Medicine Providers Research Articles

Addiction consult service involvement in PrEP and PEP delivery for patients who inject drugs admitted to an urban essential hospital

BackgroundAddiction medicine providers have a key role in HIV prevention amidst rising HIV incidence in persons who inject drugs (PWID). Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are vastly underutilized in this population. Inpatient hospitalization represents a potential touchpoint for initiation of HIV prophylaxis, though little research explores the role of addiction providers. Here we describe rates of PrEP/PEP delivery to hospitalized PWID seen by an Addiction Consult Service (ACS) at an urban, essential hospital.MethodsWe performed a cross-sectional study of hospitalized patients who were seen by the ACS from January 1, 2020 to December 31, 2022 and had plausible injection drug use. We calculated the proportion of patients who received a new prescription for PrEP/PEP at discharge. We used descriptive statistics to characterize demographics, substance use, reason for admission, and indications for PrEP/PEP. Secondarily, we calculated the monthly proportion of all patients discharged from the hospital with PrEP/PEP who were seen by the ACS compared to those not seen by the ACS.ResultsThe average monthly proportion of ACS consults with plausible injection drug use who received PrEP/PEP was 6.4%. This increased from 4.2% in 2020 to 7.5% in 2022. Those seen by the ACS who received PrEP/PEP had high rates of opioid use disorder (97.5%), stimulant use disorder (77.8%), and homelessness (58.1%); over half were admitted for an injection-related infection. The indications for PrEP/PEP were injection drug use only (70.6%), followed by combined injection and sexual risk (20.2%); 71.9% of prescriptions were for PrEP and 28.1% for PEP. Overall, the ACS was involved in 83.9% of hospital-wide discharges with PrEP/PEP prescriptions (n = 242).ConclusionsPWID who were seen by the ACS received PrEP/PEP prescriptions at rates exceeding national averages. The ACS was also involved with the care of the majority of admitted patients who received PrEP/PEP at discharge. While PrEP/PEP use for PWID remains low, the inpatient ACS represents a key resource to improve uptake by leveraging the reachable moment of an inpatient hospitalization.

Assessing a Training Program for Integrative Medicine Practitioners in the Treatment of Acute Stress Disorder.

The study examined a training program for integrative medicine (IM) providers, teaching clinical skills for treating acute stress disorder (ASD). A 10-h online training program, designed by IM and mental health professionals, was attended by a group of 32 IM providers working in supportive and palliative oncology care. Pre- and post-course questionnaires assessed self-perceived levels of IM and mental health ASD-related skills (from 1, very low; to 7, very high). Most participants (25; 78%) completed pre- and post-study questionnaires, which showed an increase in post-course scores for the expectation that IM could reduce ASD-related pain (p=0.004). Scores for self-assessed skill levels increased for treating gastro-intestinal symptoms and appetite (p=0.039) and for dyspnea (p=0.048). A borderline increase for arousal was observed (p=0.063), with no increase with other arousal symptom cluster symptoms. The ASD-focused training program for IM practitioners was associated with an increase in self-perceived levels for related clinical skills quality of life-related concerns, primarily pain, appetite and dyspnea. Further research is needed to better understand the implications of the findings, and to explore the implementation of the learned skills in clinical practice.

Reply to Editorial Comment on “Assessing Attitudes and Confidence in Managing Erectile Dysfunction Among Urology, Internal Medicine, and Family Medicine Providers”

Reply to Editorial Comment on “Assessing Attitudes and Confidence in Managing Erectile Dysfunction Among Urology, Internal Medicine, and Family Medicine Providers”

Clinical management of active bleeding: what the emergency radiologist needs to know.

Active bleeding is a clinical emergency that often requires swift action driven by efficient communication. Extravasation of intravenous (IV) contrast on computed tomography (CT) is a hallmark of active hemorrhage. This can be seen on exams performed for a variety of indications and can occur anywhere in the body. As both traumatic and non-traumatic etiologies of significant blood loss are clinical emergencies, exams demonstrating active bleeding are often performed in emergency departments and read by emergency radiologists. Prompt communication of these findings to the appropriate emergency medicine and surgical providers is crucial. Although many types of active hemorrhage can be managed by interventional radiology techniques, endoscopic and surgical management or clinical observation may be appropriate in certain cases. To facilitate optimal care, it is important for emergency radiologists to understand the scope of indications for embolization of bleeding by interventional radiologists (IR) and when an IR consultation is warranted. Similarly, timely comprehensive diagnostic radiology reporting including pertinent positive and negative findings tailored for IR colleagues can expedite the appropriate intervention.

Emergency imaging protocols for pregnant patients: a multi-institutional and multi- specialty comparison of physician education.

Previous studies have demonstrated that radiologists and other providers perceive maging to be higher than they actually are. Thus, pregnant patients were less likely to receive ionizing radiation procedures. While it is imperative to minimize fetal radiation exposure, clinicians must remember that diagnostic studies should not be avoided due to fear of radiation, particularly if the imaging study can significantly impact patient care. Although guidelines do exist regarding how best to image pregnant patients, many providers are unaware of these guidelines and thus lack confidence when making imaging decisions for pregnant patients. This study aimed to gather information about current education, confidence in, and knowledge about emergency imaging of pregnant women among radiology, emergency medicine, and OB/GYN providers. We created and distributed an anonymous survey to radiology, emergency medicine, and OB/GYN providers to evaluate their knowledge and confidence in imaging pregnant patients in the emergent setting. This study included a questionnaire with the intent of knowing the correct answers among physicians primarily across the United States (along with some international participation). We conducted subgroup analyses, comparing variables by specialty, radiology subspecialty, and training levels. Based on the survey results, we subsequently developed educational training videos. 108 radiologists, of which 32 self-identified as emergency radiologists, ten emergency medicine providers and six OB/GYN clinicians completed the survey. The overall correct response rate was 68.5%, though performance across questions was highly variable. Within our 18-question survey, four questions had a correct response rate under 50%, while five questions had correct response rates over 90%. Most responding physicians identified themselves as either "fairly" (58/124, 47%) or "very" (51/124, 41%) confident. Amongst specialties, there were differences in performance concerning the knowledge assessment (p = 0.049), with the strongest performance from radiologists. There were no differences in knowledge by training level (p = 0.4), though confidence levels differed significantly between attending physicians and trainees (p < 0.001). This study highlights deficiencies in knowledge to support appropriate decision-making surrounding the imaging of pregnant patients. Our results indicate the need for improved physician education and dissemination of standardized clinical guidelines.

Comparison of Point-of-Care Ultrasound Guidance and the Traditional Approach in Performing Simulated Emergent Cricothyroidotomy Among Emergency Medicine Physicians, Residents, and Students.

Objective Emergency cricothyroidotomy (EC) is a rare procedure used to establish airway access when both endotracheal intubation and bag-mask ventilation have failed. Point-of-care ultrasound (POCUS) has been proposed as an adjunct to aid in identifying anatomical landmarks. However, its impact on emergency physicians when performing EC remains unclear. This study compared emergency physician and student confidence, preference, and procedure time between POCUS and traditional palpation for EC. Methods Our study utilized a randomized controlled crossover design. Emergency medicine providers attended a didactic lecture demonstrating traditional palpation and POCUS techniques for EC. The participants were randomly allocated to two simulation groups. One group started with the palpation of landmarks, while the other group started with POCUS landmark identification. A randomized crossover design was employed, and in a subsequent simulation, the reverse technique was utilized. Time to anatomic landmark identification was recorded. Participants completed a survey assessing their confidence and preference. Procedure times and confidence level differences were examined via Wilcoxon signed-rank tests. Results Sixteen participants completed the survey and were included in the final analysis. All participants successfully performed EC with the two landmark identification techniques. There was no significant difference in self-reported confidence between POCUS and palpation (p = 0.17). Landmark identification by palpation was significantly faster than POCUS (p = 0.001). A total of 10 (63%) participants preferred palpation over POCUS. Conclusions Both POCUS and traditional palpation were effective in identifying anatomical landmarks for EC. Although palpation was significantly quicker, confidence and preference between the two techniques were similar. The results suggest that both approaches can benefit clinical practice, depending on the context and provider familiarity. Further studies with larger cohorts and real-world scenarios are recommended to explore the effectiveness and safety of POCUS in EC.

8079 PPI Breaks a Leg! An Unusual Case of Atypical Femur Fracture

Abstract Disclosure: M. Sedghian: None. M. Flanagan: None. D. Pinkhasova: None. K. Selk: None. G. Moloney: None. Background: Atypical femur fractures (AFF) occur along the shaft of the femur extending from the subtrochanteric region proximally to the distal femoral metaphysis. These fractures have an increased incidence in patients taking bisphosphonates and denosumab for osteoporosis and develop as stress reactions in the lateral cortex of the femoral shaft (beaking). However, few cases that meet the characteristics of these fractures have occurred in patients who have never used antiresorptive drugs. We present a case with a history of long-term proton pump inhibitor (PPI) use and possible association with AFF. Clinical Case: The patient is a 68-year-old female with a past medical history of hypothyroidism who presented to the emergency department (ED) after an atraumatic femur fracture and consequently ground level fall. The patient reported experiencing a distinctive cracking sound in her femur while leaning over to wash her feet, resulting in a fall that prompted her to seek immediate care in the ED. Upon initial evaluation, radiographic imaging was significant for displaced left mid-femoral diaphyseal fracture and right femur lateral cortex thickening consistent with AFF. Labs were consistent with elevated PTH to 100.7 [18.4-80.1], Vit D2 1,25 (OH)2 &amp;lt;8 pg/mL, Vit D 25OH 34 ng/ml [30-100], and Calcium level of 9.5. Upon further history taking, the patient stated that she has been taking PPIs intermittently for more than 10 years. She denied a history of bisphosphonate and denosumab exposure, non-Hodgkin's lymphoma, rheumatoid arthritis, and COL1A2 variant mutations as main predisposing factors for atypical femur fractures. She had potential steroid exposure for less than a year before hospitalization as she was on "adrenal complex" from her functional medicine provider. The patient underwent open reduction and internal fixation of the left femur with placement of intramedullary nail and prophylactic fixation with placement of intramedullary nail of the right femur as there was radiographic evidence of beaking. Discussion/Conclusion: Several studies suggested a possible association between PPIs and fracture risk, especially hip fractures, but the relationship remains contentious. Overall, PPIs are positively associated with elevated fracture risk in multiple studies. Increased gastrin production and hypochlorhydria are the two main mechanisms that affect bone remodeling, decreasing bone turnover, impairing calcium absorption, and altering homocysteine levels through impairment of folate and vitamin B12 absorption.This case supports a potential association between long-term PPI use and atypical femur fractures. There have been other case reports that also highlight this potential risk of PPI use. This shows the importance of more comprehensive research on this topic as the number of patients on long-term PPIs is growing in outpatient settings. Presentation: 6/2/2024

12441 Factors Affecting The Evaluation Of Adrenal Incidentalomas

Abstract Disclosure: A. Poloju: None. S.K. Pabich: None. S. Syed: None. A. Krueger: None. A. Chiu: None. Introduction: Adrenal incidentalomas are increasingly being detected, owing to the increasing number of high-resolution radiologic studies performed. While most of the nodules are non-functional, 10-15% are hormonally active and hence merit workup. We assessed the rates of, and factors associated with appropriate workup of these nodules. Methods: A retrospective analysis of CT chest and abdominal scans between Jan 1, 2021, and June 1, 2022, in adults ≥18 years at a single tertiary care center was performed. Reports were screened with key phrases to identify adrenal nodules. A chart review was conducted to confirm the reported nodule, obtain demographic data, obtain data on co-morbid conditions, and evaluate for biochemical and radiologic workup. Exclusion criteria included: patients deceased at the time of our review, previously diagnosed nodules, sub-centimeter lesions, and adrenal hemorrhage. Patients were categorized as being from high or low disadvantaged neighborhoods based on their Area Deprivation Index (ADI) score. ADI above the 50th percentile was categorized as more disadvantaged. Charleston Comorbidity Index (CCI), a 10-year survival predictor based on the presence of common diseases was abstracted. Patients with any biochemical workup were compared to patients with no workup. Bivariate analysis was performed using chi-squared and Student’s t-test analysis. A multivariate logistic regression was performed to evaluate factors associated with biochemical workup. Results: A total of 533 records were reviewed. After applying the above exclusion criteria, a total of 245 patients were included in our analysis. Baseline characteristics included: 58.7% female and 41.2% male. 67.3% had hypertension diagnosis, 22% had sleep apnea diagnosis, and 30.6% had diabetes diagnosis. 86% were White, 5.7% Black, 3.2% Hispanic, 3.2% Asian, and 1.6% Other. 71% of the patients had no biochemical workup, 18% had partial workup, and 11% had full workup. Factors associated with having either partial or full workup compared to no workup included female sex (OR 2.33, CI 1.23-4.41), internal medicine/family medicine provider ordering the scan compared to Emergency Department providers (OR 3.84, CI 1.61-9.14), and ADI scores below the 50th percentile (OR 1.98, CI 1.04-3.78). There was no statistically significant difference based on age, race, ethnicity, and CCI. There was no significant difference in the workup for hypercortisolism based on the presence of co-morbid conditions like diabetes, sleep apnea, and overweight/obesity. Conclusions: In our study population, the rates of guideline-based biochemical workup of adrenal incidentalomas were very low at 11%. Factors associated with having at least partial biochemical workup included less socioeconomic disadvantage, female sex, and studies ordered by primary care providers. Presentation: 6/3/2024

Assessing Attitudes and Confidence in Managing Erectile Dysfunction Among Urology, Internal Medicine, and Family Medicine Providers

ObjectiveTo assess and contrast attitudes and confidence regarding erectile dysfunction (ED) treatment among urologists (GU) and primary care providers (PCPs), identifying areas for collaboration, practice improvement, and additional training to enhance men's healthcare (MH) quality and access. MethodsAn anonymous survey with 25 questions on ED treatment, rated on a 5-point Likert scale, was conducted among our institution's providers in GU, internal medicine (IM), and family medicine (FM). Data were analyzed using descriptive statistics and Fisher’s exact test. Results138 providers responded, including 58 IM, 47 FM, and 33 GU. FM and IM responses generally overlapped with some differences. IM were more positive regarding vacuum erection device (VED) and inflatable penile prosthesis (IPP) satisfaction and risk.Comparing GU to FM + IM, GU displayed greater confidence and knowledge about ED. Notably, 63% of GU used the validated International Index of Erectile Function (IIEF) compared to 3% of FM + IM. Additionally, 100% of GU strongly/agreed that good options remained after pills failed vs 83% of FM + IM.Significant differences in GU vs FM + IM perspectives on IPP included patient willingness to undergo surgery for ED (67% vs. 12%), patient satisfaction (91% vs. 28%), partner satisfaction (79% vs. 26%) and willingness to recommend/repeat surgery (82% vs. 17%). Notably, 82% of GU vs 10% of FM + IM were aware that Medicare covered implants. ConclusionThis survey reveals significant knowledge gaps in ED treatment between GU and PCPs. Targeted provider education, particularly about penile prostheses, could optimize patient care.

Editorial Comment on “Assessing Attitudes and Confidence in Managing Erectile Dysfunction Among Urology, Internal Medicine, and Family Medicine Providers”

Editorial Comment on “Assessing Attitudes and Confidence in Managing Erectile Dysfunction Among Urology, Internal Medicine, and Family Medicine Providers”

Characterizing access for oral oncolytics used to treat breast cancer at an academic medical center.

116 Background: Everolimus, CDK 4/6, PIK3CA, Her2 tyrosine kinase, and PARP inhibitors are commonly used oral oncolytic agents for breast cancer patients. However, oral oncolytics are tiered differently for insurance cost coverage than IV therapies. We characterized the financial toxicity associated with breast cancer oral oncolytics, investigated the prevalence of financial assistance mechanisms utilized, and explored the association of these mechanisms with timing of treatment initiation in adult breast cancer patients. Methods: Patients 18 years or older with a primary breast cancer diagnosis who received care at the outpatient breast cancer clinic and were prescribed an oral oncolytic by a Michigan Medicine provider were included. Using the electronic medical record, we identified initial prescriptions for everolimus, CDK 4/6 inhibitors (palbociclib, ribociclib, abemaciclib), PIK3CA inhibitor (alpelisib), HER2 tyrosine kinase inhibitors (lapatinib, neratinib, tucatinib), and PARP inhibitors (olaparib, talazoparib) dated between January 1, 2014 and November 30, 2022. Patient demographics, adjuvant versus metastatic status, insurance coverage, monthly out-of-pocket costs, financial assistance obtained, prescribed date, planned medication start date, pill-to-mouth date, duration of treatment and reason for treatment discontinuation were collected. Results: There were 418 unique patients in our final cohort. Almost one third of all prescriptions were filled with financial assistance (n=126, 31.2%). The three most common assistance mechanisms were copay cards (n=55, 43.6%), grants (n=34, 26.9%) and patient assistance programs (n=31, 24.6%). For monthly out-of-pocket costs before any financial assistance was obtained, the three most common cost groups were $0-$15 (n=155, 36%), $15-$100 (n=101, 23.7%) and &gt;$500 (n=91, 21%). Among the 48 prescriptions that were never filled, almost one third were due to prohibitive cost (n=15, 28.3%). For insurance coverage, the three most common types were commercial (n=224, 54%), Medicare Part D (n=108, 26%), and Medicaid (n=57, 14%). The median number of days treatment was delayed was 10 days (range 0-495 days). Insurance approval/denial delays accounted for 33.9% of delays (n=120). Conclusions: One third of breast cancer oral oncolytic prescriptions were filled with financial assistance. In the instances in which patients were not able to receive timely treatment for their cancer, one out of three times it was due to insurance delay.

Development of a minimum data set for a blockchain-based personal health records (PHRs), for patient/physician interaction in family medicine

BACKGROUND: The primary requirement for a capable patient health record (PHR) that can interact appropriately with the family medicine system and collect and share qualified data is a minimum data set (MDS) aligned with family medicine’s functions and goals. The aim of this research was to determine the MDS for a blockchain-based PHR system that can effectively interact with family medicine providers and collect and share qualified data. This MDS is intended to be applicable to all members of the community covered by family medicine. MATERIALS AND METHODS: This applied study was conducted in 2022 in a cross-sectional and descriptive approach in three phases. In the first phase, a content analysis related to the research objectives was conducted in scientific databases, search engines, and websites of the centers and scientific research organizations with publications and policy-making in this field. Consequently, 11 studies were selected for use in the second and third phases. In the second phase, to determine information needs, a researcher-developed questionnaire including 17 classes was given to 50 people under the cover of the family medicine plan in Shiraz city. By choosing one of the two options “Yes” or “No” by them, the necessary data classes were determined. In the third phase, the second researcher-developed questionnaire was designed and administered to 100 family physicians in Shiraz city. This questionnaire included the data elements corresponding to the data classes approved in the previous phase. The family physicians were asked to rate the importance of each data element using a Likert scale with five options, ranging from “very unimportant” to “very important.” The necessary data elements were determined based on these scores. RESULTS: In the first questionnaire, 16 of the 17 data classes received approval from individuals covered by the family medicine plan. Consequently, a questionnaire comprising 16 classes and 105 data elements was administered to the family physicians. Ultimately, the MDS was determined to include 16 classes and 72 data elements. CONCLUSIONS: Determining essential data elements, especially for patient/physician interaction in family medicine, should be such that they can be managed by the person while being comprehensive and providing sufficient help to the physician during the treatment process. This MDS can be used to interact with and refer PHRs to other physicians and specialists, as well as help interoperability between the PHR and other health systems, such as hospital information systems (HIS) and electronic health records (EHRs).

Assessment of an Airway Curriculum in a Pulmonary and Critical Care Fellowship Program.

Endotracheal intubations (EIs) in the intensive care unit are high-risk procedures often performed by pulmonary and critical care medicine (PCCM) providers. The Accreditation Council for Graduate Medical Education mandates PCCM fellows' competency in this procedure; however, the learning experiences vary across programs. After conducting a needs assessment, we developed a curriculum unique to our institution to supplement our fellows' existing EI experiences in the operating room and the intensive care unit. To assess the curriculum's short-term objectives: knowledge acquisition, maintenance, and practical skills 1 year after participation. We administered a survey to the graduating PCCM fellows for two consecutive years. We designed the comprehensive airway curriculum to include didactic lectures and simulation-based education. The knowledge acquisition and maintenance were measured by administering a 26-question knowledge survey before and after curriculum participation and after 1 year. The fellows also received a practical examination 1 year after participation. To compare knowledge survey scores, we used paired t tests and permutation tests. In the needs assessment, 56% of graduating fellows believed they were proficient in performing EI, whereas 33% were undecided and 11% believed they were unprepared. Most believed they would need more than two courses after graduation to be confident in independently performing EIs. Most will only occasionally have backup for EI from anesthesiology or emergency medicine in their future jobs. One identified barrier to learning EI was the lack of a formal curriculum. In the knowledge assessment, nine first-year fellows participated in the curriculum. The cohort's mean presurvey score was 13.0 (standard deviation [SD], 4.5) versus 18.6 (SD, 3.6) mean postsurvey score. One year after participation, the mean survey score was 17 (SD, 1.2). The postsurvey and 1-year postparticipation survey scores were significantly higher than the presurvey scores (P < 0.05). One year after participation, the practical examination showed most fellows retained skills in EI using ramped position, video and direct laryngoscopy, bag-mask ventilation, and oropharyngeal airway placement. The airway curriculum enhances fellows' knowledge acquisition and maintenance 1 year after participation. The practical examination 1 year after participation highlighted the skills retained and those still needing improvement.

Building RECOVERY: development of the registry of eating disorders and their co-morbidities OVER time in youth

BackgroundEating disorder (ED) research is limited by the lack of longitudinal cohort studies, particularly those in adolescents, and the lack of inclusion of multiple perspectives and diagnoses. The objective of this study was to describe the development of a longitudinal cohort of adolescents/young adults representing varied ED diagnoses and including perspectives of parents and multi-disciplinary clinicians in addition to those of patients.MethodsPatients of an outpatient ED program who were age 10–27 years, along with their parents and clinicians, were recruited to participate in a longitudinal web-based study. Using univariate, bivariate, and multivariate analyses, we assessed rates of participation among different groups (i.e., parents, patients, different clinical disciplines) as well as factors related to attrition.Results71% of patients, 75% of parents, 56% of adolescent medicine providers, 20% of primary care physicians, 83% of dietitians, and 80% of mental health clinicians invited agreed to participate. At 12 months, 32% of patient participants had not completed their on-line surveys. Attrition rates were higher for parents (55%) and clinicians (45% of nutritionists, 55% of primary care physicians, 51% of Adolescent/Young Adult providers, and 64% of mental health providers) at 12 months.ConclusionsA longitudinal registry of patients with EDs is feasible and efficient when using web-based surveys. However, clinician participation is particularly hard to secure and maintain.

Buprenorphine prescription and treatment initiation through preemptive outreach and telehealth consultation with emergency medicine providers

Background Persons with opioid use disorder (OUD) urgently need improved access to medications for opioid use disorder (MOUD) and long-term treatment. Promising options include initiating buprenorphine in the emergency department (ED), telemedicine, and proactive treatment referrals before overdose events. Objective(s) We describe the process and outcomes of a novel referral path utilizing preemptive outreach and telemedicine to facilitate rapid access to MOUD and long-term treatment. Methods Participants were referred to telemedicine appointments with ED providers for buprenorphine initiation and to treatment agencies via an electronic referral network. Administrative data tracked participation at each stage of the process. Independent samples t-tests and chi-square tests assessed differences in process completion based on demographics. Results 163 persons with OUD or recent opioid overdose were referred, with high rates of participant follow-through, resulting in 126 new buprenorphine prescriptions and 114 linkages to long-term treatment. Of the 163 patients referred, 114 (69.9%) completed all steps. Participant demographics were not associated with significantly different completion rates. Conclusions This model serves as a viable pathway to link people to treatment resources and MOUD, and novelly combines prospective client outreach with telemedicine to reach persons before they arrive in the ED following an overdose. Future studies should examine the impact of similar programs on subsequent opioid use rates and treatment retention.

Prescription of potentially inappropriate medications in older adults; data from a dental institution

Objectives: To determine the types and frequency of potentially inappropriate medications (PIMs) prescribed to geriatric patients while considering the patients’ age groups and their American Society of Anesthesiologists (ASA) physical status.Study Design: We performed a five-year retrospective chart review of patients aged 65 and above who were seen in a dental institution. Patients’ medical history, PIM prescriptions, and prescribers’ specialty and professional status were analyzed.Results: Out of 10675 geriatric patients identified, 6.2% (n=662) received PIM prescriptions. Of those, 77% received one PIM while the others (23%) received anywhere between 2 to 6; the majority (73.7%) of these 662 patients fell within an ASA III physical status. NSAIDs were the most prescribed PIM (provided to 60.1% of subjects) followed by opioids (provided to 32.5% of subjects). Both NSAIDs and opioids were largely provided by providers in oral and maxillofacial surgery followed by those in restorative dentistry and periodontics. Benzodiazepines were mostly prescribed by endodontics providers, while tricyclic antidepressants, muscle relaxants, and anticonvulsants were mostly prescribed by oral medicine providers. Residents prescribed opioids at similar rates to faculty (p=0.78) but exceeded faculty in prescribing benzodiazepines (p<0.001).Conclusion: PIMs were prescribed at low percentages to geriatric patients; however, most prescriptions were provided to patients classified with ASA III status. Further efforts are indicated, at institutional and national levels, to monitor/limit PIMs provided to geriatric population.

Construction of TCM Institution Image: A Corpus-Based Comparative Critical Discourse Study of Chinese and Western Mainstream Media Reports

This study conducts a corpus-assisted comparative analysis of the media images of Traditional Chinese Medicine (TCM) institutions in Chinese and Western media contexts. Applying Fairclough’s three-dimensional critical discourse analysis (CDA) model alongside the TCM Social Image Evaluation Index System, this study explores media image construction and ideological factors shaping the perception of TCM institutions globally through an analysis of linguistic features in keywords, evaluative collocates and modal verbs. It’s found that Chinese media present TCM institutions in a positive light, depicting them as multifaceted organizations with a rich cultural legacy and robust capabilities in medical and scientific research. They showcase TCM institutions as cooperative, promising in integration with modern healthcare, efficient, rapid, flexible, innovative, and imbued with humanitarian values especially during the COVID-19 epidemic. Western media, however, adopt a more cautious stance. They tend to frame TCM institutions as providers of alternative medicine and temporary solutions, with a focus on health preservation, leisure and overall well-being. Concerns have also been raised about the potential illicit activities associated with some massage schools. These disparities in presenting TCM institutions reflect cultural, political and audience demand differences between China and the West. The results of this study contribute to a deeper understanding of the media portrayal of TCM institutions, provide insights into the challenges facing the global recognition and acceptance of TCM institutions, and suggest strategies for Chinese media, TCM practitioners, and policymakers to enhance their international image.

Healthcare providers’ knowledge and attitudes about overdose prevention sites in Colorado

BackgroundOverdose prevention sites (OPS) are a harm reduction strategy that offer people who use drugs a variety of resources including but not limited to sterile supplies, linkage to healthcare resources, and intervention if an overdose occurs. OPS operate in over 120 countries and evidence has demonstrated they are an effective harm reduction strategy. Despite their success elsewhere, OPS remain federally illegal in the United States and thus there is limited research on their implementation and outcomes in the United States. This study aimed to identify Colorado healthcare providers’ knowledge and attitudes about OPS and determine if there is a correlation between healthcare providers with more knowledge about OPS having a more positive attitude about OPS.MethodsAn electronic survey was distributed to healthcare providers in Colorado. Responses were collected in early 2022 and recorded on a 5-point Likert scale. Mean scores between 1 and 5 were calculated for each participant and analysis of variance methods were used to determine correlating demographic factors. A p value of ≤ 0.05 was used to determine statistical significance of all findings.ResultsThis study included 698 participants. A Pearson correlation analysis revealed a strong positive relationship (r = 0.76, p < 0.0001) between provider knowledge and attitudes about OPS. Emergency medicine providers scored the highest in mean knowledge and attitude scores in comparison to all other specialties. Respondents affiliated with a harm reduction center exhibited the highest mean knowledge and attitude scores. Mean knowledge and attitude scores generally rose with respondents’ increasing encounters with people who inject drugs in a typical workday, except when reaching nine or more encounters, where a sharp decline occurred.ConclusionsOur study highlights the importance of education, exposure to harm reduction strategies, and inter-specialty collaboration in shaping healthcare providers’ knowledge and attitudes about OPS. The positive correlation between providers’ knowledge and attitudes about OPS suggests that educating healthcare providers on harm reduction strategies, specifically OPS, may lead to reduced stigmatization of OPS among healthcare professionals.

Advice to future family physicians: findings from qualitative interviews with family medicine residents and early-career family physicians

BackgroundCanadians continue to report challenges accessing primary care. Practice choices made by primary care providers shape services available to Canadians. Although there is literature observing family medicine practice trends, there is less clarity on the reasoning underlying primary care providers’ practice intentions. Advice offered by residents and early-career family physicians may reveal challenges they have experienced, how they have adapted to them, and strategies for new residents. In this paper, we examine advice family medicine residents and early-career family physicians would give to new family medicine residents.MethodsSixty early-career family physicians and thirty residents were interviewed as part of a mixed-methods study of practice patterns of family medicine providers in Canada. During qualitative interviews, participants were asked, “what advice would you give [a new family medicine resident] about planning their career as a family physician?” We inductively analyzed responses to this question.ResultsAdvice consisted of understanding the current climate of family medicine (need for specialization, business management burden, physician burnout) and revealed reasons behind said challenges (lack of support for comprehensive clinic care, practical limitations of different practice models, and how payment models influence work-life balance). Subtheme analyses showed early-career family physicians being more vocal on understanding practical aspects of the field including practice logistics and achieving job security.ConclusionMost advice mirrored current changes and challenges as well as revealing strategies on how primary care providers are handling the realities of practicing family medicine. Multi-modal systemic interventions may be needed to support family physicians throughout the changing reality of family medicine and ensure family medicine is an appealing specialty.

Family Presence During Resuscitation: Perspectives of Saudi Emergency Medicine Providers.

Background Family presence during resuscitation (FPDR) has been a long-debated topic in medical circles in the last 40 years. Studies usually concentrate on the opinions and responses of the family members of the patients being resuscitated. Only a handful of studies have focussed on the medical practitioner's opinions and beliefs on the topic. Hence, this study aimed to investigate opinions and beliefs regarding FPDR among emergency medicine practitioners (EMPs) in the Kingdom of Saudi Arabia. Methodology This was a self-filled, questionnaire-based study conducted among 450 EMPs across the Kingdom of Saudi Arabia. Proportions and subgroup analyses were conducted with respect to gender, experience, and seniority. EMPs were asked about the number of family members they would allow to attend the resuscitation of a patient under their care in different clinical scenarios. Results A total of 392 (87.1%) EMPs participated in this study. Overall, 64% (n = 250) of EMPs reported that they would not allow FPDR in cases that involved trauma, or if the patient being revived was female. This percentage dropped to about 33% (n = 129) when the patient being resuscitated was a child or in out-of-hospital arrest. The majority of EMPs believed that the decision to allow FPDR was the physician's decision (n = 251, 64.8%) and not the right of the family (n = 133, 34.7%). Moreover, emergency medicine board-certified physicians were more likely to allow FPDR in different cases with 19 (18.5%) in adult arrest cases, 18 (18%) in pediatric cases, and 16 (15.1%) in trauma cases, than non-board-certified practitioners (p = 0.001, 0.007, and 0.031, respectively). Female EMPs were more likely to refuse FPDR than their male counterparts (p < 0.001). Conclusions Approximately, 60-70% of EMPs allowed a member of the family to attend the resuscitation of their loved one. However, this percentage dropped in cases where the patient was a female, or the case was a trauma case instead of a medical case. Most Saudi EMPs believed that FPDR hurts the resuscitating team and might hinder the resuscitation efforts.