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The Sino-German coproduction Mouzhong leisi yu wode didong: xinshi pianduan explores the medical process of a heart transplant and its aftermath through the Foucauldian theoretical framework of the "clinical gaze." The doctors' "biomedical reductionism" is caricatured for its lack of humanness; patients' physical and emotional agony denies the possibility of peaceful coexistence of the human self and technology. Cynical irony is one way of coping with the identity loss, pain, and techno-human condition of organ-transplant survivors. [ABSTRACT FROM AUTHOR]

Artificial intelligence and machine learning technologies have a variety of applications throughout the provision of health care, such as clinical documentation, diagnostic image processing, and clinical decision support. This position paper describes the American College of Physicians' (ACP) foundational positions and recommendations regarding the use of these technologies in the provision of health care. The foundation of these positions are principles in the ACP Ethics Manual. Internal medicine physicians are increasingly interacting with systems that implement artificial intelligence (AI) and machine learning (ML) technologies. Some physicians and health care systems are even developing their own AI models, both within and outside of electronic health record (EHR) systems. These technologies have various applications throughout the provision of health care, such as clinical documentation, diagnostic image processing, and clinical decision support. With the growing availability of vast amounts of patient data and unprecedented levels of clinician burnout, the proliferation of these technologies is cautiously welcomed by some physicians. Others think it presents challenges to the patient–physician relationship and the professional integrity of physicians. These dispositions are understandable, given the "black box" nature of some AI models, for which specifications and development methods can be closely guarded or proprietary, along with the relative lagging or absence of appropriate regulatory scrutiny and validation. This American College of Physicians (ACP) position paper describes the College's foundational positions and recommendations regarding the use of AI- and ML-enabled tools and systems in the provision of health care. Many of the College's positions and recommendations, such as those related to patient-centeredness, privacy, and transparency, are founded on principles in the ACP Ethics Manual. They are also derived from considerations for the clinical safety and effectiveness of the tools as well as their potential consequences regarding health disparities. The College calls for more research on the clinical and ethical implications of these technologies and their effects on patient health and well-being. [ABSTRACT FROM AUTHOR]

Access to safe and stable housing has both a direct and indirect effect on health. Homeless persons experience unique health challenges and require a health care system and professionals designed to meet their distinct needs. In this position paper, the American College of Physicians (ACP) recognizes the need to address universal access to housing to fulfil one's right to health. ACP offers several recommendations to prevent homelessness and promote the necessary health care and social needs of homeless populations. Access to safe and stable housing has both a direct and indirect effect on health. Experiencing homelessness and housing instability can induce stress and trauma, worsening behavioral health and substance use. The absence of safe and stable living conditions can make it challenging to rest, recuperate, and recover from health ailments and can pose barriers to treatment adherence. Homelessness and housing instability is associated with high rates of numerous diseases and chronic conditions. Its cyclical relationship with other social drivers of health can exacerbate health disparities. As a result, unhoused persons experience unique health challenges and require a health care system and professionals designed to meet their distinct needs. Physicians and other health professionals have a role in educating themselves about the needs of unhoused patients as well as making themselves aware of community and government resources available to these populations. Policymakers must support health professionals in these efforts by supporting the data infrastructure needed to facilitate these referrals to resources, supporting research into best practices for caring for these populations, and investing in community-based organization capacity. Policy action is needed to address the underlying drivers of homelessness, including a dearth of affordable housing, while also addressing the short-term need for safe shelter now. In this position paper, the American College of Physicians (ACP) recognizes the need to address universal access to housing to fulfill one's right to health. ACP offers several recommendations to prevent homelessness and promote the necessary health care and social needs of unhoused populations. [ABSTRACT FROM AUTHOR]

Team-based care models such as the Patient-Centered Medical Home are associated with improved patient health outcomes, better team coordination and collaboration, and increased well-being among health care professionals. Yet, hindrances to wider adoption remain. In this paper, the American College of Physicians reaffirms the importance of the physician-led health care team and offers policy recommendations on professionalism, payment models, training, licensure, and research to support the expansion of dynamic clinical care teams. Team-based care models such as the Patient-Centered Medical Home are associated with improved patient health outcomes, better team coordination and collaboration, and increased well-being among health care professionals. Despite these attributes, hindrances to wider adoption remain. In addition, some health care professionals have sought to practice independent of the physician-led health care team, potentially undermining patient access to physicians who have the skills and training to deliver whole-person, comprehensive, and longitudinal care. In this paper, the American College of Physicians reaffirms the importance of the physician-led health care team and offers policy recommendations on professionalism, payment models, training, licensure, and research to support the expansion of dynamic clinical care teams. [ABSTRACT FROM AUTHOR]

This position paper outlines and expands on the views of the American College of Physicians in recognizing health as a human right. It discusses the role of physicians, institutions, governments, and a just society regarding health as a human right and the relationship among health, the opportunity for health, and social determinants of health. The relationship of health to rights or human rights is complex. Although many find no right of any kind to health or health care, and others view health care as a right or human right, the American College of Physicians (ACP) instead sees health as a human right. The College, in the ACP Ethics Manual, has long noted the interrelated nature of health and human rights. Health as a human right also has implications for the social and structural determinants of health, including health care. Any rights framework is imperfect, and rights, human rights, and ethical obligations are not synonymous. Individual physicians and the profession have ethical obligations to patients, and these obligations can go beyond matters of rights. Society, too, has responsibilities—the equitable and universal access to appropriate health care is an ethical obligation of a just society. By recognizing health as a human right based in the intrinsic dignity and equality of all patients and supporting the patient–physician relationship and health systems that promote equitable access to appropriate health care, the United States can move closer to respecting, protecting, and fulfilling for all the opportunity for health. [ABSTRACT FROM AUTHOR]

This position paper provides guidance for how physicians should approach fundraising with grateful patients. The paper covers ethical issues and outlines practical management strategies that ensure the patient–provider relationship is respected and preserved at all times. Physician solicitation of charitable contributions from patients—also known among other things as grateful patient fundraising—raises significant ethical concerns. These include pressure on patients to donate and the effects of this on the patient–physician relationship, potential expectations of donor patients for treatment that is not indicated or preferential care, justice and fairness issues, disclosure and use of confidential patient information for nontreatment purposes, and conflicts of interest. The patient–physician relationship and knowledge of the patient's medical history, clinical status, personal information, and financial circumstances are some of the reasons development and administrative officials might see physicians as strong potential fundraisers. But those are among the reasons grateful patient fundraising is ethically problematic. This American College of Physicians position paper explores these issues and offers guidance. [ABSTRACT FROM AUTHOR]

This ACP position paper addresses current controversies about the determination of death and encourages physicians to advocate for policies and practices on the determination of death that are consistent with the profession's fundamental and timeless commitment to individual patients and the public. The determination of a patient's death is of considerable medical and ethical significance. Death is a biological concept with social implications. Acting with honesty, transparency, respect, and integrity is critical to trust in the patient–physician relationship, and the profession, in life and in death. Over time, cases about the determination of death have raised questions that need to be addressed. This American College of Physicians position paper addresses current controversies and supports a clarification to the Uniform Determination of Death Act; maintaining the 2 current independent standards of determining death, cardiorespiratory and neurologic; retaining the whole brain death standard; aligning medical testing with the standards; keeping issues about the determination of death separate from organ transplantation; reaffirming the importance and role of the dead donor rule; and engaging in educational efforts for health professionals, patients, and the public on these issues. Physicians should advocate for policies and practices on the determination of death that are consistent with the profession's fundamental and timeless commitment to individual patients and the public. [ABSTRACT FROM AUTHOR]

The onset of the COVID-19 pandemic revealed significant gaps in the United States' pandemic and public health emergency response system. In this position paper, the American College of Physicians (ACP) offers several policy recommendations for enhancing federal, state, and local preparedness for future pandemics and public health emergencies. The onset of the COVID-19 pandemic revealed significant gaps in the United States' pandemic and public health emergency response system. At the federal level, government responses were undercut by a lack of centralized coordination, inadequately defined responsibilities, and an under-resourced national stockpile. Contradictory and unclear guidance throughout the early months of the pandemic, along with inconsistent funding to public health agencies, also created notable variance in state and local responses. The lack of a coordinated response added pressure to an already overwhelmed health care system, which was forced to resort to rationing care and personal protective equipment, creating moral distress and trauma for health care workers and their patients. Despite these severe shortcomings, the COVID-19 pandemic also highlighted successful policies and approaches, such as Operation Warp Speed, which led to the fastest development and distribution of a vaccine in history. In this position paper, the American College of Physicians (ACP) offers several policy recommendations for enhancing federal, state, and local preparedness for future pandemic and public health emergencies. This policy paper builds on various statements produced by ACP throughout the COVID-19 pandemic, including on the ethical distribution of vaccinations and resources, conditions to resume economic and social activity, and efforts to protect the health and well-being of medical professionals, among others. [ABSTRACT FROM AUTHOR]

The United States' public health sector plays a crucial role in preventing illness and promoting health. However, public health is underfunded and underappreciated, forcing the field to do more with fewer resources. In this position paper, the American College of Physicians updates its 2012 policy recommendations on strengthening the nation's public health infrastructure. The United States' public health sector plays a crucial role in preventing illness and promoting health. Public health drove massive gains in life expectancy during the 20th century by supporting vaccination campaigns, promoting motor vehicle safety, and preventing and treating tobacco use. However, public health is underfunded and underappreciated, forcing the field to do more with fewer resources. In this position paper, the American College of Physicians (ACP) updates its 2012 policy recommendations on strengthening the nation's public health infrastructure. ACP calls for effective coordination of public health activities, robust and stable year-to-year funding of public health services, a renewed and well-supported public health workforce, action to address health-related dis- and misinformation, modernized public health data systems, and greater coordination between public health and medical sectors. [ABSTRACT FROM AUTHOR]

Electronic patient‐reported outcome (ePRO) programs may offer advantages for patients with cancer, clinicians, health care systems, payors, and society in general; but developing and maintaining an ePRO program will require cancer centers to navigate defining meaningful problems, collecting ePROs, implementing action when those ePROs require intervention without over‐burdening clinicians, and monitoring the successes and failures of their ePRO programs. Physician informaticists from the National Comprehensive Cancer Network Electronic Health Record Advisory Group offer 10 guiding principles to consider when contemplating, building, or refining an ePRO program for patients with cancer. [ABSTRACT FROM AUTHOR]

Clinical care delivered via telemedicine has become an accepted mode of health care delivery for many patients. There is an urgent need to understand quality of care in the telemedicine environment. This position paper presents 6 recommendations to ensure appropriate use of performance measures to evaluate the quality of clinical care that incorporates telemedicine. There has been an exponential growth in the use of telemedicine services to provide clinical care, accelerated by the COVID-19 pandemic. Clinical care delivered via telemedicine has become a major and accepted method of health care delivery for many patients. There is an urgent need to understand quality of care in the telemedicine environment. This American College of Physicians position paper presents 6 recommendations to ensure the appropriate use of performance measures to evaluate quality of clinical care provided in the telemedicine environment. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the early compression effects of adjustable pressure auricular clips, made of paper clips, during auricular surgery. Methods: 24 patients who underwent auricular surgery between August 2021 and April 2022 were selected as the study participants. Doctors used ear clips made of paper clips to prevent postoperative complications in these patients. Results: In all 24 patients, the wounds healed by stage I. Except for one case of minor local hematoma, all wounds healed well with no postoperative complications, such as subcutaneous hematoma formation, ulceration, or infected skin necrosis. Moreover, doctors were able to operate in lesser time and more conveniently with the help of the paper-clip devices. Conclusions: This study proposes, for the first time, the use of paper clips to make ear clips with adjustable pressure. This simple device is easy to manufacture, inexpensive to the user, reliable in performance, and remarkable in its clinical effects. As such, the present study provides substantial evidence to suggest that this device should be widely applied in the clinical setting. [ABSTRACT FROM AUTHOR]

Public health emergencies create challenges for the accommodation of visitors to hospitals and other care facilities. To mitigate the spread of COVID-19 early in the pandemic, health care institutions implemented severe visitor restrictions, many remaining in place more than 2 years, producing serious unintended harms. Visitor restrictions have been associated with social isolation and loneliness, worse physical and mental health outcomes, impaired or delayed decision-making, and dying alone. Patients with disabilities, communication challenges, and cognitive or psychiatric impairments are particularly vulnerable without caregiver presence. This paper critically examines the justifications for, and harms imposed by, visitor restrictions during the COVID-19 pandemic and offers ethical guidance on family caregiving, support, and visitation during public health emergencies. Visitation policies must be guided by ethical principles; incorporate the best available scientific evidence; recognize the invaluable roles of caregivers and loved ones; and involve relevant stakeholders, including physicians, who have an ethical duty to advocate for patients and families during public health crises. Visitor policies should be promptly revised as new evidence emerges regarding benefits and risks in order to prevent avoidable harms. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. In 2011, the Canadian Academy of Sport and Exercise Medicine released their first position paper on Abuse, Harassment, and Bullying in Sport. Since this time, there have been significant advancements within the global sport landscape, including the emergence of regulatory bodies and initiatives aimed at prioritizing athletes' health and well-being. While the shift to a more proactive approach for safeguarding athletes is evident and promising, athletes continue to be affected by cases of maltreatment. To advance safe sport, it is critical that all supporters of safe and healthy performance are aware of their roles and responsibilities for preventing and addressing maltreatment, including the Canadian sport medicine community. In this updated position statement, recent advancements in research on issues of maltreatment are summarized and specific recommendations are provided on how the medical community can contribute to appropriately identifying, treating, and preventing harm in sport, as well as their role in advocating for the health and well-being of athletes in their care. [ABSTRACT FROM AUTHOR]

In its position paper, the American College of Physicians (ACP) provided recommendations for strengthening U.S. public health infrastructure. The editorialists reflect on the ACP recommendations through the lens of the Centers for Disease Control and Prevention, specifically highlighting budget, workforce, and data issues. [ABSTRACT FROM AUTHOR]

The American College of Physicians (ACP) has a long-standing commitment to improving the health of all Americans and opposes any form of discrimination in the delivery of health care services. ACP is committed to working toward fully understanding and supporting the unique needs of the incarcerated population and eliminating health disparities for these persons. In this position paper, ACP offers recommendations to policymakers and administrators to improve the health and well-being of persons incarcerated in adult correctional facilities. [ABSTRACT FROM AUTHOR]

• EFIM publishes a position paper about Environment Degradation and Climate Change. • Health industry should reduce its ecological footprint. • Internists should be involved in policy decisions related to climate change. • Internists must be active agents in advocating sustainable practices for the environment. • Internists should be role models in the adoption of environmentally friendly behavior. The current data on climate change and environmental degradation are dramatic. The consequences of these changes are already having a significant impact on people's health. Physicians — as advocates of the patients, but also as citizens — have an ethical obligation to be involved in efforts to stop these changes. The European Federation of Internal Medicine (EFIM) strongly encourages the Internal Medicine societies and internists across Europe to play an active role in matters related to climate change and environmental degradation. At a national level, this includes advocating the adoption of measures that reduce greenhouse gas (GHG) emissions and environmental degradation and contributing to policy decisions related to these issues. At a hospital level and in clinical practice, supporting actions by the health sector to reduce its ecological footprint is vital. At the level of EFIM and its associated internal societies, promoting educational activities and developing a toolkit to prepare internists to better care for citizens who suffer from the consequences of climate change. In addition to advocating and implementing effective actions to reduce the ecological footprint of the health industry, recommending the introduction of these themes in scientific programs of Internal Medicine meetings and congresses and the pre- and postgraduate medical training. At a personal level, internists must be active agents in advocating sustainable practices for the environment, increasing the awareness of the community about the health risks of climate change and environmental degradation, and being role models in the adoption of environmentally friendly behaviour. [ABSTRACT FROM AUTHOR]

In recent years, it has been proposed that unrealistic requirements for academics and medical doctors to publish in scientific journals, combined with monetary publication rewards, have led to forms of contract cheating offered by organizations known as paper mills. Paper mills are alleged to offer products ranging from research data through to ghostwritten fraudulent or fabricated manuscripts and submission services. While paper mill operations remain poorly understood, it seems likely that paper mills need to balance product quantity and quality, such that they produce or contribute to large numbers of manuscripts that will be accepted for publication. Producing manuscripts at scale may be facilitated by the use of manuscript templates, which could give rise to shared features such as textual and organizational similarities, the description of highly generic study hypotheses and experimental approaches, digital images that show evidence of manipulation and/or reuse, and/or errors affecting verifiable experimental reagents. Based on these features, we propose practical steps that editors, journal staff, and peer reviewers can take to recognize and respond to research manuscripts and publications that may have been produced with undeclared assistance from paper mills. [ABSTRACT FROM AUTHOR]

The article presents a perspective on the controversial role of ChatGPT in medical writing, particularly emphasizing that human involvement is crucial in sections requiring a personal touch, like the Opinion or Discussion sections of articles. Topics include the potential drawbacks of relying on AI for non-native English speakers, the importance of developing writing skills through personal effort, and the appropriate use of ChatGPT as a tool for polishing already drafted manuscripts.

Background: Basic palliative care teaching should be included in training curricula for health care providers (HCPs) at all levels of the health service to ensure that the goal set by the South African (SA) National Policy Framework and Strategy for Palliative Care, to have an adequate number of appropriately trained HCPs in South Africa, is achieved. Furthermore, palliative learning objectives for nurses and doctors should be standardised. Many SA medical schools have integrated elements of Palliative Medicine (PM) teaching into undergraduate medical training programmes for doctors; however, the degree of integration varies widely, and consensus and standardisation of the content, structure and delivery of such PM training programmes are not yet a reality. Aim: This joint position paper aims to describe the current state of undergraduate medical PM teaching in South Africa and define the PM competencies required for an SA generalist doctor. Setting: Palliative Medicine programme leads and teachers from eight medical schools in South Africa. Methods: A survey exploring the structure, organisation and content of the respective medical undergraduate PM programmes was distributed to PM programme leads and teachers. Results: Responses were received from seven medical schools. Through a process of iterative review, competencies were defined and further grouped according to suitability for the preclinical and clinical components of the curriculum. Conclusion: Through mapping out these competencies in a spiralled medical curriculum, the authors hope to provide guidance to medical curriculum designers to effectively integrate PM teaching and learning into current curricula in line with the goals of the SA National Policy Framework and Strategy on Palliative Care (NPFSPC). [ABSTRACT FROM AUTHOR]

Background: Many physicians in Turkey are both clinicians and researchers, and publishing their research contributes to better patient care as well as to career advancement. Objective: To identify the barriers faced by Turkish physicians to writing research papers and getting them published. Methods: Respondents were asked, through eight multiple-choice questions, about the difficulties they faced in writing research papers and in getting them published in journals. We also searched published literature for accounts of similar difficulties and answers to the question 'What is your purpose in writing scientific publications?' Results: A total of 18% (155 of 871) of physicians completed the questionnaire. About the difficulties faced in writing, 82 out of the 155 participants, or 57%, reported problems in finding financial support; 58 (40%), in obtaining required permissions and clearances; 65 (45%), in acquiring relevant skills, especially those related to data analysis or statistics; and 42 (29%), in languagerelated skills. About the difficulties in getting their papers published in journals, 85 (60%) said that they tried to overcome the difficulties by searching for appropriate solutions on the internet; 66 (47%) sought help from experienced colleagues; and 47 (33%) needed professional help in English translation and editing. Need for financial support was reported by a significantly (p = 0.04) larger proportion of associate professors or full professors (69%) than that of residents (47%) and fellows (45%). Conclusion: The main problems that Turkish physicians face in preparing scientific manuscripts were lack of financial support, inadequate knowledge of data analysis and statistics, and the paperwork involved in obtaining required approvals and permissions--problems that were common to the departments of internal medicine and of surgery. The primary motivation for writing and publishing was career advancement, especially through promotion to a higher academic rank. [ABSTRACT FROM AUTHOR]

Suicide is a major global public health issue, and in recent years, there has been increasing recognition of the problem of physician suicide. This American College of Physicians policy paper examines, from the perspective of ethics, the issues that arise when individuals and institutions respond to physician suicides and when they engage in broader efforts aimed at physician suicide prevention. Emphasizing the medical profession as a unique moral community characterized by ethical and professional commitments of service to patients, each other, and society, this paper offers guidance regarding physician suicide and the role of a healing community. The response to an individual physician suicide should be characterized by respect and concern for those who are grieving, the creation of a supportive environment for suicide loss survivors, and careful communication about the event. Because suicide is a complex problem, actions aimed at preventing suicide must occur at the individual, interpersonal, community, and societal levels. The medical community has an obligation to foster a culture that supports education, screening, and access to mental health treatment, beginning at the earliest stages of medical training. [ABSTRACT FROM AUTHOR]

This paper investigates the role of admission forms in the regulation of asylum confinement in the second half of the nineteenth century. Taking the Toronto Lunatic Asylum as a case study it traces the evolution of the forms' content and structure during the first decades of this institution. Admission forms provide important material for understanding the medico-legal assessment of lunacy in a certain jurisdiction. First, they show how the description of insanity depended on a plurality of actors. Second, doctors were not necessarily required to indicate symptoms of derangement. Third, patients' relatives played a fundamental role in providing clinical information. From an historiographical perspective, this paper invites scholars to consider the function of standardized documents in shaping the written identity of patients. [ABSTRACT FROM AUTHOR]

The number of Americans aged 65 years or older is expected to increase in the coming decades. Because the risk for disability increases with age, more persons will need long-term services and supports (LTSS) to help with bathing, eating, dressing, and other everyday tasks. Long-term services and supports are delivered in nursing homes, assisted living facilities, the person's home, and other settings. However, the LTSS sector faces several challenges, including keeping patients and staff safe during the COVID-19 pandemic, workforce shortages, quality problems, and fragmented coverage options. In this position paper, the American College of Physicians offers policy recommendations on LTSS coverage, financing, workforce, safety and quality, and emergency preparedness and calls on policymakers and other stakeholders to reform and improve the LTSS sector so that care is high quality, accessible, equitable, and affordable. [ABSTRACT FROM AUTHOR]

Intensive Care Units (ICU) are units where vital support with advanced technology is given to critically ill patients and multidisciplinary approaches are frequently applied. As we all see during the pandemic, the ICU beds are limited in number; therefore, appropriate use of ICU beds is very important to give the necessary treatment to patients on time while allocating the resources rationally and efficiently. Practices to be implemented for this purpose may cause conflicts between the patients, relatives of the patients, the society and the healthcare team. It is crucial to prevent these conflicts and to ensure that they are resolved properly when they arise. This policy paper prepared by Turkish Society of Clinical Microbiology and Infection (Klimik), Turkish Society of Intensive Care and Turkish Bioethics Association brings suggestions to physicians and healthcare administrators regarding the rational use of intensive care units. We presume that it will be effective as supported by the professional organizations and medical associations operating in our country. [ABSTRACT FROM AUTHOR]

Due to the exponential growth of the number of subjects affected by coronavirus disease 2019 (COVID-19), the entire Italian health care system had to respond promptly and in a very short time with the need of semi-intensive and intensive care units. Moreover, trained dedicated COVID-19 teams consisting of physicians were coming from different specialties (intensivists or pneumologists and infectiologists), while respiratory therapists and nurses have been recruited to work on and on without rest. However, due to still limited and evolving knowledge of COVID-19, there are few recommendations concerning the need in respiratory rehabilitation and physiotherapy interventions. The presentation of this paper is the result of a consensus promoted by the Italian societies of respiratory health care professionals who contacted pulmonologists directly involved in the treatment and rehabilitation of COVID-19. The aim was to formulate the more proper and common suggestions to be applied in different hospital settings in offering rehabilitative programs and physiotherapy workforce planning for COVID-19 patients. Two main areas of intervention were identified: organization and treatment, which are described in this paper to face the emergency. [ABSTRACT FROM AUTHOR]

Executive Summary: With an increasing variety of radiopharmaceuticals for diagnostic or therapeutic nuclear medicine as valuable diagnostic or treatment option, radiobiology plays an important role in supporting optimizations. This comprises particularly safety and efficacy of radionuclide therapies, specifically tailored to each patient. As absorbed dose rates and absorbed dose distributions in space and time are very different between external irradiation and systemic radionuclide exposure, distinct radiation-induced biological responses are expected in nuclear medicine, which need to be explored. This calls for a dedicated nuclear medicine radiobiology. Radiobiology findings and absorbed dose measurements will enable an improved estimation and prediction of efficacy and adverse effects. Moreover, a better understanding on the fundamental biological mechanisms underlying tumor and normal tissue responses will help to identify predictive and prognostic biomarkers as well as biomarkers for treatment follow-up. In addition, radiobiology can form the basis for the development of radiosensitizing strategies and radioprotectant agents. Thus, EANM believes that, beyond in vitro and preclinical evaluations, radiobiology will bring important added value to clinical studies and to clinical teams. Therefore, EANM strongly supports active collaboration between radiochemists, radiopharmacists, radiobiologists, medical physicists, and physicians to foster research toward precision nuclear medicine. [ABSTRACT FROM AUTHOR]

Data were extracted and analysed, including patient demographics, lesion characteristics, pre-IVL and post-IVL diameter stenosis, complications, and stent rates. INTRAVASCULAR LITHOTRIPSY FOR THE TREATMENT OF LOWER LIMB PERIPHERAL ARTERY DISEASE: EVALUATI... LP Chan, CP Wong, Danise M Au, CHW Chan and YC Chan The University of Hong Kong, Hong Kong SAR B Aim: b Intravascular lithotripsy (IVL) is a contemporary endovascular technology used to tackle calcified atherosclerotic plaques in peripheral artery disease (PAD). B Results: b Forty-six patients requiring secondary chest wall closure were identified and 39 patients had undergone chest wall resection +/- reconstruction in the study period. B Results: b Total 24 patients were included, with 14 patients in synchronous resection group and 10 patients in the sequential resection group. [Extracted from the article]

For many, Covid-19 is a short-term, mildly debilitating disease. But some people are still struggling with monthly symptoms with persistent inflammation, chronic pain and shortness of breath. The situation of "long-term cowardice" has become so debilitating that it is now common for some to say that they are tired even if they walk a short distance. So far, the focus has been on saving lives from the plague. But now there are growing concerns about people facing the long-term consequences of the COVID epidemic. The fundamental question, with the uncertainty of whether those with chronic goiter, or all those affected, will fully recover is raised. In this paper a smart monitoring model was proposed to keep monitoring the COVID patient's health conditions. The smart method keep on watching the different changes reflected in the body conditions and ensure the changes in the database. In case any emergency is raised, then these smart monitoring tools inform the information to the doctors. This can very much helpful for the patients to communicate with the doctors. [ABSTRACT FROM AUTHOR]

Further to the approval of the Coronavirus disease 2019 (COVID‐19) vaccine BNT162b2, several severe anaphylaxis cases occured within the first few days of public vaccination. An investigation is taking place to understand the cases and their triggers. The vaccine will be administered to a large number of individuals worldwide and there are raising concerns that severe adverse events might occur. With the current information, the European Academy of Allergy and Clinical Immunology (EAACI) states its position for the following preliminary recommendations that are to be revised as soon as more data emerge. To minimize the risk of severe allergic reactions in vaccinated individuals, it is urgently required to understand the specific nature of the reported severe allergic reactions, including the background medical history of the individuals affected and the mechanisms involved. To achieve this goal, all clinical and laboratory information should be collected and reported. Mild and moderate allergic patients should not be excluded from the vaccine as this could have a significant impact on reaching the goal of population immunity. Healthcare practitioners vaccinating against COVID‐19 are required to be sufficiently prepared to recognize and treat anaphylaxis properly with the ability to administer adrenaline. Further to vaccine administration, a mandatory observation period of at least 15 minutes should be followed for all individuals. The current data have not shown any higher risk for patients suffering from allergic rhinitis or asthma, and this message should be clearly stated by physicians to enable our patients to trust the vaccine. More than 30% of the population suffers from allergic diseases and the benefit of the vaccination clearly outweighs the risk of severe COVID‐19 development. [ABSTRACT FROM AUTHOR]

Though women increasingly make up the majority of medical-school and other science graduates, they remain a minority in academic biomedical settings, where they are less likely to hold leadership positions or be awarded research funding. A major factor is the career breaks that women disproportionately take to see to familial duties. They experience a related, but overlooked, hurdle upon their return: they are often too old to be eligible for 'early-career researcher' grants and 'career-development' awards, which are stepping stones to leadership positions in many institutions and which determine the demographics of their hierarchies for decades to come. Though age limits are imposed to protect young applicants from more experienced seniors, they have an unintended side effect of excluding returning workers, still disproportionately women, from the running. In this joint effort by the European Society of Clinical Microbiology and Infectious Diseases, the Federation of European Microbiological Societies, the Infectious Disease Society of America, the International Society for Infectious Diseases and the Swiss Society for Infectious Diseases, we invited all European Congress of Clinical Microbiology and Infectious Diseases-affiliated medical societies and funding bodies to participate in a survey on current 'early-career' application restrictions and measures taken to provide protections for career breaks. The following simple consensus recommendations are geared to funding bodies, academic societies and other organizations for the fair handling of eligibility for early-career awards: 1. Apply a professional, not physiological, age limit to applicants. 2. State clearly in the award announcement that career breaks will be factored into applicants' evaluations such that: • Time absent is time extended : for every full-time equivalent of career break taken, the same full-time equivalent will be extended to the professional age limit. • Opportunity costs will also be taken into account : people who take career breaks risk additional opportunity costs, with work that they did before the career break often being forgotten or poorly documented, particularly in bibliometric accounting. Although there is no standardized metric to measure additional opportunity costs, organizations should (a) keep in mind their existence when judging applicants' submissions, and (b) note clearly in the award announcement that opportunity costs of career breaks are also taken into account. 3. State clearly that further considerations can be undertaken, using more individualized criteria that are specific to the applicant population and the award in question. The working group welcomes feedback so that these recommendations can be improved and updated as needed. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is a complex clinical syndrome that represents a major cause of morbidity and mortality in Western countries. Several nutraceuticals have shown interesting clinical results in HF prevention as well as in the treatment of the early stages of the disease, alone or in combination with pharmacological therapy. The aim of the present expert opinion position paper is to summarise the available clinical evidence on the role of phytochemicals in HF prevention and/or treatment that might be considered in those patients not treated optimally as well as in those with low therapy adherence. The level of evidence and the strength of recommendation of particular HF treatment options were weighed up and graded according to predefined scales. A systematic search strategy was developed to identify trials in PubMed (January 1970 to June 2019). The terms 'nutraceuticals', 'dietary supplements', 'herbal drug' and 'heart failure' or 'left verntricular dysfunction' were used in the literature search. The experts discussed and agreed on the recommendation levels. Available clinical trials reported that the intake of some nutraceuticals (hawthorn, coenzyme Q10, l-carnitine, d-ribose, carnosine, vitamin D, probiotics, n-3 PUFA and beet nitrates) might be associated with improvements in self-perceived quality of life and/or functional parameters such as left ventricular ejection fraction, stroke volume and cardiac output in HF patients, with minimal or no side effects. Those benefits tended to be greater in earlier HF stages. Available clinical evidence supports the usefulness of supplementation with some nutraceuticals to improve HF management in addition to evidence-based pharmacological therapy. [ABSTRACT FROM AUTHOR]

Objectives: Digitised patient-reported outcome may be beneficial for physicians and patients. The Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) can only be completed with paper and pencil (pJHEQ). We newly developed a web version of the JHEQ (wJHEQ). This study aimed to determine whether the scores obtained with the wJHEQ are equivalent to those from the pJHEQ, how much the wJHEQ would decrease missing answers, and which JHEQ the participants preferred to use. Methods: To measure equivalence between the pJHEQ and wJHEQ, we evaluated the mean score difference for each subscale (pain, movement, mental) and Visual Analogue Scale (VAS; satisfaction, right hip pain, left hip pain) and then assessed the intraclass correlation coefficients (ICC) between the two scores. ICC values ≥0.75 were defined as excellent agreement. We used Bland-Altman analysis to assess level of agreement between the values of the two questionnaires. We compared the number of incomplete forms and amount of missing data between the two questionnaires. We investigated ease of use by asking the participants which format was easier to use. Results: This study comprised 113 patients (mean age 58.1 years, 81% female) with hip disease. Mean score differences for each subscale between the wJHEQ and pJHEQ were not significantly different. The values of ICC for each subscale and each VAS were all >0.75. All 113 participants completed the wJHEQ questionnaire, whereas nine patients did not complete the pJHEQ form. There was a significant statistical difference between the completion rate of the wJHEQ and that of the pJHEQ (p = .0017). Fifty-seven participants (55%) preferred the wJHEQ, whereas 33 participants (32%) preferred the pJHEQ. Conclusion: The wJHEQ was found to be equivalent to the original pJHEQ. The wJHEQ significantly decreased the numbers of missing answers and incomplete forms. The participants felt ease of use was nearly equivalent. The wJHEQ might help facilitate more complete assessments in clinical trials and research. [ABSTRACT FROM AUTHOR]

Over the past several decades, historians of science have come increasingly to focus on the role of so-called “paper technologies,” reorganizing and transforming information through the use of paper and pen, in the emergence of modern science. Taking as a case study an effort by administrators in the seventeenth-century German princely state of Saxe-Gotha to enlist foresters and herb-women to catalog the medicinal plants of the territory, this article analyzes the varied forms of paperwork produced in the process, including an extremely unusual table, and argues that the table represented an effort to produce a synoptic visualization, akin to but not identical to a map, of the location of the territory’s herbs. While this table may not have ultimately succeeded as a viable paper technology, due to problems of incommensurability, it demonstrates the role of administrative practices and state actors in experimenting with information about the natural world during the early modern period. [ABSTRACT FROM AUTHOR]

Sir Louis Francis Knuthsen (1869–1957), the physician who painstakingly listed almost all treatments known for obstinate hiccough, ascribes the holding of breath method to Philip Henry Pye-Smith, FRS (1840–1914), consultant at Guy's Hospital in London. In fact, the strategy is much older and was mentioned by greats such as Francis Bacon (1561–1626), Aristoteles (384–322 BC), and Eryximachus (late-fifth century bce). Hypoventilation to reduce central nervous system excitability was used in antiquity as evidenced by Cyriacus' treatment of Artemia, the daughter of Emperor Diocletian (≈ 244–311). She was suffering from (among others) seizures that Cyriacus was apparently controlling by tightening a scarf around her neck, as depicted by Mathias Grünewald (1460–1528) on a wing of the so-called Heller Altar now on display at the Historical Museum, Frankfurt, Germany. In modern times, around 1920, inducing hypercapnia by CO2 inhalation as therapy for hiccups was suggested and tried by a number of anesthetists, such as Americans Russel Firth Sheldon (1885–1960) and Brian Collins Sword (1889–1956) in Boston; Briton Christopher Langton Hewer (1896–1986) at St. Bartholomew's Hospital in London; Austrian Karl Doppler (1887–1947) in Vienna; and the German/Polish Arthur Dzialoszynski (1893–1977) in Berlin. Although various authors assign the scientific primate to any of them, the first mention of carbon dioxide inhalation as treatment of singultus in the scientific literature is of French origin and was made by Paris pharmacist Henri Bocquillon-Limousin (1856–1917) in his 1892 Formulaire des médicaments nouveaux et des médications nouvelles. [ABSTRACT FROM AUTHOR]

Urgent care practice (UCP) is a novel concept for India. Urgent care primarily deals with injuries or illnesses requiring immediate care. Medical emergency and urgency can happen anywhere unannounced. Research has shown that 90% of the morbidities can be resolved within the community by primary care physicians lead teams. Given the changing professional demands, non-specialists tend to refer away far too many cases to specialists, undermining generalist medical care, particularly in Indian settings. The spillover of the patient load from the primary care setting to the tertiary care centers is enormous leading to resource mismatch. Family physicians and other primary care providers are best positioned to develop practices and provide good quality urgent care to society. Family physicians, general practitioners, and medical officers are already functioning as the frontline care providers for any emergency or medical urgency arising within communities. Urgent care is essentially ambulatory care or outpatient care outside of a traditional hospital emergency room. "UCP aims to provide timely support, which is easily accessible with a focus on good clinical outcomes, e.g. survival, recovery, lack of adverse events, and complications. Core interventions of urgent care are centered on the 4Rs - Rescue, Resuscitate, Relate, and Refer. At present, there are no available, established training model for future faculty, residents, and medical students on "UCP" in India. [ABSTRACT FROM AUTHOR]

Plain language summary: What is it?: Fetal neonatal alloimmune thrombocytopenia (FNAIT), also known as neonatal alloimmune thrombocytopenia (NAIT) or fetomaternal alloimmune thrombocytopenia (FMAIT), is a rare condition which affects a baby's platelets. This can put them at risk of problems with bleeding, particularly into the brain. One baby per week in the UK may be seriously affected and milder forms can affect one in every 1000 births. How is it caused?: Platelets are blood cells that are very important in helping blood to clot. All platelets have natural proteins on their surface called human platelet antigens (HPAs). In babies, half of these antigens are inherited from the mother and half from the father. During pregnancy, some of the baby's platelets can cross into the mother's bloodstream. In most cases, this does not cause a problem. But in cases of FNAIT, the mother's immune system does not recognise the baby's HPAs that were inherited from the father and develops antibodies, which can cross the placenta and attack the baby's platelets. These antibodies are called anti‐HPAs, and the commonest antibody implicated is anti‐HPA‐1a, but there are other rarer antibody types. If this happens, the baby's platelets may be destroyed causing their platelet count to fall dangerously low. If the platelet count is very low there is a risk to the baby of bleeding into their brain before they are born. This is very rare but if it happens it can have serious effects on the baby's health. How is it inherited?: A baby inherits half of their HPAs from its mother and half from its father. Consequently, a baby may have different HPAs from its mother. As the condition is very rare, and even if the baby is at risk of the condition we have no way of knowing how severely they will be affected, routine screening is not currently recommended. What can be done?: FNAIT is usually diagnosed if a previous baby has had a low platelet count. The parents are offered blood tests and the condition can be confirmed or ruled out. There are many other causes of low platelets in babies, which may also need to be tested for. As the condition is so rare, expertise is limited to specialist centres and normally a haematologist and fetal medicine doctor will perform and interpret the tests together. Fortunately, there is an effective treatment for the vast majority of cases called immunoglobulin, or IVIg. This 'blood product' is given intravenously through a drip every week to women at risk of the condition. It may be started from as early as 16 weeks in the next pregnancy, until birth, which would be offered at around 36–37 weeks. Less common treatments that may be considered depending on individual circumstances include steroid tablets or injections, or giving platelet transfusions to the baby. What does this paper tell you?: This paper considers the latest evidence in relation to treatment options in the management of pregnancies at risk of FNAIT. Specifically, we discuss the role of screening, when IVIg should be started, what dose should be used, and what evidence there is for maternal steroids. We also consider in very rare selected cases, the use of fetal blood sampling and giving platelet transfusions to the baby before birth. Finally, we consider the approaches to blood testing mothers to tell if babies are at risk, which is offered in some countries, and development of new treatments to reduce the risk of FNAIT. [ABSTRACT FROM AUTHOR]

In this review paper, we present the common etiology, presentation, diagnosis, and management of the following three common bunion formations: dorsal bunion, tailor's bunion, and hallux valgus (HV). Bunions are common pathologies that present to a variety of clinics, so it is important for providers to have a base understanding of these in order to provide the best care to patients. Many of these bunion formations have a variety of causes which allow providers to manage them before surgical intervention is required. The aim of this review paper is to bring attention and expanded insight on these common bunion presentations in order to minimize morbidity early on. The information provided in this review will allow both primary care and subspecialty physicians with the knowledge to accurately diagnose and optimally manage these bony deformities of the lower extremity. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine changes in the demographics and regions of work of Australian doctors over a period of 9 years. Methods: A retrospective study of Australian Health Practitioner Regulation Agency (AHPRA) registration data was performed. Data were sourced from the Health Workforce Dataset Online Data Tool which was derived from annual registration data from AHPRA for 2013–2022. The demographic factors analysed were gender, age, and origin of qualification. Regions of work were defined using the Modified Monash (MM) model. Results: The number of registered doctors increased from 82,408 in 2013 to 111,908 in 2022 but mean hours worked per week decreased from 41 to 39 leading up to 2020. Trends in age and origin of qualification remained stable, but the proportion of female workers increased from 38.5% in 2013 to 44.5% in 2022. While female hours per week (~37) were consistent from 2013 to 2020, male hours per week decreased from 43 to 41. The number of registrations and total full-time equivalent (FTE) outcomes increased consistently in metropolitan (MM1) and rural (MM2–5) regions but did not increase for remote and very remote (MM6–7) regions. Conclusion: The Australian medical workforce both grew and changed between 2013 and 2022. An overall decrease in mean hours worked appears to be driven by a decline in hours worked by male workers and the increased proportion of female workers. While increased gender parity and a decrease in hours worked per week were positive outcomes, a lack of growth in the medical workforce was noted in remote and very remote regions of Australia. What is known about the topic? Changes in the medical workforce over time are likely to impact health service delivery. What does this paper add? This paper examined changes in the gender, age, origin of qualification, and the region of work of Australia's medical workforce from 2013 to 2022. What are the implications for practitioners? An increase in gender parity and a decrease in the mean hours worked suggests improvements in workforce participation and sustainability, but lack of growth in medical workforce was noted in remote and very remote regions of Australia. [ABSTRACT FROM AUTHOR]

Background: The origin of Narrative Medicine dates back to more than 20 years ago at an international level. Narrative Medicine is not an alternative to evidence-based medicine, however these two approaches are integrated. Narrative Medicine is a methodology based on specific communication skills where storytelling is a fundamental tool to acquire, understand and integrate several points of view related to persons involving in the disease and in the healthcare process. Narrative Medicine, henceforth NM, represents a union between disease and illness between the doctor's clinical knowledge and the patient's experience. According to Byron Good, "we cannot have direct access to the experience of others' illness, not even through in-depth investigations: one of the ways in which we can learn more from the experience of others is to listen to the stories of what has happened to other people." Several studies have been published on NM; however, to the best of our knowledge, no scoping review of the literature has been performed. Objective: This paper aims to map and synthetize studies on NM according to theory, clinical practice and education/training. Method: The scoping review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) checklist. A search was conducted in PubMed, APA PsycNet and Jstor. Two authors independently assessed the eligibility and methodological quality of the studies and extracted the data. This review refers to the period from 1998 to 2022. Results: A total of 843 abstracts were identified of which 274 papers were selected based on the title/abstract. A total of 152 papers in full text were evaluated and 76 were included in the review. Papers were classified according to three issues: ✘ Nineteen studies focused on the definition and concept of NM (Theoretical). ✘ Thirty-eight papers focused on the collection of stories, projects and case reports (Clinical practice). ✘ Nineteen papers focused on the implementation of the Narrative Medicine approach in the education and training of medical doctors (Education and training). Conclusions: This scoping review presents an overview of the state of the art of the Narrative Medicine. It collect studies performed mainly in Italy and in the United States as these are the countries developing the Narrative Medicine approach in three identified areas, theoretical, clinical practice and education and training. This scoping review will help to promote the power of Narrative Medicine in all three areas supporting the development of methods to evaluate and to measure the Narrative Medicine approach using key performance indicators. [ABSTRACT FROM AUTHOR]

Ambulatory electrocardiogram (ECG) testing plays a crucial role in the early detection, diagnosis, treatment evaluation, and prevention of cardiovascular diseases. Clear ECG signals are essential for the subsequent analysis of these conditions. However, ECG signals obtained during exercise are susceptible to various noise interferences, including electrode motion artifact, baseline wander, and muscle artifact. These interferences can blur the characteristic ECG waveforms, potentially leading to misjudgment by physicians. To suppress noise in ECG signals more effectively, this paper proposes a novel deep learning-based noise reduction method. This method enhances the diffusion model network by introducing conditional noise, designing a multi-kernel convolutional transformer network structure based on noise prediction, and integrating the diffusion model inverse process to achieve noise reduction. Experiments were conducted on the QT database and MIT-BIH Noise Stress Test Database and compared with the algorithms in other papers to verify the effectiveness of the present method. The results indicate that the proposed method achieves optimal noise reduction performance across both statistical and distance-based evaluation metrics as well as waveform visualization, surpassing eight other state-of-the-art methods. The network proposed in this paper demonstrates stable performance in addressing electrode motion artifact, baseline wander, muscle artifact, and the mixed complex noise of these three types, and it is anticipated to be applied in future noise reduction analysis of clinical dynamic ECG signals. [ABSTRACT FROM AUTHOR]

Concussions are increasingly recognized as a public health concern. This paper evaluates Canadian concussion care guidelines, advocating for the inclusion of a broader range of healthcare professionals (HCPs) in concussion assessment, diagnosis, and management. It emphasizes the role of chiropractors, in addition to medical doctors (MDs) and nurse practitioners (NPs), highlighting their extensive training in musculoskeletal and neurological disorders. Chiropractors are adept at managing symptoms like headache, neck pain, and dizziness, and employing evidence-based, comprehensive interventions including patient education, exercise therapy, manual therapy, cervicovestibular rehabilitation, and return-to-sport (RTS) protocols. The paper also addresses regional variations in chiropractors' roles, focusing on Ontario's "Rowan's Law," and argues that limiting aspects of concussion care (assessment, diagnosis, RTS clearance) to MDs and NPs may result in healthcare inefficiencies and inequities. The findings are significant for policymakers and healthcare leaders, indicating a need for updated concussion care guidelines that integrate and utilize diverse HCPs. This could lead to improved patient outcomes, healthcare efficiency, and equity in concussion management across Canada. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion The COVID‐19 pandemic has not only tested the resilience of public health systems but also underscored the criticality of allocative choices on health resources. These choices, however, are not confined to health emergencies but are integral to public health decisions, which inherently grapple with limited resources. In this context, physicians play a pivotal role as the architects of clinical actions in various scenarios. Therefore, doctors are called upon to make their decisions by considering not only the criteria of clinical appropriateness but also the ethical aspects linked, in particular, to the principle of justice. Indeed, the assessment of the effectiveness of a treatment for a particular patient must be balanced against criteria of equity and justice for the whole. To be fully applied, the principle of justice presupposes the use of economic evaluation techniques designed to drive the organisation decisions by effectiveness and efficiency.The present paper aims to empirically analyse whether and to what extent economic evaluation is known and used by doctors in healthcare decision‐making and, therefore, what the most widespread approaches are used in such processes.In particular, this paper intends to present the results of an empirical study on a sample of doctors registered with the Order of Physicians in Lombardy (Italy), one of the areas most affected by the COVID‐19 pandemic.The research reveals a particular awareness of the criticality of allocation issues accompanied by a lack of knowledge of the economic evaluation techniques or, more broadly, by an almost total disuse of financial criteria. The main reasons are doctors’ need for more knowledge of these tools and insufficient availability of economic information at the country system level.In the conclusion, we propose some suggestions to facilitate the transition to more current decision‐making models consistent with the characteristics of more advanced national healthcare contexts. [ABSTRACT FROM AUTHOR]

This scoping review was conducted to provide an overview of the evidence of point-of-care lung ultrasound (LUS) in emergency medicine. By emphasizing clinical topics, time trends, study designs, and the scope of the primary outcomes, a map is provided for physicians and researchers to guide their future initiatives. Which study designs and primary outcomes are reported in published studies of LUS in emergency medicine? We performed a systematic search in the PubMed/MEDLINE, Embase, Web of Science, Scopus, and Cochrane Library databases for LUS studies published prior to May 13, 2023. Study characteristics were synthesized quantitatively. The primary outcomes in all papers were categorized into the hierarchical Fryback and Thornbury levels. A total of 4,076 papers were screened and, following selection and handsearching, 406 papers were included. The number of publications doubled from January 2020 to May 2023 (204 to 406 papers). The study designs were primarily observational (n = 375 [92%]), followed by randomized (n = 18 [4%]) and case series (n = 13 [3%]). The primary outcome measure concerned diagnostic accuracy in 319 papers (79%), diagnostic thinking in 32 (8%), therapeutic changes in 4 (1%), and patient outcomes in 14 (3%). No increase in the proportions of randomized controlled trials or the scope of primary outcome measures was observed with time. A freely available interactive database was created to enable readers to search for any given interest (https://public.tableau.com/app/profile/blinded/viz/LUSinEM%5f240216/INFO). Observational diagnostic studies have been produced in abundance, leaving a paucity of research exploring clinical utility. Notably, research exploring whether LUS causes changes to clinical decisions is imperative prior to any further research being made into patient benefits. [Display omitted] [ABSTRACT FROM AUTHOR]

Indigenous peoples in the United States experience many health disparities and barriers to accessing health care services. In addition, Indigenous communities experience poor social drivers of health, including disproportionately high rates of food insecurity, violence, and poverty, among others. These challenges are unsurprising, given historical societal discrimination toward Indigenous peoples and government policies of violence, forced relocation with loss of ancestral home, and erasure of cultures and traditions. Indigenous peoples have displayed resilience that has sustained their communities through these hardships. Through treaties between the federal government and Indigenous nations, the federal government has assumed a trust responsibility to provide for the health and well-being of Indigenous populations through the direct provision of health care services and financial support of tribally operated health systems. However, despite serving a population that has endured substantial historical trauma and subsequent health issues, federal programs serving Indigenous peoples receive inadequate federal funding and substantially fewer resources compared with other federal health care programs. Access to care is further challenged by geographic isolation and health care workforce vacancies. Given the history of Indigenous peoples in the United States and their treatment by the federal government and society, the American College of Physicians (ACP) asserts the federal government must faithfully execute its trust responsibility through increased funding and resources directed toward Indigenous communities and the undertaking of concerted policy efforts to support the health and well-being of Indigenous people. ACP believes that these efforts must be community-driven, Indigenous-led, and culturally appropriate and accepted, and center values of respect and self-determination. [ABSTRACT FROM AUTHOR]

Perl was appointed the Auschwitz concentration camp's gynecologist and head of a nine-person hospital for 32,000 women prisoners. Thanks to Phyllis Lassner and Danny M. Cohen, this 2019 edition of an out-of-print 1948 memoir by Dr. Gisella Perl, a Rumanian Holocaust survivor, offers much to learn from. I Was a Doctor in Auschwitz: by Gisella Perl, Introduction by Phyllis Lassner and Danny M. Cohen, Afterword by Eva Hoffman, Lanham, MD, Lexington Books, 2019, 125 pp., $90.00/£69.00 (cloth), $36.99/£28.00 (paper), $35.00/£27.00 (e-book). [Extracted from the article]

Half the world’s people currently live in rural and remote areas. About 70% of the world’s 1.4 billion people who are extremely poor live in rural areas. The problem is that the majority of healthcare providers prefer to serve in urban areas. Only a comprehensive and systematic approach can address these inequities. India, the largest democratic republic in the world, possesses 2.4% of the world’s land area and supports 16% of the world’s population. According to census 2011, 68.84% of population resides in rural areas. Nearly 86% of all the medical visits in India are made by rural inhabitants with a majority still traveling more than 100 km to avail healthcare facility, of which 70%–80% is born out of pocket landing them in poverty. A country’s approach must systematically and simultaneously address legal coverage and rights, health worker shortages, extension of healthcare protection, and quality of care. Only then can equitable access for all be fully achieved. Those living in rural areas have access to health protection and services that meet the criteria of availability, affordability, accessibility, acceptability, and quality. Family medicine as a broad specialty has its role from womb till tomb. Family medicine is defined as a specialty of medicine which is concerned with providing comprehensive care to individuals and families by integrating biomedical, behavioral, and social sciences. As an academic discipline, it includes comprehensive healthcare services, education, and research. A family doctor provides primary and continuing care to the entire family within the communities; addresses physical, psychological, and social problems; and coordinates comprehensive healthcare services with other specialists, as needed. The practitioners in family medicine can play an important role in providing healthcare services to the suffering humanity. The general practitioner’s responsibility in Medicare includes management of emergencies, treatment of problems relating to various medical and surgical specialties, care of entire family in its environment, appropriate referrals, and follow-up. He or she is the first-level contact for the patients and his or her family. Family medicine is the ideal solution to growing rural healthcare challenges. This article is a formal position paper of the Academy of Family Physicians of India. [ABSTRACT FROM AUTHOR]

Background: The essence of humanism in medicine and health care is relationships-caring relationships between clinicians and patients. While raising concerns regarding professional-patient boundaries has positively contributed to our understanding and prevention of potentially harmful boundary violations, there is controversy about which types of relationships, caring acts, and practices are acceptable versus cross boundary lines.Objective: To examine primary care physicians' practices and attitudes regarding acts that have been questioned as potentially "inappropriate" or "unethical" crossing of professional-patient boundaries.Design: Surveys conducted via in-person polling or electronic and mailed paper submissions from April 2016 to July 2017. We calculated descriptive statistics and examined associations with practices and attitudes using logistic regression.Participants: Random sample of all US primary care physicians who treat adult patients; convenience sample of attendees at medicine grand rounds presentations.Main Measures: Outcomes were self-reported practices and attitudes related to giving patients rides home, paying for patients' medication, helping patients find jobs, employing patients, going to dinner with patients, and providing care to personal friends.Key Results: Among 1563 total respondents, 34% had given a ride home, 34% had paid for medications, 15% helped patients find a job, 7% had employed a patient, 10% had dinner with patients, and 59% provided care to personal friends. A majority disapproved of dinner with a patient (75%) but approved of or were neutral on all other scenarios (61-90%).Conclusions: The medical profession is quite divided on questions related to drawing lines about appropriate boundaries. Contrary to official and widespread proscriptions against such practices (with exception of dinner dates), many have actually engaged in such practices and the majority found them acceptable. [ABSTRACT FROM AUTHOR]

Environmental health refers to the health effects associated with environmental factors, such as air pollution, water contamination, and climate change. Environmental hazards are associated with poor outcomes in common diseases, including diabetes and heart disease. In this position paper, the American College of Physicians (ACP) seeks to inform physicians about environmental health and offers policymakers recommendations to reduce the adverse health consequences of climate change, improve air and water quality, reduce exposure to toxic substances, and address environmental injustice. ACP affirms that all communities, including people of color, people with low income, and marginalized populations, deserve to live in a healthy environment. [ABSTRACT FROM AUTHOR]

The middle of the 19th century marks the beginning of a global process of science and knowledge transfer from -Europe to the rest of the world. During the phase of globali-zation, Austrian physician and ethnographer Jacob E. Polak (1818–1891) played a key role in the transmission of practical and scientific reasoning, leading to the development of medical science and clinical care in Persia. In 1851, Polak was commissioned by the Persian court to work as an academic teacher at the first secular institution of higher learning in Teheran, the Dār al-Fonūn. After 4 years of teaching and working as a doctor and surgeon, Polak was appointed personal physician to the Qājār king, Nāṣer-ad-Dīn Shāh (r. 1848–1896). During Polak's 9 year stay in Persia, he performed numerous surgical operations with specific focus on lithotomies on men and women of all ages. He documented each operation and collected samples of bladder calculi for the purpose of chemical analysis. After his return to Austria, he published a detailed report on his practice of lithotomy in Persia. This extensive documentation is, we believe, the only known historical evidence that currently exists of the introduction of modern urology to Persia. This study will present Polak's role as a pioneer of modern medicine and lithotomy, and will examine how he introduced the latest achievements of Viennese medicine in the field of operative urology to Persia. [ABSTRACT FROM AUTHOR]