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Xiong B, Zou J, Ali W, Daneshjou R, Williams J. Diagnosis and management of hidradenitis suppurativa: Analysis of US insurance claims data. JAAD Int 2024; 14:29-30. [PMID: 38058457 PMCID: PMC10696258 DOI: 10.1016/j.jdin.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Affiliation(s)
- Betty Xiong
- Department of Biomedical Data Science, Stanford University, Stanford, California
| | - James Zou
- Department of Biomedical Data Science, Stanford University, Stanford, California
| | | | - Roxana Daneshjou
- Department of Biomedical Data Science and Dermatology, Stanford University, Stanford, California
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2
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Zelin NS, Scott C, Avila-Quintero VJ, Curlin K, Flores JM, Bloch MH. Sexual Orientation and Racial Bias in Relation to Medical Specialty. J Homosex 2024; 71:574-599. [PMID: 36269161 DOI: 10.1080/00918369.2022.2132441] [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] [Indexed: 06/16/2023]
Abstract
Physician explicit and implicit biases involving race and sexual orientation (SO) affect patient and provider experiences in healthcare settings. An anonymous survey was disseminated nationally to graduating medical students, residents, and practicing physicians to evaluate SO and racial biases across medical specialties. SO explicit and implicit bias were measured with the Attitudes toward Lesbians and Gay Men Scale, short form (ATLG-S) and Gay-Straight Implicit Association Test (IAT). Racial explicit and implicit bias were measured with the Quick Discrimination Index (QDI) and the Black-White IAT. Medical specialty was associated with racial explicit bias and specialty prestige with Black-White IAT score. Medical specialty and specialty prestige were not associated with SO bias. Female sex, sexual and gender minority (SGM) identity, and decreased religiosity were associated with reduced SO and racial bias. Provider race was associated with racial implicit and explicit bias.
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Affiliation(s)
| | - Carter Scott
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Kaveri Curlin
- Irvine School of Medicine, University of California, Irvine, California, USA
| | - Jose M Flores
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael H Bloch
- Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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3
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Zhang Y, Zhang M, Yang H, Li H, Ma S, Xi L, Li Y, Li X, Fu Z, Zhang Z, Zhang S, Gao Q, Huang Q, Wan J, Xie W, Li J, Yang P, Zhai Z. Serum proteome profiling reveals heparanase as a candidate biomarker for chronic thromboembolic pulmonary hypertension. iScience 2024; 27:108930. [PMID: 38333700 PMCID: PMC10850736 DOI: 10.1016/j.isci.2024.108930] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/30/2023] [Accepted: 01/12/2024] [Indexed: 02/10/2024] Open
Abstract
Determining novel biomarkers for early identification of chronic thromboembolic pulmonary hypertension (CTEPH) could improve patient outcomes. We used the isobaric tag for relative and absolute quantitation approach to compare the serum protein profiles between CTEPH patients and the controls. Bioinformatics analyses and ELISA were also performed. We identified three proteins including heparanase (HPSE), gelsolin (GSN), and secreted protein acidic and rich in cysteine (SPARC) had significant changes in CTEPH. The receiver operating characteristic curve analysis showed that the areas under the curve of HPSE in CTEPH diagnosis were 0.988. Furthermore, HPSE was correlated with multiple parameters of right ventricular function. HPSE concentrations were significantly higher in patients with a low TAPSE/sPAP ratio (≤0.31 mm/mmHg) (65.4 [60.5,68.0] vs. 59.9 [35.9,63.2] ng/mL, p < 0.05). The CTEPH patients treated by balloon pulmonary angioplasty had significantly lower HPSE levels. The study demonstrates that HPSE may be a promising biomarker for noninvasive detection of CTEPH.
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Affiliation(s)
- Yunxia Zhang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Meng Zhang
- Department of Pulmonary and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongwei Yang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haobo Li
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shuangshuang Ma
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Linfeng Xi
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- China-Japan Friendship Hospital, Capital Medical University, Beijing, China
| | - Yishan Li
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- The First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Xincheng Li
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- Harbin Medical University, Harbin, China
| | - Zhihui Fu
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhu Zhang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Shuai Zhang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Qian Gao
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Qiang Huang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jun Wan
- Department of Pulmonary and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wanmu Xie
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jifeng Li
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University; Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Department of Respiratory Disease, Capital Medical University, Beijing, China
| | - Peiran Yang
- State Key Laboratory of Respiratory Health and Multimorbidity, Department of Physiology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College; National Center for Respiratory Medicine; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Zhenguo Zhai
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
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Abbiati M, Nendaz MR, Cerutti B, Brodmann Mäder M, Spinas GA, Vicente Alvarez D, Teodoro D, Savoldelli GL, Bajwa NM. Exploring Medical Career Choice to Better Inform Swiss Physician Workforce Planning: Protocol for a National Cohort Study. JMIR Res Protoc 2024; 13:e53138. [PMID: 38231561 PMCID: PMC10831588 DOI: 10.2196/53138] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND A medical student's career choice directly influences the physician workforce shortage and the misdistribution of resources. First, individual and contextual factors related to career choice have been evaluated separately, but their interaction over time is unclear. Second, actual career choice, reasons for this choice, and the influence of national political strategies are currently unknown in Switzerland. OBJECTIVE The overall objective of this study is to better understand the process of Swiss medical students' career choice and to predict this choice. Our specific aims will be to examine the predominately static (ie, sociodemographic and personality traits) and predominately dynamic (ie, learning context perceptions, anxiety state, motivation, and motives for career choice) variables that predict the career choice of Swiss medical school students, as well as their interaction, and to examine the evolution of Swiss medical students' career choice and their ultimate career path, including an international comparison with French medical students. METHODS The Swiss Medical Career Choice study is a national, multi-institution, and longitudinal study in which all medical students at all medical schools in Switzerland are eligible to participate. Data will be collected over 4 years for 4 cohorts of medical students using questionnaires in years 4 and 6. We will perform a follow-up during postgraduate training year 2 for medical graduates between 2018 and 2022. We will compare the different Swiss medical schools and a French medical school (the University of Strasbourg Faculty of Medicine). We will also examine the effect of new medical master's programs in terms of career choice and location of practice. For aim 2, in collaboration with the Swiss Institute for Medical Education, we will implement a national career choice tracking system and identify the final career choice of 2 cohorts of medical students who graduated from 4 Swiss medical schools from 2010 to 2012. We will also develop a model to predict their final career choice. Data analysis will be conducted using inferential statistics, and machine learning approaches will be used to refine the predictive model. RESULTS This study was funded by the Swiss National Science Foundation in January 2023. Recruitment began in May 2023. Data analysis will begin after the completion of the first cohort data collection. CONCLUSIONS Our research will inform national stakeholders and medical schools on the prediction of students' future career choice and on key aspects of physician workforce planning. We will identify targeted actions that may be implemented during medical school and may ultimately influence career choice and encourage the correct number of physicians in the right specialties to fulfill the needs of currently underserved regions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53138.
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Affiliation(s)
- Milena Abbiati
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Mathieu R Nendaz
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Bernard Cerutti
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Monika Brodmann Mäder
- Swiss Institute for Medical Education, Bern, Switzerland
- Department of Emergency Medicine, University Hospital Bern, Bern University, Bern, Switzerland
| | | | - David Vicente Alvarez
- Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Douglas Teodoro
- Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Georges L Savoldelli
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Anesthesia, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nadia M Bajwa
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Pediatrics, Department of Women, Children, and Adolescents, Geneva University Hospitals, Geneva, Switzerland
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Jandhyala R, Rout R. Observing expert opinion of medical affairs pharmaceutical physicians on the value of their clinical experience to the pharmaceutical industry using the Jandhyala method. Curr Med Res Opin 2023; 39:1541-1550. [PMID: 36632732 DOI: 10.1080/03007995.2023.2165814] [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: 10/11/2022] [Accepted: 12/14/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND The pharmaceutical industry requires a highly qualified workforce with diverse skillsets. Medical affairs pharmaceutical physicians (MAPPs) have unique qualifications among pharmaceutical company employees, but the exact contribution of their education and training is unknown. This study aimed to identify the medical education and training competencies MAPPs use in the pharmaceutical industry in relation to the four external stakeholders, regulators, payors, prescribers, and patients. METHOD Ten MAPPs were recruited using convenience sampling via professional networks. A systematic literature review and the Jandhyala method, a two-stage qualitative online consensus method, identified which of MAPPs' medical education and training competencies they used in their work with each external stakeholder. Statistical analyses determined heterogeneity in the relevance of competencies and competency categories to each stakeholder. RESULTS Nine MAPPs completed the study. Of the 59 competencies identified, 54 were relevant to all external stakeholders. Relevance of competencies varied significantly between external stakeholders (p = .0434). Binary competency scores varied significantly for three pairs of stakeholders, "patient vs. payor" (p = .025), "prescriber vs. regulator" (p = .013) and "prescriber vs. payor" (p = .008). Between-stakeholder overall frequency count varied significantly for two of the nine competency categories. CONCLUSION MAPPs develop a highly specialized set of competencies during medical education and training from which they use distinct subsets to meet the needs of external stakeholders in the pharmaceutical industry. Undergraduate and postgraduate competency-based medical education appears to prepare MAPPs for cognitive and technical work. Further exploration may aid understanding of how they develop soft skills.
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Affiliation(s)
- Ravi Jandhyala
- Medialis Ltd., England, UK
- Centre for Pharmaceutical Medicine Research, King's College London, University of London, London, UK
| | - Raj Rout
- Vertex Pharmaceuticals, London, UK
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Chattha M, Tahir MJ, Zia A, Chattha M, Tariq W, Masood MF, Sani S, Yousaf Z, Eljack MMF, Asghar MS. Exposure to, understanding of and interest in interventional radiology among Pakistani medical students: a cross-sectional study. Front Med (Lausanne) 2023; 10:1226294. [PMID: 37908856 PMCID: PMC10615072 DOI: 10.3389/fmed.2023.1226294] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/27/2023] [Indexed: 11/02/2023] Open
Abstract
Background Medical students need more awareness regarding minimally invasive image-guided procedures carried out by interventional radiological approach. This study analyzed the knowledge and attitudes of medical students regarding interventional radiology (IR) and the factors influencing their decision to choose IR as a specialty in the future. Methods A cross-sectional, web-based study was conducted among medical students across Pakistan. The data were collected from October 14, 2021, to November 14, 2021. The questionnaire included demographic variables, exposure, interest, and self-reported knowledge of IR, interventions, instruments utilized in IR, and the responsibilities of the interventional radiologist. Variables affecting the possible choice of IR as a future career were analyzed using logistic regression analysis. Results The median age was 22 years, with a male predominance. 65.5% exhibited an interest in radiology, and 20.2% in IR. The majority, 83.5%, perceived IR. As having good to adequate prospects. Male participants preferred IR more as compared to females. Participants willing to attend IR rotation and had an excellent view of IR as a specialty had higher propensity towards IR as a future career than their counterparts. The majority opted for IR as a better-paying job with lots of intellectual stimulation and career flexibility. Conclusion IR is a demanding specialty with rigorous routines but reasonable monetary compensation. Lack of infrastructure and low numbers of trained specialists limit medical students' exposure to IR in developing health economies like Pakistan. Clinical rotations in IR departments would help raise awareness about the field and bridging this gap.
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Affiliation(s)
- Muneeb Chattha
- Department of Medicine, Foundation University Medical College, Rawalpindi, Pakistan
| | - Muhammad Junaid Tahir
- Department of Radiology, Pakistan Kidney and Liver Institute and Research Center (PKLI & RC), Lahore, Pakistan
| | - Ahmad Zia
- Department of Radiology, Pakistan Kidney and Liver Institute and Research Center (PKLI & RC), Lahore, Pakistan
| | - Maha Chattha
- Department of Radiology, Army Medical College, Rawalpindi, Pakistan
| | - Waleed Tariq
- Department of Medicine, Mayo Hospital, Lahore, Pakistan
| | | | - Salman Sani
- Department of Medicine, Jinnah Hospital, Lahore, Pakistan
| | - Zohaib Yousaf
- Department of Medicine, Tower Health, Reading, PA, United States
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Hernandez-Moreno J, Alo C, Habashi K, Tian E, Simanton E. The Timing, Factors, and Impact of USMLE Step 1 Becoming Pass/Fail on the Process of Choosing a Specialty. Cureus 2023; 15:e46844. [PMID: 37954783 PMCID: PMC10637263 DOI: 10.7759/cureus.46844] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
Background Choosing a medical specialty is an important decision. A combination of factors influenced this decision. Student characteristics and examination performances can influence this decision. With the transition of the United States Medical Licensing Examination (USMLE) Step 1 becoming pass/fail, it is important to analyze the specialty decision process. Objective The purpose of this multimethod study is to assess when in the curriculum students choose a specialty, what factors influence their decision, and the impact of USMLE Step 1 scores on a student's assessment of competitiveness. Methods In February 2022, a survey was prepared and approved by the University of Nevada, Las Vegas (UNLV) Institutional Review Board (IRB). The survey contained multiple-choice questions and a free-response section. The survey was sent to the Class of 2022 and 2023 students at Kirk Kerkorian School of Medicine who follow a Longitudinal Integrated Clerkship. Descriptive statistics and one-sample t-tests were calculated. Results A total of 89 students completed the survey: 42 out of 60 students (70%) from the Class of 2022 and 47 out of 61 students (77%) from the Class of 2023. This study found that 78.8% of longitudinal interleaved clerkship (LInC) students committed to their specialty during the second half of the clinical year. The effects of positive and negative experiences during clerkships were most significantly different (p < 0.001). Conclusion The majority of LInC students arrive at their decision by the latter half of the clinical year. A variety of factors help students arrive at their decision. Our findings suggest that the pass/fail grading system will make it more difficult for students to assess their personal competitiveness.
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Affiliation(s)
- Jessica Hernandez-Moreno
- Medical Education, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas, Las Vegas, USA
| | - Charissa Alo
- Medical Education, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas, Las Vegas, USA
| | - Kian Habashi
- Medical Education, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas, Las Vegas, USA
| | - Elli Tian
- Medical Education, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas, Las Vegas, USA
| | - Edward Simanton
- Medical Education, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas, Las Vegas, USA
- University of Nevada Las Vegas, Office of Medical Education, Las Vegas, USA
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Maher F, Mammas IN, Spandidos DA. Challenges and perspectives of palliative medicine: A webinar by the Paediatric Virology Study Group. Med Int (Lond) 2023; 3:24. [PMID: 37153162 PMCID: PMC10155253 DOI: 10.3892/mi.2023.84] [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] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/11/2023] [Indexed: 05/09/2023]
Abstract
Palliative medicine focuses on the quality of life of patients with incurable conditions, who require the adequate relief of physical symptoms, adequate information to make decisions and spiritual wellbeing. Generalist palliative care is provided by family members, general practitioners, care home workers, community nurses and social care providers, as well as non-specialist hospital doctors and nurses. Patients with more complex, physical or psycho-social problems require the shared work of specialized doctors in palliative medicine, nurses, social workers and allied professionals. It is estimated that ~40 million patients require palliative care annually, worldwide; of these, 8 out of 10 patients reside in low- or middle-income countries, and only ~14% are able to access this type of care. Palliative medicine was recognised as a distinct medical specialty in the UK in 1987, with its own specialist curriculum and training pathway, which was recently revised in 2022. The main obstacles that palliative medicine had to overcome in order to be accepted as a separate specialization were the following: i) Defining a unique body of knowledge; ii) standardisation of training; and iii) proving that it warranted being a specialty in its own right. Over the past decade, it has been accepted as more than end-of-life care, supporting patients with an incurable illness at much earlier stages. Given the current absence of specialized palliative care in low- or middle-income countries, as well as the aging population across most European countries and the USA, it is estimated that there may be an increasing need and demand for specialists in palliative medicine in the ensuing years. This article is based on a webinar on palliative medicine, which was performed on October 20, 2022 in the context of the '8th Workshop of Paediatric Virology' organized by the Institute of Paediatric Virology based on the island of Euboea (Greece).
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Affiliation(s)
- Fergus Maher
- Department of Palliative Medicine, Norfolk and Norwich University Hospitals, NHS Foundation Trust, NR4 7UY Norwich, UK
- Norwich Medical School, University of East Anglia, NR4 7TJ Norwich, UK
| | - Ioannis N. Mammas
- Paediatric Clinic, Aliveri, 34500 Island of Euboea, Greece
- First Department of Paediatrics, University of Athens School of Medicine, 11527 Athens, Greece
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
- Correspondence to: Professor Demetrios A. Spandidos, Laboratory of Clinical Virology, Medical School, University of Crete, Voutes, 71003 Heraklion, Greece
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Fresán A, Guízar-Sánchez D, Yoldi-Negrete M, Robles-García R, Tovilla-Zárate CA, Saracco-Álvarez R. Gender Differences in Professional Adversities and Mental Health Among Surgical and Nonsurgical Medical Trainees: An Internet-Based Survey. J Surg Educ 2023; 80:666-675. [PMID: 36801202 DOI: 10.1016/j.jsurg.2023.01.013] [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: 11/30/2022] [Revised: 01/05/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Physicians in training face a variety of stressors throughout their professional development and according to their gender. Among them, surgical trainees appear to be especially at risk for mental health problems. OBJECTIVE The aim of the present study was to compare demographic features, professional activities and adversities, depression, anxiety, and distress among men and women trainees of surgical and nonsurgical medical specialties. DESIGN AND PARTICIPANTS A cross-sectional, retrospective, comparative study was conducted on a total of 12,424 trainees (68.7% nonsurgical and 31.3% surgical) from Mexico through an online survey. Demographic features, variables related to professional activities and adversities, depression, anxiety, and distress were evaluated through self-administered measures. Comparative analyses using the Cochran-Mantel-Haenszel test for categorical variables and multivariate analysis of variance including medical residency program and gender as fixed factors to test their interaction effect for continuous variables were used. RESULTS An important interaction between medical specialty and gender was found. Women trainees from surgical specialties report more frequent psychological and physical aggressions. Women from both specialties had higher distress, significant anxiety, and depression than men. Men from surgical specialties worked more hours per day. CONCLUSIONS Gender differences are evident in trainees for medical specialties, with a larger impact in surgical fields. Mistreatment of students is a pervasive behavior that affects society as a whole, and actions to improve learning and working environments in all medical specialties, but mostly in surgical fields, are urgently needed.
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Affiliation(s)
- Ana Fresán
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico.
| | - Diana Guízar-Sánchez
- Departamento de Fisiología de la Facultad de Medicina, Universidad Nacional Autónoma de México, UNAM, Copilco Universidad, Mexico City, Mexico
| | - María Yoldi-Negrete
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Rebeca Robles-García
- Centro de Investigación en Salud Mental Global, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Carlos-Alfonso Tovilla-Zárate
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Ranchería Sur, Cuarta sección, Comalcalco, Tabasco, Mexico
| | - Ricardo Saracco-Álvarez
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
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Nunes NN, Vasconcelos R, Cortez AL, Ferreira-Filho E, Kobayasi R, Willets C, Cocuzza M, Avelino-Silva VI. Is U=U consistently known and implemented? A survey among different medical specialists in Brazil. Int J STD AIDS 2023; 34:395-401. [PMID: 36693243 DOI: 10.1177/09564624231153202] [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] [Indexed: 01/25/2023]
Abstract
Despite solid scientific evidence, the concepts of treatment as prevention (TASP) and Undetectable = Untransmittable (U = U) remain unfamiliar and underutilized for some healthcare providers. We conducted a self-completion survey to evaluate the knowledge of TASP/U = U in different medical specialties. Wilcoxon Rank-Sum, Chi-square and Fisher's exact tests were used for group comparisons and a logistic regression model was used to assess factors independently associated with U = U-non-supportive attitudes. 197 physicians were included; 74% agreed/strongly agreed that people living with HIV (PLHIV) under regular treatment with undetectable viral do not transmit HIV sexually. However, only 66% agree/strongly agree that PLHIV should be informed about that. The knowledge about these concepts was poorer among gynecologists, urologists and internal medicine specialists when compared to infectious diseases specialists after adjustment for age, race/skin color, gender, and sexual orientation. Our study found that knowledge of crucial concepts of HIV prevention may be lacking for some medical specialties. This highlights the need of improvement in medical education.
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Affiliation(s)
- Nathalia Neves Nunes
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
| | - Ricardo Vasconcelos
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
| | - Andre Lazzeri Cortez
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
| | - Edson Ferreira-Filho
- Discipline of Ginecology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
| | - Renata Kobayasi
- Department of Internal Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
| | - Clarissa Willets
- Family Medicine Residency Program, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
| | - Marcelo Cocuzza
- Department of Urology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
| | - Vivian I Avelino-Silva
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
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11
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Muacevic A, Adler JR. Optimal Use of Advanced Practice Providers at an Academic Medical Center: A First-Year Retrospective Review. Cureus 2023; 15:e34475. [PMID: 36733574 PMCID: PMC9889205 DOI: 10.7759/cureus.34475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Background Physician assistants/associates (PAs) and nurse practitioners (NPs), together known as advanced practice providers (APPs), practice with a high degree of clinical autonomy and professional respect, and play a critical role in team-based care. Aligning APP care delivery models to promote top-of-license practice is essential to improving ambulatory capacity and bottom-line expectations at academic medical centers (AMCs) in the 21st century and beyond. This administrative quality improvement study assesses the downstream impact of restructuring our APP care models to promote independent practice sessions. Methods Our AMC formed an APP oversight committee in April 2021 to optimize the ambulatory care model, realign APP funds flow, and set performance standards to which PAs and NPs are being held accountable. We conducted a one-year retrospective review of internal data from July 2021 to June 30, 2022. Certified registered nurse anesthetists (CRNAs) were excluded from this analysis. Results APP productivity year-over-year (YOY) aggregate data across all School of Medicine (SOM) departments, demonstrated a 53% increase in work relative value units (wRVUs), 84% increase in payments, and 79% increase in charges from the prior fiscal year (July to June). Regarding APP ambulatory clinical effort (YOY), there was a 45% increase in the number of APP completed visits (92% return patient visits, 8% new visits). An increase in APP productivity did not adversely impact patient satisfaction, physician-generated wRVUs, or delay programmatic expansion efforts. Lastly, in a recent engagement survey, the majority of PA and NP respondents (78%) reported working either "most of the time" or "always" at the top-of-license. Conclusion This quality improvement study demonstrates that enhancement of PA and NP utilization through top-of-license initiatives can be achieved without jeopardizing physician wRVUs or performance. While we acknowledge, there are differences between healthcare institutions in terms of care delivery and compensation models, organizational culture, and distribution of clinical resources, there remains an opportunity among hospitals and health systems to optimize this critical and essential APP workforce.
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Pastrana T, De Lima L, Stoltenberg M, Peters H. Palliative Medicine Specialization in Latin America: A Comparative Analysis. J Pain Symptom Manage 2021; 62:960-967. [PMID: 33933625 DOI: 10.1016/j.jpainsymman.2021.04.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 02/12/2021] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Formal recognition of palliative medicine as a specialty has been one of the main drivers in the development of palliative care. AIM To provide a comparative, comprehensive overview on the status of palliative medicine as medical specialty across Latin America. METHODS We conducted a comparative study of 19 Latin American countries. Key informants and persons in charge of the specialization training programs were identified and interviewed. We collected data on general recognition as specialty (title, process of certification) and on training program characteristics (title, start year, requirements, training length, and type full time or part time). RESULTS Eight of 19 countries (42%) Argentina, Brazil, Colombia, Costa Rica, Ecuador, Mexico, Paraguay and Venezuela reported palliative medicine as medical specialty. Thirty-five (sub)specialization training programs in palliative medicine were identified in the region (eight as a specialty and 27 as a subspecialty), the majority in Colombia (43.5%) and Brazil (33.7%). A total of 20% of the programs have yet to graduate their first cohort. Length of clinical training as specialty varied from two to four years, and from 520 hours to three years for a subspecialty. CONCLUSION Despite long-standing efforts to improve quality of care, and significant achievements to date, most Latin American countries have yet to develop palliative medicine as medical specialty. Specialty and sub-specialty training programs remain scarce in relation to regional needs, and the programs that do exist vary widely in duration, structure, and content.
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Affiliation(s)
- Tania Pastrana
- Department of Palliative Medicine (T.P.), RWTH University Aachen, Aachen, Germany.
| | - Liliana De Lima
- International Association for Hospice and Palliative Care (IAHPC) (L.D.L.), Houston, Texas, USA
| | - Mark Stoltenberg
- Division of Palliative Care and Geriatrics (M.S.), Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School (M.S.), Boston, Massachusetts, USA
| | - Harm Peters
- Dieter Scheffner Center for Medical Education and Educational Research (H.P.), Dean´s Office of Study Affairs, Charité - Universitätsmedizin Berlin, Berlin, Germany
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13
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Lee H, Kang J, Yeo J. Medical Specialty Recommendations by an Artificial Intelligence Chatbot on a Smartphone: Development and Deployment. J Med Internet Res 2021; 23:e27460. [PMID: 33882012 PMCID: PMC8104000 DOI: 10.2196/27460] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/03/2021] [Accepted: 04/17/2021] [Indexed: 01/22/2023] Open
Abstract
Background The COVID-19 pandemic has limited daily activities and even contact between patients and primary care providers. This makes it more difficult to provide adequate primary care services, which include connecting patients to an appropriate medical specialist. A smartphone-compatible artificial intelligence (AI) chatbot that classifies patients’ symptoms and recommends the appropriate medical specialty could provide a valuable solution. Objective In order to establish a contactless method of recommending the appropriate medical specialty, this study aimed to construct a deep learning–based natural language processing (NLP) pipeline and to develop an AI chatbot that can be used on a smartphone. Methods We collected 118,008 sentences containing information on symptoms with labels (medical specialty), conducted data cleansing, and finally constructed a pipeline of 51,134 sentences for this study. Several deep learning models, including 4 different long short-term memory (LSTM) models with or without attention and with or without a pretrained FastText embedding layer, as well as bidirectional encoder representations from transformers for NLP, were trained and validated using a randomly selected test data set. The performance of the models was evaluated on the basis of the precision, recall, F1-score, and area under the receiver operating characteristic curve (AUC). An AI chatbot was also designed to make it easy for patients to use this specialty recommendation system. We used an open-source framework called “Alpha” to develop our AI chatbot. This takes the form of a web-based app with a frontend chat interface capable of conversing in text and a backend cloud-based server application to handle data collection, process the data with a deep learning model, and offer the medical specialty recommendation in a responsive web that is compatible with both desktops and smartphones. Results The bidirectional encoder representations from transformers model yielded the best performance, with an AUC of 0.964 and F1-score of 0.768, followed by LSTM model with embedding vectors, with an AUC of 0.965 and F1-score of 0.739. Considering the limitations of computing resources and the wide availability of smartphones, the LSTM model with embedding vectors trained on our data set was adopted for our AI chatbot service. We also deployed an Alpha version of the AI chatbot to be executed on both desktops and smartphones. Conclusions With the increasing need for telemedicine during the current COVID-19 pandemic, an AI chatbot with a deep learning–based NLP model that can recommend a medical specialty to patients through their smartphones would be exceedingly useful. This chatbot allows patients to identify the proper medical specialist in a rapid and contactless manner, based on their symptoms, thus potentially supporting both patients and primary care providers.
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Affiliation(s)
- Hyeonhoon Lee
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Jaehyun Kang
- Department of Computer Science, Yonsei University, Seoul, Republic of Korea
| | - Jonghyeon Yeo
- School of Computer Science and Engineering, Pusan National University, Busan, Republic of Korea
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14
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Morales A, Schultz KC, Gao S, Murphy A, Barnato AE, Fanning JB, Hall DE. Cultures of Practice: Specialty-Specific Differences in End-of-Life Conversations. Palliat Med Rep 2021; 2:71-83. [PMID: 33860283 PMCID: PMC8043084 DOI: 10.1089/pmr.2020.0054] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 11/18/2022] Open
Abstract
Importance: Goals of care discussions at the end of life give opportunity to affirm the autonomy and humanity of dying patients. Best practices exist for communication around goals of care, but there is no research on differences in approach taken by different specialties engaging these conversations. Objective: To describe the communication practices of internal medicine (IM), emergency medicine (EM), and critical care (CC) physicians in a high-fidelity simulation of a terminally ill patient with stable and defined end-of-life preferences. Design, Setting, and Participants: Mixed-methods secondary analysis of transcripts obtained from a multicenter study simulating high stakes, time-limited end-of-life decision making in a cohort of 88 volunteer physicians (27 IM, 22 EM, and 39 CC) who were called to evaluate a standardized patient in extremis. The patient had clear comfort-oriented goals of care that the physician needed to elicit and use to inform treatment decisions. Discussions were coded at the level of the sentence for semantic content. Exposures: Data were analyzed by physician specialty. Main Outcome Measure: Occurrence of content codes indicative of prudent (right outcome by the right means) goals of care conversations. Data were analyzed both for number of occurrences of the code in a simulated conversation and for presence or absence of the code within a conversation. Results: There was no difference between physician types in intubation rates or intensive care unit admissions. Codes for "comfort as a goal of care," "noncurative goals of care," and "oblique references to death" emerged as significantly different between physician types. Conclusions and Relevance: This experiment shows demonstrable differences in practice patterns between physician specialties when addressing end-of-life decision making. Some of the variation likely arose from differences in setting, but these data suggest that training in goals of care conversations may benefit if it is adapted to the distinct needs and culture of each specialty.
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Affiliation(s)
- Andre Morales
- Department of Medicine, Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevan C. Schultz
- University Center for Social and Urban Research (UCSUR), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shasha Gao
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | | | - Amber E. Barnato
- Department of Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Joseph B. Fanning
- Department of Medicine, Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel E. Hall
- Department of Surgery, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Abstract
Objectives The purpose of the study was to evaluate the impact of country self-citation rate (SCR) among medical specialties in Saudi Arabia, and to assess the impact of self-citations on the country's total cites world ranking in different specialties. Methods SCImago Journal & Country Rank (SJR) was used to collect data related to all medical specialties in Saudi Arabia for the period 1996-2019. The country SCR for the specialties was correlated with several bibliometric parameters and examined statistically. The specialties that showed a drop in Saudi Arabia's total cites world ranking following the exclusion of self-citations were identified. Results The median country SCR for 46 specialties in Saudi Arabia was 9.5% (range: 4.6-23.1%). The two specialties with the highest country SCR were Public Health (23.1%) and Family Practice (22.9%). Country SCR was significantly higher in the non-clinical specialties compared to clinical specialties (15.3% vs. 9.6%). It did not correlate significantly with any of the examined productivity indices. The exclusion of self-citations resulted in a drop in Saudi Arabia's total cites world ranking in six (13%) specialties only. There was no significant difference between the country's total cites and net total cites world rankings in the specialties. Conclusions Self-citation may be appropriate and signify an expansion of the authors' previous work. Country SCR in medical specialties in Saudi Arabia is relatively low and not affected by total documents and total cites. Non-clinical specialties tend to self-cite more. The exclusion of self-citations had minimal effect on Saudi Arabia's total cites world ranking, indicating that country SCR in the specialties is unlikely to impact its international scientific standing. Our findings do not support the argument for eliminating self-citation from citation-based metrics. We believe that more collaborative and global research practices should be encouraged.
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Affiliation(s)
- Anas M Bardeesi
- Department of Surgery, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
| | - Aimun A Jamjoom
- Department of Clinical Neuroscience, Royal Infirmary of Edinburgh, Edinburgh, GBR
| | - Abdulhadi Algahtani
- Department of Surgery, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
| | - Abdulhakim Jamjoom
- Department of Surgery, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
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16
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Zalihic A, Stanetic K, Gavran LR, Trifunovic N, Mujanovic OB, Savic S, Jatic Z. What is the Future of Family Medicine in Bosnia and Herzegovina? Mater Sociomed 2020; 32:88-92. [PMID: 32843853 PMCID: PMC7428892 DOI: 10.5455/msm.2020.32.88-92] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Although during undergraduate study students have a high opinion of family medicine and often praise it, during postgraduate studies they show little interest in this medical specialty. Aim: The study aimed to examine the interest of public medical school students in family medicine as a career choice, to establish whether it changed during the study and if there was a difference in that regard among students studying at medical schools in Bosnia and Herzegovina. Hypotheses: students’ attitudes change with learning about the way a family doctor works. Methods: Descriptive cross-sectional survey. This manuscript presents a nationwide survey (63% response rate) of public medical school students in Bosnia and Herzegovina regarding their likelihood of selecting Family Medicine as a specialty. An anonymous questionnaire was distributed to all medical students on all six state universities in Bosnia and Herzegovina. Data basis of all doctors who have completed specialization programs were taken from ministries of health. Results: In the period from 01/01/08 to 12/31/18, only 8.4% of all completed specializations were family medicine doctors in Bosnia and Herzegovina. Interest in family medicine, as a future career, was shown by 31% of medical students, of which over 75% were female students. The largest interest in family medicine was shown by the sixth-year medical students, stating their extensive knowledge of medicine as a reason. Conclusion: Students’ interest in FM specialization is changing through the years of study. Unfortunately, it is not only the lack of interest, that is the cause of the small number of family medical specialities among students but also poor health policy, which should be subjected to actual reform.
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Affiliation(s)
- Amra Zalihic
- Department of Family Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Kosana Stanetic
- Deparment of Family Medicine University of Foca, Foca, Bosnia and Herzegovina.,Department of Family Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | | | - Natasa Trifunovic
- Department of Family Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Suzana Savic
- Department of Family Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Zaim Jatic
- Department of Family Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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17
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Abstract
BACKGROUND Vision standards exist in many occupations with particular reference to medical science. The presence of a sufficient level of binocular vision is especially important in surgical specialty to perform visually demanding procedures. The purpose of this study was to reveal the level of awareness of one's binocular status among medical students, and the significance of having binocular vision in terms of specialty choice. MATERIAL AND METHODS self-constructed questionnaire was given to all subjects enrolled in the study. The first group comprised 53 students from the second and third year of the Medical University of Lodz, who then underwent an ophthalmological examination with binocularity assessment. The second group included 57 students of the last years of the Medical Faculty, who did the same survey and outlined how the ophthalmology course improved their knowledge of stereoacuity and vision requirements for the chosen specialty. Statistical analysis was performed using Person's χ<sup>2</sup> test. RESULTS Overall, 32% (N = 17) of the students from the first group and 84% (N = 48) from the second group stated to be familiar with the term "binocularity" and its importance in performing surgical procedures. The awareness of the existing occupational contraindications related to low visual acuity and binocularity was declared by 16% (N = 9) and 54% (N = 31) of the subjects included in each group, respectively. University lectures were indicated as the main source of knowledge by 28% (N = 15) of the individuals from the first group and by 59% (N = 39) from the second group. The ophthalmology course was considered to be sufficiently covering the basics needed for the future doctor by 34 resident physicians (60%). CONCLUSIONS The medical students' awareness of their own binocular status appears low. There is a strong need for implementing at least some quality standards for visual assessment to decide if a given student has an adequate eye function to participate in surgical procedures. Med Pr. 2020;71(1):9-16.
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Affiliation(s)
- Xeniya Fedoryak
- Medical University of Lodz, Łódź, Poland (Department of Binocular Vision Pathophysiology and Strabismus Treatment)
| | - Justyna Simiera
- Medical University of Lodz, Łódź, Poland (Department of Binocular Vision Pathophysiology and Strabismus Treatment)
| | - Piotr Loba
- Medical University of Lodz, Łódź, Poland (Department of Binocular Vision Pathophysiology and Strabismus Treatment)
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18
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Abstract
Purpose: Colonoscopy is the preferred screening modality for colorectal cancer (CRC) prevention. The quality of the procedure varies although medical specialists such as gastroenterologists and colorectal surgeons tend to have better outcomes. We aimed to determine whether there are demographic and clinical differences between those who received a colonoscopy from a specialist versus those who received a colonoscopy from a nonspecialist. Methods: Using the population-based South Carolina Outpatient Ambulatory Surgery Database, we looked retrospectively to obtain patient-level endoscopy records from 2010 to 2014. We used multilevel logistic regression to model whether patients saw a specialist for their colonoscopy. The primary variables were patient race and insurance type, and an interaction by rurality was tested. Results: Of the 392,285 patients included in the analysis, 81% saw a specialist for their colonoscopy. County of residence explained 30% of the variability in the outcome. Non-Hispanic black (OR=0.65; confidence interval [95% CI]: 0.64–0.67) and Hispanic patients (OR=0.75; 95% CI: 0.67–0.84) were significantly less likely than non-Hispanic white patients to see a specialist. Compared with commercial/HMO insurance, all other types were less likely to see a specialist, and even more so for rural patients. The interaction of race by rurality was not significant. Conclusions: Specialists play a key role in CRC screening and can affect later downstream outcomes. This study has shown that ethnic minorities and adults with public or other insurance, particularly in rural areas, are most likely not to see a specialist. These results are consistent with disparities in CRC incidence, mortality, and survival.
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Affiliation(s)
- Michele J Josey
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina.,Rural and Minority Health Research Center, University of South Carolina, Columbia, South Carolina
| | - Cassie L Odahowski
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina.,Rural and Minority Health Research Center, University of South Carolina, Columbia, South Carolina
| | - Whitney E Zahnd
- Rural and Minority Health Research Center, University of South Carolina, Columbia, South Carolina
| | - Mario Schootman
- Department of Clinical Analytics and Insights, Center for Clinical Excellence, SSM Health System, St. Louis, Missouri
| | - Jan M Eberth
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina.,Rural and Minority Health Research Center, University of South Carolina, Columbia, South Carolina
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Yu HY, Chen JJ, Wang JN, Chiu YL, Qiu H, Wang LY. Identification of the Differential Effect of City-Level on the Gini Coefficient of Health Service Delivery in Online Health Community. Int J Environ Res Public Health 2019; 16:ijerph16132314. [PMID: 31261952 PMCID: PMC6651774 DOI: 10.3390/ijerph16132314] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/19/2019] [Accepted: 06/26/2019] [Indexed: 11/16/2022]
Abstract
Inequality of health services for different specialty categories not only occurs in different areas in the world, but also happens in the online service platform. In the online health community (OHC), health services often display inequality for different specialty categories, including both online views and medical consultations for offline registered services. Moreover, how the city-level factors impact the inequality of health services in OHC is still unknown. We designed a causal inference study with data on distributions of serviced patients and online views in over 100 distinct specialty categories on one of the largest OHCs in China. To derive the causal effect of the city-levels (two levels inducing 1 and 0) on the Gini coefficient, we matched the focus cases in cities with rich healthcare resources with the potential control cities. For each of the specialty categories, we first estimated the average treatment effect of the specialty category’s Gini coefficient (SCGini) with the balanced covariates. For the Gini coefficient of online views, the average treatment effect of level-1 cities is 0.573, which is 0.016 higher than that of the matched group. Similarly, for the Gini coefficient of serviced patients, the average treatment effect of level-1 cities is 0.470, which is 0.029 higher than that of the matched group. The results support the argument that the total Gini coefficient of the doctors in OHCs shows that the inequality in health services is still very serious. This study contributes to the development of a theoretically grounded understanding of the causal effect of city-level factors on the inequality of health services in an online to offline health service setting. In the future, heterogeneous results should be considered for distinct groups of doctors who provide different combinations of online contributions and online attendance.
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Affiliation(s)
- Hai-Yan Yu
- School of Economics and Management, Chongqing University of Posts and Telecommunications, Chongqing 400065, China.
- Department of Statistics, Eberly College of Science, The Pennsylvania State University, University Park, PA 16802, USA.
| | - Jing-Jing Chen
- School of Economics and Management, Chongqing University of Posts and Telecommunications, Chongqing 400065, China
| | - Jying-Nan Wang
- College of International Finance and Trade, Zhejiang Yuexiu University of Foreign Languages, Shaoxing 312000, China
| | - Ya-Ling Chiu
- College of International Business, Zhejiang Yuexiu University of Foreign Languages, Shaoxing 312000, China
| | - Hang Qiu
- School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu 611731, China
- Big Data Research Center, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Li-Ya Wang
- Big Data Research Center, University of Electronic Science and Technology of China, Chengdu 611731, China
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20
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Basak A, Cadena J, Marathe A, Vullikanti A. Detection of Spatiotemporal Prescription Opioid Hot Spots With Network Scan Statistics: Multistate Analysis. JMIR Public Health Surveill 2019; 5:e12110. [PMID: 31210142 PMCID: PMC6601258 DOI: 10.2196/12110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/10/2018] [Accepted: 04/05/2019] [Indexed: 12/02/2022] Open
Abstract
Background Overuse and misuse of prescription opioids have become significant public health burdens in the United States. About 11.5 million people are estimated to have misused prescription opioids for nonmedical purposes in 2016. This has led to a significant number of drug overdose deaths in the United States. Previous studies have examined spatiotemporal clusters of opioid misuse, but they have been restricted to circular shaped regions. Objective The goal of this study was to identify spatiotemporal hot spots of opioid users and opioid prescription claims using Medicare data. Methods We examined spatiotemporal clusters with significantly higher number of beneficiaries and rate of prescriptions for opioids using Medicare payment data from the Centers for Medicare & Medicaid Services. We used network scan statistics to detect significant clusters with arbitrary shapes, the Kulldorff scan statistic to examine the significant clusters for each year (2013, 2014, and 2015) and an expectation-based version to examine the significant clusters relative to past years. Regression analysis was used to characterize the demographics of the counties that are a part of any significant cluster, and data mining techniques were used to discover the specialties of the anomalous providers. Results We examined anomalous spatial clusters with respect to opioid prescription claims and beneficiary counts and found some common patterns across states: the counties in the most anomalous clusters were fairly stable in 2014 and 2015, but they have shrunk from 2013. In Virginia, a higher percentage of African Americans in a county lower the odds of the county being anomalous in terms of opioid beneficiary counts to about 0.96 in 2015. For opioid prescription claim counts, the odds were 0.92. This pattern was consistent across the 3 states and across the 3 years. A higher number of people in the county with access to Medicaid increased the odds of the county being in the anomalous cluster to 1.16 in both types of counts in Virginia. A higher number of people with access to direct purchase of insurance plans decreased the odds of a county being in an anomalous cluster to 0.85. The expectation-based scan statistic, which captures change over time, revealed different clusters than the Kulldorff statistic. Providers with an unusually high number of opioid beneficiaries and opioid claims include specialties such as physician’s assistant, nurse practitioner, and family practice. Conclusions Our analysis of the Medicare claims data provides characteristics of the counties and provider specialties that have higher odds of being anomalous. The empirical analysis identifies highly refined spatial hot spots that are likely to encounter prescription opioid misuse and overdose. The methodology is generic and can be applied to monitor providers and their prescription behaviors in regions that are at a high risk of abuse.
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Affiliation(s)
- Arinjoy Basak
- Biocomplexity Institute of Virginia Tech, Blacksburg, VA, United States
| | - Jose Cadena
- Lawrence Livermore National Laboratory, Livermore, CA, United States
| | - Achla Marathe
- Network Systems Science and Advanced Computing Division, Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, United States.,Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Anil Vullikanti
- Network Systems Science and Advanced Computing Division, Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, United States.,Department of Computer Science, University of Virginia, Charlottesville, VA, United States
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21
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Affiliation(s)
- Héctor Miguel Ramos-Zaldívar
- GIMUNICAH, Faculty of Medicine, Universidad Catolica de Honduras, San Pedro Sula, Honduras .,Doctoral Program in Medical Sciences, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago de Chile, Chile
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22
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Fine S, Mikhailitchenko A, Crowley EL, Gooderham MJ. Canadian Research Contributions per Medical Specialty in 2 High-Impact Journals. J Cutan Med Surg 2019; 23:231-233. [PMID: 30841728 DOI: 10.1177/1203475418803075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Shamone Fine
- 1 SKiN Centre for Dermatology, Peterborough, ON, Canada.,2 Trent University, Peterborough, ON, Canada
| | - Amy Mikhailitchenko
- 1 SKiN Centre for Dermatology, Peterborough, ON, Canada.,2 Trent University, Peterborough, ON, Canada
| | - Erika L Crowley
- 1 SKiN Centre for Dermatology, Peterborough, ON, Canada.,2 Trent University, Peterborough, ON, Canada
| | - Melinda J Gooderham
- 1 SKiN Centre for Dermatology, Peterborough, ON, Canada.,3 Queen's University, Kingston, ON, Canada.,4 Probity Medical Research, Waterloo, ON, Canada
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23
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Jadidfard MP, Yazdani S. Commentary: Necessity of Blending Dental Education Into the Mainstream of Medical Education as a Specialty Area: Advocating for a Reform Idea Aiming to Promote the Health System Performance in Iran. Eval Health Prof 2018; 43:193-196. [PMID: 30336684 DOI: 10.1177/0163278718807273] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
With the knowledge we have today about the concept of health and its complexities and determinants, the separation between medical and dental education (DE) does not seem reasonable anymore. Dentistry has mainly developed based on a mechanical approach to treat the related problems. This makes the efforts for reorientation of dental care (DC) toward a preventive approach, relying upon dentists as the chief oral health (OH)-related workforce, inefficient. This is while effective strategies have been identified for prevention, as the key to simultaneously control the burden and costs of the ubiquitous oral diseases, at both individual and population levels without dentists. We think that approaching OH as an integral part of the general well-being requires fundamental changes in the structure of OH system including a substantial revision in the current situation of dentistry as an autonomous health profession with a separate education from the main body of the medicine. In this short article, we briefly discuss the necessity of blending DE into the mainstream of medical education and actual consideration of dentistry as a medical specialty area. After discussing the subject at two levels (health-care system and national levels), the next sections draw attention to some complementary issues.
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Affiliation(s)
- Mohammad-Pooyan Jadidfard
- Department of Community Oral Health, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahram Yazdani
- School of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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24
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Mullola S, Hakulinen C, de Porras DGR, Presseau J, Jokela M, Vänskä J, Paunio T, Elovainio M. Medical specialty choice and well-being at work: Physician's personality as a moderator. Arch Environ Occup Health 2018; 74:115-129. [PMID: 29522380 PMCID: PMC8855160 DOI: 10.1080/19338244.2018.1448355] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 03/01/2018] [Indexed: 06/12/2023]
Abstract
We examined whether physicians' personality traits moderate the association between medical specialty and well-being at work. Nationally representative sample of Finnish physicians (n = 2,815; 65% women; aged 25-72 years in 2015) was used. Personality was assessed with the shortened Big Five Inventory. Indicators of well-being at work were measured with scales from Work Ability Index, General Health Questionnaire, Jenkins' Sleep Problems Scale and Suicidal Ideation. Higher extraversion, openness to experience and agreeableness showed as personality traits beneficial for higher well-being at work among person-oriented specialties whereas higher conscientiousness but lower openness and agreeableness showed as personality traits beneficial for higher well-being at work among technique-oriented specialties. The role of neuroticism remains minor in general. Physicians' personality traits may moderate the association between medical specialty and well-being at work.
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Affiliation(s)
- Sari Mullola
- Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
- Columbia University Teachers College, New York, NY, USA
| | - Christian Hakulinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - David Gimeno Ruiz de Porras
- Southwest Center for Occupational and Environmental Health (SWCOEH), Department of Epidemiology, Human Genetics and Environmental Science, School of Public Health, The University of Texas Health Science Center at Houston, San Antonio, TX, USA
- Center for Research in Occupational Health (CISAL), Universitat Pompeu Fabra, Barcelona, Spain
- Centro de Investigación Biomódica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health, and Preventive Medicine, Ottawa, Canada
| | - Markus Jokela
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Tiina Paunio
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Finland
- Institute for Health and Welfare, Helsinki, Finland
| | - Marko Elovainio
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Institute for Health and Welfare, Helsinki, Finland
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25
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Able SL, Robinson RL, Kroenke K, Mease P, Williams DA, Chen Y, Wohlreich M, McCarberg BH. Variations in the management of fibromyalgia by physician specialty: rheumatology versus primary care. Pragmat Obs Res 2016; 7:11-20. [PMID: 27799842 PMCID: PMC5085275 DOI: 10.2147/por.s79441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the effect of physician specialty regarding diagnosis and treatment of fibromyalgia (FM) and assess the clinical status of patients initiating new treatment for FM using data from Real-World Examination of Fibromyalgia: Longitudinal Evaluation of Costs and Treatments. Patients and methods Outpatients from 58 sites in the United States were enrolled. Data were collected via in-office surveys and telephone interviews. Pairwise comparisons by specialty were made using chi-square, Fisher’s exact tests, and Student’s t-tests. Results Physician specialist cohorts included rheumatologists (n=54), primary care physicians (n=25), and a heterogeneous group of physicians practicing pain or physical medicine, psychiatry, neurology, obstetrics and gynecology, osteopathy, or an unspecified specialty (n=12). The rheumatologists expressed higher confidence diagnosing FM (4.5 on a five-point scale) than primary care physicians (4.1) (P=0.037). All cohorts strongly agreed that recognizing FM is their responsibility. They agreed that psychological aspects of FM are important, but disagreed that symptoms are psychosomatic. All physician cohorts agreed with a multidisciplinary approach including nonpharmacological and pharmacological treatments, although physicians were more confident prescribing medications than alternative therapies. Most patients reported moderate to severe pain, multiple comorbidities, and treatment with several medications and nonpharmacologic therapies. Conclusion Physician practice characteristics, physician attitudes, and FM patient profiles were broadly similar across specialties. The small but significant differences reported by physicians and patients across physician cohorts suggest that despite published guidelines, treatment of FM still contains important variance across specialties.
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Affiliation(s)
- Stephen L Able
- US Health Outcomes and Technology Assessment, Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA
| | - Rebecca L Robinson
- Lilly Research Labs, Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA
| | - Kurt Kroenke
- Department of Medicine, Indiana University; VA Health Services Research and Development Center for Health Information and Communication, Regenstrief Institute, Indianapolis, IN, USA
| | - Philip Mease
- Rheumatology Associates, Division of Rheumatology Clinical Research, Swedish Medical Center; University of Washington School of Medicine, Seattle, WA, USA
| | - David A Williams
- Chronic Pain and Fatigue Research Center, Michigan Institute for Clinical and Health Research, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Yi Chen
- inVentiv Health Clinical, Indianapolis, IN, USA
| | - Madelaine Wohlreich
- USMD Neuroscience, Lilly USA LLC, Eli Lilly and Company, Indianapolis, IN, USA
| | - Bill H McCarberg
- Department of Family Medicine, University of California at San Diego School of Medicine, San Diego, CA, USA
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26
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Anger JT, Cameron AP, Madison R, Saigal C, Clemens JQ. Outcomes of Sacral Neuromodulation in a Privately Insured Population. Neuromodulation 2016; 19:780-784. [PMID: 27491519 DOI: 10.1111/ner.12472] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 05/02/2016] [Accepted: 06/01/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE In this study, we analyzed claims data from the Ingenix data base to analyze outcomes of sacral neuromodulation with respect to both provider and patient factors. MATERIALS AND METHODS We used the Ingenix (I3) data base to determine demographic, diagnosis, and procedure success information for years 2002-2007 for privately insured patients. Demographic information was obtained, as were the diagnoses given and procedures performed, based on ICD-9 diagnosis codes and Current Procedural Terminology procedure codes. Multivariate analysis was performed to identify specific predictors of success, as measured by progression to implantation of a pulse generator. RESULTS Overall success, as defined by battery placement, was 49.1%. Fifty-one percent of staged procedures were followed by battery placement compared with 24.1% of percutaneous cases (p < 0.0001). Among the patient variables analyzed, women were more likely than men to progress to battery placement. After Stage I testing, patients treated by urologists were overall more likely than gynecologists to proceed to battery placement (I3: 54% vs. 47%, p < 0.0001). Unlike previous findings in other claims-based data sets, we did not observe a provider-volume relationship in the i3 data set. CONCLUSIONS Success of sacral neuromodulation, as defined by proceeding to battery placement, was much better after formal staged procedures, which leads us to question the utility of percutaneous techniques. Outcomes were also better among female patients and among those treated by a urologist. Specialty differences will likely diminish over time as more gynecologists adopt sacral neuromodulation.
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Affiliation(s)
- Jennifer T Anger
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Anne P Cameron
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
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Abstract
OBJECTIVE The objectives of this study were to determine (1) adherence to the immunization schedule for the human papillomavirus quadrivalent vaccine and (2) factors associated with completion of the 3-dose series. METHODS This was a retrospective review of health information records from an academic medical center. The sample included all 9- to 26-year-old female patients who initiated vaccination within 2 years after quadrivalent vaccine availability. Multivariable logistic regression models were estimated to determine associations with completion of the 3-dose series within 7 and 12 months. RESULTS Among the 3297 female patients who initiated vaccination with human papillomavirus quadrivalent vaccine, 67% self-identified as black and 29% self-identified as white. Fewer than 3% of vaccine doses were received earlier than recommended, but >50% of doses were received late. Completion rates were 14% by 7 months and 28% by 12 months. Independent predictors of completion by 7 months included white versus black race (odds ratio [OR]: 2.04 [95% confidence interval (CI): 1.64-2.56]; P < .001), use of contraception that required intramuscular injections every 3 months (OR: 1.53 [95% CI: 1.12-1.95]; P < .001), and private versus public insurance (OR: 1.31 [95% CI: 1.06-1.63]; P < .05). Age and clinic type were not independent predictors of completion. CONCLUSIONS Adherence to recommended intervals and completion of the vaccine series were low. Lower rates of completion in black patients compared with white patients raises concern that disparities in vaccine completion could exacerbate existing disparities in cervical cancer.
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Affiliation(s)
- Lea E. Widdice
- Cincinnati Children's Research Foundation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - David I. Bernstein
- Cincinnati Children's Research Foundation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - Anthony C. Leonard
- Department of Public Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Keith A. Marsolo
- Cincinnati Children's Research Foundation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - Jessica A. Kahn
- Cincinnati Children's Research Foundation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
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Soethout MBM, Ten Cate TJ, van der Wal G. Factors Associated with the Nature, Timing and Stability of the Specialty Career Choices of Recently Graduated Doctors in European Countries, a Literature Review. Med Educ Online 2004; 9:4360. [PMID: 28253127 DOI: 10.3402/meo.v9i.4360] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The aim of this study was to identify factors that are associated with the choice of a spe-cialty, the moment of the definitive choice, and the stability of the choice over time. The focus was on recently graduated doctors in European countries. A review of the literature from October 1994 to October 2004 was conducted. Most of the identified studies were of good quality. Enthusiasm, self-appraisal of skills, human interest and domestic circumstances were the main factors associated with the choice for medical specialization. Female doctors paid a great deal of attention to reasonable working hours and part-time jobs. They were also less certain about their career choice, and made this choice later than men. Most doctors with a preference for general practice at the time of qualification as a medical doctor achieved their aim. Women, who preferred a clinical specialization, had less opportunity than men to achieve their career satisfactorily.
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Affiliation(s)
- M B M Soethout
- a VU University Medical Center Amsterdam The Netherlands
| | | | - G van der Wal
- c VU University Medical Center Amsterdam The Netherlands
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29
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Abstract
To determine practicing physicians' strategies for diagnosing and managing uncomplicated urinary tract infection, we surveyed physicians in general internal medicine, family practice, obstetrics and gynecology, and emergency medicine in four states. Responses differed significantly by respondents' specialty. For example, nitrofurantoin was the antibiotic of first choice for 46% of obstetricians, while over 80% in the other specialties chose trimethoprim-sulfamethoxazole. Most surveyed said they do not usually order urine culture, but the percentage who do varied by specialty. Most use a colony count of 10(5) colony-forming units or more for diagnosis although evidence favors a lower threshold, and 70% continue antibiotic therapy even if the culture result is negative. This survey found considerable variation by specialty and also among individual physicians regarding diagnosis and treatment of urinary tract infection and also suggests that some of the new information from the literature has not been translated to clinical practice.
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Affiliation(s)
- R S Wigton
- Department of Internal Medicine, University of Nebraska Medical Center College of Medicine, Omaha, USA
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