Subspecialty Research Articles

Reproductive Experiences of Physicians in Medical and Surgical Subspecialties.

Objective: To evaluate the reproductive experiences of physicians across gender and specialty. Patients and Methods: Between November and December 2021, we surveyed nontrainee physicians of all genders at a single quaternary institution using a modified version of an existing survey instrument. Experiences with family planning, fertility, pregnancy, and parental leave were assessed. Results: There were 422 completed responses. Respondents reported a higher prevalence of infertility as compared to the general U.S. population (26% versus 19%), with no difference in infertility or obstetrical complications by specialty. Most respondents (75%) reported stigma regarding having children in medicine, and 71% reported delaying childbearing. These trends were strongest in the subanalysis of female respondents. Forty-five percent of respondents reported that their work increased the risk for subfertility, infertility, or pregnancy complications. Surgeons were significantly more likely to report physically demanding work conditions (75% versus 30%, p < 0.001), radiation exposure (39% versus 14%, p < 0.001), and bloodborne pathogen exposure (25% versus 12%, p = 0.03) as occupational reproductive hazards. Only 55% of respondents with a pregnancy history reported ever taking parental leave. Among those who took less than the full amount offered, 63% cited concerns about falling behind educationally or professionally as significantly influencing this decision. Conclusions: These results support previous trends showing delayed childbearing and increased infertility among physicians while shedding new light on stigma associated with childbearing and parental leave. A better understanding of the reproductive experiences of physicians is critical to recruiting and retaining a skilled workforce and fostering career and life satisfaction in this profession.

Clinician engagement strategies to increase palliative care access in a multi-site community oncology practice.

196 Background: Despite nearly 20 years since PC was recognized as a medical subspecialty, and ACS, ASCO and NCCN’s recommendations for early involvement, many oncologists continue to categorize PC synonymously with hospice and therefore refer to palliative medicine specialists very late in the disease trajectory, if at all. Each year, more oncology and PC researchers study and report the life changing impact of early PC for patients living with stage III and IV “advanced cancer” (AC). While mandating PC would have its challenges, creating workflows to encourage providers to change their behavior and attitude regarding PC, while empowering other clinical team members to directly refer, should result in patients and families receiving earlier PC services. Methods: The study included a pre-intervention period (9/1/2023 - 12/31/2023), and an intervention period (1/1/2024 - 4/30/2024). Pre-intervention referral data was collected from OncoEMR, OneAnalytics and Social Work reports. PC referrals were requested for both oncology and hematology patients, regardless of diagnosis date or stage. During the intervention period, 6 strategies were designed to increase PC referrals and were deployed equally in all 8 oncology/hematology offices. Strategies included 1) weekly MD/APP huddles with one of the goals to discuss the palliative care needs of all patients, 2) self-directed referrals from nursing, 3) self-directed referrals from social work, 4) APP referrals for advance care planning, 5) proactive chart reviews by PC APNs and direct PC referral suggestions to MD/APPs for AC patients, and 6) hardwiring timely scheduling of PC referrals. The primary end point is the percent of unique cancer (UC) patients who had a PC referral; the secondary end point is the percent of referred AC patients with early PC referral as defined by referral within 8 weeks of diagnosis. Results: During the pre-intervention period, of the 8,551 UC patients, 154 (1.8%) received PC referrals as compared to 227 (2.8%) of the 8,055 UC patients during the intervention period, yielding a 56% increase in the intervention period. In the pre-intervention period, 24 (14%) of the 177 newly diagnosed AC patients received early PC referrals compared to 32 (21%) of the 153 newly diagnosed AC patients in the intervention period, giving rise to a 50% increase. Conclusions: Strategies to increase PC referrals in a community oncology practice increased overall referrals as well as earlier referrals in newly diagnosed AC patients. As the interventions mature, the total number of PC referrals and a shift toward earlier referrals will likely be seen. Future goals will include assessing patient and family comfort with their treatment plan with PC versus without PC, as well as assessing providers' perceived value of PC over time. With attitude and behavior change, practice culture change is anticipated amid PC becoming the standard of care for all AC patients.

Closing the loop: Utilizing advanced practice providers for a 7-day post hospital discharge follow-up of GI oncology patients at an academic cancer center.

304 Background: Acute care visits for oncology patients may be preventable, especially for high-risk patients with a recent hospitalization. During our 2023 Fiscal Year, we observed an approximate 22% rate for 30 day readmissions for oncology patients, with our gastrointestinal (GI) oncology patients having the most readmissions, at Stanford Cancer Center. Readmission review through clinician surveys suggested that about 28% of unplanned admissions may have been preventable, with root cause analysis identifying timely access to ambulatory symptom management as a major driver. Methods: We established a cancer transitional care (CTC) clinic to provide consistent and timely post-discharge follow-up for oncology patients. We initiated a pilot program for GI oncology patients (chosen due to high acuity and readmission rate) who had an unplanned admission to Stanford Hospital. We aimed to schedule a visit with an advanced practice provider (APPs) within 7 days of discharge. The A3 problem solving process was implemented weekly by a multidisciplinary team. We created a referral in our electronic medical record. Inpatient oncology teams were instructed to place this referral within 3 days before discharge, allowing for adequate patient and family education regarding the goals of CTC visits and ample time for the post-discharge CTC visit to be scheduled prior to patient discharge. Prior to CTC visits, pharmacists performed outreach to reconcile medications to reduce medication errors. Eight oncology APPs were trained regarding the focused nature of a CTC visit, including symptom management, medication reconciliation, and goals of care discussions. Results: At baseline, from June 1 and November 30th, 2023, 61% of patients had follow-up within 7 days of discharge and 12% of patients with none. Between December 13, 2023 and April 19, 2024, CTC implementation resulted in a total of 220 referrals for GI oncology discharges, yielding 144 CTC clinic visits. Resulting in 66.1% of patients having follow up within 7 days of discharge and 9% of patients had no follow up scheduled. 79% of visits were within 7 days of discharge, representing a 29% increase in our goal scheduling timeline. The average time between discharge date and CTC visit was 6.2 days. Sixty six patients also received detailed pharmacy reviews with medication reconciliation and addressing medication access issues. Conclusions: Through our CTC clinic, we standardized post-discharge follow-up access for GI oncology patients, reducing variability in follow up. We plan to disseminate this model across medical oncology subspecialty clinics. Barriers included standardization of follow up with clinical team and expectations for the visit for both patients and clinicians. Future directions include integrating same day symptom management and urgent care access.

Case-Based Peer Teaching for Pain Medicine Fellows: A Curriculum for Diverse Residency Backgrounds.

Pain medicine is an advanced medical subspecialty incorporating trainees from diverse primary disciplines. A curriculum that does not assess or promote the trainees' differential expertise developed from their primary specialties may silo instead of promoting collaborative learning in a multidisciplinary subspecialty. We created a Kern-guided curriculum for the pain medicine fellowship utilizing case-based modules and a novel note-taking and knowledge-sharing format. Nine faculty-led, case-based modules of increasing complexity were developed based on pain medicine competency content. Pain medicine fellows were instructed to actively designate prior and new knowledge into four categories: Prior knowledge that is accurate and relevant, inaccurate prior knowledge, new knowledge gained from peers, and new knowledge for all trainees. After each case study, each fellow acknowledged "new knowledge gained from peers" and prepared a brief teach-back of "new knowledge for all trainees" at the beginning of the next session. Fellow participants were assessed for their reactions to the curriculum via anonymized surveys. The curriculum was implemented at a single institution pain medicine fellowship from 2021 to 2023. At the end of this curriculum, 90% of participants reported improved knowledge retention through participating in this case-based curriculum compared to the traditional didactic format, and 80% participants reported increased respect for their peers. We created a novel note-taking and knowledge-sharing platform, anchored by a well-established case-based educational strategy, to improve the learning environment and knowledge retention for multidisciplinary trainees with heterogeneous baseline knowledge.

Standardized Data Elements for Patients With Acute Pulmonary Embolism: A Consensus Report from the Pulmonary Embolism Research Collaborative.

Recent advances in therapy and the promulgation of multidisciplinary pulmonary embolism teams show great promise to improve management and outcomes of acute pulmonary embolism (PE). However, the absence of randomized evidence and lack of consensus leads to tremendous variations in treatment and compromises the wide implementation of new innovations. Moreover, the changing landscape of health care, where quality, cost, and accountability are increasingly relevant, dictates that a broad spectrum of outcomes of care must be routinely monitored to fully capture the impact of modern PE treatment. We set out to standardize data collection in patients with PE undergoing evaluation and treatment, and thus establish the foundation for an expanding evidence base that will address gaps in evidence and inform future care for acute PE. To do so, >100 international PE thought leaders convened in Washington, DC, in April 2022 to form the Pulmonary Embolism Research Collaborative. Participants included physician experts, key members of the US Food and Drug Administration, patient representatives, and industry leaders. Recognizing the multidisciplinary nature of PE care, the Pulmonary Embolism Research Collaborative was created with representative experts from stakeholder medical subspecialties, including cardiology, pulmonology, vascular medicine, critical care, hematology, cardiac surgery, emergency medicine, hospital medicine, and pharmacology. A list of critical evidence gaps was composed with a matching comprehensive set of standardized data elements; these data points will provide a foundation for productive research, knowledge enhancement, and advancement of clinical care within the field of acute PE, and contribute to answering urgent unmet needs in PE management. Evidence produced through the Pulmonary Embolism Research Collaborative, as it is applied to data collection, promises to provide crucial knowledge that will ultimately produce a robust evidence base that will lead to standardization and harmonization of PE management and improved outcomes.

Attitudes of Forensic Fellowship Psychiatry Directors towards an Applicant Match.

Forensic psychiatry fellowship programs recruit applicants through a nonstandardized process that differs by program. Although there are deadlines, informal guidance, and more recent communication guidelines, perceived differences in recruitment practices persist between geographic regions, small and large programs, and newer and more well-established programs. In the wake of a survey of fellowship applicants that found mixed opinions surrounding the application process, U.S. forensic fellowship directors undertook a mixed method quantitative-qualitative survey of their colleagues to assess interest in a match as a potential improvement and factors influencing that interest (e.g., program size, age, and unfilled positions). With responses from all 46 active U.S. programs, results indicated broad support for principles of fairness, transparency, and minimizing pressure on applicants, with an almost perfectly divided interest in a match. Respondents supported the use of a centralized database to standardize the application process and favored certain exceptions for internal applicants. Hypotheses about the reasons underlying program directors' attitudes toward a match did not yield significant results, with only the size of a program approaching significance. This novel comprehensive survey of forensic fellowship directors offers a model for assessing and monitoring the evolution of application processes for medical subspecialties interested in expanding and improving their recruitment.

Drug Pricing Stewardship from Mark Cuban's Cost Plus Generic Drug Program.

The exceedingly high US spending per capita on prescription medications is mediated, at least in part, by the inefficiencies of existing generic pharmaceutical distribution and reimbursement systems; yet, the extent of potential savings and areas for targeted interventions for generic drug prescribers remains underexplored. We aimed to analyze 2021 Medicare Part D spending on generic drugs in comparison with pricing of a low-cost generic drug program, the Mark Cuban Cost Plus Drug Company (MCCPDC), to gauge the extent of achievable potential savings. In this retrospective, observational study, we performed a systematic analysis of potential Medicare Part D savings when using MCCPDC generic pricing. The 2023 MCCPDC data, as of August 2023, were obtained from the provider's publicly available database. The 2021 Medicare Part D data and prescriber datasets were obtained from the US Centers for Medicare and Medicaid Services. Outcomes included total prescription volume, proportion of drugs with savings, total US dollar Medicare savings, and average weighted price reduction per unit drug. Results were stratified by medical and surgical subspecialties to identify areas for targeted interventions. Subspecialty-wise contribution to total savings versus contribution to total prescription volume was characterized. Total estimated Medicare Part D savings were $8.6 billion using 90-day MCCPDC pricing, with surgical drugs accounting for over $900 million. Nearly 80% of the examined drugs were more price effective through MCCPDC using 90-day supply. Commonly prescribed drugs in cardiology, psychiatry, neurology, transplant surgery, and urology demonstrated the highest estimated absolute savings. The most disproportionate savings relative to prescription volume were observed for drugs in oncology, gynecology, infectious disease, transplant surgery, and colorectal surgery. This study underscores the significant potential for Medicare Part D savings through strategies that address the systemic overpayment for generic medications. We identified key areas for reform as well as specific medical and surgical subspecialties where targeted interventions could yield substantial savings.

Influence of Model Evolution and System Roles on ChatGPT's Performance in Chinese Medical Licensing Exams: Comparative Study.

With the increasing application of large language models like ChatGPT in various industries, its potential in the medical domain, especially in standardized examinations, has become a focal point of research. The aim of this study is to assess the clinical performance of ChatGPT, focusing on its accuracy and reliability in the Chinese National Medical Licensing Examination (CNMLE). The CNMLE 2022 question set, consisting of 500 single-answer multiple choices questions, were reclassified into 15 medical subspecialties. Each question was tested 8 to 12 times in Chinese on the OpenAI platform from April 24 to May 15, 2023. Three key factors were considered: the version of GPT-3.5 and 4.0, the prompt's designation of system roles tailored to medical subspecialties, and repetition for coherence. A passing accuracy threshold was established as 60%. The χ2 tests and κ values were employed to evaluate the model's accuracy and consistency. GPT-4.0 achieved a passing accuracy of 72.7%, which was significantly higher than that of GPT-3.5 (54%; P<.001). The variability rate of repeated responses from GPT-4.0 was lower than that of GPT-3.5 (9% vs 19.5%; P<.001). However, both models showed relatively good response coherence, with κ values of 0.778 and 0.610, respectively. System roles numerically increased accuracy for both GPT-4.0 (0.3%-3.7%) and GPT-3.5 (1.3%-4.5%), and reduced variability by 1.7% and 1.8%, respectively (P>.05). In subgroup analysis, ChatGPT achieved comparable accuracy among different question types (P>.05). GPT-4.0 surpassed the accuracy threshold in 14 of 15 subspecialties, while GPT-3.5 did so in 7 of 15 on the first response. GPT-4.0 passed the CNMLE and outperformed GPT-3.5 in key areas such as accuracy, consistency, and medical subspecialty expertise. Adding a system role insignificantly enhanced the model's reliability and answer coherence. GPT-4.0 showed promising potential in medical education and clinical practice, meriting further study.

Neuromodulation guide for the non-neuromodulator clinician: What it is and how it can benefit patients?

Neuromodulation is being utilized across a variety of medical subspecialties to treat both painful and non-painful medical conditions. However, publications on neuromodulation topics infrequently occur in journals targeting generalists and medical specialties outside of pain medicine and neurosurgery. This study reviewed implantable neuromodulation devices, their respective Food and Drug Administration-approved indications for use, as well as off-label usage, and the associated potential risks and benefits for each device. PubMed and Medline databases were queried for systematic reviews with or without meta-analyses and randomized controlled trials of implantable neuromodulation devices. The literature review resulted in 106 studies eligible for inclusion, and 67 were included in the final review. In conclusion, as the clinical volume of neuromodulation continues to grow, supporting and educating medical professionals who care for patients that receive implanted neuromodulation devices is paramount. It is likely the use of neuromodulation will continue to expand across all medical subspecialties, and as such, every clinician should have a baseline understanding of this treatment.

Internal medicine in the 21st century: Back to the future

Healthcare systems face multiple challenges arising from demographic factors (population aging) and epidemiological factors (rise of chronic diseases and patients with multimorbidity) as well as threats to their financial sustainability when maintaining equitable access to medical and technological advances. Current healthcare models, based on specialized medical care, lead to fragmented care that can be harmful to the patient and is inefficient for the system due to the overuse of redundant, low-value medical acts. Internal medicine is the hospital-centered general medical specialty par excellence, providing a comprehensive and holistic vision that is centered on the patient and not on the disease. Internists should be the leading physicians in the hospital setting for complex patients with or those with an uncertain diagnosis. Internists must play a key role, as hospitalists do, in the continued care of acute patients hospitalized for medical or surgical diseases, establishing shared care models in multidisciplinary teams. Likewise, to guarantee continuity of care for chronic patients, internists must establish mechanisms for collaboration with primary care and nursing, participating in the development of new out-of-hospital care models that use the available technological resources. Internal medicine should play a leading role in graduate and postgraduate medical education to promote a holistic vision among medical students and residents in medical subspecialties.

Preoperative Care and Prehabilitation for Colorectal Surgery: Establishing a Program in Turkiye

Abstract The ERAS guidelines include recommendations for preoperative care, including patient education and counseling, nutritional and physical activity assessment, psychological rehabilitation, lifestyle recommendations, and metabolic assessment of comorbidities. Based on comprehensive assessments, establishing an individualized preoperative care and prehabilitation program is crucial to acquire better postoperative outcomes. Since the release of the latest ERAS guidelines for colorectal surgery in 2018, research on preoperative care and prehabilitation has been accelerating. To standardize this process, it is essential to establish a multidisciplinary team and a prehabilitation unit that includes healthcare professionals from various medical subspecialties and reinforces communication through an institutional and collaborative approach. The positive impact of such preoperative interventions on the postoperative period has been demonstrated in many countries, leading to the establishment of prehabilitation units. However, such prehabilitation units are lacking in Turkiye, highlighting a significant gap that needs to be addressed.

The COVID-19 Pandemic Led To A Large Decline In Physician Gross Revenue Across All Specialties In 2020.

US health care use declined during the initial phase of the COVID-19 pandemic in 2020. Although utilization is known to have recovered in 2021 and 2022, it is unknown how revenue in 2020-22 varied by physician specialty and practice setting. This study linked medical claims from a large national federation of commercial health plans to physician and practice data to estimate pandemic-associated impacts on physician revenue (defined as payments to eligible physicians) by specialty and practice characteristics. Surgical specialties, emergency medicine, and medical subspecialties each experienced a greater than 9percent adjusted gross revenue decline in 2020 relative to prepandemic baselines. By 2022, pathology and psychiatry revenue experienced robust recovery, whereas surgical and oncology revenue remained at or below baseline. Revenue recovery in 2022 was greater for physicians practicing in hospital-owned practices and in practices participating in accountable care organizations. Pandemic-associated revenue recovery in 2021 and 2022 varied by specialty and practice type. Given that physician financial instability is associated with health care consolidation and leaving practice, policy makers should closely monitor revenue trends among physicians in specialties or practice settings with sustained gross revenue reductions during the pandemic.

Assessing the Impact of the 2024 National Student Psychiatry Conference on Medical Student Career Aspirations and Subspecialty Interest

Assessing the Impact of the 2024 National Student Psychiatry Conference on Medical Student Career Aspirations and Subspecialty Interest

A real-world study of the quality of Outpatient Pain Management in patients with Cancer.

Up to 40% patients with cancer reporting pain may not receive optimal analgesia indicating inadequate treatment of pain. We examined the patterns of outpatient pain management in patients with cancer who reported pain. We used the National Ambulatory Medical Care Survey data for outpatient visits from 2006 to 2018 for patients with any cancer and reporting pain. The primary outcome was prescription of pain medications among these patients. We performed multinomial logistic regression to identify factors associated with analgesic prescriptions among patients with cancer who reported pain. We captured an estimated total of 412 million outpatient visits of which 22 million visits dealt with patients with cancer reporting pain. An estimated total of 13.8 million (61.33%) patient visits had pain reported but were not prescribed any pain medications. 5.5 million (24.44%) patient visits had non-opioid analgesic prescription while opioid analgesics were prescribed during 3.2 million (14.22%) visits. Patients who were black, aged 45-64 years, residing in rural geographical areas, visiting medical subspecialty practices, and having cancers of the respiratory and digestive systems had higher odds of receiving opioid prescription. As one of the largest pain management studies among patients with cancer in the outpatient setting, covering 412 million patient visits, our study shows that a significant proportion of patients with cancer who reported pain did not receive a prescription for analgesics suggesting a possibility of undertreatment of pain. Undertreatment of pain continues to remain a major unmet need in patients with cancer.

Child life specialist services, practice, and utilization across health care: a scoping review.

The objective of this review was to map the available evidence regarding the scope of child life specialist services, practice, and utilization. The concept of child life services began in 1922 and emerged as the child life specialist services specialty in the United States in the 1970s and 1980s. Child life specialists are members of multidisciplinary health care system teams who prioritize the developmental needs of pediatric patients to support and improve patient and family health care experiences. Evidence of the effectiveness of child life specialist services and the utilization of those services is often incorporated in multidisciplinary research reports and thus overlooked. All quantitative, qualitative, and mixed methods research study reports and systematic reviews investigating child life specialist services, practice, and utilization in health care systems were included. This review was guided by the JBI methodology for scoping reviews and a published a priori protocol. CINAHL (EBSCOhost), MEDLINE (PubMed), Scopus, and PsycINFO (APA) were searched for evidence published from January 1980 to August 2022. Research publications about child life specialist services, practice, and utilization have increased dramatically over the past decade, with more than 50% of studies published in the past 5 years. Although the first authors of the majority of the research publications were physicians, these multidisciplinary author teams depicted child life specialist services in a variety of roles, including co-investigators, interventionists, and research subjects. The 105 full-text publications reviewed were from 9 countries, plus 1 publication that surveyed people across Europe. The contexts spanned a wide scope of clinical settings and medical subspecialties, but primarily in hospitals and health centers, and to a lesser extent, in ambulatory clinics and communities. A wide variety of child life specialist services were described across these settings. Mapping the research can help delineate the barriers and facilitators to child life specialist services in health care systems. This scoping review provides evidence of the global diffusion of child life specialist services across health care system settings, with recent increases in research publications involving child life specialist services.

Eosinophil plasticity and diversity: proceedings of the 2023 International Eosinophil Society Symposium.

This issue highlights and details the program and scientific presentations at the International Eosinophil Society's 12th biennial symposium, which was held in Hamilton, Ontario, Canada, in July 2023. The meeting included sessions on regulation of eosinophil development; cell death, stress, and autophagy in eosinophils; local immunity interactions of eosinophils with multiple cell types; eosinophils in host defense; eosinophils and mast cells in gastrointestinal disorders; reciprocal interactions between eosinophils and the microbiome in homeostasis and dysbiosis; and eosinophils in tissue injury and repair and in tumor biology and cancer therapy. There was a mixture of special invited lectures and cutting-edge abstracts on specific aspects of eosinophil science, as well as enlivened pro-con debates on targeting eosinophils with biologics. A major thrust and overarching theme was that eosinophils exhibit remarkable plasticity and heterogeneity in executing their functions both in homeostasis and in pathobiology; there is a new "eo-verse" to understand. We trust that this special volume of the Journal of Leukocyte Biology will be of interest across many disciplines and medical subspecialties in biomedical sciences and demonstrate both the complexity and versatility of the eosinophil in biology and medicine.

The impact of incentive scheme on rural healthcare workforce availability: a case study of Kazakhstan

BackgroundDuring the 1990–2000, Kazakhstan experienced a decline in the number of healthcare professionals working in rural areas. Since 2009, the national government has been implementing financial incentives to encourage healthcare professionals to relocate to rural areas. This study aims to investigate the temporal and spatial patterns in the distribution of the rural healthcare workforce and evaluate the impact of this incentive scheme.MethodsInterrupted Time Series Analysis using ARIMA models and Difference in Differences analyzes were conducted to examine the impact of the incentive scheme on the density of different categories of the healthcare workforce in rural Kazakhstan in the period from 2009 to 2020.ResultsThere was a significant increase in the number of rural healthcare professionals from 2009 to 2020 in comparison to the period from 1998 to 2008. However, this increase was less pronounced in per capita terms. Moreover, a decline in the density of internists and pediatricians was observed. There is substantial variation in the density of rural nurses and physicians across different regions of Kazakhstan. The incentive scheme introduced in 2009 by the government of Kazakhstan included a one-time allowance and housing incentive. This scheme was found to have contributed insignificantly to the observed increase in the number of rural healthcare professionals.ConclusionFuture research should be undertaken to examine the impact made by the incentive scheme on other medical subspecialties, particularly primary practitioners. Addressing the shortage of healthcare workers in rural areas is a complex issue that requires a multifaceted approach. Aside from financial incentives, other policies could be considered to increase relocation and improve the retention of healthcare professionals in rural areas.

The Influence of Medical Subspecialty on the Adherence to Hepatocellular Carcinoma Surveillance in Patients with Chronic Hepatitis B

Objective: This study aimed to determine the adherence rate of HCC surveillance in CHB patients at the largest tertiary hospital in Southern Thailand and identify patient and physician factors that influence it. Materials and Methods: This retrospective cohort study included patients with CHB who were followed up for more than 1 year between 2011 and 2019 at a tertiary care hospital in Thailand. Patients diagnosed with HCC within 6 months of their first visit were excluded. The rate of adherence with HCC surveillance was calculated using percentage of time up-to-date with HCC surveillance (PTUDS). Results: The mean age of 531 eligible patients at the time HCC surveillance started was 55.5 ± 9.26 years. The most common indications for surveillance were male over 40 years of age (41.2%), female over 50 years of age (28.9%), and cirrhosis (22.6%). The median PTUDS was 70.6% (interquartile range 55.1 – 81.4%). The highest PTUDS was for cirrhosis (74.0%). For physicians’ subspecialties, the median PTUDS was 71.8% for gastroenterologists (IQR 58.3 – 81.6%) and 41.7% for internists (IQR 31.4 – 65.8%). Factors associated with increased PTUDS by multivariable analysis were having ≥2 clinical visits per year (±18.4%, p&lt;0.001), civil servant reimbursement (±8.81%, p=0.001), cirrhosis (±6.06%, p=0.003), and being follow-up by gastroenterologists (±20.4%, p&lt;0.001). Conclusion: The adherence with surveillance program in patients with CHB being followed up at a tertiary care setting in Thailand was good. This finding underscores the importance of education regarding indications for HCC surveillance, particularly in patients without cirrhosis.

Ethical and moral principles for oncology healthcare workers: A brief report from a Bioethics consortium emphasizing on need for education.

The medical sub-specialty of Oncology presents diverse ethical dilemmas, often challenging cancer healthcare workers with difficult-to-handle clinical scenarios that are tough from a personal and professional perspective. Making decisions on patient care in various circumstances is a defining obligation of an oncologist and those duty-based judgments entail more than just selecting the best treatment or solution. Ethics is an essential and inseparable aspect of clinical medicine and the oncologists as well as the allied health care workers are ethically committed to helping the patient, avoiding or minimizing harm, and respecting the patient's values and choices. This review provides an overview of ethics and clinical ethics and the four main ethical principles of autonomy, beneficence, non-maleficence, and justice are stated and explained. At times there are frequently contradictions between ethical principles in patient care scenarios, especially between beneficence and autonomy. In addition, truth-telling, professionalism, empathy, and cultural competence; which are recently considered important in cancer care, are also addressed from an Indian perspective.

Addressing Differences in Knowledge and Experience in Trauma Care Capabilities Among an International Team of Military Medical Care Providers in a Deployed Setting.

Military medical personnel are crucial in providing life-saving care at the point of injury (POI) in challenging environments such as combat zones and disaster areas. This article examines the specialized training US Military medical personnel undergo before deployment and the increasing trend of deploying as part of multinational forces in operations like those in Afghanistan with NATO and non-NATO countries. Integrating medical teams from diverse backgrounds poses significant challenges in maintaining a cohesive and efficient team due to varying trauma management training standards and medical practices among the allied forces. Tactical Combat Casualty Care (TCCC) training and the development of clinical practice guidelines (CPG) by the US Joint Trauma Service have been key strategies by the US Military to standardize care. However, the variation in trauma management training among NATO allies and the differences in medical subspecialties and approaches can lead to inefficiencies and reduced effectiveness in a multinational trauma center setting. For instance, the approach to trauma care can significantly differ between the US and European countries, impacting the interoperability and teamwork in multinational medical teams. To address these challenges, the article highlights the importance of standardized medical training programs that include cultural awareness to enhance the effectiveness of multidisciplinary, multinational medical teams. It also underscores the necessity for standardized international trauma training in the face of increasing global conflicts and the potential for large-scale combat operations. The article discusses the "Trauma Tuesday" program implemented in Kabul, Afghanistan, as an example of how intensive training and simulation exercises can improve team dynamics, knowledge, and skills in trauma management among a diverse team from various nations. The need for ongoing education and developing a standard for managing trauma patients in international teams is emphasized to ensure effective communication and coordination. The article suggests that multinational trauma training can significantly improve team cohesion and critical life-saving skills, essential for future battlefields where access to definitive care may be delayed. Further research is recommended to explore the best methods for achieving effective multinational medical team integration and training standardization.