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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]

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]

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]

Copyright of Croatian Nursing Journal is the property of University of Applied Health Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

This American College of Physicians position paper aims to inform ethical decision making surrounding participation in short term global health clinical care experiences. Although the positions are primarily intended for practicing physicians, they may apply to other health care professionals and should inform how institutions, organizations, and others structure short-term global health experiences. The primary goal of short-term global health clinical care experiences is to improve the health and well-being of the individuals and communities where they occur. In addition, potential benefits for participants in global health include increased awareness of global health issues, new medical knowledge, enhanced physical diagnosis skills when practicing in low technology settings, improved language skills, enhanced cultural sensitivity, a greater capacity for clinical problem solving, and an improved sense of self-satisfaction or professional satisfaction. However, these activities involve several ethical challenges. Addressing these challenges is critical to protecting patient welfare in all geographic locales, promoting fair and equitable care globally, and maintaining trust in the profession. This paper describes 5 core positions that focus on ethics and the clinical care context and provides case scenarios to illustrate them. [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]

The U.S. health care system is undergoing a shift from individual clinical practice toward team-based care. This move toward team-based care requires fresh thinking about clinical leadership and responsibilities to ensure that the unique skills of each clinician are used to provide the best care for the patient as the patient's needs dictate, while the team as a whole must work together to ensure that all aspects of a patient's care are coordinated for the benefit of the patient. In this position paper, the American College of Physicians offers principles, definitions, and examples to dissolve barriers that prevent movement toward dynamic clinical care teams. These principles offer a framework for an evolving, updated approach to health care delivery, providing policy guidance that can be useful to clinical teams in organizing the care processes and clinician responsibilities consistent with professionalism. [ABSTRACT FROM AUTHOR]

The environment in which physicians practice and patients receive care continues to change. Increasing employment of physicians, changing practice models, new regulatory requirements, and market dynamics all affect medical practice; some changes may also place greater emphasis on the business of medicine. Fundamental ethical principles and professional values about the patient-physician relationship, the primacy of patient welfare over self-interest, and the role of medicine as a moral community and learned profession need to be applied to the changing environment, and physicians must consider the effect the practice environment has on their ethical and professional responsibilities. Recognizing that all health care delivery arrangements come with advantages, disadvantages, and salient questions for ethics and professionalism, this American College of Physicians policy paper examines the ethical implications of issues that are particularly relevant today, including incentives in the shift to value-based care, physician contract clauses that affect care, private equity ownership, clinical priority setting, and physician leadership. Physicians should take the lead in helping to ensure that relationships and practices are structured to explicitly recognize and support the commitments of the physician and the profession of medicine to patients and patient care. [ABSTRACT FROM AUTHOR]

If Sir William Osler were alive and practising as one of our contemporary colleagues, would he be viewed as a role model by medical trainees and other physicians? Recently published literature has sought to define clinical excellence; this characterisation of physician performance establishes a context in which role models in medicine can be appraised. Building on this framework, we present rich anecdotes and quotes from Sir William Osler himself, his colleagues, and his students to consider whether Osler would have been regarded as a role model for clinical excellence today. This paper illustrates convincingly that William Osler indeed personified clinical excellence and would have been appreciated as a consummate role model if he were alive and on a medical school's faculty today. However, a century has passed since his death, and he is not sufficiently visible today to serve as a role model to modern medical trainees and physicians. Moreover, we speculate that Osler himself would not have wanted to be a role model for today's trainees, as he emphasised that medicine is best learned from teachers at the bedside-a place where he cannot be. Reanimating Osler through rich stories and inspiring quotes, and translating his example of clinical excellence into modern clinical practice, can remind us all to carry Oslerian virtues with us in our professional work. [ABSTRACT FROM AUTHOR]

In this position paper, the American College of Physicians (ACP) examines the rationale for patient and family partnership in care and reviews outcomes associated with this concept, including greater adherence to care plans, improved satisfaction, and lower costs. The paper also explores and acknowledges challenges associated with implementing patient- and family-centered models of care. On the basis of a comprehensive literature review and a multistakeholder vetting process, the ACP's Patient Partnership in Healthcare Committee developed a set of principles that form the foundation for authentic patient and family partnership in care. The principles position patients in their rightful place at the center of care while acknowledging the importance of partnership between the care team and patient in improving health care and reducing harm. The principles state that patients and families should be treated with dignity and respect, be active partners in all aspects of their care, contribute to the development and improvement of health care systems, and be partners in the education of health care professionals. This paper also recommends ways to implement these principles in daily practice. [ABSTRACT FROM AUTHOR]

Summary: Three separate but related ideas build on van Deventer’s concept of the “meta-placebo” effect in which placebo effects are hypothesized to help patients even when patients know they are receiving a placebo. First, a method is proposed to experimentally validate the meta-placebo effect without lying to experimental subjects. Second, the idea of a meta-placebo is extended to a condition where patients experience many of the elements of placebo treatments that are hypothesized to cause placebo benefits, such as an optimistic prognosis by a doctor, but patients do not actually take a placebo pill: a “curabo effect”. The final section proposes that patients might be able to experience enough placebo- and -curabo-related treatment elements to gain a beneficial effect without either a pill or a doctor. Instead, simply having the knowledge that one can derive medical benefit from placebo, meta-placebo, and -curabo treatments, and without medicine, might in itself suffice to cause some to feel better: the hypothesized meta-meta-placebo and -curabo (or “meta-bo,” for short) effect. [Copyright &y& Elsevier]

Focuses on the reaction of the British Medical Association to the proposals contained in the white paper 'Working for Patients' in Great Britain. Concerns on the harmful effects of the proposals; Opposition to centralized bureaucracy and the methods for paying doctors; Criticisms on the lack of proper consultation with the medical profession.

A personal narrative is presented which explores the author's experiences of the realities of his workday after a patient asks why doctors are complaining about the bureaucratic oversight of the payers.

Objective: Our objective was to explore the influence of health literacy on patient-physician communication. Methods: We conducted a scoping review of academic papers using PRISMA guidelines and guidance from the Joanna Briggs Institute. We explored health literacy competencies in studies by examining methods used to evaluate the effectiveness of patient-physician communication and identifying barriers and facilitators to communication in the broader context of relevant health literacy domains. Results: In total, we identified 51 papers that met inclusion criteria. Barriers to effective patient-physician communication were physicians' lack of understanding of patients' health literacy capacity, changes in healthcare delivery (time constraints and transforming technology due to COVID-19), and language barriers. Facilitators to communication included patient health literacy level, patient trust in the patient-physician relationship leading to decision-making, telehealth/digital health services, health literacy tools, and patient education materials. Conclusion: Future research, policy, and practice should aim for comprehensive assessment of all health literacy domains crucial for patient-physician communication. Delineating health literacy competencies is essential given increasing emphasis on technological resources in healthcare, culturally and linguistically appropriate care in multicultural societies, and addressing service backlogs precipitated by the COVID-19 pandemic. Findings may inform educational programs focused on health literacy. [ABSTRACT FROM AUTHOR]

In Antarctica, it is extremely difficult to organise medical evacuations in winter. Antarctic physicians are often alone and must be prepared to perform surgery and dentistry, even if they are not specialists. This scoping review summarises epidemiological data on the types of surgical procedures performed in Antarctica and identifies gaps in the literature in this area. We searched PubMed and Google Scholar, without language restriction, for papers published between 1 January 1904, and 1 February 2022. Of the 35 papers on 12 Antarctic programs, very few were retrospective observational epidemiological studies; the majority were medical reports. The search identified 41 surgical procedures or reasons for surgical consultation, 19 different reasons for medical evacuations, and 12 causes of death that may have required surgical management. The diagnostic classifications used and the prevalence of each reported surgical speciality were heterogeneous. The most cited specialities were orthopaedics, dentistry, and digestive surgery. Telemedicine was integrated into on-site care or medical evacuation decisions. The current literature is poor, and most studies do not apply to surgical issues. The heterogeneous data collection methodologies limit their interpretation. A standardised diagnostic classification and detailed and systematic epidemiological registers will help define the contours of surgical management in Antarctica. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether the use of the think-aloud method with propositional analysis could be helpful in the design of a Clinical Decision Support System (CDSS) providing guideline recommendations about long-term follow-up of childhood cancer survivors.Materials and Methods: The think-aloud method was used to gain insight into healthcare professionals' information processing while reviewing a paper-based guideline. A total of 13 healthcare professionals (6 physicians and 7 physician assistants) prepared 2 fictitious patient consults using the paper-based guideline. Propositional analysis was used to analyze verbal protocols of the think-aloud sessions. A prototype CDSS was developed and a usability study was performed, again with the think-aloud method.Results: The analysis revealed that the paper-based guideline did not support healthcare practitioners in finding patient-specific recommendations. An information processing model for retrieving recommendations was developed and used as input for the design of a CDSS prototype user interface. Usability analysis of the prototype CDSS showed that the navigational structure of the system fitted well with healthcare practitioners' daily practices.Conclusions: The think-aloud method combined with propositional analysis of healthcare practitioners' verbal utterances while they processed a paper-based guideline was useful in the design of a usable CDSS providing patient-specific guideline recommendations. [ABSTRACT FROM AUTHOR]

Background: The Interior Health Authority Physician Quality Improvement initiative implemented a dyadic leadership model in 2018. The model pairs medical and operational partners to foster a culture of learning, trust, and shared vision. Successful dyadic partnerships facilitate alignment of core values, develop collaborative relationships, demonstrate transparent communication, value complementary competencies, and model mutual respect. Methods: The rapid review methodology and survey design are published in a white paper titled "Dyadic Leadership Model--Why It Works." This article discusses the dyadic leadership factors supported through the rapid review and survey. Participant impact statements from the survey results support the discussion. Conclusions: The dyadic leadership model has become the expectation of new participants in the Interior Health Authority Physician Quality Improvement program. Feedback from cohort alumni has expressed the strength of the dyadic partnership. This model has become a core component of the program, as it provides valuable links between medical and operational partners. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this paper is to empirically describe and analyze factors deemed to be relevant for the successful provision of coordinated paediatric oncology care by physicians and nurses involved. Design/methodology/approach: A qualitative case study primarily consisting of interviews. Findings: The paper's findings indicate that certain factors (i.e. distinct mission, clear treatment protocols and support from external stakeholders) relevant for the provision of coordinated paediatric oncology care have not received sufficient attention in previous research. In addition, emphasis is placed on the necessity of facilitating constructive working relationships and a bottom-up perspective when pursuing improved care coordination. Originality/value: The factors described and analyzed may act as insights for how paediatric oncology might be improved in terms of care coordination and thus facilitate care integration. In addition, the paper's findings identify factors relevant for further empirical studies in order to delineate their generalizability. [ABSTRACT FROM AUTHOR]

Background: Inequities in health have garnered international attention and are now addressed in Sustainable Development Goal 3 (SDG3), which seeks to 'promote well-being for all'. To attain this goal globally requires innovative approaches, one of which is twinning. According to the International Confederation of Midwives, twinning focusses on empowering professionals, who can subsequently be change-agents for their communities. However, twinning in healthcare is relatively new and because the definition and understanding of twinning lacks clarity, rigorous monitoring and evaluation are rare. A clear definition of twinning is essential for the development of a scientific base for this promising form of collaboration. Method: We conducted a Concept Analysis (CA) of twinning in healthcare using Morse's method. A qualitative study of the broad literature was performed, including scientific papers, manuals, project reports, and websites. We identified relevant papers through a systematic search using scientific databases, backtracking of references, and experts in the field. Results: We found nineteen papers on twinning in healthcare. This included twelve peer reviewed research papers, four manuals on twinning, two project reports, and one website. Seven of these papers offered no definition of twinning. In the other twelve papers definitions varied. Our CA of the literature resulted in four main attributes of twinning in healthcare. First, and most frequently mentioned, was reciprocity. The other three attributes were that twinning: 2) entails the building of personal relationships, 3) is dynamic process, 4) is between two named organisations across different cultures. The literature also indicated that these four attributes, and especially reciprocity, can have an empowering effect on healthcare professionals. Conclusions: Based on these four attributes we developed the following operational definition: Twinning is a crosscultural, reciprocal process where two groups of people work together to achieve joint goals. A greater understanding and a mature definition of twinning results in clear expectations for participants and thus more effective twinning. This can be the starting point for new collaborations and for further international studies on the effect of twinning in healthcare. [ABSTRACT FROM AUTHOR]

This paper discusses the key role medical regulators have in setting standards for doctors who use artificial intelligence (AI) in patient care. Given their mandate to protect public health and safety, it is incumbent on regulators to guide the profession on emerging and vexed areas of practice such as AI. However, formulating effective and robust guidance in a novel field is challenging particularly as regulators are navigating unfamiliar territory. As such, regulators themselves will need to understand what AI is and to grapple with its ethical and practical challenges when doctors use AI in their care of patients. This paper will also argue that effective regulation of AI extends beyond devising guidance for the profession. It includes keeping abreast of developments in AI-based technology and considering the implications for regulation and the practice of medicine. On that note, medical regulators should encourage the profession to evaluate how AI may exacerbate existing issues in medicine and create unintended consequences so that doctors (and patients) are realistic about AI's potential and pitfalls when it is used in health care delivery. [ABSTRACT FROM AUTHOR]

Context: The COVID-19 pandemic has reignited a commitment from the health policy and health services research communities to rebuilding trust in healthcare and created a renewed appetite for measures of trust for system monitoring and evaluation. The aim of the present paper was to develop a multidimensional measure of trust in healthcare that: (1) Is responsive to the conceptual and methodological limitations of existing measures; (2) Can be used to identify systemic explanations for lower levels of trust in equity-deserving populations; (3) Can be used to design and evaluate interventions aiming to (re)build trust. Methods: We conducted a 2021 review of existing measures of trust in healthcare, 72 qualitative interviews (Aug-Dec 2021; oversampling for equity-deserving populations), an expert review consensus process (Oct 2021), and factor analyses and validation testing based on two waves of survey data (Nov 2021, n = 694; Jan-Feb 2022, n = 740 respectively). Findings: We present the Trust in Multidimensional Healthcare Systems Scale (TIMHSS); a 38-item correlated three-factor measure of trust in doctors, policies, and the system. Measurement of invariance tests suggest that the TIMHSS can also be reliably administered to diverse populations. Conclusions: This global measure of trust in healthcare can be used to measure trust over time at a population level, or used within specific subpopulations, to inform interventions to (re)build trust. It can also be used within a clinical setting to provide a stronger evidence base for associations between trust and therapeutic outcomes. [ABSTRACT FROM AUTHOR]

The healthcare system aims to provide a reliable and organized solution to enhance the health of human society. Studying the history of patients can help physicians to consider patients' needs in healthcare system designing and offering service, which leads to an increase in patient satisfaction. Therefore, healthcare is becoming a growing contesting market. With this significant growth in healthcare systems, such challenges as huge data volume, response time, latency, and security vulnerability are raised. Therefore, fog computing, as a well-known distributed architecture, could help to solve such challenges. In fog computing architecture, processing components are placed between the end devices and cloud components, and they execute applications. This architecture is suitable for such applications as healthcare systems that need a real-time response and low latency. In this paper, a systematic review of available approaches in the field of fog-based healthcare systems is proposed; the challenges of its application in healthcare are explored, classified, and discussed. First, the fog computing approaches in healthcare are categorized into three main classes: communication, application, and resource/service. Then, they are discussed and compared based on their tools, evaluation methods, and evaluation metrics. Finally, based on observations, some open issues and challenges are highlighted for further studies in fog-based healthcare. [ABSTRACT FROM AUTHOR]

This paper presents a review of the most recent and popular research papers on the use of artificial intelligence in the healthcare sector. SMEs consist of 60-65% of Indian medical device market. Many doctors are operating through private hospitals which come under the category of SMEs segment. Technology is proving to be a boon for all the sectors, artificial intelligence an emerging technology has the potential to change the fortune of SMEs in health care sector. In this paper there will be discussion on how artificial intelligence can help the healthcare sector in different ways. SMEs working in healthcare can take a learning from this paper and can utilize it for betterment. [ABSTRACT FROM AUTHOR]

The article presents a paper that explores ways in which general practitioners make sense of the changing political economy of this relationship. It explains that the interpersonal relationship between doctor and patient is fundamental to general medical practice. However, it is restructured by ideas about the patient as consumer, and as it increasingly constitutes the consultation as a point of interaction that may be intrinsically therapeutic. In particular, ways are explored in which consultation is the site of negotiated power relations between doctor and patient, and is the site of the doctor's negotiation of powerful discourses of professional and institutional identity. It develops some ideas about the relationship between doctors and patients in general practice. It focuses on the ways in which the professional rhetoric of general practice has come to be organized around a very specific view of the possibilities that arise from this relationship.

What research has been done to characterize the outcomes of disciplinary action or fitness-to-practice cases for regulated health professionals? To answer this research question, relevant publications were identified in PubMed, Ovid EMBASE, CINAHL via EBSCOhost, and Scopus. Included papers focused on reviews of regulatory body disciplinary action for regulated health professionals. Of 108 papers that were included, 84 studied reasons for discipline, 68 studied penalties applied, and 89 studied characteristics/predictors of discipline. Most were observational studies that used administrative data such as regulatory body discipline cases. Studies were published between 1990-2020, with twothirds published from 2010-2020. Most research has focused on physicians (64%), nurses (10%), multiple health professionals (8.3%), dentists (6.5%) and pharmacists (5.5%). Most research has originated from the United States (53%), United Kingdom (16%), Australia (9.2%), and Canada (6.5%). Characteristics that were reviewed included: gender, age, years in practice, practice specialty, license type/profession, previous disciplinary action, board certification, and performance on licensing examinations. As most research has focused on physicians and has originated from the United States, more research on other professions and jurisdictions is needed. Lack of standardization in disciplinary processes and definitions used to categorize reasons for discipline is a barrier to comparison across jurisdictions and professions. Future research on characteristics and predictors should be used to improve equity, support practitioners, and decrease disciplinary action. [ABSTRACT FROM AUTHOR]

Copyright of Annali di Igiene, Medicina Preventiva e di Comunità is the property of Societa Editrice Universo s.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The General Medical Council (GMC) instructs doctors to act 'reasonably' in obtaining consent from patients. However, the GMC does not explain what it means to be reasonable: it is left to doctors to figure out the substance of this instruction. The GMC relies on the Supreme Court's judgment in Montgomery v Lanarkshire Health Board; and it can be assumed that the judges' idea of reasonability is adopted. The aim of this paper is to flesh out this idea of reasonability. This idea is commonly personified as the audience that has to be satisfied by the doctor's justification for offering, or withholding, certain treatments and related information. In case law, this audience shifted from a reasonable doctor to a 'reasonable person in the patient's position'; and Montgomery expands the audience to include 'particular' patients, too. Senior judges have clarified that the reasonable person is a normative ideal, and not a sociological construct; but they do not set out the characteristics of this ideal. John Rawls has conceived the reasonable person-ideal as one that pursues fair terms of co-operation with other members of society. An alternative ideal can be inferred from the feminist ethic of care. However, the reasonable patient from Montgomery does not align with either theoretical ideal; but, instead, is an entirely rational being. Such a conception conflicts with both real-life constraints on rationality and the doctor's duty to care for the patient, and it challenges the practice of medicine. [ABSTRACT FROM AUTHOR]

Objective: Physician density is a crucial element of a well-functioning health system. Previous research has investigated factors affecting country-level physician supply. To date, however, no evidence has been provided about the patterns of convergence in physician density among countries. This paper thus tested club convergence in physician density in 204 countries worldwide from 1990 to 2019. A nonlinear time-varying factor model was adopted to identify potential clubs, wherein groups of countries tend to converge towards the same level of physician density. Our primary purpose was to document the potential long-lasting disparity in future global physician distribution. Results: Despite physician density increasing in all regions globally from 1990 to 2019, we found no evidence in favor of the hypothesis of global convergence. Conversely, the clustering algorithm successfully identified three main patterns (i.e., three final clubs). With few exceptions, the results indicated an uneven physician distribution between the majority of North and Sub-Saharan African countries (where physician density would remain well below the estimated threshold of at least 70% of the Universal Health Coverage Services Index) and the rest of the world. These findings support the WHO's global strategy to reverse the chronic under-investment in human resources for health. [ABSTRACT FROM AUTHOR]

Telemedicine improves health care services in remote area by providing virtual communication between patients and medical practitioners. Most of the modern clinical diagnosis uses digital images to diagnose and examine diseases. Telemedicine requires transfer of medical images between doctors or medical experts. A patient's medical image may contain his personal information, hence it is to be kept secure. It is crucial to protect the medical images from a third person's access, during transmission. Image encryption is a convenient method to conserve the medical images. Researches are going on in the area of medical image encryption in telemedicine. This paper presents a survey on recently used image encryption techniques in telemedicine. [ABSTRACT FROM AUTHOR]

The author reflects on the role of physicians in providing medical care. The author elaborates a case study about the Arthur Conan Doyle, a physician and a fictional character who happened to be a genius. The author stressed that genius may have an infinite capacity for taking pains however, it does not apply to detective work. He believes that both the doctor and detective are scientist and artists who labor to solve mysteries for their own intellectual curiosity and for the benefit of others.

The article presents abstracts of medical research papers from the North American Primary Care Research Group. They include "Continuity of Care and Trust in One's Physician: A Comparison of the United States and the United Kingdom," "How Do Family Physicians Make Cancer Screening Decisions With Unclear or Conflicting Guidelines: A National Survey Study," "Management of Mild Chronic Hypertension During Pregnancy: A Systematic Review of the Evidence" and "Posttraumatic and Somatization in Primary Care Patients."

At present, people and hospital management are wasting their time and wealth due to a lack of a smart system in the pre-examination process for patients. This paper discusses an approach to designing a healthcare system that collects necessary health condition data using a microcontroller-based smart system, the information from which is referred to an authorized device. The smart Health Care System is an economical healthcare device for a hospital; it obtains measurements of vital signs like temperature using a DS18B20 Digital Temperature Sensor, heartbeat and SpO2 level using pulse oximetry and a health rate sensor, and the height of a patient via an ultrasonic sensor, etc. The system contains a microcontroller, an Arduino UNO, and all the collected information from sensors is sent to the Arduino UNO. The LCD screen coupled with the Arduino UNO displays all measurements from the sensors. This project has an alert system that works according to the patient's condition; if there is an emergency, the RED LED will light up, and the system will generate an alert through a buzzer and send the information to the doctor using a Bluetooth system. This system can be placed before entering triage, used in the intensive care unit, or used as a personal device to monitor the health of a patient. [ABSTRACT FROM AUTHOR]

Clinical prediction plays a vital role in clinical care, as it informs healthcare professionals, patients, and their relatives of the possible disease outcome, helping them to make a medical decision and improve health outcomes, if possible. Much more credit is often given to a physician for a correct prognosis than for the acute diagnosis or skilled treatment that underlies his statement about the course of the disease and its termination. Hippocrates established medicine as a scientific profession based on clinical observation and rational inquiry. Hippocrates and his followers focused more on prognosis than diagnosis. He mastered the art of prognosis based on the patient’s signs and symptoms of diseases. The Book of Prognostics is a treatise attributed to him and fully dedicated to this prognostic approach. This book alone is sufficient to prove his greatness in terms of medical care and the art of healing. In this paper, his prognostic approach toward diseases with the help of signs and symptoms will be explored. [ABSTRACT FROM AUTHOR]

Background: Numerous publications show that electronic medical records (EMRs) may make an important contribution to increasing the quality of care. There are indications that particularly the medical specialist plays an important role in the use of EMRs in hospitals. Objective: The aim of this study was to examine how, and by which aspects, the relationship between EMR use and the quality of care in hospitals is influenced according to medical specialists. Methods: To answer this question, a qualitative study was conducted in the period of August-October 2018. Semistructured interviews of around 90 min were conducted with 11 medical specialists from 11 different Dutch hospitals. For analysis of the answers, we used a previously published taxonomy of factors that can influence the use of EMRs. Results: The professional experience of the participating medical specialists varied between 5 and 27 years. Using the previously published taxonomy, these medical specialists considered technical barriers the most significant for EMR use. The suboptimal change processes surrounding implementation were also perceived as a major barrier. A final major problem is related to the categories "social" (their relationships with the patients and fellow care providers), "psychological" (based on their personal issues, knowledge, and perceptions), and "time" (the time required to select, implement, and learn how to use EMR systems and subsequently enter data into the system). However, the medical specialists also identified potential technical facilitators, particularly in the assured availability of information to all health care professionals involved in the care of a patient. They see promise in using EMRs for medical decision support to improve the quality of care but consider these possibilities currently lacking. Conclusions: The 11 medical specialists shared positive experiences with EMR use when comparing it to formerly used paper records. The fact that involved health care professionals can access patient data at any time they need is considered important. However, in practice, potential quality improvement lags as long as decision support cannot be applied because of the lack of a fully coded patient record. [ABSTRACT FROM AUTHOR]

The article discusses the criticism that the use of routine consultations as an efficient way of promoting prevention is an abuse of the role of doctors and an infringement of patient autonomy. It is said that the basis of the argument proposed in favor of general practice is on the assumption the purpose of medical activity is to lessen illness and prolong life.

Physician health is strongly connected to patient health outcomes such that barriers to seeking help and medical care for impaired physicians may compromise patient safety and quality of care. It is important to understand and identify barriers that may reduce the likelihood of physicians seeking help. Using medical licensure questions that necessitate self-reporting of health conditions is one of the ways regulatory bodies such as the College of Physicians and Surgeons of Alberta (CPSA) seeks to protect the public and ensure physician competency. The objective of this paper is to review the current body of literature on the impact of these medical licensure questions on physician health-seeking behavior as well as patient care. Five online databases (Scopus, APA PsychINFO, Web of Science, PubMed, and MEDLINE) were searched using combined key terms to identify relevant articles. Based on the inclusion and exclusion criteria, nine primary quantitative studies were selected. Results suggest that licensure applications with questions on previous impairments and mental health condition acts as both a barrier to reporting and to seeking care. These findings highlight the need for further research in examining the utility of health licensure questions in identifying impaired physicians and their impact on the quality of patient care. [ABSTRACT FROM AUTHOR]

Aim: To evaluate disparities in the frequency of scientific activity between medical doctors and nurses in Peru. Methods: We carried out a secondary data analysis of the National Health Services Users' Satisfaction Survey (ENSUSALUD), 2016. This nationally representative survey evaluates doctors and nurses working in clinical settings. We defined scientific activity as i) having published an original article (journal indexed in Web of Science, Scopus or Medline); and ii) having authored an abstract in a national or international conference. We estimated crude and adjusted disparities prevalence ratios (aDPR) and 95% confidence intervals (95%CI). Results: We included 2025 doctors and 2877 nurses in the analysis; 71% of doctors doctor were male, and 93% of nurses were female (p<0.001). Among doctors, 13.9% had published an article, and 8.4% presented an abstract at a conference in the last two years, while these proportions were 0.6% and 2.5% for nurses, respectively. The adjusted models showed that doctors, when compared to nurses, were approximately 27 times likely to have published a paper (aDPR = 27.86; 95% CI 10.46 to 74.19) and twice as likely to have authored a conference abstract (aDPR = 2.51; 95% CI 1.39 to 4.53). Conclusions: There are important disparities in scientific activity between doctors and nurses working in clinical settings in Peru. Disparities are more significant for article publication than for authoring in conference abstracts. We suggest public policies that promote research dissemination between health professionals, with emphasis on nurses. [ABSTRACT FROM AUTHOR]

This year marks the 20th anniversary of the publication by the Institute of Mother and Child in Warsaw of a document establishing the Polish standards for preventive health care of school-age children and adolescents by general practitioners, which are still in force today. Since then, their health status and the health risk factors have changed. Polish society and its expectations of health care are also different. The Polish economy has grown, and the proportion of the public budget spent on health care has increased. The current system of preventive health care for young people seems to be facing a problem. Over the past decade, the percentage of children and adolescents attending preventive medical visits in Poland has decreased by approximately 30%. During well-care visits, doctors commonly avoid selected physical examinations and sensitive topics, such as sexuality or mental health. It appears that most young people visit doctors only because they falsely believe that check-up visits are mandatory and usually rate the experience negatively. The co-authors of this paper conclude that there is a need for a broad debate on the Polish standards of preventive health care for adolescents and their possible reform, which would lead to their adaptation to the challenges of modern times and the opportunities offered by the progress of medical science and technology. The selection of topics is subjective and certainly does not cover all aspects requiring attention. The authors’ intention is to contribute to further discussion rather than to provide a basis for conclusions or postulates. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the Edwards-SAPIEN aortic valve trial by Makkar et al which was shortlisted for the ``Research Paper of the Year award 2013'' and had excluded allocated patients and was brought to attention by British Medical Journal (BMJ) in the May, 2013 issue.

The article reports on the importance of constant vigil to maintain a high standard of surgical care. To ensure that the proposed operation is still appropriate and that the patient has considered any alternative management is even more important. This gives the patient another opportunity to discuss probable side-effects of the operation. Also, it is important on the part of the surgeon to see the patient before the premedication because it is the strongest safeguard against a wrong operation.

Communication is critical to strong patient-physician relationships and high-quality health care. In recent years, advances in health information technology have altered how patients and doctors interact and communicate. Increasingly, e-communication outside of in-person clinical encounters occurs in many ways, including through e-mail, patient-portals, texting, and messaging applications. This American College of Physicians (ACP) position paper provides ethics and professionalism guidance for these forms of e-communication to help maintain trust in patient-physician relationships and the profession and alignment between patient and physician expectations. [ABSTRACT FROM AUTHOR]

Aim: To describe the facilitators and barriers perceived by healthcare teams after the implementation of the Awakening, Breathing, Coordination, Delirium monitoring/management and Early mobility bundle in an intensive care unit in Italy. This multicomponent intervention strategy has been associated with lower probabilities of delirium, improved functional outcomes and shorter duration of mechanical ventilation. Methods: A survey study conducted between June 2015 and May 2016 explored variables related to intensive care unit team members: perceptions of delirium; knowledge of the Awakening, Breathing, Coordination, Delirium monitoring/management and Early mobility bundle; teamwork perception and resource availability. Results: Most of the participants affirmed having reasonable knowledge of delirium, outcomes of delirious episodes, Awakening, Breathing, Coordination, Delirium monitoring/management and Early mobility bundle components and their effectiveness. Low coordination between healthcare professionals was identified as a barrier. Overall, the time elapsing from the beginning of implementation of the bundle determined an increase in levels of awareness and confidence in the application of the bundle protocol and the Confusion Assessment Method Intensive Care Unit scale. Conclusion: Issues with the Awakening, Breathing, Coordination, Delirium monitoring/management and Early mobility bundle relating to coordination, management and interdisciplinary ward rounds are critical and should be remedied and monitored. This study could provide the basis for improving bundle implementation strategies and surveying levels of progression in other intensive care units. Summary statements: What is already known about this topic? Many patients admitted to intensive care units acquire iatrogenic comorbidities. These conditions can complicate their recovery from critical illness and negatively affect their post‐discharge quality of life.The ABCDE bundle is an evidence‐based approach that can help to reduce the negative consequences of an intensive care unit stay.No literature describes health professionals' experiences of implementation of the whole ABCDE bundle in a European country. What this paper adds? The experiences of the ABCDE bundle implementation could provide a basis for the improvement of these strategies in other countries.The time elapsing from the beginning of implementation of the ABCDE bundle determines an increase in levels of awareness and confidence in the application of the ABCDE bundle protocol itself, and the CAM‐ICU scale. The implications of this paper: The implementation of the ABCDE bundle is feasible and may be perceived as necessary because of professionals' high awareness of the patient complications resulting from bed rest, delirium and prolonged mechanical ventilation.Issues with the ABCDE bundle relating to coordination, management and interdisciplinary ward rounds are critical and should be remedied and monitored.A longitudinal study could improve understanding of the long‐time effects of the bundle on patients' outcome. [ABSTRACT FROM AUTHOR]

Telemedicine has emerged as an effective means to connect health service providers with patients remotely. In the context of emergency care, telemedicine typically involves a telemedicine service hub (TSH) that matches remote physicians with patients in emergency wards. Effective operation of such systems requires careful and continuous coordination between physicians and local providers and as such, physician staffing and scheduling is a major managerial challenge that a TSH has to overcome. In this context, our paper studies a setting, where the TSH must respond to an arriving emergency case by assigning a physician within a considerably short time window. An emergency case at a facility can be matched only with a physician who is credentialed at that facility. Since care is urgent, queuing patients is not an option when there is no available on-shift physician. In such cases, the system must invoke the off-shift physicians, which is referred to as "blast." The telemedicine company tries to avoid this option due to high costs. We propose a novel integer programming model for generating physician schedules with optimal mix of credentials and coverage across multiple hospitals. The proposed model aims to minimize total costs under a chance constraint that limits the blast probabilities and other tactical constraints that are unique to this setting. Two fast acting heuristic-based solution approaches are developed for real-life size problems and their computational performances were demonstrated via numerical analyses. [ABSTRACT FROM AUTHOR]

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Networks form the backbone of any healthcare system. Various databases were searched with relevant keywords, data were abstracted, and numerous papers were appraised for this synthesis. This compiled systematic review gives a comprehensive overview of various networks that are found in healthcare, with a special reference to the treatment, referral, and best-practice care of patients. Special support networks, such as Clinical decision support systems, Physician collaboration networks, Telemedicine networks, and Shared healthcare record access, are also described, as these support networks play a pivotal role in improving the quality of healthcare for patients. [ABSTRACT FROM AUTHOR]

Today, the whole world is fighting the pandemic of COVID-19. In these circumstances, the medical professionals and Doctors are being viewed as the frontline warriors who are risking their lives for the sake of helping, caring, and curing these patients. However, in these difficult times, there are few medical professionals and health care providers who are taking advantage of this situation and milking distressed and distraught patients at will. A conflict between professional and personal ethical values makes them depressed and puzzled. It is tough for them to maintain a good image of their profession and business. The objectives of this study are to review the ethical conflict amid the ongoing Covid pandemic and post-Covid pandemic (vaccination period) in the context of medical professionals and health care providers. The paper is designed based on a literature review. Almost fifty-two research papers, articles, survey reports, and newspapers were studied in the context of ethics in business/profession. After reviewing moral distress is ongoing and post -pandemic period, the researchers have tried to present the medical professionals and health care providers' critical situation to give priority to their professional ethics or personal interest. [ABSTRACT FROM AUTHOR]