Physician Specialty Research Articles

Defensive medicine practice among physicians in Egypt versus Saudi Arabia: causes and associated factors

BackgroundDefensive medicine (DM) is an international dilemma affecting developed and developing countries. Most research studies were conducted in high-income countries. Thus, the current study aimed to compare the attitudes and practices of DM among different specialty physicians practicing in Egypt and Saudi Arabia (KSA). Associated factors and causes of DM practice were also examined. This survey study is based on a self-administered online questionnaire consisting of seven domains that targeted physicians with different specialties and workplaces in Egypt and KSA.ResultsA total of 829 physicians completed the questionnaire. Physicians practicing in Egypt (31.4%) exhibited significantly higher rates of DM practice than those in KSA (13.2%). Regarding types of DM practice, 47% and 40% of all studied physicians practiced positive and negative DM, respectively, with significantly higher rates in Egypt than in KSA. Factors that predict DM practice were different among both countries; however, legal concerns are the basic factors that are significantly associated with positive and negative DM practice in both countries. Fear of legal concern is the main reason physicians practicing in Egypt use DM practice while following clinical standards and ethics is the main cause reported by those practicing in KSA.ConclusionDefensive medicine practices are prevalent among physicians in Egypt and KSA, with some differences between both countries in associated factors. Addressing physicians' legal concerns, improving medical education, and implementing evidence-based practices may help reduce unnecessary DM.

Exploring Physicians' Perspectives on Antibiotic Stewardship Implementation: A Qualitative Investigation in Al-Nasiriyah Hospitals

Background: The overuse and inappropriate use of antibiotics cause antimicrobial resistance (AMR). The antibiotic stewardship program (ASP) plays a crucial role in improving prescribing antibiotics. Although the Iraqi Ministry of Health has issued ASP legislation, its full implementation in clinical practice remains incomplete. Objectives: To explore physicians' perspectives regarding the current and potential implementation of ASP in Al-Nasiriya hospitals. Methods: A qualitative study was conducted in Al-Nasiriyah public hospitals from December 17, 2023, to January 21, 2024, using face-to-face interviews. Physicians who prescribe antibiotics, work in Al-Nasiriyah public hospitals, and consent to participate in the study were recruited using purposeful and snowball sampling, and the size of the sample was specified by saturation. The interviews' audio was transcribed verbatim and analyzed thematically. Results: Nine public hospitals in Al-Nasiriyah were included in the study. One hospital was excluded because the ASP was activated after data collection began. Sixteen physicians in different specialties were recruited, 15 males and one female. Thematic analysis revealed two major themes: challenges in antibiotic prescribing practices (3 subthemes: antibiotic selection, review, and practice, antibiotic mismanagement, and antibiotic resistance) and antibiotic stewardship implementation (4 subthemes: ASP knowledge and components, perceived benefits and importance, implementation challenges and barriers, and ASP enablers). Conclusions: There were many challenges in antibiotic prescribing practice, including antibiotic mismanagement and AMR. The participants acknowledged the importance of the ASP, but they mentioned many barriers to its application.

Skin Cancer Diagnosis by Lesion, Physician, and Examination Type

Skin cancer is the most common cancer in the US; accurate detection can minimize morbidity and mortality. To assess the accuracy of skin cancer diagnosis by lesion type, physician specialty and experience, and physical examination method. PubMed, Embase, and Web of Science. Cross-sectional and case-control studies, randomized clinical trials, and nonrandomized controlled trials that used dermatologists or primary care physicians (PCPs) to examine keratinocytic and/or melanocytic skin lesions were included. Search terms, study objectives, and protocol methods were defined before study initiation. Data extraction was performed by a reviewer, with verification by a second reviewer. A mixed-effects model was used in the data analysis. Data analyses were performed from May 2022 to December 2023. Meta-analysis of diagnostic accuracy comprised sensitivity and specificity by physician type (primary care physician or dermatologist; experienced or inexperienced) and examination method (in-person clinical examination and/or clinical images vs dermoscopy and/or dermoscopic images). In all, 100 studies were included in the analysis. With experienced dermatologists using clinical examination and clinical images, the sensitivity and specificity for diagnosing keratinocytic carcinomas were 79.0% and 89.1%, respectively; using dermoscopy and dermoscopic images, sensitivity and specificity were 83.7% and 87.4%, and for PCPs, 81.4% and 80.1%. Experienced dermatologists had 2.5-fold higher odds of accurate diagnosis of keratinocytic carcinomas using in-person dermoscopy and dermoscopic images compared with in-person clinical examination and images. When examining for melanoma using clinical examination and images, sensitivity and specificity were 76.9% and 89.1% for experienced dermatologists, 78.3% and 66.2% for inexperienced dermatologists, and 37.5% and 84.6% for PCPs, respectively; whereas when using dermoscopy and dermoscopic images, sensitivity and specificity were 85.7% and 81.3%, 78.0% and 69.5%, and 49.5% and 91.3%, respectively. Experienced dermatologists had 5.7-fold higher odds of accurate diagnosis of melanoma using dermoscopy compared with clinical examination. Compared with PCPs, experienced dermatologists had 13.3-fold higher odds of accurate diagnosis of melanoma using dermoscopic images. The findings of this systematic review and meta-analysis indicate that there are significant differences in diagnostic accuracy for skin cancer when comparing physician specialty and experience, and examination methods. These summary metrics of clinician diagnostic accuracy could be useful benchmarks for clinical trials, practitioner training, and the performance of emerging technologies.

Real-world use of androgen-deprivation therapy intensification for metastatic hormone-sensitive prostate cancer: a systematic review.

To conduct a systematic literature review of real-world data (RWD) studies to summarise treatment patterns among men with metastatic hormone-sensitive prostate cancer (mHSPC).While androgen-deprivation therapy (ADT) is a primary treatment strategy for mHSPC, ADT intensification with androgen receptor pathway inhibitors (ARPIs) and/or chemotherapy is recommended by current guidelines and has improved clinical outcomes in the last decade. We searched electronic databases (PubMed; Excerpta Medica dataBASE [EMBASE]) for eligible studies (retrospective or prospective observational RWD studies examining mHSPC treatment patterns) between database inception and July 2023, and manually screened the past 2 years of relevant conference proceedings. Of 2336 retrieved citations, 29 studies met the inclusion criteria, covering North America (United States, n = 21; Canada, n = 2), Europe (n = 8), and Asia (n = 6). Most studies utilised retrospective cohorts (n = 26) and included men with a median age of ≥70 years (n = 20). ADT monotherapy was predominantly used across geographies, followed by ADT + ARPI and ADT + docetaxel in the United States and Europe but not in Asia, where use of each combination remained low. Studies with recent electronic medical record data from cancer centres/registries showed >40% use of ADT + ARPI in the United States and Europe. Abiraterone was the most frequently used ARPI, followed by enzalutamide. Quantitative factors associated with ADT intensification were high disease burden, younger age, Eastern Cooperative Oncology Group performance status score of 0 to 1, fewer comorbidities, and oncologist physician specialty; qualitative factors were patient preference, unsatisfactory response to ADT, ability to tolerate adverse events, and absence of cost barriers. While there was an increasing trend in ADT intensification for mHSPC over the study period across geographies, use remained suboptimal considering the high proportion of patients who were still receiving ADT monotherapy only. These findings highlight the need for interventions to further optimise current mHSPC therapies with high guideline concordance.

Effect of physician specialty training on pediatric appendectomy outcomes: an NSQIP-P analysis.

Appendectomies are the most common abdominal emergency surgery in pediatric patients. Both pediatric and general surgeons are credentialed to perform this procedure, however pediatric surgeons are specialized in pediatrics. This study seeks to determine differences in pediatric appendectomy outcomes between general and pediatric surgeons. Pediatric patients undergoing appendectomies between 2015 and 2020 were identified in the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database. Multivariable logistic regression models examined association of surgeon specialty with readmission, postoperative complications, reoperation, non-home discharge destination, operative time, etc. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated. Average ages of pediatric patients undergoing appendectomy by pediatric and general surgeons were 11.2 (n = 68,638) and 12.3 (n = 3,986) years, respectively (p < .001). General surgeons were not more likely to have adverse outcomes [AOR: 1.00 (0.99-1.01), p = 0.57], readmissions [AOR: 0.995 (0.98-1.00), p = 0.11], reoperations [AOR: 1.00 (0.99-1.00), p = 0.54], or non-home discharges [AOR: 0.99 (0.99-1.00), p = 0.94]. Similar outcomes arise in pediatric appendectomies performed by general surgery at a children's hospital or hospitals with a pediatric wing. Significant limitations to using the NSQIP-P database persist. Further research including hospitals contributing to both adult and pediatric databases can provide a clearer picture of post-surgical outcomes in appendectomies.

Impact of Physician Specialty on Treatment Costs of Invasive Melanoma.

Melanoma is a deadly type of skin cancer that develops from melanocytes and can manifest on the skin or other regions of the body. Its incidence is increasing rapidly, with approximately 100,000 diagnoses and 7000 deaths per year in the US alone. We conducted a cross-sectional study with the aim of determining an association between the cost of care for invasive melanoma and the specialty involved in the treatment to adequately guide future treatment. We analyzed data from 3817 patients (2013-2018) using the Florida inpatient/outpatient dataset, CMS cost reports, and the National Plan and Provider Enumeration System. Covariates included age, sex, race/ethnicity, insurance type, region, county rurality, the number of procedures, the comorbidity index, obesity, metastatic cancer presence, hospital size, and physician volume. Multivariable mixed linear regression was used to analyze the data, and the cost was adjusted to the 2019 USD. Dermatology had the largest decrease in the overall and outpatient costs compared to general surgery, followed by plastic surgery. The inpatient costs for dermatology and plastic surgery were lower than those for general surgery, but not significantly so. The costs associated with surgical procedures may vary depending on the specialty of the physician treating the patient. Dermatology was associated with lower treatment costs for invasive melanoma compared to other specialties, indicating that physician specialty influences the cost of care.

Costs of physician and diagnostic imaging services for shoulder, knee, and low back pain conditions: A population-based study in Alberta, Canada.

To 1) estimate the utilization and costs of physician and diagnostic imaging (DI) services for shoulder, knee, and low-back pain (LBP) conditions; and 2) examine determinants of the utilization and costs of these services. All patients visiting a physician for shoulder, knee, or LBP conditions (identified by the ICD-9 codes) in Alberta, Canada, in fiscal year (FY) 2022/2023 were included. Interested outcomes included numbers and costs of physician visits and DI exams stratified by condition, physician specialty, DI modality, and patients' sex and age. Multivariate regressions were used to examine determinants of the outcomes. In FY 2022/2023, 10.4%, 7.0%, and 6.7% of the population saw physicians for shoulder, knee, and LBP conditions, respectively. This costs Alberta $307.04 million ($67.93 per capita), of which shoulder accounted for 41%, knee 28%, and LBP 31%. In the same FY, 17,734 computed tomography (CT), 43,939 magnetic resonance imaging (MRI), 686 ultrasound (US), and 170,936 X-ray exams related to shoulder/knee/LBP conditions were ordered for these patients, costing another $29.07 million, of which CT accounted for 14%, MRI 48%, US 0%, and X-ray 37%. Female, older age, comorbidity scores, and capital zone used physician services more frequently. Patients with a higher comorbidity index scores or more physician visits were more likely being referred for CT or MRI. Musculoskeletal conditions are common and result in patients seeking healthcare services. Visits to family physicians, specialists, and the ordering of DI contribute to extensive utilization of health services, contributing to considerable health system costs.

Effectiveness of a Combination of Nasturtium Herb and Horseradish Root (Angocin®Anti-Infekt N) Compared to Antibiotics in Managing Acute and Recurrent Urinary Tract Infections: A Retrospective Real-world Cohort Study.

The goal of this study was to evaluate whether the medical recommendation of Angocin®Anti-Infekt N, compared to standard antibiotic treatment shortly after the diagnosis of a urinary tract infection (UTI) or cystitis, is negatively associated with an early, sporadic, or recurrent UTI, subsequent antibiotic prescriptions, pyelonephritis as a renal complication, or UTI-associated sick leave. This retrospective cohort study was based on data from the IQVIATM Disease Analyzer database and included patients diagnosed with acute UTI or cystitis by physicians in Germany between 2005 and 2021, who were prescribed either Angocin® or standard antibiotics within 4 days after diagnosis. Patients prescribed antibiotics were matched to those prescribed Angocin® (5:1) using propensity scores. Univariable logistic and Cox regression models were used to investigate the association between Angocin® prescription and the defined study outcomes. The effects of Angocin® were adjusted for age, sex, insurance status, index diagnosis, and physician specialty. A total of 2277 Angocin® patients and 11,385 antibiotic patients were available for analysis. Compared to antibiotic prescriptions, Angocin® prescription was associated with significantly lower odds of an early relapse within 1-30 days after the index date (odds ratio (OR): 0.74; 95% confidence interval (CI): 0.62-0.87; p < 0.001), further sporadic UTI within 31-365 days after the index date (OR: 0.68; 95% CI: 0.58-0.78; p < 0.001), and recurrent UTI (OR: 0.63; 95% CI: 0.48-0.82; p < 0.001). This was also accompanied by reduced antibiotic prescriptions (1-30 days: OR: 0.63; 95% CI: 0.53-0.74, p < 0.001; 31-365 days: OR: 0.56; 95% CI: 0.49-0.64, p < 0.001). A strong, but due to the low incidence, not significant, negative association was observed between Angocin® prescription and the occurrence of pyelonephritis (hazard ratio (HR): 0.67; 95% CI: 0.43-1.06; p = 0.073). The results of this real-world data study demonstrate that Angocin® can be an effective therapeutic option for managing acute and recurrent UTIs and serves as an alternative therapy to antibiotics.

Current practices in diagnosing acute pulmonary embolism: a comprehensive analysis of adherence to contemporary practice guidelines.

Acute pulmonary embolism (APE) poses significant diagnostic challenges, with potentially fatal outcomes if not promptly identified and treated. Despite the availability of clinical guidelines, adherence to diagnostic strategies varies globally, impacting patient outcomes. Our aim was to investigate current practices for PE diagnosis among Polish physicians and their adherence to the contemporary 2019 European Society of Cardiology (ESC) guidelines. This cross‑sectional study, utilizing a web‑based survey developed with the Delphi methodology, included hospital‑based physicians of various specialties from Poland. The survey focused on diagnostic practices, risk stratification, and adherence to the ESC 2019 guidelines for PE. The study showed a limited use of guideline‑recommended clinical prediction rules, with predominant reliance on D‑dimer assessment and computed tomography pulmonary angiography. Risk stratification practices varied, and were often based on individual experience rather than evidence‑based strategies. The vast majority of physicians (80.5%) had never contacted a PE response team, but 88% stated that they would if it were available. Cardiologists were more likely to employ guideline‑recommended methods than other specialists. There is a need for increased adherence to guideline‑recommended diagnostic and risk stratification strategies in APE among physicians in Poland. Enhancing the availability of PE response teams and promoting guideline‑directed practices could improve diagnostic accuracy and patient outcomes.

Multidisciplinary management of gastroesophageal reflux disease: an italian retrospective study

Abstract Background Millions of individuals are affected by gastroesophageal reflux disease (GERD) that causes significant discomfort negatively affecting patients’ overall quality of life. For a collaborative approach of continuous improvement in public health we wanted to know the real-world perspectives in the multidisciplinary and multimodal management pathway. Methods We aimed to interview a sample of gastroenterologists (GE), primary care physicians (GP), and otolaryngologists (ENT) to investigate the management of the intake and treatment of patients reporting symptoms of GERD. Symptoms were divided into typical and extraesophageal, and their severity and impact on quality of life was explored with the GERD Impact Scale (GSI) and Reflux Symptom Index (RSI). Results A total of 6211 patients were analyzed of whom with typical symptoms were 53.5%, while those with extraesophageal symptoms were 46.5%. The latter were more frequently reported by ENT patients (53.6%, p &amp;lt; 0.0001). GSI was highest in patients followed by GE (9 points) and GP (9 points) than ENT specialists (8 points), while the RSI was higher in the ENT group (14.3 ± 6.93) than in the groups of GP and GE, respectively (10.36 ± 6.36 and 10.81 ± 7.30, p &amp;lt; 0.0001). Chest pain had the greatest negative impact on quality of life (p &amp;lt; 0.0001). Of the 3,025 patients who used (proton pump inhibitors) PPIs, non-responders had a lower GSI when treated with a combination of adjunctive drug treatments and bioadhesive compounds, compared with single-component drugs. Conclusions The multidisciplinary and multimodal approach to the management pathway of GERD patients reveals variations in patient profiles by physician specialty, directing toward more appropriate and targeted treatments. In addition, the combination of adjunctive drug treatments and bioadhesive compounds appears to be effective in the management of patients refractory to PPIs. Key messages • The presentation of GERD symptoms is different in accordance with the physician’s speciality: the patients with GERD referred to a gastroenterologist had more severe disease and poorer quality of life. • The combination of adjunctive pharmacological treatments and bioadhesive compounds seems to be effective in the management of PPI refractory patients.

Occupational burnout of health care workers in a specialised COVID hospital setting

The aim is to evaluate the peculiarities of the development of professional burnout (PB) among physicians of therapeutic and surgical specialties, as well as middle medical workers, specialised red zones, as well as its prediction and prevention in this category of workers. Material and methods. The following groups of medical workers were examined: the 1st group consisted of doctors of therapeutic specialities (GPs) working in the red zone (n=111); the 2nd group consisted of doctors of surgical specialities (MDs) working in the ‘red zone’ (n=61); the 3rd group consisted of nurses working in the red zone (n=29); the 4th group – the control group included workers of engineering, technical and economic specialities not related to work in medical organisations (n=190). Professional burnout syndrome was assessed using the Maslach Burnout questionnaire and V.V. Boyko’s technique of diagnosing the level of burnout [4, 5]. The data were processed using Statistica statistical package by StatSoft (USA). Results. It was found that the work of therapeutic and surgical doctors, as well as middle medical workers of specialised red zones, is connected with the exposure of medical workers to a number of specific risk factors related to the provision of medical care to infected patients, as well as with significant changes in the work regarding aspects related to organisation, safety, which contribute to the increase in the level of stress and the increase in the level of SP. Conclusions. The work of physicians of therapeutic and surgical specialities, as well as middle medical workers of specialised red zones, is associated with an increase in the level of professional stress and the level of SP. It is necessary to continue the research of emotional state of medical doctors and average medical workers working in conditions of extreme epidemic situations with the purpose of timely preventive treatment for preservation of health of medical workers.

The number of patient scheduled hours resulting in a 40-hour work week by physician specialty and setting: a cross-sectional study using electronic health record event log data.

To quantify how many patient scheduled hours would result in a 40-h work week (PSH40) for ambulatory physicians and to determine how PSH40 varies by specialty and practice type. We calculated PSH40 for 186188 ambulatory physicians across 395 organizations from November 2021 through April 2022 stratified by specialty. Median PSH40 for the sample was 33.2 h (IQR: 28.7-36.5). PSH40 was lowest in infectious disease (26.2, IQR: 21.6-31.1), geriatrics (27.2, IQR: 21.5-32.0) and hematology (28.6, IQR: 23.6-32.6) and highest in plastic surgery (35.7, IQR: 32.8-37.7), pain medicine (35.8, IQR: 32.6-37.9) and sports medicine (36.0, IQR: 33.3-38.1). Health system leaders and physicians will benefit from data driven and transparent discussions about work hour expectations. The PSH40 measure can also be used to quantify the impact of variations in the clinical care environment on the in-person ambulatory patient care time available to physicians. PSH40 is a novel measure that can be generated from vendor-derived metrics and used by operational leaders to inform work expectations. It can also support research into the impact of changes in the care environment on physicians' workload and capacity.

Effects of Citizenship Status on International Medical Graduate Specialty Choice and Practice Location.

The number of both US citizen and noncitizen international medical graduates (IMGs) practicing in the United States has grown substantially over the last two decades, but little is known about how these groups differ in clinical specialty and practice location. To evaluate the effects of citizenship status on IMG specialty choice (primary care vs nonprimary care) and practice location (rural and health professional shortage areas [HPSAs]). To analyze the retrospective, cross sectional data between 2010 and 2019, we estimated a series of multivariate logistic regressions with year fixed effects after assessing trends in new physician specialty choice and practice location. Survey of Residents Completing Training in New York, the largest publicly available annual survey of graduating residents and fellows in the US. 15,133 new physicians who accepted a job offer in our study period, including 8,177 US medical graduates (USMGs), 2,753 US citizen IMGs, 1,057 permanent resident IMGs, and 3,146 noncitizen non-permanent resident (NCNP) IMGs. IMG and Citizenship status. Whether a new physician chose to practice primary care; whether a new primary care physician chose to work in a rural area; whether a new primary care physician chose to work in a HPSA. Compared to 2010, there were 20% fewer NCNP IMGs entering primary care in 2019. Our logistic analysis found that US citizen IMGs were five times, permanent resident IMGs seven times, and NCNP IMGs nine times more likely to enter primary care compared to USMGs. Among new primary care physicians, NCNP IMGs were more likely to work in a rural area compared to USMGs while US citizen IMGs and permanent resident IMGs acted similarly to USMGs. NCNP IMGs were five times more likely to work in a HPSA while US citizen IMGs and permanent resident IMGs were less likely, compared to USMGs. There was a declining proportion of NCNP IMGs entering primary care; citizenship status affected IMGs' specialty and practice location choices with NCNP IMGs more likely to choose primary care and work in rural areas and HPSAs.

Metabolic, cardiac, and bone health testing in patients with prostate cancer on androgen-deprivation therapy: A population-based assessment of adherence to therapeutic monitoring guidelines.

Androgen-deprivation therapy (ADT) remains a cornerstone in treatment for patients with advanced prostate cancer. ADT is associated with several adverse effects, including osteoporosis, metabolic syndrome, and cardiovascular events, leading to guidelines recommending routine testing to monitor for these toxicities. There is a lack of data assessing adherence to these recommendations. The authors conducted a retrospective cohort study using administrative data from Ontario, Canada between 2008 and 2021. They identified all older men (aged 65 years and older) who received ADT for prostate cancer using comprehensive provincial health databases. The primary outcomes were the use of testing for lipids, dysglycemia (glucose), bone health serum, and bone density between 6 weeks before and 1 year after the initiation of ADT. In total, 29,097 patients were examined, of whom 52.8% were prescribed ADT by urologists, 37.9% were prescribed ADT by radiation oncologists, 2.8% were prescribed ADT by medical oncologists, and 2.4% were prescribed ADT by other physicians. Adherence to guidelines was low: only 21.3% of patients received a bone density scan, 41.2% underwent bone health-related serum tests, 51.3% completed a lipid profile, and 65.9% underwent dysglycemia testing within 1 year of diagnosis. Overall, only 11.9% of patients received all of the recommended investigations. Adherence to testing did not appear to improve over time (2008-2021) or with guideline publication. Patient (age) and physician (specialty) factors had important associations with adherence to testing. Most patients receiving ADT for prostate cancer do not receive recommended testing to monitor for treatment-related toxicity. Further study is required to address barriers to therapeutic monitoring of men on ADT and to reduce treatment-associated adverse events.

Comparison of Croup Management Patterns between Pediatricians and Emergency Medicine Physicians: A Single Pediatric Emergency Department Study

Background/Objectives: With the advent of the field of pediatric emergency medicine, studies on the differences in treatment patterns between pediatricians and emergency medicine (EM) physicians in various pediatric conditions have been accumulating. This study aimed to compare croup (acute laryngotracheobronchitis) management patterns between pediatricians and EM physicians to enhance pediatric emergency care and inform the training of future specialists. Methods: A retrospective review of medical records was conducted for 1676 previously healthy children diagnosed with croup who visited a single pediatric emergency department (PED) of a tertiary university-affiliated hospital in South Korea, from March 2019 to February 2023. Patient characteristics, management patterns, and the impact of physician specialty on emergency care were analyzed. Results: EM physicians used injected dexamethasone monotherapy in 30.54% of the cases, more frequently than the 3.57% among pediatricians. In contrast, pediatricians used a combination of nebulized epinephrine and dexamethasone in 88.29% of the cases, compared with 67.71% for EM physicians. The appropriate use of nebulized epinephrine based on the Westley Croup Score was significantly higher in the EM physician group (77.64% vs. 57.89%, p &lt; 0.001). Pediatricians also prescribed oral antibiotics and corticosteroids more frequently (25.13% vs. 3.13% and 81.54% vs. 22.69%, respectively; p &lt; 0.001 for both). Despite these differences, there were no significant disparities in PED length of stay or 48 h revisit rates. Conclusions: EM physicians adhered more closely to currently accepted management algorithms for croup management. These findings underscore the need for standardized, evidence-based pediatric emergency care and provide valuable insights for training programs in this field.

Computed tomography referral guidelines adherence in Europe: insights from a seven-country audit.

Ensuring appropriate computed tomography (CT) utilization optimizes patient care while minimizing radiation exposure. Decision support tools show promise for standardizing appropriateness. In the current study, we aimed to assess CT appropriateness rates using the European Society of Radiology (ESR) iGuide criteria across seven European countries. Additional objectives were to identify factors associated with appropriateness variability and examine recommended alternative exams. As part of the European Commission-funded EU-JUST-CT project, 6734 anonymized CT referrals were audited across 125 centers in Belgium, Denmark, Estonia, Finland, Greece, Hungary, and Slovenia. In each country, two blinded radiologists independently scored each exam's appropriateness using the ESR iGuide and noted any recommended alternatives based on presented indications. Arbitration was used in case auditors disagreed. Associations between appropriateness rate and institution type, patient's age and sex, inpatient/outpatient patient status, anatomical area, and referring physician's specialty were statistically examined within each country. The average appropriateness rate was 75%, ranging from 58% in Greece to 86% in Denmark. Higher rates were associated with public hospitals, inpatient settings, and referrals from specialists. Variability in appropriateness existed by country and anatomical area, patient age, and gender. Common alternative exam recommendations included magnetic resonance imaging, X-ray, and ultrasound. This multi-country evaluation found that even when using a standardized imaging guideline, significant variations in CT appropriateness persist, ranging from 58% to 86% across the participating countries. The study provided valuable insights into real-world utilization patterns and identified opportunities to optimize practices and reduce clinical and demographic disparities in CT use. Question Largest multinational study (7 EU countries, 6734 CT referrals) assessed real-world CT appropriateness using ESR iGuide, enabling cross-system comparisons. Findings Significant variability in appropriateness rates across institution type, patient status, age, gender, exam area, and physician specialty, highlighted the opportunities to optimize practices based on local factors. Clinical relevance International collaboration on imaging guidelines and decision support can maximize CT benefits while optimizing radiation exposure; ongoing research is crucial for refining evidence-based guidelines globally.

7513 Presence Of Hispanic/Latino Physicians In Academic Research. Are We There Yet?

Abstract Disclosure: C.E. Guillen Lopez: None. A. Patel: None. A. Rocha: None. C. Arima: None. A. Molkina: None. L. Robles: None. A. Arce Gastelum: None. Hispanic/Latino endocrinologists' presence and active involvement in diabetes research play a pivotal role in shaping the trajectory of healthcare initiatives in the United States. Diabetes, a prevalent and complex health condition, disproportionately affects diverse communities, with Hispanics/Latinos being among the groups facing higher incidence rates. In this context, the significance of Hispanic/Latino endocrinologists cannot be overstated, as their unique perspectives and cultural insights contribute to a more nuanced understanding of the multifaceted factors influencing diabetes prevalence, management, and outcomes in the U.S. By actively involving Hispanic/Latino endocrinologists in diabetes research, we not only enhance the representation of diverse patient populations but also foster a more comprehensive approach to addressing the intricate intersections of genetics, lifestyle, and socio-cultural factors contributing to diabetes disparities in the nation. In the 2021 Physician Specialty Data Report, the Association of American Medical Colleges (AAMC) incorporated physician race and ethnicity information for the first time. Within the 7,354 actively practicing endocrinologists surveyed, only 636 individuals identified as Hispanic/Latino. The majority of these endocrinologists were predominantly dedicated to clinical practice. A descriptive analysis of 1011 abstracts on diabetes and glucose metabolism presented at the Endo Society from 2021 to 2023 revealed that 549 were authored by women and 458 by men. The majority (705 posters, 69.7%) originated from the U.S., and 306 (30.26%) were classified as international posters. Among these, 152 posters (15%) were associated with the Hispanic or Latino authors, but only 91 (9%) were published in the U.S. In conclusion, the engagement of Hispanic/Latino physicians in endocrinology is indispensable for advancing healthcare. Their participation brings diverse perspectives, facilitates a better understanding of health disparities, and promotes innovative research and patient care strategies. By actively involving Hispanic/Latino physicians, we contribute to a more comprehensive understanding of endocrine disorders and work towards a healthcare system that prioritizes inclusivity, cultural sensitivity, and collaboration, ultimately benefiting the well-being of individuals across diverse communities. Presentation: 6/2/2024

Estimating the impact of physician risky-prescribing on the network structure underlying physician shared-patient relationships

Social network analysis and shared-patient physician networks have become effective ways of studying physician collaborations. Assortative mixing or “homophily” is the network phenomenon whereby the propensity for similar individuals to form ties is greater than for dissimilar individuals. Motivated by the public health concern of risky-prescribing among older patients in the United States, we develop network models and tests involving novel network measures to study whether there is evidence of homophily in prescribing and deprescribing in the specific shared-patient network of physicians linked to the US state of Ohio in 2014. Evidence of homophily in risky-prescribing would imply that prescribing behaviors help shape physician networks and would suggest strategies for interventions seeking to reduce risky-prescribing (e.g., strategies to directly reduce risky prescribing might be most effective if applied as group interventions to risky prescribing physicians connected through the network and the connections between these physicians could be targeted by tie dissolution interventions as an indirect way of reducing risky prescribing). Furthermore, if such effects varied depending on the structural features of a physician’s position in the network (e.g., by whether or not they are involved in cliques—groups of actors that are fully connected to each other—such as closed triangles in the case of three actors), this would further strengthen the case for targeting groups of physicians involved in risky prescribing and the network connections between them for interventions. Using accompanying Medicare Part D data, we converted patient longitudinal prescription receipts into novel measures of the intensity of each physician’s risky-prescribing. Exponential random graph models were used to simultaneously estimate the importance of homophily in prescribing and deprescribing in the network beyond the characteristics of physician specialty (or other metadata) and network-derived features. In addition, novel network measures were introduced to allow homophily to be characterized in relation to specific triadic (three-actor) structural configurations in the network with associated non-parametric randomization tests to evaluate their statistical significance in the network against the null hypothesis of no such phenomena. We found physician homophily in prescribing and deprescribing. We also found that physicians exhibited within-triad homophily in risky-prescribing, with the prevalence of homophilic triads significantly higher than expected by chance absent homophily. These results may explain why communities of prescribers emerge and evolve, helping to justify group-level prescriber interventions. The methodology may be applied, adapted or generalized to study homophily and its generalizations on other network and attribute combinations involving analogous shared-patient networks and more generally using other kinds of network data underlying other kinds of social phenomena.

The Prevalence and Impact of Migraine Among Physicians in Saudi Arabia: A Cross-Sectional Study.

Background Migraine is a primary headache disorder and one of the most common causes of disability worldwide. Prior reports showed a higher prevalence of migraine among physicians. We conducted this study to estimate the prevalence of migraine among physicians in Saudi Arabia, as well as its impact on quality of life. Methods A cross-sectional study was conducted using a validated online questionnaire that was distributed among physicians in various medical and surgical specialties in Saudi Arabia from January to June 2023. The inclusion criteria involved physicians in all specialties, who worked in governmental or private hospitals in Saudi Arabia. Employed or healthcare workers other than physicians were excluded. To measure the impact of headache on a person's quality of life, the Migraine Disability Assessment (MIDAS) test was applied. Statistical analysis of the study was conducted using the Statistical Package for the Social Sciences (SPSS) Version 24 (IBM Corp., Armonk, NY). Results We had 387 respondents, of whom 362 fulfilled the inclusion criteria. The mean age was 33.02 ± 9.07 years, and genders were distributed equally. Most physicians worked in departments of internal medicine, family medicine, general practice, and general surgery. The prevalence of migraine was recorded in 17.1% (62 patients) of all the included participants, with a female predominance. MIDAS revealed a total mean score of 16.823±14.149. The severity grades were classified as moderate (37.1%), severe (35.5%), or little to no (21.0%). Stress and light were cited as the top factors that trigger or worsen migraine, while sleep, rest, and quiet and darknesswere cited as the top relieving factors. The average number of headache attacks (month) was 6.823. Most patients with migraine were board residents (27.4%), living in the western region (53.2%), and working in a governmental hospital (38.7%). Conclusion Migraine is a common disorder among physicians in Saudi Arabia, with significant moderate-to-severe disability. Stress is identified as a major trigger. Proper awareness, stress management programs, and therapeutic intervention may mitigate the untoward consequences of migraine.

Quantifying the Accuracy of Clinician Risk Assessment for Postpartum Hemorrhage

Abstract Objective To measure the accuracy of postpartum hemorrhage (PPH) risk assessment performed by unaided individual clinicians, to inform future comparison to alternative risk assessment methods. Methods Prospective PPH risk assessments were collected from obstetric care team clinicians at two quaternary medical centers in the United States (Vanderbilt University Medical Center, Brigham and Women’s Hospital) from January 2022 to January 2023, following written informed consent from the providers. The data included a cohort of both vaginal and cesarean deliveries (CD). For each assessment, the clinician quantified the patient’s predicted PPH risk on a scale from 0 to 100% and rated their confidence in these assessments using a 5-point Likert scale, ranging from ‘not at all confident’ to ‘completely confident’. Medical records were reviewed 24 hours postpartum to assess the dichotomous outcome of PPH, defined as blood loss ≥1000 mL. The accuracy of these predictions was evaluated using the area under the receiver operating characteristic curve (AUC). Results Of 271 patients, 32 (11.8%) experienced PPH, accounting for 11.4% (104/915) of assessments. The overall AUC was 0.64 (95% confidence interval (CI): 0.58–0.71). Prediction accuracy was higher for CD than for vaginal deliveries, with AUCs of 0.82 (95% CI: 0.72–0.91) and 0.56 (95% CI: 0.48–0.63), respectively. No significant differences in the accuracy of assessments were observed according to physician specialty, physician experience level, or confidence level of the assessment. Conclusion Overall unaided clinician performance in predicting PPH was moderate, with an AUC of 0.64. Predictions were more accurate for patients undergoing CD. Further study is needed to understand how clinician performance compares to other modalities of risk prediction.