Physicians In Other Specialties Research Articles

Screening for hepatocellular carcinoma by Egyptian physicians

To assess the practice of Egyptian physicians in screening patients for hepatocellular carcinoma (HCC). The study included 154 physicians from all over Egypt caring for patients at risk for HCC. The study was based on a questionnaire with 20 items. Each questionnaire consisted of two parts: (1) personal information regarding the physician (name, age, specialty and type of health care setting); and (2) professional experience in the care of patients at risk for HCC development (screening, knowledge about the cause and natural course of liver diseases and HCC risk). Sixty-eight percent of doctors with an MD degree, 48% of doctors with a master degree or a diploma and 40% of doctors with a Bachelor of Medicine, Bachelor of Surgery certificate considered the hepatitis C virus (HCV) genotype as risk factor for HCC development (P < 0.05). Ninety percent of physicians specialized in tropical medicine, internal medicine or gastroenterology and 67% of physicians in other specialties advise patients to undergo screening for HCV and hepatitis B virus infection as well as liver cirrhosis (P < 0.05). Eighty-six percent of doctors in University Hospitals and 69% of Ministry of Health (MOH) doctors consider HCV infection as the leading cause of HCC in Egypt (P < 0.05). Seventy-two percent of doctors with an MD degree, 55% of doctors with a master degree or a diploma, 56% of doctors with an MBBCH certificate, 74% of doctors in University Hospitals and 46% of MOH hospital doctors consider abdominal ultrasonography as the most important investigation in HCC screening (P < 0.05). Sixty-five percent of physicians in tropical medicine, internal medicine or gastroenterology and 37% of physicians in other specialties recommend as HCC screening interval of 3 mo (P < 0.05). Seventy-one percent of doctors with an MD degree, 50% of doctors with a master degree or diploma and 60% of doctors with an MBBCH certificate follow the same recommendation. In Egypt, physicians specialized in tropical medicine, internal medicine or gastroenterology with an MD degree and working in a University Hospital are best informed about HCC.

Myofascial pain: from Virchow's to our days

Myalgia is not a definite nosological entity and fixes the attention of neurologists, rheumatologists, and physicians in other specialties. This is first of all associated with the high incidence of chronic pain syndrome that leads to long-term disability mainly in young and middle-aged persons. One of the most common reasons for seeking advice from a therapist and neurologist is low back pain that may be due to the involvement of three key anatomical players: facet joints (arthrosis treatment should make an emphasis on hondroprotectors), intervertebral disks (in case of discopathy, clinicians tend to favor nonsteroidal anti-inflammatory drugs – NSAIDs), and a muscular frame. In this case, two thirds of patients with pain syndromes in the trunk and limbs are found to have myofascial dysfunction that is defined as impaired function of one or other muscle, which occurs with its overload and manifests itself as muscle spasm and the presence of painful muscle infiltrations or local muscle hypertonus and trigger points in the tense muscles. Ignoring this fact gives rise to the irrational use of analgesic and anti-inflammatory drugs and further to the increase of their doses because the treatment is ineffective. Modern-day therapy for myofascial syndrome is multimodal and encompasses physiotherapic and manual procedures and the use of myorelaxants rather than NSAIDs. To prescribe myorelaxants, it is necessary to understand their mechanisms of action and the effects of different agents in this group.

Nuclear medicine training and practice in Poland.

In Poland, nuclear medicine (NM) has been an independent specialty since 1988. At the end of 2013, the syllabus for postgraduate specialization in NM has been modified to be in close accordance with the syllabus approved by the European Union of Medical Specialists and is expected to be enforced before the end of 2014. The National Consultant in Nuclear Medicine is responsible for the specialization program in NM. The Medical Center of Postgraduate Training is the administrative body which accepts the specialization programs, supervises the training, organizes the examinations, and awards the specialist title. Specialization in NM for physicians lasts for five years. It consists of 36 months of training in a native nuclear medicine department, 12 months of internship in radiology, 3 months in cardiology, 3 months in endocrinology, 3 months in oncology, and 3 months in two other departments of NM. If a NM trainee is a specialist of a clinical discipline and/or is after a long residency in NM departments, the specialization in NM can be shortened to three years. During the training, there are obligatory courses to be attended which include the elements of anatomy imaging in USG, CT, and MR. Currently, there are about 170 active NM specialists working for 38.5 million inhabitants in Poland. For other professionals working in NM departments, it is possible to get the title of a medical physics specialist after completing 3.5 years of training (for those with a master's in physics, technical physics or biomedical engineering) or the title of a radiopharmacy specialist after completing 3 years of training (for those with a master's in chemistry or biology). At present, the specialization program in NM for nurses is being developed by the Medical Centre of Postgraduate Education. Continuing education and professional development are obligatory for all physicians and governed by the Polish Medical Chamber. The Polish Society of Nuclear Medicine (PTMN) organizes regular postgraduate training for physicians working in NM. Educational programs are comprehensive, covering both diagnostics and current forms of radioisotope therapy. They are aimed not only at physicians specialized/specializing in NM, but also at other medical professionals employed in radionuclide departments as well as physicians of other specialties.

Patterns of Change in ACGME-Accredited Residency Programs and Positions: Implication for the Adequacy of GME Positions and Supply of Physicians in the United States.

Recent studies suggest that the supply of primary care physicians and generalist physicians in other specialties may be inadequate to meet the needs of the US population. Data on the numbers and types of physicians-in-training, such as those collected by the Accreditation Council for Graduate Medical Education (ACGME), can be used to help understand variables affecting this supply. We assessed trends in the number and type of medical school graduates entering accredited residencies, and the impact those trends could have on the future physician workforce. Since 2004, the ACGME has published annually its data on accredited institutions, programs, and residents to help the graduate medical education community understand major trends in residency education, and to help guide graduate medical education policy. We present key results and trends for the period between academic years 2003-2004 and 2012-2013. The data show that increases in trainees in accredited programs are not uniform across specialties, or the types of medical school from which trainees graduated. In the past 10years, the growth in residents entering training that culminates in initial board certification ("pipeline" specialties) was 13.0%, the number of trainees entering subspecialty education increased 39.9%. In the past 5years, there has been a 25.8% increase in the number of osteopathic physicians entering allopathic programs. These trends portend challenges in absorbing the increasing numbers of allopathic and osteopathic graduates, and US international graduates in accredited programs. The increasing trend in subspecialization appears at odds with the current understanding of the need for generalist physicians.

Acceptance of Insurance by Psychiatrists and the Implications for Access to Mental Health Care

There have been recent calls for increased access to mental health services, but access may be limited owing to psychiatrist refusal to accept insurance. To describe recent trends in acceptance of insurance by psychiatrists compared with physicians in other specialties. We used data from a national survey of office-based physicians in the United States to calculate rates of acceptance of private noncapitated insurance, Medicare, and Medicaid by psychiatrists vs physicians in other specialties and to compare characteristics of psychiatrists who accepted insurance and those who did not. Our main outcome variables were physician acceptance of new patients with private noncapitated insurance, Medicare, or Medicaid. Our main independent variables were physician specialty and year groupings (2005-2006, 2007-2008, and 2009-2010). The percentage of psychiatrists who accepted private noncapitated insurance in 2009-2010 was significantly lower than the percentage of physicians in other specialties (55.3% [95% CI, 46.7%-63.8%] vs 88.7% [86.4%-90.7%]; P < .001) and had declined by 17.0% since 2005-2006. Similarly, the percentage of psychiatrists who accepted Medicare in 2009-2010 was significantly lower than that for other physicians (54.8% [95% CI, 46.6%-62.7%] vs 86.1% [84.4%-87.7%]; P < .001) and had declined by 19.5% since 2005-2006. Psychiatrists' Medicaid acceptance rates in 2009-2010 were also lower than those for other physicians (43.1% [95% CI, 34.9%-51.7%] vs 73.0% [70.3%-75.5%]; P < .001) but had not declined significantly from 2005-2006. Psychiatrists in the Midwest were more likely to accept private noncapitated insurance (85.1%) than those in the Northeast (48.5%), South (43.0%), or West (57.8%) (P = .02). Acceptance rates for all types of insurance were significantly lower for psychiatrists than for physicians in other specialties. These low rates of acceptance may pose a barrier to access to mental health services.

EPA-0368 – Liaison psychiatry in poland - can we acchieve the successful holistic diagnosis? - survey

The decades bring increasing number of new medical specialties together with inevitable progress of medical science. This is caused by an expanding amount of knowledge, but remaining constant physical and intellectual capabilities of man. In the contrast to the time of Hippocrates, today you can not be an expert in every field of medicine. We need to consult with specialists in various fields to properly diagnose the patient. Without that often a definitive diagnosis is impossible. The objective of our survey was to check how often psychiatrists use the consultation with physicians in other specialties and whether there is a relationship between the place of work, academic degree, work experience in the profession and the amount of commissioned consultations. It was also important for us whether consultations affect the place of the final diagnosis. Most of the respondents are young doctors, specialists from large cities. They rarely consult with doctors of other specialties - 1/10 cases - take into account the recognition of these cases. However they are sceptical about the opinions of other psychiatrists. Proctologist, pathologist are specializations with which psychiatrists consult the least (> 76% did not cooperate). The most often they work with specialists in the field of neurology and internists. The key to diagnostic success is a holistic view of the patient, which consists of components of knowledge about somatic and mental disorders. It is necessary, therefore, possibly the most effective cooperation of doctors of various specialties.

Dermatology on YouTube

YouTube, reaches upwards of six billion users on a monthly basis and is a unique source of information distribution and communication. Although the influence of YouTube on personal health decision-making is well established, this study assessed the type of content and viewership on a broad scope of dermatology related content on YouTube. Select terms (i.e. dermatology, sun protection, skin cancer, skin cancer awareness, and skin conditions) were searched on YouTube. Overall, the results included 100 videos with over 47 million viewers. Advocacy was the most prevalent content type at 24% of the total search results. These 100 videos were "shared" a total of 101,173 times and have driven 6,325 subscriptions to distinct YouTube user pages. Of the total videos, 35% were uploaded by or featured an MD/DO/PhD in dermatology or other specialty/field, 2% FNP/PA, 1% RN, and 62% other. As one of the most trafficked global sites on the Internet, YouTube is a valuable resource for dermatologists, physicians in other specialties, and the general public to share their dermatology-related content and gain subscribers. However, challenges of accessing and determining evidence-based data remain an issue.

Increasing use of non-traditional vehicles for psoriasis and other inflammatory skin conditions

Although topical corticosteroid ointments were once viewed as the best vehicle for treating inflammatory skin diseases, the recognition of the problem of poor compliance and patients' preferences for other vehicles has led to the development of corticosteroid products in alternative formulations. To describe patterns of use of newer vehicle formulations including foams, shampoos, sprays, and lotions for the treatment of psoriasis and other dermatoses. The use of non-traditional vehicles was identified using visit with diagnoses for psoriasis and other dermatoses from the National Ambulatory Medical Care Survey 2000-2010 data. Trends in corticosteroid vehicles mentions were evaluated over the study period to determine how the use of non-traditional vehicles has changed. The odds ratios of being prescribed a nontraditional vehicle were reported for patient and office-based characteristics of visits. Approximately 2.3% and 1.9% of visits mentioned foam and other non-traditional vehicles (shampoo, lotion, spray), respectively. The use of corticosteroids in shampoo, lotion, or spray preparations increased by 0.5% annually (p=0.008) but did not significantly change for corticosteroids in a foam preparation (p=0.10). Psoriasis and seborrheic dermatitis were the leading diagnoses at visits prescribed corticosteroids in nontraditional vehicles. Dermatologists were more likely than non-dermatologists to prescribe foam products [OR: 8.4 (3.6, 19.9)] or clobetasol in another non-traditional vehicle [OR: 49.7 (10.3, 240.5)]. Product vehicle was not specified for all corticosteroids. Although there was increasing use of non-traditional vehicles, the rate of use has remained low. Dermatologists appear to have greater familiarity with the use of these newer vehicle formulations than do physicians in other specialties.

Breast cancer management: towards optimum diagnostic and therapeutic methods

The second biennial congress of the Hellenic Society of Breast Surgeons took place in Athens, Greece, from 28 to 30 June 2013. It was highly attended by breast surgeons who are members of the society, but also by a large number of physicians of other specialties involved in the management of breast cancer, including pathologists, diagnostic radiologists, medical oncologists, radiotherapists and plastic surgeons. As well as surgical issues, important topics regarding the role of the radiologist in preoperative diagnosis, controversies in breast pathology, recent advances in systemic treatment and new techniques of radiotherapy were extensively debated in roundtable discussions. Finally, three workshops on diagnostic radiology, the importance of molecular biology in breast cancer treatment decisions and ‘surgical skills’ for young breast surgeons were also included in the 3-day scientific program. Here, we present a summary of the highlights of the congress.

Clinical implementation of musculoskeletal ultrasound in rheumatology in Austria

The aim of the study is to assess the clinical implementation of musculoskeletal ultrasound (MSUS) in rheumatology in Austria. A survey was conducted among Austrian rheumatologists and physicians of other specialties with a focus on rheumatology. The questionnaire was designed by the members of the Austrian Radiology-Rheumatology Initiative for Musculoskeletal UltraSound including the following items: demographics, access to MSUS and MSUS training, application of MSUS to support diagnosis, monitoring and treatment decisions, and obstacles for the routine performance of MSUS. Eighty-eight (21.9 %) out of the 402 surveyed physicians responded. No access to MSUS and/or inadequate training in the technique was more commonly reported by senior (>50 years; 64.3 and 67.7 %, respectively) than by younger physicians (16.7 %, p = 0.01 and 18.5 %, p < 0.001, respectively). The lowest availability of sonography was found among senior rheumatologists (25.0 %, p = 0.001 compared to the total group). MSUS is routinely used for diagnosis and/or monitoring purposes by 12.5 % of physicians and 20.5 % perform sonography in clinically unclear cases. A limited number of physicians apply the method to support treatment decisions and/or to evaluate treatment success. The most important obstacles for routine application of MSUS in rheumatology are limited access to ultrasound machines, lack of training/education in the technique, and time constraints in daily routine. Low access to high-end ultrasound devices, lack of training, and time constraints may explain the low appreciation of MSUS among Austrian physicians evaluating patients with rheumatic diseases.

In Reply

I thank the authors Giordano, Gravenstein, and Rice for their valuable comments on the subject of “Capnography Outside the Operating Rooms.”1 Due to the limitations of word count for “Clinical Concepts Commentary,” a detailed account of each capnogram was not provided. Given the wider scope of electronic accessibility, the intention of the article was to provide a comprehensive review of the use of capnography outside operating rooms not only to anesthesiologists and certified registered nurse anesthetists, but also to physicians in other specialties and nurses who provide sedation. Therefore, the article was scripted to provide a concise physiologic background and clinical applications of capnography.Giordano et al. raised important comments regarding capnograms 2C and 3A–D of the article.1 Analysis of capnograms 2C and 3A–D in the aforementioned article is a little more complex than the explanation provided by Giordano etal. Regarding 2C, they state that the inspiratory downstroke will sluggishly return to a zero baseline (or a β angle &gt;90 degrees) during inspiratory valve malfunction. This may be true in the typical circumstance described by Giordano et al., where an assumption is made that half of the expiratory gases will enter the inspiratory limb. However in reality, the quantity of expiratory gases entering the inspiratory limb is dependent on the resistance to the flow of expiratory gases in each limb of the circuit. The resistance in turn is dependent on the design of the valves, extent of malfunction of the inspiratory valve, fresh gas flows, and the length of the circuit. In addition, the carbon dioxide concentration across the inspiratory limb is also dependent on turbulent versus laminar flow of expiratory gases and mixing of carbon dioxide–free fresh gases with expiratory gases in the inspiratory limb (expiratory gases do not flow in blocks). For example, if malfunction of the inspiratory valve results in decreased resistance, it is conceivable that more than half of the expiratory gases might enter the inspiratory limb. This, in conjunction with the gas mixing between carbon dioxide–containing expiratory gases and carbon dioxide–free fresh gases may cause the final portion of the inspiratory tidal volume to contain certain amounts of carbon dioxide. Thus, the resulting downstroke of the capnogram (phase 0) will not reach the zero baseline. This was illustrated by me and my colleagues in a case report where we recorded capnograms during inspiratory valve malfunction and the subsequent inspiratory downstrokes did not reach the baseline.2 However, it was also demonstrated by our group that capnograms can apparently appear normal despite substantial rebreathing resulting from inspiratory valve malfunction. However, when respiratory gas flows were superimposed on the capnograms, the significant rebreathing was obvious.3Regarding capnogram 3A–D illustrated in the original article,1 the morphology of capnograms depends, once again, on several factors. These include patient’s respiratory rate, tidal volume, supplementary oxygen flow, gas leaks from the mask resulting in the carbon dioxide washout by the oxygen flow, and more importantly, the site of the carbon dioxide sampling. In capnograms 3A–D, the site of the sampling was adjacent to the inside wall of the mask via an adaptor, and not at the nostril. Therefore, the recorded carbon dioxide concentration does not represent the carbon dioxide concentration at the nostril. The morphology of the capnograms depends on the location of carbon dioxide sampling within the mask and on the washout of carbon dioxide by the supplementary oxygen flow. Unless carbon dioxide measurements are performed at the nostril, it may be difficult to ascertain whether there is rebreathing (although minimal). For example, figure 1A and B from this reply shows a patient undergoing upper gastroinstestinal endoscopy with supplementary oxygen provided via the mask, and end-tidal carbon dioxide monitoring was performed within the nostril using carbon dioxide sampling nasal cannula. The endoscope was inserted via a “U-shaped flap cut” in the mask. In this case, the carbon dioxide rebreathing was zero (fig. 1B) due to the carbon dioxide washout by supplementary oxygen at the nostril. Capnograms during sedation is a good subject for future discussion.

Gender disparity among US anaesthesiologists: are women underrepresented in academic ranks and scholarly productivity?

The h-index is an objective indicator of research productivity and influence on scholarly discourse within a discipline. It may be a valuable adjunct for measuring research productivity, a key component in decisions regarding appointment and promotion in academic medicine. The objectives of this analysis were to (1) examine whether there are gender disparities in research productivity among academic anaesthesiologists, and (2) compare results to measures of research productivity in other specialties. A bibliometric analysis of faculty members from 25 academic anaesthesiology departments was performed using the Scopus database. Academic anaesthesiologists were organised by academic rank and gender. The h-index and publication range (in years) of faculty members were calculated. Male anaesthesiologists had higher research productivity, as measured by the h-index, than female colleagues. Organised by rank, this difference was noted only among full professors. Men had higher overall and early-career research productivity, while women had mid-career research productivity rates equivalent to and surpassing that of their male colleagues. Gender disparities in research productivity were also noted among a sample of academic physicians in other specialties. While men had higher overall research productivity, women had equivalent or higher mid-career research output, suggesting that early-career considerations unique to women should be taken into account during appointment and promotion in academic anaesthesiology. While disparities in gender representation among anaesthesiologists have also been noted in Europe, further study as to whether these differences also extend to research productivity and academic promotion outside of the US would be of interest.

The role and utilization of electronic medical records in ambulatory otolaryngology

To estimate the usage of electronic medical records (EMRs) in ambulatory otolaryngology and to compare the usage trends between otolaryngologists and physicians in other specialties. Cross-sectional analysis of data taken from the National Ambulatory Medical Care Survey (NAMCS). The 2005 to 2010 NAMCS datasets were analyzed for whether storage of patient records in otolaryngology practices were completely electronic, partly electronic, or paper based. The trend of EMR utilization in the studied period was compared between otolaryngology and other specialties. Furthermore, the usage of different EMR functions (e.g., ordering tests) was also evaluated. The proportion of otolaryngology practices with complete or partial EMR usage increased from 27.0% in 2005 to 2006, to 48.5% in 2009 to 2010 (P < .001), and was projected to increase to 80.3% in 2015 to 2016. Otolaryngologists had variable usage of different functions of EMRs. Neither the overall use of EMRs nor their different functions were statistically different between otolaryngologists and other specialists. Further exploration of data revealed that 34.0% of otolaryngologists intended to install new EMR systems within the following years. Finally, 39.9% of otolaryngologists had plans to apply for Medicare or Medicaid incentive payments, of which 92.3% expected to start meaningful use in 2011. The increasing utilization of EMRs in ambulatory otolaryngology is an important marker of progress in compliance with health care reform. Despite this upward trend, however, <50% of ambulatory offices had adopted EMRs in 2009 to 2010, and it remains to be seen how the field will adapt to the evolving challenge of EMR adoption and implementation.

Knowledge of Glasgow coma scale by Physicians in a Tertiary Health Institution in Nigeria

The Glasgow coma scale (GCS) form the basis for important management decisions by the attending physicians or other health personnel in the care of comatose patients. Inaccurate reporting may result in unnecessary treatment and diagnostic tests. The purpose of this study is to assess the knowledge of GCS among physicians in different specialties of training in a tertiary centre in Nigeria. The study was a descriptive survey conducted among doctors at the University of Ilorin Teaching Hospital (UITH) Ilorin, in North Central Nigeria. Physicians from different specialties and all levels of training were surveyed. Questionnaires were administered simultaneously within a department without prior notification. Participants were instructed not to use any reference materials while completing the questionnaire. Majority of the physicians could indicate correctly what GCS stands for (97%) and identify each category correctly. However, only 37% could score all the categories correctly. There was a positive impact in theoretical knowledge and recall among respondents who has had training in GCS. The level of training of respondents correlated well with recall of GCS with Residents and interns faring better than fellows and medical officers. Recall of GCS scoring was least among Physicians in family medicine compared to physicians in other specialties. Improved training with retention strategies in the use of the GCS and retraining of all physicians involved in the management of the comatose patients should be the focus of future strategic plans.

Contribution of the Pitié-Salpêtrière Hospital to French Anesthesiology

Contribution of the Pitié-Salpêtrière Hospital to French Anesthesiology

Drug diversion by anesthesiologists: Identification through intensive auditing

Physicians’ rates for misuse of opioids are up to five times higher than those in other professions,1 and anesthesiologists are up to four times more likely to be treated for drug addiction than physicians in other specialties.2 Furthermore, physician drug abuse has been linked to an increased risk of suicide,1,3 and the physician suicide rate is twice that of the general population, with anesthesiologists having the highest suicide rate of all physicians.1 Because of its fast-acting effects and highly effective pain relief, fentanyl has consistently been the most commonly abused medication among anesthesiologists.1,4 Despite measures in more recent years to monitor controlled substances and restrict their availability to anesthesiologists, these physicians’ relatively easy access to these drugs continues to be the major theory advanced for the high rate of diversion and abuse within the specialty.2 We intermittently audit all surgical procedures in our institution for a given time period (usually one month) by extracting data from anesthesia records and comparing them with proof-of-use documents such as narcotic records and automated dispensing machine (ADM) records. Variables such as patient age and weight, surgery time, anesthesia time, and use of reversal agents are included. These data are then compared for individual anesthesiologists. We have observed not only the usual problems associated with poor record keeping but also identified a practitioner who appeared to be diverting fentanyl. Although the individual’s record keeping was impeccable, with good agreement between the anesthesia record and the ADM documentation, his use of fentanyl (in terms of amount per patient weight) was 1.5–2.5 times that of his peers (table). His use of other agents was similar to that of his peers, as were his anesthesia and surgery times and his use of reversal agents.

The factors associated with successful paediatric endotracheal intubation on the first attempt in emergency departments: A 13-emergency-department registry study

BackgroundWe investigated which factors are associated with successful paediatric endotracheal intubation (ETI) on the first attempt in emergency department (EDs) from multicentre emergency airway registry data. MethodsWe created a multicentre registry of intubations at 13 EDs and performed surveillance over 5 years. Each intubator filled out a data form after an intubation. We defined “paediatric patients” as patients younger than 10 years of age. We assessed the specialty and level of training of intubator, the method, the equipment, and the associated adverse events. We analysed the intubation success rates on the first attempt (first-pass success, FPS) based on these variables. ResultsA total of 430 ETIs were performed on 281 children seen in the ED. The overall FPS rate was 67.6%, but emergency medicine (EM) physicians showed a significantly greater success rate of 74.4%. In the logistic regression analysis, the intubator's specialty was the only independent predictive factor for paediatric FPS. In the subgroup analysis, the EM physicians used the rapid sequence intubation/intubation (RSI) method and Macintosh laryngoscope more frequently than physicians of other specialties. ETI-related adverse events occurred in 21 (7.2%) out of the 281 cases. The most common adverse event in the FPS group was mainstem bronchus intubation, and vomiting was the most common event in the non-FPS group. The incidence of adverse events was lower in the FPS group than in the non-FPS group, but this difference was not statistically significant. ConclusionsThe intubator's specialty was the major factor associated with FPS in emergency department paediatric ETI, The overall ETI FPS rate among paediatric patients was 67.6%, but the EM physicians had a FPS rate of 74.4%. A well structured airway skill training program, and more actively using the RSI method are important and this could explain this differences.

The Front Line of Genomic Translation

The Front Line of Genomic Translation

Urgent need for formal medical training in infectious diseases in India

Urgent need for formal medical training in infectious diseases in India

Placebos in Clinical Practice: Comparing Attitudes, Beliefs, and Patterns of Use between Academic Psychiatrists and Nonpsychiatrists

Controversial and ethically tenuous, the use of placebos is central to medicine but even more pivotal to psychosocial therapies. Scholars, researchers, and practitioners largely disagree about the conceptualization of placebos. While different professionals often confound the meanings of placebo effects with placebo responses, physicians continue to prescribe placebos as part of clinical practice. Our study aims to review attitudes and beliefs concerning placebos outside of clinical research. Herein we compare patterns of placebo use reported by academic psychiatrists with those reported by physicians from different specialties across Canadian medical schools. Using a web-based tool, we circulated an online survey to all 17 Canadian medical schools, with a special emphasis on psychiatry departments therein and in university-affiliated teaching hospitals. A variation on earlier efforts, our 5-minute, 21-question survey was anonymous. Among the 606 respondents who completed our online survey, 257 were psychiatrists. Our analysis revealed that psychiatrists prescribed significantly more subtherapeutic doses of medication than physicians in other specialties, although about 20% of both psychiatrists and nonpsychiatrists prescribed placebos regularly as part of routine clinical practice. However, compared with 6% of nonpsychiatrists, only 2% of psychiatrists deemed placebos of no clinical benefit. In addition, more than 60% of psychiatrists either agreed or strongly agreed that placebos had therapeutic effects relative to fewer than 45% of other practitioners. Findings from this pan-Canadian survey suggest that, compared with other physicians, psychiatrists seem to better value the influence placebos wield on the mind and body and maintain more favourable beliefs and attitudes toward placebo phenomena.