Views Of Physicians Research Articles

Pan-Stakeholder Core Outcome Set (COS) Definition for Selected Hematological Malignancies - Results of the Harmony Alliance

Pan-Stakeholder Core Outcome Set (COS) Definition for Selected Hematological Malignancies - Results of the Harmony Alliance

Guidelines for the management of patients with bipolar disorder with mixed presentations: Will the updated recommendations help the clinician?

When I got into psychiatry in 2001 after working as a physician for 13 years, my image of a depressed patient was that of an exhausted, sad, and quiet person, which probably corresponds to an average physician's view. However, this image was soon transformed, and I became confused regarding the presentation of depression.

Family physicians can contribute to Olympic and Paralympic Games or other sports events.

Many sports physicians are from primary care backgrounds around the world but not in Japan. However, from the view of family physicians who contributed to Tokyo 2020 Olympic and Paralympic Games as medical staff, family physicians in Japan can play an active role in sporting events.

A survey of physicians’ treatment switching practice in people on long-term prophylaxis for hemophilia in five European countries

Objective Recombinant factor VIII and factor IX Fc fusion proteins (rFVIIIFc and rFIXFc) were developed with an extended half-life (EHL) to improve the management of people with hemophilia A (PwHA) and B (PwHB), respectively. Methods This survey gathered physician-reported treatment decisions and physician views on outcomes in PwHA or PwHB who switched to rFVIIIFc or rFIXFc in the 12 months prior to study completion. Results Physicians (N = 37) considered bleeds, pharmacokinetic parameters, joint health and adherence the most important factors to assess both in routine care and when deciding to switch to an EHL therapy. In the 12 months prior to study completion, 37 physicians switched 113 PwHA to rFVIIIFc and 25 physicians switched 36 PwHB to rFIXFc. Most PwH (>90%) had moderate or severe hemophilia and many (>60%) switched within 6 months of the survey. The main reason for switching PwHA to rFVIIIFc was to allow fewer injections (49%), while the main reason for switching PwHB to rFIXFc was the product becoming available for use (36%). Overall, 96% of PwHA and 89% of PwHB who were switched remained on these EHL products at the time of survey. Mean total weekly dose, injection frequency and annualized bleeding rate were reported to have reduced following switching. Conclusion This survey provides valuable insight into reasons for, and challenges to, the use of EHL products in clinical practice. Physicians perceived that switching to treatment with rFVIIIFc or rFIXFc can improve quality of life, treatment burden, disease control and adherence.

Control Measures for Continuous Deep Sedation Until Death: A Framing Analysis of the Views of Physicians.

Physicians have been subject to increasing external control to improve their medical practice, and scholars have theorized extensively about their opposition to such control. However, little empirical attention has been paid to the views and reasoning that lie behind this opposition. An in-depth understanding is necessary for enhancing the effectiveness and efficiency of external controls, and continuous deep sedation until death (CDS) is an interesting case in this regard. This study aims to explore how physicians frame control measures for CDS. We conducted 47 semi-structured interviews with Belgian physicians in 2019. A qualitative framing analysis was performed to analyze their views and reasoning. This study reveals that physicians approach CDS practice and control measures with different emphases. Controlling by mechanisms of professional self-regulation and state governance are put forward as appropriate means to improve CDS practice. Policymakers should take into consideration physicians' frames to develop sound control measures.

Visual Phenomena Associated With Migraine and Their Differential Diagnosis.

Visual phenomena are of many different kinds; their differential diagnosis is usually possible with directed history-taking. In this review, we describe common visual phenomena that must be distinguished from a migraine aura. This review is based on publications retrieved by a selective search in PubMed and the Web of Knowledge/Science, with special attention to the current classification of the International Headache Society and the recommendations of the German Migraine and Headache Society. The following search terms were used: "visual phenomena/phenomenon," "migraine aura," and "persistent/complication/ long-lasting/ongoing." The most helpful questions for differential diagnosis are whether the symptoms are present in one eye only or in both, whether their onset was sudden or over minutes or days, and whether the phenomenon has occurred only once or repeatedly, or is persistently present. A visual aura associated with migraine must be distinguished, in rare cases, from an isolated epileptic aura, from cerebral/retinal ischemia, or from visual snow. Further differential diagnoses include a persisting perceptual disturbance after hallucinogen use (HPPD, "hallucinogen persisting perception disorder") and the Charles Bonnet syndrome (CBS); the latter arises as a consequence of severely impaired vision. Posterior reversible encephalopathy syndrome (PRES) is rare and generally reveals itself over its further course through the appearance of additional clinical manifestations. Primary ophthalmological causes can usually be readily identified and classified by ophthalmological examination. Patients with visual phenomena typically consult physicians from various medical specialties. A correct differential diagnosis can be made based on the history if the physician views the symptoms in their overall context to determine the particular disease entity that is responsible.

Promoting Culture Change Within Organizations.

Promoting Culture Change Within Organizations.

Physician Perceptions on Quality of Life and Resuscitation Preferences for Extremely Early Newborns.

The study aimed to explore physician views on whether extremely early newborns will have an acceptable quality of life (QOL), and if these views are associated with physician resuscitation preferences. We performed a cross-sectional survey of neonatologists and maternal fetal medicine (MFM) attendings, fellows, and residents at four U.S. medical centers exploring physician views on future QOL of extremely early newborns and physician resuscitation preferences. Mixed-effects logistic regression models examined association of perceived QOL and resuscitation preferences when adjusting for specialty, level of training, gender, and experience with ex-premature infants. A total of 254 of 544 (47%) physicians were responded. A minority of physicians had interacted with surviving extremely early newborns when they were ≥3 years old (23% of physicians in pediatrics/neonatology and 6% in obstetrics/MFM). The majority of physicians did not believe an extremely early newborn would have an acceptable QOL at the earliest gestational ages (11% at 22 and 23% at 23 weeks). The majority of physicians (73%) believed that having an extremely preterm infant would have negative effects on the family's QOL. Mixed-effects logistic regression models (odds ratio [OR], 95% confidence interval [CI]) revealed that physicians who believed infants would have an acceptable QOL were less likely to offer comfort care only at 22 (OR: 0.19, 95% CI: 0.05-0.65, p < 0.01) and 23 weeks (OR: 0.24, 95% CI: 0.07-0.78, p < 0.02). They were also more likely to offer active treatment only at 24 weeks (OR: 9.66, 95% CI: 2.56-38.87, p < 0.01) and 25 weeks (OR: 19.51, 95% CI: 3.33-126.72, p < 0.01). Physician views of extremely early newborns' future QOL correlated with self-reported resuscitation preferences. Residents and obstetric physicians reported more pessimistic views on QOL. · Views of QOL varied by specialty and level of training.. · Contact with former extremely early newborns was limited.. · QOL views were associated with preferred resuscitation practices..

Geriatric traumatology (e. g. "Alterstraumatologie") is more than orthogeriatrics-Experiences of aphysician in advanced training.

This article reporting the view of an early career physician focuses on the diverse components of orthogeriatric co-management in aclinical setting. Geriatric trauma patients require amultimodal and interdisciplinary management, which includes individual and age-specific aspects, such as intensified physiotherapy, trauma surgery and geriatric expertise as well as social support. In Germany this surgical and geriatric co-treatment is provided by the program geriatric traumatology (Alterstraumatologie), which is implemented and certified at special institutions called geriatric trauma centers (Alters-Trauma-Zentrum). This special care is accomplished by an orthogeriatric co-management, which combines the efforts of both modern state of the art trauma surgery and geriatric medicine, preferable by using the procedure of the so-called geriatric early rehabilitative complex treatment (geriatrische frührehabilitative Komplexbehandlung) according to the diagnosis-related group (DRG) procedure OPS 8550. This is administered in 3periods: the preoperative period, perioperative period and postoperative period and if indicated followed and completed by ageriatric rehabilitation. According to recent studies this approach has proved to be beneficial especially with respect to a reduction of posttraumatic morbidity rates and avoiding loss of function.

Changing Configurations in the Portrayal of Doctors in Graphic Narratives: A Study ofThe Bad DoctorandThe Lady Doctor

The figure of the doctor has always been surrounded by a heroic aura, warranted by the possession of hard-earned medical knowledge and the tenacious reliance on doctors’ ability to heal and emancipate from pain and suffering. However, recent literary and visual-cultural representations of doctors have unsettled the dominant and homogenized perception of physicians as heroes. Particularly, representations in mainstream books, popular media, and comics, which have predominantly offered unilaterally positive initial portrayals of doctors as superhuman figures, eventually provided people with more nuanced and realistic representations, disclosing the “undesirable and unprofessional attitudes” of physicians and their sufferings. Ian Williams’ graphic narratives The Bad Doctor (2014, Oxford: Myriad Editions) and The Lady Doctor (2019, Oxford: Myriad Editions) serve as a critical lens to reflect on the postmodern perspective of doctor as a “wounded healer” and illuminate the problematic view of physicians as heroes. Drawing instances from the aforementioned graphic narratives, this essay aims to provide a revisionary understanding of physicians from heroes to victims of larger-than-life forces such as bureaucracy and the demands of patients. The essay scrutinizes how the verbal-visual medium of comics facilitates the envisioning and enunciating of the troubled personal and professional lives of physicians and the complexities involved in the medical profession.

WhatsApp Tele-Medicine \u2013 usage patterns and physicians views on the platform

Background Telemedicine has become an integral part of health care delivery in recent years. One of the leading applications for this use is WhatsApp — a free smartphone application that allows instant messaging with pictures and videos. This study analyzed the emerging role of WhatsApp on reducing the need for referrals to medical specialists and to compare the views of physicians regarding WhatsApp consultations.MethodsA cross-sectional study based on an anonymous web-survey was conducted among PCPs and medical specialists working in the Israel Defense Forces Medical-Corps during September and October, 2019.ResultsOf 201 participants, 153 were PCPs and 48 were medical specialists. 86.9 % of PCPs and 86.5 % of specialists used WhatsApp every day in professional settings. Added workload, potential breaching of patient confidentiality and lack of full documentation of consultations were the main concerns among physicians using the application. 60.7 % of PCPs and 95.7 % of specialists stated that these consultations have reduced the need for in-person appointments at least once a week.ConclusionsIn times of COVID-19 that require social distancing, WhatsApp provides a simple, readily available platform for consultations between healthcare providers, even to the extent of rendering some in-person appointments unnecessary. Healthcare organizations should address the matters troubling healthcare providers, mainly patient confidentiality and lack of documentation in patients’ medical records, while providing adequate compensation for those providing the service during and after work hours.

Management of prediabetes from the perspective of Spanish physicians and community pharmacists: Detecta2 study

IntroductionPrediabetes is a high-risk state for diabetes. The study aims to describe routine clinical practice and the views of physicians and pharmacists on prediabetes management. Materials and methodsAn observational, descriptive, cross-sectional study was conducted using a structured questionnaire. ResultsA total of 410 physicians and 393 pharmacists completed the questionnaire. Self-adherence to clinical practice guidelines (CPGs) was reported by 51.5% and 23.2% of physicians and pharmacists, respectively. Less than 60% of participants defined prediabetes according to main CPG. Regarding the use of screening strategies to detect prediabetes (physicians: 96%; pharmacists: 42.1%), reports indicate the opportunistic strategy is widely employed (≥75%) whereas systematic screening is unusual (<20%). Changes in lifestyle were deemed essential by almost all participants (≥95%), but in clinical practice only 58.3% of healthcare centers and 28.0% of pharmacies were found to provide awareness-raising/instruction. The role of pharmacists in the prevention of prediabetes/diabetes was judged useful by most participants. ConclusionsUse of CPG, systematic prediabetes screening strategies, and specific strategies for patient education are scarce. The support of community pharmacists in prediabetes management was well valued. Therefore, it is crucial that the lines of action followed by both physicians and pharmacists align with each other and with the CPG.

Perceptions of Hematology Among Palliative Care Physicians: Results of a Nationwide Survey

ContextPalliative care integration for patients with hematologic diseases has lagged behind solid-organ malignancies. Previous work has characterized hematologist perspectives, but less is known about palliative care physician views of this phenomenon. ObjectivesTo examine palliative care physician attitudes and beliefs regarding hematologic diseases, patient care, and collaboration. MethodsA 44-item survey containing Likert and free-response items was mailed to 1000 AAHPM physician members. Sections explored respondent comfort with specific diagnoses, palliative care integration, relationships with hematologists, and hematology-specific patient care. Logistic regression models with generalized estimating equations were used to compare parallel Likert responses. Free responses were analyzed using thematic analysis. ResultsThe response rate was 55.5%. Respondents reported comfort managing symptoms in leukemia (84.0%), lymphoma (92.1%), multiple myeloma (92.9%), and following hematopoietic stem cell transplant (51.6%). Fewer expressed comfort with understanding disease trajectory (64.9%, 75.7%, 78.5%, and 35.4%) and discussing prognosis (71.0%, 82.6%, 81.6%, and 40.6%). 97.6% of respondents disagreed that palliative care and hematology are incompatible. 50.6% felt that palliative care physicians’ limited hematology-specific knowledge hinders collaboration. 89.4% felt that relapse should trigger referral. 80.0% felt that hospice referrals occurred late. In exploring perceptions of hematology-palliative care relationships, three themes were identified: misperceptions of palliative care, desire for integration, and lacking a shared model of understanding. ConclusionThese data inform efforts to integrate palliative care into hematologic care at large, echoing previous studies of hematologist perspectives. Palliative care physicians express enthusiasm for caring for these patients, desire for improved understanding of palliative care, and ongoing opportunities to improve hematology-specific knowledge and skills.

Ethical discourse of medical students and physicians on conscientious objection: A qualitative study in Turkey.

This study is an investigation of the views of medical students (N=15) and physicians (N=14), in Turkey, on conscientious objection through elaboration on their experiences in medical practice within the framework of conscientious objection, and evaluation of the data from an ethical perspective. The data received from in-depth interviews were evaluated by using the thematic content analysis method. They were then divided into contexts and themes as follows: "Refusal to provide healthcare services," "scope of conscientious objection," and "impact of conscientious objection (in case of legal entitlement)." The opinions of our research participants suggest that conscientious objection has become widespread in medical practices. It is argued that the tendency of healthcare providers and patients to find temporary resolutions to ethical dilemmas only complicates such resolutions. It is imperative, therefore, to set a rational limit on conscientious objection so as to prevent the adoption of an attitude shaped completely by the personal beliefs of the physician or the patient.

Public vs physician views of liability for artificial intelligence in health care.

The growing use of artificial intelligence (AI) in health care has raised questions about who should be held liable for medical errors that result from care delivered jointly by physicians and algorithms. In this survey study comparing views of physicians and the U.S. public, we find that the public is significantly more likely to believe that physicians should be held responsible when an error occurs during care delivered with medical AI, though the majority of both physicians and the public hold this view (66.0% vs 57.3%; P = .020). Physicians are more likely than the public to believe that vendors (43.8% vs 32.9%; P = .004) and healthcare organizations should be liable for AI-related medical errors (29.2% vs 22.6%; P = .05). Views of medical liability did not differ by clinical specialty. Among the general public, younger people are more likely to hold nearly all parties liable.

"O homem, em toda parte é a riqueza da nação": o discurso eugênico na Sociedade de Medicina de Porto Alegre nas décadas de 1920 e 1930

A Eugenia, desde seu desenvolvimento como teoria científica por Francis Galton, teve grande difusão por diversos países durante a primeira metade do século XX. Advinda de um período de intensa discussão sobre hereditariedade, influência do meio ambiente e degeneração, a Eugenia assumiu diferentes referenciais na composição de suas propostas, resultando em um corpo teórico bastante heterogêneo e multifacetado. Esse artigo tem por objetivo analisar a difusão do ideário eugênico nos discursos da Sociedade de Medicina de Porto Alegre. Tendo como objeto de estudo o periódico da instituição, o Archivos Rio Grandenses de Medicina, buscamos entender como a ciência eugênica moldou a visão de determinados médicos não só sobre doenças venéreas e patologias infectocontagiosas, mas também sobre temas como reprodução, maternidade, primeira infância, vícios e mortalidade.

Views of Bedouin physicians and nurses on nursing as a profession in Israel: There is more to strive for.

Bedouin society poses challenges to attempts at modernization. Great efforts are being made to expand the number of nurses coming from the Bedouin population. This cross-sectional study among 201 Bedouin nurses and physicians from southern Israel examined differences in their views on nursing as a profession and its relationship to the working environment, using a self-administered questionnaire. Bedouin physicians demonstrated less positive attitudes towards the nursing profession than did nurses, but perceived the nursing work environment more positively. Compared to nurses, physicians ranked both nurses' involvement in policy practice and their clinical contribution to quality care lower, but scored nurses' dependence on physicians' orders higher. They also ranked teamwork and professional nursing development higher, and the autonomy of nurses lower. In conclusion, the perception of nursing as a profession in Bedouin society is linked to cultural fundamentals, gender, and the social status of women. Managers of multicultural teams, especially those including Bedouin-origin healthcare workers, should be aware of the effect of cultural background and should take care to address social disparities and eliminate differences in perspectives.

WORK–LIFE BALANCE OF YOUNG PHYSICIANS IN JAPAN

Background: Geographical and specialty maldistribution of physicians are key&#x0D; issues in the Japanese healthcare system. These are strongly related to work–life&#x0D; balance issues that physicians face, including long working hours, burnout, and&#x0D; discontinuation of female physicians’ careers.&#x0D; Objective: To obtain the opinions of young physicians in Japan on policies&#x0D; regarding work–life balance and career building.&#x0D; Method: A cross-national study was conducted using a questionnaire that was sent&#x0D; to physician across Japanese Red Cross Hospitals.&#x0D; Results: Young physicians view work–life balance as important in choosing&#x0D; specialties and work location. In addition to the motivation to gain training&#x0D; experience, they seek adequate rest through shift work, and work efficiency by&#x0D; sharing tasks with other medical professionals, using IT, and improving operation&#x0D; management.&#x0D; Discussion: As an example of work-style reform in progress, we would like to&#x0D; introduce the shift-work system at our institution’s Obstetrics and Gynecology&#x0D; Department. By clarifying the line between work and life, physicians can balance&#x0D; career building and time for self-improvement.&#x0D; Conclusion: For young physicians to continue their careers without burning out&#x0D; and excel in various fields, we must create a system that allows for efficient&#x0D; learning and work–life balance for both mental and physical well-being.

Muslim American physicians' views on brain death: Findings from a national survey.

ABSTRACTBackground:Biotechnology has introduced a new physiological state, “brain death,” that continues to attract controversy and confusion. While variability in diagnostic criteria for, and physician practices regarding, “brain death” has been studied, few studies examine physicians’ normative views on the significance of “brain death” and how religiosity implicates these views.Objective:The objective is to assess how Muslim physicians’ views on death, and how their religiosity and acculturation, associate with their perceptions of “brain death.”Methods:A randomized national sample of 626 American Muslim physicians completed a mailed questionnaire assessing sociodemographic characteristics, religiosity, and views about death. Measures of religious practice and acculturation were analyzed as predictors of physician views at the bivariate and multivariable levels. In conducting the multivariate analysis, P-values less than 0.05 were deemed statistically significant.Results:Two-hundred and fifty-five respondents completed the survey (41% response rate). Most participants agreed that death is the irreversible cessation of cardiac and respiratory function (90%), while half agreed or disagreed with other definitions of death, such as loss of personhood or the equivalence of cardiopulmonary and neurological criteria for death. Physicians who scored higher on the religious practice scale had significantly lower odds of agreeing with the statement; “brain death” signifies the departure of the soul from the body [odds ratio (OR) = 0.57, 95% confidence interval (CI): 0.33–0.98]. Those who were born in the US, or immigrated to the US as a child, had greater odds of viewing death as the irreversible loss of personhood and consciousness [OR = 3.52, 95% CI: 1.62–7.63].Conclusion:Physician characteristics such as religiosity and acculturation appear to influence their views on what constitutes death and how it should be diagnosed. In our sample of Muslim physicians, there appears to be significant reservation toward equating neurological and cardiopulmonary criteria to determine death and disquiet regarding the meaning of “brain death” in general.

Study of the relation between Plasma Transfusion and Clinical Outcome in Critically Ill Children at Pediatric Intensive Care Unit

Background: Plasma transfusions are commonly used in adult and paediatric intensive care units. Latest data showed a correlation in adult trauma patients between plasma transfusions and worse clinical results. Plasma transfusions are frequently prescribed worldwide; the indications for their use remain unclear. Objective: To identify signs of plasma transfusions and evaluation of the impact of plasma transfusions on coagulation studies. Patients and Methods: This prospective cohort study was conducted at the Pediatric Intensive Care unit, Zagazig University Hospital between July 2019 and January 2020. Participants in the study had a full background of socio-demographic characteristics. Total clinical examination and the seriousness of the disease was measured at admission using the Sequential Organ Failure Assessment (SOFA) score as per Ferreira 2001. Patients have been checked for critical parameters. Results: Our analysis found that 50 percent of plasma transfusions were attributed to bleeding, 40.7 percent to hypoalbuminemia, and 9.3 percent of plasma transfusions were due to surgical conceptions. The mortality rate in our study was 25.9 percent. Conclusion: Plasma transfusion does not have a statistical effect on mortality, but there has been little improvement in mortality over predictive SOFA mortality. Approximately ten times, no bleeding or proposed bleeding-risk operations earned plasma, based on the physician's views and conceptions. Plasma transfusion was insufficient to correct minor coagulation irregularities. Major research evaluating effective plasma transfusion techniques are desperately needed.