Private Physicians Research Articles

ВРАЧИ-САМОЗВАНЦЫ И ВРАЧИ-ШАРЛАТАНЫ: ПРИЗНАНИЕ ПРОФЕССИОНАЛЬНОГО СООБЩЕСТВА В РОССИИ XVII ВЕКА

The article is devoted to the conflicts between the corporation of doctors of the Apothecary Chancery (Aptekarsky Prikaz) and representatives of other medical practices: private physicians, faith-healer, as well as the perception of such practices in the bureaucratic environment. The author considers bureaucratic mechanisms arising in the course of such conflicts, when the corporation defines a physician as an self-proclamated and, not considering him a part of its group, refuses to recognise his professional competences. At the same time, private practice itself is not a barrier to entry into the professional community, and being labelled an impostor, hence a charlatan, becomes a way of resolving intra- and inter-group conflicts. Such conflicts are different in each of the three examples with representatives of different social groups, but they equally illustrate the fact that a person who commits unconventional actions becomes an impostor in the eyes of the community.

Comparing the Quality of Direct-to-Consumer Telemedicine Dominated and Delivered by Public and Private Sector Platforms in China: Standardized Patient Study.

Telemedicine is expanding rapidly, with public direct-to-consumer (DTC) telemedicine representing 70% of the market. A key priority is establishing clear quality distinctions between the public and private sectors. No studies have directly compared the quality of DTC telemedicine in the public and private sectors using objective evaluation methods. Using a standardized patient (SP) approach, this study aimed to compare the quality of DTC telemedicine provided by China's public and private sectors. We recruited 10 SPs presenting fixed cases (urticaria and childhood diarrhea), with 594 interactions between them and physicians. The SPs evaluated various aspects of the quality of care, effectiveness, safety, patient-centeredness (PCC), efficiency, and timeliness using the Institute of Medicine (IOM) quality framework. Ordinary least-squares (OLS) regression models with fixed effects were used for continuous variables, while logistic regression models with fixed effects were used for categorical variables. Significant quality differences were observed between public and private DTC telemedicine. Physicians from private platforms were significantly more likely to adhere to clinical checklists (adjusted β 15.22, P<.001); provide an accurate diagnosis (adjusted odds ratio [OR] 3.85, P<.001), an appropriate prescription (adjusted OR 3.87, P<.001), and lifestyle modification advice (adjusted OR 6.82, P<.001); ensure more PCC (adjusted β 3.34, P<.001); and spend more time with SPs (adjusted β 839.70, P<.001), with more responses (adjusted β 1.33, P=.001) and more words (adjusted β 50.93, P=.009). However, SPs on private platforms waited longer for the first response (adjusted β 505.87, P=.001) and each response (adjusted β 168.33, P=.04) and paid more for the average visit (adjusted β 40.03, P<.001). There is significant quality inequality in different DTC telemedicine platforms. Private physicians might provide a higher quality of service regarding effectiveness and safety, PCC, and response times and words. However, private platforms have longer wait times for their first response, as well as higher costs. Refining online reviews, establishing standardized norms and pricing, enhancing the performance evaluation mechanism for public DTC telemedicine, and imposing stricter limitations on the first response time for private physicians should be considered practical approaches to optimizing the management of DTC telemedicine.

Revolutionizing Physical Activity: How Private Sector Physicians Harness Mobile Apps for Enhanced Health Outcomes.

The vital importance of engaging in physical activity for the maintenance and improvement of health is undeniable. The advent of digital technology has significantly enhanced the encouragement of physical activity (PA) through numerous interventions. Our study's goal is to examine the usage and prescription practices of mobile applications and fitness trackers by doctors operating in the private sector. cross-sectional study, which targeted doctors in the private sector, whether general practitioners or specialists was carried out in January and February 2024, A paper questionnaire was distributed to the doctors' offices. the mean age was 44.3±11.7 years, 77% of doctors are physically active, the prevalence of use of mobile applications and fitness trackers among private sector physicians for improving and monitoring their physical activity was 32% with a CI ranging from [26-40] % and only 15% recommend mobile apps to patients. This reluctance was attributed to the applications' lack of customization and the challenges patients faced in using them. In our research, we found that doctors rarely utilized mobile applications to enhance their practice of physical activity and were hesitant to recommend them to their patients.

In-training and private physicians' knowledge, attitudes, practices and perceived barriers on the utilization of low dose chest CT scan as lung cancer screening for high-risk patients in a tertiary hospital: Single center experience.

150 Background: Lung cancer is the leading cause of cancer-related deaths worldwide. Aside from smoking cessation efforts and guidelines from all proficient panels, utilizing Low dose CT scan (LDCT) of the chest as lung cancer screening (LCS) has been poorly adopted. Methods: This was conducted after institutional review board approval. The respondents were handed hard copy or electronic consent forms and survey questionnaire depending on the platform of their choice. Results: Majority of the respondents were in-training female physicians with median age of 31 years old who specialized in Internal Medicine practicing between 1-5 years who catered to more than 10 patients per week in outpatient clinics. Nearly half of the respondents answered that the recommended frequency for lung cancer screening (LCS) for high-risk individuals is done bi-annually. Majority agreed that lung cancer screening is effective in decreasing lung cancer mortality and morbidity. Most respondents have initiated discussion about the risks and benefits of low dose chest CT scan (LDCT) as lung cancer screening among eligible high-risk patients. However, most of the respondents disagreed that lung cancer screening is cost effective. The top three perceived barriers on the utilization of Low dose chest CT scan as lung cancer screening reported in descending order revealed that it is not cost-effective, some forgets to screen patients and lung cancer screening has the potential to cause mental anguish or anxiety to patients. Conclusions: This study recommends conducting further studies exploring the socio-economic burden and impact assessment of lung cancer in the Philippines to enable translation of more meaningful strategies for local and national lung cancer screening access, health policies and financing. Promoting continuous lung cancer screening forums, lectures and information dissemination of annual LDCT of the chest among high risk patients will encourage and strengthen interdepartmental and multidisciplinary referral and collaboration in increasing earlier detection of lung cancer and decreasing related morbidity and mortality.

Preferences for Management of Pediatric Pneumonia: A Clinician Survey of Artificially Generated Patient Cases.

It is unknown which factors are associated with chest radiograph (CXR) and antibiotic use for suspected community-acquired pneumonia (CAP) in children. We evaluated factors associated with CXR and antibiotic preferences among clinicians for children with suspected CAP using case scenarios generated through artificial intelligence (AI). We performed a survey of general pediatric, pediatric emergency medicine, and emergency medicine attending physicians employed by a private physician contractor. Respondents were given 5 unique, AI-generated case scenarios. We used generalized estimating equations to identify factors associated with CXR and antibiotic use. We evaluated the cluster-weighted correlation between clinician suspicion and clinical prediction model risk estimates for CAP using 2 predictive models. A total of 172 respondents provided responses to 839 scenarios. Factors associated with CXR acquisition (OR, [95% CI]) included presence of crackles (4.17 [2.19, 7.95]), prior pneumonia (2.38 [1.32, 4.20]), chest pain (1.90 [1.18, 3.05]) and fever (1.82 [1.32, 2.52]). The decision to use antibiotics before knowledge of CXR results included past hospitalization for pneumonia (4.24 [1.88, 9.57]), focal decreased breath sounds (3.86 [1.98, 7.52]), and crackles (3.45 [2.15, 5.53]). After revealing CXR results to clinicians, these results were the sole predictor associated with antibiotic decision-making. Suspicion for CAP correlated with one of 2 prediction models for CAP (Spearman's rho = 0.25). Factors associated with a greater suspicion of pneumonia included prior pneumonia, duration of illness, worsening course of illness, shortness of breath, vomiting, decreased oral intake or urinary output, respiratory distress, head nodding, focal decreased breath sounds, focal rhonchi, fever, and crackles, and lower pulse oximetry. Ordering preferences for CXRs demonstrated similarities and differences with evidence-based risk models for CAP. Clinicians relied heavily on CXR findings to guide antibiotic ordering. These findings can be used within decision support systems to promote evidence-based management practices for pediatric CAP.

Physician marriage survey reveals sex and specialty differences in marital satisfaction factors

Physician marriage is a valuable indicator of how vocational factors (e.g. work hours, stressors) impact satisfaction in relationships and physician wellness overall. Previous studies suggest that gender and specialty influence marriage satisfaction for physicians, though these often come from limited, local, cohorts. A cross-sectional survey was designed and distributed to publicly available email addresses representing academic and private practice physician organizations across the United States, receiving 321 responses (253 complete). Responses included data on demographics, medical specialty, age at marriage, stage of training at marriage, number of children, and factors leading to marital satisfaction/distress. A multivariable ordinal logistic regression was conducted to find associations between survey variables and marriage satisfaction. Survey results indicated that 86.5% of physicians have been married (average age at first marriage was 27.8 years old), and the rate of first marriages ending is at least 14.7%. Men had significantly more children than women. Physicians married at least once averaged 1.98 children. “Other” specialty physicians had significantly more children on average than psychiatrists. Marrying before medical school predicted practicing in private practice settings. Job stress, work hours, children, and sex were most frequently sources of marital distress, while strong communication, finances, and children were most frequently sources of marital stability. Sex differences were also found in distressing and stabilizing marital factors: Female physicians were more likely to cite their spouse’s work hours and job stress as sources of marital distress. Finally, surgery specialty and Judaism were associated with higher marriage satisfaction, whereas possession of an M.D. degree was associated with lower marriage satisfaction. This study elucidated new perspectives on physician marriage and families based on specialty, practice setting, and stage of training at marriage. Future studies may focus on factors mediating specialty and sex’s impact on having children and marriage satisfaction. To our knowledge, this study is the first physician marriage survey which integrates multiple factors in the analysis of physician marriages.

Forecasting the Early Impact of COVID-19 on Physician Supply in EU Countries.

Many countries faced health workforce challenges even before the pandemic, such as impending retirements, negative population growth, or sub-optimal allocation of resources across health sectors. Current quantitative models are often of limited use, either because they require extensive individual-level data to be properly calibrated, or (in the absence of such data) because they are too simplistic to capture important demographic changes or disruptive epidemiological shocks such as the SARS-CoV-2 pandemic. We propose a population-dynamic and stock-flow-consistent approach to physician supply forecasting that is complex enough to account for dynamically changing behaviour, while requiring only publicly available time-series data for full calibration. We demonstrate the utility of this model by applying it to 21 European countries to forecast the supply of generalist and specialist physicians to 2040, and the impact of increased healthcare utilisation due to COVID-19 on this supply. Compared with the workforce needed to maintain physician density at 2019 levels, we find that in many countries there is indeed a significant trend towards decreasing generalist density at the expense of increasing specialist density. The trends for specialists are exacerbated by expectations of negative population growth in many Southern and Eastern European countries. Compared to the expected demographic changes in the population and the health workforce, we expect a limited impact of COVID-19 on these trends, even under conservative modelling assumptions. Finally, we generalise the approach to a multi-professional, multi-regional and multi-sectoral model for Austria, where we find an additional suboptimal distribution in the supply of contracted versus non-contracted (private) physicians. It is therefore vital to develop tools for decision-makers to influence the allocation and supply of doctors across specialties and sectors to address these imbalances.

Palliative Approach Remains Lacking in Terminal Hospital Admissions for Chronic Disease Across Rural Settings: Multisite Retrospective Medical Record Audit

Introduction/AimDespite clear benefit from palliative care in end-stage chronic diseases, access is often limited, and rural access largely undescribed. This study sought to determine if a palliative approach is provided to people with chronic disease in their terminal hospital admission. MethodsMultisite, retrospective medical record audit, of decedents with a primary diagnosis of chronic lung, heart, or renal failure, or multimorbidity of these conditions over 2019. ResultsOf 241 decedents, across five clinical sites, 143 (59.3%) were men, with mean age 80.47 years (SD 11.509), and diagnoses of chronic lung (n = 56, 23.2%), heart (n = 56, 23.2%), renal (n = 24, 10.0%) or multimorbidity disease (n = 105, 43.6%), and had 2.88 (3.04SD) admissions within 12 months. Outpatient chronic disease care was evident (n = 171, 73.7%), however, contact with a private physician (n = 91, 37.8%), chronic disease program (n = 61, 25.3%), or specialist nurse (n = 17, 7.1%) were less apparent. “Not-for-resuscitation” orders were common (n = 139, 57.7%), however, advance care planning (n = 71, 29.5%), preferred place of death (n = 18, 7.9%), and spiritual support (n = 18, 7.5%) were rarely documented. Referral to and input from palliative services were low (n = 74, 30.7% and n = 49, 20.3%), as was review of nonessential medications or blood tests (n = 86, 35.7%, and n = 78, 32.4%). Opioids were prescribed in 45.2% (n = 109). Hospital site and diagnosis were significantly associated with outpatient care and palliative approach (P<0.001). ConclusionsEnd-of-life planning and specialist palliative care involvement occurred infrequently for people with chronic disease who died in rural hospitals. Targeted strategies are necessary to improve care for these prevalent and high needs rural populations.

Real-world trough concentrations and effectiveness of long-acting cabotegravir and rilpivirine: a multicenter prospective observational study in Switzerland

The efficacy and tolerability of long-acting cabotegravir and rilpivirine were demonstrated in Phase III trials. However, low concentrations combined with other risk factors have been associated with an increased risk of virologic failure. This study aims to verify whether drug concentrations measured in a real-world setting are consistent with those previously reported. SHCS-879 is a nationwide observational study within the Swiss HIV Cohort Study for the monitoring of people with HIV (PWH) on long-acting cabotegravir plus rilpivirine. Samples were collected from March 2022 to March2023. Overall, 725 samples were obtained from 186 PWH. Our data show a large inter-individual variability in cabotegravir and rilpivirine concentrations, with some individuals exhibiting repeatedly low concentrations. Rilpivirine trough concentrations were consistent with those from Phase III trials, while cabotegravir concentrations were lower. The first concentrations quartile was only slightly above the target of 664ng/mL. Exploratory statistical analyses found 35% (p<0·01) lower cabotegravir trough in males compared to females. Overall, 172 PWH (92%) remained suppressed and three experienced virologic failures (1·6%), of those, two had sub-optimal drug exposure. No association was found between low trough levels and detectable viral load. Real-world cabotegravir concentrations are substantially lower than previously reported. However, these concentrations appear sufficient to ensure sustained virological suppression in almost every PWH. These reassuring data challenge the rather conservative thresholds adopted to date, which may raise unnecessary concerns. Yet, our study reveals that some PWH have repeatedly very low drug levels, for reasons that remain to be elucidated. This work was funded by the Swiss National Science Foundation, grant number N◦ 324730_192449. This study received no support from pharmaceutical industries. This study was performed within the framework of the Swiss HIV Cohort Study, supported by the Swiss National Science Foundation (grant #201369), by SHCS project #879, and by the SHCS research foundation. The SHCS data were gathered by the Five Swiss University Hospitals, two Cantonal Hospitals, 15 affiliated hospitals and 36 private physicians (listed in http://www.shcs.ch/180-health-care-providers).

A comparative study on perception and use of generic drugs between public and private health practitioners.

The perception of generic drugs may vary significantly between government and private doctors because physicians in the private sector have more prescribing choices and flexibility. Hence, this study was undertaken to analyse the knowledge, attitude and perception (KAP) of government and private physicians on generic drugs. This was a questionnaire-based cross-sectional study conducted among physicians working in public and private health sectors. The questionnaire had 25 closed-ended questions related to the KAP of generic medicine. The overall scores were categorised using Bloom's cut-off point. The Chi-square or Mann-Whitney U-test was used to compare the differences between the two groups. About 80% of the participants in both groups agreed that generic medicines contain the same active ingredients as brand-name drugs, are less expensive and are available in the Indian market. Nearly 84% of government physicians and only 64% of private physicians believed that generic medicines are just as effective and secure as branded medicines (P - 0.003). The majority of physicians from both groups concurred that there is a lack of quality check in generic drug manufacturing, and they require more information about bioequivalence studies. In both categories, about 75% of participants preferred generic medications for their patients. However, in both groups, more than 50% of physicians were concerned about therapeutic failure and expressed reluctance to prescribe generic medications in life-threatening situations. Knowledge and acceptance of generic drugs regarding efficacy, safety, bioequivalence and therapeutic failure are low among both government and private physicians.

Association Between Facility and Clinician Characteristics and Family Planning Services Provided During U.S. Outpatient Care Visits.

Recent guidelines from the Centers for Disease Control and Prevention emphasize the importance of access to comprehensive family planning services and recommend patient-centered contraceptive counseling be incorporated into routine primary care visits for reproductive-age individuals. This study aims to describe family planning service provision in outpatient care settings and assess differences by facility and clinician characteristics. Using National Ambulatory Medical Care Survey data, a nationally representative survey of outpatient care visits, we assessed family planning service provision by facility location, facility type, physician specialty, types of clinicians seen, and whether the patient was seen by their primary care provider. We used random intercept logistic regression with robust standard errors, adjusting for patient characteristics, and state and year fixed effects. The analytic sample included 53,489 patient visits with reproductive-age (15-49years) individuals between 2011 and 2019. Family planning services were provided at 8% of total sampled visits and were more likely to be provided in urban compared with rural areas (adjusted odds ratio, 1.45; p=.02) and at community health centers compared with private physician practices (adjusted odds ratio, 1.74; p=.00). Family planning services were also more likely to be provided when the patient saw a physician assistant or nurse compared with only a physician. After controlling for observed covariates, measures of between-clinician heterogeneity indicate wide variation in which clinicians provided family planning services. Family planning services were more likely to be provided in urban areas, at community health centers, and when patients received team-based care. The wide variation between clinicians suggests a need to better incorporate family planning services into primary care and other outpatient settings to meet patient needs and preferences.

Greater Obstetric Barriers for Female Urologists Compared to Peer-Physicians

ObjectivesTo determine the prevalence of pregnancy complications, infertility, and maternal support for female urologists in comparison to the general population and other female physicians. MethodsAn anonymous, voluntary survey was distributed to female physicians via private physician social media groups from June to August 2021. The survey queried pregnancy demographics and complications, infertility diagnosis and treatment, workplace environment, and prior education on these topics. Results were compared between urologists and the general population and other female physicians with Fisher’s exact test, chi-square with Yates’s correction, or Student’s t-tests as indicated. Results4612 female physicians completed the survey including 241 (5%) urologists. Compared with the general population, urologists were more likely to have a miscarriage or pre-term birth, have children later in life, and undergo infertility evaluation or infertility treatment (all p<0.0001). 42% of urologists reported experiencing a pregnancy complication and only 9% of those surveyed received education on the risks of delaying pregnancy. Despite being educated more often regarding the risks of delaying pregnancy compared to other physicians, urologists were less likely to have children, had fewer children, and were more likely to be discouraged from starting a family during training and practice (all p<0.0001). Additionally, urologists reported shorter parental leave, worked more hours per week while pregnant, and were less likely to receive lactation accommodations compared to other female physicians (all p<0.001). ConclusionsEducation for trainees on family planning and fostering a culture of support are deficits identified in overcoming obstetric barriers in urologists.

Treatment of idiopathic facial paralysis (Bell’s Palsy) and secondary facial paralysis with extracellular vesicles: a pilot safety study

BackgroundParalysis of the facial nerve (CN VII) is one of the most debilitating issues that any patient can encounter. Bell’s palsy is the most commonly seen mononeuropathy. Although usually self-limited, symptomatology can persist for decades in persistent cases. The non-surgical alternative therapies discussed in this study are successful without reconstruction and are regenerative.Objective and designWe sought to determine a safe new treatment could be developed to restore facial nerve function using extracellular vesicles (EVs) in patients who have been unable to return to normal under a variety of conditions. We performed a pilot safety study of 7 patients with idiopathic and secondary facial paralysis to determine if any functional restoration was possible. Each patient had symptomology for varying periods of time, with diverse House-Brackmann scores. They were all treated with the same protocol of extracellular vesicles (EVs) over a 4-week period of time and were evaluated both before and after treatment.Case presentationsAll patients in this study received treatment by their private physicians prior to entering the study. A record review was completed, with independent physical examinations. House-Brackmann scores and Facial Disability Indices were obtained prior to, and after completing the study. EVs were injected into the area of the main trunk of the facial nerve on the affected side, and an intravenous drip of EVs on visits during weeks 1, 2, and 4.ConclusionsAll seven patients enrolled in the study improved with this treatment protocol. After the second week of treatment, we saw a progression of independent motion of the affected eyelid, brow motion, and commissure. Although all patients began at different House-Brackman starting points, almost all ended at the same endpoint on the scale over the same period of time – four weeks. No adverse effects were encountered.Clearly, the duration of the treatment protocol needs to be longer than one month. The pathomechanism is still unknown. But it appears that the mechanism is reversible. At last, these patients can have hope.Trial registrationThe Institute of Regenerative and Cellular Medicine IRB approval number: IRCM-2021–304.

Op. Dr. İlhami Güneral (1914–2006), author and illustrator of the first original dissection manual in Turkish and his contributions to anatomy

Objectives: İlhami Güneral was a Turkish physician and surgeon whose contributions to anatomy education and medical illustration remained under-appreciated until this day. This study aims to outline his achievements throughout his career and acknowledge his unreported contributions to anatomical sciences in Türkiye. Methods: A series of interviews were conducted with his surviving family, relatives, and friends. Additional documents were also collected from various national and international institutions. Results: İlhami Güneral was born in 1914 in Anadolu Kavağı, İstanbul. He attended İstanbul University Faculty of Medicine and graduated in 1942. Upon graduation, he published his first book titled “Diseksiyon Atlası” which he also illustrated himself. His illustrations were later used in Prof. Dr. Zeki Zeren’s dissection handbook published in 1953. He visited and worked with renowned neuropathologist Philipp Schwartz between 1958 and 1960 in Warren, Pennsylvania. During his stay, he co-constructed a detachable “Transparent Brain Model” for teaching brain anatomy which was awarded with the Billings Gold Medal at the 109th Annual Meeting of the American Medical Association. After his return to Türkiye, he published his final illustrated anatomy atlas in 1972, the “Atlas Cerebri Humani”. He spent the remaining days of his life in his long standing home in Ödemiş, İzmir, as a private physician and surgeon. He was diagnosed with prostate cancer in 1993, and passed away due to his illness in 2006. Conclusion: This interesting and unique dramatis persona is the author and illustrator of the first original dissection manual printed in Turkish.

Brazilian Medical Survey on Telemedicine since the onset of COVID-19.

The primary aim of this study was to understand the difference in the use of Telemedicine by Brazilian physicians before and after the onset of COVID-19 pandemic and their intention to continue using it post the pandemic period. The secondary objective was to analyze the differences of opinion between physicians in the private and public sectors. We conducted an online medical survey through the SurveyMonkey platform in a large hospital in São Paulo, Brazil, from May to July 2022. Three-hundred-and -two physicians responded to the survey. We found that there was a significant increase in the number of physicians who started using Telemedicine in both the public and private sectors (p<0.0001) since the onset of COVID-19 pandemic and that >50% of them intend to continue using Telemedicine in their daily practice. Most responders consider that Telemedicine is useful in screening, diagnosis and management of patients; that it facilitates the physician's daily practice; that it can maintain or even add financial gains through reducing office expenses; and that is another medium for dispensing medical care. They also believe that Telemedicine should be regulated by the Brazilian Federal Council of Medicine. There were no significant differences between the responses from private and public sector physicians. Telemedicine has played a major role in healthcare since the onset of COVID-19 pandemic and most of the physicians approve its use and intend to continue using Telemedicine in their daily practice.

E23 Pediatric rheumatology in primary care in Tunisia

Abstract Background Primary care medicine is the first line of defence in the management of all diseases, and pediatric rheumatology is no exception to this rule. The aim of our work was to assess the management of rheumatological manifestations in the pediatric population, particularly in cases of suspected juvenile idiopathic arthritis (JIA). Methods A self-administered survey via google forms, was conducted among Tunisian primary care practitioners, during the month of February 2023. They were asked about their usual practice when children with articular symptoms consulted them. Results Our work included 33 practitioners, 25 of whom were women and eight men, with a female to male ratio of 3:1 and a mean age of 26 years [25–57]. Eighty-eight percent were family medicine residents (n = 29), nine percent were public health physicians (n = 3) and three percent were private physicians (n = 1). The average number of years in practice was three years [1–26]. Fifty-eight percent (n = 19) practiced in a university hospital, 18% (n = 6) in a regional hospital, 21% (n = 7) in a local dispensary, and three percent (n = 1) in a private practice. Regarding the number of pediatric-aged consultations per week, 70% (n = 23) reported seeing less than five patients and 21% more than ten per week (n = 7). A rheumatological reason for these patients was found in less than five consultations per week according to 94% of practitioners (n = 31). Forty-eight per cent (n = 16) of participants expressed anxiety when asked how they felt about managing a rheumatological case in this population, nine per cent (n = 3) were confident, 21% felt fearful (n = 7), 27% (n = 8) were indifferent and three per cent (n = 1) were alert. Forty-two per cent (n = 14) suspected JIA in a patient. In 77% of cases, the patients were seen repeatedly for polyarthralgia, 47% for arthritis, 18% for spinal pain, and 47% for systemic manifestations. 79% believe that early management of JIA brings a benefit in terms of health costs. When asked about their sources of training in JIA, 76% said it was through clinical courses and nine per cent through medical days, six per cent webinars and workshops and three per cent felt they had not received any training. As for sources of information, 31% through peer groups, 49% on medical websites, 27% through medical journals and 49% through medical school courses. To the question ‘On a scale of 0–5, how would you rate your training in the management of rheumatological manifestations in children and adolescents’ the answers were 0 in 21% of cases, 1 in 42% of cases, 2 in 12% and 3 in 24%. When faced with a suspicion of JIA, 49% of practitioners referred patients to pediatrics, 64% to rheumatology, 55% initiated a biological and imaging work-up and 18% prescribed symptomatic treatment. For the treatment, 67% prescribed paracetamol, 58% NSAIDs, 15% corticosteroids, 9% did not prescribe any treatment and three percent admitted not knowing what to prescribe in this situation. Conclusion JIA may affect functional and even vital prognosis of young patients. The detection and early management of the disease depend on the reinforcement of training and awareness for primary care physicians.

Cancer recurrence: Detection and diagnostic intervals in Danish primary care.

e13110 Background: Danish cancer survivors receive hospital-based, specialized follow-up care with one central aim to detect cancer recurrence (CR) at an early stage. Nevertheless, CR is frequently detected outside of scheduled follow-up visits as 40-60% of CR patients encounter and present symptoms. The family physician (FP) is presumed to facilitate most of these diagnostic pathways. However, little is known about CR detection in primary care. We aim to examine diagnostic intervals, actions taken by the FP and sub-optimal events for patients presenting symptoms of CR in primary care. Methods: We are conducting a retrospective, national cohort study based on questionnaire data linked to register data at the individual level. Patients diagnosed with CR of melanoma, lung, breast, colorectal, bladder, ovarian and endometrial cancer between Jan 2022 and May 2024 are included. Patients are identified consecutively using validated, register-based algorithms. All Danish citizens have access to free healthcare and 99% are listed with a specific FP. The affiliated FP is invited to complete a questionnaire on the diagnostic pathway utilizing the patient medical record. Danish health registers provide information on the primary cancer, CR diagnosis date, comorbidity, education, sex, and age. Results: We aim to include 3,000 CR patients and expect to receive information on 1,000 CR diagnostic pathways initiated in primary care. We will present preliminary results from the first 500 responders. The proportion of diagnostic pathways initiated in primary care was 33%, hospital-based follow-up was 44%, and another route was 23%. The FPs initiated the diagnostic pathway by referral to cancer specific urgent pathway for 31% of patients, by referral to specialized private or hospital-based physician including diagnostic imaging for 30% of patients. For 31% of diagnostic pathways, the FPs reported sub-optimal or delaying events. The most frequently reported sub-optimal event was regarding clinical decisions by the FP (12%). For patients with CR of breast cancer (n=53), the mean diagnostic interval (time from first contact to CR diagnosis) was 86 days [95% CI = 61 to 112days]. Conclusions: One third of diagnostic pathways for CR was initiated in primary care. This project will provide novel, comprehensive evidence on these diagnostic pathways to inform the efforts for early detection of CR and survivorship in primary care.

Pharmacies'income and its effective factors in Iran: A cross-sectional study.

Financial assessment of pharmacies and the factors affecting it is an important issue in health system and pharmaceutical industry. The present study aimed to analyze the revenue of pharmacies in Iran and the factors affecting it. In the present study revenue data of all active pharmacies in Shiraz in 2018 (n = 298) were gathered using a checklist. Descriptive statistics, mean difference test, correlation, and regression analysis were performed for statistical evaluation. Heteroskedasticity and multicollinearity also were checked. Stata 15 was used for statistical analysis. Average monthly income of the pharmacies was $82,879 USD (SD = 30,635). The monthly revenue of 24 hpharmacies was about $6560 higher than that of the daily pharmacies. The pharmacies founded by non-pharmacists made about $44,038 more than others, and the pharmacies located on main streets earned over $84,247 more than the ones located on side streets. Besides, the pharmacies inside or near hospitals, clinics, or physician buildings made more money than others. Correlation analysis also showed that the pharmacies'working years, the number of adjacent pharmacies, the number of OTC prescriptions, and the number of staff working at the cosmetics counters had a positive relationship with the pharmacies'income. Final findings indicated that 24 hpharmacies, pharmacies located on main streets, the ones located in hospitals or private clinics and physician buildings, pharmacies with more OTC prescriptions, and the ones with a larger number of employees in the cosmetics departments had higher monthly revenues.

Auricle Myxoma, Evidence from the Clinic to Cardiovascular Emergency Surgery, Triad: Cardiac, Systemic, Embolic

Cardiac tumors are infrequent, primary tumors, such as atrial myxoma, are estimated at 000017 to 0.13% of all cardiac neoplasms, postmortem records, n relation to its frequency, it is more than the other primary ones, in 67% the left atrial myxoma, 23% in the right atrium and less frequent the biaurals left. age group from 30 to 60 years, more in the female sex, in the childhood is more related to alterations in skin lentiginosis, nevi as Carney.autosomica dominant síndrome. In genetic studies, alterations in the PRKAR1A gene on chromosome 17 are found. We present the case of a patient with a request for pre-surgical evaluation, urological prolapse of the bladder, with systemic manifestations, weight loss, chronic anemic syndrome treated with vitamins and trace elements, by a private physician, without remission. It is worth mentioning that the physical and cardiovascular examination revealed semiotic onygomatic seizures of Duroziez in the mitral area, with auscultatory changes in the left lateral decubitus position, for which reason I propose the diagnosis of mitral valvular heart disease vs atrial myxoma, with 2 elements of clinical judgment of the classic triad of myxoma, in the performance of the transcutaneous echocardiogram, a cardiac mass was observed, at the level of the left atrium, spherical, of 5.5 cmt diameter, hyperechogenic. Great mobility in cycles cardiac, prolapse of the mitral valve in diastole with stenosis, the emergency consultation was made to cardiovascular surgery in a hospital of greater complexity, a procedure with complete excision of the tumor of approx 12 cmt by 5.5 cmt diameter, with satisfactory evolution of the patient

Santé mentale des médecins libéraux français pendant la deuxième vague de COVID 19

IntroductionThe 2019 coronavirus (COVID-19) pandemic has caused a public health crisis worldwide. Concerns have been expressed about the rapid deterioration of mental health among primary care physicians among whom burnout already had a high prevalence prior to the pandemic. However, there is little data on private doctors during the pandemic. France experienced a second wave with a second lockdown. We aimed to assess and compare physicians’ burnout, anxiety and depression symptoms and insomnia between general practitioners (GP) and all other private specialists during the second Covid-19 wave. MethodsWe conducted an online survey of private practitioners registered on Doctolib® (n=32,655), the interface software most used by private practitioners for booking medical appointments in France. Doctors were invited by email to complete an online survey in November 2020. Inclusions were closed on 1st December. The 2nd lockdown lasted from 30th October to 15th December 2020. We used the Copenhagen Burnout Inventory (CBI) to assess burnout syndrome. A mean score of>50 in at least one subscale defined burnout. The Hospital Anxiety and Depression Scale assessed anxiety and depression symptoms. We used two cut-offs, 8 (>7) and 11 (>10), as both are validated in the ability to find cases. The Insomnia Severity Index (ISI) measures sleep-related complaints among physicians (cut-off >7). To link variations in the psychological scales to the COVID-19 pandemic, one of the items asked explicitly whether participants considered that “the COVID-19 epidemic we are currently experiencing is a source of excess stress, psychological suffering or burnout”. Approval for this study was obtained from the local institutional review board of the University of Paris-Saclay, France. The questionnaires were collected anonymously. Statistical significance was tested using the chi-square test and student's t-test to compare the prevalence between GPs and other specialities. Subsequently, logistic regression models were run for statistically significant associations. Results1992 physicians replied, a response rate of 12.8% of those who received the invitation email. Among them, 79.4% suffered from psychological distress (symptoms of anxiety or depression or burnout), of which 71.3% suffered from burnout, 26.7% from depressive symptoms, 58.9% from anxiety symptoms and 45.8% from insomnia. There was no difference in gender between GPs and specialists, but there was an age difference (P<0.001). GPs had a higher prevalence of burnout (OR=1.33 CI95 [1.09;1.63]) and took more psychotropic drugs (1.38 CI95 [1.05;1.81]). They were also more likely to perceive their stress as work-related (OR=1.50 CI95 [1.23;1.81]) or COVID-19-related (OR=1.43 CI95 [1.16;1.77]). ConclusionOur study is the first to assess the mental health of private practitioners in the second wave in association with COVID-19 stress. Firstly, GPs who provide primary care have a significantly higher burnout rate than other doctors. Secondly, COVID-19 stress is associated with more significant psychological distress. Thirdly, almost 80% of the private doctors surveyed suffer from psychological pain, and 71% suffer from burnout. This study has strengths and limitations. Firstly, this study assesses mental health and stress related to its COVID-19 association. Second, this is the largest population of private physicians during the COVID-19 pandemic. The low response rate is the main limit of this study. The alarming rates of psychological distress among private doctors and, in particular, GPs should lead to intervention to help doctors reduce stress, burnout and other mental disorders. This study gives a picture of the situation during the second wave and the lock-in, and we need to be cautious with the next waves.