Specialist Physicians Research Articles

The Immediate Effect of Texture Foot Plate on Balance in Diabetic Patients With Neuropathy

Background and Objectives: According to previous studies, balance problems are one of the most critical disorders in diabetic patients with neuropathy. Because diabetic neuropathy may cause sense disorder and decreased balance in these patients. Thus, it seems that using texture insole may help to improve proprioception and lead to a positive effect on balance in this case. Therefore, this study aims to evaluate the effect of texture insole on static and dynamic balance in diabetic patients with neuropathy. Methods: This is a single-group pre-test-post-test design with the participation of 16 patients with neuropathy who were referred by endocrine specialist physicians in terms of inclusion criteria to Firoozgar Hospital. Data were collected using a force plate to evaluate the static balance and the time up and go (TUG) test for dynamic balance. Results: Six men (37.5%) and ten women (62.5%) participated in this study. The results of this study showed that the means of parameters of static and dynamic balance among participants decreased significantly (P<0.05) Conclusion: This study showed that the static and dynamic balance has improved after using the texture foot plate by these patients.

Lower back pain amongst medical trainees in clinical rotations: implications for choosing future career regarding medical practice

BackgroundLow back pain (LBP) is an increasing concern amongst medical students. There is a dearth of publications regarding how the occurrence of LBP impact medical trainees’ career decisions.ObjectiveTo determine: (i) the point and annual prevalence of LBP amongst Ugandan medical students, (ii) its associated factors, and (iii) whether the experience of LBP during clinical rotations influence medical students’ career choices regarding medical practice.MethodsA multi-center cross-sectional study of 387 randomly selected clinical-phase students was conducted in three Ugandan medical schools, during 17th January to 10th March 2023. Proportions of participants with current and 12-months history of LBP were computed as well as odds for career prospects. We performed binary logistic regression models to determine factors associated with LBP at 95% confidence interval regarding p < 0.05 as statistically significant.ResultsThe response rate was 100%. Participants’ mean age was 24.7 ± 3.2 years of which 66.2% (256/387) were males. The point and annual prevalence of LBP was 52.5% (203/387) and 66.1% (256/387) respectively. Age [OR 1.23, 95% CI (1.03–1.47), p = 0.02], time spent sitting per day [OR 1.08, 95% CI (1.06–1.3), p < 0.01], perceived influence of LBP on future medical career [OR 4.75, 95% CI (1.87–12.06), p < 0.01] were the significant predictors of LBP. LBP interrupted the students’ learning for at least 6.8 ± 12.8 h in 42.4% of participants. Nearly half of participants affirmed that their LBP experience would influence their career prospects. Based on their LBP experiences, trainees ruled out surgery 51.5% (172/334), obstetrics/gynecology 29.6% (99/334), paediatrics 18.3% (61/334), and internal medicine 17.7% (59/334) as their future career specialties. The proportion of trainees that would not consider surgical as opposed to medical disciplines were 81.1% vs. 36.0%, respectively, (p < 0.001).ConclusionThe high prevalence of low back pain among medical students impacts their choices of future medical career with an aversion towards specialization in surgical disciplines. This has far-reaching implications on the disparities in specialist physician health workforce in Low-middle-income countries.

Comparative Study of Ayurvedic & Allopathic Treatment of patient with Psoriasis

India was synonymous with rich ancient culture, spicy food, vibrant colors and also Ayurveda. When Ayurveda is mentioned, another word, allopathy, is bought for comparison. Ayurveda has its roots in ancient texts, the Vedas, and allopathy is a term that is mostly associated with modern medicine. One has its origin in the deep East and the other is influenced by the West. Long before modern medicine found its way to distant India, Ayurveda was the main healing system. Instead of doctors, there were vaidyas and rishis who used Vedic knowledge to treat not only minor but also serious ailments. Then, in the 19th century, Allopathy appeared and paved the way to the current structure of medicine. This research aimed to study & counsel the local patient with psoriasis disease. The treatment taken by the patient regarding the disease of using ayurvedic & allopathic medicines, we have visited the patient to counsel, retailer pharmacist & skin specialist physician. The comparison between ayurvedic & allopathic medicine with their benefits, effects, side effects & patient preference is studied.

Area-level socioeconomic status impacts healthcare visit frequency by Australian inflammatory arthritis patients: results from the Australian Rheumatology Association Database.

Individuals with inflammatory arthritis (IA) require long-term rheumatologist care for optimal outcomes. We sought to determine if socioeconomic status (SES) influences general practitioner (GP) and specialist physician visit frequency and out of pocket (OOP) visit costs. We linked data from Australian Rheumatology Association Database (ARAD) participants with rheumatoid arthritis or psoriatic arthritis to the Pharmaceutical Benefits (PBS) and Medicare Benefits Schedule (MBS) from 2011-2018. Small-area SES was approximated as quintiles of the Index of Relative Socieconomic Advantage and Disadvantage. A comorbidity index (Rx-Risk) was determined from PBS data. Analysis was performed using panel regression methods. We included 1916 ARAD participants (76.3% rheumatoid arthritis, 71.1% women, mean [SD] age 54 [12] years and disease duration 6 [4] years). Participants averaged 9.0 (95% CI 8.6, 9.4) annual GP visits and 3.9 (3.8 to 4.1) annual specialist physician visits. After adjustment for sex, age, education, remoteness and comorbidity, there was an inverse relationship between annual GP visit frequency and higher SES quintile (-0.6 [-0.9, -0.3] visits/quintile) and a direct relationship between more frequent specialist visits and higher SES (linear slope 0.3 [0.2, 0.5] visits/quintile). Average OOP costs/visit were higher for specialist physician (AUD$38.43 [37.34, 39.53] versus GP visits (AUD$7.86 [7.42, 8.31], and higher SES was associated with greater OOP cost. Higher SES patients have relatively fewer GP visits and more specialist physician visits compared with lower SES patients, suggesting lower SES patients may receive suboptimal specialist physician care. OOP costs may be a contributing factor.

The state of primary health care systems in ten high-income countries

Abstract Primary care systems in high-income countries perform comparatively better than the U.S. system in large part due to decades of investment, an adequate workforce supply, and universal healthcare. This research identifies successes and areas of improvement of 10 high-performing primary care systems in four areas of care: 1) access, 2) continuity, 3) comprehensiveness, 4) and coordination. Cross-national comparisons using primary data from the 2022 CMWF International Health Policy Survey of Primary Care Physicians (N ranged from 321-2,092) and the 2023 CMWF International Health Policy Survey on the General Population (N ranged from 750-4,820). Countries included: Australia, Canada, France, Germany, Netherlands, New Zealand, Sweden, Switzerland, the U.K., and the U.S. • More than 90% of adults in all surveyed countries reported having a regular primary care doctor except Sweden, the U.S., and Canada. • Less than 5% of physicians reported high telehealth use in their patient encounters, except for in the U.K. and New Zealand where over 10% reported high use. • Over a quarter of physicians in the U.S., Germany, and France report screening patients for social needs, compared to just 8% in the Netherlands. • Care coordination with social services was a major challenge in all surveyed countries, with over 75% of physicians in the U.K., Australia, and France reporting major challenges. Primary care systems in 10 other high-income countries outperform the U.S. system, particularly when it comes to access to care and care continuity. Policy options to consider for U.S. policymakers include narrowing the wage gap between generalist and specialist physicians and rewarding and holding providers accountable for continuity of care. On the other hand, countries like Sweden and the Netherlands can learn from the U.S. on how to adequately coordinate care between primary care physicians, specialists, and hospitals. Key messages • Investment in primary care yields better health outcomes, greater equity and lower costs. • Many high-income countries in Europe have high performing primary care systems, something the U.S. system can learn from.

Evaluation of Adipose Tissue Hormones and Tumor Necrosis factor in Patients with Endometriosis

Objective: To evaluate levels of physiological parameters (Testosterone, follicle stimulating hormone FSH, luteinizing hormone LH, leptin and tumor necrosis factor TNF-α, Adipsin and Ghrelin), Total antioxidant capacity-TAC, Glutathione S transfers -GST in sera of patients with endometriosis. Method: This study involved (85) women within reproductive age (25-40) years, who were distributed into two groups: patientsʹ group (55) women diagnosed with endometriosis, and (30) healthy control women. The study was carried out at Al-Karkh Maternity Hospital/ Baghdad and extended from 20/4/2024 to 20/5/2024. The pathological cases of patients were diagnosed by clinical examinations and confirmed by specialist physician with ultrasound examination. Blood samples were taken from both groups, serum was separated for each individual by a centrifuge. Results: a significant rise in the (FSH, Leptin, TNF -α, Adipisin) while a significant decrease in levels of (Testosterone , LH, GST, TAC, Ghrelin) concentration were found in the sera of patients compered to healthy women , with a probability of P ≤ 0.05. According to Receiver operating characteristic (ROC) statistical analysis, Area under curve (AUC ) for LH, leptin, TNF -α, adipsin, ghrelin, GST, TAC were closely or equal to (1) for patients . Conclusion: serum levels of LH, Leptin, Adipisin, Gherlin, TNF-α and GST can be dependable as prognostic indicator markers that reflect the degree of oxidative stress accompanying endometriosis.

Parental awareness and dental health behavior of children with congenital heart disease, with diabetes mellitus, or undergoing anti-cancer treatment, compared to healthy children.

Children with chronic diseases tend to experience a considerably higher burden of oral disease compared to their healthy peers. Low awareness of the impact of systemic diseases on oral health, lack of motivation, and discomfort may render the maintenance of good oral hygiene challenging. We conducted a study of four groups of parents: of children with congenital heart disease (CHD), with diabetes mellitus type 1 (DM), and undergoing anti-cancer treatment (ACT); and a control group of healthy children (C). We aimed to compare between the groups, parental attitudes and knowledge of their children's oral health, and their reports of their children's dental habits. Parents who arrived with their children for routine check-ups at three main clinics: cardiology, endocrinology, and hematology-oncology were asked to respond to a questionnaire regarding their children's oral and dental health. A total of 287 questionnaires were collected from 76 parents of children with CHD, 100 parents of children with DM, 50 parents of children undergoing ACT, and 61 parents who comprised group C. Compared to the CHD and DM groups, the ACT group demonstrated significantly more awareness of the importance of maintaining oral and dental health following diagnosis of their children's medical condition. Mothers' education was found to correlate with dental health knowledge. Most children in the DM and C groups had previous dental examinations, compared to only half in the CHD and ACT groups. A higher proportion of the children in the C than the other groups brushed teeth twice daily. The groups were similar in their consumption of sugary drinks, and of sweets and snacks. The children's specialist physicians were the main source of information on oral health, especially in the ACT group. Although most of the parents reported awareness to the oral health aspects of their children's disease, only part of them reported that their children visited dentists, and brushed their teeth twice daily. For the parents of children with CHD, DM, and ACT, their children's treating specialists were the primary source of information regarding oral health. This highlights the importance of clear and continuous communication between pediatric specialists and dentists.

Investigation Role of IL-10 And IL-13 with Some Viral Species in Pathogenesis of Heart Diseases

Background; cardiovascular disease (CVD) is the most common cause of mortality and impairment. Atherosclerosis is the primary underpinning pathophysiology of CVD, but several variables could trigger it. The occurrence of it is linked to multiple risk factors related to metabolism, such as overweight and dyslipidemia. Objective; Detective predictive roles of IL-10 and IL-13 and positivity of viral infections in heart diseases. 60 blood samples were harvested (gel tube) from heart diseases patients who sleeping in hospital after diagnosis them by specialist physician.30 blood samples were taken from healthy individuals that labeled them as a control group. Interleukins (IL-10 and IL-13) and viral species (Parvovirus B19, SARS-CoV-2, HCV and HBV) were calculated by (ELISA). Present outcomes mentioned the most patients were males (71.7%) with age groups 51-60 (26.7%) and 61-70 (33.3%), ex-smokers (65.0%), and lean BMI (63.3%). Our investigation showed Parvovirus B19 scored highest positivity (15.0%), followed by HBV (6.7%), SARS-CoV-2 (5.0%), and then HCV (3.3%) in heart diseases patients with significant difference (p<0.05). Based on interleukins levels, present outcomes showed significant raised levels (p<0.05) of IL-10 and IL-13 in patients than control. ROC curve results showed the IL-13 scored highest sensitivity (80%) and specificity (84%) at cut off (>2.50) compared to IL-10 that showed highest sensitivity (81%) and low specificity (57%) at cut off (>9.50). Conclusions; gender, age and smoking are risk factors for heart diseases. Due to decreased immune state in patients, several viruses were discovered in those patients. IL-10 and IL-13 were raised in patients due to presence inflammation. IL-10 has paradoxical role (pro and anti-inflammatory) in pathogenesis heart diseases . IL-13 is more preferred in diagnosis heart diseases than IL-10 due to has (IL-13) highest sensitivity and specificity. Finally, there is no strong correlation between IL-10 and IL-13 in pathophysiology of heart diseases.

06 Eating disorder toolkit 2023: Standards of practice in the primary care setting

Abstract Background Throughout the COVID 19 pandemic, physicians across Canada began to see a 'shadow pandemic' unfold as new diagnosis of eating disorders and hospital admissions for patients with medically unstable eating disorders increased exponentially. As these rates remain high, specialists stressed the importance of the role primary care physicians play in the early recognition, assessment, and diagnosis of eating disorders as a way to improve prognosis. Further, the high volume of patients has resulted in the need to manage patients in the community or engage in collaborative care between the eating disorder specialist and primary care physician. This Eating Disorder Toolkit was created as a knowledge mobilization resource to provide primary care and community providers with Standards of Practice and improve care for eating disorder patients. Objectives 1. Provide an updated and easily readable evidence-based reference tool for PCPs 2. Clarify PCPs role in working with, monitoring, and treating EDs in a shared care model 3. Strive for early diagnosis and connection to care for improved prognosis and decreased morbidity 4. Highlight unique considerations for specific populations 5. Align with the upcoming Eating Disorders Pathway project Design/Methods The first edition of the ED Toolkit was reviewed and based on feedback sought and provided by key partners including PCPs already using the Toolkit, areas of improvement were identified. These included formatting to improve accessibility in the primary care setting, updating the guidelines, and including unique considerations for specific populations. A literature review of current guidelines and practices internationally was completed. Experienced paediatric and adult ED specialists reviewed the material to ensure it was appropriate for clinical practice. Key partners contacted for feedback and collaboration included the Provincial ED Steering Committee, Provincial ED Pathway Project Committee, UBC Continuing Professional Development, and Primary Care physicians. This ensured the resource was meeting PCPs identified needs and was usable in the primary care setting. Edits were made to reflect the feedback received. Finally, the resource was reviewed to ensure alignment with the upcoming Provincial ED Pathway Project. Results The Eating Disorder Toolkit 2023: Standards of Practice in the Primary Care Setting is now available and has been distributed widely across British Columbia. In addition, Kelty Mental Health and Compass, leading resource hubs in the province, host the live document on their sites. Finally, the toolkit is also provided to any health providers upon request to their regional ED clinic. While we have not formally studied the outcome of this resources, anecdotal reports via email and verbal feedback from nurse practitioners, paediatricians, and ED specialists across the province has been positive. Conclusion Eating disorders are complex illnesses associated with significant medical and psychiatric complications. Early recognition and management improves prognosis. Community providers play a crucial role in recognizing and managing these patients, however many do not have expertise in this area. It is hoped that this resource will support PCPs in managing ED patients in British Columbia and there may be a potential scope for use across Canada with adaptations to local guidelines and resources.

Measuring the impact: Severity of harm from laboratory errors in 195 tests.

This study aimed to objectively assess the potential severity of harm associated with erroneous results in 195 laboratory tests by surveying 514 specialist physicians and medical biochemistry experts. The survey obtained participants' (75 medical biochemists, 439 clinicians) opinions on severity of harm for the erroneous results of 195 tests. The comprehensive list of errors and their effects on test results were obtained from the literature, and then matched with severity of harm scores, from 1 (negligible effect) to 5 (life-threatening injury/death), obtained from the survey responses. Participants perceived tests such as cardiac biomarkers, blood gases, coagulation parameters (activated partial thromboplastin time, prothrombin time, international normalized ratio, and dimerized plasmin fragment D), critical ions (potassium, sodium), toxic trace elements (lead, mercury), and specific serum drug levels (lithium, digoxin) to have a greater potential for patient harm in case of errors. Medical biochemistry specialists assigned higher severity scores to some laboratory tests, including total bilirubin, pseudocholinesterase, platelet indices, and some drug levels (cyclosporine, methotrexate, vancomycin). A substantial agreement (91%) was observed between medical biochemists and clinicians in terms of the most frequently chosen severity of harm score. The study provided objective severity scores and identified high-risk tests for targeted quality improvement.

Real-World Evidence of Clinical Outcomes of the Use of the Adalimumab Biosimilar SB5 in Rheumatic and Gastrointestinal Immune-Mediated Inflammatory Diseases: 12-Month Data from the PERFUSE Study.

There is a need for published data on real-world use of SB5, an adalimumab (ADL) biosimilar approved in Europe in 2017, on the basis of evidence from pre-clinical and analytic data as well as phase I and III clinical studies demonstrating equivalent efficacy and comparable pharmacokinetics, safety and immunogenicity profiles as the reference ADL. The purpose of this study was to estimate patient persistence on SB5 at 12 months post-initiation using clinical and healthcare claims data from the French Système National des Données de Santé (national healthcare claims database, SNDS) in addressing data gaps. PERFUSE is a 12-month, observational, multi-centre cohort study of patients with rheumatic or gastrointestinal immune-mediated inflammatory diseases (IMIDs) who initiated routine SB5 treatment between October 2018 and October 2020, either as their first ADL (naïve) or transitioning from another ADL (switched). Clinical data, including disease activity scores, C-reactive protein levels, and dosing information, were collected as available from patient records captured during routine visits to specialist physicians. Persistence data were supplemented with data from the French national healthcare claims database (SNDS). Analyses of clinical data were descriptive, while persistence was assessed using a Kaplan-Meier survival analysis. Overall, 911 patients were included: 507 from rheumatology centres [116 with rheumatoid arthritis (RA), 78 psoriatic arthritis (PsA), and 313 ankylosing spondylitis (AS)] and 404 from gastroenterology centres [316 with Crohn's disease (CD) and 88 ulcerative colitis (UC)]. Among naïve patients, 12-month remission/low activity rates were 58% for RA, 66% for PsA, 59% for AS, 94% for CD, and 85% for UC, increasing significantly from baseline for all indications (p < 0.05). Switched patients' remission rates remained stable between baseline and month 12 (M12) for all indications (p > 0.05). Persistence (95% CI) at M12 among naïve patients was 59% (46.5, 68.8) for RA, 65% (49.7, 77.1) for PsA, 56% (48.3, 62.6) for AS, 70% (63.0, 75.7) for CD, and 42% (30.7, 53.1) for UC, compared to 60% (42.7, 73.7) for RA, 57% (37.3, 72.1) for PsA, 55% (45.8, 64.0) for AS, 63% (53.4, 71.7) for CD, and 56% (27.2, 77.6) for UC among switched patients. No significant differences were observed between naïve and switched patients (p > 0.05). SNDS pairing provided information on 68 of the 132 patients (52%) who were lost to follow-up in the clinical database, of whom 57 (84%) were confirmed persistent at M12 and 11 (16%) non-persistent. Primary treatment failure (naïve patients) and patient decision (switched patients) were the most common reasons stated for treatment discontinuation. SB5 provides clinically effective treatment of both gastrointestinal and rheumatic IMIDs for naïve and switched patients, with no loss of control observed when switching. Persistence was comparable between naïve and switched populations, though the reasons for non-persistence differed. Trial registration number: Clinical Trials identifier NCT03662919. Trial registration date: 10 September 2018.

Challenges in Diagnosis and Management of SLE in Africa: An Online Survey.

We surveyed African physicians about challenges in diagnosis and management of systemic lupus erythematosus (SLE). We used a cross-sectional, online questionnaire-based survey of African specialist physicians on availability of laboratory tests, medications, and specialized services for the diagnosis of SLE. Our 226 respondents from 31 countries were dermatologists (38%), rheumatologists (28%), and nephrologists (23%), the majority practicing at university/state-funded hospitals (80.8%), but over half of patients (59.6%) were self-funded for laboratory tests and medications. Antinuclear antibody (ANA), antiphospholipid antibody, and complement tests were available to 79.4%, 67.6%, and 62.3% of respondents, respectively, but fewer in the East and West African regions. Median turnaround time for the ANA test was within two weeks but more than four weeks for 5.6% of respondents, and longer in West Africa compared with other regions (P = 0.0002). Availability of urine protein-to-creatinine test, skin and renal histopathology was 82%, 82.5%, and 76.2%, respectively. Median turnaround times were within one to two weeks, but more than four weeks for 13.8% of respondents for skin histology results and usually within four weeks but more than four weeks for 24.5% of respondents for renal histology. Glucocorticoids and antimalarials were readily available across all regions, with variable availability of immunosuppressants from 93.7% for methotrexate to 65% for calcineurin inhibitors and only 58.4% for the biologic rituximab. Intensive care units/high care facilities, hemodialysis, and renal transplantation were available to 69.8%, 91.9%, and 56.5% of respondents, respectively. Variable availability of laboratory tests, medications, and supportive services coupled with cost constraints are major impediments to early diagnosis and optimal management of SLE in most of Africa and are likely factors contributing to underreporting and poor prognosis of SLE in Africa.

Under-Prescription of Drugs in the Elderly Population of Western Romania: An Analysis Based on STOPP/START Version 2 Criteria.

Background/Objectives: Numerous European countries, including Romania, are facing the concern of rapid ageing of their populations. Moreover, Romania's life expectancy ranks among the lowest in the European Union. In light of this, it is imperative that the assessment of medication-related harm be given national priority in order to secure and enhance pharmacotherapy and the medical act. In this study, we sought to describe and evaluate the under-prescribing practices among the Romanian elderly population. Methods: We conducted a cross-sectional study in urban areas of two counties in Western Romania (Timis and Arad) from November 2017 to February 2019. We collected chronic electronic prescriptions issued for elderly patients (>65 years old) with chronic conditions. The medication was prescribed by generalist or specialist physicians for periods ranging between 30 and 90 days. To assess inappropriate prescribing behaviours, a multidisciplinary team of specialists applied the Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert to Right Treatment (STOPP/START) v.2 criteria to the collected prescriptions. Results: Within the 1498 prescriptions included in the study, 57% were issued to females, the mean age was 74.1 ± 6.95, and the average number of medicines per prescription was 4.7 ± 1.51. The STOPP criteria most commonly identified were the (1) long treatment duration (23.6%) and (2) prescription of neuroleptics (14.6%) or zopiclone (14.0%) as medications that increase the risk of falls. According to START criteria, the following medicines were under-prescribed: (1) statins (47.4%), (2) beta-blockers (24.5%), (3) antiresorptive therapy (10.0%), and (4) β2-agonists and muscarinic antagonists for chronic obstructive pulmonary disease (COPD) (4.5%). Within our study group, the prevalence of potentially inappropriate medications was 18.58%, whereas the prevalence of potential prescribing omissions was 49.2%. Conclusions: To decrease medication-related harm and morbid-mortality, and to increase the quality of life for elderly people in Romania, immediate actions are needed from national authorities. These actions include reinforcing primary care services, providing periodic training for physicians, implementing medication review services by pharmacists, and utilising electronic health records at their full capacity.

Sleep-disordered breathing diagnosis: a comprehensive audit of home sleep testing in real clinical settings.

This study aimed to investigate the indications and outcomes of Home Sleep Testing (HST) for patients with suspected obstructive sleep apnea (OSA), aligning with guidelines set forth by the American Academy of Sleep Medicine and the European Sleep Research Society. Specifically, we aimed to audit whether validated type 3 polygraphy could effectively ensure patient care while optimizing resource utilization. A retrospective analysis was conducted on data from patients undergoing type 3 polygraphy for suspected OSA in a tertiary referral hospital between January 2022 and December 2022. Demographic, clinical, and management data were collected. The efficacy of HST in guiding management plans was evaluated, with outcomes categorized as effective or ineffective based on subsequent need for in-laboratory polysomnography. While 85% of patients received a reliable diagnosis, 44.4% of them still required subsequent polysomnography, primarily due to adherence to funding regulations, rather than clinical need for further testing. Factors impacting the efficacy of HST included patient age, severity of apnea, and referral by a certified sleep specialist physician. Our study highlighted the potential of type 3 polygraphy, as a valuable tool for diagnosing OSA in an outpatient setting. However, having the result interpreted by a certified sleep specialist doctor was not enough. To streamline the care pathway, the referral for polygraphy had also to be made by a trained specialist. Challenges related to funding regulations, patient demographics and physician training stress the need for optimized diagnostic pathways to improve patient care and resource utilization.

"Doctor ChatGPT, Can You Help Me?" The Patient's Perspective: Cross-Sectional Study.

Artificial intelligence and the language models derived from it, such as ChatGPT, offer immense possibilities, particularly in the field of medicine. It is already evident that ChatGPT can provide adequate and, in some cases, expert-level responses to health-related queries and advice for patients. However, it is currently unknown how patients perceive these capabilities, whether they can derive benefit from them, and whether potential risks, such as harmful suggestions, are detected by patients. This study aims to clarify whether patients can get useful and safe health care advice from an artificial intelligence chatbot assistant. This cross-sectional study was conducted using 100 publicly available health-related questions from 5 medical specialties (trauma, general surgery, otolaryngology, pediatrics, and internal medicine) from a web-based platform for patients. Responses generated by ChatGPT-4.0 and by an expert panel (EP) of experienced physicians from the aforementioned web-based platform were packed into 10 sets consisting of 10 questions each. The blinded evaluation was carried out by patients regarding empathy and usefulness (assessed through the question: "Would this answer have helped you?") on a scale from 1 to 5. As a control, evaluation was also performed by 3 physicians in each respective medical specialty, who were additionally asked about the potential harm of the response and its correctness. In total, 200 sets of questions were submitted by 64 patients (mean 45.7, SD 15.9 years; 29/64, 45.3% male), resulting in 2000 evaluated answers of ChatGPT and the EP each. ChatGPT scored higher in terms of empathy (4.18 vs 2.7; P<.001) and usefulness (4.04 vs 2.98; P<.001). Subanalysis revealed a small bias in terms of levels of empathy given by women in comparison with men (4.46 vs 4.14; P=.049). Ratings of ChatGPT were high regardless of the participant's age. The same highly significant results were observed in the evaluation of the respective specialist physicians. ChatGPT outperformed significantly in correctness (4.51 vs 3.55; P<.001). Specialists rated the usefulness (3.93 vs 4.59) and correctness (4.62 vs 3.84) significantly lower in potentially harmful responses from ChatGPT (P<.001). This was not the case among patients. The results indicate that ChatGPT is capable of supporting patients in health-related queries better than physicians, at least in terms of written advice through a web-based platform. In this study, ChatGPT's responses had a lower percentage of potentially harmful advice than the web-based EP. However, it is crucial to note that this finding is based on a specific study design and may not generalize to all health care settings. Alarmingly, patients are not able to independently recognize these potential dangers.

Prevalence of falls in the last weeks of life and relationship between falls, independence and quality of dying in Japan: a large prospective cohort study

ObjectiveThis study aims to determine the frequency of falls and their serious complications in palliative care units (PCUs), as well as explore the complex interplay between falls, independence and quality...

Discovery of Ornithodoros tholozani, the Main Vector of Iranian Tick-born Relapsing Fever.

Doctor Joseph Désiré Tholozan was a French physician who became the special physician of Nassereddin Shah, King of Persia (Iran) in the 19th century. He studied lots of topics in the field of epidemiology of infectious diseases. His efforts led to the discovery of the main vector of Iranian tick-born relapsing fever, Ornithodoros tholozani. He was also one of the pioneers of the Iranian Sanitary Council, whose efforts led to the foundation of the Ministry of Health of Iran a few decades later. This paper is a brief review of his biography and his roles in promoting health in Iran in the 19th century.

Improvement of the Facial and Dental Esthetics With Surgery-Only Approach.

With the development and introduction of orthodontic techniques and surgical protocols, modern patient prototypes are emerging. This paves the way for new approaches to the treatment of dentomaxillofacial deformities. The aim of the authors' study is to determine the appropriate timing and procedure for orthognathic surgery and to obtain the best patient and physician-oriented results. It is stated that surgery first and surgery only approaches are protocols that increase the motivation for treatment, with esthetic improvement being the priority. In this case report, the treatment of the authors' patient, who complained of asymmetry and planned to have a prosthetic restoration after correction of the skeletal deformity, with only a surgical protocol, is described. Treatment of dentomaxillofacial deformities involves a comprehensive analysis of patient, orthodontist, and surgeon-specific variables. Within appropriate indications, only a surgical approach can be an ideal approach for patients and specialist physicians in a short time.

Strengths, weaknesses, opportunities, and threats (SWOT) of the electronic prescribing systems executed in Iran from the physician’s viewpoint: a qualitative study

BackgroundElectronic prescribing (e-prescribing) is an essential technology in the modern health system. This technology has made many changes in the prescription process, which have advantages and disadvantages and have created opportunities for transforming the health system. This study aimed to investigate the strengths, weaknesses, opportunities, and threats of the e-prescribing system implemented in Iran from the physician’s viewpoint.MethodsThis phenomenological qualitative study was conducted in 2022. The participants were 15 Iranian specialist physicians working at Urmia University of Medical Sciences, selected purposively and deliberately. Data was collected through in-depth semi-structured interviews using an interview guide comprising 16 questions. Interviews were conducted until data saturation was reached. The audio data was transcribed into text and analyzed using the thematic analysis. To ensure the validity and reliability of the findings, the criteria introduced by Lincoln and Guba were employed.ResultsThe results of this study showed that the e-prescribing system executed in Iran has diverse and multidimensional strengths, weaknesses, opportunities, and threats. In the strengths section, the analysis of the interviews led to the extraction of semantic units in the categories of prescription process, prescriber, patient, technical, economic, communication, and insurance. Also, the weaknesses in the three categories of the prescriber, patient, and technical were debatable. The opportunities extracted from the narratives of the interviewees were placed in four categories including technical, national macro policies, Ministry of Health macro-policies, and socio-cultural issues. Finally, the discussed threats are classified into two technical and macro policies of the Ministry of Health categories. On the other hand, technical issues played an effective role in all aspects of the SWOT model.ConclusionThe e-prescribing system in Iran has strengths, weaknesses, opportunities, and threats. An overarching factor across all aspects of the SWOT model was technical infrastructure. A robust technical infrastructure is considered a strength and an opportunity for the growth of the electronic prescribing system in Iran. Conversely, any shortcomings in these systems are viewed as weaknesses and pose a threat to the system’s sustainability.

Evaluating the Effects of Ketamine on Serum Glutamate Dehydrogenase, Glutamine Synthetase and Asparagine Synthetase Levels in Patients with Major Depressive Disorder Before and After Ketamine Treatment

Introduction: It has been revealed that major depressive disorder (MDD)is a common and debilitating psychiatric disorder. Dysfunctional enzymes involved in neurotransmission glutamate dehydrogenase (GDH), Glutamine synthetase (GS) and Asparagine synthetase (ASNS) may underlie the pathophysiology of MDD. The present project aimed to explore the effects of Ketamine on GDH, GS and ASNS in MDD patients. This study provides evidence of interactions between ketamine and GDH, ASNS and GS levels in patients with MDD. Materials and Methods: Patients with MDD are referred to the psychiatric ward of Shaheed Yahyanejad Hospital for regular follow-up. Patients diagnosed with MDD were based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), structured clinical interviews, as well as the severity of depression based on clinical criteria determined by a specialist physician. Serum samples from MDD patients before and after ketamine administration were taken to examine the changes in GDH, ASNS and GS levels. In this project, 29 patients with MDD therapy were evaluated with ketamine (0.75 mg/kg). Results: Our study showed that after administrating ketamine, the level of ASNS and Glutamate dehydrogenase GDH in patients with MDD was reduced compared to pre-treatment. However, the level of GS was increased compared to before treatment. The results show that ketamine occurs at the metabolism level in MDD patients. Also, our results demonstrated that GDH, ASNS, and GS levels can be measured to evaluate the effect of Ketamine on MDD patients. Conclusions: Patient success has improved depression after two months of administrating ketamine. Marginally, more than 80% of patients diagnosed with MDD treated with ketamine showed complete remission. Current results may be helpful in understanding the mechanisms responsible for ketamine’s clinical efficacy.