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Stiers M, Van Asbroeck PJ, Hoogmartens O, Guldentops J, Sabbe M. Redefining the role of emergency medicine in mass gatherings. Eur J Emerg Med 2024; 31:171-172. [PMID: 38411506 DOI: 10.1097/mej.0000000000001131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Affiliation(s)
- Michiel Stiers
- Department of Public Health and Primary Care, Research unit Emergency Medicine, KU Leuven
- Department of Emergency Medicine, University Hospitals Leuven, Leuven
| | | | - Olivier Hoogmartens
- Department of Public Health and Primary Care, Research unit Emergency Medicine, KU Leuven
- Department of Emergency Medicine, University Hospitals Leuven, Leuven
| | - Joris Guldentops
- Department of Public Health and Primary Care, Research unit Emergency Medicine, KU Leuven
| | - Marc Sabbe
- Department of Public Health and Primary Care, Research unit Emergency Medicine, KU Leuven
- Department of Emergency Medicine, University Hospitals Leuven, Leuven
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Haugen T. Continuing the Conversation on "The Role of the Otolaryngologist in Sexual Health". Otolaryngol Head Neck Surg 2024; 170:1479-1480. [PMID: 38415866 DOI: 10.1002/ohn.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Thorsen Haugen
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania, USA
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3
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Bongaerts THG, Büchner FL, Nierkens V, Crone MR, Guicherit OR, Numans ME. Perceptions and beliefs of general practitioners on their role in the cancer screening programmes in the Netherlands: a mixed-methods study. BMC Prim Care 2024; 25:129. [PMID: 38658815 PMCID: PMC11040810 DOI: 10.1186/s12875-024-02394-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 04/17/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND In the Netherlands, population-based cancer screening programmes (CSPs) are organized aiming at cervical, breast and colorectal cancer. For a CSP to be effective, high participation rates are essential; however, there is an alarming downward trend, including wide regional variation in screening uptake. General practitioner (GP) involvement can have a stimulating effect on screening participation. Current GP involvement is however, limited, varies between the programmes and has changed over time. Unexplored is what GPs think of their role(s) in the CSPs. The aim of this study was therefore to map the perceptions and beliefs of GPs regarding their current and future role in the Dutch CSPs. METHODS A mixed-methods sequential explanatory study was conducted in the Leiden/The Hague area of the Netherlands, between the end of 2021 and 2022. A questionnaire was developed and distributed among 110 GPs. The aggregated results obtained from the questionnaires served as starting points for conducting semi-structured interviews, with purposefully selected GPs. With this sequential approach we aimed to further enhance the understanding of the questionnaire data, and delved into the topics that emerged from the questionnaire responses. RESULTS In total, 46 GPs completed the online questionnaire (response rate 42%). Subsequent five semi-structured comprehensive interviews were conducted. GPs indicated that they frequently encounter the CSP in their daily practice and consider it important. They also emphasised it is important that GPs remain closely involved with the CSPs in the future. Nevertheless, GPs also repeatedly mentioned that they are not eager to take on more logistical/organizational tasks. They are however willing to empower CSPs in a positive manner. CONCLUSION GPs were generally positive about the CSPs and their current role within these programmes. Nevertheless, several options have been proposed to improve the CSPs, especially to increase screening uptake for populations in a socioeconomically disadvantaged position. Since it is of utmost importance to screen those who are most at risk of developing the screening-specific tumours, efforts should be made to achieve this goal.
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Affiliation(s)
- Thomas H G Bongaerts
- Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands.
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
| | - Frederike L Büchner
- Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Vera Nierkens
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Matty R Crone
- Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
| | - Onno R Guicherit
- University Cancer Center Leiden - The Hague, Haaglanden Medical Center, The Hague, the Netherlands
| | - Mattijs E Numans
- Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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Palakshappa D, Thompson LA. Why Is the Pediatrician Asking Me About Social Drivers of Health? JAMA Pediatr 2024; 178:422. [PMID: 38407878 DOI: 10.1001/jamapediatrics.2023.6419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
This JAMA Pediatrics Patient Page describes why pediatric clinics ask families about social drivers of health.
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Affiliation(s)
- Deepak Palakshappa
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
- Department of Pediatrics, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Lindsay A Thompson
- Department of Pediatrics, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
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Richards MP, Shalin SC, Guram M, Vyas K. The Role of Dermatology in Identifying and Reporting a Primary Varicella Outbreak. Cutis 2024; 113:E16-E19. [PMID: 38648595 DOI: 10.12788/cutis.0981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Madeline P Richards
- University of Arkansas for Medical Sciences. Madeline P. Richards is from the College of Medicine, North Little Rock. Dr. Shalin is from the Departments of Dermatology and Pathology, Dr. Guram is from the Department of Dermatology, and Dr. Vyas is from the Department of Internal Medicine, Little Rock
| | - Sara C Shalin
- University of Arkansas for Medical Sciences. Madeline P. Richards is from the College of Medicine, North Little Rock. Dr. Shalin is from the Departments of Dermatology and Pathology, Dr. Guram is from the Department of Dermatology, and Dr. Vyas is from the Department of Internal Medicine, Little Rock
| | - Mavinder Guram
- University of Arkansas for Medical Sciences. Madeline P. Richards is from the College of Medicine, North Little Rock. Dr. Shalin is from the Departments of Dermatology and Pathology, Dr. Guram is from the Department of Dermatology, and Dr. Vyas is from the Department of Internal Medicine, Little Rock
| | - Keyur Vyas
- University of Arkansas for Medical Sciences. Madeline P. Richards is from the College of Medicine, North Little Rock. Dr. Shalin is from the Departments of Dermatology and Pathology, Dr. Guram is from the Department of Dermatology, and Dr. Vyas is from the Department of Internal Medicine, Little Rock
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7
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Britton CR, Blackwood D. The evolving role of advanced clinical practitioners: challenges and opportunities. Br J Hosp Med (Lond) 2024; 85:1-3. [PMID: 38416519 DOI: 10.12968/hmed.2023.0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
This editorial reviews the roles of advanced clinical practitioners, suggesting how the debate could evolve, returning to the original intent behind these roles and progressing towards ways of sustaining high-quality, equitable and safe care under strong medical leadership.
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Affiliation(s)
- Carolina R Britton
- Theatres and Anaesthetics, Division of Surgery and Interventional Science, University College London Hospitals NHS Foundation Trust, University College London, London, UK
| | - Douglas Blackwood
- Anaesthesia and Perioperative Medicine, Division of Surgery and Interventional Science, University College London Hospitals NHS Foundation Trust, University College London, London, UK
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Casey E, Linehan C. The physician's role in reducing health disparities for persons with epilepsy and intellectual disability: "it's not just epilepsy…you really have to take a deeper dive.". Epilepsy Behav 2024; 151:109646. [PMID: 38271851 DOI: 10.1016/j.yebeh.2024.109646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/02/2024] [Accepted: 01/10/2024] [Indexed: 01/27/2024]
Abstract
Epilepsy affects approximately 25 % of people with intellectual disability (ID). Despite this high prevalence, evidence of health disparity exists in healthcare access and health outcomes for this population. Patients with ID experience additional challenges in accessing appropriate epilepsy care, and are at greater risk of experiencing inappropriate prescribing, polypharmacy and misdiagnosis compared with the general population. The expectations, attitudes and actions of physicians are key in addressing health inequalities, particularly those which disproportionately impact a specific group of patients, such as patients with ID and epilepsy. This qualitative study aimed to explore the views of specialist physicians as to why they believe this patient group are at a disadvantage when it comes to accessing appropriate epilepsy care, and how physicians can intervene to ensure that patients with ID are given equal access to suitable epilepsy care, and equal opportunity to achieve the best possible treatment outcomes. Semi-structured interviews were carried out with six physicians, located in six countries, who specialise in the care of persons with ID who have epilepsy. Interviews sought views on prognostic expectations, experiences of disparities in epilepsy care, and suggestions for advocacy interventions. Interviews were analysed using reflexive thematic analysis. Three core themes and nine subthemes were identified. Core themes included (1) 'Nervousness in care and treatment,' which reflected participants' descriptions of a nervousness by colleagues when treating epilepsy in patients with ID. (2) 'Taking a deeper dive' captured the harmful effects of accepting "common dogma," as well as the issue of a lack of clarity around treatment pathways for patients with epilepsy and ID. (3) 'Teach me' illustrated the importance of shared expertise, reflective practice and continued research and advocacy. Findings reflected participants' recommendations to address disparities in epilepsy care for patients with ID. These recommendations highlighted education and training, taking time to learn how to communicate in different ways, and regular reflection on personal assumptions and biases as important contributors to addressing inequalities in epilepsy care for patients with ID. It is hoped that findings will prompt those providing epilepsy care to reflect on their own practice and identify ways in which they might intervene to minimise inadvertent harm and reduce health disparities in epilepsy care for patients with ID.
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Affiliation(s)
- Emma Casey
- University College Dublin, UCD School of Psychology, Dublin, Ireland.
| | - Christine Linehan
- University College Dublin, UCD School of Psychology, Dublin, Ireland; UCD Centre for Disability Studies, University College Dublin, Dublin, Ireland
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Fava GA. The Role of Well-Being in Physicians' Health. Am J Med 2024; 137:83-84. [PMID: 37984776 DOI: 10.1016/j.amjmed.2023.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Giovanni A Fava
- Department of Psychiatry, State University of New York at Buffalo.
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10
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Ball CG, Inaba K, Harvey EJ. What does professionalism really mean in the contemporary surgical landscape? Can J Surg 2024; 67:E66-E67. [PMID: 38383029 PMCID: PMC10890788 DOI: 10.1503/cjs.001524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Affiliation(s)
- Chad G Ball
- Coeditors-in-chief, CJS (Ball, Harvey); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); the Department of Surgery, McGill University, Montréal, Que. (Harvey); and the Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, Calif. (Inaba)
| | - Kenji Inaba
- Coeditors-in-chief, CJS (Ball, Harvey); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); the Department of Surgery, McGill University, Montréal, Que. (Harvey); and the Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, Calif. (Inaba)
| | - Edward J Harvey
- Coeditors-in-chief, CJS (Ball, Harvey); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); the Department of Surgery, McGill University, Montréal, Que. (Harvey); and the Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, Calif. (Inaba)
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Abstract
This essay describes a palliative medicine physician’s experience with a dying patient and reflections on life.
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Affiliation(s)
- Yael Schenker
- Palliative Research Center (PaRC), Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Abstract
In this narrative medicine essay, a family medicine physician’s experience while undergoing a breast biopsy inspires her to build trust with her patients by listening and counseling more.
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Pozzi G, van den Hoven J. Physicians' Professional Role in Clinical Care: AI as a Change Agent. Am J Bioeth 2023; 23:57-59. [PMID: 38010672 DOI: 10.1080/15265161.2023.2272924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
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14
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Rasooly A. Resilience amidst chaos: an Israeli physician's reflections. Lancet 2023; 402:1623. [PMID: 37898139 DOI: 10.1016/s0140-6736(23)02399-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023]
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Angell AM, Lindly OJ, Floríndez D, Floríndez LI, Duker LIS, Zuckerman KE, Yin L, Solomon O. Pediatricians' role in healthcare for Latino autistic children: Shared decision-making versus "You've got to do everything on your own". Autism 2023; 27:2407-2421. [PMID: 37070240 PMCID: PMC10579452 DOI: 10.1177/13623613231163056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
LAY ABSTRACT Latino parents may choose to use complementary health approaches, such as vitamins, supplements, and special diets, for their autistic children. However, they might not tell their pediatrician about their complementary health approach use if they worry that the pediatrician will disapprove or judge them. This fear, along with pediatricians' lack of autism knowledge, creates barriers to "shared decision-making" between parents and pediatricians. Shared decision-making is a process where families and healthcare providers collaborate and exchange information in order to come to an agreement about treatment options. In our qualitative study with 12 bilingual Latino families of autistic children, we interviewed and observed families to learn about their experiences with both conventional healthcare (their pediatrician) and complementary health approaches. Our study results describe the parents' different pathways to an autism assessment, a process that is sometimes called the "diagnostic odyssey." The parents reported that conventional healthcare met their needs for their child's physical health but not for their child's developmental challenges. The parents who used complementary health approaches for their autistic children were more frustrated about a lack of autism information from pediatricians than those who did not use complementary health approaches. Finally, we describe two examples of successful shared decision-making between parents and pediatricians. We conclude that pediatricians who are able to talk about complementary health approaches with Latino families may help to facilitate shared decision-making and reduce healthcare disparities for Latino autistic children.
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Affiliation(s)
- Amber M. Angell
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles CA
| | - Olivia J. Lindly
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ
| | | | - Lucía I. Floríndez
- Department of Nursing Research, Cedars Sinai Medical Center, Los Angeles CA
| | - Leah I. Stein Duker
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles CA
| | - Katharine E. Zuckerman
- Division of General Pediatrics and OHSU-PSU School of Public Health, Oregon Health & Science University, Portland OR
| | - Larry Yin
- Keck School of Medicine and Children’s Hospital Los Angeles, University of Southern California, Los Angeles CA
| | - Olga Solomon
- Department of Nursing Research, Cedars Sinai Medical Center, Los Angeles CA
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Guay E. A resident physician's reflection on rural medicine. Can J Rural Med 2023; 28:203-204. [PMID: 37861606 DOI: 10.4103/cjrm.cjrm_26_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Affiliation(s)
- Evelyne Guay
- 2nd Year Family Medicine Resident, Rural Grimsby Site, McMaser University, Grimsby, Ontario, Canada
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17
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Abbasi J. Critical Care Physician Takes on Climate Change in New WHO Role. JAMA 2023; 330:1120-1123. [PMID: 37672237 DOI: 10.1001/jama.2023.14207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
This Medical News article is an interview with Vanessa Kerry, MD, MSc, the World Health Organization’s first-ever Special Envoy for Climate Change and Health.
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Sideman AB, Ma M, Hernandez de Jesus A, Alagappan C, Razon N, Dohan D, Chodos A, Al-Rousan T, Alving LI, Segal-Gidan F, Rosen H, Rankin KP, Possin KL, Borson S. Primary Care Pracitioner Perspectives on the Role of Primary Care in Dementia Diagnosis and Care. JAMA Netw Open 2023; 6:e2336030. [PMID: 37768660 PMCID: PMC10539983 DOI: 10.1001/jamanetworkopen.2023.36030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Importance Although the barriers to dementia care in primary care are well characterized, primary care practitioner (PCP) perspectives could be used to support the design of values-aligned dementia care pathways that strengthen the role of primary care. Objective To describe PCP perspectives on their role in dementia diagnosis and care. Design, Setting, and Participation In this qualitative study, interviews were conducted with 39 PCPs (medical doctors, nurse practitioners, and doctors of osteopathic medicine) in California between March 2020 and November 2022. Results were analyzed using thematic analysis. Main Outcomes and Measures Overarching themes associated with PCP roles in dementia care. Results Interviews were conducted with 39 PCPs (25 [64.1%] were female; 16 [41%] were Asian). The majority (36 PCPs [92.3%]) reported that more than half of their patients were insured via MediCal, the California Medicaid program serving low-income individuals. Six themes were identified that convey PCPs' perspectives on their role in dementia care. These themes focused on (1) their role as first point of contact and in the diagnostic workup; (2) the importance of long-term, trusting relationships with patients; (3) the value of understanding patients' life contexts; (4) their work to involve and educate families; (5) their activities around coordinating dementia care; and (6) how the care they want to provide may be limited by systems-level constraints. Conclusions and Relevance In this qualitative study of PCP perspectives on their role in dementia care, there was alignment between PCP perspectives about the core values of primary care and their work diagnosing and providing care for people living with dementia. The study also identified a mismatch between these values and the health systems infrastructure for dementia care in their practice environment.
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Affiliation(s)
- Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
- Department of Humanities and Social Sciences, University of California, San Francisco
- Department of Neurology, University of California, San Francisco
- Global Brain Health Institute, University of California, San Francisco
| | - Melissa Ma
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | | | - Cecilia Alagappan
- Global Brain Health Institute, University of California, San Francisco
| | - Na'amah Razon
- Department of Family and Community Medicine, University of California, Davis, Sacramento
| | - Daniel Dohan
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Anna Chodos
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Loren I Alving
- California Alzheimer's Disease Center, University of California, San Francisco at Fresno
| | - Freddi Segal-Gidan
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles
| | - Howie Rosen
- Department of Neurology, University of California, San Francisco
| | | | | | - Soo Borson
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles
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Dunn C, Wong A, Stahly S, Kieffer J, Nathoo R, Hunter J, Kaufmann M. The value of discovery: Camp Discovery augments resident physician's education-a survey-based evaluation. J Am Acad Dermatol 2023; 89:147-149. [PMID: 36813136 DOI: 10.1016/j.jaad.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/03/2023] [Accepted: 02/09/2023] [Indexed: 02/23/2023]
Affiliation(s)
- Charles Dunn
- Department of Dermatology, KCU-GME/ADCS Consortium, Maitland, Florida.
| | - Alan Wong
- Department of Dermatology, KCU-GME/ADCS Consortium, Maitland, Florida
| | - Samuel Stahly
- Department of Dermatology, KCU-GME/ADCS Consortium, Maitland, Florida
| | - Jason Kieffer
- Department of Dermatology, KCU-GME/ADCS Consortium, Maitland, Florida
| | - Rajiv Nathoo
- Department of Dermatology, KCU-GME/ADCS Consortium, Maitland, Florida
| | - Jacob Hunter
- Department of Scholarly Activity, Kansas City University, Kansas City, Missouri
| | - Mark Kaufmann
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
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Ahimaz P, Foltz JC, Ross MJ, Florido ME, Sebastin M, Yu JE. Exploring the role of genetic counselors in immunology: A study of immunologist and allergist perspectives. J Allergy Clin Immunol Pract 2023; 11:1939-1942.e2. [PMID: 36787825 DOI: 10.1016/j.jaip.2023.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/18/2023] [Accepted: 01/30/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Priyanka Ahimaz
- Genetic Counseling Graduate Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Division of Molecular Genetics, Department of Pediatrics, Columbia University, New York, NY.
| | - Jennah C Foltz
- Genetic Counseling Graduate Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Meredith J Ross
- Division of Clinical Genetics, Department of Pediatrics, Columbia University, New York, NY
| | - Michelle E Florido
- Genetic Counseling Graduate Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Genetics and Development, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Monisha Sebastin
- Division of Clinical Genetics, Department of Pediatrics, Montefiore Medical Center, New York, NY
| | - Joyce E Yu
- Division of Allergy, Immunology & Rheumatology, Department of Pediatrics, Columbia University, New York, NY
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21
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Gustafson P, Rutberg H. [Not Available]. Lakartidningen 2023; 120:23024. [PMID: 36876886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Affiliation(s)
- Pelle Gustafson
- docent, chef-läkare, , Löf regionernas ömsesidiga försäkringsbolag; Lunds universitet
| | - Hans Rutberg
- f d chefläkare, f d adjungerad professor i patientsäker-het, Region Östergötland; Linköpings universitet
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Abstract
Introduction Although the CanMEDS framework sets the standard for Canadian training, health advocacy competence does not appear to factor heavily into high stakes assessment decisions. Without forces motivating uptake, there is little movement by educational programs to integrate robust advocacy teaching and assessment practices. However, by adopting CanMEDS, the Canadian medical education community endorses that advocacy is required for competent medical practice. It's time to back up that endorsement with meaningful action. Our purpose was to aid this work by answering the key questions that continue to challenge training for this intrinsic physician role. Methods We used a critical review methodology to both examine literature relevant to the complexities impeding robust advocacy assessment, and develop recommendations. Our review moved iteratively through five phases: focusing the question, searching the literature, appraising and selecting sources, and analyzing results. Results Improving advocacy training relies, in part, on the medical education community developing a shared vision of the Health Advocate (HA) role, designing, implementing, and integrating developmentally appropriate curricula, and considering ethical implications of assessing a role that may be risky to enact. Conclusion Changes to assessment could be a key driver of curricular change for the HA role, provided implementation timelines and resources are sufficient to make necessary changes meaningful. To truly be meaningful, however, advocacy first needs to be perceived as valuable. Our recommendations are intended as a roadmap for transforming advocacy from a theoretical and aspirational value into one viewed as having both practical relevance and consequential implications.
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Affiliation(s)
| | | | - Ian Scott
- University of British Columbia, British Columbia, Canada
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Richwine C, Johnson C, Patel V. Disparities in patient portal access and the role of providers in encouraging access and use. J Am Med Inform Assoc 2023; 30:308-317. [PMID: 36451262 PMCID: PMC9846679 DOI: 10.1093/jamia/ocac227] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/19/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify racial and ethnic disparities in patient portal offers, access, and use and to examine the role of providers in facilitating access to electronic health information (EHI) by offering patient portals and encouraging their use. MATERIALS AND METHODS Using nationally representative survey data from 2019 and 2020 (N = 8028), we examined disparities in patients being offered access to a portal by their provider and differences in subsequent access and use. Using multivariable models, we estimated the effect of race and ethnicity on the likelihood of being offered, accessing or using a portal. Among those offered, we examined the relationship between provider encouragement and portal access; and for those who did not access their portal, we explored reasons for nonuse. RESULTS Black and Hispanic individuals were offered and accessed patient portals at significantly lower rates than White individuals. Compared to Whites, Black and Hispanic individuals were 5.2 percentage-points less likely to be offered a portal (P < .05) and, among those offered, 7.9 percentage-points less likely to access their portal (P < .05). Black and Hispanic individuals who were offered and accessed a portal were 12 percentage-points more likely than Whites to use it to download or transmit information (P < .01). Individuals who were offered a portal and encouraged to use it were 21 percentage-points more likely to access it. DISCUSSION Differences in patient portal access and use are likely driven by disparities in which groups of patients reported being offered a portal. CONCLUSIONS Providers play an important role in increasing access to EHI by facilitating access to patient portals.
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Affiliation(s)
- Chelsea Richwine
- Office of the National Coordinator for Health Information Technology, Office of Technology, Washington, District of Columbia, USA
| | - Christian Johnson
- Office of the National Coordinator for Health Information Technology, Office of Technology, Washington, District of Columbia, USA
| | - Vaishali Patel
- Office of the National Coordinator for Health Information Technology, Office of Technology, Washington, District of Columbia, USA
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Su CT, Shankaran V. Defining the Role of the Modern Oncology Provider in Mitigating Financial Toxicity. J Am Coll Radiol 2023; 20:51-56. [PMID: 36513257 PMCID: PMC9898149 DOI: 10.1016/j.jacr.2022.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 12/14/2022]
Abstract
Financial toxicity, the cumulative financial hardships resulting from cancer diagnosis and treatment, is a growing problem in the United States. With the proliferation of costly novel therapeutics and improved cancer survival, financial toxicity will remain a major issue in cancer care delivery. Frontline oncology providers serve as gatekeepers in the medical system and, as such, could play essential roles in recognizing and addressing financial toxicity. Providers and health systems could help mitigate financial toxicity through routine financial toxicity screening, financial navigation, and advocacy. Specific strategies include developing and implementing financial screening instruments that can be integrated in electronic medical records and establishing team-based financial navigation programs to help patients with out-of-pocket medical costs, nonmedical spending, and insurance optimization. Finally, providers should continue to advocate for policies and legislation that decrease cost and promote value-based care. In this review, we examine opportunities for provider engagement in these areas and highlight gaps for future research.
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Affiliation(s)
- Christopher T Su
- Division of Hematology, University of Washington School of Medicine, Seattle, Washington; and Hutchinson Institute for Cancer Outcome Research, Fred Hutchinson Cancer Center, Seattle, Washington.
| | - Veena Shankaran
- Division of Medical Oncology, University of Washington School of Medicine, Seattle, Washington; and Codirector, Hutchinson Institute for Cancer Outcome Research, Fred Hutchinson Cancer Center, Seattle, Washington
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Unwin BK, Bedsaul NB, Stubbs S. The Physician's Role in Transitioning Older Adults Into Long-term Care Facilities. Am Fam Physician 2022; 106:714-717. [PMID: 36521476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Brian K Unwin
- Carilion Clinic Center for Healthy Aging, Roanoke, Virginia
| | | | - Sarah Stubbs
- Carilion Clinic Center for Healthy Aging, Roanoke, Virginia
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Mayo NL, Ellenbogen RL, Mendoza MD, Russell HA. The family physician's role in long COVID management. J Fam Pract 2022; 71:426-431. [PMID: 36735950 DOI: 10.12788/jfp.0517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
A paucity of both data and therapeutics presents obstacles to care and makes your role in symptom management, psychological support, and referral-all described here-essential.
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Affiliation(s)
- Nicole L Mayo
- Department of Public Health Sciences (Dr. Mayo), Department of Family Medicine (Drs. Ellenbogen, Mendoza, and Russell), Department of Public Health Sciences and Nursing (Dr. Mendoza), and Center for Community Health and Prevention (Dr. Russell), University of Rochester School of Medicine and Dentistry, NY; Monroe County Department of Public Health, Rochester, NY (Dr. Mendoza)
| | - Rachel L Ellenbogen
- Department of Public Health Sciences (Dr. Mayo), Department of Family Medicine (Drs. Ellenbogen, Mendoza, and Russell), Department of Public Health Sciences and Nursing (Dr. Mendoza), and Center for Community Health and Prevention (Dr. Russell), University of Rochester School of Medicine and Dentistry, NY; Monroe County Department of Public Health, Rochester, NY (Dr. Mendoza)
| | - Michael D Mendoza
- Department of Public Health Sciences (Dr. Mayo), Department of Family Medicine (Drs. Ellenbogen, Mendoza, and Russell), Department of Public Health Sciences and Nursing (Dr. Mendoza), and Center for Community Health and Prevention (Dr. Russell), University of Rochester School of Medicine and Dentistry, NY; Monroe County Department of Public Health, Rochester, NY (Dr. Mendoza)
| | - Holly Ann Russell
- Department of Public Health Sciences (Dr. Mayo), Department of Family Medicine (Drs. Ellenbogen, Mendoza, and Russell), Department of Public Health Sciences and Nursing (Dr. Mendoza), and Center for Community Health and Prevention (Dr. Russell), University of Rochester School of Medicine and Dentistry, NY; Monroe County Department of Public Health, Rochester, NY (Dr. Mendoza)
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Speth MM, Biesinger E. Maintaining contact with clinical colleagues in Myanmar. Lancet 2022; 400:1401. [PMID: 36273473 DOI: 10.1016/s0140-6736(22)01897-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Marlene M Speth
- Clinic for Otolaryngology, Head and Neck Surgery, University Hospital Basel, Basel 4051, Switzerland.
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Summerfield D. Is the international regulation of medical complicity with torture largely window dressing? The case of Israel and the lessons of a 12-year medical ethical appeal. J Med Ethics 2022; 48:367-370. [PMID: 34131004 DOI: 10.1136/medethics-2021-107340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/26/2021] [Indexed: 06/12/2023]
Abstract
This is the account of an ongoing appeal initiated in 2009 by 725 doctors from 43 countries concerning medical complicity with torture in Israel. It has been underpinned by a voluminous and still accumulating evidence base from reputable international and regional human rights organisations, quoted below, and has spanned the terms of office of four World Medical Association (WMA) presidencies and two UN special rapporteurs on torture. This campaign has been a litmus test of whether international medical codes regarding doctors and torture actually matter, and are applied rigorously and even-handededly, particularly when compelling evidence incriminates a WMA member association. Our findings in the case of Israel suggest that this is not true, and that impunity largely operates. The WMA seems in partisan violation of its mandate to be the official international watchdog on the ethical behaviour of doctors. And as the IMA case demonstrates, by their inaction national medical associations or other regulatory bodies appear to function at base as buttresses and shields of the state.
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Affiliation(s)
- Derek Summerfield
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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The Adaptation of Infant Welfare Work to Private Practice. JAMA 2022; 327:493. [PMID: 35103776 DOI: 10.1001/jama.2021.16834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
Electronic cigarettes (e-cigarettes) are battery powered electronic nicotine delivery systems that use a propylene glycol/vegetable glycerin base to deliver vaporized nicotine and flavorings to the body. E-cigarettes became commercially available without evidence regarding their risks, long-term safety, or utility in smoking cessation. Recent clinical trials suggest that e-cigarette use with counseling may be effective in reducing cigarette use but not nicotine dependence. However, meta-analyses of observational studies demonstrate that e-cigarette use is not associated with smoking cessation. Cardiovascular studies reported sympathetic activation, vascular stiffening, and endothelial dysfunction, which are associated with adverse cardiovascular events. The majority of pulmonary clinical trials in e-cigarette users included standard spirometry as the primary outcome measure, reporting no change in lung function. However, studies reported increased biomarkers of pulmonary disease in e-cigarette users. These studies were conducted in adults, but >30% of high school-age adolescents reported e-cigarette use. The effects of e-cigarette use on cardiopulmonary endpoints in adolescents and young adults remain unstudied. Because of adverse clinical findings and associations between e-cigarette use and increased incidence of respiratory diseases in people who have never smoked, large longitudinal studies are needed to understand the risk profile of e-cigarettes. Consistent with the Centers for Disease Control and Prevention recommendations, clinicians should monitor the health risks of e-cigarette use, discourage nonsmokers and adolescents from using e-cigarettes, and discourage smokers from engaging in dual use without cigarette reduction or cessation.
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Affiliation(s)
- Evan W Neczypor
- Colleges of Nursing and Medicine (E.W.N., M.J.M., L.E.W.), The Ohio State University, Columbus
- Dorothy M. Davis Heart and Lung Research Institute, Department of Physiology and Cell Biology, College of Medicine (E.W.N., M.J.M., L.E.W.), The Ohio State University, Columbus
| | - Matthew J Mears
- Colleges of Nursing and Medicine (E.W.N., M.J.M., L.E.W.), The Ohio State University, Columbus
- Dorothy M. Davis Heart and Lung Research Institute, Department of Physiology and Cell Biology, College of Medicine (E.W.N., M.J.M., L.E.W.), The Ohio State University, Columbus
| | - Arunava Ghosh
- Department of Cell Biology and Physiology, The University of North Carolina, Chapel Hill (A.G., M.F.S., R.T.)
| | - M Flori Sassano
- Department of Cell Biology and Physiology, The University of North Carolina, Chapel Hill (A.G., M.F.S., R.T.)
| | - Richard J Gumina
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (R.J.G.)
| | - Loren E Wold
- Colleges of Nursing and Medicine (E.W.N., M.J.M., L.E.W.), The Ohio State University, Columbus
- Dorothy M. Davis Heart and Lung Research Institute, Department of Physiology and Cell Biology, College of Medicine (E.W.N., M.J.M., L.E.W.), The Ohio State University, Columbus
| | - Robert Tarran
- Department of Cell Biology and Physiology, The University of North Carolina, Chapel Hill (A.G., M.F.S., R.T.)
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Ingraham A, Schumacher J, Fernandes-Taylor S, Yang DY, Godat L, Smith A, Barbosa R, Cribari C, Salim A, Schroeppel T, Staudenmayer K, Crandall M, Utter G. General surgeon involvement in the care of patients designated with an American Association for the Surgery of Trauma-endorsed ICD-10-CM emergency general surgery diagnosis code in Wisconsin. J Trauma Acute Care Surg 2022; 92:117-125. [PMID: 34446657 PMCID: PMC8692334 DOI: 10.1097/ta.0000000000003387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The current national burden of emergency general surgery (EGS) illnesses and the extent of surgeon involvement in the care of these patients remain largely unknown. To inform needs assessments, research, and education, we sought to: (1) translate previously developed International Classification of Diseases (ICD), 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes representing EGS conditions to ICD 10th Revision, CM (ICD-10-CM) codes and (2) determine the national burden of and assess surgeon involvement across EGS conditions. METHODS We converted ICD-9-CM codes to candidate ICD-10-CM codes using General Equivalence Mappings then iteratively refined the code list. We used National Inpatient Sample 2016 to 2017 data to develop a national estimate of the burden of EGS disease. To evaluate surgeon involvement, using Wisconsin Hospital Association discharge data (January 1, 2016 to June 30, 2018), we selected adult urgent/emergent encounters with an EGS condition as the principal diagnosis. Surgeon involvement was defined as a surgeon being either the attending provider or procedural physician. RESULTS Four hundred and eighty-five ICD-9-CM codes mapped to 1,696 ICD-10-CM codes. The final list contained 985 ICD-10-CM codes. Nationally, there were 2,977,843 adult patient encounters with an ICD-10-CM EGS diagnosis. Of 94,903 EGS patients in the Wisconsin Hospital Association data set, most encounters were inpatient as compared with observation (75,878 [80.0%] vs. 19,025 [20.0%]). There were 57,780 patients (60.9%) that underwent any procedure. Among all Wisconsin EGS patients, most had no surgeon involvement (64.9% [n = 61,616]). Of the seven most common EGS diagnoses, surgeon involvement was highest for appendicitis (96.0%) and biliary tract disease (77.1%). For the other five most common conditions (skin/soft tissue infections, gastrointestinal hemorrhage, intestinal obstruction/ileus, pancreatitis, diverticular disease), surgeons were involved in roughly 20% of patient care episodes. CONCLUSION Surgeon involvement for EGS conditions ranges from highly likely (appendicitis) to relatively unlikely (skin/soft tissue infections). The wide range in surgeon involvement underscores the importance of multidisciplinary collaboration in the care of EGS patients. LEVEL OF EVIDENCE Prognostic/epidemiological, Level III.
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Affiliation(s)
- Angela Ingraham
- From the Department of Surgery (A.I., J.S., S.F.-T., D.-Y.Y.), University of Wisconsin-Madison, Madison, Wisconsin; Department of Surgery (L.G., A.S.), University of California-San Diego, San Diego, California; Department of Surgery (R.B.), Legacy Health, Portland, Oregon; Department of Surgery (C.C.), University of Colorado Health, Loveland, Colorado; Department of Surgery (A.S.), Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery (T.S.), University of Colorado Health, Colorado Springs, Colorado; Department of Surgery (K.S.), Stanford University, Palo Alto, California; Department of Surgery (M.C.), University of Florida, Jacksonville, Florida; and Department of Surgery (G.U.), University of California-Davis, Sacramento, California
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Malone J. An Attitude of Gratitude: The Physicians' Role in Philanthropy. Narrat Inq Bioeth 2022; 12:20-22. [PMID: 35912601 DOI: 10.1353/nib.2022.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Gavrilov B, Schmidt M, Kasten S, Sommer S, Hunzelar C, Bockheim F, Paños-Willuhn J, Offenberg L, Oberholz M, Ikar N, Weltermann B. More GP contacts and poorer health of informal caregivers with low socioeconomic status in Germany: results from the population-based DEGS1 and the cross-sectional GPCare-1 study. BMJ Open 2021; 11:e053146. [PMID: 36916141 PMCID: PMC8719219 DOI: 10.1136/bmjopen-2021-053146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Informal caregivers are known to have poorer mental health. Risk factors for caregiver burden include low education, female gender, cohabitation with the care recipient and lack of resources. General practitioners (GPs) have an important role in supporting caregivers. Drawing on data from two surveys, associations between caregivers' socioeconomic status (SES), psychophysical health and GP contacts are analysed. DESIGN Cross-sectional study. The study draws on data from two surveys (German Health Interview and Examination Survey for Adults, DEGS1 and General Practice Care-1, GPCare-1). SETTING Germany. PARTICIPANTS DEGS1: German general population (18+ years) n=7987. GPCare-1: general practice patients (18+ years) n=813. PRIMARY OUTCOME Psychophysical health, GP contacts and communication. METHODS Using representative DEGS1 data, the prevalence of informal caregivers, caregivers' burden, chronic stress, various health conditions and frequency of GP contacts were evaluated stratified by SES. Data from the GPCare-1 study addressed caregivers' experiences and communication preferences with GPs. RESULTS In the DEGS1, the prevalence of caregivers was 6.5%. Compared with non-caregivers, caregivers scored significantly higher for chronic stress (15.45 vs 11.90), self-reported poor health (37.6% vs 23.7%) and GP visits last year (3.95 vs 3.11), while lifestyle and chronic diseases were similar. Compared with caregivers with medium/high SES, those with low SES had a significantly lower prevalence of high/medium caregiver burden (47.9% vs 67.7%) but poorer self-reported health (56.9% vs 33.0%), while other characteristics did not differ. In the GPCare-1 study, the prevalence of caregivers was 12.6%. The majority of them felt that their GP takes their problems seriously (63.6%) without difference by SES. CONCLUSION Caregivers with low SES constitute an especially high-risk group for psychological strain, requiring special GP attention to support their needs.
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Affiliation(s)
- Boris Gavrilov
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Manuela Schmidt
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Stefanie Kasten
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Samira Sommer
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Carmen Hunzelar
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Florian Bockheim
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Joana Paños-Willuhn
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Luisa Offenberg
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Maja Oberholz
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Nur Ikar
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
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Rideout M, Dawlett M, Plant J, Chitkara M, Trainor JL. Essential yet Ill-defined: leadership roles to support fourth-year medical students in pediatrics. Med Educ Online 2021; 26:1950108. [PMID: 34232843 PMCID: PMC8266242 DOI: 10.1080/10872981.2021.1950108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Few studies have been published about specialty-specific fourth-year medical student leadership in any discipline. This paper provides insight from pediatric educators about the current status and recommendations for pediatric-specific fourth-year leaders. OBJECTIVE To identify the prevalence of pediatric fourth-year medical student directors across the US and Canada and to compare current and ideal responsibilities for this role. METHODS Five multi-part questions were written and submitted for the 2019 Council on Medical Student Education in Pediatrics (COMSEP) Annual Survey and subsequently disseminated to all COMSEP member physicians. Anonymous responses were collected and results analyzed. The study was IRB exempt. RESULTS The program-level survey response rate was 79%. Of 115 respondent medical schools, 37% reported having a pediatric fourth-year director separate from the clerkship director, with an average of 9.8% full-time equivalent (FTE) protected time for the role. In contrast, individuals indicated 20% FTE would be ideal for fourth-year director responsibilities. The most common role identified for pediatric fourth-year directors was directing sub-internships. Respondents indicated it would be ideal for pediatric fourth-year directors to have an increased level of involvement in all areas queried in the survey, especially directing a pediatric residency preparatory course/boot camp, faculty development for educators of fourth-year students, and remediating fourth-year students. CONCLUSIONS As specialty-specific experiences have grown in the fourth year of medical school, there is an increasing demand for faculty leadership separate from direction of the pediatric clerkship. In this national survey, pediatric educators expressed a need for additional protected time to lead fourth-year specific activities. Similar findings in other disciplines would support advocating for more protected time and expanded roles for specialty-specific fourth-year directors nationally.
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Affiliation(s)
- Molly Rideout
- Department of Pediatrics, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Marie Dawlett
- Department of Pediatrics, University of Texas Medical Branch School of Medicine, Galveston, TX, USA
| | - Jennifer Plant
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Maribeth Chitkara
- Department of Pediatrics, Renaissance School of Medicine at Stony Brook University, NY, USA
| | - Jennifer L. Trainor
- Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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Murugiah K, Chen L, Castro-Dominguez Y, Khera R, Krumholz HM. Scope of Practice of US Interventional Cardiologists from an Analysis of Medicare Billing Data. Am J Cardiol 2021; 160:40-45. [PMID: 34610872 DOI: 10.1016/j.amjcard.2021.08.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 11/27/2022]
Abstract
The contemporary scope of practice of interventional cardiologists (ICs) in the United States and recent trends are unknown. Using Medicare claims from 2013 to 2017, we categorized ICs into 4 practice categories (only percutaneous coronary intervention [PCI], PCI with noninvasive imaging, PCI with specialized interventions [peripheral/structural], and all 3 services) and evaluated associations with region, hospital bed size and teaching status, gender, and graduation year. Of 6,083 ICs in 2017, 10.9% performed only PCI, 68.3% PCI with noninvasive imaging, 5.7% PCI with specialized interventions, and 15.1% all 3 services. A higher proportion of Northeast ICs (vs South ICs) were performing only PCI (24.8% vs 7.3%) and PCI with specialized interventions (12% vs 3.4%), but lower PCI and noninvasive imaging (53.8% vs 71.7%) and all 3 services (9.3% and 17.6%). Regarding ICs at larger hospitals (bed size >575 vs <218), a higher proportion was performing only PCI (23.8% vs 5.2%) or PCI with specialized interventions (13.5% vs 1.7%) and lower proportion was performing PCI with noninvasive imaging (48.8% vs 78%), similar to teaching hospitals. Female ICs (vs male ICs) more frequently performed only PCI (18.9% vs 10.6%) and less frequently all 3 services (8.3% vs 15.4%). A lower proportion of recent graduates (2001 to 2016) performed only PCI (9.8% vs 13.8%) and PCI with noninvasive imaging (66.3% vs 72.6%) but a higher proportion performed all 3 services (18% vs 8.4%) than earlier graduates (1959 to 1984). From 2013 to 2017, only PCI and PCI with noninvasive imaging decreased, whereas PCI and specialized interventions and all 3 services increased (all p <0.001). In conclusion, there is marked heterogeneity in practice responsibilities among ICs, which has implications for training and competency assessments.
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Affiliation(s)
- Karthik Murugiah
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut.
| | - Lian Chen
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Yulanka Castro-Dominguez
- Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
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Fischer G, Anderson L, Ranson M, Sellen D, McArthur E. Public perceptions on pathology: a fundamental change is required. J Clin Pathol 2021; 74:812-815. [PMID: 33097589 PMCID: PMC8606462 DOI: 10.1136/jclinpath-2020-206873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/19/2020] [Accepted: 10/07/2020] [Indexed: 11/27/2022]
Abstract
Pathology has been mostly invisible for the public. The missing recognition affects the pathologists' reputation, and efforts with recruitment and advocacy. Our survey with 387 respondents confirms that the public knowledge on the role of the pathologists has not improved despite campaigns and advocacy efforts. Pathology was identified as a medical specialty by 79.1% of the respondents. Only 34.8% assumed that it takes more than 8 years of post-high school training to become a pathologist. Most commonly, another medical specialist was identified as the ultimate diagnostician on Pap tests (gynaecologist), breast biopsies or malignant surgical excisions (oncologist), gastrointestinal biopsies (gastroenterologist) or prostate biopsies (urologist). The experience gained by undergoing these procedures had minimal impact on understanding the pathologists' role, since they were identified as ultimate diagnosis makers by the minority of these patients (13.8%-36.4%). The integration of pathologist-interactions into patient care may be a potential solution with benefits beyond improved perceptions.
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Affiliation(s)
- Gabor Fischer
- Pathology, University of Manitoba, Winnipeg, Manitoba, Canada
- Shared Health Diagnostic Services, Winnipeg, Manitoba, Canada
| | - Leslie Anderson
- Pathology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marc Ranson
- Pathology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David Sellen
- Pathology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eric McArthur
- Pathology, Institute for Clinical Evaluative Sciences, London, Ontario, Canada
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Hamilton F, West C. Predatory marriage: Doctors can help to spot and prevent this exploitation. BMJ 2021; 375:n2906. [PMID: 34819320 DOI: 10.1136/bmj.n2906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Garcia-Guillén A, Jeria S, Lobo-Prat D, Sainz L. COVID-19: Overview of rheumatology fellows. ACTA ACUST UNITED AC 2021; 17:491-493. [PMID: 34756308 PMCID: PMC7561292 DOI: 10.1016/j.reumae.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/21/2020] [Indexed: 11/20/2022]
Abstract
SARS-COV-2 infection has spread worldwide since it originated in December 2019, in Wuhan, China. The pandemic has largely demonstrated the resilience of the world's health systems and is the greatest health emergency since World War II. There is no single therapeutic approach to the treatment of COVID-19 and the associated immune disorder. The lack of randomised clinical trials (RCTs) has led different countries to tackle the disease based on case series, or from results of observational studies with off-label drugs. We as rheumatologists in general, and specifically rheumatology fellows, have been on the front line of the pandemic, modifying our activities and altering our training itinerary. We have attended patients, we have learned about the management of the disease and from our previous experience with drugs for arthritis and giant cell arteritis, we have used these drugs to treat COVID-19.
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Affiliation(s)
| | - Sicylle Jeria
- Servei de Reumatologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - David Lobo-Prat
- Servei de Reumatologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Luís Sainz
- Servei de Reumatologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Kim S, Cho AR, Chung CW. Newly appointed medical faculty members’ self-evaluation of their educational roles at the Catholic University of Korea College of Medicine in 2020 and 2021: a cross-sectional survey-based study. J Educ Eval Health Prof 2021; 18:28. [PMID: 34736297 PMCID: PMC8616723 DOI: 10.3352/jeehp.2021.18.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Abstract
This study aimed to investigate the degree to which newly appointed medical faculty members at the Catholic University of Korea are aware of Harden and Crosby’s 12 educational roles and to identify their preferred educational roles. A 12-item survey questionnaire was distributed to 110 participants, and 100 responses were included in the analysis. The respondents gave the highest score to “clinical or practical teacher” and the lowest score to “curriculum planner” for their current personal competencies. For their preferred personal future competencies, they assigned the highest score to “on the job role model” and the lowest score to “student assessor.” They gave almost equally high values to all 12 roles. However, individual faculty members had different preferences for educational roles. Accordingly, medical schools need to plan and implement customized faculty development programs, and efforts to provide appropriate educational roles according to individual faculty members’ preferences are needed.
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Affiliation(s)
- Sun Kim
- Department of Medical Education, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - A Ra Cho
- Department of Medical Education, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Woon Chung
- Department of General Surgery, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
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Joshi M, Schwartz HEM, Teherani A, Fahimi J. Scrubs Addressing the Firearm Epidemic: A Novel Multidisciplinary Elective for Preclinical Students. Acad Med 2021; 96:S190. [PMID: 34705689 DOI: 10.1097/acm.0000000000004313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Mihir Joshi
- Author affiliations: M. Joshi, H.E.M. Schwartz, A. Teherani, J. Fahimi, University of California, San Francisco
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Wellbery CE, Lewandowski A, Holder C. Climate Change and the Local Environment: Communicating with Your Patients about Health Impacts. Am Fam Physician 2021; 104:526-530. [PMID: 34783491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | | | - Cheryl Holder
- Georgetown University School of Medicine, Washington, DC, USA
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Abstract
PURPOSE Recent national events, including the COVID-19 pandemic and protests of racial inequities, have drawn attention to the role of physicians in advocating for improvements in the social, economic, and political factors that affect health. Characterizing the current state of advocacy training in U.S. medical schools may help set expectations for physician advocacy and predict future curricular needs. METHOD Using the member school directory provided by the Association of American Medical Colleges, the authors compiled a list of 154 MD-granting medical schools in the United States in 2019-2020. They used multiple search strategies to identify online course catalogues and advocacy-related curricula using variations of the terms "advocacy," "policy," "equity," and "social determinants of health." They used an iterative process to generate a preliminary coding schema and to code all course descriptions, conducting content analysis to describe the structure of courses and topics covered. RESULTS Of 134 medical schools with any online course catalogue available, 103 (76.9%) offered at least 1 advocacy course. Required courses were typically survey courses focused on general content in health policy, population health, or public health/epidemiology, whereas elective courses were more likely to focus specifically on advocacy skills building and to feature field experiences. Of 352 advocacy-specific courses, 93 (26.4%) concentrated on a specific population (e.g., children or persons with low socioeconomic status). Few courses (n = 8) focused on racial/ethnic minorities and racial inequities. CONCLUSIONS Findings suggest that while most U.S. medical schools offer at least 1 advocacy course, the majority are elective rather than required, and the structure and content of advocacy-related courses vary substantially. Given the urgency to address social, economic, and political factors affecting health and health equity, this study provides an important and timely overview of the prevalence and content of advocacy curricula at U.S. medical schools.
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Affiliation(s)
- Teva D Brender
- T.D. Brender is a medical student, Oregon Health & Science University, Portland, Oregon
| | - Wesley Plinke
- W. Plinke is a medical student, Oregon Health & Science University, Portland, Oregon
| | - Vineet M Arora
- V.M. Arora is the Herbert T. Abelson Professor of Medicine and assistant dean, Scholarship and Discovery, University of Chicago School of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0002-4745-7599
| | - Jane M Zhu
- J.M. Zhu is assistant professor of medicine, Division of General Internal Medicine, Oregon Health & Science University, Portland, Oregon; ORCID: http://orcid.org/0000-0002-4868-6078
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Adler DA, Erlich MD, Goldman B, Berlant J, Edwards ML, First MB, Oslin DW, Siris SG, Talley RM, Wagner ES. Psychiatry in the Time of COVID: Credibility, Uncertainty, and Self-Reflection. J Nerv Ment Dis 2021; 209:779-782. [PMID: 34468441 PMCID: PMC9207939 DOI: 10.1097/nmd.0000000000001404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Public trust in the credibility of medicine and physicians has been severely tested amid the COVID-19 pandemic and growing sociopolitical fissures in the United States. Physicians are being asked to be ambassadors to the public of scientific information. Psychiatrists have an opportunity to help the public understand and accept a "new normal" during a time of such uncertainty. Using a case example, we review the impact of uncertainty and fear on scientific and medical credibility. Although the pandemic provides an opportunity for systemic change, the consequences of any change remain unknown. To help patients navigate the uncertainty, we conclude by offering four guidelines to clinicians: the public has little interest in understanding the scientific method; we need to acknowledge that we do not have all the answers; credibility and trustworthiness are linked to our ability to be trusted, believable messengers; and we can retain scientific credibility while acknowledging uncertainty.
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Affiliation(s)
- David A. Adler
- Department of Psychiatry, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - Matthew D. Erlich
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian, New York, New York
| | | | - Jeffrey Berlant
- Optum Idaho, Boise, Idaho
- Canyon Manor Mental Health Rehabilitation, Novato, California
| | | | - Michael B. First
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian, New York, New York
| | - David W. Oslin
- Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, Pennsylvania
| | - Samuel G. Siris
- Department of Psychiatry, Donna and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Rachel M. Talley
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth S. Wagner
- Department of Psychiatry, Brown University Alpert Medical School, Providence, Rhode Island
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Jones M, Rockley M, Jetty P. Physician-modified Steerable Endovascular Catheter. Ann Vasc Surg 2021; 79:427-431. [PMID: 34656719 DOI: 10.1016/j.avsg.2021.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 11/18/2022]
Abstract
We demonstrate a simple, intraoperative modification to a 65 cm Beacon Tip Kumpe catheter (Cook Medical) using readily-available components in order to increase its functionality during endovascular procedures. The steerable endovascular catheter has near-spherical range, improving accessibility to challenging anatomy over conventional catheters as demonstrated by our qualitative modeling. In addition, the modification provides structural reinforcement at the catheter tip leading to precise wire advancement. Use of the steerable catheter was demonstrated in vivo during contralateral gate cannulation of an endovascular aneurysm repair, however it holds broad applications in visceral, branched and fenestrated cannulations. Physician-modified devices offer the potential to improve endovascular techniques and reduce additional procedure costs while avoiding regulatory board approval required of novel steerable endovascular devices.
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Affiliation(s)
- Melissa Jones
- Section of Vascular Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada..
| | - Mark Rockley
- Section of Vascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Prasad Jetty
- Section of Vascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
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Noble B. Medical profession cannot be instrument of law to legalise assisted dying. BMJ 2021; 375:n2491. [PMID: 34645597 DOI: 10.1136/bmj.n2491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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