Health Physicians Research Articles

Role of Pharmacogenomics in Comprehensive Medication Management: Considerations for Employers.

Rising prescription costs, poor medication adherence, and safety issues pose persistent challenges to employer-sponsored health care plans and their beneficiaries. Comprehensive medication management (CMM), a patient-centered approach to medication optimization, enriched by pharmacogenomics (PGx), has been shown to improve the efficacy and safety of pharmaceutical regimens. This has contributed to improved health care outcomes, reduced costs of treatments, better adherence, shorter durations of treatment, and fewer adverse effects from drug therapy. Despite compelling clinical and economic evidence to justify the application of CMM guided by PGx, implementation in clinical settings remains sparse; notable barriers include limited physician adoption and health insurance coverage. Ultimately, these challenges may be overcome through comprehensive programs that include clinical decision support systems and education through employer-sponsored population health management channels to the benefit of the employees, employers, health care providers, and health care systems. This article discusses benefits, considerations, and barriers of scalable PGx-enriched CMM programs in the context of self-insured employers.

Sports participation, performance and medical-psychiatric health and illness: Cultural and religious effects

Abstract: Using one religion as an example, in the context of its historical culture, this article examines the medical and psychiatric literature on the role of religion and culture as it has affected sports. By way of providing background, we first review historical examples of how religion and its culture can affect sports participation, performance and psychiatric health/illness. Given these emotionally and religiously powerful influences over historical time, we then review implications for the sports physician or mental health therapist with a focus on how religious and cultural issues can affect diagnosis and treatment for athletes, their teams and communities. A case example is presented by way of illustrating the need to both be aware of religious-cultural negative and positive factors as they affect integrative treatment of athletes.

Fellows in Training Wellness in Allergy and Immunology: AAAAI Workgroup Report

Physician health and wellness can be negatively affected by burnout, which in turn can lead to multiple potential professional and personal issues. Burnout issues can start in medical school and progress during residency and fellowship, and throughout a physician's career. A previous survey of allergists and immunologists reported a burnout rate of 35%. However, there are currently few data regarding health and wellness specifically for fellows-in-training (FIT) in allergy and immunology. This workgroup report was developed to assess health and wellness among FIT in our specialty. The American Academy of Allergy, Asthma & Immunology electronically distributed an anonymous questionnaire using the validated mini-Z survey to a total of 388 allergy and immunology FIT. In addition to the mini-Z items, the survey queried personal and professional demographic characteristics and included open-ended wellness questions. A total of 82 FIT completed the survey, yielding a 24% response rate. The burnout rate was 39%, which is lower than the national average among US physicians. Overall job satisfaction was 82%, and 72% reported satisfactory or better control over workload. Our results identify FIT-specific concerns in our specialty that can be used to develop tailored interventions to improve wellness and minimize burnout among this group. However, future surveys are needed to continue to address allergy and immunology FIT-specific wellness challenges.

Federation of State Physician Health Programs' Response to Helping the Helpers.

Federation of State Physician Health Programs Ridgeland, MS Mississippi Physician Health Committee, Ridgeland, MS Molina Healthcare of Mississippi, Jackson, MS Federation of State Physician Health Programs Ridgeland, MS Washington Physician Health Program, Seattle, WA [email protected] Federation of State Physician Health Programs, Ridgeland, MS Physician's Health Program, Tennessee Medical Foundation, Brentwood, TN Received for publication August 10, 2022; accepted August 18, 2022. The authors have no sources of support to report. Drs Bundy, Baron, and Hambleton were on a Task Force of the FSPHP Board that prepared the FSPHP Position Statement “Safety Considerations for Medication Treatment of Opioid Use Disorders in Monitored Health Professionals.” Dr Baron was on FSMB Workgroup that wrote the policy “Physician Illness and Impairment: Towards a Model that Optimizes Patient Safety and Physician Health.”

Response to the Federation of State Physician Health Program's Commentary.

Response to the Federation of State Physician Health Program's Commentary.

Factors Associated with Vaccination Intention against the COVID-19 Pandemic: A Global Population-Based Study

Several vaccines have been developed for COVID-19 since the pandemic began. This study aimed to evaluate the factors associated with COVID-19 vaccination intention. A global survey was conducted across 26 countries from October, 2020 to December, 2021 using an online self-administered questionnaire. Demographic information, socio-economic status, and clinical information were collected. A logistic regression examined the associations between vaccine intention and factors such as perceptions and the presence of chronic physical and mental conditions. The sample included 2459 participants, with 384 participants (15.7%) expressing lower COVID-19 vaccination intent. Individuals who identified as female; belonged to an older age group; had a higher level of education; were students; had full health insurance coverage; or had a previous history of influenza vaccination were more willing to receive vaccination. Conversely, those who were working part-time, were self-employed, or were receiving social welfare were less likely to report an intention to get vaccinated. Participants with mental or physical health conditions were more unwilling to receive vaccination, especially those with sickle cell disease, cancer history within the past five years, or mental illness. Stronger vaccination intent was associated with recommendations from the government or family doctors. The presence of chronic conditions was associated with lower vaccine intention. Individuals with health conditions are especially vulnerable to health complications and may experience an increased severity of COVID-19 symptoms. Future research should evaluate the effectiveness of interventions targeting the vaccine perceptions and behaviours of at-risk groups. As such, public awareness campaigns conducted by the government and proactive endorsement from health physicians may help improve COVID-19 vaccination intention.

What are the attitudes of medical students and housestaff towards health advocacy? A physician-led voter registration initiative and health advocacy survey

Compared to the general population, physicians have been shown to be less engaged in civic participation and less likely to vote. However, perspectives of current trainees on health advocacy remain under-explored. To investigate perspectives on a physician led voter registration initiative and identify current beliefs of physicians in training and medical students regarding physician health advocacy. Cross sectional survey performed at a single urban academic center. A total of 366 medical students, residents, and fellows voluntarily participated in the survey out of a total of 1,719 available (21% response rate). We examined the current perceptions surrounding health advocacy among medical students and physicians in training and how this was impacted by the COVID-19 pandemic. Responses were analyzed using Chi-square analysis and logistic regression. The voter registration code was scanned 131 times prior to the 2020 Presidential elections. Barriers to hospital-based voter registration included lack of time, lack of fit into the workflow and forgetting to ask. Over half of internal medicine-based residents and fellows (51%) and medical students (63%) agreed that physicians should be involved in helping patients register to vote compared to 34% of surgical-based trainees. A large majority (87%) indicated that the COVID-19 pandemic made it more necessary for physicians to be involved in politics. A high proportion of medical students and housestaff across specialties report an obligation to be involved in health advocacy, though there were differing views towards direct involvement in voter registration.

Prepare for 2023: Evaluation and Management Code and Guideline Changes Announced

This article addresses Changes to evaluation and management (E/M) code categories Code categories that will be selected based on either the level of medical decision-making (MDM) or on the physician or other qualified health care professional’s (QHP’s) total time on the date of the encounter, with 1 exception Notable differences in the descriptions of total time for codes revised in 2023

Reasons for informal payments from the perspective of health care providers and recipients: a qualitative study in Iran

BackgroundInformal payments are one of the major obstacles to health system reform in many developing countries, and its elimination is on the agenda of health system policymakers in many countries, including Iran. This study was conducted to identify the causes of informal payments in the Iranian health system.MethodsThis was a qualitative and exploratory study. The study environment included the Ministry of Health, physicians' offices, medical universities, and hospitals and health centers. The study population included health care providers (physicians and hospital staff, managers, supervisors, and nurses) and health care recipients (patients or patients who had a history of dealing with informal payments). Data were collected using open-ended questions and semi-structured interviews. Snowball sampling method was used to select managers, chief executive officers (CEOs) and nurses. Convenience sampling was used to select physicians due to their lack of participation and cooperation. Content analysis method was used to analyze the data.ResultsReasons for informal payments were divided into 4 themes including: Economic factors (improper tariff valuation of services; failure to increase tariffs proportionate to inflation; lack of comprehensive participation of stakeholders in determining tariffs; tariff inconsistency in the public, private and charity sectors; etc.); socio-cultural factors (decreased social capital of the medical community among the people; improving the quality of life; incorrect comparison of providers' income levels with the income of doctors in other countries; existence of a culture of gratitude and appreciation; health as a priority for society; pride of service recipients; pride of service providers; etc.); service delivery challenges (high professional skills of the doctor; use of modern medical equipment; the monopoly of some doctors, etc.) and legal-political factors (inadequate monitoring by upstream organizations; lack of strict rules; difficulty of proving informal payments; presence of stakeholders in management and policy making processes).ConclusionsKnowing the causes of informal payments can help reduce or eliminate it. The results of this study identified the causes of informal payments in the Iranian health system. Accurate knowledge of the needs and motivations of both health care providers and recipients can be effective in accurately identifying and eliminating this phenomenon.

The Effectiveness Group Emotion Regulation Training on Promoting the Mental Health of Physicians and Nurses of Public Hospitals in Isfahan

The Effectiveness Group Emotion Regulation Training on Promoting the Mental Health of Physicians and Nurses of Public Hospitals in Isfahan

From Screening to the Receipt of Services: A Qualitative Examination

Research has focused on developing methods to facilitate screening and tracking data on social risk factors in healthcare settings. Less is known about the multiple factors that shape patients' acceptance of healthcare-based social risk programs. This qualitative study sought to elucidate the multilevel (individual, interpersonal, family/community, system, policy) factors that influence patients' acceptance of a healthcare-based social risk program within a Federally Qualified Health Center in New York City. Participants included 5 patients receiving care at the Federally Qualified Health Center who screened positive for social risks, 4 nurses who are responsible for conducting social risk screenings, and 5 Family Support Services counselors who conduct outreach to patients who screened positive. Interviews were conducted from March to June 2021 and analyzed from July to September 2021 using the constant comparative method. Analyses of the transcripts identified the following 3 themes: (1) Patients appreciated being asked about social risk factors, but there was a mismatch between their understanding of the screening process, their desire for assistance, and the support received. Although nurses and counselors described relationship-centered approaches to involve patients in the process, patients reported feeling initial discomfort and confusion; (2) Multilevel barriers inhibit patients' acceptance of assistance; and (3) Patient trust in the physician and healthcare organization serves as facilitators to acceptance. Patients' views about the purpose of a healthcare-based social risk program differed from nurses' and counselors' perspectives of the process. Although patients face multilevel challenges, strong trust in the physician and Family Health Centers served as facilitators to accepting healthcare-based assistance.

Physician burnout in critical care and emergency unit setting

All types of healthcare professionals can develop burnout syndrome (BOS), while those who serve in critical care and emergency units are more susceptible to it. The emergence of BOS is linked to an imbalance between a team member's personal traits and problems at work or with other organisational elements. BOS is linked to a number of negative effects, including as higher rates of employee turnover, lower patient satisfaction, and lower levels of care quality. BOS also has a direct impact on the mental and physical health of the many physicians and other healthcare workers that work in emergency and critical care settings around the world. Critical care medical professionals and other psychological illnesses went mostly undetected until recently. The current paper examines the burnout prevalence among doctors in critical care (CC) unit and emergency unit physicians, the risk factors (RF) of burnout and their consequences, prevention and treatment measures of BOS and intensive and non-ICU healthcare workers' burnout prevalence comparison were also studied. It finally concludes from the study that the physicians from the Critical Care Unit and emergency department unit are more stressed and prone to high burnout levels than others.

It’s about time – Associations between working time dimensions and well-being of physicians

ABSTRACT Several working time characteristics have been linked to negative outcomes for health personnel. The aim was to investigate the impact of working time dimensions on well-being in a representative sample of physicians. Data was collected during a baseline study. Linear regression analysis was performed on a sample including 669 physicians of different medical specialties. The questionnaire included sociodemographic characteristics and information on working time dimensions (e.g. shift work). In addition, job satisfaction, workload and self-reported health were explored. The majority were female, working in internal medicine and the mean age was 42.5 years. Findings reveal that overtime hours (β = −0.478, p = .011) and autonomy (β = 0.444, p < .001) were significantly associated with job satisfaction. The number of free weekends (β = −2.622, p = .005) and autonomy significantly predicted personal (β = −6.153, p < .001), work-related (β = −6.597, p < .001) and patient-related workload (β = −4.731, p < .001). Overall health was only affected by working time autonomy (β = 3.804, p < .001). In conclusion, the study suggests that working time characteristics have negative consequences for well-being and need to be addressed to ensure health, performance and safety of physicians.

Essential strategies and tactics for managing sickle cell disease.

Key to patients' well-being is the family physician's watchfulness-through periodic lab testing and health checks and diligent application of preventive measures.

Preparing for 2023: Selecting the Level of Risk Associated With Patient Management

This article continues discussion of the elements of MDM. Either the level of MDM or the total time spent by the physician or other qualified health care professional (QHP) directed to care of the individual patient may be used in office E/M code selection (unlike other E/M codes selected based on key components or face-to-face time).

COVID Collaborations: A Physician Assistant Program and Health Department Partnership

The onset of the COVID-19 pandemic resulted in the displacement of clinical-phase medical learners across the country. Physician assistant (PA) and other health professions programs were challenged to innovate and offer alternate learning experiences that would meet students' needs as future health care professionals. At the same time, local and state health departments were faced with quickly increasing their capacity for contact tracing and case investigation in response to the growing number of COVID-19 infections. Through a collaborative partnership based on the needs of the local health department and clinical-phase PA students, the Duke PA program developed an elective in which students served as contact tracers and case investigators. PA students provided over 1500 hours of contact tracing and case investigation support to the local health department. Qualitative review showed students gained a greater appreciation of the impact of social determinants of health, saw first-hand how the pandemic disproportionately affected communities of color, and increased their knowledge about the role of public health. The partnership between the PA program and the health department was mutually beneficial and established a foundation for future collaborative experiences that support both the community and the needs of health professions' learners.

Prevalence and risk factors for depressive symptoms in physicians working in the icus in alexandria main university hospital

Introduction Depression can lead to significant emotional distress or impairment in social life, home life, and work. Both depression and substance disorders have been identified as major risk factors for the high rate of suicides among physicians, with more than 90% of those physicians who suicide having a history of mood disorder and/or substance abuse. Therefore, interest in the psychological well-being of physicians has increased recently, warranting further research regarding factors that influence the mental health of physicians. Worldwide prevalence of depression among physicians is around 28.8% (20–40%). Both developing and developed countries were high in the prevalence of depression in physicians. The percentage was more marked in a study from Egypt (73.8%) and USA (41%). Fewer studies are found in Asian countries. But the rate was high eventually (30.1%). Objective The aim of the study was to estimate the prevalence of depressive symptoms among critical care residents in Alexandria Main University Hospital and to identify the risk factors among them. Patients and methods This study implemented a cross-sectional survey. We present a questionnaire to each doctor, which includes three sections: sociodemographic information, lifestyle- and work-related characteristics, and Patient Health Questionnaire-9 survey. Results Three quarter of the surveyed ICU physicians reported moderate to severe depressive symptoms. In women, the level of stress is significantly higher than in men. In people working in the 12 and 24-h system and taking overtime hours, the stress level was the highest. Poor patient outcome and decisions with do-not-resuscitate are contributing with more depressive symptoms. Physically active physicians have less depressive symptoms. Conclusion Prevalence of depressive symptoms was high among Alexandria Main University Hospital residents. Lack of support and large number of patients along with poor patient outcome and long working hours were the most relevant risk factors.

Extracorporeal Life Support Organization Guidelines for the Provision and Assessment of Nutritional Support in the Neonatal and Pediatric ECMO Patient.

This guideline is intended for educational use to build the knowledge of physicians and other health professionals in assessing the conditions and managing the treatment of patients undergoing extracorporeal life support (ECLS)/extracorporeal membrane oxygenation (ECMO) and describe what are believed to be useful and safe practice for extracorporeal life support (ECLS, ECMO) but these are not necessarily consensus recommendations. The aim of clinical guidelines are to help clinicians to make informed decisions about their patients. However, adherence to a guideline does not guarantee a successful outcome. Ultimately, healthcare professionals must make their own treatment decisions about care on a case-by-case basis, after consultation with their patients, using their clinical judgment, knowledge, and expertise. These guidelines do not take the place of physicians' and other health professionals' judgment in diagnosing and treatment of particular patients. These guidelines are not intended to and should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment must be made by the physician and other health professionals and the patient in light of all the circumstances presented by the individual patient, and the known variability and biologic behavior of the clinical condition. These guidelines reflect the data at the time the guidelines were prepared; the results of subsequent studies or other information may cause revisions to the recommendations in these guidelines to be prudent to reflect new data, but Extracorporeal Life Support Organization (ELSO) is under no obligation to provide updates. In no event will ELSO be liable for any decision made or action taken in reliance upon the information provided through these guidelines.

Validity and reliability of the Arabic version of the Self-Efficacy for Managing Chronic Disease scale in rheumatoid arthritis patients

Background and objectivesRheumatoid arthritis (RA) is an autoimmune inflammatory condition that causing disability and affection of patient’s quality of life (QoL). Self-efficacy investigation helps us to detect the requirements of chronically affected patients and evaluation of self-care management programs. The aim of our study was to test validity and reliability of Self-Efficacy for Managing Chronic Disease (SEMCD-Arabic) in RA patients.MethodThis study included 248 RA patients, carried out at Rheumatology and Rehabilitation Department. The SEMCD-Arabic Validity was assessed by correlating the SEMCD-Arabic scale with the validated Arabic version of the modified Health Assessment Questionnaire HAQ (MHAQ), the Arabic version of the Multidimensional Assessment of Fatigue (MAF) scale, and the Arabic version of Short Form 36 version 2 for quality of life (SF QoL). Internal consistency, test–retest reliability was assessed.ResultsConvergent validity was confirmed by a positive correlation between (physical, mental) component of SF QoL and SEMCD-Arabic (r = 0.918, r = 0.925) respectively, and negative correlation between MAF and SEMCD-Arabic (r = − 0.657) and MHAQ with SEMCD-Arabic (r = − 0.595). Discriminant validity confirmed by a significant negative correlation between visual analogue scale (VAS) for pain, disease activity scale (DAS28), Morning stiffness, patient health, physician health, age, duration, and SEMCD-Arabic (r = − 0.1–0.7) (P < 0.001). Test–retest reliability was estimated which revealed a high interclass correlation coefficient (ICC = 0.87–0.997) indicating excellent agreement and internal consistency is acceptable as the Cronbach’s alpha value (0.660 to 0.78).ConclusionThe SEMCD-Arabic questionnaire can be used as a valid and reliable measure for assessment of patient’s self-efficacy in RA.Key Points• The SEMCD-Arabic questionnaire has a statistically significant validity in correlation with different clinical manifestations MHAQ, SF QoL, and MAF.• The Arabic SEMCD is highly reliable with a Cronbach’s alpha of 0.660 to 0.78.

Abstract 6242: Association of prostate cancer risk variants with gene expression in prostate stroma

Abstract Background: Prostate cancer genome-wide association studies have identified &amp;gt;260 germline risk variants which provide strong risk prediction for prostate cancer. Functional interpretation and biological mechanisms of these risk variants are not always clear. Many of the prostate cancer risk variants are expression quantitative trait loci (eQTLs), but studies have mostly been performed in tumor or epithelial-enriched normal prostate tissue. Given emerging evidence supporting that stroma contributes to the carcinogenic process, we examined the associations of prostate cancer risk variants with the expression of genes in prostate stroma. Methods: We generated mRNA expression data for 13,577 genes with the Illumina TruSeq RNA Exome library preparation kit from stromal samples in specimens from participants of the Health Professionals Follow-up Study and Physicians’ Health Study cohorts. Specifically, we profiled 172 stromal samples adjacent to tumor and 86 paired stroma distant from tumor. We included 264 prostate cancer risk variants genotyped data and imputed using a common reference panel (1,000 Genomes Phase I release). We performed cis- (≤1 Mb from the SNP (single nucleotide polymorphism) to the gene) and trans- eQTL analyses using a linear regression model in the R package Matrix eQTL. Results: Thirty-four SNPs were significantly (P &amp;lt; 0.01) associated with cis-expression of 41 nearby genes in prostate stroma adjacent to tumor, and 41 SNPs with 52 nearby genes for stroma distant from tumor. Genome-wide, 86 SNPs were significantly (FDR &amp;lt; 0.10) associated with the expression of 126 genes in stroma adjacent to tumor, and 64 SNPs with 291 genes for stroma distant from tumor. Conclusions: This is the first study to comprehensively examine associations between prostate cancer risk variants and gene expression in prostate stroma. We observed some previous reported associations but also novel associations which may suggest genes that contribute to prostate cancer risk within the stromal tissue. Identifications of eQTLs within prostate stroma may suggest potential mechanisms in specific cell types for their effect on disease. Citation Format: Chaoran Ma, Yinglu Zhou, Anna Plym, Giuseppe Nicolò Fanelli, Massimo Loda, Lorelei Mucci, Svitlana Tyekucheva, Kathryn Penney. Association of prostate cancer risk variants with gene expression in prostate stroma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6242.