Physicians For Advice Research Articles

Educating a diverse group of women in Los Angeles County on ovarian and uterine cancers and clinical trials.

e23105 Background: Ovarian and uterine cancers are among the deadliest cancers for women and due to vague symptoms, diagnosis is often delayed. In addition, there are ethnic disparities in time to diagnosis, treatment, and outcome for these cancers. The purpose of this study was to assess a diverse group of Los Angeles (LA) County women’s understanding of both ovarian and uterine cancers and assess the impact of intervention by community health organizations. Methods: A Qualtrics survey was administered online and in-person to 185 women aged 18 and older in LA County between May 3rd and July 15th 2023. The survey aimed to investigate participants’ knowledge, awareness, and attitudes on women’s cancers’ risk factors, symptoms, screening, treatment options, and clinical trials. Information on participant demographics was also collected. Chi-square analysis, descriptive statistics, filtering and sub-setting, correlation analysis were utilized using R-Studio. MiOra Health Educators provided face-to-face education on ovarian and uterine cancers as well as clinical trials to this sample of participants. Results: Out of 185 respondents, 117 (63.2%) were Hispanic or Latina and 65 (35.1%) reported completing 4 year of college education. 137 (74.0%) reported attending their annual women’s wellness visit. Women with insurance (143, 77.0%) were more likely to report having women’s cancer screening compared to those who were uninsured (71, 38.0%). 93 women (50.3%) reported going to their primary physicians for advice on sexual and/or genital organ health rather than visiting a gynecologist; however older women (aged 41-50) reported seeing their gynecologist more often than the women in younger groups. Moreover, 127 women (68.6%) were aware of clinical trials (the majority being college-educated) however, a majority of the total participants (154, 83.2%) did not know where to locate clinical trials or that one may leave a clinical trial at any time (123, 66.5 %). Prior to educational intervention, only 104 women (56.2%) reported being “somewhat knowledgeable” about women’s cancers’ risk factors and symptoms. Following educational intervention, 143 (77.7%) reported feeling more knowledgeable about women’s cancers’ risk factors and symptoms and 122 (66.6%) reported feeling more knowledgeable about clinical trials and comfortable participating in one. Conclusions: In this pilot study we found that a majority of diverse LA County women attend their annual wellness visits; however, only a small portion receive women’s cancer screening. Lack of insurance appears to be a significant barrier for access to screening tests. In addition to awareness of clinical trials, the ability to locate a clinical trial appears to influence participation in one. Although primary care providers and obstetricians are the most trusted health resources, community health educators may be effective in educating women to close these gaps.

The nature of inappropriate referrals to wellness services in primary care setting in Qatar: Outcome of multifaced interventions on rate and quality of referrals

ObjectivesThe objectives of this study were to explore the rate and types of inappropriate referrals to the wellness services and to assess the impact of multi-level interventions on the rate of inappropriate referrals at Rawdat Al-Khail health center in Qatar. MethodsThis study employed a retrospective analysis of all referrals data to Rawdat Al-Khail wellness services extracted from the Electronic Health Records (EHRs) between July 2022 and August 2023. The monthly rates and types of inappropriate referrals were calculated. In this study, pre-post analyses were performed to evaluate the impact of two sets of interventions on reducing inappropriate referral rates. The first set involved the development and distribution of e-referral pathways training manual in September 2022. The second set, implemented in April 2023, included close monitoring the rate and types of referrals, and the initiation of feedback communication between wellness services supervisors and referring physicians for advice and corrective actions. ResultsA total of 966 referrals were received during the study period, with 1:5 male-to-female ratio. Of all referrals, 34.9 % were classified as inappropriate, exhibiting considerable variations among different referring health centers. The most common reason for inappropriate referrals was due to the lack of “exercise wellness gym assessment form” (23.8 %). While interventions aimed at enhancing the referral process, they did not result in a significant overall reduction in inappropriate referral rates. However, there was a noteworthy reduction in the inappropriate referrals caused by the lack of “exercise wellness gym assessment form” observed from March to August 2023 (41 %–18 %). ConclusionThis study sheds light on the complexities of wellness services referrals, revealing a high rate of inappropriate referrals that require closer scrutiny. Despite interventions not significantly reducing the rate of these referrals, it emphasizes the need for ongoing improvement strategies. Structured, periodic interventions at higher levels are recommended to enhance referral appropriateness.

Patient Experience and Feedback After Using an Electronic Health Record-Integrated COVID-19 Symptom Checker: Survey Study.

BackgroundSymptom checkers have been widely used during the COVID-19 pandemic to alleviate strain on health systems and offer patients a 24-7 self-service triage option. Although studies suggest that users may positively perceive web-based symptom checkers, no studies have quantified user feedback after use of an electronic health record–integrated COVID-19 symptom checker with self-scheduling functionality.ObjectiveIn this paper, we aimed to understand user experience, user satisfaction, and user-reported alternatives to the use of a COVID-19 symptom checker with self-triage and self-scheduling functionality.MethodsWe launched a patient-portal–based self-triage and self-scheduling tool in March 2020 for patients with COVID-19 symptoms, exposures, or questions. We made an optional, anonymous Qualtrics survey available to patients immediately after they completed the symptom checker.ResultsBetween December 16, 2021, and March 28, 2022, there were 395 unique responses to the survey. Overall, the respondents reported high satisfaction across all demographics, with a median rating of 8 out of 10 and 288/395 (47.6%) of the respondents giving a rating of 9 or 10 out of 10. User satisfaction scores were not associated with any demographic factors. The most common user-reported alternatives had the web-based tool not been available were calling the COVID-19 telephone hotline and sending a patient-portal message to their physician for advice. The ability to schedule a test online was the most important symptom checker feature for the respondents. The most common categories of user feedback were regarding other COVID-19 services (eg, telephone hotline), policies, or procedures, and requesting additional features or functionality.ConclusionsThis analysis suggests that COVID-19 symptom checkers with self-triage and self-scheduling functionality may have high overall user satisfaction, regardless of user demographics. By allowing users to self-triage and self-schedule tests and visits, tools such as this may prevent unnecessary calls and messages to clinicians. Individual feedback suggested that the user experience for this type of tool is highly dependent on the organization's operational workflows for COVID-19 testing and care. This study provides insight for the implementation and improvement of COVID-19 symptom checkers to ensure high user satisfaction.

Pharmacist-Mediated Thyroid-Stimulating Hormone (TSH) Test Guideline Monitoring Program- Outcomes of a Retrospective Study In Patients On Levothyroxine

Thirty to sixty percent of individuals taking levothyroxine were either under or overtreated, which leads to organ damage and excess mortality. This study aims to assess the gaps in the “thyroid-stimulating hormone (TSH) test guideline compliance rate” and validate the scope of ambulatory care pharmacist-mediated practice in patients on levothyroxine. At the study site, pharmacists offered patient-centered telephonic counseling to patients on levothyroxine who had been non-compliant with TSH tests for more than a year. A two-month quantitative retrospective analysis of this practice was conducted to assess its impact on TSH lab test adherence and dose modification outcomes. 415 patients met the study’s inclusion criteria who received pharmacist counseling with documented intervention. Pharmacists bridged the significant gap in practice by creating new TSH lab requests with counseling in 81.2% (n = 337) of the study population who did not have TSH lab requests prior to the program. The non-compliance rate population dropped from 79.27% (n = 329) to 17.59% (n = 73) in the study population who had been non-compliant with the TSH test for 13 and 24 months. 74.5% (n = 309) were found to have performed their TSH test after the pharmacist’s intervention. Among 100, 66% (n = 66) patients with abnormal TSH values consulted their physician for advice, of which 60.6% (n=40) had their levothyroxine dose adjusted (χ2=82.702, P < 0.01. The study suggests that pharmacists can significantly mediate between patients and physicians to enhance TSH test compliance and essential dose adjustment in patients prescribed levothyroxine.

‘I keep my brain on my iPhone’ – being and becoming an emergency physician in a technological age

ABSTRACT The use of mobile information and communication technologies within health and medical education contexts is widespread and generally viewed positively. Such technologies are primarily used for information seeking and are often undertaken informally. This qualitative, phenomenological study offers not only a deep and contextually sensitive discussion of how emergency physicians use mobile technologies in their day-to-day work, but also extends this discussion to the practice of ongoing professional learning in the workplace. We find that the most common uses for mobile technology include (re)checking medicine orders and/or diagnoses and for communicating with other physicians for advice, support, and on occasion, discussion. Moreover, physicians often perceive mobile technology as an extension of self and represent an externalisation of expertise. There is skepticism, however, about the use of these technologies particularly among more experienced and established Attending Physicians (or Consultants in other jurisdictions). In all, these findings provide new perspectives on and further directions for both research and practice in health and medical education contexts given that the use of mobile technology in the emergency department is ubiquitous and increasingly normalised, particularly within the clinical interaction with patients.

Pharmacotherapy based on medical genetics for smoking cessation

Indonesia is the fourth highest consumer of cigarettes in the world with an estimated high cost in healthcare expenditure on tobacco-related diseases. Nonetheless, regulations on tobacco products are lax and healthcare provider involvement in aiding smoking cessation is minimal. Generally, a variety of smoking cessation aids exists and medical genetics have come into play to enhance their efficacy. A questionnaire survey was piloted to query participants on their smoking habits, past cessation attempts, opinions on factors related to smoking cessation, and reactions to information that medical genetics could provide within the context of smoking cessation. The findings showed that most participants have attempted cessation without aid. Pharmacotherapy was not used by any respondents while behavioral interventions were scarcely used. Nevertheless, 83% of participants indicated that medical genetics information would be useful in future cessation attempts and that they would consult physicians for advice.

Practicing Clinical Bioethics: Reflections from the Bedside

Biomedical dilemmas are becoming more complex as modern medical technologies continue to advance. In my capacity as a clinical bioethicist, I deal with patients and families confronted by ethical issues and questions that arise during medical treatment. Muslim patients often turn to their faith to help them make medical decisions. In their efforts to avoid what is religiously impermissible, they often ask local imams, community leaders, or Muslim physicians for advice. But these groups typically lack sufficient training when it comes to applying Islamic concepts to the medical dilemmas we face in American hospitals today. In fact, Muslim religious advisors who lack the appropriate medical and religious training should not be giving medical advice. Instead, they should refer their questions to the appropriate scholars, professionals, or referral centers. I have noticed that recommendations received from higher-level Islamic scholars with clinical backgrounds are usually more thoughtful, nuanced, and flexible. Clinicians, patients, and families must be able to access thoughtful Islamic scholarship that supports medical decision making in an accessible, timely, and clinically useful way. By intensifying efforts to combine religious scholarship, clinical understanding, and the effective dissemination of information, those in the field of Islamic bioethics scholarship can better help and support patients and families in determining the most appropriate religiously sanctioned options for their particular circumstances. The American Muslim community must prioritize this field of study.

Assessment of Pharmaceutical Company and Device Manufacturer Payments to Gastroenterologists and Their Participation in Clinical Practice Guideline Panels

Payments from pharmaceutical and device manufacturers to physicians may influence the advice physicians give patients and peers. To investigate the nature and amounts of monetary and other benefits that gastroenterologists received and to determine the participation of those receiving benefits in the formulation of clinical practice guidelines. This cohort study analyzed information from the Centers for Medicare & Medicaid Services Open Payments database, including all reports about payments that pharmaceutical and device manufacturers gave to adult or pediatric gastroenterologists in 2016. PubMed was used to examine the professional affiliations and publication records of top payment recipients. Panelists of clinical guidelines who also received personal financial rewards listed in the Open Payments database were identified. Payments made to gastroenterologists by pharmaceutical company and device manufacturers. Of 15 497 gastroenterologists, 13 467 (86.9%) received a total of 432 463 payments accounting for a total expenditure of $67 144 862. Direct financial payments for consultations, talks, or other services were made to 2055 physicians and were responsible for 4.2% of payments (18 179 of 432 463), but for 62.7% of total expenditures ($42 086 207 of $67 144 862). Although a significant number of submissions were for food and beverages, they constituted only a small amount of total expenditure. For gastroenterologists treating adult patients, 10 products were linked to 63.8% of payments (11 221 of 17 588) related to direct financial rewards and 37.1% of the total expenditures ($24 892 643 of $67 144 862). Twenty-nine of 36 clinical practice guidelines included panelists who had received honoraria or consultation fees from industry sources, with amounts exceeding $10 000 in 8 of them (22%). Most gastroenterologists accept meals or gifts from industry, with 2055 of 15 497 gastroenterologists receiving direct payments and 8 of 36 clinical practice guidelines panelists having received more than $10 000. Considering the known impact of such benefits on prescribing patterns and other professional behaviors, policy makers should consider revising regulations governing interactions with industry and disclosure formats alerting others to their potential biasing impact.

A Case of Torn Loyalty? Industry Rewards and Payments to Gastroenterologists

Introduction: Payments from pharmaceutical and device manufacturers to physicians may influence the advice physicians give patients and peers. Choosing the medical specialty of gastroenterology, we examined the nature and amounts of monetary and other benefits that physicians received more than a decade after many institutions implemented conflict of interest policies. Methods: We analyzed information from the Open Payments database (https://www.cms.gov/openpayments/), including all reports about payments that pharmaceutical and device manufacturers or group purchasing organizations gave to adult or pediatric gastroenterologists in 2016. Using PubMed, we examined the professional affiliations and publication records of top payment recipients and identified panelists of clinical guidelines who also received personal financial rewards, listed in the Open Payments database. Results: A total of 432463 payments went to 13467 individuals and accounted for a total expenditure of $67,144,862. Nearly 90% of the submissions were related to food and beverages. Direct financial payments for consultations, talks, or other services were made to 2055 physicians (13.2%) and were responsible for 4•1% payments, but for 62•7% of the total expenditures. Ten products were linked to 63•8% of payments related to direct financial rewards and 59•1% of the total expenditures. Twenty-nine of 36 clinical practice guidelines included panelists who had received honoraria or consultation fees from industry sources, with amounts listed in the Open Payments database exceeding $10,000 in one third of them. Conclusion: Most gastroenterologists accept meals or gifts from industry, with one in seven receiving direct payments. Considering the known impact of such benefits on prescribing patterns and other professional behaviors, policy makers should consider revising regulations governing interactions with industry and disclosure formats alerting others to their potential biasing impact.1087_A Figure 1. Relative distribution of payments by nature of rewards1087_B Figure 2. Relative distribution of direct financial rewards paid by industry sources1087_C Figure 3. The ten most common drugs linked to payments, as reported in the Open Payments Database

Differences in knowledge among patients with atrial fibrillation receiving non-vitamin K antagonist oral anticoagulants and vitamin K antagonists.

Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly used for stroke prevention in patients with atrial fibrillation (AF) worldwide. Few articles have compared current understanding of AF patients about the disease and anticoagulant therapy in relation to the medications used. We sought to compare the knowledge of AF and anticoagulation between AF patients treated with NOACs and those on vitamin K antagonists (VKAs). We used the Jessa AF Knowledge Questionnaire (JAKQ), developed and validated in Belgium. Patients were re-cruited at a tertiary centre in Kraków, Poland. A total of 479 AF patients completed the JAKQ. Patients on NOACs (n = 276, 57.6%) compared with those on VKAs (n = 175, 36.5%) did not differ regarding demographic and clinical variables. The mean score of the JAKQ was very similar in the NOAC and VKA group (60.7 ± 17.0% vs. 61.6 ± 17.1%; p = 0.4, respectively). The differences in the proportion of correct responses referred to three questions. Consequences of AF, such as blood clots and cerebral infarction, were more obvious for patients on NOACs compared with those on VKAs (81.5% vs. 70.9%; p = 0.01). The patients on NOACs (78.7% vs. 67.6%; p = 0.009) more frequently considered consulting a physician for advice concerning anticoagulant treatment before surgery, while fewer patients on NOACs were aware of the need to take their medication even if they did not feel AF (76.1% vs. 89.7%; p = 0.0004). Only 25.9% of the VKA patients and 49.3% of the NOAC users knew what to do if they missed a dose of the anticoagulant. The knowledge of arrhythmia and anticoagulation is better regarding the safety issues among subjects on NOACs compared with those on VKAs. Irrespective of the type of oral anticoagulation therapy, education of AF patients should be improved.

Infant and Young Child Feeding Practices in Infants Receiving Skin to Skin Care at Birth: Follow-up of Randomized Cohort.

Skin to Skin Care (SSC) in neonatal period influences immediate breastfeeding outcomes in early childhood, especially the duration of exclusive breastfeeding. We investigated influence of 17 hours of SSC given from day one of life on Infant and Young Child Feeding (IYCF) practices through one year of life. Follow-up of a Superiority Randomized Control Trial (RCT) (CTRI/2013/06/003790) conducted in a teaching hospital located in central Gujarat. Mothers of 100 neonates (48 girls, 52 boys) from previous study cohort of RCT on SSC were followed. A survey on IYCF practices during the first year of life was administered after the end of infancy. In RCT, 50 neonates had received SSC beginning of 30 min- 1 hour after birth for average 17 hours on day 1 of life. In the control group, 50 newborn were placed next to the mother and conventional care was provided. There was a significant difference between hypothermia incidences in these groups in the first two days of life. There was no difference in the groups as far as the duration of exclusive breastfeeding, number of times breastfed per day, or stoppage of night feeds. No baby in either group received bottled feeds but about 53 received some form of extra lacteal feeds in the first 6 months without significant group difference. Fewer SSC mothers reported difficulties with breastfeeding or extra lacteal supplementation. All mothers who faced problems contacted physicians for advice and 20 were advised top milk and 6 given other foods. At one year of life 66% mothers were giving less than the recommended five food servings. There was no difference in practices related to hand washing, food preparation and storage, feeding habits of child and illness episodes in the children. IYCF practices in this small group were not as per guidelines. Few positive trends were seen with fewer SSC mothers facing problems related to breastfeeding. The study was underpowered to detect differences in IYCF practices in relation to SSC.

Increasing Incidences of STIs in Pakistani Youth : Role of Family Physicians in Prevention , Treatment and Control of STIs

There is a rapid rise in STIs in Pakistan. The rise in injectable drug use also poses a continued threat to youth. The sufferers prefer family physicians for advice and treatment because they are easily accessible in their own local communities. There is intense need to train family physicians in the prevention control and treatment of STIs. There should be counseling facilities at all family clinics. There is an urgent need for record keeping of patients suffering from STIs and partner notification. The best way to avoid STIs is restriction to one partner use of condoms and reduction in number of injectable drug users. (Excerpts)

Interrupted Fertility

Mrs Buff, wife of Mr Buff, silk weaver in Fashion Street in Spitafields, London, aged twenty-seven years the mother of several childerine, on 27th of July 1774, having gone her usual time of pregnancy, was attended by her midwife several days, but the labour pains ceasing, the midwife left her promising to return soon but did not fulfil her promise. Mrs B. not being delivered of her child, thought she might have a month longer to go and went about her domestic affairs as usual. Christmas following she prov’d with child again and not being delivered of the former one she became uncommonly big and unwieldly, she applied to several physicians for advice and particularly to Dr. Wyman an eminent man midwife in Aldermanbury, who ordered her a variety of purgative medicines but without relief.

PO-0128 Infant And Young Child Feeding Practices In Infants Receiving Skin To Skin Care At Birth: A Follow Up Of Randomised Cohort

Background and aims Skin to Skin (STS) care in neonatal period influences immediate breastfeeding outcomes in early childhood, especially the duration of exclusive breastfeeding. We investigated influence of STS care given on day one of life on infant and child feeding (IYCF) practices through one year of life. Methods Mothers of 100 neonates (48 girls, 52 boys) from previous study cohort of RCT on STS care was followed. A telephonic survey on IYCF practices during the first year of life was administered. Results There was no difference in the groups as far as the duration of exclusive breastfeeding, number of times breastfed per day, or stoppage of night feeds. No baby in either group received bottled feeds but about 53 received some form of extra lacteal feeds in the first 6 months without significant group difference. Fewer STS group mothers reported difficulties with breastfeeding or extra lacteal supplementation. All mothers who faced problems contacted physicians for advice, and 20 were advised top milk and 6 given other foods. At one year of life 66% mothers were giving less than the recommended five food servings. There was no difference in practices related to handwashing, food preparation and storage, feeding habits of child and illness episodes in the children. Conclusions IYCF practices even in this small group were not as per recommended guidelines. Few positive trends were seen with fewer STS mothers facing problems related to breastfeeding. The study was underpowered to detect differences in IYCF practices in relation to STS care.

A segmentation analysis for pharmacists' and patients' views of pharmacists' roles

Pharmacists' roles in health care systems are expanding. However, some patients are slow to accept and make use of this expanded role. The objectives for this study were to identify and describe segments of pharmacists and patients based upon their perceptions of the pharmacist's role in serving as an advisor on medication use. Data were collected from random samples of pharmacists and patients in 1995, 1998, 2001, 2004, 2007, and 2010. Overall, 1518 pharmacists (overall response rate = 47%) and 1278 patients (overall response rate = 42%) were surveyed from 1995 through 2010. Factor analysis was applied to a Counselor Role Orientation measure and identified three factors for use in segmentation analysis. The factors were: (1) Time Pressures, (2) Reliance on Physician, and (3) Pharmacist Restrictions. Segmentation analysis was conducted using a two-step cluster analysis with an agglomerative hierarchical clustering method and a log-likelihood (probability) distance measure. Descriptive statistics were used to describe identified segments. Cluster analysis identified four segments which were named: (1) All Low, (2) Time Pressures, (3) Reliance On Physician, and (4) All High. The largest segment for pharmacists was Time Pressures (45% of pharmacists) and for patients was Reliance on Physician (50% of patients). Composition of the four segments was consistent over time between the years 1995 through2010. The pattern of findings suggested a cycle of dysfunction in which many pharmacists, hindered by Time Pressures, do not provide patient care beyond the dispensing of a product. In turn, patients, relying on their physician for advice about medications, do not acknowledge the pharmacist as an advisor for medications. This cycle has reinforced dysfunctional behaviors and creates no motivation for either party in this dyadic relationship to change.

Encouraging Smokers to Talk With Their Physicians About Quitting

OVER THE NEXT FEW MONTHS, PHYSICIANS MAY see an increase in patients asking for help in quitting smoking. Why? The Office on Smoking and Health at the Centers for Disease Control and Prevention recently launched the second stage of its national media campaign, Tips from Former Smokers (Tips). Some of the ads include a new call to action with the message, “You can quit. Talk with your doctor for help.” This “talk with your doctor” initiative provides physicians with a golden opportunity to help more patients quit smoking. The Tips campaign motivates smokers to quit and directs smokers who want help to evidence-based cessation resources. The campaign ads feature real stories from former smokers about how serious smoking-related diseases have affected their lives and their families. The campaign includes both well-known consequences of smoking such as lung cancer and chronic obstructive pulmonary disease, as well as lesser-known consequences such as stroke, heart disease, head and neck cancer, Buerger disease, and exacerbation of asthma and diabetes. Stories emphasize the morbidity caused by smoking, rather than mortality, based on what we heard from smokers during formative testing. The campaign includes ads for television, radio, billboards, newspapers, and magazines, as well as for digital and social media channels. Each Tips ad ends by providing a cessation resource for smokers who want help quitting: 1-800-QUIT-NOW, which directs callers to their state quitlines for free cessation counseling, or the Tips campaign website, which provides information on the campaign and practical quitting advice. National television ads during the week of May 27 will include the “talk with your doctor” call-to-action message, and it will continue to be promoted for the remaining 3 weeks of the campaign. This message is intended to empower patients to ask their physicians for advice about quitting smoking and to make it easier for clinicians to engage smokers in this conversation. How can physicians use the Tips campaign to raise the topic of quitting with patients who smoke? First, physicians can ask patients if they have seen any of the Tips ads, what they think of the ads, and if the ads motivated them to try to quit. Physicians can also underscore the truth of the stories in the ads, based on their experience with patients who smoke. If patients have not seen the ads, physicians can encourage them to view the ads. Physicians can also place Tips posters (available from the health care practitioner section of the Tips website) in waiting rooms and examination rooms. What can a physician do when a patient asks for help in quitting smoking? The Tips campaign provides a great opportunity to discuss a patient’s concerns about smoking and quitting, as well as to personalize the risks the patient faces from smoking, and strongly encourage the patient to quit. Physicians can also reassure patients who smoke that, although quitting is difficult, they can succeed, reminding them that more than half of all Americans who ever smoked have successfully quit. In addition, physicians can encourage their patients to use evidence-based treatments, including individual, group, and telephone counseling and the 7 US Food and Drug Administration−approved medications, and let patients know these methods can double their chances of success. Patients can access more cessation resources at the Tips campaign website, including materials and links to the National Cancer Institute’s cessation programs. The Centers for Disease Control and Prevention has been working with numerous professional associations, such as the American Medical Association, the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Physicians, and the American Congress of Obstetricians and Gynecologists, to get the word out about the “talk with your doctor” initiative. For example, a scripted card is available to assist physicians in navigating the process of intervening with patients who smoke. To support the “talk with your doctor” initiative, the Centers for Disease Control and Prevention has developed a special section of the Tips campaign website for health care practitioners, which includes links to materials and resources.

A survey of Tennessee veterinarian and physician attitudes, knowledge, and practices regarding zoonoses prevention among animal owners with HIV infection or AIDS

To examine the attitudes, knowledge, and practices of Tennessee veterinarians and physicians engaged in clinical practice regarding the risk for and prevention of zoonoses in people with HIV infection or AIDS. Cross-sectional survey. Licensed Tennessee veterinarians and physicians engaged in clinical practice. A survey was mailed in January 2010 to 454 licensed veterinarians and 1,737 licensed physicians. 181 of 419 (43.20%) eligible veterinarians and 201 of 1,376 (14.61%) eligible physicians responded to the survey. A majority of both veterinarians (131/179 [73.18%]) and physicians (97/192 [50.52%]) indicated that veterinarians should always or almost always be involved in advising clients with HIV infection or AIDS. The majority of veterinarians (120/173 [69.36%]) indicated they always or almost always discussed with clients the potential risk to immune-compromised persons after diagnosing a zoonosis. A high proportion (88/94 [93.62%]) of physicians indicated they never or rarely initiated discussions about zoonoses with patients with HIV infection or AIDS. All physicians (94/94 [100%]) indicated they never or rarely contacted veterinarians for advice on zoonoses. Similarly, 174 of 180 (96.76%) veterinarians had never or rarely contacted physicians for advice on zoonoses risks. Only 25.97% of veterinarians and 33.33% of physicians were correctly able to identify zoonotic pathogens of greatest concern to people with HIV infection or AIDS. We identified several implications for veterinary medical and medical practice that may reduce zoonoses transmission risks for people with HIV infection or AIDS, including increased communication between veterinarians and physicians, increased communication between people with HIV infection or AIDS and health-care providers, increased availability of client educational materials, and increased participation in zoonoses continuing education opportunities by health-care providers.

Perceptions and attitudes in Alzheimer disease caregivers in Greece: a cross-sectional study

People with Alzheimer's disease (AD) need care. This is usually provided by family members, mainly the patient's spouse and children. The aim of this study is to investigate the relationship between patients and caregivers in Greece, the involvement of the caregiver in the patient's daily life, and the impact this involvement has on the caregiver's life. This study was conducted during October and December 2009 in Athens, Greece. Using a specially designed questionnaire, clinical psychologists conducted face-to-face interviews with family caregivers to collect information on five main domains: caregiver characteristics, patients’ characteristics and history of AD, medical treatment, the caregiver's experience of living with AD, disease awareness and information resource use. 600 caregivers participated in the study. They were mainly women and first degree relatives, sharing the same home with the patient. Half of them were over the age of 55 and only one-third were highly educated. Half of the patients were over 76 years old and the majority was diagnosed with AD. Patients’ doctors were the commonest source of information for caregivers. Psychological and economical burden were reported equally distressing. Among the background characteristics, the amount of the caregiver's burden was proved to have a strong correlation with the stage of the disease and the caregivers’ age. Caregivers of AD sufferers in Greece are usually family members who rely on the attending physician for advice and information. The emotional, practical and economical impact of caregiving on caregivers’ life was increasing with the disease progress.

Prevention of Cognitive Impairment

The public is increasingly inundated with suggestions on how they can reduce their risk of developing cognitive impairment or dementia and are turning to physicians for advice. This study examines physicians’ perceptions and practices related to reducing cognitive impairment or dementia risk. Data from Porter Novelli’s 2008 DocStyles survey are used to examine physicians’ perceptions and practices related to this issue. About 40% of physicians reported discussing concerns about cognitive impairment often or very often with adult patients without dementia. The majority advised patients to reduce risk through physical activity, mental stimulation, and healthy diet. These data shed light on physicians’ perceptions and practices related to reducing cognitive impairmentrisk among their patients. Increased information about this issue may inform development of and access to educational materials to meet physicians’ needs to address patient concerns related to reducing cognitive impairment or dementia risk.

Half of the Homebound Elderly Living in a Large Midwestern City Rely on Their Physicians for Advice Regarding Taking or Not Taking Vitamin or Mineral Supplements

Half of the Homebound Elderly Living in a Large Midwestern City Rely on Their Physicians for Advice Regarding Taking or Not Taking Vitamin or Mineral Supplements