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As the United States Navy transitions from Operation Iraqi Freedom/Operation Enduring Freedom to preparing for a near-peer competition, an increasing focus of wartime strategy relies upon a network of distributed naval assets for total sea control, known as Distributed Maritime Operations (DMO). Historically, embedded medical personnel have provided care at sea in times of war. Recent reviews of shipboard and evacuated mass casualty incidents have alluded to weaknesses in the existing Navy Medicine approach that will require advances in care provision to sustain high-quality care that would benefit from industry and civilian academic collaboration. To gain input from civilian prehospital expertise and insight, the current DMO and Navy En-Route Care (ERC) systems must be plainly described for non-Navy military and civilian leaders, clinicians, and researchers to understand. N/A In this review, we translate US Navy structure and vernacular into common civilian and non-Navy language, describe the maritime role-tiered ERC system, elucidate the medical assets on each naval warship, and discuss clinician levels and capabilities while deployed to help communicate the inherent challenges of US Navy maritime medical care during routine operations, casualty treatment, stabilization, and evacuation. We describe the roles of care, clinician levels, and medical assets within the Navy ERC system for researchers and military leaders who aim to mitigate the inherent challenges of future maritime trauma care in the age of Distributed Maritime Operations. This paper lays the framework of the Navy deployed medical system to enable research in maritime en-route care, and prompt inclusion of identified solutions into common use in the US Navy. [ABSTRACT FROM AUTHOR]

More than 60% of physicians in the U.S. practice as small healthcare providers. The realm of small healthcare providers includes dental offices, orthodontists, chiropractors, massage therapists, optometrists, long-term care facilities and other small, independent clinics that typically have 1 –30 employees. While studies have reported variable levels of Health Insurance Portability and Accountability Act (HIPAA) information security (InfoSec) compliance among hospitals and large medical facilities (Anthony DL, Appari A, Johnson ME. Institutionalizing HIPAA compliance: Organizations and competing logics in U.S. health care. J Health Soc Behav 2014;55(1):108–24; Brady, JW. Securing health care: Assessing factors that affect HIPAA security compliance in academic medical centers. Proceedings of the 2011 44th Hawaii International Conference on System Sciences, Manoa, Hawaii; 2011.), small healthcare providers face even more challenges in their effort to be HIPAA compliant. This paper will use a case study to examine factors that affect the small healthcare providers’ effort in meeting HIPAA InfoSec compliance. The paper also discusses services and technologies available to them to become compliant and how they can maintain continued compliance once they become compliant. Both a process model and an action compass are proposed to guide small healthcare providers. This case study provides support to existing compliance theories. The proposed guidance is useful for not only small healthcare providers but also mid-sized and large businesses in general. [ABSTRACT FROM PUBLISHER]

This paper reviews the use of psychotherapeutic approaches to treat individuals who have committed sex crimes and/or have problematic sexual interests (PSI); including types of psychotherapy used, descriptions of preventive and reintegration programmes, and highlighting specific theoretical controversies. In the second part, experts from Canada, the Czech Republic, Russia, the United Kingdom, and the United States, who participated in an International Consensus Meeting held in Prague (2017), summarize treatment programmes in their countries. The comparison revealed some general findings: each country has variability between its own programmes; most countries have different programmes for people who are in custody and who are in the community; the state-directed treatment programmes are primarily focused on criminal individuals, while non-criminal individuals are treated in preventive programmes and/or in special clinics or are untreated; the presence of PSI in patients is acknowledged in most programmes, although specific programmes exclusively for individuals with PSI rarely exist. Studies on effectiveness are difficult to compare due to methodologic, political, and cultural differences. Further communication between more countries to share knowledge about successful treatments and preventive approaches is needed, especially enhanced international collaboration between researchers and clinicians to verify the effectiveness of current clinical and experimental program, rs. [ABSTRACT FROM AUTHOR]

Over the past 10 years, European pharmaceutical regulators (especially the European Medicines Agency [EMA]) have enacted a wave of transparency policies. Since 2010, the overwhelming majority have focused on releasing more scientific medicines information online and providing open access to regulatory data. Amongst other benefits, EMA expects its policies to build public trust and provide outsiders with a better understanding of regulatory decision-making. Yet, few studies have empirically examined the EMA’s transparency policies, especially on the end users of ‘transparent’ information (e.g. medical doctors or patients). This paper presents standout findings from a November 2014 survey conducted in Spain, Germany, France and the United Kingdom with a sample of 1005 general practitioners and medical specialists treating either multiple sclerosis, rheumatoid arthritis, osteoporosis, idiopathic pulmonary fibrosis or HIV/AIDS. The study found that 76% of respondents think it is a bad idea to release information into the public domain before possible safety issues have been investigated by the regulators and (relevant) pharmaceutical company. The results also suggested that medical doctors in Europe have a poor understanding of pharmaceutical regulatory activities. In particular, the majority were largely unaware of the current activities of the EMA, did not have good knowledge of how the regulators assess the safety of medicines (e.g. only 17% said they had good knowledge of how EMA assess the safety of medicines) and were unfamiliar with regulatory documents frequently used by regulators and industry to discuss the safety of medicines (e.g. in approving a medicine). [ABSTRACT FROM PUBLISHER]

With the rise of clinical management, new skills of medical doctors stand out, including leadership skills. Medical doctors organize medical work and improve patient care. The training of frontline leadership skills, however, is weakly developed in residency programmes. Medical professional cultures tend to resist organizational techniques and values. This paper analyses cultural interventions in health-care organizations, aimed at overcoming ‘clashes’ between professional and organizational logics in frontline domains. These interventions do not work against, but ‘use’ professional traditions, styles and customs as cultural resources. We use one particular project to illustrate this, a project in which internal medicine residents are invited to join quality improvement sessions, during which they identify critical (organizational) experiences with care provision and realize change. We show how residents feel enabled to establish results and cooperate with other professionals. We also show how this project links organizational responsibilities and medical professionalism – how complementarity (instead of conflict) is established. This is done in practical ways, which commit instead of alienate medical professionals. [ABSTRACT FROM PUBLISHER]

This article presents emerging findings from the first year of a two-year study, which employed ethnographic methods to explore the culture of interprofessional collaboration (IPC) and family member involvement in eight North American intensive care units (ICUs). The study utilized a comparative ethnographic approach - gathering observation, interview and documentary data relating to the behaviors and attitudes of healthcare providers and family members across several sites. In total, 504 hours of ICU-based observational data were gathered over a 12-month period in four ICUs based in two US cities. In addition, 56 semi-structured interviews were undertaken with a range of ICU staff (e.g. nurses, doctors and pharmacists) and family members. Documentary data (e.g. clinical guidelines and unit policies) were also collected to help develop an insight into how the different sites engaged organizationally with IPC and family member involvement. Directed content analysis enabled the identification and categorization of major themes within the data. An interprofessional conceptual framework was utilized to help frame the coding for the analysis. The preliminary findings presented in this paper illuminate a number of issues related to the nature of IPC and family member involvement within an ICU context. These findings are discussed in relation to the wider interprofessional and health services literature. [ABSTRACT FROM AUTHOR]

Background: Little is known about the experiences of transgender and gender non-binary (TNB) physicians in medical residency training programs. Aim: To identify the self-reported experiences and needs of TNB individuals during medical residency in United States training programs. Methods: An online, anonymous survey of TNB current residents and recent graduates was designed. Results: A total of 26 respondents completed the survey. The most common reported gender identity was non-binary or gender queer (n = 11, 42.3%) and male or transgender man (n = 7, 26.9%). About half of participants (n = 14, 53.8%) had undergone gender affirming interventions prior to residency. Most participants (n = 19, 73.1%) did not know all the gender affirming healthcare benefits offered by their program. The majority (n = 21, 80.8%) also reported 2 hours or less of transgender-related didactics in residency. Respondents were most likely to disclose their gender identity to other residents (n = 19, 73.1%) and faculty (n = 19, 73.1%) and were least likely to disclose their identity to patients (n = 6, 23.1%). Most respondents (n = 15, 57.7%) stated that program faculty and staff communicated support for their gender identity. Most participants (n = 16, 61.5%) reported that they perceived transgender residents to be treated similarly to their non-transgender peers in their training program, while the remainder (n = 7, 26.9%) disagreed or strongly disagreed. Nevertheless, approximately three-quarters of trainees (n = 22, 84.6%) self-reported microaggressions during their training program and non-binary and transfeminine trainees were more likely to report these experiences than transmasculine people. Nearly a quarter of transfeminine and non-binary participants reported macroaggressions, with none of the transmasculine respondents reporting these negative experiences. Most macroaggressions were from program faculty. Discussion: This study highlights that while most physicians in residency report support from their program for their TNB identity, TNB physicians still experience significant barriers and prejudices throughout training and more action is needed among program faculty for support of TNB trainees. [ABSTRACT FROM AUTHOR]

Contemporary state-of-the-art healthcare facilities are incorporating technology into their building design to improve communication and patient care. However, technological innovations may also have unintended consequences. This study seeks to better understand how technology influences interprofessional communication within a hospital setting based in the United States. Nine focus groups were conducted including a range of healthcare professions. The focus groups explored practitioners’ experiences working on two floors of a newly designed hospital and included questions about the ways in which technology shaped communication with other healthcare professionals. All focus groups were recorded, transcribed, and coded to identify themes. Participant responses focused on the electronic medical record, and while some benefits of the electronic medical record were discussed, participants indicated use of the electronic medical record has resulted in a reduction of in-person communication. Different charting approaches resulted in barriers to communication between specialties and reduced confidence that other practitioners had received one’s notes. Limitations in technology—including limited computer availability, documentation complexity, and sluggish sign-in processes—also were identified as barriers to effective and timely communication between practitioners. Given the ways in which technology shapes interprofessional communication, future research should explore how to create standardised electronic medical record use across professions at the optimal level to support communication and patient care. [ABSTRACT FROM PUBLISHER]

An online survey of 691 clinicians who use hypnosis was conducted in 31 countries to gain a broad real-world picture of current practices, views, and experiences in clinical hypnosis. Among 36 common clinical uses, stress reduction, wellbeing and self-esteem-enhancement, surgery preparations, anxiety interventions, mindfulness facilitation, and labor and childbirth applications were the most frequently rated as highly effective (each by ≥70% of raters) in the clinicians' own experience. Adverse hypnosis-associated effects had been encountered by 55% of clinicians but were generally short-lived and very rarely judged as serious. The most common hypnosis approaches used were Ericksonian (71%), hypnotic relaxation therapy (55%), and traditional hypnosis (50%). Almost all respondents reported regularly using other therapeutic modalities alongside hypnosis. Among a range of client variables potentially affecting therapy, most clinicians rated hypnotist-client rapport (88%) and client motivation (75%) as very or extremely important factors for successful hypnotherapy. The majority of respondents had conducted hypnosis treatment via teletherapy, and 54% of those estimated it to be as effective as in-person treatment. [ABSTRACT FROM AUTHOR]

We analyze gender and racial disparities in academic otolaryngology from 2007 to 2018 in the United States (US). A cross-sectional retrospective analysis was done using data from the American Association of Medical Colleges. The distribution of gender and race, academic ranks, tenure tracks, and degrees was reported. The total number of otolaryngologists increased from 1,490 to 2,239, where 53 percent were females. All races experienced an increase; however, Whites and Asians had a greater increase compared to Black and Hispanics. Regarding percentages at different ranks, White were the majority (>50 percent) in every category. As for tenure, the general trend was a decrease in the total number of tenured physicians from 327 in 2007 to 318 in 2018, where Black, Hispanic, and Asian tenured physicians increased, while White tenured physicians decreased. White male otolaryngologists were the majority for every subgroup (>60 percent), whereas Black faculty made up less than 1 percent of tenured category. Female representation gradually increased for all levels of tenure. As for all degrees, Whites were the majority for all levels of education (>60 percent). There were some improvements in the representations for the females in all and Asians on the tenure track. However, progress for the URM remains an elusive dream. [ABSTRACT FROM AUTHOR]

Issue: As U.S. healthcare systems plan for future physician workforce needs, the systemic impacts of climate change, a worldwide environmental and health crisis, have not been factored in. The current focus on increasing the number of trained physicians and optimizing efficiencies in healthcare delivery may be insufficient. Graduate medical education (GME) priorities and training should be considered in order to prepare a climate-educated physician workforce. Evidence: We used a holistic lens to explore the available literature regarding the intersection of future physician workforce needs, GME program priorities, and resident education within the larger context of climate change. Our interinstitutional, transdisciplinary team brought perspectives from their own fields, including climate science, climate and health research, and medical education to provide recommendations for building a climate-educated physician workforce. Implications: Acknowledging and preparing for the effects of climate change on the physician workforce will require identification of workforce gaps, changes to GME program priorities, and education of trainees on the health and societal impacts of climate change. Alignment of GME training with workforce considerations and climate action and adaptation initiatives will be critical in ensuring the U.S. has a climate-educated physician workforce capable of addressing health and healthcare system challenges. This article offers a number of recommendations for physician workforce priorities, resident education, and system-level changes to better prepare for the health and health system impacts of climate change. [ABSTRACT FROM AUTHOR]

A challenging obstacle to primary health care in the United States (US) is patient no-shows or missed appointments. The no-show rate can vary from 5.5% to 50%. A no-show may contribute to increased health risks, poor continuity of care, and loss of revenue. In this study, we develop and test a predictive model of patient visits. Retrospective regression analyzed patient visits in 2014 and 2015. Dependent variables were month, day, age, gender, race, ethnicity, insurance type, visit type, and the number of previous no-shows. A threshold for classifying no-shows was determined. The model was prospectively tested on patient visits in 2016. Significant variables included age, visit type, insurance, and number of previous no-shows. The model performed at 47% sensitivity and 79% specificity. The receiver operating characteristic (ROC) area under curve (AUC) was 0.72 (95% CI, 0.69–0.76) for the model and 0.70 (95% CI, 0.65–0.74) for prospective analysis. Simulated overbooking with the model resulted in 3.67 vs. 6.87 unused appointments, P < 0.000 (mean diff 3.2, 95% CI, 2.9–3.5). It is feasible to develop and implement a predictive model for single physician practices and implementation may improve practice efficiency. [ABSTRACT FROM AUTHOR]

Patients with end-stage liver disease (ESLD) have impaired physical, psychological, and social functions, which can diminish patient quality of life, burden family caregivers, and increase health-care utilization. For those with a life expectancy of less than six months, these impairments and their downstream effects can be addressed effectively through high-quality hospice care, delivered by multidisciplinary teams and focused on the physical, emotional, social, and spiritual wellbeing of patients and caregivers, with a goal of improving quality of life. In this review, we examine the evidence supporting hospice for ESLD, we compare this evidence to that supporting hospice more broadly, and we identify potential criteria that may be useful in determining hospice appropriateness. Despite the potential for hospice to improve care for those at the end of life, it is underutilized for patients with ESLD. Increasing the appropriate utilization of hospice for ESLD requires a better understanding of patient eligibility, which can be based on predictors of high short-term mortality and liver transplant ineligibility. Such hospice criteria should be data-driven and should accommodate the uncertainty faced by patients and physicians. [ABSTRACT FROM AUTHOR]

Phenomenon: Point-of-care ultrasound is fast becoming standard clinical bedside practice for diverse specialties. Medical schools are responding by adding ultrasound education, though the majority use it to supplement the learning of basic sciences. Point-of-care ultrasound practice-based clinical skills education is rare. There also is a lack of standardization across curricula, leading to much variability in the ultrasound skills that medical students from different schools bring to residency. To best inform a point-of-care ultrasound curriculum for our Transition-to Residency program, we investigated literature on 1) how medical students are being prepared for use of point-of-care ultrasound in clinical practice, 2) what skills are being taught, 3) what point-of-care ultrasound skills residency programs expect from incoming residents. Approach: We reviewed literature to identify curricula in U.S. medical schools that teach the concepts, knowledge, and skills related to point-of-care ultrasound. We also mapped point-of-care ultrasound expectations set forth by the Entrustable Professional Activities for undergraduate medical education to the specialty-specific milestones identified by the Accreditation Council for Graduate Medical Education. Additionally, we reviewed specialty-specific professional organizations for position statements and guidelines describing the point-of-care ultrasound skills expected for practicing physicians in their respective specialties. The goal was to identify any needs and gaps in education regarding point-of-care ultrasound across the undergraduate to graduate medical education continuum to practice. Findings: We found seven published point-of-care ultrasound curricula for medical students. There was wide variability in these curricula regarding what point-of-care ultrasound content is being taught, as well as when and how this skill is taught. No Entrustable Professional Activity listed point-of-care ultrasound as a skill requirement for graduating medical students. For graduate medical education, there was wide variability across specialties in residency milestones related to point-of-care ultrasound; some (e.g., emergency medicine) listed extensive milestones while others (e.g., internal medicine) listed none. However, we found that many specialty-specific professional organizations do list detailed point-of-care ultrasound expectations for their practicing physicians. Insights: As point-of-care ultrasound is fast becoming common practice across many specialties, standardization of education and related competencies—similar to other clinical skills training—is necessary across medical schools. Mapping point-of-care ultrasound expectations to current teaching across the continuum from undergraduate to graduate medical education may allow schools to tailor point-of-care ultrasound training for Transition-to-Residency programs. We provide a sample pilot point-of-care ultrasound curriculum that we designed for our Transition-to-Residency course. [ABSTRACT FROM AUTHOR]

In the US, disagreement over the biological basis of "chronic Lyme disease" has resulted in the institutionalization of two standards of care: "mainstream" and "Lyme-literate." For mainstream physicians, chronic Lyme disease is a "medically unexplained illness" that presents with an abundance of "symptoms" in the absence of diagnostic "signs." For Lyme-literate physicians, and complementary and alternative medicine practitioners more generally, symptoms alone provide sufficient evidence for medical explanation. Drawing upon ethnographic research among mainstream and Lyme-literate physicians, I suggest that medically unexplained illness is not a biomedical anomaly but an intrinsic feature of biomedicine. [ABSTRACT FROM AUTHOR]

Background: Opioid overdose is a national health priority and curbing inappropriate prescribing is critical. In 2016, the Centers for Disease Control and Prevention (CDC) issued appropriate prescribing guidelines. Objectives: Examine associations between care networks defined by shared patients and problematic opioid prescribing. Methods: Analysis was at the provider-year level. Social network analysis (SNA) applied to the Medicaid MarketScan® Research Database for the years 2010–2015 identified care communities, each community's level of integration (centralization), and each provider's integration (centrality). Nested multivariable logistic regressions controlling for patient mix and provider specialty simultaneously examined the risk of any (incident) and repeated (prevalent) inappropriate prescribing. Outcomes: Four behaviors defined by the CDC guidelines were examined: (1) more than 90 days continuous supply of high-dose opioid analgesics for chronic pain, (2) overlapping opioid supplies, (3) overlapping opioid and benzodiazepine prescriptions, and (4) prescribing an extended release opioid for an acute pain diagnosis. Results: Provider centrality was associated with reduced incidence of outcome (2) (OR: 0.95) and decreased prevalence of outcomes (1), (2), and (3). However, higher incidence (OR: 1.32) and prevalence (OR: 1.027) of outcome (4) were observed. Conversely, centralization associated with decreased incidence of (1) and (2) and lower prevalence of (1), (2), and (3). Conclusions: Greater provider integration is associated with a lower risk of a provider's patients repeatedly having potentially inappropriate prescription fills; however, the association with a provider having any potentially problematic prescription is more ambiguous. [ABSTRACT FROM AUTHOR]

Previous literature has demonstrated a gap between what health care consumers say they want to know about their physicians and the publicly available information the health care industry provides. This systematic analysis of Yelp reviews from the 25 most populous U.S. metropolitan areas is predicated on the assumptions that patients who post online physician reviews include information they would find useful when choosing a physician, and that this information represents an ecologically valid sample for making inferences regarding patients' decision making process. Obstetrician gynecologists are twice as likely to be reviewed as other physicians, but this is, to our knowledge, the first study examining online reviews of obstetrician-gynecologists specifically. This study contributes to the literature on medical decision making, demonstrating that the physician choice decision is made using a heuristic tallying model, in which only two, nearly equally weighted parameters are meaningful: patient (which, within the reviews, incorporates physician interpersonal manner and physician knowledge and skills) and office management. Yelp reviews of obstetrician-gynecologists follow patterns previously established in scholarship: ratings are bimodal, and approximately two-thirds are positive. In the absence of objective, user-friendly physician-level information, patients will turn to review sites like Yelp when choosing physicians. Rather than resisting this trend, physicians and hospital systems would be better served by working with review sites, or creating their own, to emphasize aspects of the experience patients are qualified to evaluate: the physician's interpersonal manner and office management. [ABSTRACT FROM AUTHOR]

The article presents a study on physicians' education under the Physician Payments Sunshine Act (PPSA) as well as its significance on the improvement of patient trust in the U.S. Discussed are issues on conflicts of interest (COI) in medical journals and studies on transparency at the medical care sector. Challenges on medical policy under the PPSA are explored.

An editorial is presented on arguments for physician aid-in-dying (PAD) for psychiatric disorders. Topics discussed include permitting PPAD would not have negative policy and practice implications serious enough to outweigh the intended merits; conflicts with the practice of involuntary commitment in psychiatry; and parity argument has the following form: If PAD for terminal physical illness is justified on the basis of suffering.

Objective: The aims of this study were: 1) to determine the short-term impact of the SleepTrackTXT2 intervention on air-medical clinician fatigue during work shifts and 2) determine the longer-term impact on sleep quality over 120 days. Methods: We used a multi-site randomized controlled trial study design with a targeted enrollment of 100 (ClinicalTrials.gov NCT02783027). The intervention was behavioral (non-pharmacological) and participation was scheduled for 120 days. Participation was voluntary. All consented participants answered baseline as well as follow-up surveys. All participants answered text message queries, which assessed self-rated fatigue, sleepiness, concentration, recovery, and hours of sleep. Intervention participants received additional text messages with recommendations for behaviors that can mitigate fatigue. Intervention participants received weekly text messages that promoted sleep. Our analysis was guided by the intent-to-treat principle. For the long-term outcome of interest (sleep quality at 120 days), we used a two-sample t-test on the change in sleep quality to determine the intervention effect. Results: Eighty-three individuals were randomized and 2,828 shifts documented (median shifts per participant =37, IQR 23–49). Seventy-one percent of individuals randomized (n = 59) participated up to the 120-day study period and 52% (n = 43) completed the follow-up survey. Of the 69,530 text messages distributed, participants responded to 61,571 (88.6%). Mean sleep quality at 120 days did not differ from baseline for intervention (p > 0.05) or control group participants (p > 0.05), and did not differ between groups (p > 0.05). There was no change from baseline to 120 days in the proportion with poor sleep quality in either group. Intra-shift fatigue increased (worsened) over the course of 12-hour shifts for participants in both study arms. Fatigue at the end of 12-hour shifts was higher among control group participants than participants in the intervention group (p < 0.05). Pre-shift hours of sleep were often less than 7 hours and did not differ between the groups over time. Conclusions: The SleepTrackTXT2 behavioral intervention showed a positive short-term impact on self-rated fatigue during 12-hour shifts, but did not impact longer duration shifts or have a longer-term impact on sleep quality among air-medical EMS clinicians. [ABSTRACT FROM AUTHOR]

Purpose: Physician review portals are becoming increasingly popular among patients and often serve as a primary advisory tool during the search for a doctor. However, it has not been established whether these platforms favor leaders of the field; i.e., physicians with high academic rank. Here, we assessed online ratings of US ophthalmologists, selected for their outstanding scientific performance.Methods: This cross-sectional, Internet-based study was performed in September 2016. First, we selected US ophthalmologists who published at least one manuscript or conference abstract that reached at least 100 citations from 2006 to 2016. Second, academic impact of preselected physicians, measured by overall number of citations or Hirsch index, was correlated with their ratings on two physician review portals: healthgrades.com and zocdoc.com.Results: We selected 105 ophthalmologists who met established criteria. A total of 78 were rated on healthgrades.com, but only two were rated on zocdoc.com. The average rating on healthgrades.com was 4.2 +/-0.9, similar to the previously reported US mean for a physician (∼4). The rating did not correlate with the number of citations or with Hirsh index.Conclusions: Highly cited ophthalmologist are not rated proportionately to their scientific achievements. Their reviews are positive, but do not stand out in comparison to other physicians. Additionally, we found that this group of ophthalmologists might be significantly underrepresented on particular review websites. [ABSTRACT FROM AUTHOR]

The inappropriate use of opioids in the United States has increased markedly and has resulted in a tragic loss of lives. To combat this problem, prescription drug monitoring programs (PDMPs) have been instituted in most states. Use of the programs is voluntary for prescribers in some states, whereas in other states it is mandatory. The current study used a self-report survey instrument that was administered to 223 participant physicians. The goal of the study was to compare awareness and use of the PDMP in a state that mandates use (Ohio) with one that does not (North Carolina). Although awareness was not significantly different between respondents from the two states, self-reported use was significantly higher in the state mandating use (Ohio post-mandate vs. Ohio pre-mandate: 64% vs. 51%; χ2 = 15.66, P <.0001; and Ohio post-mandate vs. North Carolina: 64% vs. 42%; χ2 = 12.76, P <.0001). Based on these results, mandating use may be an effective method to increase PDMP utilization. [ABSTRACT FROM AUTHOR]

Models of care for people living with HIV (PLWH) have varied over time due to long term survival, development of HIV-associated non-AIDS conditions, and HIV specific primary care guidelines that differ from those of the general population. The objectives of this study are to assess how often infectious disease (ID) physicians provide primary care for PLWH, assess their practice patterns and barriers in the provision of primary care. We used a 6-item survey electronically distributed to ID physician members of Emerging Infections Network (EIN). Of the 1248 active EIN members, 644 (52%) responded to the survey. Among the 644 respondents, 431 (67%) treated PLWH. Of these 431 responders, 326 (75%) acted as their primary care physicians. Responders who reported always/mostly performing a screening assessment as recommended per guidelines were: (1) Screening specific to HIV (tuberculosis 95%, genital chlamydia/gonorrhoea 77%, hepatitis C 67%, extra genital chlamydia/gonorrhoea 47%, baseline anal PAP smear for women 36% and men 34%); (2) Primary care related screening (fasting lipids 95%, colonoscopy 95%, mammogram 90%, cervical PAP smears 88%, depression 57%, osteoporosis in postmenopausal women 55% and men >50 yrs 33%). Respondents who worked in university hospitals, had <5 years of ID experience, and those who cared for more PLWH were most likely to provide primary care to all or most of their patients. Common barriers reported include: refusal by patient (72%), non-adherence to HIV medications (43%), other health priorities (44%), time constraints during clinic visit (43%) and financial/insurance limitations (40%). Most ID physicians act as primary care providers for their HIV infected patients especially if they are recent ID graduates and work in university hospitals. Current screening rates are suboptimal. Interventions to increase screening practices and to decrease barriers are urgently needed to address the needs of the aging HIV population in the United States. [ABSTRACT FROM AUTHOR]

Following a concussion, both cognitive and physical rest are imperative aspects of injury management. The inclusion of academic adjustments and the formation of an interprofessional concussion management team (ICMT) provide a mechanism to manage academic issues following a concussion. As one of the sole healthcare providers presents during school hours, the school nurse may offer unique insight regarding the infrastructure of an ICMT in the secondary school setting. The purpose of this study was to explore school nurses’ perceptions of and experiences with an ICMT for adolescents following a concussion in the secondary school setting. The consensual qualitative research approach was used to guide this study. Semi-structured individual telephone interviews were conducted with 15 school nurses employed in the secondary school setting across the United States. During data analysis, themes and categories were established based on a consensus process by the research team. Study findings indicated that school nurses identified several stakeholders regarding the concussion management team that are essential to include in the concussion management process. In addition to the school nurse, participants perceived an ICMT should include a physician, athletic trainer, school counsellor, teachers, and other stakeholders such as the patient and their parents. Additionally, participants discussed their perceptions of their own role as a member of an ICMT in the secondary school setting. The inclusion of an ICMT to aid the recovery following a concussion is vital to ensure proper care for the adolescent patient. Furthermore, the school nurse and athletic trainer must effectively collaborate, when possible, to ensure that concussed adolescents are allowed sufficient cognitive rest via the incorporation of academic adjustments during the recovery process. [ABSTRACT FROM PUBLISHER]

Twilight Sleep (TS) is an obstetric intervention during which a laboring woman enters a semiconscious state via injection. TS received enthusiastic support in Brooklyn, NY, inThe Brooklyn Eagle(TBE) newspaper between 1914 and 1918. The purpose of this article is to analyze the framing of TS inTBEas the most popular obstetric intervention among wealthy, White socialites in Brooklyn during the period. The coverage inTBEprompted a nearly universally positive perception of TS among the newspaper’s wider readership. After extensive historiographical research and rhetorical analysis of newspaper coverage of TS inTBE, we discovered a form of framing we call “high-society framing,” rooted in both wealth and notoriety. We discuss four possible effects of high-society framing: The first is the ability of high-society framing to attract or repel the public regarding a health care issue, and the second is the impact of high-society framing on public perception of medical interventions, procedures, or pharmaceuticals. A third possible effect of high-society framing is that it can alter notions of necessity, and a fourth is that high-society framing can elicit a tacit acceptance of medical interventions, procedures, and pharmaceuticals, thus obfuscating risk. Finally, we argue that high-society framing has implications for the discussion of health care in present-day mediated discourses. [ABSTRACT FROM PUBLISHER]

More than 75,000 health care professionals worldwide share information and discuss treatments on Twitter, making it one of the most popular and influential social media sites for health. This engaging medium has enormous potential for establishing relationships and disseminating information among physicians, their colleagues, and patients. However, little is known about how physicians navigate Twitter and what challenges and benefits come from using the platform. By conducting in-depth interviews with 17 physicians who interact with Twitter at least once per week, it was revealed that physicians overcome concerns of privacy and time constraints to learn and share new research, connect with colleagues, manage online personas, and develop relationships with patients on a new level that goes beyond the typical office visit. Implications include the possibility of enriched patient-provider relationships due to physicians divulging opinions and personal information in a public forum to minimize established power structures and enable better communication. This exploratory study establishes that Twitter is fertile ground for future research to explore how the medium can influence patient behavior, alter attitudes, and influence communication between patients and providers. [ABSTRACT FROM AUTHOR]

The article discusses the transition of graduate medical education into New Accreditation System in accreditation requirements. It mentions that changes are for education training programs for Osteopathic (DO) and Allopathic (MD) physicians. It also mentions the need of library service re-boot in specific areas like residency curricula.

Background: Inhalant use by adolescents is cause for concern due to the early age of inhalant use initiation and the many short- and long-term health consequences that can occur concurrently with and subsequent to use. However, inhalant use research has been limited relative to the literature available on other drug use.Objectives: The present research examined long-term trends in inhalant use prevalence, demographic risk factors of inhalant use, and median grade level of first use.Methods: Monitoring the Future data from 1991 to 2011, which includes information drawn from United States eighth, tenth, and twelfth graders, were examined. The total sample comprised more than one million participants. Results were examined descriptively with figures and quantitatively with mixed-effects regression models of the effect of time on use rates.Results: Inhalant use prevalence rates generally declined over the selected period. Though rates of use by males and females decreased significantly, the proportion of females among lifetime users increased significantly. Whites, Hispanics, and members of uncategorized “other” ethnicities showed the highest prevalence rates. Although the proportion of Whites among lifetime users decreased significantly, the proportion of Hispanics and “other” ethnicities increased significantly. The median first use was between sixth and ninth grade.Conclusions/Importance: Results suggest a need to tailor inhalant use treatment and prevention programs to the needs of specific demographic groups and to target interventions early to prevent youth inhalant use. Strengths, limitations, and directions for future research are discussed. [ABSTRACT FROM PUBLISHER]

The 19th-century surgical theaters in which American gynecological science was perfected were sites animated by multiple forms—and myriad conceptions—of labor. While newly professionalized white medical men celebrated the work of their own hands in speeches and in published articles, the lives and work of enslaved women in these early clinical spaces were alternately effaced and re-imagined in support of dominant narratives of medical progress. Black women’s injuries, their suffering, their instances of endurance, and, indeed, their very bodies were made to testify to the prowess of their examining physicians. The black female test subjects who comprised the first cohorts subjected to the emergent gynecological technologies of the mid-19th-century labored under the condition of enslavement. Their value in the discursive and syntagmatic spaces of the case reports written about them during the latter decades of the century was, therefore, wrought through with the political economy of chattel slavery. This essay argues that the early clinical spaces created by the American medical men heralded as the founding fathers of American gynecology—including James Marion Sims and his colleague Nathan Bozeman—mark critical locations mapping slavery’s circuits of value production. Further, it troubles prevailing historiography of slavery and medicine by considering the repetitive representations of black women’s bodies as part of the reproductive work that they were called to do. [ABSTRACT FROM PUBLISHER]

Objective. Shift workers regularly report sleep problems, fatigue, and the need for recuperative rest between shifts (intershift recovery). We sought to characterize intershift recovery among emergency medical services (EMS) workers and the role of worker demographics and work-related factors. Methods. We combined cross-sectional survey data from two studies of EMS shift workers who completed standardized instruments, including the Occupational Fatigue Exhaustion Recovery (OFER) scale. A multivariable regression identified demographic and work factors most strongly associated with intershift recovery. Results. Mean intershift recovery among 450 EMS workers varied by clinical setting, general health status, length of work shift, sleep quality score, fatigue score, and daytime sleepiness. Recovery was better for EMS workers who report greater satisfaction with their schedule, higher for shift schedules >12 hours, and lowest for individuals who usually work 12-hour shifts. Conclusion. In this sample of EMS workers, greater recovery between shifts is associated with satisfaction with scheduling and longer shift length. There were weaker associations of recovery with health status, sleep quality, and workplace fatigue. Future studies should address the relationship of intershift recovery with time off between shifts, workload, and workplace safety and performance. [ABSTRACT FROM AUTHOR]

Shortly before and during the Second World War, Japanese doctors and medical researchers conducted large-scale human experiments in occupied China that were at least as gruesome as those conducted by Nazi doctors. Japan never officially acknowledged the occurrence of the experiments, never tried any of the perpetrators, and never provided compensation to the victims or issued an apology. Building on work by Jing-Bao Nie, this article argues that the U.S. government is heavily complicit in this grave injustice, and should respond in an appropriate way in order to reduce this complicity, as well as to avoid complicity in future unethical medical experiments. It also calls on other U.S. institutions, in particular the Presidential Commission for the Study of Bioethical Issues, to urge the government to respond, or to at least inform the public and initiate a debate about this dark page of American and Japanese history. [ABSTRACT FROM AUTHOR]

Joseph Barratt was a British-born and educated physician who settled in the United States in 1819. He had a great interest in natural history, collecting both plants and insects and studying geology, mycology, ornithology, chemistry, meteorology, Native Americans, and local history. He was apparently a man of great energy and ambition but one who could not focus to see a project to completion. Barratt was active in the early history of the discovery of vertebrate footprints in the Newark Supergroup in the eastern United States but latter developed some very strange theories regarding the age and significance of these deposits. In his latter years, Barratt's mental state deteriorated and he became even more obsessed with trying to publicize his outlandish theories. Dr. Joseph Barratt is remembered in ichnology for basically two things; he sold Edward Hitchcock a superb specimen of vertebrate tracks; and he may have the most elaborate ichnological tombstone ever constructed. [ABSTRACT FROM AUTHOR]

The article reports that developments in the financing and delivery of the U.S. health care have made it a highly profitable commercial enterprise in which doctors increasingly play the role of entrepreneurs or corporate hirelings and patients the role of consumers. Efforts to reduce health care spending that encourage physicians to withhold potentially beneficial medical care from patients to save money add momentum to the regression.

Background: The use of outpatient parenteral antimicrobial therapy (OPAT) is standard medical practice; however, significant heterogeneity in practice exists. We hypothesized that formal OPAT programs are associated with increased physician participation in patient safety activities. Methods: United States Infectious Disease (ID) physicians were contacted and asked to participate in an electronic survey from April through June 2012. Data were analyzed using SPSS version 20. Results: In all, 3718 physicians were contacted and 316 (8.5%) responded. Respondents practice in 47 states; the majority (79%) practice adult ID, 11% pediatric ID, 10% a combination of the two. Sixty percent reported that ID consultation was not mandatory before OPAT, and 75% of these respondents thought it should be compulsory. The most common indications were osteomyelitis, prosthetic joint infections, and endocarditis, and the most common antibiotics were vancomycin, ceftriaxone, and ertapenem. Most respondents (59%) discharge patients with OPAT weekly, and have a median number of 11 OPAT patients (95% confidence interval (CI) 8.5-13.4). Half of respondents have a formal OPAT program. Fifty-two percent report no systematic method of communication between inpatient and outpatient physicians when patients are discharged with OPAT, 49% have no systematic method of lab tracking, and 34% have no method of ensuring patient adherence to clinic visits. All of these patient safety measures were more likely to be present in practice sites with formal OPAT programs (p < 0.001). Conclusions: Opportunities exist for improving OPAT monitoring and patient safety. Formal OPAT programs provide the framework for safe and effective care and are to be encouraged. [ABSTRACT FROM AUTHOR]

Introduction. In the United States, out-of-hospital cardiac arrest from drug overdose (OD-OHCA) caused over 38,000 deaths in 2010. A study in Pittsburgh found that OD-OHCA patients differed demographically and in the resuscitation treatments they received, despite identical AHA resuscitation guidelines. We hypothesized that health-care provider perceptions affect decision-making in the treatment of OD-OHCA versus non-OD OHCA. Methods. We conducted this survey at the National Association of EMS Physicians 2013 Scientific Assembly. Physicians and non-physician health-care providers were given one of two surveys containing 19 questions pertaining to the respondents' affiliated EMS agencies, the estimated proportion of OD-OHCA as well as the drugs involved, and the respondents' belief about the treatments for OD versus non-OD OHCA. Results. One hundred ninety-three respondents participated in this survey. Of the 193, 144 (75%) were physicians and 49 (25%) were nonphysicians. Seventy-nine percent of physicians identified current status as a medical director and 76% of nonphysicians identified as a paramedic. Participants estimated the average monthly proportion of all OHCA due to OD to be 9.4%. Participants ranked opioids, alcohol, antidepressants, and benzodiazepines as the most commonly utilized agents in OD-OHCA. The majority of physicians (42%) felt that the incidence of OD-OHCA was not changing while the majority of nonphysicians (53%) felt the incidence was increasing. Eighty-four percent of all respondents reported the use of naloxone during OD-OHCA resuscitation, while 13% reported administering naloxone during non-OD OHCA resuscitation. Eighty-nine percent of physicians and 67% of nonphysicians indicated that OD-OHCA patients had different demographics than non-OD OHCA, with primary reported differences being age, comorbidities, and socioeconomic status. Sixty-three percent of physicians and 71% of nonphysicians felt that OD-OHCA patients should be treated differently, with primary differences being the incorporation of etiology-specific treatments, performing different CPR with a focus on airway support, and transporting earlier. Conclusions. When surveyed, physicians and nonphysician providers report perceiving OD-OHCA treatment, outcomes, and patient demographics differently than non-OD OHCA and making different treatment decisions based on these perceptions. This may result in etiology-oriented resuscitation in the out-of-hospital setting, despite the lack of OD-specific resuscitation guidelines. [ABSTRACT FROM AUTHOR]

[ABSTRACT FROM PUBLISHER]

Objective: The article studied the knowledge and practice patterns of primary care providers and internal medicine residents in their initial evaluation of thyroid nodules and determined whether their practice is in accordance with published guidelines by the American Thyroid Association and American Association of Clinical Endocrinologists. Method: A survey was distributed to primary care physicians (PCPs) and internal medicine residents at a community hospital in Baltimore and a chart review was conducted at the Diabetes and Endocrine Center in the same hospital. Results: A total of 47 physicians (70%) responded to the survey, 16 PCPs and 33 residents. Most responders (96%) will always obtain a TSH, and of these, 21% of PCP and 25% of residents will obtain a TSH without any other laboratory work-up. Fifty percent of the physicians (PCP, 75%; resident, 39%) will always obtain a thyroid ultrasound (p=0.043). Most physicians (97%) will refer for a fine-needle aspiration (FNA) biopsy of a nodule >1 cm. Sixty-two percent of the physicians will not put a euthyroid patient on levothyroxine suppression therapy. Many physicians (48%) are not aware of the AACE and ATA thyroid nodule guidelines. Most physicians (65%) have not read the guidelines. Of the 113 charts reviewed, TSH was obtained alone in 40% and with other laboratory tests in 74%. Thyroid ultrasound was done in 67%. Only one patient was on levothyroxine for levothyroxine suppression therapy. Discussion: Although many physicians were not aware of the guidelines, and a small number of physicians have read them, many PCP and residents responded in concordance with the guidelines in obtaining TSH, an ultrasound, performing FNA biopsy, and not providing levothyroxine suppressive therapy in euthyroid patients. No differences were found between the responses of PCP and residents except for obtaining an ultrasound. Chart review data also showed that majority of tests ordered for non-toxic thyroid nodule evaluation were in agreement with the guidelines. Limitations include lowsurvey response rate among PCPs and that results are from one community hospital. Conclusion: Our findings from the survey and chart review conclude that majority of primary care physicians were initiating the appropriate work up of thyroid nodules prior to referral to a specialist. [ABSTRACT FROM AUTHOR]