Role Of Physician Research Articles

Legionnaires' Disease in Occupational Settings: A Cross-Sectional Study from Northeastern Italy (2019).

In Italy, Legionnaires' Disease (LD) causes >1000 hospital admissions per year, with a lethality rate of 5 to 10%. Occupational exposures could reasonably explain a substantial share of total cases, but the role of Occupational Physicians (OPs) in management and prevention of LD has been scarcely investigated. The present survey therefore evaluates the knowledge, attitudes and practices (KAP) regarding LD from a convenience sample of Italian OPs, focusing on their participation in preventive interventions. A total of 165 OPs were recruited through a training event (Parma, Northeastern Italy, 2019), and completed a specifically designed structured questionnaire. The association between reported participation in preventive interventions and individual factors was analyzed using a binary logistic regression model, calculating corresponding multivariable Odds Ratio (aOR). Overall, participants exhibited satisfactory knowledge of the clinical and diagnostic aspects of LD, while substantial uncertainties were associated epidemiological factors (i.e., notification rate and lethality). Although the majority of participating OPs reportedly assisted at least one hospital (26.7%) and/or a nursing home (42.4%) and/or a wastewater treatment plant, only 41.8% reportedly contributed to the risk assessment for LD and 18.8% promoted specifically designed preventive measures. Working as OPs in nursing homes (aOR 8.732; 95% Confidence Intervals [95%CI] 2.991 to 25.487) and wastewater treatment plants (aOR 8.710; 95%CI 2.844 to 26.668) was associated with participation in the risk assessment for LD, while the promotion of preventive practice was associated with working as an OP in hospitals (aOR 6.792; 95%CI 2.026 to 22.764) and wastewater treatment plants (aOR 4.464, 95%CI 1.363 to 14.619). In other words, the effective participation of the OP in the implementation of preventive measures appears uncommon and is limited to certain occupational settings. Collectively, these results highlight the importance of tailoring specifically designed information campaigns aimed to raise the involvement of OPs in the prevention of LD in occupational settings other than healthcare.

Setting up the functional pathology laboratory in a hospital attached to a medical institute: An insight from soup to nuts

Laboratory physician's role by and large is confined to diagnostics and academics. Exposure on practical aspects is limited which is nevertheless essential. There is a significant gap in literature on how a four walled space is transformed into functioning laboratory.. We wish to narrate challenges and experiences faced during the process of setting up a diagnostic pathology laboratory attached to a teaching hospital in a rural geographic area. Bulk of data is the authors first-hand experience in setting up the laboratory from October 2019 to July 2021. For specifications and infrastructure related information, guidelines of national and international statutory governing bodies like National Medical Commission (NMC), National Board for Accreditation of Laboratories(NABL), Clinical and Laboratory Standards Institute(CLSI) were referred along with discussion from peers working in established laboratories. Various facets to make a laboratory fully functional were compiled and presented. A diagnostic pathology laboratory with basic subdivisions had been made functional to cater to healthcare needs of patients keeping in mind the scope for future expansion and growth. Basic fundamentals of infrastructure, manpower, consumables, vendor and data management are pertinent to even the laboratory associated medical professionals. An integrated and systematic approach with open mind for continual improvement is what it takes to face challenges and set up the diagnostics. A knowledge and hands on experience of various facets pertaining to a functional laboratory is essential to the practicing pathologists. This article provides the much-needed literature on challenges faced which can be a reference material for others undertaking a similar setting at work.

The Role of the General Practitioner-Family Doctor in the Pharmacotherapy of Tuberculosis During the War

The role of the general practitioner-family physician in the pharmacotherapy of tuberculosis during the war is extremely important. The military conflict can cause an increase in cases of tuberculosis due to the deterioration of hygienic conditions, internal displacement of the population, evacuation of patients, insufficient medical and pharmaceutical assistance. In a wartime setting, family physicians may be the primary providers of early diagnosis and pharmacotherapy for many tuberculosis patients. Crowding of people in damp shelters, insufficient nutrition, stress. The role of family physicians is to properly treat and monitor patients, prevent the spread of tuberculosis, and collaborate with other specialists for optimal management of this disease.

Self-Care Practices and Their Role in the Control of Diabetes: A Narrative Review.

Diabetes mellitus (DM) is a long-standing, continuously growing metabolic ailment in which levels of glucose in the blood increase due to a total (DM of type 1) or incomplete (DM of type 2) decrease in the level of the hormone insulin. Diabetes mellitus affects a large number of individuals worldwide, and as more people develop the disease, the burden will double from what it is now. The requirements of people suffering from diabetes are not only confined to the control of blood glucose; there is also a need to prevent disabilities, side effects, and difficulties in rehabilitation. Studies suggest that seven self-care practices for individuals suffering from this disease have shown good outcomes. Those practices include assessment of sugar levels in the blood, consuming healthy foods, remaining physically active, taking medications regularly and on time, maintaining healthy behavior, and decreasing risk factors. All of these practices collectively have shown good results in maintaining blood glucose levels, decreasing side effects, and increasing life expectancy in people with diabetes mellitus. Those who have DM and practice self-care have shown positive results by reducing the complications of DM, decreasing its progression, and leading to a huge reduction in the burden due to DM. Despite these positive changes, people sticking to these self-care practices are very few, specifically when we see broad and chronic changes. There are many positive contributing factors, such as social factors, demographic factors, and various socio-economic factors, but the role of physicians in increasing the practices associated with personal care for people with this disease is crucial and most important for the desired outcome. Keeping in mind the burden and multidimensional nature of the disorder, proper systematic and combined efforts are needed to increase these self-care practices in patients with diabetes to reduce any chronic side effects and complications.

Inclusion of Confined Space Rescue in EMS Physician Fellowship Programs

Introduction: In July 2021, the ACGME updated the Program Requirements for Graduate Medical Education in Emergency Medical Services to include participation in special operations trainings as a required key index procedure during an EMS fellowship. These requirements now include documentation of “participation in confined space, technical rescue, or collapse/trench training”. EMS fellowships may have limited opportunities for fellows to actively participate in these complex events. Background: Federal or State Urban Search and Rescue (USAR) teams present a unique opportunity to meet this training requirement. USAR teams perform search and rescue operations in collapsed structures and provide emergency medical care for entrapped survivors, task force personnel, and search canines. The physician is integrated into the Incident Command Structure of the USAR teams under the Medical Branch as the “Medical Team Manager”. This provides a defined team role in training and promotes physician level knowledge and skills in rescue operations. Methods: The University of Chicago EMS Fellowship partnered with Illinois Task Force-1 USAR team to meet the new training requirements and participate as a Medical Team Manager on the team. Results: During the 12-month fellowship period, the EMS fellow participated in monthly USAR training that included both single day and multi-day exercises. The exercises included scenarios with complex hazardous materials, confined space rescue, high angle rescue, collapsed structure and trench rescue. With a dedicated physician role on the USAR team, the EMS fellow integrates into the response structure as a Medical Team Manager and can learn how to deliver high quality patient care in an austere environment. USAR training fulfilled several of the new ACGME key index procedure for an EMS fellow in the special operations environment including participation in hazardous materials response training, participation in confined space, technical rescue, or collapse/trench training, and participation in vehicle rescue/extrication training. Conclusions: EMS fellowship programs can collaborate with Urban Search and Rescue teams to provide training opportunities in confined space rescue to meet ACGME requirements for key index procedures and integrate qualified EMS physicians into USAR responses. Collaboration between EMS fellowship programs and USAR teams can be mutually beneficial.

Characteristics of Team Physicians in the National Football League: The Road to Success and a Call for Diversity.

The role of team physician (TP) in professional sports is a highly coveted position within sports medicine. There is currently limited research on the demographic characteristics of TPs within the National Football League (NFL). To identify demographic characteristics and educational backgrounds of NFL head TPs (HTPs) and assistant TPs (ATPs). Cross-sectional study. A list of TPs was identified through the National Football League Physicians Society (NFLPS). Variables investigated include age, gender, race, medical specialty, location and year of residency and fellowship training, leadership among medical societies and editorial boards, academic rank, and personal Scopus Hirsch index (h-index). Linear regression was performed to determine correlation, and t tests were used to assess differences in the h-index. Of the 170 TPs, 21.2% were HTPs and 78.8% were ATPs. TPs were 97.6% male, 91.2% were non-Hispanic White, and 60% had attained an academic rank. The mean ages of the HTPs and ATPs were a 56.2 ± 9.6 and 52.6 ± 9.6 years, respectively (P = .047). Among orthopaedic surgeons, the most common subspecialties were sports medicine (70.5%), foot and ankle (7.6%), and spine (5.7%). Of the TPs, 48.2% and 32.9% worked for a team in the same state in which they graduated residency and fellowship, respectively. HTPs and ATPs had been in the NFLPS for a mean of 16.9 ± 10.8 and 8.8 ± 8.3 years, respectively (P < .001). Further, TPs holding an academic rank had a mean h-index of 14.0 ± 19.3, while those without an academic rank had a mean h-index of 6.2 ± 8.8 (P < .01). HTPs and ATPs had mean h-indices of 15.7 ± 15.9 and 9.6 ± 16.3 (P = .0503), respectively. TPs in the NFL are typically White men in their mid-50s who have trained at specific high-ranking institutions and obtained a fellowship in sports medicine. HTPs were likely to be older with longer tenures within the NFLPS and with more impactful research than their ATP counterparts.

The role of physical activity in obesity: let's actively manage obesity

Obesity, physical inactivity and sedentary behaviour are major public health concerns. A complex interaction of many factors leads to obesity, which requires an individualised multicomponent management strategy. As new interventions become available to help individuals manage obesity, it is essential that physical activity remains a core part of the approach. Here, we summarise current evidence regarding the benefits of physical activity as part of a management strategy of obesity. Additionally, we discuss current methods for increasing physical activity levels in individuals with obesity and outline the role of sport and exercise medicine physicians as part of the multidisciplinary team.

Comorbidities in Patients with Multiple Sclerosis and How Lifestyle Behaviors Can Change the Comorbidities, Role of the Family Physician and Neurologist

Introduction: Comorbidity can be defined as any additional disease that coexists in an individual with a given index disease, which is not an obvious complication of the index disease. Physical and mental comorbid conditions are common among persons with MS. Searching Strategy and Selection Criteria: We identified relevant articles in English for this review by searching PubMed, for articles published between January 1, 2017, and Feb 28, 2023, and reference lists from relevant articles. Comorbidities in MS: The most prevalent comorbidities in MS are depression (23.7%), anxiety (21.9%), hypertension (18.6%), hypercholesterolemia (10.9%), and chronic lung disease (10%). Lifestyle Behaviors: In the last years, multiple studies shown that the exercise can improve not only the physical part, also the mental health and quality of life. In the recent years several studies concludes that the Paleolithic diet have good results in the relieve of the symptoms of MS like fatigue and the cognitive functions. It ?s well know that the stress, depression, and anxiety have a high prevalence in MS patients. In one cross-sectional study of RRMS and PMS patients, the patients with RRMS reported a higher emotional support, affection support and positive social interaction. Conclusion: Having lifestyle changes like exercise, good nutrition and supplementation can reduce the risk of the mention comorbidities also have a positive result in the psychological and social area diminishing symptoms and mental diseases.

Maternity Access in Rural America: The Role of Family Physicians in Providing Access to Cesarean Sections.

As an increasing number of rural hospitals close their maternity care units, many of the approximately 28 million reproductive-age women living in rural America do not have local access to obstetric services. We sought to describe the characteristics and distribution of cesarean section-providing family physicians who may provide critical services in maintaining obstetric access in rural hospitals. Using a cross-sectional study design, we linked data from the 2017 to 2022 American Board of Family Medicine's Continuting Certification Questionnaire on provision of cesarean sections as primary surgeon and practice characteristics to geographic data. Logistic regression determined associations with provision of cesarean sections. Of 28,526 family physicians, 589 (2.1%) provided cesarean sections as primary surgeon. Those who provided cesarean sections were more likely to be male (odds ratio (OR) = 1.573, 95% confidence limits (CL) 1.246-1.986), and work in rural health clinics (OR = 2.157, CL 1.397-3.330), small rural counties (OR = 4.038, CL 1.887-8.642), and in counties without obstetrician/gynecologists (OR = 2.163, CL 1.440-3.250). Although few in number, family physicians who provide cesarean sections as primary surgeon disproportionately serve rural communities and counties without obstetrician/gynecologists, suggesting that they provide access to obstetric services in these communities. Policies that support family physician training in cesarean sections and facilitate credentialing of trained family physicians could reverse the trend of closing obstetric units in rural communities and reduce disparities in maternal and infant health outcomes.

What was happening in the collaboration between general practitioners and public health nurses in the community: A qualitative study.

Interprofessional collaboration in the community is becoming essential in primary care, particularly collaboration between public health nurses and general practitioners. However, the precise value of such collaboration has not been sufficiently studied. The purpose of this study was to conduct a qualitative analysis of collaboration between general practitioners and public health nurses in the community to explore the details of the phenomenon and its possible impact on the community. Since 2015, The University of Toyama has been implementing the Collaborative Health Activities Project, in which general practitioners and public health nurses work together to promote community health. Focus group and individual interviews were conducted with participating staff, and the data were analyzed qualitatively. Fifteen themes were generated, in six categories. The categories were as follows: enhanced roles of public health nurses and physicians in the community, new perspectives on the community, public health nurses' sense of trust and empathy toward physicians, bonds of solidarity between public health nurses and physicians, proactive change in residents, and supporting "hangout places". The collaboration between general practitioners and public health nurses familiar with the same community fostered a sense of trust and empathy and created the bonds of solidarity between staff and residents. The results also suggest the collaboration may have a positive impact on the local community by inspiring residents to change proactively and supporting "hangouts" where residents and professionals can informally connect.

Manejo desde atención primaria de la infección por la viruela del mono (MPOX) en humanos

Monkeypox (MPOX) is a viral zoonosis endemic in West or Central African countries that is sporadically exported to another area. In May 2022, a global outbreak of MPOX smallpox began to occur in several countries in Europe and North America. Most of the reported cases are identified at the outpatient level and mainly affect men who have sex with men (MSM). Transmission is by close contact with lesions, body fluids, respiratory secretions or contaminated material from an infected person or animal. The clinical picture is similar to human smallpox, with less severity. Mild, self-limiting skin involvement predominates after 2-4 weeks. In MSM, atypical skin lesions appear due to the mode of infection. Severe forms or complications may appear in certain risk groups. The case fatality rate is 3%-6% depending on the clade responsible. The diagnosis of suspicion is confirmed by detection of the virus from exudates of lesions or scabs, with nucleic acid amplification techniques by conventional or real-time PCR. Clinical management in most cases is performed in primary care (PC), by monitoring the main symptoms. Between 5-10% require hospital management and there are some specific antiviral treatment options. Human smallpox vaccines protect against MPOX and are used as pre- and post-exposure prophylaxis for persons at risk. Measures to reduce exposure to the virus are the main MPOX prevention strategy. In addition, the role of the family physician is key to controlling the spread of MPOX through active surveillance and early diagnosis of the disease.

An analysis of policies supporting the roles of family physicians in four regions in Canada during the COVID-19 pandemic.

Policy supports are needed to ensure that Family Physicians (FPs) can carry out pandemic-related roles. We conducted a document analysis in four regions in Canada to identify regulation, expenditure, and public ownership policies during the COVID-19 pandemic to support FP pandemic roles. Policies supported FP roles in five areas: FP leadership, Infection Prevention and Control (IPAC), provision of primary care services, COVID-19 vaccination, and redeployment. Public ownership polices were used to operate assessment, testing and vaccination, and influenza-like illness clinics and facilitate access to personal protective equipment. Expenditure policies were used to remunerate FPs for virtual care and carrying out COVID-19-related tasks. Regulatory policies were region-specific and used to enact and facilitate virtual care, build surge capacity, and enforce IPAC requirements. By matching FP roles to policy supports, the findings highlight different policy approaches for FPs in carrying out pandemic roles and will help to inform future pandemic preparedness.

How do patients perceive the AI-radiologists interaction? Results of a survey on 2119 responders

PurposeIn this study we investigate how patients perceive the interaction between artificial intelligence (AI) and radiologists by designing a survey. MethodWe created a survey focused on the application of Artificial Intelligence in radiology which consisted of 20 questions distributed in three sections:1.Demographic characteristics.2.General knowledge of new technologies and AI.3.Patients' perceptions of AI in diagnostic settings.Only completed questionnaires were considered for analysis. Results2119 subjects completed the survey. Among them, 1216 respondents were over 60 years old, showing interest in AI even though they were not digital natives. Although >45% of the respondents reported a high level of education, only 3% said they were AI experts. 87% of respondents favored using AI to support diagnosis but would like to be informed. Only 10% would consult another specialist if their doctor used AI support. Most respondents (76%) said they would not feel comfortable if the diagnosis was made by the AI alone, highlighting the importance of the physician's role in the emotional management of the patient. Finally, 36% of respondents were willing to discuss the topic further in a focus group. ConclusionPatients’ perception of the use of AI in radiology was positive, although still strictly linked to the supervision of the radiologist. Respondents showed interest and willingness to learn more about AI in the medical field, confirming how patients' confidence in AI technology and its acceptance is central to its widespread use in clinical practice.

The Importance of Urine Sediment Analysis in the Diagnosis and Management of Acute Kidney Injury

The Urine sediment analysis is an extremely valuable yet underutilized test. Our case discussion aims to highlight its diagnostic value and emphasize the role of physicians in the performance of the test as diagnosis and management strategies may differ, leading to clinical improvement and more specific therapeutic interventions.

Transitioning to Telehealth: The Multifaceted Impact of a Midcareer Transition in Practice.

The medical education continuum is interrupted by several transition periods that can adversely affect performance. Most of what has been learned about such periods focuses upon movement from one stage of training to another and movement from training to practice. Established physicians, however, experience transitions throughout their careers at idiosyncratic times and with little assistance. Better understanding how physicians experience transition, where they struggle and how they adapt, would enable better support to be provided. We investigated the COVID-19-forced transition in clinical practice to virtual care, particularly its effect on physician roles and the ways that established physicians faced challenges they encountered when transitioning to virtual care. Ten semistructured interviews were conducted between November 2020 and February 2021 with physicians across different specialties and practice contexts who transitioned their practice to virtual care during the COVID-19 pandemic. Interview data were analyzed iteratively using "generic qualitative methodology" with constant comparison to identify themes in relation to observations. The transition to telehealth had implications that extended beyond the patient encounter, appearing to affect all aspects of the physician's practice. To reflect that, CanMEDS was chosen as a useful organizing framework. The effects, captured in the theme "changes to the physician's roles," were nuanced, illustrated a consistent need to adapt to context, and could be framed positively or negatively or both. Additionally identified themes were labeled "physicians' mental health" and "strategies to mitigate challenges." These themes highlighted that, despite the effort involved and novelty of the situation, all participants found remarkably similar ways of grappling with the challenges faced. While the basic roles of the physician do not appear to have changed through the transition to telehealth, our findings indicated that these roles were redefined in fundamental ways in response to changing societal needs.

The Influence of Anti-LGBTQIA+ Legislation on Graduate Medical Education

The Influence of Anti-LGBTQIA+ Legislation on Graduate Medical Education

The role of emergency physicians in the fight against health misinformation: Implications for resident training.

Emergency physicians on the frontlines of the COVID-19 pandemic are first-hand witnesses to the direct impact of health misinformation and disinformation on individual patients, communities, and public health at large. Therefore, emergency physicians naturally have a crucial role to play to steward factual information and combat health misinformation. Unfortunately, most physicians lack the communications and social media training needed to address health misinformation with patients and online, highlighting an obvious gap in emergency medicine training. We convened an expert panel of academic emergency physicians who have taught and conducted research about health misinformation at the Society for Academic Emergency Medicine (SAEM) Annual Meeting in New Orleans, LA, on May 13, 2022. The panelists represented geographically diverse institutions including Baystate Medical Center/Tufts University, Boston Medical Center, Northwestern University, Rush Medical College, and Stanford University. In this article, we describe the scope and impact of health misinformation, introduce methods for addressing misinformation in the clinical environment and online, acknowledge the challenges of tackling misinformation from our physician colleagues, demonstrate strategies for debunking and prebunking, and highlight implications for education and training in emergency medicine. Finally, we discuss several actionable interventions that define the role of the emergency physician in the management of health misinformation.

Doping-free lifestyle and health care trends offered for athletes

This article is a systematic review of recent publication that identify the peculiarities and potential risks for athletes in sports. The research elucidates the benefits of doping-free healthy lifestyle and mentions the crucial role of family physician in health care trends offered for athletes in order to improve their well-being and prevent the potential negative consequences.

THE DOCTOR-PATIENT RELATIONSHIP IN THE ERA OF E-HEALTH

The doctor-patient relationship is one of the most complex interpersonal relationships in that it involves individuals who are not on the same level, it has not been sought by both individuals, it is emotionally loaded, and it requires close mutual cooperation towards a shared goal. The digital revolution will have a profound impact on how physicians and healthcare delivery organizations interact with patients and the community at large. In the following years, personal contact between patients and doctors will become increasingly rare, and exchanges between consumers and providers will be progressively mediated by electronic devices, from which trust will suffer continually. Unfortunately, this progress has also had a negative impact on physician-patient relations, data protection, and the role of physicians. The main goals of this commentary are to describe the influence of digitalization in the form of eHealth on the doctor-patient relationship. It will be essential that clinicians, managers, policymakers, and researchers gain an increased understanding of this trend so that healthcare systems around the globe can adapt, adopt, and embrace these rapidly evolving digital technologies.

A novel treatment program for adolescents with post traumatic stress disorder with virtual reality technology

Recent advancements in the study of posttraumatic stress disorder (PTSD) have led to the discovery of innovative improvements to therapies that have already received empirical validation. The purpose of this paper is to investigate the theoretical feasibility and expected effects of a new treatment approach for the adolescent PTSD patient population that combines VR virtual reality technology with traditional treatment modalities by referring to relevant studies, literature, and survey feedback from the relevant groups. The main focus is on the use of virtual reality technology to address the reluctance of the adolescent patient population to accept treatment and to explore other possibilities for the development of a relevant target population. The limitations and drawbacks of current VR systems in the treatment of psychological disorders are also discussed, but theoretical solutions are also given. The specific role of the senses in the theoretical model and the role and usefulness for patients, physicians, and others, respectively, are also given.