Trust In Medical Professionals Research Articles

Attitudes and Beliefs Regarding Pain and Discrimination Among Black Adults with Sickle Cell Disease: A Mixed Methods Evaluation of an Adapted Chronic Pain Intervention.

This study sought to adapt a chronic pain group curriculum for adults with sickle cell disease (SCD). Given the association of experiences of racism and discrimination with health outcomes, this study also explored how such experiences for patients with SCD impact their interactions with clinicians and health-care systems. This mixed methods study recruited patients (aged ≥18 years) in a sickle cell treatment program; all self-identified as Black or African American. Key informant interviews evaluated a chronic pain program curriculum and rated the curriculum sessions' importance for SCD pain management. A survey containing six validated instruments then measured experiences of pain and discrimination, level of emotional expressivity, and trust in physicians and health insurers. Of the 19 adult patients approached, 12 (63%) completed the interview and survey. Interview data analysis resulted in five themes comprising pain, treatment, mental/emotional, health-care clinicians, and differences in SCD versus other chronic conditions. Each curriculum session was rated as "very important" or "important" by participants. Most described at least one experience of racism or discrimination in the medical setting and identified clinicians' lack of knowledge as a barrier to appropriate SCD care. Participants identified the importance of non-pharmacological treatments for SCD pain and appropriately managing pain caused by comorbid chronic conditions. Conversely, survey responses reported moderate levels of pain, infrequent discriminatory experiences in the medical setting, and moderate trust in medical professionals, whereas most reported experiences of discrimination in general settings. Many participants reported they either accepted it or did nothing in response to discriminatory experiences. Study findings emphasize the need to address experiences of racism and stigma in addition to experiences of emotional and physical pain among patients with SCD in the context of pain management. Findings from this study will inform the development of a SCD pain group curriculum for adult patients.

Healthcare Operations Management: Optimizing Patient Flow and Quality Care in India

Patients' preferences changed from general practice to sub-specialty practice because there was no referral system in place. Most people would rather speak with a medical expert. The cheap medical tariff may make it easier for patients to see a doctor. Patients can see a doctor for even less money thanks to medical insurance companies. In addition, the cost of a doctor's appointment remains the same regardless of how straightforward the case may be. It fosters competition between general practitioners and experts, with the belief that the latter are superior. In addition, confusion and repeated visits to the doctor are caused by a patient's lack of trust in medical professionals and their ignorance of medical procedures. Social Security recipients' hospitals are overworked. The quality of services decreases as the patient base grows. Equipment and facilities are ageing out of date. Providers are forced to restrict their flexibility and ability to adjust to the unique needs of their patients due to staffing shortages and scheduling constraints. Physicians may be forced to refer patients to paramedical departments instead of doing a complete examination in order to deliver a proper diagnosis due to the rising demand for medical services. The current study, which makes reference to India, focusses on healthcare quality management strategies in multispecialty hospitals.

Advancing genetic testing for neurological disorders in Tanzania: importance, challenges, and strategies for implementation.

This manuscript discusses the critical need for advancing genetic testing capabilities for neurological disorders (NDs) in Tanzania, emphasizing the importance, challenges, and strategies for implementation. Neurological disorders, often caused by a complex interplay of genetic and environmental factors, disproportionately affect low and middle-income countries like Tanzania. Patients with neurogenetic diagnoses in Tanzania face substantial obstacles, including lack of trust in medical professionals, stigmatization, and limited access to proper care. The manuscript underscores the infancy of genetic testing implementation for NDs in Tanzania, citing challenges such as high costs, limited availability, and the absence of routine testing in diagnostic procedures. The paper recommends establishing well-characterized cohorts, conducting a nationwide emergency census survey, and enhancing diagnostic services and healthcare financing. The paper stresses on the importance of collaboration, research, public awareness, and advocacy to address the challenges posed by NDs in Tanzania. The manuscript proposes a comprehensive plan, including training and capacity building in molecular diagnosis and bioinformatics, to establish genetic testing capabilities and reduce the burden of NDs in the country. Overall, the manuscript calls for a collaborative effort involving government support, stakeholder engagement, and international partnerships to advance genetic testing and improve healthcare outcomes for individuals with neurological disorders in Tanzania.

Collaborative attitudes and trust among medical and dental professionals in Saudi Arabia.

Interprofessional collaboration involves coordinated efforts by individuals from different professions. Trust is defined as an individual's willingness to be vulnerable within a relationship, while expecting the other party to act in their best interests. This study aimed to assess the attitudes of collaboration and trust among dental and medical professionals in Saudi Arabia. This cross-sectional study evaluated the attitudes of collaboration and trust among dental and medical professionals in Saudi Arabia using an online self-reported questionnaire distributed via social media. Data analysis was performed using SPSS. The overall mean score for collaborative attitude was 6.2 (SD = 1.52), with 69.23% of participants exhibiting a positive attitude about collaboration. Participants rated family medicine (76.67%) and pediatric medicine (76.41%) as the medical specialties most relevant to dentistry, while obstetrics/gynecology was rated the lowest (32.31%). Dental professionals had a significantly higher mean score for collaborative attitude (m = 6.46, SD = 1.48) than did medical professionals (m = 5.93, SD = 1.51; p < 0.001). The score for dental professionals' trust in medical professionals (DTM) (m = 36.94, SD = 8.06) was significantly higher (p < 0.001) than the score for medical professionals' trust in dental professionals (MTD) (m = 33.81, SD = 8.20). The collaborative attitude scores among dental and medical professionals were not statistically significant when tested against the MTD score (p = 0.777) and DTM score (p = 0.419). There is a high level of collaborative attitude and trust between dental and medical professionals in Saudi Arabia. Dentists exhibit a higher degree of these attributes than medical professionals. These findings support the implementation of a collaborative medical-dental education framework in Saudi Arabia, where both specialties can train together during their undergraduate years.

Understanding COVID-19 vaccination decisions during pregnancy and while breastfeeding in a Canadian province

ABSTRACTBackgroundVaccination in pregnancy is important for preventing illness for mothers and babies; however, vaccine uptake in pregnant individuals is lower than non-pregnant females of fertile age. Given the devastating effects of COVID-19 and the increased morbidity and mortality risk for pregnant individuals, it is important to understand the determinants of vaccine hesitancy in pregnancy. The focus of our study was to explore COVID-19 vaccination among pregnant and breastfeeding individuals and its association with their reasons (psychological factors) for vaccination using the 5C scale and other factors.MethodsAn online survey investigating prior vaccinations, level of trust in healthcare providers, demographic information, and the 5C scale was used for, pregnant and breastfeeding individuals in a Canadian province.ResultsPrior vaccinations, higher levels of trust in medical professionals, education, confidence, and collective responsibility predicted increased vaccine uptake pregnant and breastfeeding individuals.ConclusionsThere are specific psychological and socio-demographic determinants that affect COVID-19 vaccine uptake in pregnant populations. Implications of these findings include targeting these determinants when informing and developing intervention and educational programs for both pregnant and breastfeeding individuals, as well as healthcare professionals who are making vaccine recommendations to patients. Study limitations include a small sample and lack of ethnic and socioeconomic diversity.

Trust in Medical Professionals Moderates Depression in Hong Kong during COVID-19

Objectives. Given the continuing COVID-19 pandemic and the associated prevention and control measures implemented, the psychological burden brought by the pandemic on citizens is expected to increase. This study is aimed at exploring the predictors of depressive symptoms among Hong Kong people during the epidemic, as well as factors that could potentially alleviate the negative effects of the epidemic. Methods. The third wave follow-up survey (December 2021 to January 2022) from a longitudinal prospective survey study conducted in Hong Kong was used for a cross-sectional analysis. The participants ( n = 803 ) are adults aged 18 and above in Hong Kong. Logistic and linear regression were performed to test the predictors and moderating effects, respectively, with depression as the outcome variable. Results. With minimized confounding effects of demographic variables, higher levels of concern about infection, experience with COVID-19 infection and previous epidemics, hassles, and trust in authority increased the odds of being depressed, while a higher level of trust in medical professionals reduced the odds of depression. Moreover, greater trust in medical professionals, as a moderator, lessened the positive associations between the levels of depression and hassles and concern about infection. Conclusions. Even though the threats of COVID-19 seem to have lowered, this study shows that a few factors associated with the pandemic continue to threaten people’s mental health. However, developing greater trust in medical experts may be an effective way to relieve psychological burden.

How pandemic-related changes in global attitudes toward the scientific community shape "post-pandemic" environmental opinion.

Low public concern about anthropogenic climate change (ACC)-due in part to distrust in the scientific community-may decrease demand for policies aimed at mitigating its deleterious effects. Encouragingly, though, recent research finds that experiences with the COVID-19 pandemic has elevated trust in scientific expertise worldwide. We explore the possibility that positive attitudes toward the medical community are "spilling over" to increase ACC acceptance via globally representative survey data from 107 countries (N = 119,088) conducted during the COVID-19 pandemic. We show that trust in medical experts' handling of the COVID-19 pandemic is associated with increased ACC acceptance, worldwide. Problematically, though, we also show that the effects of trust in medical professionals is strongest in countries experiencing the most positive change in attitudes toward the scientific community, which tend to be disproportionately wealthy, and less likely to bear the unequal effects of climate change.

Covid-19 Risk Perception in a Sample of Iranian Population

"How people behave in an emergency depends on many social, cultural, and contextual factors. This study aimed to determine the COVID-19 risk perception in Iranian people. This study was descriptive. The study population was the assistant of patients who had come to Baqiyatallah Hospital in 2021. The number of participants was 500. The study tool was the COVID-19 risk assessment questionnaire. Data were analyzed using SPSS-22 software. The mean risk perception score was 2.78(±0.6) on a 7-point scale. The lowest and highest mean of the predictors of risk perception in COVID-19 was trust in government and personal efficacy, respectively. There was a significant difference between men and women in the mean of collective efficacy (P= 0.032). Social knowledge (p=0.007), trust in science (p=0.001), and trust in medical professionals (p=0.050) in positive direct experience people were significantly more than in people with negative direct experience of COVID-19. The most important predictors of risk perception in the COVID-19 epidemic were gender, education, social knowledge, and trust in science (P&lt;0.05). People's perception of the risk of COVID-19 depends on several various factors, the most important factors were gender, level of education, social knowledge, and people's trust in science. "

Assessing the role of collectivism and individualism on COVID-19 beliefs and behaviors in the Southeastern United States.

America's unique response to the global COVID-19 pandemic has been both criticized and applauded across political and social spectrums. Compared to other developed nations, U.S. incidence and mortality rates were exceptionally high, due in part to inconsistent policies across local, state, and federal agencies regarding preventive behaviors like mask wearing and social distancing. Furthermore, vaccine hesitancy and conspiracy theories around COVID-19 and vaccine safety have proliferated widely, making herd immunity that much more challenging. What factors of the U.S. culture have contributed to the significant impact of the pandemic? Why have we not responded better to the challenges of COVID-19? Or would many people in the U.S. claim that we have responded perfectly well? To explore these questions, we conducted a qualitative and quantitative study of Florida State University faculty, staff, and students. This study measured their perceptions of the pandemic, their behaviors tied to safety and community, and how these practices were tied to beliefs of individualism and collectivism. We found that collectivist orientations were associated with a greater likelihood of wearing masks consistently, severe interruptions of one's social life caused by the pandemic, greater concern for infecting others, and higher levels of trust in medical professionals for behavioral guidelines surrounding the pandemic. These associations largely persist even after adjusting for political affiliation, which we find is also a strong predictor of COVID-19 beliefs and behaviors.

COVID-19 pandemic and transgender migrant women in India: Socio-economic vulnerability and vaccine hesitancy

In India, transgender women, often referred to as hijra or kinnar, remain a marginalized group and encounter interpersonal and structural barriers that subject them to social exclusion, discrimination, lack of access to education and health care, and fewer job opportunities compared with the general population. During the COVID-19 pandemic these disparities were heightened and the livelihood of transgender migrant women were severely hit and disrupted, causing further financial and physical hardship. The present study aims to explore the socio-economic vulnerability faced by these women during the pandemic and the factors that contribute to vaccine hesitancy in order to assist government officials and policy makers in the formulation of more inclusive policies for transgender people. Results indicate that the pandemic has adversely impacted their livelihood as most of them depend on sex work and begging. In order to fulfil their daily needs during the lockdown, they have borrowed loans from multiple sources with a higher interest rates and remain in debt. On vaccination status, only seven out of 43 transgender migrant women have taken one vaccine dose, and the rest are not willing to visit vaccine centres because of societal stigma and discrimination including from healthcare personnel. The study reported that these migrant women suffered intensified social stigma, verbal hostility and transphobia attitudes from healthcare professionals whihc caused panic, fear, anxiety and depression among them, and thus they evade these spaces for further consultation or to obtain any other services. Many of them have decided not to take the COVID-19 vaccine in order to stay away from hostility. Further, the lack of trust in medical professionals is also one of the principal concerns leading to vaccine hesitancy among transgender migrant women. Thus a systemic inclusive healthcare services policy is required to address the factors that may influence the vaccine acceptance among transgender women in India.

Health Beliefs, Health Practices, and Health-Seeking Behaviors among Swartzentruber Amish in Clark County, Wisconsin

Although the literature contains valuable information about Amish culture, few qualitative studies have been conducted on the health beliefs, health practices, and health-seeking behaviors of the Swartzentruber Amish, the most conservative group of Old Order Amish. The purpose of this study was to describe these dynamics for the Swartzentruber Amish of Clark County, Wisconsin. Utilizing the grounded theory approach, 25 participants were interviewed and seven themes were identified: shared decision-making is common in families; causes of illness are believed to be etiological or the will of God; home remedies are the first choice; preventive medicine is an unfamiliar concept; health information is sought from within their settlement; and professional medical care is a last resort in treatment. These Amish identified several obstacles to seeking or using professional medical care: unfamiliarity with the English medical system; communication barriers; lack of trust in medical professionals; the high cost of medical care; belief of diminished or no say in a child’s healthcare; and concern about prescription drugs. An understanding of the Swartzentruber Amish is important if healthcare professionals are to provide them with culturally congruent care. Numerous recommendations based on the findings are included for healthcare providers. [Abstract by author.]

Understanding Canadians' knowledge, attitudes and practices related to antimicrobial resistance and antibiotic use: Results from public opinion research.

Antimicrobial resistance is a current and pressing issue in Canada. Population-level antibiotic consumption is a key driver. The Public Health Agency of Canada undertook a comprehensive assessment of the Canadian public's knowledge, attitudes and practices in relation to antimicrobial resistance and antibiotic use, to help inform the implementation of public awareness and knowledge mobilization. Data were collected in three phases: 1) six in-person focus groups (53 participants) to help frame the survey; 2) nationwide survey administration to 1,515 Canadians 18 years and older via cell phone and landline; and 3) 12 online focus groups to analyze survey responses. Survey data is descriptive. A third (33.9%) of survey respondents reported using antibiotics at least once in the previous 12 months, 15.8% more than twice and 4.6% more than five times. Antibiotic use was reported more among 1) those with a household income below $60,000, 2) those with a medical condition, 3) those without a university education and 4) among the youngest adults (18-24 years of age) and (25-34 years of age). Misinformation about antibiotics was common: 32.5% said antibiotics "can kill viruses"; 27.9% said they are "effective against colds and flu"; and 45.8% said they are "effective in treating fungal infections". Inaccurate information was reported more often by those 1) aged 18-24 years, 2) with a high school degree or less and 3) with a household income below $60,000. In focus groups, the time/money trade-offs involved in accessing medical care were reported to contribute to pushing for a prescription or using unprescribed antibiotics, particularly in more remote contexts, while the cost of a prescription contributed to sharing and using old antibiotics. A large majority, across all demographic groups, followed the advice of medical professionals in making health decisions. High trust in medical professionals presents an important opportunity for knowledge mobilization. Delayed prescriptions may alleviate concerns about the time/money constraints of accessing future care. Consideration should be given to prioritizing access to appropriate diagnostic and other technology for northern and/or remote communities and/or medical settings serving many young children to alleviate concerns of needing a prescription or of needing to return later.

COVID-19 risk perception and associated factors in older adults in southern Ethiopia.

BackgroundCOVID‐19 remains a public health concern in lower income countries. Risk perception has been studied in different countries with different population groups. However, there have been few studies conducted risk perception on older adults and limited data from African continent. This study aimed to assess coronavirus disease low risk perception level and associated factors among older adults in Ethiopia.MethodsWe conducted a cross‐sectional study among older adults in Areka town, Wolaita Zone, Southern Ethiopia, from August 1, 2021, to August 30, 2021. Multi‐stage sampling method was applied to select study participants. The data were collected through a structured questionnaire with the mobile application created with Open Data Kit mobile.ResultsOverall, risk perception was fairly low. Risk perception was particularly low among individuals aged 65 to 74 years (AOR = 4.76, 95% CI: 2.35–9.64), poor practice on preventing coronavirus disease (AOR = 2.39, 95% CI: 1.51–3.78), with low trust level in medical professionals (AOR = 2.44, 95% CI: 1.45–4.10), no history of coronavirus disease (AOR = 6.45, 95%CI [2.02–20.58]), and poor perceived self‐efficacy for preventive practice (AOR = 2.25, 95% CI: 1.43–3.54).ConclusionsIn the current study area, the perception of risk of coronavirus disease was affected by age, perceived self‐efficacy, trust in medical professionals, preventive practice, and history of COVID‐19. The findings of this study would help lower income countries to generate evidence‐based policy decisions for older adults during the COVI‐D‐19 pandemic and future pandemic(s).

Dyadic Validation of Relational Processes in Seroconcordant Mozambican Couples: Social Support, Physician Trust, and Stigma.

Psychometric instruments can quantify how people living with HIV experience three key barriers to antiretroviral therapy (ART) and retention: partner support, trust in medical professionals, and internalized HIV-related stigma. However, two challenges arise when using these instruments to measure and interpret relational processes among Mozambican couples, especially those participating in a couples intervention. First, relational measures have almost exclusively been developed and normed with Western, middle-class, and/or White adults. Second, traditional measurement approaches neglect the relational processes between partners. Using dyadic modeling, this paper demonstrates metric and scalar invariance for instruments measuring partner support (CFI = 0.964, TLI = 0.965, RMSEA = 0.034, SRMR = 0.052), trust in medical professionals (CFI = 0.978, TLI = 0.980, RMSEA = 0.033, SRMR = 0.039), and internalized HIV-related stigma (CFI = 0.960, TLI = 0.961, RMSEA = 0.050, SRMR = 0.060) within the novel context of seroconcordant HIV+ couples in Zambézia province.

Can we trust a chatbot like a physician? A qualitative study on understanding the emergence of trust toward diagnostic chatbots

Technological advancements in the virtual assistants' domain pave the way to implement complex autonomous agents like diagnostic chatbots. Drawing on the assumption that chatbots are perceived as both technological tools and social actors, we aim to create a deep understanding of trust-building processes towards diagnostic chatbots compared to trust in medical professionals. We conducted a laboratory experiment in which participants interacted either with a diagnostic chatbot only or with an additional telemedicine professional before we interviewed them primarily on trust-building factors. We identified numerous software-related, user-related, and environment-related factors and derived a model of the initial trust-building process. The results support our assumption that it is equally essential to consider dimensions of physician and technology trust. One significant finding is that trust in a chatbot arises cognitively, while trusting a human agent is affect-based. We argue that the lack of affect-based trust inhibits the willingness to rely on diagnostic chatbots and facilitates the user's desire to keep control. Considering dimensions from doctor-patient trust, we found evidence that a chatbot's communication competencies are more important than empathic reactions as the latter may evoke incredibility feelings. To verify our findings, we applied the derived code system in a larger online survey.

Relationship Between High Organ Donation Rates and COVID-19 Vaccination Coverage.

BackgroundBesides attaining the goal of self-protection, the rollout of vaccination programs also encourages altruistic practices. Therefore, the progress in vaccination against coronavirus disease (COVID-19) in each country may be related to the prevalence of cooperative and altruistic practices in health care. I hypothesized that in countries where organ donation is popular, individuals would exhibit a greater tendency to become vaccinated.MethodsI examined the correlation between the level of progress of COVID-19 vaccination and the status of organ donation just before the pandemic in Organization for Economic Co-operation and Development (OECD) countries. Publicly available statistical information on the progress of immunization and organ donation was used. Univariate and multivariate analyses were conducted to examine common drivers of immunization and organ donation.ResultsIn OECD countries, progress in vaccination was found to be significantly correlated with the status of organ donation in each country. This relationship was stable after the summer (September 1: Pearson's r = 0.442, October 1: 0.457, November 1: 0.366). The results of the univariate and multivariate analyses showed that high trust in medical professionals was significantly correlated with both the “progress of vaccinations” and “organ donations.”ConclusionsProgress in COVID-19 vaccination and organ donation status for transplantation have similar trends, and both may involve people's trust in medical personnel and public health systems. Similar to the efforts to obtain organ donors, governments around the world need to take further steps to ensure that vaccination programs are supported by people's trust and sense of solidarity.

Trust in medical professionals and its influence on the stress experience of parents of premature infants.

To examine parents' perceptions of stress and their trust in physicians and nursing staff and to investigate whether trust influences the parental perceptions of potential stressors resulting from their infant's hospitalisation in a neonatal intensive care unit. Parents of very and extremely low birth weight infants were surveyed in a nationwide retrospective cross-sectional study 6-18months after their child's birth. Parental stress was measured utilising the PSS:NICU_German/2-scales, and trust was measured by the scales Trust in Physicians and Trust in Nursing Staff. In addition to descriptive analyses, multiple linear regression models were conducted. The change in parents' anticipated roles was assessed as more stressful than their infant's appearance and behaviour. Trust in nursing staff significantly influenced the parental stress level. Although the level of trust in physicians was rated higher than trust in nursing staff, trust in physicians did not yield a significant effect on the parental stress experience. Efforts to foster parental trust in nursing staff may reduce the parental stress level and hence enable parents to better cope with the situation. The parental resources unleashed in this way can be employed to enhance parenting.

‘Physio’s not going to repair a torn tendon’: patient decision-making related to surgery for rotator cuff tendinopathy

Introduction: Rotator cuff tendinopathy is a common and disabling shoulder condition and surgical management is becoming more common. The rates and costs of surgical interventions have been on the rise. Understanding decision-making related to surgery and providing adequate information to people with rotator cuff tendinopathy may improve patient-centred care and potentially reduce rates of surgery. The aim of this study was to explore the decision-making processors of people who have undertaken surgery for rotator cuff tendinopathy. Methods: Interviews were conducted (30-45 minutes) with patients from Melbourne who had had surgical management for rotator cuff tendinopathy. Data were transcribed verbatim and analysed using an inductive thematic approach. Results: Fifteen participants were recruited. Six key themes were identified: (1) Needing to get it done: “It was necessary to remedy the dire situation”; (2) Non-surgical treatment experience: ”I knew that I'd done all I could”; (3) Mechanical problem: ”Physio’s not going to repair a torn tendon”; (4) Trust in medical professionals “If they told me that I needed to swallow a thousand spiders, I would have done it.”; (5) Varied information sources “Dr Google played a big part in it”; (6) Organisational barriers “It was absolutely useless, my insurance”. Discussion: Consistent with decision theories, people generally considered multiple factors and benefits and costs when considering surgery. Surgery appears to be commonly precipitated by unremitted severe symptoms and failed non-surgical treatment. While there was strong trust in highly trained surgeons, decision to undergo surgery also drew on questionable pathoanatomical beliefs and instances of inadequate patient information about treatment choices. A commonly held belief among participants in this study was that surgery was inevitable because of mechanical damage or tears in their rotator cuff tendons. Providing information about treatment choices and risks may improve patient-centredness of rotator cuff tendinopathy care. Conflict of interest statement: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.

Compromising Confidentiality: Where to Strike the Balance?

"Patient confidentiality is a central tenet of medical practice, fundamental to ensuring the maintenance of trust in medical professionals. Yet are there any circumstances where a duty of care to others overrides patient confidentiality and allows disclosure of medical information without consent from the index patient? We present the case of a patient with CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) a progressive, neurodegenerative condition that is inherited in an autosomal dominant manner. Admitted to ICU with a severe Traumatic Brain Injury (TBI), the patient ultimately had withdrawal of life sustaining therapy following discussion with family. The patient never regained capacity following admission and had never disclosed the diagnosis of CADASIL to his daughters. The question of whether to disclose the diagnosis to adult children and alert them to their potential risk of inheriting CADASIL (the knowledge of which could fundamentally affect their life choices) raises tensions around confidentiality and any duty of care to the patient’s daughters. Previously, for inheritable risks, the prevailing discourse gave prominence to patient confidentiality. However, a recent UK court case and professional guidance is challenging this notion. ICU clinicians faced the choice of disclosing the CADASIL diagnosis to the adult children, breaking patient confidentiality or remaining silent so allowing potential harm to befall them and even future generations. We examine the ethical issues this raises and suggest how clinicians, if faced with a similar situation in future, might proceed. "

Difficulties in Differential Diagnosis of Thyrotoxicosis: Clinical Case

Introduction: Thyrotoxicosis (T) develops as a result of persistent excess of thyroid hormones (TH). There are two groups of diseases that are fundamentally different in pathogenesis. The first group includes those in which the production of TH increases. Diseases of the second group are accompanied by T caused by destruction of the thyroid gland tissue. Therapeutic approaches for different pathogenetic types of T are different, therefore, a careful differential diagnosis of T is necessary, even if at first glance the diagnosis seems obvious. Clinical Case: A 35-year-old patient consulted a physician complaining of weakness, weight loss by 11 kg in 1.5 months, tremors, palpitations, which first appeared about a month ago. The examination revealed TSH <0.0083 mU/l (0.4-4.0), and an endocrinologist’s consultation was recommended. On examination, the thyroid gland is no larger than the distal phalanx of the subject’s thumb, BMI=24 kg/m2, HR=100 bpm, BP=115/80 mm Hg. Laboratory examination: TSH <0.0083 mU/l, free T4 =28.29 pmol/l (9.0-19.05). Ultrasound of the thyroid gland: signs of diffuse changes in tissue, the total volume=16.8 ml3. For differential diagnosis of T, antibodies to TSH receptors were determined, the titer of which turned out to be slightly increased 1.43 IU / L (<1). A diagnosis of Graves’ disease (GD) was made and treatment was prescribed (Tyrozol 30 mg, Bisoprolol 2.5 mg per day). After 3 weeks, the patient noted an improvement in well-being, but weakness, tremor, an increase in free T4 (23.33 pmol/l) and total T3 (3.26nmol / l at a rate of 0.98-2.33) remained. The lack of achievement of the target values of TH levels was regarded as inadequacy of the received dose of Tyrozol, in connection with which it was decided to increase the dose to 40 mg per day. After 2 weeks, an increase in free T4 (27.26 pmol/L) and total T3 (3.84 nmol/L) remained. The lack of positive dynamics called into question the diagnosis of GD. With a more thorough collection of anamnesis, it was found that 1.5 years ago, the patient took amiodarone for 6 months as prescribed by a cardiologist (he does not remember the dose). In this connection, to establish the cause of T, scintigraphy was performed: revealed a weak accumulation of a radiopharmaceutical with diffuse uneven distribution. Based on the data obtained, amiodarone-induced T type 2 was verified. Treatment was corrected: Tyrosol withdrawal and Prednisolone administration, 40 mg/day with positive dynamics from treatment. Conclusion: Clinical case demonstrates how important it is to carefully collect the patient’s history and follow the algorithms for differential diagnosis. Errors in diagnosis lead to incorrectly prescribed treatment, lengthening the duration of symptoms, which affects not only the patient’s quality of life, but also reduces the level of his trust in medical professionals.