orthopedic trauma CPT codes nationwide. The authors anticipate significant variability between states and hypothesize that Medicaid payment will be significantly less than Medicare payment. The top 20 most common orthopedic trauma surgery procedural codes were identified from a previous analysis performed by Haglin et al.1 The Centers for Medicare and Medicaid services physician fee schedule was used to determine reimbursement rates from Medicare, and state Medicaid fee schedules were used to determine reimbursement rates for Medicaid. State Medicaid rates were compared to their corresponding Medicare rates to determine a dollar difference. Additionally, the dollar difference for each CPT code was divided by its respective physician relative value unit (RVU). This was utilized to acknowledge the possible variability in the complexity of orthopedic procedures and the related physician effort. The Medicare Wage Index was used to adjust Medicaid rates based on the cost of living for the state as well. Coefficients of variation were calculated to represent overall variability in Medicaid and Medicare reimbursement rates. The mean reimbursement rates for Medicaid were lower for all 20 procedures compared to Medicare. On average, Medicaid reimbursed 16.0% less than Medicare, and 29.6% less when adjusting for cost-of-living. MCD reimbursed at a higher rate than MCR for all procedures in only nine states (Alaska, Arizona, Arkansas, Montana, Nebraska, New Jersey, New Mexico, and North Dakota, and South Dakota) while 38 states reimbursed at a lower rate than MCR, on average. The coefficient of variation ranged from 0.24 to 0.34 for the Medicaid unadjusted group and from 0.35 to 0.46 for the Medicare Wage-Index adjusted group. In contrast, the Medicare group was consistent at 0.06 for all 20 procedures. The average dollar difference across the 20 CPT codes for Medicaid reimbursement compared to Medicare ranged from -$76.89 to -$225.17, and the dollar difference per relative value unit ranged from -$5.96 to -$15.16. This study found a high amount of variation between state Medicaid reimbursement rates and average rates that were significantly lower than Medicare reimbursement rates for the top twenty most utilized orthopedic trauma CPT codes as identified by Haglin et al. The discrepancy in reimbursement was increased when Medicaid rates were adjusted for state cost-of-living. Level III. See Instructions for Authors for a complete description of levels of evidence.

The complexity of physician power.

Inequitable variation in physician effort and resource use is revealed.

How power shapes behavior: Evidence from physicians.

Power-the asymmetric control of valued resources-affects most human interactions. Although power is challenging to study with real-world data, a distinctive dataset allowed us to do so within the critical context of doctor-patient relationships. Using 1.5 million quasi-random assignments in US military emergency departments, we examined how power differentials between doctor and patient (measured by using differences in military ranks) affect physician behavior. Our findings indicate that power confers nontrivial advantages: "High-power" patients (who outrank their physician) receive more resources and have better outcomes than equivalently ranked "low-power" patients. Patient promotions even increase physician effort. Furthermore, low-power patients suffer if their physician concurrently cares for a high-power patient. Doctor-patient concordance on race and sex also matters. Overall, power-driven variation in behavior can harm the most vulnerable populations in health care settings.

The Military-Civilian Partnership Quality Improvement Program Concept: A Process to Improve Data Collection and Outcomes Assessment.

Military-Civilian Partnerships (MCPs) are vital for maintaining the deployment readiness of military health care physicians. However, tracking their clinical activity has proven to be challenging. In this study, we introduce a locally driven process aimed at the passive collection of external clinical workload data. This process is designed to facilitate an assessment of MCP physicians' deployment readiness and the effectiveness of individual MCPs. From March 2020 to February 2023, we conducted a series of quality improvement projects at the Wright Patterson Medical Center (WPMC) to enhance our data collection efforts for MCP physicians. Our methodology encompassed several steps. First, we assessed our existing data collection processes and their outcomes to identify improvement areas. Next, we tested various data collection methods, including self-reporting, a web-based smart phone application, and an automated process based on billing or electronic health record data. Following this, we refined our data collection process, incorporating the identified improvements and systematically tracking outcomes. Finally, we evaluated the refined process in 2 different MCPs, with our primary outcome measure being the collection of monthly health care data. Our examination at the WPMC initially identified several weaknesses in our established data collection efforts. These included unclear responsibility for data collection within the Medical Group, an inadequate roster of participating MCP physicians, and underutilization of military and community resources for data collection. To address these issues, we implemented revisions to our data collection process. These revisions included establishing clear responsibility for data collection through the Office of Military-Civilian Partnerships, introducing a regular "roll call" to match physicians to MCP agreements, passively collecting data each month through civilian partner billing or information technology offices, and integrating Office of Military-Civilian Partnership efforts into regular executive committee meetings. As a result, we observed a 4-fold increase in monthly data capture at WPMC, with similar gains when the refined process was implemented at an Air Force Center for the Sustainment of Trauma and Readiness Skills site. The Military-Civilian Partnership Quality Improvement Program concept is an effective, locally driven process for enhancing the capture of external clinical workload data for military providers engaged in MCPs. Further examination of the Military-Civilian Partnership Quality Improvement Program process is needed at other institutions to validate its effectiveness and build a community of MCP champions.

Abstract 669: Interrogating circadian clock compounds as an adjuvant to chemoradiation against GBM

Abstract Despite the extensive efforts of researchers and physicians over the past two decades, glioblastoma (GBM) remains the most prevalent brain tumor type with a grim average survival time of 8 months following diagnosis irrespective of treatment. Additionally, the current standard-of-care has not changed from maximal surgical resection followed by concurrent chemoradiation from its establishment in 2005. One of the major challenges that limits progress in treating GBM is the presence of GBM stem cells (GSCs) that are highly invasive, reaching far past the tumor margins, are resistant to both chemotherapy and radiation, and can recapitulate the primary tumor following resection. Recent studies have found that GSCs, however, are highly sensitive to targeting of core circadian clock components, particularly positive regulators of the clock Brain and Muscle ARNTL-Like 1 (BMAL1) and Circadian Locomoter Output Cycles Protein Kaput (CLOCK). Here we employ the use of small molecule compounds that upregulate the activity of the negative regulators of the clock in order to suppress BMAL1::CLOCK transcriptional activity or repress BMAL1 transcription. We find that these compounds not only have a much more potent effect against GSCs compared to temozolomide (TMZ) chemotherapy but also, they display combination effect against both GSCs and differentiated GSCs (DGCs) when combined with TMZ. These results suggest that the blood brain barrier (BBB) penetrant circadian clock compounds can be utilized as an adjuvant to current GBM therapies as they can effectively target both the primary tumor cells and GSCs. Citation Format: Priscilla Chan, Qiulian Wu, Anahit Hovsepyan, Seda Mkhitaryan, Gevorg Karapetyan, Khalid Shah, Hiroaki Wakimoto, Theodore Kamenecka, Laura A. Solt, Jamie Cope, Tsuyoshi Hirota, Rex A. Moats, Jeremy N. Rich, Steve A. Kay. Interrogating circadian clock compounds as an adjuvant to chemoradiation against GBM [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 669.

High Hopes for the Biofabrication of Articular Cartilage-What Lies beyond the Horizon of Tissue Engineering and 3D Bioprinting?

Technologies and biomaterials for 3D bioprinting have been developing extremely quickly in the past decade as they hold great potential in tissue engineering. This, together with the possibility to differentiate stem cells of different origin into any cell type, raises the hopes in regenerative medicine once again after the initial breakthrough with stem cells in the 1980s. Nevertheless, three decades of 3D bioprinting experiments have shown that the production of functional tissues would take a longer time than anticipated. Cartilage, one of the simplest tissues in the body, consists of only one cell type. It is not vascularised and innervated and does not have lymphatic vessels either, which makes it a perfect target tissue for successful implantation. The tremendous amount of work since the beginning of this century, combining the efforts of bioengineers, material scientists, biologists, and physicians, has culminated in multiple proof-of-concept constructs that have been implanted in animals. However, there is no single reproducible, standardised, widely accessible and accepted strategy that can be readily applied in the clinic. In this review, we focus on the current progress in the field of the 3D biofabrication of articular cartilage and critically assess failures and future challenges.

Emerging approaches for the development of artificial islets.

The islet of Langerhans, functioning as a "mini organ", plays a vital role in regulating endocrine activities due to its intricate structure. Dysfunction in these islets is closely associated with the development of diabetes mellitus (DM). To offer valuable insights for DM research and treatment, various approaches have been proposed to create artificial islets or islet organoids with high similarity to natural islets, under the collaborative effort of biologists, clinical physicians, and biomedical engineers. This review investigates the design and fabrication of artificial islets considering both biological and tissue engineering aspects. It begins by examining the natural structures and functions of native islets and proceeds to analyze the protocols for generating islets from stem cells. The review also outlines various techniques used in crafting artificial islets, with a specific focus on hydrogel-based ones. Additionally, it provides a concise overview of the materials and devices employed in the clinical applications of artificial islets. Throughout, the primary goal is to develop artificial islets, thereby bridging the realms of developmental biology, clinical medicine, and tissue engineering.

Role of Multidisciplinary Approach in Research Innovation in Ayurveda

Abstract: Ayurveda works on true health care rather just providing disease management only. In today’s scenario there is massive rise in scenario of antimicrobial body resistance and Ayurveda can provide the best approach of defending ourselves. But the Research in field of Ayurveda is at the level of infancy which can be matured up by multidisciplinary approach in field of Ayurveda. Ayurveda Research will always be at margins but by adopting few measures, it can go beyond the boundaries like new innovative therapeutic approaches which are not earlier mentioned in Samhitas must be worked on along with a joint effort of Ayurveda physicians, scientists from other areas, data managers and engineers for new instrumentation and tools development. The articles and ideas should come out from the published section to incorporate section and a cumulative effort to make that idea worldwide should be worked upon. This can bring out the outcome which is cost effective for public, and which is centrally focused on patient centric approach. The nano-technology in collaboration with Ayurveda can bring such wonderful outcomes in form of Ayurveda Medicinal products. The Genomics branch of science can help in resolving many hidden genetic concepts of Ayurveda like Matrujadi Shad Bhavas that can be helpful in treating many genetic diseases. This paper highlights the role of multidisciplinary approach in field of Ayurveda Research so that we can gain the future territories of Ayurveda.

Towards a Regulatory Framework for Workflow Improvement in Electronic Medical Records.

Physicians have to complete several time-consuming and burnout-inducing tasks in their EMRs for everyday care of patients. Poor workflow design generates increased effort for physicians. In this study, we measure time doctors take to retrieve and review information in the patient chart at the beginning of a visit; one of approximately 12 tasks a doctor must do in the EMR during the visit. Information retrieval takes approximately 40 minutes per day. Automation could save 75% of that time. We estimate that if every family doctor in Canada could save 30 minutes through automation of just this one process, we could free up time equivalent to >3000 physicians and >5 million patients; enough to absorb the vast majority of patients who currently do not have a doctor. We know of no more powerful intervention than workflow automation in Canadian EMRs to increase the supply of doctors while simultaneously reducing a major cause of burnout. We recommend an accelerated research program to identify additional opportunities for workflow automation and a regulatory program to ensure that every physician has access to workflow automation in their EMR.

EXPLORING THE RELATIONSHIP BETWEEN PATIENT SYMPTOMS AND PROVIDER GOALS FOR MUCOSAL HEALING IN IBD: INSIGHTS FROM THE IBD QORUS SURVEY DATA

Abstract INTRODUCTION Patients with inflammatory bowel disease (IBD) often experience symptoms such as abdominal pain, diarrhea, and bloody bowel movements. While these symptoms traditionally guided treatment, their predictive value for disease progression is limited. The latest STRIDE-II guidelines recommend a comprehensive IBD management approach, with an emphasis on short-term symptom relief, intermediate-term biomarker normalization, and long-term achievement of endoscopic remission. This treat-to-target strategy necessitates collaboration between physicians and patients. Our study aims to investigate the relationship between patient-reported outcomes and physician efforts to achieve mucosal healing (MH) using IBD QORUS patient and provider survey data. METHODS This was a multi-center prospective study that used patient and provider matched survey data from the Crohn’s &amp; Colitis Foundation IBD QORUS program. Surveys completed between June 2021-October 2022 were analyzed. Univariate and multivariate analyses were performed to determine the relationship between severity of patient reported symptoms and frequency of MH assessment with modalities including endoscopy and fecal calprotectin, as well as to determine how symptoms and MH status influence treatment. RESULTS In total 5,460 paired patient and provider surveys (Crohn’s disease (CD), n=3,276; ulcerative colitis (UC), n=2,184) were included in the analysis. Demographic information including age, sex and steroid-free MH, as well as severity of patient-reported symptoms were similar between CD and UC patients (Table 1). Abdominal pain severity reported by both IBD populations significantly impacted plans for future endoscopy (CD, p=0.000019; UC, p=0.000055) but not for fecal calprotectin testing. Reported stool frequency in both IBD populations significantly impacted future endoscopy plans (CD, p=0.000001; UC, p=0.000001) and future fecal calprotectin testing (CD, p=0.000304; UC, p=0.000001). Reported blood in stool had no effect on MH assessment in CD patients whereas it significantly affected plans for endoscopy (p=0.000001) and fecal calprotectin testing (p=0.000001) in UC patients. Provider discussions regarding MH occurred with 82.4% of CD patients and 85.3% of UC patients, and treatment plans in those without steroid free MH were influenced by severity of symptoms (p=0.000001). DISCUSSION Patient reported symptoms influenced fecal calprotectin and endoscopy plans in both IBD groups. Similarly, severity of symptoms in those without steroid-free MH significantly affected treatment management. These findings suggest that target-based treatment for IBD is feasible in the clinical setting and holds the potential to enhance patient outcomes.

Job satisfaction and work stress among physicians in Norway and Germany-A cross-sectional study.

Physicians' health and wellbeing are important albeit often neglected quality indicators of health care systems. The aims of the study were to compare job satisfaction and work stress among doctors in Germany and Norway, and to identify predictors for job satisfaction. All active physicians in Schleswig-Holstein, Germany (N = 13,304) and a nationwide sample of Norwegian physicians (N = 2,316) were surveyed in a cross-sectional design in 2021. Response rates of German and Norwegian physicians were n = 4,385 (33%) and n = 1,639 (70.8%), respectively. In addition to age, sex, and work-hours, the main outcome measures were the validated Job Satisfaction Scale (JSS) and the short form of the Effort-Reward Imbalance Questionnaire (ERI). There were significant differences between Norwegian and German physicians in job satisfaction but with small effect sizes. All effort scores of German physicians were significantly higher and four of seven reward scores significantly lower than for their Norwegian colleagues. The proportion of German physicians in the state of a gratification crisis was significantly higher (67%) than in their Norwegian colleagues (53%). In both countries, physicians with a gratification crisis scored significantly lower on all items of job satisfaction. There were only minor gender differences in job satisfaction and effort-reward balance. Age, effort, and reward accounted for 46% of the explained variance of job satisfaction. Lower job satisfaction and reward in some areas and higher perceived effort of physicians in Germany than in Norway are still in favor of Norwegian working conditions, but the differences seem to diminish. The high proportions of gratification crises in both countries warrants appropriate measures for prevention and health promotion.

Когнитивные нарушения у мужчин с церебральной микроангиопатией и возрастным гипогонадизмом

Cognitive function impairment is one of the main disabling manifestations of vascular and degenerative brain pathology. The main cause of vascular dementia is cerebral microangiopathy (CMA) caused by arterial hypertension. The existing gender differences in the age of onset of cerebral vascular pathology in men increasingly draw researchers’ attention to the problem of age-related decline in gonadal function. The high association of metabolic risk factors for cardiovascular diseases with age-related hypogonadism (AHG) and the prospects of its correction determined our interest in the study of cognitive functions in adult men. The purpose was to investigate the structure and severity of cognitive disorders in patients with CMA and AHG. Material and methods. We performed an in-depth neuropsychological testing of 171 men aged 45 to 60 years with complaints of memory and attention impairment against the background of CMA and 52 practically healthy individuals without cerebral complaints (control group). Based on clinical and laboratory assessment of sexual function, patients with CMA were divided into groups: group 1 with AHG (74 persons) and group 2 without it (77 persons). Results. The examined men did not differ in age, education, behavioral disorders, stress level, Apo E 4 allele carrier both in the main and comparison groups; the manifestations of metabolic syndrome and CMA in men with AHG were more expressed than in men with normal gonadal function. Psychometric studies revealed impairment of frontal-executive functions both in isolation and in combination with other cognitive disorders (multifunctional type of moderate cognitive disorders) significantly more often in hypogonadal men. Conclusions. Complaints of cognitive decline in men with cerebral microangiopathy should promote the efforts of physicians to search for AHG in order to correct it and prevent cognitive impairment in the future.

Peer Feedback in Clinical High-Volume Activities: How Ranking Designs and Ability Affect Physician Effort

Peer Feedback in Clinical High-Volume Activities: How Ranking Designs and Ability Affect Physician Effort

Atypical Presentation of Meningoencephalitis in an Infant Caused by Meningococcemia and Complicated by Ventriculitis with Bilateral Extra Axial Septated Collection

Background: The diagnosis of meningitis in the infancy period is a challenging. Clinical evaluation and high index of suspicion with early empirical treatment guidelines continue to evolve and support physician efforts to decrease the morbidity and mortality associated with pediatric meningitis. Case report: We report a case of a previously healthy 2-month-old male who presented with excessive crying, preceded by subjective fever and watery diarrhea, for one day without any other symptoms. Parents gave multiple antipyretic doses at home for irritability which might mask his fever. The patient was tachycardic with an unremarkable physical exam. Full septic work-up done after stabilization of the patient and empirical antibiotics started. His blood culture grew Neisseria meningitides which caused meningoencephalitis and ventriculitis with bilateral extra-axial collection, the patient was in septic shock with multiple organ dysfunction. Conclusion: Meningococcal meningitis in the neonatal and infancy periods remains a serious health threat with high morbidity and mortality. This case report urges the physician to keep a high index of suspicion by taking detailed history and frequent assessment in each suspected cases as the clinical presentations, signs and symptoms in the infancy period are not specific nor classic to guide the physician.

CATCHU: A NOVEL VISUAL-SOMATOSENSORY INTEGRATION TOOL FOR PREDICTING FALLS

Abstract Ability to integrate information across sensory systems is a vital aspect of human functioning in the real world. While multisensory integration effects are measured across a wide array of populations using various sensory pairings and different neuroscience techniques, a gold standard for quantifying multisensory integration was seemingly lacking. We recently established a standardized protocol for administering and calculating behavioral multisensory integration effects across diverse clinical populations and age-ranges. Our previous work has linked the magnitude of visual-somatosensory integration (measured behaviorally using simple reaction time tasks) to important cognitive (attention) and motor (balance, gait, and falls) outcomes in healthy and cognitively impaired older adults. Given the paucity of extant translational multisensory integration tools in clinical settings, we recently developed a novel digital health app grounded in over 15 years of multisensory research. CatchU® (Before You Fall…) quantitatively measures visual-somatosensory integration performance, while considering medical comorbidities, to detect one’s fall propensity. Our goal is to facilitate the identification of patients who are at increased risk of falls and promote physician-initiated falls counseling in routine practice (e.g., annual wellness, sick, or follow-up visits). This will thereby raise awareness of falls and foster physician efforts to alleviate disability, promote independence, and improve the well-being of older adults, all while aiming to reduce the significant societal cost of falls in older adults and others at high risk.