Proportion Of Physicians Research Articles

Attitudes towards patient safety among physicians and nurses in Iranian governmental teaching hospitals: a cross-sectional survey

ObjectivesTo assess and compare attitudes towards patient safety among physicians and nurses in Iranian governmental teaching hospitals and to identify factors associated with attitudes towards patient safety.DesignAn institution-based, cross-sectional survey...

Assessment of emergency physicians’ awareness and knowledge of hereditary angioedema

Aims: Hereditary angioedema can occur with life-threatening attacks of severe laryngeal edema, and epinephrine is insufficient in the treatment of attacks. We sought an answer to the question, 'Do emergency physicians, who frequently encounter angioedema cases that are so important for the emergency department, have sufficient awareness about this issue?' Methods: In this study, the online questionnaire was conducted among physicians working in adult emergency departments between April and August 2022. The questionnaire form consisted of two parts. The first part contained three questions about medical experience, academic degree, and encounter with hereditary angioedema patients. The second part of the questionnaire contained seven questions about the diagnosis and treatment of hereditary angioedema. Results: A total of 103 physicians working in emergency departments participated in the survey. The proportion of physicians is as follows: The percentage of physicians with less than 15 years of experience was 92.2%. Research assistants represented the largest group of participants at 51.5%. When asked "What is not a symptom of hereditary angioedema?" Only 40.6% of physicians could answer the question correctly. While 39.8% of physicians thougt that epinephrine and antihistamines were useful in treating these attacks, 53.4% felt that epinephrine and antihistamines were not. While there was a difference in hereditary angioedema awareness between the group with more than 15 years of professional experience and the group with less experience, there was no meaningful difference between research assistants, specialists, and academicians. According to this survey, professional experience was important, but academic title did not make a difference in terms of disease awareness. Conclusion: It is necessary to increase the awareness of emergency physicians about hereditary angioedema, which can cause fatal attacks and whose diagnosis and treatment are different from other angioedemas.

Exercise Is a Vital Sign.

Description In this review, we argue that exercise (physical activity) be monitored as a vital sign since no other basic sign or symptom provides as much information about a patient's health status. The influence of regular exercise on patient health is indisputable, with strong evidence to show the power of exercise to mitigate chronic disease and improve overall health. Several simple tools, such as Physical Activity as a Vital Sign and Exercise as a Vital Sign are available to assess patient physical activity. When properly applied, there is evidence to support the efficacy of these tools, but there are barriers that prevent broad inclusion in primary care, among which are time and provider knowledge. In our review, we also discussed the value of physician-led lifestyle discussions with patients and found they view these discussions favorably. There is also evidence that physicians who exercise are more likely to have these lifestyle discussions with their patients, but the proportion of physicians who exercise regularly is fairly low. We believe physicians' awareness of their patients' sedentary lifestyles should prompt a prescription to increase physical activity, but additional in-clinic support and community resources need to be in place for patients to get a regular dose.

Duration of New-Onset Depressive Symptoms During Medical Residency

The implications of new-onset depressive symptoms during residency, particularly for first-year physicians (ie, interns), on the long-term mental health of physicians are unknown. To examine the association between and persistence of new-onset and long-term depressive symptoms among interns. The ongoing Intern Health Study (IHS) is a prospective annual cohort study that assesses the mental health of incoming US-based resident physicians. The IHS began in 2007, and a total of 105 residency programs have been represented in this national study. Interns enrolled sequentially in annual cohorts and completed follow-up surveys to screen for depression using the 9-item Patient Health Questionnaire-9 (PHQ-9) throughout and after medical training. The data were analyzed from May 2023 to March 2024. A positive screening result for depression, defined as an elevated PHQ-9 score of 10 or greater (indicating moderate to severe depression) at 1 or more time points during the first postgraduate year of medical training (ie, the intern year). The main outcomes assessed were mean PHQ-9 scores (continuous) and proportions of physicians with an elevated PHQ-9 score (≥10; categorical or binary) at the time of the annual follow-up survey. To account for repeated measures over time, a linear mixed model was used to analyze mean PHQ-9 scores and a generalized estimating equation (GEE) was used to analyze the binary indicator for a PHQ-9 score of 10 or greater. This study included 858 physicians with a PHQ-9 score of less than 10 before the start of their internship. Their mean (SD) age was 27.4 (9.0) years, and more than half (53.0% [95% CI, 48.5%-57.5%]) were women. Over the follow-up period, mean PHQ-9 scores did not return to the baseline level assessed before the start of the internship in either group (those with a positive depression screen as interns and those without). Among interns who screened positive for depression (PHQ-9 score ≥10) during their internship, mean PHQ-9 scores were significantly higher at both 5 years (4.7 [95% CI, 4.4-5.0] vs 2.8 [95% CI, 2.5-3.0]; P < .001) and 10 years (5.1 [95% CI, 4.5-5.7] vs 3.5 [95% CI, 3.0-4.0]; P < .001) of follow-up. Furthermore, interns with an elevated PHQ-9 score (≥10) demonstrated a higher likelihood of meeting this threshold during each year of follow-up. In this cohort study of IHS participants, a positive depression screening result during the intern year had long-term implications for physicians, including having persistently higher mean PHQ-9 scores and a higher likelihood of meeting this threshold again. These findings underscore the pressing need to address the mental health of physicians who experience depressive symptoms during their training and to emphasize the importance of interventions to sustain the health of physicians throughout their careers.

Physician Specialty Differences in Unprofessional Behaviors Observed and Reported by Coworkers

Because unprofessional behaviors are associated with patient complications, malpractice claims, and well-being concerns, monitoring concerns requiring investigation and individuals identified in multiple reports may provide important opportunities for health care leaders to support all team members. To examine the distribution of physicians by specialty who demonstrate unprofessional behaviors measured through safety reports submitted by coworkers. This retrospective cohort study was conducted among physicians who practiced at the 193 hospitals in the Coworker Concern Observation Reporting System (CORS), administered by the Vanderbilt Center for Patient and Professional Advocacy. Data were collected from January 2018 to December 2022. Submitted reports concerning communication, professional responsibility, medical care, and professional integrity. Physicians' total number and categories of CORS reports. The proportion of physicians in each specialty (nonsurgeon nonproceduralists, emergency medicine physicians, nonsurgeon proceduralists, and surgeons) who received at least 1 report and who qualified for intervention were calculated; logistic regression was used to calculate the odds of any CORS report. The cohort included 35 120 physicians: 18 288 (52.1%) nonsurgeon nonproceduralists, 1876 (5.3%) emergency medicine physicians, 6743 (19.2%) nonsurgeon proceduralists, and 8213 (23.4%) surgeons. There were 3179 physicians (9.1%) with at least 1 CORS report. Nonsurgeon nonproceduralists had the lowest percentage of physicians with at least 1 report (1032 [5.6%]), followed by emergency medicine (204 [10.9%]), nonsurgeon proceduralists (809 [12.0%]), and surgeons (1134 [13.8%]). Nonsurgeon nonproceduralists were less likely to be named in a CORS report than other specialties (5.6% vs 12.8% for other specialties combined; difference in percentages, -7.1 percentage points; 95% CI, -7.7 to -6.5 percentage points; P < .001). Pediatric-focused nonsurgeon nonproceduralists (2897 physicians) were significantly less likely to be associated with a CORS report than nonpediatric nonsurgeon nonproceduralists (15 391 physicians) (105 [3.6%] vs 927 [6.0%]; difference in percentages, -2.4 percentage points, 95% CI, -3.2 to -1.6 percentage points; P < .001). Pediatric-focused emergency medicine physicians, nonsurgeon proceduralists, and surgeons had no significant differences in reporting compared with nonpediatric-focused physicians. In this cohort study, less than 10% of physicians ever received a coworker report with a concern about unprofessional behavior. Monitoring reports of unprofessional behaviors provides important opportunities for health care organizations to identify and intervene as needed to support team members.

COVID-19 vaccine uptake among Ontario physicians: a descriptive population-based retrospective cohort study

ObjectivesTo determine COVID-19 vaccine uptake among physicians in Ontario, Canada from 14 December 2020 to 13 February 2022.DesignPopulation-based retrospective cohort study.SettingAll registered physicians in Ontario, Canada using data from linked...

Feasibility and Acceptability of Pediatric Smartphone Lung Auscultation by Parents: Cross-Sectional Study.

The use of a smartphone built-in microphone for auscultation is a feasible alternative to the use of a stethoscope, when applied by physicians. This cross-sectional study aims to assess the feasibility of this technology when used by parents-the real intended end users. Physicians recruited 46 children (male: n=33, 72%; age: mean 11.3, SD 3.1 y; children with asthma: n=24, 52%) during medical visits in a pediatric department of a tertiary hospital. Smartphone auscultation using an app was performed at 4 locations (trachea, right anterior chest, and right and left lung bases), first by a physician (recordings: n=297) and later by a parent (recordings: n=344). All recordings (N=641) were classified by 3 annotators for quality and the presence of adventitious sounds. Parents completed a questionnaire to provide feedback on the app, using a Likert scale ranging from 1 ("totally disagree") to 5 ("totally agree"). Most recordings had quality (physicians' recordings: 253/297, 85.2%; parents' recordings: 266/346, 76.9%). The proportions of physicians' recordings (34/253, 13.4%) and parents' recordings (31/266, 11.7%) with adventitious sounds were similar. Parents found the app easy to use (questionnaire: median 5, IQR 5-5) and were willing to use it (questionnaire: median 5, IQR 5-5). Our results show that smartphone auscultation is feasible when performed by parents in the clinical context, but further investigation is needed to test its feasibility in real life.

Workplace Violence in the Pediatric Emergency Department: A National Survey of Physicians in the United States.

Previous work shows that health care workers, and particularly emergency department (ED) staff, are at an above average risk of workplace violence (WPV), defined as verbal threats or physical violence in the workplace. Previous data suggest that staff of a single pediatric ED frequently feel unsafe. The objective of this study was to conduct the first national survey study to assess the prevalence and incidence of WPV in the pediatric ED. In this cross-sectional survey study, a representative sample of US pediatric emergency medicine physicians were invited to participate in a national survey adapted from the previously validated Workplace Violence in the Health Sector questionnaire from the World Health Organization. The primary outcome measure was the proportion of physicians who have been exposed to WPV. Rates of exposure to violence, reporting habits, and physician perception of various violence prevention strategies were studied secondarily. Surveys were completed by 207 (45%) invited participants, representing 31 US children's hospitals. The prevalence of WPV exposure was 96%. Physical violence with a weapon was witnessed by 20% of participants. Injuries requiring medical attention or time off work were experienced by 10% of participants. Half of participants never reported violent events. Security guards were welcome by 99%, armed law enforcement officers by 70%, and metal detectors by 81% of physicians. Self-arming was opposed by 85% of respondents. Exposure to WPV is frequent among pediatric emergency medicine physicians with a prevalence similar to that of general emergency departments. Workplace violence remains underreported. This national survey contributes to the objective evaluation of individual- and systems-level violence prevention interventions.

A Survey of U.S. and Canadian Physicians’ Clinical Practices Related to Pharmacologic, Herbal, and Nutritional Substances Used to Increase Milk Production

Objectives:Physicians may be asked to prescribe, recommend, or discuss foods, herbs, and medications for low milk supply. It is unclear how factors such as education, experience, and regulations influence clinical practice. The objective was to document physicians’ clinical practice surrounding pharmacologic, nutritional, and herbal products for the management of low milk supply.Methods:Physicians from two Facebook groups completed an anonymous, online survey about their clinical use of pharmaceutical, supplemental, and nutritional substances perceived to increase milk production. The association between practice patterns and lactation medicine expertise or country for different perceived galactagogues was determined.Results:A total of 307 physicians completed the primary portion of the survey. There was no difference in the proportion of physicians in Canada or the United States (U.S.) who were defined as lactation medicine experts. Canadian physicians were more likely to prescribe metformin, levothyroxine, and domperidone for low milk supply compared with U.S.-based physicians. Canadians and experts were more likely than U.S.-based and nonexpert physicians, respectively, to include herbs in their practice. Patient request, personal and clinical experience, and lack of education, research, or access were frequently selected as reasons for or against using a specific substance.Conclusions:The U.S. Food and Drug Administration ban on domperidone affects low milk supply management in North America. Though Canadian physicians prescribed domperidone without limitations, U.S. physicians were less likely to incorporate it into clinical practice. Despite a lack of evidence, physicians in North America frequently used herbs and foods to increase milk production.

Provider attitudes and current practice regarding the prescription of opioid-containing pain medication for vaginal delivery.

The epidemic of opioid misuse and abuse is rampant in the United States. A large percentage of patients who go on to misuse or abuse opioids were initially legally prescribed an opioid medication by their physician. One of the most common reasons patients of reproductive age seek medical care is for pregnancy and delivery. These patients are frequently prescribed opioids. Greater than one in 10 Medicaid-enrolled women fill an opioid prescription after vaginal delivery. To assess the opioid prescribing patterns of obstetric providers following vaginal deliveries. Obstetric physicians and certified nurse midwives (CNMs) from different practice backgrounds were administered a questionnaire regarding opioid prescribing practices for patients who undergo vaginal delivery. Providers were contacted via email and completed survey via REDCap. Ninety-nine providers completed the survey between October 2018 and January 2019. Eight percent of all providers reported prescribing opioids at discharge after vaginal deliveries. There was a statistically significant difference in the proportion of physicians who provided opioid prescriptions at discharge compared to CNMs (16.7 percent vs 1.8 percent, respectively, p < .05). Common reasons for prescribing opioids at discharge included post-partum tubal ligation (56.4 percent), third- and fourth-degree lacerations (59.6 and 73.4 percent, respectively), and operative deliveries (26.6 percent). Physicians were significantly more likely to prescribe an opioid after a second-degree laceration than CNMs (19.1 percent vs 5.3 percent, p < 0.05). Practice patterns for opioid prescription vary by provider type as well as by delivery characteristics. Further study is necessary to delineate the optimal care while minimizing unnecessary opioid prescriptions.

The Physician Anesthesia Workforce in Canada From 1996 to 2018: A Longitudinal Analysis of Health Administrative Data.

A robust anesthesia workforce is essential to the provision of safe surgical, obstetrical, and critical care but information describing the physician anesthesia workforce and volume of clinical services delivered in Canada is limited. This study examines the Canadian physician anesthesia workforce, exploring trends in physician characteristics and activity levels over time. Practice patterns of specialist anesthesiologists and family physician anesthetists (FPAs) working in urban and rural communities were of particular interest. Physicians who provided anesthesia care between 1996 and 2018 were identified using health administrative data from the Canadian Institute of Health Information (CIHI). In addition, data from the Canadian Post-MD Education Registry (CAPER) were used to characterize physicians pursuing postgraduate anesthesia training (1996-2019). Descriptive analyses of physician demographics, training, location, specialty designations, and volume of clinical services were undertaken. Between 1996 and 2018, the anesthesia workforce grew 1.8-fold to 3681 physicians, including 536 FPAs. Over the same time, nerve block services increased 7-fold, and payments for other anesthesia services increased 5-fold. The average age of the anesthesiology workforce increased by 2.3 years and the annual retirement rate was 3%. The workforce has become more gender balanced but remains predominantly male (73% in 2018). The proportion of physicians who were trained internationally (about 30%; 38% in rural areas) remained stable (and higher than that in the overall physician workforce). FPAs provided most anesthesia care in rural Canada and their attrition rate was generally 2- to 3-fold higher than specialists. Physicians in the rural anesthesia workforce provided anesthesia services more intensively over time. Relatively few FPAs who left the anesthesia workforce entered full retirement and they instead contributed other medical services to their communities. This study provides foundational information regarding anesthesia workforce capacity over a 22-year period, including insights into demographics, locations of practice, and clinical volumes. The results do not quantify the gap between service capacity and need; however, they support the need for a national workforce strategy to achieve equitable access to sustainable anesthesia services in Canada, particularly for rural communities.

Impact of a structured educational intervention on attitudes and clinical practices in heart failure among physicians in argentina

Abstract Introduction It is necessary to identify areas for improvement in the care of patients with heart failure (HF), and thus implement educational interventions to optimize the quality of care and their clinical outcomes. Objective The aim of this study was to evaluate the attitudes, knowledge, confidence and care pathways of patients with HF among physicians in Argentina and their subsequent changes after an educational intervention. Methods We conducted a cross-sectional study using a self-administered survey to evaluate clinical practice patterns and attitudes/perceptions regarding the diagnosis, treatment and follow-up of HF patients in the outpatient and inpatient settings. Survey respondents were physicians from 22 centers in Argentina who participated in a comprehensive educational programme for the care of HF patients conducted between March and July 2021. The educational intervention was based on a 30-hour training programme in heart failure clinics and a final examination. Simple road maps were created to address the knowledge gaps identified in the pre-intervention phase. Results A total of 50 physicians were surveyed; the mean age was 41±8 years and 86% were cardiologists. The educational intervention significantly increased physicians' confidence in diagnosing HFpEF, with 52% feeling "confident" or "very confident" before and 84% after the intervention (p&amp;lt;0.001). In outpatients with HFrEF, more physicians reported prioritizing quadruple therapy with SLGT-2i, mineralocorticoid receptor antagonists (MRA), beta-blockers and angiotensin receptor neprilysin inhibitors (ARNI) in the post-intervention period (p&amp;lt;0.05, figure 2). No differences were found in the reported time to optimal medical treatment (p=0.7). After the intervention, the proportion of physicians who felt "confident" or "very confident" in identifying patients who could benefit from an implantable cardioverter-defibrillator increased from 70% to 96% (p=0.01). After the intervention, more doctors considered "relevant" and "very relevant" the administration of hypertonic saline (22% to 52%; p=0.01), and intravenous iron (56% to 80%; p=0.041). Compared to the pre-intervention period, more physicians prioritized quadruple therapy with beta-blockers, MRA, ARNI and SGLT2i (p&amp;lt;0.05, figure 2) at hospital discharge. There was a significant increase in the use of the discharge checklist from 26% to 48% (p=0.05). Conclusions A multifaceted structured educational intervention was effective in improving knowledge and attitudes about the diagnosis and management of patients with HF among physicians in Argentina. The results of the present study demonstrate that an educational intervention can increase knowledge and improve clinical attitudes in the diagnosis of HFpEF and management of outpatients and hospitalized patients with HFrEF. Further studies are needed to determine the impact of such programmes in other countries.

Knowledge about chest imaging findings in COVID-19 among healthcare workers in Goma, Democratic Republic of the Congo

Objectives: Chest imaging, particularly computed tomography, plays a crucial role in the evaluation of patients with Coronavirus disease 2019 (COVID-19) infection. This study aimed to assess physicians’ knowledge about chest imaging findings in COVID-19 patients in Goma, North Kivu Province (Democratic Republic of the Congo). Materials and Methods: This was a cross-sectional study involving 202 physicians who responded to the survey questionnaire. Performance was tested in terms of the mean score and proportions of correct answers for each questionnaire item. Multiple logistic regressions were used to identify factors associated with good knowledge. Results: The mean score obtained by respondents was 8.55 ± 2.49 out of 16 points. The proportion of physicians with more than 60% correct answers was 37.13%. There was no significant statistical association between good knowledge and the demographic and professional characteristics of the respondents (P &gt; 0.05). Conclusion: This study found that physicians’ knowledge about chest imaging findings in COVID-19 patients is poor. This lack of sufficient information on the part of healthcare workers indicates the need to develop continuing education programs.

Patterns in Physician Burnout in a Stable-Linked Cohort

Physician burnout is widely reported to be an increasing problem in the US. Although prior analyses suggest physician burnout is rising nationally, these analyses have substantial limitations, including different physicians joining and leaving clinical practice. To examine the prevalence of burnout among physicians in a large multispecialty group over a 5-year period. This survey study was conducted in 2017, 2019, and 2021 and involved physician faculty members of the Massachusetts General Physicians Organization. Participants represented different clinical specialties and a full range of career stages. The online survey instrument had 4 domains: physician career and compensation satisfaction, physician well-being, administrative workload on physicians, and leadership and diversity. Time. Physician burnout, which was assessed with the Maslach Burnout Inventory. A binary burnout measure was used, which defined burnout as a high score in 2 of the 3 burnout subscales: Exhaustion, Cynicism, and Reduced Personal Efficacy. A total of 1373 physicians (72.9% of the original 2017 cohort) participated in all 3 surveys. The cohort included 690 (50.3%) male, 921 (67.1%) White, and 1189 (86.6%) non-Hispanic individuals. The response rates were 93.0% in 2017, 93.0% in 2019, and 92.0% in 2021. Concerning years of experience, the cohort was relatively well distributed, with the highest number and proportion of physicians (478 [34.8%]) reporting between 11 and 20 years of experience. Within this group, burnout declined from 44.4% (610 physicians) in 2017 to 41.9% (575) in 2019 (P = .18) before increasing to 50.4% (692) in 2021 (P < .001). Findings of this survey study suggest that the physician burnout rate in the US is increasing. This pattern represents a potential threat to the ability of the US health care system to care for patients and needs urgent solutions.

Analysis of Physician Compliance with Guideline-Directed Medical Therapy for Patients with Heart Failure with Reduced Ejection Fraction: A Real-World Study.

Although compliance with the guideline recommendations for heart failure (HF) is associated with improved survival, the effects of medication on clinical practice often fail to meet expectations due to physician and/or patient-related reasons that are unclear. This study analyzed physicians' compliance with guideline-directed medical therapy (GDMT) based on real-world clinical data and identified risk factors of low compliance. This study included patients with HF, who were treated at the Affiliated Hospital of North Sichuan Medical College from July 2017 to June 2021. All patients were divided into high compliance, moderate compliance, and low compliance with GDMT groups. The proportion of patients receiving treatment in compliance with GDMT was analyzed, the relationship between compliance with GDMT and clinical outcomes was evaluated, and the risk factors of low compliance were identified. Of all patients with HF included in the study, 498 (23.8%) had low compliance with GDMT, 1413 (67.4%) had moderate compliance with GDMT, and 185 (8.8%) had high compliance with GDMT. The readmission rate of patients in the moderate compliance with GDMT group was significantly higher than that in the high and low compliance groups (p = 0.028). There were no significant differences in the rates of severe cardiovascular disease among the three groups. The mortality rate of patients in the high compliance with GDMT group was significantly higher than that of the other groups (p 0.001). We found that a history of hypertension; New York Heart Association (NYHA) classification (III and IV vs. I); and abnormal heart rate, high-sensitive troponin T (hsTnT), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), uric acid, and left ventricular diastolic dysfunction (LVDD) were all significantly associated with low compliance with GDMT. The proportion of physicians' compliance with GDMT in treating patients with HF is low. Risk factors of low compliance include hypertension; NYHA classification (III and IV vs. I); and abnormal heart rate, hsTnT, NT proBNP, uric acid, and LVDD.

Implementation of the Canadian syncope pathway: a pilot non-randomized stepped wedge trial.

We developed the Canadian Syncope Pathway (CSP) based on the Canadian Syncope Risk Score (CSRS) to aid emergency department (ED) syncope management. This pilot implementation study assessed patient inclusion, length of transition period, as well as process measures (engagement, reach, adoption, and fidelity) to prepare for multicenter implementation. A non-randomized stepped wedge trial at two hospitals was conducted over a 7-month period. After 2-3months in the control condition, the hospitals crossed over in a stepwise fashion to the intervention condition. Study participants were ED and non-ED physicians, or their delegates, and patients (aged ≥ 18years) with syncope. We aimed to analyze patient characteristics, ED management including disposition decision, and CSRS recommendations application for all eligible patients during the intervention period. Our targets were 95% inclusion rate, 70% adoption (proportion of physicians who applied the pathway), 60% reach (intervention applied to eligible patients) and 70% fidelity (appropriate recommendations application) for all eligible patients. Clinical Trials registration NCT04790058. 1002 eligible patients (mean age 56.6years; 51.0% males) were included: 349 patients during the control and 653 patients during the intervention period. Physician engagement varied from 39.7% to 97.1% for presentation at meetings. Process measures for the first month and the end of the intervention were: adoption 70.7% (58/82) and 84.4% (103/122), reach 67.5% (108/160) and 55.0% (359/653), fidelity among patients with physician data form completion 86.3% (88/102) and 88.3% (294/333), versus fidelity among all eligible patients 83.8% (134/160) and 83.3% (544/653) respectively with no significant differences in fidelity at one month and the end of the intervention period. In this pilot study, we achieved all prespecified benchmarks for proceeding to the multicenter CSP implementation except reach. Our results indicate a 1-month transition period will be adequate though regular reminders will be needed during full-scale implementation.

Changes in comprehensiveness of services delivered by Canadian family physicians: Analysis of population-based linked data in 4 provinces.

To describe changes in the comprehensiveness of services delivered by family physicians across service settings and service areas in 4 Canadian provinces, to identify which settings and areas have changed the most, and to compare the magnitude of changes by physician characteristics. Descriptive analysis of province-wide, population-based billing data linked to population and physician registries. British Columbia, Manitoba, Ontario, and Nova Scotia. Family physicians registered to practise in the 1999-2000 and 2017-2018 fiscal years. Comprehensiveness was measured across 7 service settings (home care, long-term care, emergency departments, hospitals, obstetric care, surgical assistance, anesthesiology) and in 7 service areas consistent with office-based practice (prenatal and postnatal care, Papanicolaou testing, mental health, substance use, cancer care, minor surgery, palliative home visits). The proportion of physicians with activity in each setting and area are reported and the average number of service settings and areas by physician characteristics is described (years in practice, sex, urban or rural practice setting, and location of medical degree training). Declines in comprehensiveness were observed across all provinces studied. Declines were greater for comprehensiveness of settings than for areas consistent with office-based practice. Changes were observed across all physician characteristics. On average across provinces, declines in the number of service settings and service areas were highest among physicians in practice 20 years or longer, male physicians, and physicians practising in urban areas. Declining comprehensiveness was observed across all physician characteristics, pointing to changes in the practice and policy contexts in which all family physicians work.

Physician-reported barriers and strategies to using tumor mutational burden (TMB) testing in oncology care: An interview based study.

e15063 Background: Despite the availability of genomic technologies to inform treatment for oncology patients, widespread adoption of genomic testing in the U.S. has been challenging. Little information is available about the factors that influence clinical decision making regarding the use of TMB testing. The purpose of this study was to identify barriers to the adoption of TMB testing and preferred strategies to increase testing from the physician’s perspective. Methods: Semi-structured video-based interviews were conducted with a sample of U.S. physicians (N = 11), including 6 general medical oncologists, 3 surgical oncologists, and 2 gynecologic oncologists. Physicians were asked about practice characteristics, perceived barriers to testing, and potential strategies for alleviating these barriers. Results: Eighty-two percent (N = 9) of physicians reported utilizing TMB testing in their routine clinical practice. Reimbursement was the most commonly reported barrier (64%) including coverage policy language indicating the testing as “experimental”/“unproven”, patients having to pay out of pocket, and unclear/inconsistent payer policies (27% each) [Table 1]. Knowledge, resource-related, and logistical barriers were reported among the same proportion of physicians (45%). Suggested strategies to improve TMB testing uptake rates among physicians included better understanding of clinical utility of the test and corresponding therapies, integrating results into electronical medical records, incorporating TMB into routine testing, and shorter turnaround time for results. Conclusions: This qualitative study of physicians identified barriers to TMB testing of oncology patients. Results suggest that challenges around reimbursement, knowledge, resources, and logistics are key barriers to use of TMB testing for physicians. The findings of this study provide insights for future research and strategies to increase the adoption of TMB testing. [Table: see text]

An assessment of the relationship between national rates of Covid-19 incidence and mortality as reported to an international comparison database: An ecological study.

Making a judgment only based on formal national reports can be misleading. We aimed to assess the relationship between countries' development indicators and reported coronavirus disease 2019 (Covid-19)-related incidences and death. Covid-19 related incidence and death cases were extracted from the updated Humanitarian Data Exchange Website on October 8, 2021. Univariable and multivariable negative binomial regression were utilized to investigate the relationship between development indicator and incidence and mortality from Covid-19 by calculating the Incidence rate ratio (IRR), mortality rate ratio (MRR), and fatality risk ratio (FRR). Very high human development index (HDI) compared with low HDI (IRR:3.56; MRR:9.04), the proportion of physicians (IRR:1.20; MRR:1.16), besides extreme poverty (IRR:1.01; MRR:1.01) were independently correlated with the mortality and incidence rate of Covid-19. Very high HDI and population density were inversely correlated with the fatality risk (FRRs of 0.54 and 0.99). The cross-continental comparison shows Europe and the North Americas, had significantly higher incidence and mortality rates with IRR of 3.56 and 1.84 as well as MRRs of 6.65 and 3.62, respectively. Also, they inversely correlated with the fatality (FRR:0.84 and 0.91, respectively). A positive correlation between the fatality rate ratio based on countries' development indicators and the reverse for the incidence and mortality rate was found. Developed countries with sensitive healthcare systems can diagnose infected cases as soon as possible. Also, the mortality rate of Covid-19 will be accurately registered and reported. Due to more access to diagnostic tests, patients are diagnosed at the initial stages and will have a better opportunity to receive treatment. This leads to higher reports of incidence/and/or mortality rates and lower fatality of COVID-19. In conclusion, more Covid-19 incidence and mortality cases in developed countries can result from a more comprehensive care system and a more accurate recording procedure.

Approaches of Surgical and Internal Branch Resident Physicians to Anaphylaxis

Aim:The aim of this study is to evaluate the level of knowledge about anaphylaxis among resident physicians working in a tertiary care hospital in Istanbul.&#x0D; Materyal and Methods:Our descriptive study was conducted with resident physicians working in a tertiary hospital in Istanbul.A questionnaire including questions about the diagnosis and treatment of anaphylaxis was administered to physicians. &#x0D; Results:172 resident physicians were surveyed within the scope of the study.While 47.0% (n=79) of the physicians were internal medicine residents, 53.0%(n=89) were surgical medicine residents. In terms of duration of employment in the profession, 76.2% (n=131) had a working period of 5 years or less.Median age was 29.0 years; minimum age was 25.0 years and maximum age was 53.0 years.All resident physicians felt that anaphylaxis could be life-threatening.The rate of those who correctly knew the clinical criteria for the diagnosis of anaphylaxis was 63.4% (n=109).The rate of those who knew that adrenaline was the first-line drug in the treatment of anaphylaxis was 95.9% (n=165).While 86.6% (n=149) of the physicians answered that adrenaline was administered intramuscularly, 70.0% (n=119) correctly answered the dose of adrenaline and 76.0% (n=130) correctly answered the name of the muscle where adrenaline was administered.The proportion of physicians who stated that anaphylaxis patients should be followed up for 24 to 72 hours was significantly higher in surgical branches (82.0%; n=73) than in internal branches (68.4%; n=54) (p