Physician Understanding Research Articles

The Catholic Church and Its Hospitals

In this conversation from a recent episode of SoundPractice, the discussion focuses on Patricia Gabow’s book *The Catholic Church and Its Hospitals: A Marriage Made in Heaven?*. We delve into the role of bishops and Ethical and Religious Directives (ERDs) in shaping policies within the Catholic health system. We reveal surprising statistics about the reach and influence of Catholic healthcare and discuss the implications for patient care and physician understanding, especially regarding reproductive and end-of-life care. Gabow’s book also addresses considerations for the Catholic health system’s return to mission fidelity.

25 Genomic medicine in paediatric care for neurodevelopmental disorders: An assessment of practices, attitudes and education needs of Ontario paediatricians

Abstract Background Non-geneticist healthcare professionals are increasingly responsible for delivering genetics-informed care to individuals and their families affected by neurodevelopmental disorders (NDDs). Developing education tools to support their continuing education will require an understanding of physicians’ current approaches, attitudes and desired resources regarding genomic medicine, in the context of their specialty and healthcare system. Objectives Our goal was to assess paediatricians’ current practices, attitudes, and education needs regarding the provision of genomic medicine to individuals with NDDs in Ontario. Design/Methods We distributed an anonymous electronic questionnaire between April 2023 and June 2023 using online dissemination strategies. Inclusion criteria were paediatricians who self-identify as providing care to patients with NDDs. A multi-disciplinary team of genetic and non-genetic experts and a family partner developed the questionnaire. It had four sections: 1) demographic and clinical practice information, 2) experience with providing genomic medicine, 3) attitudes about providing genomic medicine, 4) education needs. Results One hundred and thirty paediatricians completed the questionnaire (estimated response rate of 10%, based on estimated 1300 Ontario paediatricians with varied practices). General paediatricians comprised 76% of responders; 50% of responders practiced outside a large urban centre. In terms of experience with genomic medicine: 58% of responders always/often discuss genetic testing options with families. Barriers to ordering genetic testing included lack of knowledge, confidence, access to lab services and time. Rates of ordering genetic testing varied by NDD and genetic test. Some paediatricians endorsed outdated testing practices (e.g., 9% order karyotype for patients with autism). Paediatricians also order genetic tests outside of standard clinical guidelines (e.g., 38% order a genetic test for patients with isolated language delay). In terms of attitudes regarding genomic medicine: majority believe that it is important to become educated about delivering genetic services to patients with NDDs. Over 60% strongly agree/agree that a genetic diagnosis may offer improved health management and research access, and about 50% strongly agree/agree that it may offer improved access to medical services and positive psychological impact for families. Commonest barriers to integrating genomic medicine in paediatric care were concerns about unanticipated genetic results, lack of local resources/logistical challenges, and competing psychosocial considerations. In terms of genetic education needs: paediatricians expressed strongest interest in learning about genetic testing (e.g. utility, interpretation, management) and advances in genomic technologies. Conclusion Ontario paediatricians integrate aspects of genomic medicine in the care of individuals with NDDs, though sometimes outside of clinically recommended contexts. They desire more support in optimizing this integration as genomic technologies and information evolve. Our study provides valuable information to guide the creation of genetic education tools to enhance collaborative healthcare for children and youth with NDDs.

Post myocardial infarction left ventricular intramyocardial dissecting hematoma penetrated right ventricular outflow tract: a rare complication report

BackgroundIntramyocardial dissecting hematoma (IDH) is a rare mechanical complication following myocardial infarction (MI), and only a few isolated cases have been reported to date. IDH presents with diverse clinical manifestations, often resulting in missed or misdiagnosed cases due to limited physician understanding. The diagnosis and treatment of IDH is a major challenge.Case presentationsWe report a case of acute extensive anterior MI in a 73-year-old woman, who underwent percutaneous coronary intervention (PCI); the left ventricular intramyocardial dissecting hematoma (LVIDH) penetrated the right ventricular outflow tract (RVOT), resulting in thrombus formation and subsequent RVOT obstruction. Clinically insignificant IDH was detected by transthoracic echocardiography (TTE) at 3 days, 43 days, and 75 days post-PCI, with characteristic changes in the left ventricular wall ultrasound images. This unusual case highlights the important role of continuous transthoracic echocardiography in identifying this rare complication of LVIDH. After a detailed discussion with the patient, the choice between conservative or surgical management of IDH depends on factors such as the size of the hematomae, left ventricular systolic function, and the patient’s clinical and haemodynamic status. In this particular case, conservative management was chosen by the patient who declined surgery but unfortunately succumbed to cardiogenic shock.ConclusionsThis case describes a rare complication of acute myocardial infarction (AMI) and also focuses on the utility of TTE in the diagnosis of this rare complication. Whether LVIDH is treated conservatively or surgically requires careful evaluation to achieve the best prognosis for the patient.

Opportunities and barriers for telemedicine in pain management: insights from a SIAARTI survey among Italian pain physicians

BackgroundThe integration of telemedicine in pain management represents a significant advancement in healthcare delivery, offering opportunities to enhance patient access to specialized care, improve satisfaction, and streamline chronic pain management. Despite its growing adoption, there remains a lack of comprehensive data on its utilization in pain therapy, necessitating a deeper understanding of physicians’ perspectives, experiences, and challenges.MethodsA survey was conducted in Italy between January 2024 and May 2024. Specialist center members of the SIAARTI were sent an online questionnaire testing the state of the art of telemedicine for pain medicine.ResultsOne-hundred thirty-one centers across Italy reveal varied adoption rates, with 40% routinely using telemedicine. Regional disparities exist, with Northern Italy showing higher adoption rates. Barriers include the absence of protocols, resource constraints, and bureaucratic obstacles. Despite challenges, telemedicine has shown positive impacts on service delivery, with increased service volume reported. Technological capabilities, including image sharing and teleconsultation with specialists, indicate promising interdisciplinary potential.ConclusionsThe integration of advanced telemedicine software utilizing artificial intelligence holds promise for enhancing telemonitoring and alert systems, potentially leading to more proactive and personalized pain management strategies.

Palliative Care Knowledge among Physicians in King Abdullah Medical City, Makkah, Saudi Arabia: A Cross Section Study

Aims: To estimate the level of understanding of non-palliative physicians regarding the palliative approach and to identify areas of weakness in their management of advanced terminal symptoms. Study Design: An observational study was conducted among physicians at a single center using a cross-sectional design. Location and Duration of Study: King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia. Methodology: The sample size was determined using ROA software based on the number of physicians. A validated survey was used from a comparable study conducted in Vietnam. The data was transmitted via an electronic iteration of the authorized survey. Statistical significance will be assessed using a significance level of P < 0.05 and a confidence range of 95%. Results: The study included a sample size of 80 individuals, with the highest proportion (37.5%) belonging to the age group of 31-40 years. The findings revealed that 57.5% of the participants have knowledge about comprehensive and appropriate palliative care. The study found significant positive correlations between healthcare provider practices and education (r: 0.360, P <0.001), as well as comprehensive Palliative Care Practices (r: 0.476, P <0.001). A negative correlation was seen between knowledge and belief of end- of-life (r = -0.358, P <0.001). Statistically significant correlations were observed between knowledge of palliative care and age (p =0.028), degree (P <0.001), and clinical practice area (P =0.004). The pain management category showed a significant positive correlation with healthcare providers and practices (r: 0.316, P =0.004). Conclusion: The findings revealed that physicians possessed insufficient knowledge in the areas of pain management and palliative care. Knowledge levels are associated with age, educational attainment, and beliefs about end-of-life care. The study recommended the implementation of additional specialized facilities and the establishment of more efficient palliative care education programs.

Post hoc analysis of the characteristics and treatment needs of patients with dementia with Lewy bodies (DLB) and their caregivers and their physicians' awareness of those treatment needs according to the duration after diagnosis of DLB.

To investigate the differences in patient/caregiver characteristics, their treatment needs, and the attending physician's understanding of those treatment needs according to the duration after diagnosis of dementia with Lewy bodies (DLB). This was a post hoc analysis of a multicenter, cross-sectional, questionnaire survey study. A total of 263 patient-caregiver pairs were reclassified into two groups according to the median duration after diagnosis of DLB as follows: short (<24months; S-group) and long (≥24months; L-group) post-DLB diagnosis duration. Treatment need was defined as the symptom domain that caused the patient or caregiver the most distress. Concordance rates between patient-physician and caregiver-physician were calculated for physicians' understanding of treatment needs. In this analysis, 126 pairs (32 physicians) and 137 pairs (34 physicians) were classified as the S- and L-groups, respectively. Patient and caregiver characteristics were broadly similar between groups (mean age for patients 78.7±6.6 vs. 79.8±6.7, for caregivers 64.7±12.9 vs. 64.9±12.8; number of male/female for patients 61/65 vs. 67/70, for caregivers 34/92 vs. 38/99), but the prevalence of parkinsonism (82.5% vs. 66.7%) and autonomic dysfunction (49.6% vs. 33.3%), severity of parkinsonism (MDS-UPDRS Part III total scores, 29.2±22.6 vs. 18.0±16.4; Part II total score, 14.6±12.0 vs. 7.6±7.9), and caregiver burden (J-ZBI_8 score, 9.1±6.7 vs. 7.5±5.8) were higher in the L-group than the S-group. Regarding treatment needs, the invalid answer rates for patients were 34.9% and 46.8%, and those for caregivers were 28.6% and 34.9% in the S- and L groups, respectively. Patients' treatment needs did not significantly differ (p=0.056), but S-group patients were more likely to select cognitive impairment (p=0.045) as their treatment need, whereas L-group patients were more likely to select parkinsonism (p=0.003). Caregivers' treatment needs significantly differed (p=0.032) between groups. S-group caregivers were more likely to select cognitive impairment (p=0.001), whereas L-group caregivers were more likely to select other symptom domains such as parkinsonism (S-group vs. L-group: 10.3% vs. 16.7%), psychiatric symptoms (20.6% vs. 24.6%), sleep-related disorder (4.0% vs. 7.1%), and autonomic dysfunction (4.8% vs. 9.5%). Concordance rates between patient-physician and caregiver-physician were low in both groups. There were some differences in characteristics according to the duration after diagnosis of DLB. Cognitive dysfunction may be a particular concern for patients and caregivers soon after diagnosis of DLB. Treatment needs of patients and caregivers for parkinsonism, psychiatric symptoms, sleep-related disorder, or autonomic dysfunction were different according to the duration after diagnosis of DLB. Physicians' perception of patients'/caregivers' treatment needs was poor regardless of the duration after diagnosis of DLB. UMIN Clinical Trials Registry (UMIN000041844).

A Phenomenological Exploration of Physicians' Moral Distress: Situating Emotion Within Lived Experiences.

Physicians often experience moral distress from being prevented from taking what they believe to be the right course of action. Although causes and consequences of moral distress have been studied, little research offers insight into the significance of feeling morally challenged, especially in medicine. This study was undertaken to advance understanding of what physicians experience when encountering morally challenging situations and to examine how those experiences influence their interactions with the world of health care. Guided by hermeneutic phenomenology, the authors conducted semistructured interviews with purposefully sampled Canadian physicians from September 2022 to January 2023. Analysis used Van Manen's 6 activities of hermeneutic research and included "story crafting" to sharpen insights. Late in that process, Van Manen's "lived existentials" was determined to provide a strong framework for physicians' experiences of moral distress. Of the 12 physicians interviewed, all experienced varied and long-lasting emotional reactions to morally challenging experiences. The emotions associated with moral distress, reported as inevitable, were experienced in ways that aligned with the lived existentials of body, space, time, and relations. A richer understanding of physicians' lived experiences with moral distress can help mentors and educators more thoughtfully engage in conversations about it with colleagues and learners. This study highlights the core dimensions of moral distress through body, space, time, and relations, thereby providing a means to enrich discussion about emotions and their transformational power. Through such nuanced consideration, calls for emotional candor may be strengthened to enhance practice by acknowledging the scope of impact that efforts to deliver care are likely to provoke.

Can physician judgment enhance model trustworthiness? A case study on predicting pathological lymph nodes in rectal cancer

Explainability is key to enhancing the trustworthiness of artificial intelligence in medicine. However, there exists a significant gap between physicians’ expectations for model explainability and the actual behavior of these models. This gap arises from the absence of a consensus on a physician-centered evaluation framework, which is needed to quantitatively assess the practical benefits that effective explainability should offer practitioners. Here, we hypothesize that superior attention maps, as a mechanism of model explanation, should align with the information that physicians focus on, potentially reducing prediction uncertainty and increasing model reliability. We employed a multimodal transformer to predict lymph node metastasis of rectal cancer using clinical data and magnetic resonance imaging. We explored how well attention maps, visualized through a state-of-the-art technique, can achieve agreement with physician understanding. Subsequently, we compared two distinct approaches for estimating uncertainty: a standalone estimation using only the variance of prediction probability, and a human-in-the-loop estimation that considers both the variance of prediction probability and the quantified agreement. Our findings revealed no significant advantage of the human-in-the-loop approach over the standalone one. In conclusion, this case study did not confirm the anticipated benefit of the explanation in enhancing model reliability. Superficial explanations could do more harm than good by misleading physicians into relying on uncertain predictions, suggesting that the current state of attention mechanisms should not be overestimated in the context of model explainability.

Association Between Health Literacy and Understanding of Doctors' Explanations: The Yamagata Study.

In Japan, the doctor-patient relationship has traditionally been characterized by a power imbalance that may contribute to communication gaps. To date, however, the link between patients' health literacy levels and their understanding of doctors' explanations of medical conditions and treatment has yet to be fully examined in Japan. The purpose of this study was to investigate the association between patients' health literacy level and their understanding of doctors' explanations. This was a cross-sectional study analyzing data derived from 11,217 questionnaires collected in July 2021 from participants of the Yamagata Study, a community-based cohort study implemented by Yamagata University since 2009. The results showed lower health literacy was associated with poorer understanding of physicians' explanations, adjusting for potential confounding factors. In addition to low health literacy, factors associated with lower comprehension were being male, not having a regular family doctor, and having lower self-perceived levels of health and happiness. The results suggest that health care professionals need to communicate with patients according to their health literacy level and ensure they fully understand their medical condition and treatment. Medical providers need to create a better health-literate environment to enable patients and families to make decisions by themselves. [HLRP: Health Literacy Research and Practice. 2024;8(3):e175-e183.].

What Is the Medical and Legal Risk of Physicians Supervising Advanced Practice Providers?

Physicians would be prudent to carefully evaluate their legal duties when supervising advanced practice providers. There are real legal risks inherent in the supervisory role physicians assume in today’s medical practice models. This article highlights the legal risks and the due diligence necessary when considering how to manage the agency relationship between physicians and advanced practice providers. The understanding of respondeat superior doctrine and vicarious liability will facilitate physician understanding of how to manage these relationships and mitigate legal risk.

An Empirical Analysis of Servant Leadership's Impact on Psychological Wellbeing and Employee Creativity in the Healthcare Sector

The study explores the role and impact of servant leadership (SL) on employee psychological well-being and creativity in the healthcare industry. SL, rooted in traditional values, prioritizes others' needs and promotes moral behavior and ethical viewpoints. The study explores the impact of social learning (SL) on employee creativity and psychological well-being in the healthcare sector, demonstrating its alignment with the profession's commitment to quality patient care. The study postulates and empirically show the favorable relationships between SL and employee creativity and psychological well-being, building on the “Job Demands-Resources (JD-R) theory”. A study was conducted using an online survey to gather data on physicians' perspectives and features in the hospital setting. The survey, conducted in collaboration with healthcare providers, involved 122 physicians aged 18-40+, with 49% female and 51% male. Data was collected using Google Forms, and participants' experiences ranged from 5 to over 20 years. The study used convenience and purposive sampling approaches to increase sample diversity. Despite limitations like self-administrative data and selection bias, the technique provided a systematic understanding of physicians' perspectives and hospital settings. The study reveals a strong positive correlation between employee creativity (EC) and servant leadership (SL), highlighting its role in fostering innovative workplace cultures. It also reveals a strong correlation between SL and psychological well-being, confirming its ability to improve mental health and job happiness in healthcare workers. The study's theoretical implications integrate the JD-R theory and provide insights into contextual elements affecting SL effectiveness. Companies are encouraged to incorporate SL practices into their management strategies to promote creativity and prioritize employee welfare. However, the study's shortcomings, such as its cross-sectional methodology and geographical focus, suggest the need for more research projects. The study concludes that an effective leadership style is servant leadership in the healthcare industry, promoting creative and healthy work cultures.

Patient reported colonoscopy barriers: A cross sectional survey.

e23149 Background: As a leading cause of cancer-related death in the United States, colorectal cancer (CRC) screening is an acceptable cost-effective strategy to reducing mortality indices in the country. 10-yearly colonoscopy screening is the most effective with a mortality reduction of 73%. Despite this, CRC screening rates remain low. The purpose of this study was to describe barriers associated with colonoscopy screening in primary care settings. Methods: Postage pre-paid return envelopes and surveys were sent to all established patients aged &gt; 50 from primary care practices (n = 4) in an employed physician group; the group also serves as a residency continuity clinic for a community teaching hospital. Variables included demographics and literature-reported barriers to colonoscopy screening. Whether or not a patient had a colonoscopy (including if &gt; 10 years since a colonoscopy) was compared to patient reported barriers and demographics. Statistical significance was set at p &lt; 0.05; strength of association was measured by Cramer’s V. Results: Average age of patients was 62 + 6 years; 61.4% were female; 35.3% were privately insured; and 10.3% were non-white. Older patients were slightly more likely to get screened, 63 + 6 years vs. 60 + 7 years (p = 0.006). Neither race, sex, insurance guarantor, education, marital status or income were associated with screening. Rate of colonoscopy screening in this series was 76.7% (n = 276/360), which was greater than rates reported by CDC for Ohio. In those screened, the rate of colonic or rectal polyps was remarkably noted to be up to 47.5% (131/276). The most important barriers to colonoscopy screening were knowledge of insurance coverage (p &lt; 0.001; Cramer’s V = 0.216, p &lt; 0.001); transportation to procedure (p = 0.001; Cramer’s V = 0.172, p = 0.001); someone to accompany patient (p = 0.002; Cramer’s V = 0.164, p = 0.002); and unaware of screening or lack of perceived health threat (p = 0.019; Cramer’s V = 0.150, p = 0.019). The remaining barriers were not associated with increased likelihood of colonoscopy: fear of finding cancer, belief in screening effectiveness, embarrassment or anxiety, or fear of invasive test. While bowel prep is often cited as a barrier to colonoscopy, this factor was not statistically significant. Likewise, physician-initiated discussion and time off from employment were not associated with screening. The most important colonoscopy barrier was patient knowledge regarding insurance for the procedure; overall, 29% of patients reported that they were unsure if colonoscopy was covered. Among those not screened, the rate rose to 47%. Conclusions: The most important colonoscopy barrier identified was patient knowledge regarding insurance for the procedure. While physician counseling for colonoscopy needs to include bowel prep and procedure risks, greater awareness of insurance coverage and social factors may facilitate physician understanding of colonoscopy screening hesitancy.

Physicians’ understanding of antibiotic intravenous-to-oral switching—a qualitative study in Suzhou, China

BackgroundThe implementation of antibiotic intravenous-to-oral switch (IVOS) therapy in hospitals can slow down the development of drug resistance, reduce the occurrence of adverse reactions, and bring significant economic benefits. The aim of this study is to investigate the understanding of physicians at the Second Affiliated Hospital of Soochow University in Suzhou, China towards the antibiotic IVOS therapy.Methods15 physicians working in 9 different departments of the Second Affiliated Hospital of Soochow University participated in this study. A semi-structured face-to-face interview was conducted to collect interview information about the antibiotic IVOS therapy. NVivo12 software was used to organize the entire interview content, and the interview data was analyzed and summarized using the Colaizzi seven step method.Results60% of participants were not familiar with antibiotic IVOS therapy. Barriers of antibiotic IVOS therapy were included by three key issues: (i) Physicians’ potential cognition: ‘Iv is always better than oral’; (ii) Subjective infusion intention of patients; and (iii) Limitations of drug selection. 60% of participants expressed welcome for pharmacists to help them perform antibiotic IVOS treatment. And electronic recognition technology may be a feasible method for prompting IVOS conversion that recognized by all participants in the interview. Participants also provided some suggestions for pharmacists and IVOS computer reminders.ConclusionPhysicians’ in China still have insufficient understanding of antibiotic IVOS therapy. The promotion of antibiotic IVOS therapy in China faces many challenges and obstacles. Strategies such as IVOS therapy computer reminders and clinical pharmacists’ medication guidance were worth studying to help physicians develop antibiotic IVOS treatment.

Lifelong development in medicine: a thematic analysis of coaching goals throughout medical careers

ObjectivesHealthcare grapples with staff shortages and rising burnout rates for medical students, residents and specialists. To prioritise both their well-being and the delivery of high-quality patient care, it becomes imperative...

What’s up doc? Physicians’ reflections on their sustainable employability throughout careers: a narrative inquiry

BackgroundPhysicians have complex and demanding jobs that may negatively affect their sustainable employability (SE) and quality of care. Despite its societal and occupational relevance, empirical research on physicians’ SE is scarce. To further advance our understanding of physicians’ SE, this study explores how physicians perceive their employment context to affect their SE, how physicians self-regulate with the intent to sustain their employability, and how self-regulations affect physicians’ SE and their employment context.MethodsTwenty Dutch physicians from different specialisms were narratively interviewed between March and September 2021 by a researcher with a similar background (surgeon) to allow participants to speak in their own jargon. The interviews were analyzed collaboratively by the research team in accordance with theory-led thematic analysis.ResultsAccording to the interviewees, group dynamics, whether positive or negative, and (mis)matches between personal professional standards and group norms on professionalism, affect their SE in the long run. Interviewees self-regulate with the intent to sustain their employability by (I) influencing work; (II) influencing themselves; and (III) influencing others. Interviewees also reflect on long-term, unintended, and dysfunctional consequences of their self-regulations.ConclusionsWe conclude that physicians’ SE develops from the interplay between the employment context in which they function and their self-regulations intended to sustain employability. As self-regulations may unintentionally contribute to dysfunctional work practices in the employment context, there is a potential for a vicious cycle. Insights from this study can be used to understand and appraise how physicians self-regulate to face complex challenges at work and to prevent both dysfunctional work practices that incite self-regulation and dysfunctional consequences resulting from self-regulations.

The Impact of an Educational Intervention on Enhancing Clinical Knowledge of Physicians and Pharmacists Regarding Statins and Monitoring Parameters: The Experience of a Tertiary Teaching Hospital.

Understanding the latest guideline recommendations is crucial for healthcare professionals to apply statin therapy effectively. Thus, the purpose of this study was to evaluate the efficacy of an educational intervention in enhancing the awareness and understanding of physicians and pharmacists concerning risk assessment of Atherosclerotic cardiovascular disease (ASCVD) and the role of statin therapy. This pre- and post-intervention study was conducted in Sana'a, Yemen's capital city, at the University of Science and Technology Hospital. The study was done between 11/2021-12/2021, and two separate educational sessions were ‎held. The McNemar's test and Wilcoxon signed-rank test were employed as necessary. Participants' awareness of the Framingham CVD risk calculator improved significantly from 40.4% pre-intervention to 78.7% post-intervention. Similarly, understanding of the parameters used in the 10-year ASCVD Risk calculator rose from 46.8% pre-intervention to 76.6% post-intervention. The ability to identify high, moderate, and low-intensity statin therapy, for instance, increased from 34% to 63.8% post-intervention. Regarding statins' contraindications, safety, and efficacy monitoring parameters, pre-intervention knowledge was unsatisfactory, and the educational intervention improved it significantly (p <0.05). For physicians, the median ASCVD risk assessment knowledge score was significantly improved from ‎‎4 (IQR = 3-5) pre-intervention to 7 (6.25-8) immediately post-intervention, while the statin therapy clinical knowledge median score ‎significantly improved from 3 (1.25-6.5) to 9 (7.25-14.75) post-education intervention, p-values were 0.002 and 0.003; respectively. For pharmacists, a similar significant improvement (p <0.05) in the overall knowledge scores for both ASCVD risk ‎assessment and statin therapy was noted. The educational intervention improved participants' knowledge of statin therapy and ASCVD risk assessment. Therefore, further education lectures and training programs through continuing ‎medical ‎education on the up-to-date guidelines' recommendations should be regularly implemented to raise ‎awareness and improve ‎the clinical knowledge and appropriateness of statins use in clinical settings.‎.

Physician awareness and understanding of chronic inflammatory demyelinating polyradiculoneuropathy in Japan: a web-based study

ObjectivesTo investigate potential knowledge gaps between neurologists and non-specialists and identify challenges in the current management of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), with a focus on ‘early diagnosis’ and ‘appropriate...

Osteopathic Approach to a Patient with Recurring Low Back Pain following OMT results in Diagnosis of Underlying Gynecological Etiology: A Case Report

Abstract This case report describes the occurrence of acute low back pain, and the application of Osteopathic Manipulative Treatment techniques (OMT) initially resulting in resolution of the patient's presenting symptoms. When OMT is successful in resolving the patient's symptoms, this usually supports a musculoskeletal etiology; however, when confronted with recurrence of symptoms despite repeated successful resolution of these symptoms with OMT, the physician should suspect an organic etiology. This case demonstrates the importance of the osteopathic physician understanding viscerosomatic dysfunctions and the efficacy of the osteopathic approach to arriving at correct diagnoses. Of note, the osteopathic approach to a patient with recurring low back pain following OMT resulted in diagnosis of the underlying gynecological organic etiology for this patient's symptoms.

Eating problems in people with dementia with Lewy bodies: Associations with various symptoms and the physician's understanding.

Eating problems frequently occur in people with dementia with Lewy bodies (DLB), but few studies have investigated the clinical background of this phenomenon. This study examined the relationship between eating problems and various symptoms of DLB and the relation between the treatment needs for DLB people with eating problems and the understanding of their eating problems by caregivers and physicians. This was a subanalysis of a cross-sectional, questionnaire-based survey study. Two hundred sixty-one subjects with DLB were divided into subjects with or without eating problems. Logistic or linear regression analysis was used to investigate the factors influencing eating problems. The treatment needs of DLB people for their eating problems and the understanding of these needs by caregivers and physicians were calculated as participant-caregiver and participant-physician kappa coefficient. Of the 261 participants, 27% suffered from eating problems. The presence of eating problems in participants with DLB was related to depression (p = 0.01, OR : 2.19, 95% CI: 1.23-3.91) and apathy (p = 0.01, OR 2.15, 95% CI: 1.20-3.87), while the worsening of eating problems was related to dysphagia (β = 0.24, p = 0.03), apathy (β = 0.23, p = 0.05), and nighttime behavior (β = 0.24, p = 0.04). The participant-physician kappa coefficient for physician understanding of constipation, weight loss, dysphagia, weight gain, and increase in appetite was significantly lower than the corresponding participant-caregiver kappa coefficient (p-value of five symptoms < 0.01). Physicians need to pay more attention to eating problems and their neuropsychiatric background in the long-term support and management of DLB subjects.

A120 A HUMAN-CENTERED DESIGN APPROACH TO THE DEVELOPMENT OF A VACCINE IMPLEMENTATION STRATEGY IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Abstract Background Vaccination uptake amongst patients with inflammatory bowel disease (IBD) remains suboptimal. Our previous study assessed perceived barriers and solutions related to implementation of evidence-based guidelines for vaccine preventable illness (VPI). Barriers included limited time, lack of access to a family physician, and incomplete understandings of coverage/access to vaccines. Aims The aim of this study was to use human-centered design (HCD) to design a vaccine implementation program in patients with IBD. Methods The HCD approach consisted of multiple phases. Phase 1 (discovery and define) consisted of semi-structured interviews of healthcare providers. Phase 1 also included the development of a context-specific patient journey map of the processes involved in accessing vaccines. This map was developed in collaboration with a multidisciplinary IBD team. Phase 2 involved identifying common barriers and facilitators through thematic analysis and journey mapping. In Phase 3, these analyses were used to design an implementation strategy for evidence-based management of VPI in the local health system context. Results Twelve interviews (including 11 gastroenterologists and one IBD nurse practicing in Nova Scotia and New Brunswick) were conducted. Mean participant age was 45.1 years, with 63.6% identifying practice in an urban/academic setting compared to a rural/community setting (36.4%). Lack of access to a family physician, limited time, vaccine hesitancy, and incomplete understanding of coverage/access to vaccines were among the barriers identified. Using facilitator themes as well as the journey mapping process, a proposal for an early implementation strategy prototype was designed. Prototype development involved collaborative partnership with a third-party patient support program to overcome various barriers identified in our surveys. Conclusions Barriers to implementation of evidence-based guidelines for management of VPI are well documented. The use of HCD to design an effective implementation strategy that is sensitive to the local healthcare context holds potential to increase access to and uptake of high quality, evidence-based VPI management. In future studies, the implementation-effectiveness of the implementation strategy (model prototype) will be evaluated and compared to standard of care. Funding Agencies None