Physician Scores Research Articles

69 A Population-based Study of Parent-reported Health Outcomes at Preschool Age of Children Born Very Preterm

Abstract Background Most existing literature on health status (HS) and health-related quality of life (HRQL) of preterm survivors focuses on late childhood, adolescent, and adult age, with only a small body of data on preschool age children. Little is known about the relationship between parent-reported HS outcomes and standardized neurodevelopmental outcomes measured in preterm survivors at preschool age. Objectives To present parent-reported HS outcomes at 36 months of age in a population-based cohort of very preterm survivors and compare parent-reported subjective outcomes to standardized neurodevelopmental outcomes measured by clinicians at the same age. Design/Methods Infants <31 weeks’ gestation born between April 2014 and June 2016 were prospectively followed through the Perinatal Follow-Up Program and enrolled in a population-based database. HS was measured using the Health Status Classification System for Pre-School Children questionnaire, completed by parents when children reached 36 months’ age. At the same age, neurological examination and standardized developmental assessments were completed by clinicians, using the Bayley Scales of Infant and Toddler Development – III to determine neurodevelopmental impairment (NDI). NDI was categorized as none, “mild”, or “significant" (moderate or severe cerebral palsy, Bayley-III <70, blind or required hearing aid). Inter-rater reliability between the physician and parent scores was assessed using Cohen’s weighted kappa coefficient. Results Of 118 children included, there were 47 and 71 children born in <28 and ≥28 weeks’ gestational age, respectively. At 36 months’ age, 73.7% had a parental health concern, mild in >50% and severe in only 8.5%. The most affected HS attributes were language (46.6%) and self-care (39.0%). Nearly 75% of the participants did not meet the criteria for NDI. Of 11 (9.3%) children with significant NDI at 36 months’ age, all parents reported moderate (36.4%) or severe (63.6%) health concerns. Conversely, of 26 (22%) children with parents reporting moderate to severe health concerns, 11 (42.3%) met the criteria for significant NDI (Table 1). Weighted Kappa coefficient was 0.33 (CI=0.20,0.046). Conclusion Most parents expressed at least one concern for their preschool-aged child born preterm. Despite high parental concern, most children did not meet the criteria for NDI via clinician assessment. Overall, there was fair agreement between parental concerns and clinician-reported outcomes.

Mind + Machine: ChatGPT as a Basic Clinical Decisions Support Tool.

Background Generative artificial intelligence (AI) has integrated into various industries as it has demonstrated enormous potential in automating elaborate processes and enhancing complex decision-making. The ability of these chatbots to critically triage, diagnose, and manage complex medical conditions, remains unknownand requires further research. Objective This cross-sectional study sought to quantitatively analyze the appropriateness of ChatGPT (OpenAI, San Francisco, CA, US) in its ability to triage, synthesize differential diagnoses, and generate treatment plans for nine diverse but common clinical scenarios. Methods Various common clinical scenarios were developed. Each was input into ChatGPT, and the chatbot was asked to develop diagnostic and treatment plans. Five practicing physicians independently scored ChatGPT's responses to the clinical scenarios. Results The average overall score for the triage ranking was 4.2 (SD 0.7). The lowest overall score was for the completeness of the differential diagnosis at 4.1 (0.5). The highest overall scores were seen with the accuracy of the differential diagnosis, initial treatment plan, and overall usefulness of the response (all with an average score of 4.4). Variance among physician scores ranged from 0.24 for accuracy of the differential diagnosis to 0.49 for appropriateness of triage ranking. Discussion ChatGPT has the potential to augment clinical decision-making. More extensive research, however, is needed to ensure accuracy and appropriate recommendations are provided.

Safety, Tolerability, Pharmacokinetics, and Pharmacodynamics of ZY-IL1 in Three Patients with Cryopyrin-Associated Periodic Syndromes.

We present the first results of the proof-of-concept phase 2a study of oral NLRP3 inflammasome inhibitor in subjects with cryopyrin-associated periodic syndromes (CAPS). Three adult subjects with a confirmed diagnosis of CAPS were enrolled and administered 50mg of ZYIL1 twice daily for 7 days. A total of 5 treatment-emergent adverse events (TEAEs) were reported in 2 subjects. All 5 TEAEs were mild in severity and considered unrelated to the study drug. At steady state, the average plasma concentration and trough concentration ranged from 2.5 to 4.2 and 1.4 to 2.5µg/mL, respectively. Inflammatory markers and disease activity (physician and patient global assessment score) decreased notably 12 hours post-last dose.

Internally versus externally trained residents and fellows hired as attendings at a large integrated healthcare system: a 20-year retrospective study

BackgroundThere remains a question of whether graduates trained internally are different than those trained elsewhere. We examine the difference between physicians trained within our Graduate Medical Education (GME) programs versus physicians trained elsewhere. Our large integrated healthcare system is unique in addressing this objective due to its large physician labor hiring needs across different specialties of GME graduates.MethodsA retrospective review was performed from Jan 2000 to August 2020 of Kaiser Permanente Southern California (KPSC) physicians hired: KPSC GME trained versus non-KPSC GME trained. We examined five variables: retention, leadership (current or historical), physician relations cases, member appraisal of physician and provider services survey (MAPPS) scores, and rate of board certification. Chi-square test of proportions was used for comparison, p < 0.05 was significant.ResultsFrom Jan 2000 to August 2020, 2940 residents and fellows graduated from KPSC GME programs, of which 1127 (38%) were hired on at KPSC as full time attendings. Across all five metrics (Retention 82% vs 76% (p = < 0.01), Leadership [current 13% vs 10% (p = < 0.01)or historical 17% vs 14% (p = 0.01)], Physician Relations 23% vs 26% (p = 0.04), MAPPS 75% vs 69% (p = < 0.01), and Board Certification 81% vs 74% (p = < 0.01)), KPSC outperformed non-KPSC GME-trained physicians to a statistically significant degree.ConclusionsWe have shown that an internally sponsored GME program can represent an opportunity for recruitment of physicians that may have higher retention rates, higher probability of being physician leaders, decreased likelihood of physician relations issues, improved patient satisfaction, and increased rates of board certification.

Psychological factors and prognostic communication preferences in advanced cancer: multicentre study

ObjectivesCommunication regarding prognosis to patients with advanced cancer is fundamental for informed medical decision making. Our objective was to analyse (1) the proportion of subjects with advanced cancer who prefer...

Artículo traducido] Efectividad de guselkumab en pacientes con hidradenitis supurativa en condiciones de práctica clínica: estudio retrospectivo y multicéntrico en España

BackgroundHidradenitis suppurativa (HS) is a chronic skin condition causing lesions in which high levels of interleukin (IL)-23 and T-helper17 cells are found. Adalimumab remains the only approved treatment. Guselkumab, an antibody targeting the p19 protein subunit of extracellular IL-23, is approved for the treatment of moderate-severe psoriasis, but evidence on its efficacy in treating HS is limited. ObjectivesTo assess the effectiveness and safety of guselkumab in treating moderate-severe HS under clinical practice conditions. MethodsA multicentre retrospective observational study was carried out in 13 Spanish hospitals including adult HS patients treated with guselkumab within a compassionate use programme (March 2020-March 2022). Data referred to patient demographic and clinical characteristics at treatment initiation (baseline), patient-reported outcomes (Numerical Pain Rating Scale [NPRS] and Dermatology Life Quality Index [DLQI]), physician scores (International Hidradenitis Suppurativa Severity Score System [IHS4], HS Physical Global Score [HS-PGA] and Hidradenitis Suppurativa Clinical Response [HiSCR]) were recorded at baseline and at 16, 24, and 48weeks of treatment. ResultsA total of 69 patients were included. Most (84.10%) had severe HS (HurleyIII) and had been diagnosed for over ten years (58.80%). The patients had been subjected to multiple non-biological (mean: 3.56) or biological (mean: 1.78) therapies, and almost 90% of those treated with biologics had received adalimumab. A significant decrease in IHS4, HS-PGA, NPRS, and DLQI scores was observed from baseline to 48weeks of guselkumab treatment (all P<.01). HiSCR was achieved in 58.33% and 56.52% of the patients at 16 and 24weeks, respectively. Overall, 16 patients discontinued treatment, mostly due to inefficacy (n=7) or loss of efficacy (n=3). No serious adverse events were observed. ConclusionsOur results indicate that guselkumab may be a safe and effective therapeutic alternative for patients with severe HS that fail to respond to other biologics.

Knowledge Tensor-Aided Breast Ultrasound Image Assistant Inference Framework.

Breast cancer is one of the most prevalent cancers in women nowadays, and medical intervention at an early stage of cancer can significantly improve the prognosis of patients. Breast ultrasound (BUS) is a widely used tool for the early screening of breast cancer in primary care hospitals but it relies heavily on the ability and experience of physicians. Accordingly, we propose a knowledge tensor-based Breast Imaging Reporting and Data System (BI-RADS)-score-assisted generalized inference model, which uses the BI-RADS score of senior physicians as the gold standard to construct a knowledge tensor model to infer the benignity and malignancy of breast tumors and axes the diagnostic results against those of junior physicians to provide an aid for breast ultrasound diagnosis. The experimental results showed that the diagnostic AUC of the knowledge tensor constructed using the BI-RADS characteristics labeled by senior radiologists achieved 0.983 (95% confidential interval (CI) = 0.975-0.992) for benign and malignant breast cancer, while the diagnostic performance of the knowledge tensor constructed using the BI-RADS characteristics labeled by junior radiologists was only 0.849 (95% CI = 0.823-0.876). With the knowledge tensor fusion, the AUC is improved to 0.887 (95% CI = 0.864-0.909). Therefore, our proposed knowledge tensor can effectively help reduce the misclassification of BI-RADS characteristics by senior radiologists and, thus, improve the diagnostic performance of breast-ultrasound-assisted diagnosis.

Efficacy and efficiency of information retrieval of community family physicians at the point of care: exploring the associations with information and computer literacy

Objective: This study aimed to measure the association between the efficacy/efficiency of digital information retrieval among community family physicians at the point of care and information and computer literacy. Methods: This study is a part of a cross-sectional anonymous online survey-based study among community family physicians who reported no affiliation with an academic institution in eight Arab countries. Results: A total of 72 physicians were included. The mean total score for the information literacy scale was 59.8 out of 91 (SD = 11.4). The mean score was 29.3 (SD = 5.6) out of 55 on the computer literacy scale. A one-way ANOVA revealed a statistically significant association between information literacy and information retrieval efficacy (F (2,69) = 4.466, p = 0.015) and efficiency of information retrieval (F (2.69) = 4.563, p = 0.014). Computer literacy was not associated with information retrieval efficacy or efficiency. Conclusion: The information and computer literacy scores of community family physicians in eight Arab countries are average. Information literacy, rather than computer literacy, is positively associated with the efficacy and efficiency of information retrieval at the point of care. There is room for improvement in evidence-based medicine curricula and continuous professional development to improve information literacy for better information retrieval and patient care.

The Effectiveness of Guselkumab in Patients With Hidradenitis Suppurativa Under Clinical Practice Conditions: A Spanish Multicentre Retrospective Study

BackgroundHidradenitis suppurativa (HS) is a chronic skin condition causing lesions in which high levels of interleukin (IL)-23 and T-helper 17 cells are found. Adalimumab remains the only approved treatment. Guselkumab, an antibody targeting the p19 protein subunit of extracellular IL-23, is approved for the treatment of moderate–severe psoriasis, but evidence on its efficacy in treating HS is limited. ObjectivesTo assess the effectiveness and safety of guselkumab in treating moderate–severe HS under clinical practice conditions. MethodsA multicentre retrospective observational study was carried out in 13 Spanish Hospitals including adult HS patients treated with guselkumab within a compassionate use programme (March 2020–March 2022). Data referred to patient demographic and clinical characteristics at treatment initiation (baseline), patient-reported outcomes (Numerical Pain Rating Scale [NPRS] and Dermatology Life Quality Index [DLQI]), physician scores (International Hidradenitis Suppurativa Severity Score System [IHS4], HS Physical Global Score [HS-PGA] and Hidradenitis Suppurativa Clinical Response [HiSCR]) were recorded at baseline and at 16, 24, and 48 weeks of treatment. ResultsA total of 69 patients were included. Most (84.10%) had severe HS (Hurley III) and had been diagnosed for over ten years (58.80%). The patients had been subjected to multiple non-biological (mean 3.56) or biological (mean 1.78) therapies, and almost 90% of those treated with biologics had received adalimumab. A significant decrease in IHS4, HS-PGA, NPRS, and DLQI scores was observed from baseline to 48 weeks of guselkumab treatment (all p<0.01). HiSCR was achieved in 58.33% and 56.52% of the patients at 16 and 24 weeks, respectively. Overall, 16 patients discontinued treatment, mostly due to inefficacy (n=7) or loss of efficacy (n=3). No serious adverse events were observed. ConclusionsOur results indicate that guselkumab may be a safe and effective therapeutic alternative for patients with severe HS that fail to respond to other biologics.

A Comparison of Checklist and Domain-Based Ratings in the Assessment of Objective Structured Clinical Examination (OSCE) Performance.

The Objective Structured Clinical Examination (OSCE) is the mainstay of clinical assessment in the final-year undergraduate Family Medicine clerkship at King Faisal Specialist Hospital and Research Centre (KFSHRC). The gold standard for OSCE assessment is the checklist rating, completed by physician examiners. Numerous studies have suggested that global or domain-based OSCE ratings may be a better indicator of competence than checklist ratings. The aim of this study was to examine the utility of domain-based OSCE ratings in the context of final-year, undergraduate, Family Medicine OSCE examinations in Riyadh, Saudi Arabia. This is akin to an exercise in quality improvement, as we continuously look for ways to improve our OSCE assessment processes. This study utilised a quantitative methodology. Three final year OSCE exams were chosen. Physicians rated each student using a checklist score and using a more holistic domain-based score. Physician checklist scores and physician domain-based scores were then compared, and correlation was assessed. We also looked at the internal consistency of the scoring methods. A significant correlation was found between checklist and domain-based scores by physicians for all exams (r=0.858, p<0.01), with a good internal consistency for these methodologies for all exams. The results demonstrate that both checklist and domain-based scores offer some benefit to the assessment, with a similar internal consistency and strong correlation. Domain-based ratings should be utilised for softer skills that are not easily assessed by checklists. There is clearly a need to rethink our OSCE assessment. The assessment should combine checklist and domain-based physician scores. As trainees become more experienced, checklist OSCE may penalise directness and efficiency, while domain-based ratings would offer a better appraisal of competence, and have been shown to be more sensitive to the level of training and expertise. Changing the assessment methods will lead to necessary changes in the student approach to the OSCE and improve authenticity and validity.

The impact of physician gender on patient satisfaction in an academic hematology/oncology practice.

11022 Background: Gender disparities continue to remain under addressed in medicine. While prevalent in many forms, patient bias and perceptions toward their healthcare team can impact patient compliance and care. Health systems often gauge patient satisfaction with physicians and post these ratings online. It is possible that gender biases affect patient satisfaction scores and evaluations. Here, we assess the impact of physician gender on patient satisfaction scores and comments in an academic hematology/oncology practice. Methods: A retrospective mixed-method analysis was conducted from patient satisfaction scores and comments obtained between January and June of 2021. Patients were asked a series of three questions about their care. Patients’ response to the question, “How likely would you be to recommend this providers office to friends and family?”, was analyzed on a score of 0-10, with 10 being extremely likely and 0 being not at all likely. Patients were then asked for the primary reason for their scoring, in an open-ended format. Mixed-gender codified data was quantified from de-identified, de-gendered patient comments. To identify the differences in patient perception between male and female physicians, we specifically examined the data of positive and negative impressions of variables including professional behaviors, expertise, kindness, compassion, and interactions with ancillary staff amongst providers. Results: Patient satisfaction scores from 199 unique patients were reviewed; 140 (70.4%) were about male-identifying physicians while 59 (29.6%) were related to female-identifying physicians. The mean satisfaction score was 9.95 ± 0.29 for female physicians and 9.64 ± 1.38 for male physicians (p = 0.011). Of patients responding, 76 (38%) were male and 123 (63%) were female. Female physicians scored higher than male physicians for both male and female patients (10.0 ± 0 versus 9.65 ± 1.37 (p = 0.011) and 9.77 ± 0.60 versus 9.62 ± 1.40 (p = 0.011), respectively). Kindness and compassion were mentioned in 36% and 42% of all female physician scores, respectively, and in 29% and 33% of all male physician scores; these did not reach statistical significance (p = 0.587 and p = 0.257). 21% of all male physician scores positively mentioned physician expertise, compared to 15% of female physician scores; this also did not reach statistical significance (p = 0.434). Conclusions: Female physicians had a higher mean satisfaction score in patient evaluations than their male counterparts by both male and female patients. Numerically, more patient comments about female physicians mentioned kindness or compassion, while fewer mentioned expertise. This early work will be expanded to a larger dataset of evaluations in addition to further exploration of how female and male oncology providers are perceived by patients in multiple other categories.

Reliability of Risk Assessment for Intra-Hospital Venous Thromboembolism: An Exploratory Cross-Sectional Study.

Hospital-associated venous thromboembolism (VTE) is a major cause of unintended death in hospitalized patients. Standardized and reasonable prevention measures may reduce its occurrence effectively. This study aims to analyze the consistency of VTE risk assessment by physicians and nurses and its potential causes. A total of 897 patients admitted to Shanghai East Hospital from December 2021 to March 2022 were recruited. The VTE assessment scores of physicians and nurses and the activities of daily living (ADL) scores within the first 24 h of admission were collected for each patient. Cohen's Kappa values were calculated to assess the inter-rater consistency of these scores. VTE scores were fairly consistent between doctors and nurses in both surgical (Kappa = 0.30, 95% CI: 0.25-0.34) and non-surgical (Kappa = 0.35, 95% CI: 0.31-0.38) departments. There was moderate agreement in VTE risk assessment between doctors and nurses in surgical departments (Kappa = 0.50, 95% CI: 0.38-0.62) while fair agreement in VTE risk assessment between doctors and nurses in non-surgical departments (Kappa = 0.32, 95% CI: 0.26-0.40). The assessment of the mobility impairment component was fairly consistent between doctors and nurses in the non-surgical departments (Kappa = 0.31, 95% CI: 0.25-0.37). Due to the poor consistency of VTE risk assessment between doctors and nurses, it is necessary to provide systematic training and develop a standardized assessment process for healthcare professionals to construct a scientific and effective VTE prevention and treatment system.

Better together: A team-based approach to improve prior authorization efficiencies and wellness in physicians and advanced care providers.

e13664 Background: The burden of prior authorizations (PAs) required for costly oncologic treatments is high. Upon PA denials, peer-to-peer requests are performed. These requests consume time and effort of physicians and advanced care providers (APPs) contributing to burnout and may have a negative impact on patient care. We aimed to assess the degree to which the PA process contributed to burnout among oncology clinicians prior to implementation of a new streamlined workflow aimed at improving clinician wellness. Methods: A baseline wellness survey was sent to all hematology-oncology faculty and APPs at the largest clinical site of our academic cancer center. Burn out, our primary outcome, was measured using the work-related Copenhagen Burnout Inventory. We included selected questions from the American Medical Association (AMA) surveys regarding physician perceived impact of PAs on clinical workload and care delivery. We asked physicians and APPs to rate the impact of PAs on burnout on a scale of 0-100. Analysis was conducted using descriptive statistics. This study was sponsored by our Office of Well-Being and Resilience. Results: The wellness survey was completed by 35 physicians and 21 APPs with a response rate of 53% in both. The median Copenhagen burnout score for physicians was 46.43 (35.71-60.71) with higher burn out scores among those identifying as females, in practice less than 15 years and with more than 60% time in direct patient care. The median burn out score for APPs was 64.28 (50-83.03). Similar to physicians, APPs with less clinical experience had higher burn out scores. When asked about the impact of PAs on burnout on a scale of 0-100, physicians at the main site reported a median of 13.5, while APPs reported a median of 53.5. Conclusions: Physicians and APPs report noteworthy baseline rates of burnout and dedicate a significant portion of the week to completing PAs. Importantly, APPs perceived the PAs to have a high impact on their burn out compared to physicians. We will use these data to determine the efficacy of a new process that utilizes a single EMR platform for finance and cancer registry teams to abstract and document all of the required elements to streamline the PA process for intravenous/injection cancer treatments with the goal to reduce the number of PAs and improve wellness. [Table: see text]

Trust in physicians and definitive diagnosis time among Japanese patients with specific intractable diseases: A cross-sectional study.

Trust in physicians is an important metric in shared decision-making. Many patients with rare diseases experience misdiagnosis or delayed diagnosis because of difficulties in diagnosis or access to specialists. What impact do these have on trust in physicians? This study focused on patients with rare diseases, evaluated the effects of a delayed diagnosis and misdiagnosis on trust in physicians, and clarified the backgrounds of patients who have experienced delayed diagnoses. Patients with any of the 334 intractable diseases in Japan were registered, and a questionnaire survey was conducted on 1,000 valid registrations. Scores were calculated on a five-point Likert scale, and Cronbach's alpha coefficient was calculated to determine internal consistency, which was 0.973. Independent sample t-tests and analysis of variance were used to compare average trust scores based on patient demographics. The mean trust in physician score of patients who waited ≤ 1 year until definitive diagnosis was 47.66 ± 11.69, while those of patients who waited > 1 year was 45.07 ± 11.63 (p = 0.004). The average trust scores of patients with or without a misdiagnosis were 46.69 ± 11.96 and 47.22 ± 11.65 (p = 0.550), respectively. Among patients with time to a definitive diagnosis of > 1 year, 62.8% had a period from symptom onset to initial hospital visit of > 1 year. A longer time to definitive diagnosis lowered the degree of trust in physicians. Many patients who experienced delayed diagnoses also had a long time from symptom onset to the initial medical visit. This aspect is important for understanding the background of patients who experienced delayed definitive diagnoses.

Evaluating knowledge and attitude of physicians regarding medicinal drugs and driving: a descriptive-analytical cross-sectional study

Background. Drugged driving is a growing traffic safety issue in many countries. Adequate knowledge of physicians concerning the effects of different medicines on driving can help them prescribe safer medications. This study aimed to assess the knowledge and attitudes of family physicians regarding the effect of medicines on driving. Methods. This cross-sectional study was conducted on 91 family physicians in East Azerbaijan Province. A researcher-made questionnaire was used for data collection. This study considered knowledge and attitude as dependent variables and demographic characteristics as independent variables. To investigate the relationship between independent and dependent variables, independent t-test, one-way analysis of variance (ANOVA), chi-square, and multiple linear regression were used. Data were analyzed using Stata version 17. Results. According to the results, almost 65 (71.43%) of the participants were women and 26 (28.57%) were men with an average age of 31.54 years. The average score of physicians’ attitude about the effect of medicines on driving was 71.70 ± 14.94, and the average score of their knowledge was 37.52 ± 10.23. Therefore, 44 (48.35%) of the physicians had a good level of attitude, whereas 46 (52.87%) of them had a low level of knowledge regarding medications and driving. Receiving education regarding medications and driving was significantly correlated with the level of knowledge and the attitude of physicians (P&lt;0.05). However, no significant relationship was observed between the attitude and knowledge of physicians and other demographic variables. Conclusion. Considering physicians’ inadequate knowledge regarding the effect of medicines on driving, it is essential to hold training and retraining courses in the field of medicines and driving for physicians and develop a classification system for the drugs affecting driving in Iran. Practical Implications. The findings of this study can be presented to the policy-makers of the Ministry of Health in order to provide an opportunity to boost the knowledge and attitude of physicians regarding medicines and driving with the support of universities of medical sciences. As a result, an important step can be taken to reduce traffic accidents caused by prescription medicines.

The process and outcomes of chronic low back pain treatment provided by osteopathic and allopathic physicians: a retrospective cohort study.

Osteopathic physicians are trained to treat patients with musculoskeletal symptoms, to treat somatic dysfunction with osteopathic manipulative treatment (OMT), and to avoid unnecessarily prescribing drugs such as opioids. It is also generally believed that osteopathic physicians provide a unique patient-centered approach to medical care that involves effective communication and empathy. Such training and characteristics of osteopathic medical care (OMC) may enhance clinical outcomes among patients with chronic pain. The objectives of this study were to measure and compare the process and longitudinal outcomes of chronic low back pain (CLBP) treatment provided by osteopathic and allopathic physicians and to identify mediators of the treatment effects of OMC. This retrospective cohort study was conducted utilizing adult participants with CLBP within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION) from April 2016 through December 2022. Participants having an osteopathic or allopathic physician for at least 1month prior to registry enrollment were included and followed at quarterly intervals for up to 12months. Physician communication and physician empathy were measured at registry enrollment. Opioid prescribing and effectiveness and safety outcomes were measured at registry enrollment and for up to 12months and were analyzed with generalized estimating equations to compare participants treated by osteopathic vs. allopathic physicians. Multiple mediator models, including physician communication, physician empathy, opioid prescribing, and OMT, with covariate adjustments, were utilized to identify mediators of OMC treatment effects. A total of 1,079 participants and 4,779 registry encounters were studied. The mean (SD) age of participants at enrollment was 52.9 (13.2) years, 796 (73.8 %) were female, and 167 (15.5 %) reported having an osteopathic physician. The mean physician communication score for osteopathic physicians was 71.2 (95 % CI, 67.6-74.7) vs. 66.2 (95 % CI, 64.8-67.7) for allopathic physicians (p=0.01). The respective mean scores for physician empathy were 41.6 (95 % CI, 39.9-43.2) vs. 38.3 (95 % CI, 37.6-39.1) (p<0.001). There was no significant difference in opioid prescribing for low back pain between osteopathic and allopathic physicians. Although participants treated by osteopathic physicians reported less severe nausea and vomiting as adverse events potentially attributable to opioids in a multivariable model, neither result was clinically relevant. OMC was associated with statistically significant and clinically relevant outcomes pertaining to low back pain intensity, physical function, and health-related quality of life (HRQOL) over 12months. Physician empathy was a significant mediator of OMC treatment effects in each of the three outcome domains; however, physician communication, opioid prescribing, and OMT were not mediators. The study findings indicate that osteopathic physicians provide a patient-centered approach to CLBP treatment, particularly involving empathy, that yields significant and clinically relevant outcomes pertaining to low back pain intensity, physical function, and HRQOL over 12months of follow-up.

Association of Patient Experience of Care and Radiation Therapy Initiation Among Women With Early-Stage Breast Cancer

For women diagnosed with early-stage breast cancer, lumpectomy followed by radiation therapy (RT) has been a guideline-recommended treatment. However, lumpectomy followed by hormonal therapy is also an approved treatment for certain women. It is unclear what patient-driven factors are related to decisions to receive RT. This study examined relationships between patient-reported experience of care, an important dimension of health care quality, and receipt of RT after lumpectomy. We used National Cancer Institute Surveillance, Epidemiology, and End Results data linked to the CMS Medicare Consumer Assessment of Healthcare Providers and Systems patient surveys (SEER-CAHPS) to examine experiences of care among women diagnosed with local/regional stage breast cancer 2000 to 2017 who received lumpectomy, were enrolled in fee-for-service Medicare, completed a CAHPS survey ≤18 months after diagnosis, and survived for this study period. Experience of care was assessed by patient-provided scores for physicians, doctor communication, care coordination, and other aspects of care. Multivariable logistic regression models assessed associations of receipt of external beam RT with care experience and patient sociodemographic and clinical characteristics. The study population included 824 women; 655 (79%) received RT. Women with higher experience of care scores for their personal doctor were significantly more likely to have received any RT (odds ratio [OR], 1.18; P=.033). Nonsignificant trends were observed for associations of increased RT with higher CAHPS measures of doctor communications (OR, 1.15; P=.055) and care coordination (OR, 1.24; P=.051). In contrast, women reporting higher scores for Part D prescription drug plans were significantly less likely to have received RT (OR, 0.78; P=.030). Patient experience of care was significantly associated with receipt of RT after lumpectomy among women with breast cancer. Health care organization leaders may want to consider incorporating experience of care into quality improvement initiatives and other activities that aim to improve patient decision-making, care, and outcomes.

Gathering expert consensus to inform a proposed trial in chronic nonbacterial osteomyelitis (CNO)

Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disease that primarily affects children and adolescents. CNO is associated with pain, bone swelling, deformity, and fractures. Its pathophysiology is characterized by increased inflammasome assembly and imbalanced expression of cytokines. Treatment is currently based on personal experience, case series and resulting expert recommendations.Randomized controlled trials (RCTs) have not been initiated because of the rarity of CNO, expired patent protection of some medications, and the absence of agreed outcome measures. An international group of fourteen CNO experts and two patient/parent representatives was assembled to generate consensus to inform and conduct future RCTs.The exercise delivered consensus inclusion and exclusion criteria, patent protected (excludes TNF inhibitors) treatments of immediate interest (biological DMARDs targeting IL-1 and IL-17), primary (improvement of pain; physician global assessment) and secondary endpoints (improved MRI; improved PedCNO score which includes physician and patient global scores) for future RCTs in CNO.

The Use of Artificial Intelligence Guidance for Rheumatic Heart Disease Screening by Novices

A novel technology utilizing artificial intelligence (AI) to provide real-time image-acquisition guidance, enabling novices to obtain diagnostic echocardiographic images, holds promise to expand the reach of echo screening for rheumatic heart disease (RHD). We evaluated the ability of nonexperts to obtain diagnostic-quality images in patients with RHD using AI guidance with color Doppler. Novice providers without prior ultrasound experience underwent a 1-day training curriculum to complete a 7-view screening protocol using AI guidance in Kampala, Uganda. All trainees then scanned 8 to 10 volunteer patients using AI guidance, half RHD and half normal. The same patients were scanned by 2 expert sonographers without the use of AI guidance. Images were evaluated by expert blinded cardiologists to assess (1) diagnostic quality to determine presence/absence of RHD and (2) valvular function and (3) to assign an American College of Emergency Physicians score of 1 to 5 for each view. Thirty-six novice participants scanned a total of 50 patients, resulting in a total of 462 echocardiogram studies, 362 obtained by nonexperts using AI guidance and 100 obtained by expert sonographers without AI guidance. Novice images enabled diagnostic interpretation in >90% of studies for presence/absence of RHD, abnormal MV morphology, and mitral regurgitation (vs 99% by experts, P ≤ .001). Images were less diagnostic for aortic valve disease (79% for aortic regurgitation, 50% for aortic stenosis, vs 99% and 91% by experts, P<.001). The American College of Emergency Physicians scores of nonexpert images were highest in the parasternal long-axis images (mean, 3.45; 81%≥3) compared with lower scores for apical 4-chamber (mean, 3.20; 74%≥3) and apical 5-chamber images (mean, 2.43; 38%≥3). Artificial intelligence guidance with color Doppler is feasible to enable RHD screening by nonexperts, performing significantly better for assessment of the mitral than aortic valve. Further refinement is needed to optimize acquisition of color Doppler apical views.

Does moral sensitivity contribute to patient satisfaction? A cross-sectional survey in educational hospitals.

Our study aims to assess interactions between the moral sensitivity of physicians and the satisfaction of patients.This is a cross-sectional study. Data were collected by a standard questionnaire of the physicians' moral sensitivity about decision-making and a researcher-made patient satisfaction questionnaire. The physicians were selected through the census method, and patients were selected using quota sampling to equal the selection of each physician from each work shift. All information was analyzed by SPSS statistical software version 23.The mean score for physicians' moral sensitivity was 91.6 ± 0.63 which shows a high level of moral sensitivity. The average patient satisfaction was 61.97 ± 3.55 out of the total score (23-115) which shows a moderate level of satisfaction with the highest scores in the domain of "professionalism" and the lowest scores were related to the domain of "Technical Quality of Care".For improving patient satisfaction, adopting appropriate strategies like performing the periodic evaluation of this phenomenon and providing some codified training in this regard are required to increase the level of moral sensitivity of physicians and provide high-quality care.