Medicine Professionals Research Articles

Call It an "Evolution": Promoting Student-Athlete Well-Being During the Transition From Collegiate Sport.

After highly publicized stories of student-athletes' struggles with mental health, the spotlight on mental health and well-being in this special issue coincides with a broader growing concern for the long-term impact of competitive sport participation on student-athlete health and wellness. The end of a competitive sport career represents a potentially vulnerable life transition. As demonstrated in the literature, the unique aspects of elite sport culture shape student-athletes' perceptions of their identity, health, and health behaviors, which have implications for how student-athletes navigate their health and well-being as they transition away from the embedded health care structure inherent to elite sport. Given evidence indicating that student-athletes may face mental and physical health concerns after retirement from sports, targeted transitional strategies are needed to provide patient-centered care in this population. In this article, we briefly summarize current understanding of sport transition and highlight some key findings from studies conducted by the contributing authors' research groups exploring the impact of sport career transitions on student-athlete well-being. We also reflect on limitations of the existing research and transition models and, in turn, propose potential directions for adopting a nuanced and multidimensional framework to explore interconnected transition domains. We conclude by offering recommendations for sports medicine professionals to consider in future research, programming, and policies to promote student-athletes' holistic well-being through this critical transition.

Establishing Benchmark Percentiles for the Classification of Body Fat Percentage of Professional Male Athletes Competing in Combat Sports through Bioimpedanciometry

Body composition as a meaningful factor can result in physiological responses in both the physical body and general health status. Nevertheless, the schemes for establishing cut-off points for identifying the classifications of the body fat percentage of athletes competing in combat sports still include gaps. The aim of this study was, by using bioimpedanciometry, to calculate the percentiles for the classification of body fat percentages in Lithuanian professional male athletes (n = 52) competing in combat sports with weight classes. A total of 52 Lithuanian professional male athletes competing in combat sports with weight classes were evaluated using a multi-frequency bioelectrical impedance analysis method with frequencies ranging from 1 kHz to 1000 kHz. Percentiles P3, P10, P25, P50, P75, P90, and P97 were used to determine the classification. As a consequence, the following classification categories were assigned: 6.6–7.8% (extremely low); 7.9–10.9% (very low); 11.0–14.7% (below normal); 14.8–18.8% (normal); 18.9–21.5% (above normal); 21.6–29.3% (very excessive); and ≥29.4% (extremely excessive). The assessment of body composition in combat sports athletes identified an inverse association between higher body fat levels and a decrease in the muscle-to-fat ratio (β –1.3, 95% confidence interval (CI): –1.5; –1.0, p < 0.001). The relationship between lower body fat percentage and lighter weight categories in which combat sports athletes from different combat sports were competing has been identified (β 0.3%, 95% CI: 0.2; 0.3, p < 0.0001). The established cut-off points may assist sports medicine professionals and sports dietitians in monitoring the adiposity of combat sports athletes.

Experience of treatment of chronic migraine with botulinum toxin type A among aesthetic medicine professionals in Poland.

This study aimed to evaluate the knowledge and standard of treatment of chronic migraine with botulinum toxin by Polish aesthetic medicine professionals. Onabotulinum toxin A injections are used as a preventive treatment for chronic migraine. Besides neurologists, healthcare professionals of multiple specialisms can offer this treatment. Aesthetic medicine professionals commonly use the treatment to extend the scope of their practice. This may bring about a situation wherein physicians with different levels of experience and training are providing botulinum toxin injections for chronic migraine. An online survey asking about patient qualification procedures, the level of adherence to the PREEMPT paradigm, product-, technique-, dosing-, and treatment intervals-related aspects of the treatment, efficacy evaluation practices and concerns about the use of botulinum toxin in chronic migraine was sent to 110 Polish physicians practicing aesthetic medicine. The response rate was 73.6%. The results of the survey revealed multiple deviations from the current paradigm of treatment of chronic migraine with botulinum toxin, from improper patient qualification through treatment procedure to the evaluation of the efficacy. Only around one-third of professionals evaluated the observed effectiveness of therapy as very good. Most respondents wanted to expand their knowledge and skills in chronic migraine treatment. There is a considerable willingness among aesthetic medicine specialists to treat patients with chronic migraine with botulinum toxin. The current levels of knowledge and skills in this treatment are limited, and multiple physicians declared deviations from the diagnostic criteria and the therapeutic protocol. Transferring aesthetic medicine practices to neurology treatment is common and may result in a lack of effectiveness of treatment or even intensification of symptoms. An appropriate educational programme should be implemented for all physicians authorised to administer BoNT-A in Poland.

A Ten-Year Follow-Up Case Report on the Treatment of Severe Obstructive Sleep Apnea Using a Mandibular Advancement Device

This report describes the challenging case of a 45-year-old male Caucasian patient with morbid obesity and severe obstructive sleep apnea who was followed up for over 10 years by a multidisciplinary team that included sleep and dental medicine professionals, physiotherapists, and nutritionists. The patient underwent seven polysomnographic studies during the follow-up period; furthermore, nocturnal digital monitoring (NDM) was performed during the COVID-19 pandemic. The polysomnographic study revealed that the apnea-hypopnea index of the patient reduced from 131.7 ev/h to 9.4 ev/h without symptoms, while his NDM oxygen desaturation index varied because of weight gain during the COVID-19 pandemic. This case report highlights the importance of a multidisciplinary team in ensuring the success of mandibular advancement device therapy with excellent clinical outcomes. Furthermore, this report suggests that NDM was a good tool for follow-up during the COVID-19 pandemic.

ПОДРОСТОК С ХРОНИЧЕСКОЙ БОЛЕЗНЬЮ ПОЧЕК — ГОТОВНОСТЬ К ПЕРЕВОДУ ВО ВЗРОСЛУЮ НЕФРОЛОГИЧЕСКУЮ СЛУЖБУ ЗДРАВООХРАНЕНИЯ И ТРУДНОСТИ ПЕРЕХОДНОГО ПЕРИОДА: ОБЗОР ЛИТЕРАТУРЫ, СОБСТВЕННЫЕ НАБЛЮДЕНИЯ

Transition of an adolescent patient with chronic kidney disease (CKD) from pediatric to adult healthcare system is an urgent problem Worldwide. The purpose of this research was to generalize the idea of readiness of adolescents with CKD to transfer into adult nephrology healthcare system, to describe the challenges of such transition period and to determine the roles of participants in the process and their mutual interactions in order to develop and implement the working regional model for organizing the transition of adolescents with CKD within a clustered system of provision of specialized healthcare services. Materials and methods used: a single-center cross-sectional questionnaire surveying of adolescents and young adults with CKD regarding their readiness to transition in two observation groups was carried out on the basis of both adult and pediatric sections of the Samara Oblast Regional Clinical Hospital named after V.D. Seredavin (Samara, Russia) in Jan. 2021-March 2023. Group 1 consisted of young adults aged 18 to 22 y/o with CKD stages 2 to 3; and Group 2 included adolescents aged 13 to 18 y/o with CKD stages 2 to 5. The results were then evaluated with the TRxANSITION Index (formerly TRxANSITION Scale), PedsQL and the SF-36 questionnaire. Adolescents’ parents/caretakers took a survey on the independence of their children as well. Results: the data on the insufficient independence of adolescents were obtained, as follows: 66.7% [34.9-90.1%] (n=8) “never” took medication on their own, 50.0% [21.1-78.9%] (n=6) have never asked their physicians questions (p<0.001), 50.0% [21.1-78.9%] (n=6) “never” and 33.3% [9.9-65.1%] (n=4) “almost never” did they agree to meet with the physician (p=0.005). Adolescents experienced difficulties in both communicating and working together with a physician: 33.3% [9.9-65.1%] (n=4) and 25.0% [5.5-57.2%] (n=3) “difficult,” respectively; 50.0% [21.1-78.9%] (n=6) and 58.3% [27.7-84.8%] (n= 7) “almost difficult,” respectively (p<0.001). On the other hand, “almost everything” and “everything” do they know about their health status 47.1% [23.0-72.2%] (n=8) and 35.4% [14.2-61.7%] (n=6), respectively, of young adults with CKD vs. adolescents (p<0.001). Conclusion: structurization of the participants’ roles in the communication system “patient and his family members - medicine professionals - psychologists - social workers” contributes to the stabilization of an adolescent with CKD during the transition period.

Establishing an expert opinion framework for lung volume reduction in Ireland: a Delphi consensus technique

BackgroundLung volume reduction (LVR) is an effective treatment option offered to patients with emphysema. There is no formalised LVR referral network in Ireland. A rigorous approach to agreeing and implementing a LVR referral framework in an Irish context is required. A Delphi process was used to provide a basis for a framework of multi-disciplinary teams (MDTs) which can provide LVR as a management option. A Delphi process offers a framework for understanding variations and developing a consensus from expert opinion.AimThe aim of this study was to develop consensus on recommendations for LVR referral guidelines in an Irish context and provide a national scope based on current practice and evidence.DesignIn accordance with Guidance on Conducting and Reporting Delphi Studies, a consensus-building Delphi study was performed. Thirty-three statements informed from review of research literature were identified and presented to participants. Evaluation of the statements was performed by an expert panel using a 5-point Likert scale. ≥ 70% agreement was defined as consensus and items with a consensus rating of < 70% were revised during the process. In total, Delphi questionnaires were distributed to 18 experts with a response rate of 78% (n = 14) and a follow-up response-rate of 50% (n = 7).Setting/participants.The expert panel in Ireland consisted of representatives from respiratory medicine, cardiothoracic surgery and allied-health professionals with expertise in COPD care.ResultsOf the initial 33 statements in five dimensions, there were consensus regarding 31 statements.ConclusionsThe 31 statements agreed through this Delphi study clarify a coherent direction for development of a LVR framework in Ireland. The Delphi study methodology described is a useful process to reach consensus among multi-disciplinary experts.

The maintenance of classism in medical education: "time" as a form of social capital in first-generation and low-income medical students.

As first generation (FG)/low income (LI) students enter the elite profession of medicine, schools make presumptions about how FGLI students allocate their time. However, their lives are markedly different compared to their peers. This study argues that while all forms of capital are necessary for success, time as a specific form keeps classism in place. Using constructivist grounded theory techniques, we interviewed 48 FGLI students to understand where, why and how they allocated their time, and the perceived impact it had on them. Using open coding and constant comparison, we developed an understanding of FGLI students' relationship to time and then contextualized it within larger conversations on how time is conceptualized in a capitalist system that demands time efficiency, and the activities where time is needed in medical school. When students discussed time, they invoked the concept of 'time famine;' having too much to do and not enough time. In attempting to meet medicine's expectations, they conceptualized time as something that was 'spent' or 'given/taken' as they traversed different marketplaces, using their time as a form of currency to make up for the social capital expected of them. This study shows that because medical education was designed around the social elite, a strata of individuals who have generational resources, time is a critical aspect separating FGLI students from their peers. This study undergirds the idea that time is a hidden organizational framework that helps to maintain classism, thus positioning FGLI students at a disadvantage.

Cardiac amyloidosis in Latin America: Gaps and opportunities to increase awareness of the disease. Findings from the AMILO-LATAM research group

BackgroundCardiac amyloidosis (CA) is an under-diagnosed disease presenting as a restrictive cardiomyopathy with high morbidity and mortality. Wild-type transthyretin amyloid cardiomyopathy (ATTR-CM) is mostly seen in elderly patients, with increasing prevalence as life expectancy is growing. New diagnostic imaging techniques and treatments allow for a better prognosis, but lack of clinical awareness delays timely diagnosis and appropriate management. Our purpose was to investigate the knowledge of clinicians regarding ATTR-CM and to assess the availability of imaging resources in the Latin-American region. Methods and ResultsTwo online surveys were distributed among clinicians and nuclear medicine professionals, respectively: one asking about awareness of CA in different clinical scenarios, and the other about the availability of diagnostic resources and studies performed. 406 responses were received for the first survey and 82 for the second, representing 17 and 14 countries, respectively. A significant lack of awareness was identified among clinicians, although appropriate diagnostic resources are generally available. Survey data showed that very few patients are evaluated for ATTR-CM in most Latin-American countries. ConclusionsThe surveys demonstrated the need for educational programs and other measures to increase clinical awareness and early detection of CA, so patients receive timely treatment and management of the disease.

Effects of dual job practices on professionalism amongst doctors - A critical literature review

Abstract&#x0D; Background&#x0D; Professionalism in medicine is a trust based social contract between professionals and public wherein professionals are expected to subordinate all their interests to the larger interests of patients and public. Recent commercialization trends have eroded ethical as well as scientific underpinnings of this sacred profession. This situation calls for immediate and planned resuscitative measures to reverse it. Healthcare professionals particularly dual jobs holding doctors themselves are the key persons in this regards.&#x0D; Objective&#x0D; To systematically examine literature on perceptions of doctors about dual jobs and its effects on professionalism in resource limited settings.&#x0D; Methods&#x0D; Through systematic searches of Medline, Ovid, ERIC and Science Direct combined with grey search from Google Scholar and hand search from reference lists and selected journals, eighteen articles were found appropriate to be included in this review.&#x0D; Results: Six themes were identified: dual job and motives behind private practice; monetary gains and non-professional behavior; threats to professionals and professionalism; role of medical education in building up professionalism; economic principles, law &amp; medical professionalism and finally the governance in healthcare development. The results suggest paucity of qualitative studies on perspectives of doctors with dual jobs about the practices of professionalism in both public and private sectors and their views about remedial measures in low income settings.&#x0D; Conclusions: The review highlighted the need to explore the perceptions of the key elements i.e. doctors; particularly those with dual jobs about the practices of professionalism in public and private sectors along with their proposals about remedial measures in resource limited settings.&#x0D;

Construct validity of the perceived stress scale (PSS-10) in a sample of health professionals in family medicine in Bosnia and Herzegovina

BackgroundThe 10-item Perceived Stress Scale (PSS-10) has not been translated into Bosnian, nor has a study been conducted employing a sample of family medicine physicians and nurses to examine the instrument's reliability, validity, and factorial structure. Thus, the goal of this study was to investigate the reliability and construct validity of the Bosnian version of the PSS-10 among family medicine professionals. Study designCross-sectional descriptive study provided among healthcare professionals in family medicine, using Google forms questionnaire (PSS-10) in Bosnian language. MethodsTranslation of PSS-10 in Bosnian is performed according to the proposed set of standardized guidelines. The questionnaire was sent on the email addresses of family physicians and nurses in whole Bosnia and Herzegovina. The collected data were subjected to reliability testing, exploratory and confirmatory factor analysis, which tested three alternative plausible models suggested by the extant literature: single factor, correlated two-factor and bifactor. ResultsA total of 272 out of 440 (RR = 61.3) nurses and physician working in family medicine in Bosnia and Herzegovina completed the PSS-10 Bosnia and Herzegovina version (BH). Participants were aged 25 to 69, with a mean age of 44.7 (±10.55). Most participants were women (86.8%) and physicians (58.8%) with specialisation in family medicine (43%). The overall Cronbach's alpha was 0.87 and the test–retest reliability coefficient was 0.88. Exploratory Factor Analysis yielded 2 factors with eigenvalues of 4.77 and 1.35, accounting for 61.2% of variance. Factor 1 consisted of 6 items representing ‘’perceived distress'’, whereas Factor 2 consisted of 4 items representing ‘’perceived coping’’. The Confirmatory factor analysis indicated a very good fit of this bifactor model to this sample. ConclusionsOur results implies that the PSS-10-BH, as a bifactor model with good reliability and validity, may accurately measure the stress levels of family medicine physicians and nurses.

Exploring the Mental Health Challenges of Emergency Medicine and Critical Care Professionals: A Comprehensive Review and Meta-Analysis.

Burnout and depression are global problems affecting healthcare providers, especially those working in stressful departments such as emergency departments (EDs) and critical care units (CCUs). However, pooled data analysis comparing healthcare providers operating in the ED and CCU is yet to be conducted. Therefore, this meta-analysis was systematically conducted to investigate and compare the prevalence of burnout and depression among emergency medicine (EM) and critical care medicine (CCM) professionals. We systematically searched for articles related to our research topic using the database search method and manual search method, which involved reviewing the reference lists of articles from electronic databases for additional studies. After screening the literature from the databases using the eligibility criteria, a quality appraisal using the Newcastle-Ottawa scale was performed on the eligible studies. In addition, a meta-analysis using the Review Manager software was performed to investigate the prevalence rates of burnout and depression. A total of 10 studies with 1,353 EM and 1,250 CCM professionals were included for analysis in the present study. The pooled analysis did not establish any considerable differences between EM and CCM healthcare workers on the prevalence of high emotional exhaustion (EE) (odds ratio (OR) = 1.01; 95% confidence interval (CI) = 0.46-2.19; p = 0.98), high depersonalization (OR = 1.16; 95% CI = 0.61-2.21; p = 0.64), low personal accomplishment (PA) (OR = 0.87; 95% CI = 0.67 - 1.12; p = 0.28), and depression (OR = 1.20; 95% CI = 0.74-1.95; p = 0.45). Moreover, pooled data showed no considerable differences in EE scores (mean difference (MD) = -1.07; 95% CI = -4.24-2.09; p = 0.51) and depersonalization scores (MD = -0.31; 95% CI = -1.35-0.73; p = 0.56). However, EM healthcare workers seemed to have considerably lower PA scores than their CCM counterparts (MD = 0.12; 95% CI = 0.08-0.16; p < 0.00001). No considerable difference was recorded in the prevalence of burnout and depression between EM and CCM healthcare workers. However, our findings suggest that EM professionals have lower PA scores than CCM professionals; therefore, more attention should be paid to the mental health of EM professionals to improve their PA.

Quality and Reliability of Liver Cancer–Related Short Chinese Videos on TikTok and Bilibili: Cross-Sectional Content Analysis Study

Background Liver cancer incidence has been increasing in China in the recent years, leading to increased public concern regarding the burden of this disease. Short videos on liver cancer are disseminated through TikTok and Bilibili apps, which have gained popularity in recent years as an easily accessible source of health information. However, the credibility, quality, and usefulness of the information in these short videos and the professional knowledge of the individuals uploading health information–based videos in these platforms have not yet been evaluated. Objective Our study aims to assess the quality of the information in Chinese short videos on liver cancer shared on the TikTok and Bilibili short video–sharing platforms. Methods In March 2023, we assessed the top 100 Chinese short videos on liver cancer in TikTok and Bilibili (200 videos in total) for their information quality and reliability by using 2 rating tools, namely, global quality score (GQS) and the DISCERN instrument. Correlation and Poisson regression analyses were applied to discuss the factors that could impact video quality. Results Compared to Bilibili, TikTok is more popular, although the length of the videos on TikTok is shorter than that of the videos on Bilibili (P&lt;.001). The quality of the short videos on liver cancer in TikTok and Bilibili was not satisfactory, with median GQS of 3 (IQR 2-4) and 2 (IQR 1-5) and median DISCERN scores of 5 (IQR 4-6) and 4 (IQR 2-7), respectively. In general, the quality of videos sourced from professional institutions and individuals was better than that of those sourced from nonprofessionals, and videos involving disease-related knowledge were of better quality than those covering news and reports. No significant differences were found in the quality of videos uploaded by individuals from different professions, with the exception of those uploaded by traditional Chinese medicine professionals, which demonstrated poorer quality. Only video shares were positively correlated with the GQS (r=0.17, P=.01), and no video variables could predict the video quality. Conclusions Our study shows that the quality of short videos on health information related to liver cancer is poor on Bilibili and TikTok, but videos uploaded by health care professionals can be considered reliable in terms of comprehensiveness and content quality. Thus, short videos providing medical information on TikTok and Bilibili must be carefully considered for scientific soundness by active information seekers before they make decisions on their health care management.

Burnout and Disengagement in Pathology.

Despite widely prevalent burnout and attendant disengagement in medicine, the specific patterns and drivers within pathology and laboratory medicine are uncommonly studied. To assess the prevalence and drivers of burnout among pathology and laboratory medicine professionals, retrospectively, prior to the COVID-19 pandemic. This was a cross-sectional, mixed-methods study engaging pathology and laboratory medicine professionals as subjects. Of 2363 respondents, 438 identified as pathologists, 111 as pathology assistants, and 911 as pathology and laboratory professionals. The burnout rate was 58.4% (1380 of 2363) across all respondents in pathology and laboratory medicine. Burnout varied by job role (P < .01) and was highest among pathology and laboratory professionals. Disparities in burnout rate were observed by race. Fifty-six percent (1323 of 2363) of respondents felt that they had at least 1 symptom of burnout and were advancing toward a breaking point. Underlying factors ranked highly among all groups included control over workload and loss of meaning in work. Data provided from this cohort may help departments create successful strategies to reduce disengagement and burnout in the laboratory, especially during periods of increased stress as experienced during the COVID-19 pandemic. Further, these data may serve as a baseline comparison for future studies.

Poster 361: Prolotherapy in the Treatment of Sports-Related Tendinopathies: A Systematic Review

Objectives: Prolotherapy (PrT) involves the injection of a proliferant in order to irritate a microenvironment and promote healing via the inflammatory cascade. PrT has become an increasingly popular nonoperative treatment in orthopedics. However, numerous prolotherapy solutions exist and varying applications and results have been described. The purpose of this study is to review high-quality randomized controlled trials (RCTs) that analyzed efficacy and safety profiles of prolotherapy (PrT) treatments for the most common sports-related tendinopathies. Methods: All RCTs published in English between January 1st 1980 and July 30th 2021, reported in Embase, Medline, and Web of Science databases, were queried with search terms including sclerotherapy, prolotherapy, sports medicine, sports injuries, tendinopathies, and musculoskeletal pain/injuries. PRISMA guidelines were used. Studies analyzing tendinopathies using a RCT design were included, while case controls, reviews, and observational studies were excluded. Duplicates were eliminated through Endnote. The remaining articles were screened by titles, followed by abstract and then by full text analysis. The Cochrane collaboration tool was used to assess for risk of bias. Two researchers independently performed the screening and conflicts were resolved using Rayyan © software (Rayyan Systems Inc., Cambridge, MA, USA). Graphical representations were created using SPSS version 28.00. Results: Application of the inclusion and exclusion criteria yielded 20 RCTs (fig. 1): 6 studies on lateral epicondylitis (LE); 6 on rotator cuff tendinopathy (RC); 5 on plantar fasciitis (PF); 2 on Osgood-Schlatter disease (OSD); 1 on Achilles tendinosis. Most of the trials used dextrose injections over P2G or hypertonic glucose (fig. 2), and the most common studied conditions were LE and RC (fig.3). The average follow-up period was 12 weeks. No significant adverse effects were reported, and the most common outcome measures were visual analog scale (VAS), patient rated tennis elbow evaluation (PRTEE), quick- disabilities of the arm, shoulder, and hand (Q-DASH), and symptoms relief. For the treatment of LE, dextrose PrT was associated with significant improvement in VAS pain score at rest and PRTEE compared to normal saline (p&lt;0.041, p&lt;0.013 respectively). Additionally, compared to hyaluronic acid and lifestyle modifications, PrT showed significant improvement in VAS pain score with activity, Q-DASH, and PRTEE scores (p&lt;0.04, p&lt;0.04, p&lt;0.05 respectively). For the treatment of RC, dextrose PrT was found superior to physiotherapy in the shoulder disability index (p&lt;0.001). Finally, dextrose PrT demonstrated significant improvements in foot function index (p&lt;0.001) for the treatment of PF, and reduction of symptoms in OSD (p&lt;0.024) compared to physical therapy and lidocaine controls. Patients with AT had a more rapid improvement in symptoms in the combined PrT/eccentric loading exercises protocols compared to dextrose PrT alone (p&lt;0.007). A graphical representation of the results is reported in figure 4. Conclusions: This systematic review summarized high quality RCTs and found PrT injections to be overall safe and effective in the treatment of sports-related tendinopathies. Further RCTs with larger sample sizes and comparisons to orthobiologics would add to the literature. Based on the current findings, sports medicine professionals may safely pursue PrT as an additional component of conservative treatment before surgery.

Poster 396: Barriers and facilitators to national licensure for US medical professionals: what Covid has taught us and using sports medicine as a launch pad

Objectives: GLOBAL AIM: Increase license portability across state lines for all US medical professionals. SPECIFIC AIM: Increase the ability to provide medical care nationwide for all US sports medicine physicians (who have a CAQ for their specialty) across state lines and set a precedent for other licensed healthcare professionals by 2026. The aim is to extend the portability of medical licensure across state lines to all sports medicine professionals (not just those who care for professional teams) and use this as a precedent eventually for all types of healthcare workers. Currently sports medicine physicians for professional teams are allowed to provide care across state lines which is legislated by “The Sports Medicine Licensure Clarity Act” (SMLCA) in 2018. As July 22, 2022, licensure is allowed for at least telemedicine across state lines for 23 states and has been extended by the HHS as part of Covid healthcare measures that were implemented in 2020. Methods: Review of current policies, barriers and facilitators has been performed using various search strategies and qualitative techniques. Current state and national laws were reviewed and will be presented. California has a large population where there is no reciprocity for other medical professionals, therefore meetings have been set with the Business Professions Committee with a plan to submit a bill sponsored by a state assemblyman to expand access to licensure across state lines in 2023. Results: One barrier is the loss of states’ autonomy as well as the individual authority and stature a medical professional may gain from being on a licensing board. Most US states have no reciprocity and not all have the licensure process standardized. Some states have a non-transparent process and others do not wish to participate in regional compacts such as California. Even more concerning, some states are found to more-likely censure doctors of color and perform sham peer review. This is an example of bias in medical credentialing that can impede diversity and inclusion efforts. The European Union allows medical licensure across national borders. Doctors need to pass a language proficiency test for the country they wish to practice in, regardless of which European country they received their medical training. Given that English is the only language of instruction in the US, proficiency can be easily evaluated. Language should not be a barrier to license portability, especially if one is already licensed in one US state even for foreign medical graduates. The Covid pandemic showed licensure is obtainable in a relatively rapid fashion across state lines. In addition, federal health care facilities such as the VA system already allow practitioners licensed in one state to practice in another without a license to that specific state. Portability across state-lines aids practitioners who practice on state borders in both rural and urban areas, such as the NH and VT border(rural), and NY and DC metro areas (urban) as well as telehealth for both an immobile and mobile populations, enhancing equitable healthcare access. This also removes financial barriers of cost for licensing fees for practitioners and staff resources to process licenses. Conclusions: The US has one of the most restrictive medical licensures of all developed countries, making mobilization of healthcare workers extremely difficult. Removing this barrier will be beneficial when medical staff is needed across state lines for pandemics, natural disasters, intake of refugees/immigrants, and global sporting events held in the US such as the World Cup in 2026, and Olympics in 2028. This could also extend access for the general US population to healthcare providers via “tele-medicine” (virtual/video visits), to essentially all populations (socio-economically disadvantaged, immigrants, those with mobility and transportation barriers, rural locations etc). This will ensure higher quality care, better follow-up along with more timely and equitable healthcare, which are all currently limited by restricting portability and requiring licenses for each individual state.

THE PREVENTIVE POWER OF PHYSICAL ACTIVITY ON DEPRESSION AND ANXIETY: A NARRATIVE REVIEW

Background:Effective treatments for depression and anxiety include psychology and medications. It is proposed that one of the tools of self-care is physical activity (PA), which is an adjuvant treatment that may play a crucial role in managing depression and anxiety, in addition to promoting a better quality of life (QoL).Through this narrative review, we aim to summarize the latest available evidence and guide our healthcare colleagues to help anyone suffering from depression and anxiety. Summary:PubMed and Cochrane databases were systematically searched for relevantstudies published between January 2018 and June 2023 with no language restriction. Systematic reviews were included in the search. We performed the study selection in 3 stages: initially, we did screening by conducting an electronic search. Article titles and their abstracts were then screened. In the second screening stage, we assessed the full texts. In the last stage, we included studies that met our eligibility criteria. Key Messages:Based on most studies examined, we could conclude that there is an apparent positive effect on depression and anxiety in all adult age groups, nevertheless, in many physical, mental, and psychological conditions.We encourage all our colleagues in preventive medicine, family medicine, and other specialties to prescribe PA as an adjuvant therapy to prevent or treat patients suffering from depression and anxiety. In addition, we recommend that public health and community medicine professionals advocate for PA and draw and implement strategies to motivate people to include PA as a lifestyle. There are still gaps in this field, and we recommend further research and trials to add more to healthcare and science.

Procedures for Dossier Preparation and their Marketing Authorisation in Zimbabwe Country for Complementary Drug

The Medicines Control Authority of Zimbabwe (MCAZ) is the authority to regulate from the Ministry of Health. It is established through an Act of Parliament which gives these bodies the `power to regulate the quality and sale of Complementary medicines. The objectives of this study were to evaluate the current regulatory review process of the Medicines Control Authority of Zimbabwe (MCAZ), identify key milestones and target timelines, evaluate overall performance from 2017 to 2019, identify best practices in review, evaluate the quality of decision-making processes and identify challenges and opportunities for improvement. Complementary medicine has always been at the heart of most Zimbabweans. That most of the drug is located close to the African community makes it very attractive, user-friendly, cost-effective and flexible in adapting to the dynamics of modern societal trends. The aim is to understand the need for professionalization of complementary medicine. The guidelines were studied from the website. We studied the guidelines to prepare a checklist and dossier preparation to submit to the authority of Zimbabwe.

A Study on Prof. Dr. Osman Kaya's Life and Scientific Studies

Biography studies are also included in the research studies in the history of veterinary medicine.&#x0D; It is very valuable in terms of the formation of the history of the profession that people who are known for their contributions to the veterinary medicine profession in the process they live in are written down and presented in a tidy article. Many biographical books (Berkman, 1945; Erk and Dinçer, 1945; Sinmez and Yaşar 2011) and articles (Yaşar 1997; Yaşar 1998a, 1998b; Yaşar et al.,2010; Sinmez et al., 2012; Yaşar et al., 2020) have been published due to the fact that it has an important and valuable place in Veterinary History research. Similarly, it seems that it has become a tradition to write biographies of faculty members who retired or died in order to establish the history of Aydın Adnan Menderes University Veterinary Faculty (Arslan, 1999; Arslan, 2004; Arslan, 2008a, 2008b).&#x0D; In this respect, who carries out his academic and scientific studies in Aydın Adnan Menderes University Veterinary Faculty Microbiology Department and contributes to the training of many scientists in his field writing the biography of Prof. Dr. Osman Kaya is also seen as an important debt of loyalty for the history of the profession.&#x0D; Osman Kaya, who provided not only academic contributions but also support and services at the point of development and structuring of the university, also served as the Vice Rector of Aydın Adnan Menderes University. While carrying out his academic and administrative duties, Kaya could not get rid of his cancer disease, which was still under treatment, and was sent off on his last journey on February 03, 2017.&#x0D; The aim of this study is to the "national and international studies", and "academic and administrative duties" carried out in the veterinary microbiology discipline to reveal Prof. Dr. Osman Kaya's contributions to the history of science and the world of science. In addition to this, it also to contribute in terms of bibliography by giving the works in an orderly and collective way.

Anesthesia and the Classics: Essays on Avatars of Professional Values

Anesthesia and the Classics: Essays on Avatars of Professional Values

Burnout in Academic Medicine: A Peripandemic Assessment

The impact of burnout on academic medicine has affected its 3 major missions-education, patient care, and research-in ways both similar to and dissimilar from the community practice of medicine. The authors have assessed major themes in the literature regarding burnout in health care professionals in academic medicine in the peripandemic periods-pre-, intra-, and postpandemic-to gain information on the impact of the pandemic on these perspectives. Additionally, burnout in military physicians, particularly in the military medicine academic community, was assessed to provide comparative perspectives on the factors of military training, personal resiliency, and unit cohesiveness on the development of, or resistance to, professional burnout. Overall, there are data to indicate an aggravation of burnout during the pandemic, but currently no long-term data to indicate a persistence of its effects over time on health care professionals beyond baseline prevalence identified prepandemic. Based on the assessments, recommendations are provided for future research, including clarification and standardization of the concepts of burnout, developing longitudinal studies on health care practitioner burnout status with preventive and/or mitigating interventions, and the special protection of certain professionals, including female physicians, physicians in training, and early-career faculty, including nonclinical researchers.