Senior Physician Research Articles

The incidence of congenital heart disease in Azerbaijan: prospective epidemiological study

Background The incidence of Congenital Heart Disease (CHD) in Azerbaijan has never been calculated with a prospective study, using Echo-2D as a study method
 Aim First prospective epidemiology study calculating incidence and types of CHD in Baku, Azerbaijan.
 Population-method From June 2016 to August 2018, 2570 term neonates were screened in 2 major maternity units. The screening was randomized to equal females/males with no known previous obstetric alert regarding CHD. Scanning was done by two teams of pediatric cardiologists in echo-2D. Each team was ‘blinded’ to the findings of each other. All scans were recorded, and a third senior physician reevaluated them.
 Results From 2570 term neonates of the general population we detected 47 CHD’s. From them, 17 were c-CHD and 5, s-CHD. 25 were simple or moderate complex non-cyanotic CHD. The estimated incidence was 1.828%. 17/47 (36.2%) were cyanotic. The incidence of simple CHD was 25/47(53.2%). Analysis of the specific anatomy is presented in table 1.
 Conclusions This first-ever prospective epidemiology study in Azerbaijan involving a cohort equal to 1.65% of the annual living births of the country, estimated a high incidence. This is among the highest reported globally. The amount of critical & cyanotic CHD was 46.8% and 36.2% respectable. These high numbers are possibly related to an isolated population and conjugated marriage customs of the country. This represents a public population health burden.

A Collaborative Deprescribing Intervention in a Subacute Medical Outpatient Clinic: A Pilot Randomized Controlled Trial.

Medication deprescribing is essential to prevent inappropriate medication use in multimorbid patients. However, experience of deprescribing in Danish Subacute Medical Outpatient Clinics (SMOCs) is limited. The objective of our pilot study was to evaluate the feasibility and sustainability of a collaborative deprescribing intervention by a pharmacist and a physician to multimorbid patients in a SMOC. A randomized controlled pilot study was conducted, with phone follow-up at 30 and 365+ days. A senior pharmacist performed a systematic deprescribing intervention using the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria, the Danish deprescribing list, and patient interviews. A senior physician received the proposed recommendations and decided which should be implemented. The main outcome was the number of patients having ≥1 medication where deprescribing status was sustained 30 days after inclusion. Out of 76 eligible patients, 72 (95%) were included and 67 (93%) completed the study (57% male; mean age 73 years; mean number of 10 prescribed medications). Nineteen patients (56%) in the intervention group and four (12%) in the control group had ≥1 medication where deprescribing status was sustained 30 days after inclusion (p = 0.015). In total, 37 medications were deprescribed in the intervention group and five in the control group. At 365+ days after inclusion, 97% and 100% of the deprescribed medications were sustained in the intervention and control groups, respectively. The three most frequently deprescribed medication groups were analgesics, cardiovascular, and gastrointestinal medications. In conclusion, a collaborative deprescribing intervention for multimorbid patients was feasible and resulted in sustainable deprescribing of medication in a SMOC.

ОСОБЛИВОСТІ ПІДГОТОВКИ МАГІСТРІВ У ГАЛУЗІ МЕДИЦИНИ В УНІВЕРСИТЕТАХ КИТАЮ

The article investigates and theoretically summarizes the peculiarities of training doctors at the master's level at the universities of ROC. Higher education in China is characterized by numerous changes due to the accumulation and adaptation of advanced successful experience in training specialists in different countries of the world. In this context, the property of scientists and educators of ROC concerning the organization of professional training of masters in medicine is of particular interest for Ukraine. Scientists are constantly searching for solutions and improving higher medical education in ROC. In the universities of the Republic of China, according to the field of study, the degree of master in medicine can be obtained as a professional degree and scientific degree. As a result, after completing the master's program in professional field, the master may work in positions such as senior physician, senior physician in health care, senior dentist, senior pharmaceutical, and the master in research field may work as the doctor-scientist, who carries out medical research as the main professional activity. The name of medical degrees is also different, for the professional field – clinical medicine, for the research field – preclinical medicine. Clinical medicine includes such areas of master's programs in medicine as health care, dentistry, pharmacological science; preclinical medicine includes clinical medicine, preventive medicine, dentistry, the science of human progress, the history of science and technology, biomedical engineering, social medicine and health management. The article examines the experience of implementing master's programs in medicine at higher educational institutions in China. The competence-based approach, forms and specialization of training in the organization of training and practicing students due to master's programs in medicine in ROC were determined.

Medical crisis checklists in the emergency department: a simulation-based multi-institutional randomised controlled trial

BackgroundStudies carried out in simulated environments suggest that checklists improve the management of surgical and intensive care crises. Whether checklists improve the management of medical crises simulated in actual emergency...

Automatic Detection and Classification of Focal Liver Lesions Based on Deep Convolutional Neural Networks: A Preliminary Study

With the increasing daily workload of physicians, computer-aided diagnosis (CAD) systems based on deep learning play an increasingly important role in pattern recognition of diagnostic medical images. In this paper, we propose a framework based on hierarchical convolutional neural networks (CNNs) for automatic detection and classification of focal liver lesions (FLLs) in multi-phasic computed tomography (CT). A total of 616 nodules, composed of three types of malignant lesions (hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and metastasis) and benign lesions (hemangioma, focal nodular hyperplasia, and cyst), were randomly divided into training and test sets at an approximate ratio of 3:1. To evaluate the performance of our model, other commonly adopted CNN models and two physicians were included for comparison. Our model achieved the best results to detect FLLs, with an average test precision of 82.8%, recall of 93.4%, and F1-score of 87.8%. Our model initially classified FLLs into malignant and benign and then classified them into more detailed classes. For the binary and six-class classification, our model achieved average accuracy results of 82.5 and73.4%, respectively, which were better than the other three classification neural networks. Interestingly, the classification performance of the model was placed between a junior physician and a senior physician. Overall, this preliminary study demonstrates that our proposed multi-modality and multi-scale CNN structure can locate and classify FLLs accurately in a limited dataset, and would help inexperienced physicians to reach a diagnosis in clinical practice.

Comparison of septoplasty with three high-tension line resection and two high-tension line resection.

To compare the operation time, subjective and objective outcomes of septoplasty with three high-tension line resection and two high-tension line resection. A prospective randomized controlled study was conducted to identify patients with septal deviation and symptomatic nasal obstruction. The patients were classified into a three high-tension line resection and senior physician group (Group A), a two high-tension line resection and senior physician group (Group B), a three high-tension line resection and junior physician group (Group C), a two high-tension line resection and junior physician group (Group D). In addition, according to whether there were the anterior deviation, some of patients were also divided into a three high-tension line resection and anterior deviation group (Group E) and a two high-tension line resection and anterior deviation group (Group F). The operation time was recorded. The patients completed the Nasal Obstruction Symptom Evaluation (NOSE) Scale (subjective symptom), nasal endoscopy (bodily sign) and rhinomanometry (objective examination) before and 6 months after septoplasty. The operation time and the efficacy were compared between three high-tension line resection operation and two high-tension line resection operation. There was no significant difference in the operation time between the Group A and the Group B (t=0.724, P=0.799), but the operation time in the Group D was significant shorter than that in the Group C (t=4.200, P=0.017). There were no significant difference in the NOSE scale between the Group A and the Group B, the Group C and the Group D, the Group E and the Group F (t=0.481, -0.147, 1.369, all P>0.05). There was no significant difference in the nasal endoscopy scale between the Group A and Group B, the Group C and Group D, the Group E and the Group F (t=0.806, -0.111, -0.536, all P>0.05). There was no significant difference in rhinomanometry between the Group A and the Group B, the Group C and the Group D, the Group E and the Group F (t=0.472, 1.180, -0.225, all P>0.05)．. The effect of septoplasty with two high-tension line resection is as good as septoplasty with three high-tension line resection. The septoplasty with two high-tension line resection is more suitable to junior physician because it is easier and the operation time is shorter.

Body surface area capping may not improve cytotoxic drugs tolerance

Capping body surface area (BSA) at 2 m2 is a routine clinical practice. It aims at reducing toxicities in over 2 m2 BSA patients. 455,502 computerized chemotherapy prescriptions made between 2011 and 2017 were taken from BPC software. Chemotherapy computerized order entry is created by a senior physician prescribers before patient consultation. Only prescriptions with dose calculation involving BSA were selected. 51,179 chemotherapy prescriptions were analyzed; corresponding to 7206 patients who received intravenous chemotherapy. The number of chemotherapy prescriptions in over 2 m2 BSA patients was nearly the same in the hematology as in the oncology departments. But, 79.1% of prescriptions were capped at 2 m2 in the oncology department contrary to 21.9% in the hematology department. Practices analysis showed more dose limitation in palliative situations in both departments. Unexpectedly, 6.53% of capped prescriptions were performed in patients with normal BMI. The patients who received capped doses of chemotherapy had neither fewer dose reductions due to toxicity nor deterioration of their general condition. Capping did not induce fewer dose reductions in patients with BSA greater than 2 m2. Prospective studies in this population are needed to standardize chemotherapy administration in population with BSA > 2 m2.

Addiction Medicine After COVID-19: The Imperative of a Trained Workforce

Addiction Medicine After COVID-19: The Imperative of a Trained Workforce

Chronicle and mix

Senior physician of the Odessa psychiatric hospital, doctor of medicine B.I. Vorotynskiy was elected as a medical faculty in Odessa as a privat-docent in the department of nervous and mental illnesses.

Physician led team triage shortens the length of stay of patients in Emergency department; a descriptive case series.

BACKGROUND: Length of stay of patients in the Emergency Department (ED) is a quality indicator for ED performance. Prolonged stay risks patient safety and reduces their satisfaction. The presence of a senior physician in triage allows rapid assessment of patients and shortens the overall length of stay of patients. The objectives of this study were first, to determine the mean length of stay of patients in the emergency department and secondly, to compare the mean length of stay of patients seen in nurse-led triage as compared to physician-led triage. METHODS: This descriptive case series was conducted in the emergency department of Shifa International Hospital Islamabad from July 2017 to December 2017. The existing functioning of the department was such that rapid assessment by a senior physician in triage was done from 08:00 am to 11:59 pm. After 12:00 am till 08:00 am, the triage was done by the nurse only. This di erence was used to collect two data sets by consecutive non-probability sampling. RESULTS: A total of 500 patients were enrolled; 250 in each group. The mean age of patients was 44.50(±18.055) years. The mean length of stay was 102.11 ± 110.049 minutes. It showed a signi cant decrease of 103.31 minutes (p=0.000) from 153.76(±114.539) minutes in the nurse triage group compared to 50.45(±76.116) minutes in the physician triage group. CONCLUSION: The presence of a senior physician in triage can shorten the length of stay of patients in emergency department.

Exposure and confidence across critical airway procedures in pediatric emergency medicine: An international survey study.

Airway management procedures are critical for emergency medicine (EM) physicians, but rarely performed skills in pediatric patients. Worldwide experience with respect to frequency and confidence in performing airway management skills has not been previously described. Our aims were 1) to determine the frequency with which emergency medicine physicians perform airway procedures including: bag-mask ventilation (BMV), endotracheal intubation (ETI), laryngeal mask airway (LMA) insertion, tracheostomy tube change (TTC), and surgical airways, and 2) to investigate predictors of procedural confidence regarding advanced airway management in children. A web-based survey of senior emergency physicians was distributed through the six research networks associated with Pediatric Emergency Research Network (PERN). Senior physician was defined as anyone working without direct supervision at any point in a 24-hcycle. Physicians were queried regarding their most recent clinical experience performing or supervising airway procedures, as well as with hands on practice time or procedural teaching. Reponses were dichotomized to within the last year, or≥1year. Confidence was assessed using a Likert scale for each procedure, with results for ETI and LMA stratified by age. Response levels were dichotomized to "not confident" or "confident." Multivariate regression models were used to assess relevant associations. 1602 of 2446 (65%) eligible clinicians at 96 PERN sites responded. In the previous year, 1297 (85%) physicians reported having performed bag-mask ventilation, 900 (59%) had performed intubation, 248 (17%) had placed a laryngeal mask airway, 348 (23%) had changed a tracheostomy tube, and 18 (1%) had performed a surgical airway. Of respondents, 13% of physicians reported the opportunity to supervise but not provide ETI, 5% for LMA and 5% for BMV. The percentage of physicians reporting "confidence" in performing each procedure was: BMV (95%) TTC (43%), and surgical airway (16%). Clinician confidence in ETT and LMA varied by patient age. Supervision of an airway procedure was the strongest predictor of procedural confidence across airway procedures. BMV and ETI were the most commonly performed pediatric airway procedures by emergency medicine physicians, and surgical airways are very infrequent. Supervising airway procedures may serve to maintain procedural confidence for physicians despite infrequent opportunities as the primary proceduralist.

Chronicle and mix

- On October 14, there was a celebration of Dr. B. I. Vorotynsky, who was leaving for the place of the senior physician of the psychiatric department of the Odessa City Hospital. Members of the Society of neuropathologists and psychiatrists took part in the supper on his departure, headed by the chairman and comrade. the chairman, including the number and colleagues in the psychiatric clinic; in addition, doctors of the Military Hospital, where B.I. was a consultant, doctors of the District Hospital, Zemsky Hospital, and graduates. The celebration was sincere. In rѣchakh, at the address leaving together with good wishes, the high quality of BI was noted as a guarantee of his future success. The next day, Dr. B. Vorotynskiy went out of Kazan.

Training strategies for a sustainable medical care: a survey among assistant and chief physicians in a tertiary care hospital in Germany.

PurposeAs an essential part of the health care system, the requirements for specialist training are subject to a continuous process of change. The aim of the present study was to evaluate the current specialist training situation of all departments in a tertiary care hospital in Germany. Differences between assistant and chief physicians should be pointed out.Materials and methodsThe analysis of the current training situation was carried out on the basis of an individually created questionnaire. The questionnaire content included career goal and specialism. The characteristic values initial training (IT), training structure (TS) and training content were measured on a numeric scale from 1 to 5. In addition, an overall assessment of the trainers’ competences was performed. The questionnaire was sent to 208 assistant physicians (AP) and 34 chief physicians (CP).ResultsTotally 92 APs (44.2%) and 22 CPs (64.7%) participated. Senior physician was the most common career goal (34.1%), followed by the branch (28.6%). The importance of the topics initial training (IT) and training structure (TS) were evaluated as mean value: ITCP=1.5, ITAP=1.6; p=0.701 and TSCP=1.4, TSAP=1.5; p=0.669. The results concerning the implementation of the topics IT and TS in the daily routine show significant differences between APs and CPs (ITCP=2.0, ITAP=3.2; p=0.002; TSCP=1.9, TSAP=3.0; p<0.001). Skills lab training was acknowledged as the most important training format (CP=1.3, AP=1.5; p=0.401). The practical medical skills of the professional trainers were evaluated as high: AP: 94.6% (CP: 100.0%), as well as the training in interprofessional collaboration: AP: 79.4% (CP: 100.0%).ConclusionOur data underline the importance of specialist training subjects. These are partly perceived very differently by APs and CPs. Innovative concepts for the induction phase, well-structured training curricula, providing management skills, the overall use of skills labs and digital documentation might support the satisfaction and the outcome of specialist training. This could also improve quality in patient care.

The first military hospitals in Saint Petersburg

Abstract. The documentary materials from the funds of the Russian State Archive of the Navy, other archives, published letters and documents of Peter the Great, his Daily Note and other sources about the history of the first military hospitals (infirmaries) of Saint Petersburg are studied. At the same time, the history of the first military hospitals is reflected against the background of the difficult events of the Northern War of 17001721, with which the establishment of hospitals for the Russian army and the navy and the development of military medicine are inextricably linked. The organization of military medicine became aggravated immediately with the outbreak of hostilities, with the first wounded and sick. The fight against the plague epidemic and other infections during the war, the shortage of doctors, healers, infirmaries, hospitals and their own national staff greatly complicated the provision of medical care. Numerous documents and facts prove that the events before 1715 can be attributed to the first stage in the development of military medicine in Saint Petersburg. It was established that in 1704 the issue of establishing a military land hospital in the northern capital was already discussed (Peter I, A.D. Menshikov, N.L. Bidloo); hospital), and the senior physician of the Navy Yang Govi served in it with zeal In 1713, by the decree of the Great Sovereign Y. Govi, he was appointed head of the Admiralty Hospital, doctors, apprentices and medical students in it. By that time, Dr. R. Erskine actually assumed the office of archiatrist (until 1712). A detailed statement of Lieutenant General R.V. Bruce on the number of sick and wounded who received medical care in hospitals and hospitals in Saint Petersburg from 1713 to 1715. The decree of Peter I on the construction of a complex of General hospitals with anatomical theaters on the Vyborgskaya side (1715) according to Dr. Areskins drawing, and the establishment of a medical school (until 1719) are the next stage in the development of military medicine in Saint Petersburg, prepared by all previous events.

Improving the percentage of HIV tests offered to patients admitted to an acute hospital trust with community-acquired pneumonia

Young people and adults diagnosed with an HIV indicator condition should be offered an HIV test (NICE [National Institute of Clinical Excellence] guidance). Community-acquired pneumonia (CAP) is considered to be...

Evaluation of deep learning-based auto-segmentation algorithms for delineating clinical target volume and organs at risk involving data for 125 cervical cancer patients.

ObjectiveTo evaluate the accuracy of a deep learning‐based auto‐segmentation mode to that of manual contouring by one medical resident, where both entities tried to mimic the delineation "habits" of the same clinical senior physician.MethodsThis study included 125 cervical cancer patients whose clinical target volumes (CTVs) and organs at risk (OARs) were delineated by the same senior physician. Of these 125 cases, 100 were used for model training and the remaining 25 for model testing. In addition, the medical resident instructed by the senior physician for approximately 8 months delineated the CTVs and OARs for the testing cases. The dice similarity coefficient (DSC) and the Hausdorff Distance (HD) were used to evaluate the delineation accuracy for CTV, bladder, rectum, small intestine, femoral‐head‐left, and femoral‐head‐right.ResultsThe DSC values of the auto‐segmentation model and manual contouring by the resident were, respectively, 0.86 and 0.83 for the CTV (P < 0.05), 0.91 and 0.91 for the bladder (P > 0.05), 0.88 and 0.84 for the femoral‐head‐right (P < 0.05), 0.88 and 0.84 for the femoral‐head‐left (P < 0.05), 0.86 and 0.81 for the small intestine (P < 0.05), and 0.81 and 0.84 for the rectum (P > 0.05). The HD (mm) values were, respectively, 14.84 and 18.37 for the CTV (P < 0.05), 7.82 and 7.63 for the bladder (P > 0.05), 6.18 and 6.75 for the femoral‐head‐right (P > 0.05), 6.17 and 6.31 for the femoral‐head‐left (P > 0.05), 22.21 and 26.70 for the small intestine (P > 0.05), and 7.04 and 6.13 for the rectum (P > 0.05). The auto‐segmentation model took approximately 2 min to delineate the CTV and OARs while the resident took approximately 90 min to complete the same task.ConclusionThe auto‐segmentation model was as accurate as the medical resident but with much better efficiency in this study. Furthermore, the auto‐segmentation approach offers additional perceivable advantages of being consistent and ever improving when compared with manual approaches.

Сh. Vallon et Ar. Marie. Les alienes en Russie 1899

Recently in Paris, a new book appeared on sale under the written title, compiled by two French psychiatrists. One of the authors (Ch Vallon) is the senior physician of the hospital for the mentally ill near Paris (Asile d'alienes de Villejnif), and the other (Ar. Marie) is the physician-director de la colonie familiale de Dun-sur-Aaron (Cher). Both authors were official delegates to the international congress of doctors in Moscow in 1897 and took this opportunity to inspect all the main psychiatric institutions in Russia, moreover, this task was also included in the program of their business trip. This book thus represents a kind of report on their business trip, and this report concerns only the results of the examination of psychiatric hospitals and clinics.

Diagnostic reliability of quantitative flow ratio for detection of myocardial ischemia compared with other angiographic and experience-dependent visual predicted indices

Abstract Background Quantitative flow ratio (QFR) is an image-based virtual fractional flow reserve (FFR) computed by three dimensional quantitative coronary angiography (3D-QCA) and estimated flow velocity. Several studies have reported that QFR had a good diagnostic performance as compared with wire-based FFR or instantaneous wave-free ratio (iFR). Purpose We compared the diagnostic reliability of QFR for detection of myocardial ischemia with other angiographic and visual predicted indices. Methods In 301 coronary lesions (263 patients) from our QFR database for previously-reported two studies, the diagnostic reliability of QFR, several angiographic and visual predicted indices were investigated using ROC analysis as reference of FFR≤0.8 or iFR≤0.89. Visual predicted FFR were estimated by 3 physicians (25-year experienced expert, 10-year experienced senior physician and 3-year experienced trainee) blinded to other indices. Results Area under the curve (AUC) of each index in ROC analysis is shown in Table. Conclusion QFR was reliable index detecting myocardial ischemia compared with other angiographic and experience-dependent visual predicted indices. Funding Acknowledgement Type of funding source: None

Creative Strategies Implemented During the Coronavirus Pandemic That Will Impact the Future of Cancer Care.

The coronavirus pandemic has significantly impacted operations at leading cancer centers across the United States. In the midst of the chaos, at least one silver lining has emerged: the development of new, creative strategies for delivering cancer care that are likely to continue post pandemic. The NCCN Best Practices Committee, which is composed of senior physician, nursing, and administrative leaders at NCCN Member Institutions, conducted a webinar series in June 2020 highlighting the most promising and effective strategies to date. Experts from NCCN Member Institutions participated in the series to share their experiences, knowledge, and thoughts about the future of cancer care.

In-House, Overnight Physician Staffing: A Cross-Sectional Survey of Canadian Adult ICUs.

Overnight physician staffing in the ICU has been recommended by the Society of Critical Care Medicine and the Leapfrog Consortium. We conducted a survey to review practice in the current era and to compare this with results from a 2006 survey. Cross-sectional survey. Canadian adult ICUs. ICU directors. None. A 29-question survey was sent to ICU directors describing overnight staffing by residents, fellows, nurse practitioners, and staff physicians, as well as duty duration, clinical responsibilities, and unit characteristics. We established contact with 122 ICU directors, of whom 107 (88%) responded. Of the 107 units, 60 (56%) had overnight in-house physicians. Compared with ICUs without overnight in-house physician coverage, ICUs with in-house physicians were in larger hospitals (p < 0.0001), had more beds (p < 0.0001), had more ventilated patients (p < 0.0001), and had more admissions (p < 0.0001). Overnight in-house physicians were first year residents (R1) in 20 of 60 (33%), second to fifth year residents (R2-R5) in 46 of 60 (77%), and Critical Care Medicine trainees in 19 of 60 (32%). Advanced practice nurses provided overnight coverage in four of 107 ICUs (4%). The most senior in-house physician was a staff physician in 12 of 60 ICUs (20%), a Critical Care Medicine trainee in 14 of 60 (23%), and a resident (R2-R5) in 20 of 60 (33%). The duration of overnight duty was on average 20-24 hours in 22 of 46 units (48%) with R2-R5 residents and 14 of 19 units (74%) covered by Critical Care Medicine trainees. Variability of in-house overnight physician presence in Canadian adult ICUs is linked to therapeutic complexity and unit characteristics and has not changed significantly over the decade since our 2006 survey. Additional evidence about patient and resident outcomes would better inform decisions to revise physician scheduling in Canadian ICUs.