Professional Medical Organizations Research Articles

Tips for Addressing Screening Concerns: "Harms of Screening".

Early detection decreases deaths from breast cancer. Yet, there are conflicting recommendations about screening mammography by major professional medical organizations, including the age and frequency with which women should be screened. The controversy over breast cancer screening is centered on 3 main points: the impact on mortality, overdiagnosis, and false positive results. Some studies claim that adverse psychological effects such as anxiety or distress are caused by screening mammography. The purpose of this article is to address negative breast cancer screening concerns including overdiagnosis and overtreatment, effect on mortality, false positive results, mammography-related anxiety, and fear of radiation.

Legal Implications of Psychiatric Assessment for Medical Aid in Dying.

In recent years, several jurisdictions have passed legislation to permit medical aid in dying (MAID) worldwide, with considerable expansion in the availability of this practice. MAID has been defined as the practice of a clinician prescribing lethal drugs in response to a direct request from the patient, with a shared understanding that the patient intends to use the medication to bring about the patient's death. Wider legalization of MAID has prompted debates and legal controversies regarding the extent to which MAID should be available and its application for people experiencing mental illness as the primary indication. This article examines shifting attitudes of professional medical organizations toward MAID. We discuss the existing statutory provisions for psychiatric assessment for MAID in the United States and the implications on such assessments should MAID be expanded to include mental illness as the primary indication. This article also assesses legal disputes concerning MAID regulations and explores the role of psychiatric experts in the practice of MAID.

Defining change: Exploring expert views about the regulatory challenges in adaptive artificial intelligence for healthcare

ObjectiveContinuously learning or adaptive artificial intelligence (AI) applications for screening, diagnostic and other clinical services are yet to be widely deployed. This is partly due to existing device regulation mechanisms that are not fit for purpose regarding the adaptive features of AI. This study aims to identify the challenges in and opportunities for the regulation of adaptive features of AI. Materials and MethodsWe performed in-depth qualitative, semi-structured interviews with a diverse group of 72 experts in high-income countries (Australia, Canada, New Zealand, US, and UK) who are involved in the development, acquisition, deployment and regulation of healthcare AI systems. ResultsOur findings revealed perceived challenges in the regulation of adaptive features of machine learning (ML) systems. These challenges include the complexity of AI applications as products subject to regulation; lack of accepted definitions of adaptive changes; diverse approaches to defining significant adaptive change; and lack of clarity about regulation of adaptive change. Our findings reflect potentially competing interests among different stakeholders and diversity of approaches from regulatory bodies and legislators in different jurisdictions across the globe. In addition, our findings highlight the complex regulatory implications of adaptive AI that differ from traditional medical products, drugs or devices. ConclusionThe perceived regulatory challenges raised by adaptive features of AI applications require high-level coordination within a complex regulatory ecosystem that consists of medical device regulators, professional accreditation agencies, professional medical organisations, and healthcare service providers. Regulatory approaches should complement existing safety protocols with new governance mechanisms that specifically take into account the variety of roles and responsibilities that will be required to monitor, evaluate and oversee adaptive changes.

Умови застосування примусових заходів медичного характеру

The conditions for applying compulsory medical measures are an important topic that requires careful study and understanding, especially in the context of human rights and medical ethics. Decisionmaking on the application of such measures should be based on specific circumstances and strike a balance between the needs of the individual and the interests of public health. The practice of applying compulsory medical measures is determined by the legislation of each country and international standards. As a rule, they are allowed only in cases of an urgent threat to the life or health of a person or other persons, when an individual cannot make an informed and conscious decision about treatment due to mental illness or other circumstances. At the same time, the use of compulsory medical measures should be limited in time and as effective as possible to achieve the goal of ensuring the safety and well-being of the individual. In addition, it should be accompanied by appropriate human rights guarantees, such as the right to information, consultation and legal protection. This article analyzes the conditions under which coercive medical measures may be applied. In particular, it examines the ethical, legal and practical aspects of this issue, taking into account the rights and interests of patients, as well as the possible consequences for their health and well-being. The article includes a review of relevant international and national legislation, case law and recommendations of professional medical organizations on the use of compulsory medical measures. The author also examines modern approaches to this issue and possible ways to resolve it within the framework of ethical and legal norms. The author of the article provides substantiated recommendations for improving the legislation and practice of applying compulsory medical measures in order to ensure maximum protection of rights and decent treatment of patients in medical institutions.

Paediatric gender medicine: Longitudinal studies have not consistently shown improvement in depression or suicidality.

Systematic literature reviews have found the evidence for hormonal interventions in paediatric-age patients with gender dysphoria is of low certainty. Studies in this field have all been observational, and generally of low quality. Nevertheless, some experts assert that the observational studies in this field have consistently found improvement in mental health, and therefore constitute sufficient evidentiary basis for hormonal interventions. The present review sought to characterise results of the longitudinal clinical research studies that have reported depression and suicidality outcomes. The present review collated, from examination of six existing reviews, 14 longitudinal clinical research studies that have specifically investigated depression and/or suicidality outcomes. Significantly positive depression outcomes were reported in six studies, and significantly positive suicidality outcomes in two studies. Outcomes were negative in the largest study. Notably, some studies articulated positive conclusions about hormonal interventions even in the setting of insignificant, small or negative findings. Analysis of longitudinal clinical research in this field showed inconsistent demonstration of benefit with respect to depression and suicidality. This analysis suggests that, contrary to assertions of some experts and North American professional medical organisations, the impact of hormonal interventions on depression and suicidality in this population is unknown.

New Recommendations for the Care of Severely Injured Patients: Revision of the S3 Guideline on Treatment of Polytrauma/Severe Injuries.

Die 3. Überarbeitung der S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung wurde unter der Federführung der Deutschen Gesellschaft für Unfallchirurgie (DGU) von insgesamt 26 Fachgesellschaften und Organisationen durchgeführt und stellt eine umfassende Aktualisierung der Handlungsempfehlungen zur Schwerverletzten-Versorgung auf Basis neuer wissenschaftlicher Erkenntnisse und Studien dar. Die Leitlinie enthält 332 Kernempfehlungen unterschiedlicher Empfehlungsgrade und dazugehörige Erläuterungen, die Expertenwissen und über 2400 zitierte Literaturstellen berücksichtigen und somit das höchste Niveau (S3) einer Leitlinie erfüllen. Die Änderungen, insbesondere zur Schockraumalarmierung, sind für den Rettungsdienst von besonderer Bedeutung. Zwei neue Kapitel mit Empfehlungen für die Blutstillung und Schmerzbehandlung in der prähospitalen Versorgung wurden hinzugefügt, insgesamt bleibt die Leitlinie ein wichtiger Standard für Entscheidungsfindungen bei Diagnostik und Therapie von Schwerverletzten.

State Public Insurance Coverage Policies and Postpartum Care Among Immigrants

(JAMA. 2023;330(3):238–246) While physicians and professional medical organizations advocate for routine postpartum care for adults, some states impose restrictions on public insurance coverage for undocumented immigrants and immigrants granted legal documentation status within the past 5 years. The aim of this study was to investigate the relationship between public insurance coverage and postpartum care among low-income immigrants and to determine the difference in postpartum care receipt between immigrants and nonimmigrants.

Volunteerism Addressing Environmental Disparities in Allergy (VAEDIA): The presidential initiative to combat environmental injustice in allergy and immunology—a Work Group Report of the AAAAI VAEDIA task force

Many vulnerable people lose their health or lives each year as a result of unhealthy environmental conditions that perpetuate medical conditions within the scope of allergy and immunology specialists' expertise. While detrimental environmental factors impact all humans globally, the effect is disproportionately more profound in impoverished neighborhoods. Environmental injustice is the inequitable exposure of disadvantaged populations to environmental hazards. Professional medical organizations such as the American Academy of Allergy, Asthma & Immunology (AAAAI) are well positioned to engage and encourage community outreach volunteer programs to combat environmental justice. Here we discuss how environmental injustices and climate change impacts allergic diseases among vulnerable populations. We discuss pathways allergists/immunologists can use to contribute to addressing environmental determinants by providing volunteer clinical service, education, and advocacy. Furthermore, allergists/immunologists can play a role in building trust within these communities, partnering with other patient advocacy nonprofit stakeholders, and engaging with local, state, national, and international nongovernmental organizations, faith-based organizations, and governments. The AAAAI's Volunteerism Addressing Environmental Disparities in Allergy (VAEDIA) is the presidential task force aiming to promote volunteer initiatives by creating platforms for discussion and collaboration and by funding community-based projects to address environmental injustice.

Defining the "ideal state": A primer on critical care pharmacy practice models.

Critical care pharmacists (CCPs) have been clearly established as value-added members of the interprofessional team, and their contributions positively impact patient outcomes in the intensive care unit (ICU). Despite this, not every critically ill patient in the US receives care from a CCP and the model through which CCPs practice is variable, which has important implications. The purpose of this primer is to review current CCP models and discuss elements of the optimal CCP practice model. Current CCP practice models are defined, including the drug processing and dispensing model, clinical pharmacy specialist model, integrated pharmacy generalist model, and hybrid model, as well as unit-based vs service-based models. The optimal CCP practice model considers the Triple Domain of CCP workload, which includes direct patient care, indirect patient care, and professional service. Elements of the ideal CCP practice model including 24/7/365 CCP services, unit- vs service-based models, prescriptive authority, operational support, and CCP-to-patient ratio are discussed. Other vital elements include dedicated offline time, use of appropriate workload metrics, development of career ladders, opportunities for professional development, and providing wellness resources. The ideal CCP practice model must also be considered through the lens of the patient and medical team, the CCP, the institution, and professional organizations. Strategies for optimizing current CCP practice models are provided, and application of optimal CCP practice model elements is explored through 5 case studies. The optimal CCP practice model includes multiple elements and incorporates the viewpoints of patients, providers, CCPs, institutions, and professional organizations; this model will increase access of all ICU patients to CCPs, enhance the scope of CCP cognitive services, and ensure the economic sustainability of CCP practice while establishing CCP involvement in activities outside of patient care and in professional service.

Making a Statement: Positions of Professional Medical Organizations Towards Gender-Affirming Care.

Despite politically charged media coverage and legislation surrounding gender affirming care (GAC), many organizations have released position statements to provide scientifically backed clinical practice standards, combat misinformation, and inform medicolegal policies. The purpose of this study is to objectively assess the availability and the content of the official position statements of relevant medical professional organizations regarding GAC. A list of U.S. medical professional organizations with likely involvement in GAC based on medical or surgical specialties was compiled. For included organizations, we evaluated the availability, content, and publication year of positions on GAC through October 2023. When available, formal positions were categorized as supportive or unsupportive. A total of 314 professional medical organizations were screened for our study based on specialty, relevance to GAC, and issuance of patient guidelines or position statements. Inclusion criteria were met by 55 organizations. Most organizations (35, 63.6%) had formal position statements on GAC. Support for GAC was described in 97.1% (n=34). Further, 94.2% (n=33) of available statements explicitly addressed GAC in individuals less than 18 years old and were largely supportive (96.9%, n=32). This cross-sectional analysis demonstrates that a majority of multidisciplinary professional medical organizations with relevance to GAC have issued formal position statements on the topic. Available positions were overwhelmingly supportive of individualized access to gender-affirming therapies in adult and adolescent populations. However, silence from some organizations continues to represent a modifiable disparity in the provision of GAC.

Alcohol's impact on fine motor skills: Insights from minimally invasive surgical simulation

BackgroundAlcohol misuse among medical professionals poses a significant concern, and there is a lack of clarity in (inter)national guidelines regarding alcohol use during work. Moreover, there exists an insufficient body of research on the specific impact of alcohol on fine motor skills within the medical sector, specifically surgery. This study aims to investigate the impact of alcohol on fine motor skills in a minimally invasive surgical setting. MethodsA cross-sectional study was conducted at Lowland Science on August 19th, 20th, and 21st, 2022, during the Lowlands music festival in Biddinghuizen, the Netherlands. Participants were divided into five groups based on measured alcohol consumption. Exclusion criteria included drug use, prior surgical experience, being underage, and previous participation. The main outcomes were the number of correctly transferred rings during the PEG transfer task and the number of errors. Blood alcohol concentration (BAC) was measured using a breathalyser. ResultsA total of 1056 participants were included in the study. The results indicated an inverse relationship between BAC levels and surgical performance, with higher alcohol levels associated with a decrease in performance (p = 0.023). However, there was no significant difference in the number of errors among the five groups (p = 0.597). The group with the highest alcohol consumption (BAC >0.08 %) exhibited significantly worse performance compared to the group with a BAC of 0.0 % (p = 0.002). ConclusionThis study uncovers a negative impact of increased alcohol intake on fine motor skills in a minimally invasive surgery simulation exercise. While there was no effect on the occurrence of errors. Professional medical organizations should reconsider and explicate their position on alcohol use in (surgical) healthcare.

Attitudes toward the American Cancer Society's 2020 cervical cancer screening guidelines: A qualitative study of a national sample of US clinicians.

The 2020 American Cancer Society (ACS) guidelines are the most recent national guidelines for cervical cancer screening. These guidelines propose two major changes from current practice: initiating screening at age 25 years and using primary human papillomavirus (HPV) testing. Adoption of guidelines often occurs slowly, and therefore understanding clinician attitudes is important to facilitate practice change. Interviews with a national sample of clinicians who perform cervical cancer screening in a variety of settings explored attitudes toward the two major changes from the 2020 ACS cervical cancer screening guidelines. Clinicians participated in 30- to 60-min interviews exploring their attitudes toward various aspects of cervical cancer screening. Qualitative analysis was performed. Seventy clinicians participated from across the United States. Few respondents were initiating screening at age 25 years, and none were using primary HPV testing. However, over half would be willing to adopt these practices if supported by scientific evidence and recommended by professional medical organizations. Barriers to adoption included the lack of endorsement by professional societies, lack of laboratory availability and insurance coverage, limited autonomy within large health care systems, and concerns related to missed disease. Few clinicians have adopted screening initiation or primary HPV testing, as recommended by the 2020 ACS guidelines, but over half were open to adopting these changes. Implementation may be facilitated via professional organization endorsement, clinician education, and laboratory, health care system, and insurance support. In 2020, the American Cancer Society (ACS) released updated guidelines for cervical cancer screening. The main changes to current practices were to initiate screening at age 25 years instead of age 21 years and to screen using primary human papillomavirus (HPV) testing rather than cytology alone or in combination with HPV testing. We performed in-depth interviews with 70 obstetrics and gynecology, family medicine, and internal medicine physicians and advanced practice providers about their attitudes toward these guidelines. Few clinicians are following the 2020 ACS guidelines, but over half were open to changing practice if the changes were supported by evidence and recommended by professional medicalorganizations. Barriers to adoption included the lack of endorsement by professional medical organizations, logistical issues, and concerns about missed disease.

Readability of cerebrovascular diseases online educational material from major cerebrovascular organizations

IntroductionThe internet is an essential resource for patients and their loved ones to understand their medical conditions, and professional medical organizations have taken great strides to develop educational material targeting...

Annual Meeting Content Analysis: Leveraging Annual Meetings to Promote Diversity, Equity, Inclusion, and Belonging in the Academy of Consultation-Liaison Psychiatry

BackgroundThere is an increasing need to promote diversity, equity, and inclusion (DEI) in all aspects of academic medicine, including through continuing medical education (CME). Although professional medical organizations' annual meetings play an instrumental role in CME for physicians, there are no studies describing DEI content in the annual meeting programming of professional medical organizations, including the Academy of Consultation-Liaison Psychiatry (ACLP), the primary professional organization for Consultation-Liaison (C-L) psychiatrists. MethodsWe examined the publicly available ACLP annual meeting content titles on the ACLP website from 2010 to 2021. National DEI leaders from ACLP’s DEI subcommittee iteratively generated keywords that covered a broad scope of DEI-related themes. Each annual meeting content was independently coded by two members of the DEI subcommittee with discrepancies adjudicated by two additional members. Descriptive statistics were used to characterize the annual meeting content. ResultsOf the 2615 annual meeting titles from 2010-2021 which were analyzed, 2531 were not coded to have DEI themes. 3% (n=84) of titles were coded to have a DEI theme as follows: Culture/Diversity (n=20, 24%), Bias/Disparities (n=17, 20%), Race/Racism (n=17, 20%), Social Justice (n=12, 14%), Gender/Sexism (n=10, 12%), and LGBTQ+ (n=8, 10%). The frequency of DEI titles each year ranged from 1% (2010, 2018) to 17% (2021) with an increase in DEI content in 2021 (n=24, 17%). ConclusionAlthough professional medical organizations like the ACLP are poised to leverage their CME platforms embedded in annual meeting programming to train CL psychiatrists on DEI topics, our findings suggest more work is needed to develop and promote DEI focused educational programming for their annual meetings.

Innovative practice in the training of future doctors

Modernization of medical education has key directions. The first direction is the system of continuing medical education. Continuing medical education ensures the improvement of professional knowledge and skills throughout the course of professional activity. The principles of continuing medical education are: individuality, continuity, community with professional medical and pharmaceutical organizations, the widespread use of distance technologies, simulation and e-learning. The second direction is the introduction of a system of accreditation of specialists, which makes it possible to determine the readiness of specialists in the field of medicine to carry out professional activities. The practical part of training specialists in the field of medicine is a mandatory component of the educational standard and educational process. The formation of research skills prepares a medical student for the independent implementation of research activities in the relevant field of professional activity. The results of the study are presented, which reflect the level of formation of research skills in students of the specialty “Medical biochemistry”. According to the results of the study, groups of students with different levels of research skills were identified.

Cataloging formal medical student surgical funding opportunities: A retrospective characterization

Representation of female surgical residents has slowly increased, but underrepresented in medicine (URiM) representation remains disappointingly low. National residency matching reports suggest that meaningful research experience improves surgical residency match success - therefore, formal funding opportunities and early mentorship for URiM medical students. In this study, we catalog medical student (MS) funding opportunities (funding type, eligibility by year, mission, compensation, length of commitment, number of awardees, and dollar investment amount per student) from 7 surgical departments (general surgery, thoracic surgery, vascular surgery, plastic surgery, otorhinolaryngology, orthopedic surgery, neurosurgery) within 196 US medical schools and 20 professional surgical educational organizations through manually searching web pages. We recorded 146 surgical funding opportunities from medical school surgical departments and 16 surgical funding opportunities from professional organizations. Overall, we find that medical institutions' surgical departments and professional surgical educational organizations may not be effectively utilizing recruitment strategies in MS funding opportunities.

LEGALITAS ORGANISASI BARU DI LUAR WADAH TUNGGAL ORGANISASI PROFESI DOKTER DI INDONESIA DALAM TINJAUAN YURIDIS

The Association of Indonesian Doctors has been formed and declared in a Decree of the Ministry of Law and Human Rights, Number AHU-003638.AH.01.07.2022. The Indonesian Doctors Association is no longer the sole forum for medical organizations in Indonesia. The study of the legality of this new association and the study of the organization of the Indonesian Doctors' Association have violated the right to associate and human rights because it is the sole forum for the medical professional organization which is the focus of the problem raised by the author. The study uses a normative juridical approach to seek answers with certainty and legal certainty through existing legal theories, norms and legislation. The conclusions obtained are that in order to protect patients, improve service quality, and ensure legal and statutory certainty, the medical professional association or organization must be one. Determination of quality and service, competency standards, and professional ethics must come from a professional organization. With a noble purpose, a single professional organization does not violate the law on association and human rights. The presence of a new medical society organization will not interfere with the position of the Indonesian Doctors Association as a professional organization. The suggestion from this study is that new organizations such as the Association of Indonesian Doctors must synergize and become the task force for the Indonesian Doctors Association in controlling the running of the organization while simultaneously providing a driving force for services to the Indonesian people.
 
 Key words: Professional organizations; Constitution; Medical practice

How to Exercise Integrity in Medical Billing: Don't Distort Prices, Don't Free-Ride on Other Physicians.

This paper proposes that billing gamesmanship occurs when physicians free-ride on the billing practices of other physicians. Gamesmanship is non-universalizable and does not exercise a competitive advantage; consequently, it distorts prices and allocates resources inefficiently. This explains why gamesmanship is wrong. This explanation differs from the recent proposal of Heath (2020. Ethical issues in physician billing under fee-for-service plans. J. Med. Philos. 45(1):86-104) that gamesmanship is wrong because of specific features of health care and of health insurance. These features are aggravating factors but do not explain gamesmanship's primary wrong-making feature, which is to cause diffuse harm not traceable to any particular patient or insurer. This conclusion has important consequences for how medical schools and professional organizations encourage integrity in billing. To avoid free-riding, physicians should ask themselves, "could all physicians bill this way?" and if not, "does the patient benefit from the distinctive service I am providing under this code?" If both answers are "no," physicians should refrain from the billing practice in question.

THE REFORMATION OF MEDICAL ORGANIZATIONS IN OMNIBUS LAW ON HEALTH: SINGLE OR MULTI-BAR

The Omnibus Law on Health had been approved which in consequence allow other medical professional organizations to be established as doctors’ right to organize in which may provoke ethical problems. The recent Omnibus Law on Health enabled opportunity for multi-bar organizations; even it was in accordance with single-bar system. This paper aims to review the medical professional organization system in the Omnibus Law on Health which is most in line with the freedom of association and does not reduce the right to health as a human right that must be accepted by the wider community. The author argues that the emergence of several professional organizations as embodiment of doctor’s right may not suitable as it may procure ethical ambiguity. However, the compulsion to join single organization per se was a violation of our Constitution. In this case, we need the highest regulatory and controlling authority from the State to preserve the public interest. The concept of this federal multi-bar association may solve this problem.

Corrective Justice For Medical Personnel Who Violate The Law: Where Is The Professional Organizations Involvement?

The provision of criminal sanctions for medical personnel who violate the law in the form of gross negligence creates legal uncertainty apart from the unclear definition of serious negligence and does not involve the role of professional medical professional organizations in determining criminal witnesses for medical personnel. This study aims to formulate aspects of corrective justice for medical personnel who violate the law, especially in the realm of criminal law. This research is a normative legal research with a concept and statutory approach. The results of the study confirm that the criminal responsibility of medical personnel requires the role of the professional organization of the medical personnel concerned. This is because the assessment of the professional organization of medical personnel is important as a form of guaranteeing justice and legal certainty for medical personnel. Corrective justice-based medical personnel accountability orientation can actually be carried out by involving the roles and recommendations of medical professional organizations. In addition, health law reform is also needed by formulating criminal sanctions for medical personnel based on ultimum remidium, namely utilizing non-prison criminal sanctions in order to achieve justice for medical personnel