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Background: Somatisation is a highly prevalent psychiatric syndrome in both women and men, in which psychological distress is manifested in physical symptoms without a medical explanation. Many patients with somatisation disorder are high healthcare utilisers, particularly at emergency departments. Unnecessary investigations and diagnostic operations occur frequently, which cause both patient suffering and a significant burden on the healthcare system. Emergency department physicians' awareness of somatisation and its manifestations has not previously been studied. This study aimed to investigate awareness about somatisation disorder among physicians working at emergency departments in western Sweden, and to explore differences between gender, specialty, and work experience., Methods: A web-based, cross-sectional survey consisting of six dichotomous questions about somatisation disorder was conducted, in December 2021 - January 2022, among licensed physicians of various specialties working at emergency departments in western Sweden. Descriptive analyses and comparative analyses were performed to investigate differences between gender, type of specialty, and years of practice. Data were analysed using chi 2 tests and Fisher's exact test., Results: Of the 526 eligible physicians who received the survey, 241 responded; response rate 45.8%. The majority of the respondents (56.4%) were women, and most (35.3%) were specialised in obstetrics/gynaecology. Average years of work experience was 11.1 (SD 8.7) years. Although 71% of respondents were aware of the diagnosis, only 7% knew the diagnostic criteria and only 6% had ever diagnosed a patient with somatisation disorder. Female physicians were more aware of underlying factors than their male colleagues (55.7% vs. 38.2%; p = .010). Type of specialty or years of practice did not affect awareness., Conclusions: Awareness of somatisation disorder is low among physicians working at emergency departments in western Sweden. The findings suggest a need to increase awareness and knowledge and provide training in diagnosing the condition, to ensure correct decisions and optimal patient management. Clinical guidelines need to be developed to support diagnosis, investigation, and treatment, in Sweden as well as internationally., (© 2024. The Author(s).)

Postgraduate medical education is an essential societal enterprise that prepares highly skilled physicians for the health workforce. In recent years, PGME systems have been criticized worldwide for problems with variable graduate abilities, concerns about patient safety, and issues with teaching and assessment methods. In response, competency based medical education approaches, with an emphasis on graduate outcomes, have been proposed as the direction for 21st century health profession education. However, there are few published models of large-scale implementation of these approaches. We describe the rationale and design for a national, time-variable competency-based multi-specialty system for postgraduate medical education called Competence by Design. Fourteen innovations were bundled to create this new system, using the Van Melle Core Components of competency based medical education as the basis for the transformation. The successful execution of this transformational training system shows competency based medical education can be implemented at scale. The lessons learned in the early implementation of Competence by Design can inform competency based medical education innovation efforts across professions worldwide., Competing Interests: JRF, JK, LSS, FB, VN, ST, JF, KH, RST were employees of the Royal College.JS, AA, AO, AKH, LC, SD, DR, WJC, RBC, TD, BT, LF, WG, ND, BW, RS, RA, DD, AB, MG, and EVM performed contract work for the Royal College., (Copyright: © 2024 The Author(s).)

Despite the numerous calls for integrating quality improvement and patient safety (QIPS) curricula into health professions education, there are limited examples of effective implementation for early learners. Typically, pre-clinical QIPS experiences involve lectures or lessons that are disconnected from the practice of medicine. Consequently, students often prioritize other content they consider more important. As a result, they may enter clinical settings without essential QIPS skills and struggle to incorporate these concepts into their early professional identity formation. In this paper, we present twelve tips aimed at assisting educators in developing QIPS education early in the curricula of health professions students. These tips address various key issues, including aligning incentives, providing longitudinal experiences, incorporating real-world care outcomes, optimizing learning environments, communicating successes, and continually enhancing education and care delivery processes.

Background: Training in clinical ultrasound has become highly relevant for working as an otorhinolaryngologist. While there is a high demand for standardized and certified training courses, until recently, there was no possibility to attend web-based and exclusively virtual head and neck ultrasound courses certified by the Deutsche Gesellschaft für Ultraschall in der Medizin (DEGUM; German Society for Ultrasound in Medicine)., Objective: The aim of this study was to provide a qualitative and semi-quantitative analysis of the first purely virtual DEGUM-certified head and neck ultrasound courses., Materials and Methods: In 2021, three purely web-based DEGUM-certified head and neck ultrasound courses were carried out and then qualitatively analyzed using questionnaires including an examination., Results: The purely virtual implementation of head and neck ultrasound courses proved to be a viable alternative to the conventional course format, with a high level of acceptance among the participants. The lack of practice among the participants remains a relevant criticism., Conclusion: A more dominant role of web-based and remote ultrasound training is likely and should be considered as an alternative depending on existing conditions. Nevertheless, acquisition of practical sonographic skills remains a major hurdle if courses are purely digital., (© 2024. The Author(s).)

Transformative changes in health professions education need to incorporate effective faculty development, but few very large-scale faculty development designs have been described. The Royal College of Physicians and Surgeons of Canada's Competence by Design project was launched to transform the delivery of postgraduate medical education in Canada using a competency-based model. In this paper we outline the goals, principles, and rationale of the Royal College's national strategy for faculty and resident development initiatives to support the implementation of Competence by Design. We describe the activities and resources for both faculty and trainees that facilitated the redesign of training programs for each specialty and subspecialty at the national level, as well as supporting the implementation of the redesign at the local level. This undertaking was not without its challenges: we thus reflect on those challenges, enablers, and the lessons learned, and discuss a continuous quality improvement approach that was taken to iteratively inform the implementation process moving forward., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Chronic tendon and ligament diseases are commonly encountered in both athletic humans and animals, especially horses. Distal limb diseases, including suspensory ligament (SL) pathology due to anatomical, histological, and biomechanical properties, can be considered a model for tendon and ligament pathologies in humans. The appropriate selection of therapy is often crucial in optimising the healing process. One decisive factor influencing the possibility of returning to pre-disease training levels appears to be the utilisation of physical activity, including controlled movement, during the rehabilitation process. In the pathogenesis of musculoskeletal diseases and rehabilitation, adipocytokines play diverse roles. However, it is unclear what significance they hold in horses and in specific disease entities as well as the consequences of their mutual interactions. Recent studies indicate that in the pathogenesis of diseases with varied aetiologies in humans, their value varies at different stages, resulting in a diverse response to treatment. The results of this study demonstrate lower resistin concentrations in the venous blood plasma of horses with proximal suspensory desmopathy (PSD), while higher levels were observed in regularly trained and paddocked animals. The horses investigated in this study showed higher concentrations of resistin and IL-8, particularly in paddocked horses as well as in the working group of horses. The results suggest that these concentrations, including resistin in blood plasma, may be clinically significant. This attempt to explore the aetiopathogenesis of the processes occurring in the area of the proximal attachment of the suspensory ligament may optimise the procedures for the treatment and rehabilitation of horses.

Competing Interests: HC, SH, and SPR are the Co-Chairs of the Lancet Commission on Medicine, Nazism, and the Holocaust, VR was a Co-Chair of this Lancet Commission until September, 2021, and the other authors are members of this Lancet Commission. TC has received honoraria and travel support for lectures, presentations, and educational events about medicine, Nazism, and the Holocaust from academic institutions only. HC has received travel funding for a Lancet Commission meeting in Jerusalem (2022) and a grant from the Max Planck Society for a project on the history of brain research using Nazi victims' brains. MAF has received funding from the Israel Medical Association for leading seminar tours on medicine and the Holocaust. SH has received royalties from Berghahn Books for The Anatomy of Murder, honoraria from educational institutions for lectures about medicine and anatomy in Nazi Germany, and is an unpaid member of the Harvard Human Remains Research Review Committee and the American Association for Anatomy Task Force on Legacy Collections. EL has received royalties from Classiques Garnier for his book L'Homme, cet inconnu d'Alexis Carrel (1935), serves as an unpaid member of the Israel National Commission according to the Patient at end-of-life Law (2005), and received travel reimbursement for attending a symposium at Cedars Sinai Center for Medicine, Holocaust and Genocide Studies (Los Angeles, CA, USA) and the Lancet Commission meeting in Vienna (2023). MO has received occasional honoraria from educational institutions for lectures on medicine, Nazism, and the Holocaust at educational institutions, as well as travel reimbursement for the Lancet Commission meetings in Jerusalem (2022) and Vienna (2023). AO declares travel reimbursement for attending the Lancet Commission meeting in Vienna (2023). VR received a grant for a project financed by the Max Planck Society on the use of body parts of Nazi victims in brain research. MR received a contract from the district of Upper Bavaria for research and a book project on victims of National Socialist euthanasia starting in October, 2023; received travel reimbursement for presentations on psychiatry in Nazi Germany at educational institutions; and serves as an unpaid member on the advisory boards for Brandenburg memorial sites, Hadamar memorial site, Irsee memorial site, Klingenmünster Psychiatric Hospital, the Bernhard Nocht Institute, the German Society of Pediatrics and Adolescent Medicine, the German Association for Psychiatry, Psychotherapy and Psychosomatics, and the Hessian Ministry of Science. CS received an honorarium from the Max Planck Society (work contract) for participation at the Lancet Commission meeting in Vienna (2023). SJS received travel reimbursement from the Cedars-Sinai Center for Medicine, Holocaust and Genocide Studies for attending the Lancet Commission meeting in Vienna (2023) and has received honoraria from educational institutions for presentations on medicine, Nazism, and the Holocaust. AT has received royalties from Cambridge University Press for the book Social Mendelism: Genetics and the Politics of Race in Germany, 1900–1948, and an honorarium from the University of Leeds (Leeds, UK) for a lecture titled “Mendeling Jews: a history of racial genetics”. HSW has received honoraria from educational institutions for presentations on the legacy of medicine during the Holocaust and professional identity formation. MKW has received a grant from the Macy Foundation for the implementation of this Lancet Commission's first teacher training fellowship; has received honoraria from educational institutions for lectures on medicine and the Holocaust, which he donates to his institution's fund to support programmes related to this history; serves as Co-Chair of the American Medical Association's Truth, Reconciliation, Health and Transformation Task Force (for which he receives an annual honorarium that he donates to his university); and is an unpaid member of the Fellows Council for the Hastings Center and the Advisory Council for Physicians for Human Rights. All other authors declare no competing interests.

Competing Interests: Declaration of interests TC has received honoraria and travel support for lectures, presentations, and educational events about medicine, Nazism, and the Holocaust from academic institutions only. HC has received travel funding for a Lancet Commission meeting in Jerusalem (2022), and a grant from the Max Planck Society for a project on the history of brain research using Nazi victims' brains. MF has received funding from the Israel Medical Association for leading seminar tours on medicine and the Holocaust. SH has received royalties from Berghahn Books for The Anatomy of Murder, honoraria from educational institutions for lectures about medicine and anatomy in Nazi Germany, and is an unpaid member of the Harvard Human Remains Research Review Committee and the American Association for Anatomy Task Force on Legacy Collections. EL has received royalties from Classiques Garnier for his book L'Homme, cet inconnu d'Alexis Carrel, 1935, serves as an unpaid member of the Israel National Commission according to the Patient at end-of-life Law (2005), and received travel reimbursement for attending a symposium at Cedars Sinai Center for Medicine, Holocaust and Genocide Studies (Los Angeles, CA, USA) and the Lancet Commission meeting in Vienna (2023). MO has received occasional honoraria from educational institutions for lectures on medicine, Nazism, and the Holocaust at educational institutions, as well as travel reimbursement for the Lancet Commission meetings in Jerusalem (2022) and Vienna (2023). AO declares travel reimbursement for attending the Lancet Commission meeting in Vienna (2023). VR received a grant for a project financed by the Max Planck Society on the use of body parts of Nazi victims in brain research. MR received a contract from the district of Upper Bavaria for research and a book project on victims of National Socialist euthanasia starting in October, 2023; received travel reimbursement for presentations on psychiatry in Nazi Germany at educational institutions; and serves as an unpaid member on the advisory boards for Brandenburg memorial sites, Hadamar memorial site, Irsee memorial site, Klingenmünster Psychiatric hospital, the Bernhard Nocht Institute, the German Society of Pediatrics and Adolescent Medicine, the German Association for Psychiatry, Psychotherapy and Psychosomatics, and the Hessian Ministry of Science. CS received an honorarium from the Max Planck Society (work contract) for participation at the Lancet Commission meeting in Vienna (2023). SJS received travel reimbursement from the Cedars-Sinai Center for Medicine, Holocaust and Genocide Studies for attending the Lancet Commission meeting in Vienna (2023) and has received honoraria from educational institutions for presentations on medicine, Nazism, and the Holocaust. AT has received royalties from Cambridge University Press for the book Social Mendelism: Genetics and the Politics of Race in Germany, 1900–1948, and an honorarium from the University of Leeds (Leeds, UK) for a lecture titled “Mendeling Jews: a history of racial genetics”. HSW has received honoraria from educational institutions for presentations on the legacy of medicine during the Holocaust and professional identity formation. MKW has received a grant from the Macy Foundation for the implementation of this Commission's first teacher training fellowship; has received honoraria from educational institutions for lectures on medicine and the Holocaust, which he donates to his institution's fund to support programmes related to this history; serves as Co-Chair of the American Medical Association's Truth, Reconciliation, Health and Transformation Task Force (for which he receives an annual honorarium that he donates to his university); and is an unpaid member of the Fellows Council for the Hastings Center and the Advisory Council for Physicians for Human Rights. All other authors declare no competing interests.

Research on effectiveness of rehabilitation programmes continues to investigate impact of therapeutic interventions on various motor parameters in children with intellectual disability (ID). This study compared the effectiveness of rehabilitation, reflected by physical fitness, static balance, and dynamic balance measurements, in children with mild ID. A total of 70 children with mild ID were enrolled for the study and were divided into two equal groups based on their body mass index (BMI) percentile, reflecting obesity or normal weight. Physical fitness was assessed using the Eurofit Special Test, whereas balance was evaluated with single-leg stance and timed up and go tests. The examinations were performed twice: At the beginning and at the end of a six-month therapy programme. Improvements were shown in the muscle strength of the upper limbs (p < 0.001) and lower limbs (p = 0.001), flexibility (p = 0.005), and static balance (p < 0.001) for the entire cohort. The effects of rehabilitation did not differ significantly between the children with obesity and those with a normal weight. These results may be important from the viewpoint of clinical practice and preventive measures, as they present evidence showing that rehabilitation is equally effective in both obese and normal weight children with mild ID. Therefore, these findings may be of assistance to those designing therapeutic programmes in special education centres., (© 2023. Springer Nature Limited.)

Biomedical research recruitment today focuses on including participants representative of global genetic variation-rightfully so. But ethnographic attention to practices of inclusion highlights how this agenda often transforms into "predatory inclusion," simplistic pushes to get Black and brown people into genomic databases. As anthropologists of medicine, we argue that the question of how to get from diverse data to concrete benefit for people who are marginalized cannot be presumed to work itself out as a byproduct of diverse datasets. To actualize the equitable translation of genomics, practitioners need to place the impacts of ancestral genetic difference in the scope of much more impactful social determinants. For this to happen, multidisciplinary expertise needs to be leveraged, and current, structurally unequal health care systems ultimately need to transform. As modest steps toward this goal, new models for benefit-sharing must be developed and implemented to mitigate existing inequality between data donors and the entities profiting from that data., (© 2023 The Hastings Center.)

Background: Increasingly, policymakers and professional organizations support screening for social assets and risks during clinical care. Scant evidence exists on how screening impacts patients, providers, or health systems., Objective: To systematically review published literature for evidence of the clinical utility of screening for social determinants of health in clinical obstetric and gynecologic (OBGYN) care., Search Strategy: We systematically searched Pubmed (March 2022, 5,302 identified) and identified additional articles using hand sorting (searching articles citing key articles (273 identified) and through bibliography review (20 identified))., Selection Criteria: We included all articles that measured a quantitative outcome of systematic social determinants of health (SDOH) screening in an OBGYN clinical setting. Each identified citation was reviewed by two independent reviewers at both the title/abstract and full text stages., Data Collection and Analysis: We identified 19 articles for inclusion and present the results using narrative synthesis., Main Results: The majority of articles reported on SDOH screening during prenatal care (16/19) and the most common SDOH was intimate partner violence (13/19 studies). Overall, patients had favorable attitudes towards SDOH screening (in 8/9 articles measuring attitudes), and referrals were common following positive screening (range 5.3%-63.6%). Only two articles presented data on the effects of SDOH screening on clinicians and none on health systems. Three articles present data on resolution of social needs, with inconsistent results., Conclusions: Limited evidence exists on the benefits of SDOH screening in OBGYN clinical settings. Innovative studies leveraging existing data collection are needed to expand and improve SDOH screening., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 National Medical Association. Published by Elsevier Inc. All rights reserved.)

Background of the Project: Stakeholders in healthcare and science increasingly demand the rapid integration of teaching content on planetary health (PIH) into the curricula of all the healthcare professions. In medical education, such topics are currently only covered inadequately and are mostly limited to elective courses., Why Was the Project Initiated?: In order to reach all medical students in the sense of a learning spiral and promote an interdisciplinary understanding of planetary health, a longitudinal mosaic curriculum is being developed that introduces aspects of planetary health throughout the entire course of study. We share the first experiences of the start of this project as an example to inspire similar activities elsewhere., Implementation of the Project: We mapped all the courses at the Faculty of Medicine in Würzburg and compared them with existing learning objectives on planetary health topics from the National Competency-Based Catalog of Learning Objectives for Medical Education. We then identified curricular injection points and held consultations with teaching staff and course coordinators from 26 different specialities in order to integrate the respective contents into the courses and, if necessary, develop new content. An overview of all curricular injection points with the corresponding topics, learning objectives, and teaching and examination methods is under development., Evaluation of the Project: The lecturers exchanged ideas with the project team of the teaching clinic of the Faculty of Medicine; further networking meetings to coordinate a learning spiral are to follow. The lecturers were asked to provide structured learning objectives in the categories "knowledge", "attitudes", "skills", and "confidence" on the topics integrated into the courses. Oral as well as written evaluations using Evasys ® questionnaires among students and lecturers are planned., Final Overall Assessment Outlook: Planetary Health topics have been introduced in several courses following our intervention. In the context of a learning spiral, teaching staff from further medical disciplines will be contacted so that more perspectives can be highlighted at different points in the curriculum. In addition, interdisciplinary teaching formats will be developed in order to take the complexity of the interrelationships into account., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2023 Schmid et al.)

Osteoarthritis (OA) is a common disease among the human population worldwide. OA causes functional impairment, leads to disability and poses serious socioeconomic burden. The rehabilitation offers a function-oriented method to reduce the disability using diverse interventions (kinesiotherapy, physical therapy, occupational therapy, education, and pharmacotherapy). OA as a widespread disease among elderly patients is often treated by rehabilitation specialists and physiotherapists, however the results of rehabilitation are sometimes unsatisfactory. The understanding of molecular mechanisms activated by rehabilitation may enable the development of more effective rehabilitation procedures. Molecular biology methods may prove crucial in rehabilitation as the majority of rehabilitation procedures cannot be estimated in double-blinded placebo-controlled trials commonly used in pharmacotherapy. This article attempts to present and estimate the role of molecular biology in the development of modern rehabilitation. The role of clinicians in adequate molecular biology experimental design is also described.

Background: Fitspiration is a social media phenomenon purported to inspire viewers to lead healthier lifestyles but can result in negative psychological outcomes such as body dissatisfaction. This study aimed to develop a tool to audit Instagram fitspiration accounts and screen for content that could have potentially negative psychological effects., Methods: This study developed and implemented an audit tool to (1) identify credible fitspiration accounts (i.e., accounts that do not portray potentially harmful or unhealthy content) and (2) describe the content of identified accounts. The most recent 15 posts of 100 leading Instagram fitspiration accounts were audited. Accounts were deemed non-credible and were excluded if they contained fewer than four fitness-related posts or portrayed nudity or inappropriate clothing, sexualisation or objectification, extreme body types, "thinspiration", or negative messages., Results: Many accounts contained fewer than four fitness-related posts (n = 41), sexualisation or objectification (n = 26), nudity or inappropriate clothing (n = 22), and/or extreme body types (n = 15). Three accounts failed on all four criteria, while 13, 10 and 33 failed on three, two, or one criterion, respectively. Therefore, only 41% of accounts were considered credible. Inter-rater reliability (percentage agreement and Brennan and Prediger's coefficient κ q ) was high (Stage 1: 92% agreement [95% CI 87, 97], κ q 0.84 [95% CI 0.73, 0.95]; Stage 2: 93% agreement [95% CI 83, 100], κ q 0.85 [95% CI 0.67, 1.00]). Account holders of credible fitspiration accounts were predominantly female (59%), aged 25-34 (54%), Caucasian (62%), and from the United States (79%). Half held a qualification related to physical activity or physical health (e.g., personal trainer, physiotherapy; 54%). Most included accounts included an exercise video (93%) and example workout (76%)., Conclusion: While many popular Instagram fitspiration accounts offered credible content such as example workouts, many accounts contained sexualisation, objectification or promotion of unhealthy or unrealistic body shapes. The audit tool could be used by Instagram users to ensure the accounts they follow do not portray potentially harmful or unhealthy content. Future research could use the audit tool to identify credible fitspiration accounts and examine whether exposure to these accounts positively influences physical activity., (© 2023. The Author(s).)

Importance: Investing in educators, educational innovation, and scholarship is essential for excellence in health professions education and health care. Funds for education innovations and educator development remain at significant risk because they virtually never generate offsetting revenue. A broader shared framework is needed to determine the value of such investments., Objective: To explore the value factors using the value measurement methodology domains (individual, financial, operational, social or societal, strategic or political) that health professions leaders placed on educator investment programs, including intramural grants and endowed chairs., Design, Setting, and Participants: This qualitative study used semi-structured interviews with participants from an urban academic health professions institution and its affiliated systems that were conducted between June and September 2019 and were audio recorded and transcribed. Thematic analysis was used to identify themes with a constructivist orientation. Participants included 31 leaders at multiple levels of the organization (eg, deans, department chairs, and health system leaders) and with a range of experience. Individuals who did not respond initially were followed up with until a sufficient representation of leader roles was achieved., Main Outcomes and Measures: Outcomes include value factors defined by the leaders for educator investment programs across the 5 value measurement methodology domains: individual, financial, operational, social or societal, and strategic or political., Results: This study included 29 leaders (5 [17%] campus or university leaders; 3 [10%] health systems leaders; 6 [21%] health professions school leaders; 15 [52%] department leaders). They identified value factors across the 5 value measurement methods domains. Individual factors emphasized the impact on faculty career, stature, and personal and professional development. Financial factors included tangible support, the ability to attract additional resources, and the importance of these investments as a monetary input rather than output. Operational factors identified educational programs and faculty recruitment or retention. Social and societal factors showcased scholarship and dissemination benefits to the external community beyond the organization and to the internal community of faculty, learners, and patients. Strategic and political factors highlighted impact on culture and symbolism, innovation, and organizational success., Conclusions and Relevance: These findings suggest that health sciences and health system leaders find value in funding educator investment programs in multiple domains beyond direct financial return on investment. These value factors can inform program design and evaluation, effective feedback to leaders, and advocacy for future investments. This approach can be used by other institutions to identify context-specific value factors.

Objective: The aim: To assess the situation, relevance and opportunities for providing medical rehabilitation services in Ukraine and to determine the current trends in the development of medical rehabilitation in the world., Patients and Methods: Materials and methods: An analysis was made of WHO data on the prospects for the development of rehabilitation services, as well as the legal framework of Ukraine and data from the National Health Service on medical rehabilitation., Conclusion: Conclusions: Demand for rehabilitation services is growing. Ukraine is following the path of active adaptation and implementation of world documents from medical rehabilitation to practical health care, taking into account the dynamics of population aging, the prevalence of non-communicable diseases, and as a component of the strategy of improving the quality and availability of medical care, adequacy to the realities of the times.

BackgroundAdequate identification and testing of people at risk for HIV is fundamental for the HIV care continuum. A key strategy to improve timely testing is HIV indicator condition (IC) guided testing.AimTo evaluate the uptake of HIV testing recommendations in HIV IC-specific guidelines in European countries.MethodsBetween 2019 and 2021, European HIV experts reviewed guideline databases to identify all national guidelines of 62 HIV ICs. The proportion of HIV IC guidelines recommending HIV testing was reported, stratified by subgroup (HIV IC, country, eastern/western Europe, achievement of 90-90-90 goals and medical specialty).ResultsOf 30 invited European countries, 15 participated. A total of 791 HIV IC guidelines were identified: median 47 (IQR: 38-68) per country. Association with HIV was reported in 69% (545/791) of the guidelines, and 46% (366/791) recommended HIV testing, while 42% (101/242) of the AIDS-defining conditions recommended HIV testing. HIV testing recommendations were observed more frequently in guidelines in eastern (53%) than western (42%) European countries and in countries yet to achieve the 90-90-90 goals (52%) compared to those that had (38%). The medical specialties internal medicine, neurology/neurosurgery, ophthalmology, pulmonology and gynaecology/obstetrics had an HIV testing recommendation uptake below the 46% average. None of the 62 HIV ICs, countries or medical specialties had 100% accurate testing recommendation coverage in all their available HIV IC guidelines.ConclusionFewer than half the HIV IC guidelines recommended HIV testing. This signals an insufficient adoption of this recommendation in non-HIV specialty guidelines across Europe.

As health and social service professions increasingly emphasize commitments to equity, advocacy and social justice, non-traditional entrants to the professions increasingly bring much-needed diversity of social backgrounds and locations. Long the domain of elite social classes, the professions are not always welcoming cultures for those from lower social class backgrounds. This paper draws on notions of material, social and cultural capital, along with habitus, to examine the experiences of professionals with lower-class backgrounds, in educational programs and in their professions. The critical interpretive qualitative study draws on interviews with 27 professionals across Canada in medicine, nursing, social work and occupational therapy. While participants were clearly set apart from their colleagues by class origins, which posed distinct struggles, they also brought valuable assets to their work: enhanced connection and rapport with clients/patients, approachability, structural analysis and advocacy, plus nuanced re-envisioning of professional ethics to minimize power dichotomies. Rather than helping lower-class entrants adapt to the professions, it may be more beneficial to alter normative professional cultures to better suit these practitioners., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Competing Interests: The authors declare no conflict of interest.

In laboratory medicine, much effort has been put into analytical quality in the past decades, making this medical profession one of the most standardized with the lowest rates of error. However, even the best analytical quality cannot compensate for errors or low quality in the pre or postanalytical phase of the total testing process. Guidelines for data reporting focus solely on defined data elements, which have to be provided alongside the analytical test results. No guidelines on how to format laboratory reports exist. The habit of reporting as much diagnostic data as possible, including supplemental information, may lead to an information overload. Considering the multiple tasks physicians have to do simultaneously, unfiltered data presentation may contribute to patient risk, as important information may be overlooked, or juxtaposition errors may occur. As laboratories should aim to answer clinical questions, rather than providing sole analytical results, optimizing formatting options may help improve the effectiveness and efficiency of medical decision-making. In this narrative review, we focus on the underappreciated topic of laboratory result reporting. We present published literature, focusing on the impact of laboratory result report formatting on medical decisions as well as approaches, potential benefits, and limitations for alternative report formats. We discuss influencing variables such as, for example, the type of patient (e.g. acute versus chronic), the medical specialty of the recipient of the report, the display of reference intervals, the medium or platform on which the laboratory report is presented (printed paper, within electronic health record systems, on handheld devices, etc.), the context in which the report is viewed in, and difficulties in formatting single versus cumulative reports. Evidence on this topic, especially experimental studies, is scarce. When considering the medical impact, it is of utmost importance that laboratories focus not only on the analytical aspects but on the total testing process. The achievement of high analytical quality may be of minor value if essential results get lost in overload or scattering of information by using a non-formatted tabular design. More experimental studies to define guidelines and to standardize effective and efficient reporting are most definitely needed.

Objective This study examined the distribution of the sexes across Australian medical procedural specialties in 2017 and investigated the proportion of currently registered female specialists based on their graduation date from 1969 to 2008. Methods A cross-sectional analysis of current Australian procedural and surgical specialists registered with the Australian Health Practitioner Registration Agency as of January 2017 was undertaken. Participants included 4851 surgical specialists (594 female, 4257 male) and 14948 specialists in specialties with high levels of procedural clinical work (4418 female, 10530 male). The number of male and female specialists across each procedural specialty and the medical school graduation date of current female specialists were analysed. Results In 2017, female fellows represented only one in 10 surgeons and three in 10 procedural specialists. All surgical specialties are underrepresented by female specialists. Cardiology is least represented by female practitioners (one in 10), followed by intensive care and ophthalmology (two in 10). General surgery, otolaryngology and urology saw more female specialists with graduation dates between 1983 and 2003 compared with the other surgical specialties. Conclusion The number of female practitioners registered as specialists is increasing, but they continue to be underrepresented at specialist level across many procedural and surgical specialties. What is known about the topic? Although the number of female students entering medical school now outnumbers that of males, female practitioners remain underrepresented at the specialist level. What does this paper add? Surgery continues to be underrepresented by female specialists, but general surgery, otolaryngology and urology have shown increases in females reaching specialist level. All procedural specialties have shown increasing numbers of female practitioners reaching the specialist level. What are the implications for practitioners? All surgical specialties and nearly all procedural specialties need to adopt evidence-based practices to make their training programs both appealing and sustainable to female trainees in order to work towards achieving gender parity.

Given the long history and pervasive nature of racism in medical culture, this essay argues that diversifying efforts alone cannot address systemic racism in medical education. Positive affirmation of anti-racist values and racial consciousness in the admissions process is necessary to create a truly inclusive culture in medical education and begin to undo centuries of racial prejudice in medicine. Drawing from historic examples, scholarship on the sociology of racialized space, recent research on race and medical education, and personal experience, we propose that medical educational institutions make a more concerted effort to consider racial attitudes and awareness as part of the admissions process as well as curricular reform efforts. We also provide examples of potential ways to practically implement this proposal in the admissions process.

Prescribing nature-based health interventions (green prescribing)-such as therapeutic horticulture or conservation activities-is an emerging transdisciplinary strategy focussed on reducing noncommunicable diseases. However, little is known about the practice of, and socioecological constraints/opportunities associated with, green prescribing in the UK. Furthermore, the distribution of green prescribing has yet to be comprehensively mapped. In this study, we conducted a socioecological exploration of green prescribing. We deployed online questionnaires to collect data from general practitioners (GPs) and nature-based organisations (NBOs) around the UK and conducted spatial analyses. Our results indicate that GPs and NBOs perceive and express some common and distinct constraints to green prescribing. This highlights the need to promote cross-disciplinary communication pathways. Greenspace presence and abundance within close proximity (100 and 250 m) to GP surgeries (but not greenness-as a proxy for vegetation cover) and NBO presence within 5 km were associated with higher levels of green prescribing provision. Lower levels of deprivation were associated with higher frequency of NBOs. This suggests that the availability of greenspaces and NBOs could be important for green prescribing provision, but there could be greater opportunities in less deprived areas. Important foci for future research should be to establish transdisciplinary collaborative pathways, efficient infrastructure management and a common vocabulary in green prescribing-with the overall aim of reducing inequalities and enhancing planetary health., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Individuals may have conflicts of interest (CoI) when they choose between the duties of their jobs and their own private interests. In medicine, CoI are potentially ubiquitous and their disclosure has now become the most frequent strategy to address them in professional lives. In the medical literature, CoI are classified into two different types-financial and non-financial. Financial CoI are easy to identify and can bias any kind of results in research; so, their disclosure is very important. The unsolvable dilemma is where to set the lowest limit for sums received from industry. Non-financial CoI are a very large category intrinsically related to the individuals concerned, ranging from family relationships to religious beliefs, and the mere disclosure of many of them can raise privacy and ethical issues. Two opposite narratives characterize the debate on financial CoI caused by pharmaceutical industry. The critical side argues that, because the primary goal of pharmaceutical industry is inevitably to promote its products, the best strategy is to stay away from financial CoI. On the other hand, the defensive side claims that financial CoI are boosted by ideology but meaningless in real practice, since any kind of interest can raise a potential conflict. A missing point in the debate on financial CoI is that health care is a classical example of 'market failure' in the economic theory. Since health cannot be considered a 'consumer good', the economic paradigm of 'free market' does not fit for healthcare products. To conclude, even though transparency on financial CoI cannot itself deter the risk of bias, rejecting it would be an even bigger mistake. At variance, mandatory disclosure of non-financial CoI risks to be confusing and questionable in many cases, paradoxically distracting attention from the potential bias created by financial CoI.

Objective: The shortage of skilled workers and overloaded schedules make further training of health professionals difficult. In addition, child protection is not a systematic part of medical studies. The evaluation of an online course on child protection in medicine reveals positive feedback but also that the main reason for participants aborting the course is lack of time. Dissemination, as an active, targeted spreading of knowledge, can help to further spread knowledge about child protection in the target group. The aim of this article is to investigate whether and how the contents of the online course can be disseminated by professionals who have completed the online course. Methodology: The data were collected through a quantitative online evaluation and qualitative telephone interviews with doctors who had completed the online course and evaluated it using an interpretive-reductive analysis. Results: The respondents consider the need for further training and dissemination measures on the topic of child protection in medicine to be high. However, lack of time and insufficient relevance of the topic would present obstacles in the implementation of such measures. Meaningfulness and time off work or remuneration would in turn create incentives for implementation. Participants in dissemination measures could be motivated for example by further education points. In addition we were able to identify possible approaches for the implementation of such measures. Conclusion: Various parameters influence the motivation of doctors regarding the implementation/perception of dissemination measures. Based on these, recommendations for action are given for different areas of the health care system, such as supplementing the training curricula and providing ready-made materials for dissemination., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2020 Maier et al.)

Economists traditionally describe individuals as well-informed and rational decision-makers. Recent developments in behavioural economics, which lies at the intersection between psychology and economics, challenge these assumptions and describe the common cognitive biases that affect us all. The resulting decision errors are particularly frequent in health and health care given the predominance of uncertainty and the complexity of choices. Interventions aiming at correcting, or exploiting, these biases to improve decisions of citizens, patients, and health professionals have recently emerged. We present here a critical synthesis of findings and discuss potential applications in our health system., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Medical experts are one of the main sources used by journalists in reporting on medical science. This study aims to 1) identify problems that medical experts encounter in contacts with the media representatives, 2) elucidate their attitudes about interactions with journalists and 3) reflect on solutions that could improve the quality of medical journalism. By using in-depth interviews, focus groups and a survey directed to 600 medical experts in 21 countries, this cohort study elucidates medical experts' experiences and views on participating in popular media. A strong interest in interacting with the media was identified among the experts, where nearly one fifth of the respondents in the survey claimed that they contacted the media more than 10 times per year. Six obstacles for improving the quality of medical reporting in the media were found: deadlines, headlines, choice of topic or angle, journalist's level of medical knowledge, differences in professional culture and colleagues' opinions. The main concern among experts was that short deadlines and exaggerated headlines could harm journalistic quality. It is possible that this is partly due to ongoing changes in the media landscape with many new platforms and less control functions. Nevertheless, for several reasons many experts have great interest in interacting with the media, something that could contribute to better communication and fewer misunderstandings. Our results highlight factors like expert networks, media training for scientists and regular meetings that may facilitate communication between medical experts and medical reporters., Competing Interests: The authors have declared that no competing interests exist.

Hippocrates was the first to raise awareness of medicine as a science. He asserted the body being a unified whole and emphasized the importance of preventive and predictive medicine, spurring physicians to foster patient collaboration. Recent achievements today have permitted a new approach "P4 medicine" - Predictive, Preventive, Personalized and Participatory - with the aim of depicting an individual's health history and molecular profile in determining the best medical intervention in maintaining or restoring wellbeing. There is a link, which brings together Hippocrates and P4 Medicine. This review will elaborate further this statement, considering the scientific achievements that paved the way for recent medical approaches. Emphasis will be given to the social impact of new diagnostic and therapeutic protocols, considering their costs and their success probabilities.

Research on science fiction within the medical humanities should articulate interpretative frameworks that do justice to medical themes within the genre. This means challenging modes of reading that encourage unduly narrow accounts of science fiction. Admittedly, science studies has moved away from reading science fiction as a variety of scientific popularisation and instead understands science fiction as an intervention in the technoscientific imaginary that calls for investment in particular scientific enterprises, including various biomedical technologies. However, this mode of reading neglects science fiction's critical relationship to the construction of 'the future' in the present: the ways in which science fiction proposes concrete alternatives to hegemonic narratives of medical progress and fosters critical self-awareness of the contingent activity which gives 'the future' substance in the here-and-now. Moreover, the future orientation of science fiction should not distract from the function of medical science fiction as 'cognitive estrangement': the technological innovations that dominate science-fiction narratives are less concrete predictions and more generic devices that explain in historical time the origins of a marvellous world bearing provocative correspondences to our own, everyday reality. The editorial concludes with a series of introductions to the articles comprising the special issue, covering the print edition and a special online-only section., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Background: Family medicine has been recognized as the key element of a good health care system. Despite the significance of the family physician's role the number of medical students choosing to train in family medicine has been declining in recent years., Aim: The aim of this study was to describe opinions about family medicine and family medicine teaching among medical students., Material and Methods: A cross sectional study with an anonymous questionnaire was carried out. The study population was all sixth-year students in Faculty Medicine of Jagiellonian University Medical College, who completed family medicine course in winter semester of academic year 2012/2013., Results: 111 students filled in the questionnaire. The response rate was 84.1%. Less than one third of respondents (30.6%) considered family medicine as a future career choice. Almost all students recognized responsibility of the family doctor for the health of community. 52% of respondents agreed that the family doctor is competent to provide most of the health care an individual may require. Experience from family medicine course was according to the students the most important factor influencing their opinions., Conclusions: Medical students appreciate the social role of family doctors. Family medicine teachers should not only pass on knowledge, but they also should encourage medical students to family medicine as a future career choice.

Background: National end-of-life care policies propose that health professionals regularly discuss matters such as preferred place of death (PPD) with patients., Aim: To explore clinician experiences of discussing PPD with palliative care patients., Method: Six clinicians from a Scottish hospice each participated in a semi-structured interview. Interview data was analysed using interpretative phenomenological analysis., Results: Four themes were integral to the participants' accounts: the importance of discussing preferences at the end of life (staff recognise the value of discussing patients' final wishes), identifying how and when to discuss PPD (discussions are tailored to the individual), reflecting on the emotional aspects of discussing PPD (discussing PPD is challenging but rewarding), and a journey from expectations to experience (discussing PPD becomes easier with time)., Conclusion: Although potentially difficult, the participants believed that advance care planning is important and beneficial. With time, they had developed communication strategies enabling them to discuss PPD in an effective, patient-centred way.

The implementation of choice for patients over where and when they are seen by specialists in hospital outpatient clinics has been supported by electronic referral systems in England and the Netherlands. This paper compares the implementation of 'Choose and Book' in England and 'ZorgDomein' in a region of the Netherlands. For England the analysis draws on national data and published studies on 'Choose and Book', national patient surveys, and qualitative data based on general practitioner (GP) focus groups. For the Netherlands the analysis draws on qualitative data collected during observational study as well as survey data among patients, GPs and medical specialists. We find that despite significant differences in the genesis and design of the policy, similar challenges have been faced. The electronic referral systems have forced changes to the process of care at the interface between primary and secondary care and standardisation between practices. Although these changes have the potential to generate improvements and benefits, for example, convenience, certainty and choice for patients and efficiency gains through for example reduced do not attend rates, repeat consultations and duplicative diagnostic tests; they have also generated problems during implementation including GP resistance. Policy ambitions for patient choice may not be realised if the implementation of the booking system is not carefully designed and evaluated.

Studies of the usefulness of SNOMED CT in everyday clinical practice have received little attention. The purpose of this study was to evaluate the usefulness of SNOMED CT in a multidisciplinary clinical setting. Another aim was to examine how well the terminology of care-planning procedures in a local development project could be mapped to SNOMED CT, and to explore the terminological surroundings in terms of superordinate concepts, subordinate concepts and coordinate concepts. A term list of 66 non-analysed types of procedures, considered necessary in the documentation of care planning, had been compiled in a local development project. The Clue-browser, version 5.5, was used to browse for matching concepts in SNOMED CT, and the degree of correspondence was assessed for each item. Of the 66 procedures, 72% corresponded completely and 22% corresponded partly to concepts in SNOMED CT. No match was found for 6% of the procedures. More subordinate concepts) were lacking in 30% of the concepts. The study showed that SNOMED CT could be mapped fairly well to care-planning procedures in a multidisciplinary setting such as advanced home health care. The terminological surroundings were extensive and stable for superordinate concepts (stem concepts), but unstable regarding subordinate concepts. SNOMED CT and the Clue-browser were feasible for choosing terminology with machine-readable codes for a specific area where there is no terminology in Swedish.

The "Warsaw Medical Journal" (Pamietnik Lekarski Warszawski), the first Polish scientific medical journal, was published in Warsaw in the years 1828 and 1829. Its editor and publisher was W. Malcz - a great social activist and distinguished doctor. The articles were written mainly by doctors, but also by pharmacists and a writer, who informed readers about the development of medicine at home and abroad, enabled them to raise their professional qualifications, and encouraged them to engage in academic and literary activity. The articles comprised original works, sophistry, translations from foreign periodicals, descriptions of new instruments, book reviews and correspondence from Paris. The range of topics in the "Warsaw Medical Journal" was very broad. Articles covered internal and external diseases and pharmacology. In 1830 the journal was made the official organ of the Warsaw Medical Society. But then the November Uprising broke out, and prevented the journal's further development.

To achieve better quality and efficiency of care and services for clients, social and health care professionals should be educated to adopt an interprofessional way of working and thinking. This requires the development of an interprofessional identity alongside a professional identity. The process must be facilitated comprehensively in social and health care operations. The aim of this observational and cross-sectional mixed-method study was to investigate readiness and perceived development needs concerning interprofessional work among social and health care students and professionals. Furthermore, the aim was to examine the formation of an interprofessional identity in relation to the theoretical framework of interprofessional socialization. In our results, development needs, expressed by the respondents, were categorized at the system, profession, and individual levels of social and health care. Although, positive attitudes were established among students and professionals, our findings demonstrate that the formation of an interprofessional identity requires comprehensive support from social and health care operations. Interprofessional identity can be enhanced especially by applying and developing interprofessional education and lifelong learning.

This study explored the way in which detailed data about how time is spent on classroom activities, generated by the FILL+ tool (Framework for Interactive Learning in Lectures), can stimulate professional conversations about teaching practices and aid reflection for STEMM lecturers. The lecturers felt that personalised data provided an unbiased view of the lecture, overcoming the difficulty of relying on their memory alone. They indicated that this approach would help them to reflect on their teaching, particularly when the data was surprising, and many felt that it would encourage them to make changes to their teaching practice.

The overwhelming majority of professionals who serve the autistic community using applied behavior analysis (ABA) do so from a place of caring and compassion to improve the quality of life for the individuals they serve. As researchers and practitioners, the authors feel it is essential to acknowledge concerns that have arisen from neurodiversity activists and their families surrounding the effects of ABA on the autism population and claims that the goals and strategies in ABA are ableistic. This paper will highlight major issues neurodiversity advocates have reported regarding ABA, examine areas considered to be ableistic, and discuss ways ABA has positively impacted society while emphasizing the importance of listening and responding to expressed concerns of stakeholders.

Teaching English for specific purposes (ESP), such as Medical English, is especially impactful due to high student motivation and immediate real-world application. Medical professionals devote their careers to improving the health and lives of others. With English-language skills, medical professionals can further their own professional development by attending international conferences, reading journals, and sharing their own discoveries with peers. In fact, as the majority of medical journals and international conferences utilize English, learning the language allows professionals who are nonnative English speakers to acquire medical terminology and be active in their community (Popa 2013; Chia et al. 1999). The benefits of teaching a Medical English ESP course are far-reaching and positively affect an unknown number of people. For instance, working with doctors and nurses to increase their English level enables them to more accurately interact with, diagnose, and treat their patients.

Nuclear magnetic resonance (NMR) spectroscopy is the tool of choice for organic chemists to determine the molecular structure of organic molecules and, as a result, is a fundamental topic in the organic chemistry curriculum. A novel laboratory module has been developed to expand the scope of NMR spectroscopy beyond structure validation at the undergraduate level to include how organic chemistry and FT-NMR spectroscopy are directly related to contrast-assisted magnetic resonance imaging (MRI). This laboratory module allows students to synthesize commercially available MRI contrast agents and exposes students to the important concepts of longitudinal relaxation time ("T"[subscript 1]) and relaxation rate ("r"[subscript 1]), and how both properties can be enhanced by paramagnetic contrast agents. By using an NMR spectrometer for inversion recovery experiments, students will be able to bridge the concepts of NMR and MRI, while understanding how organic chemistry plays a vital role in a technology that revolutionized diagnostic and therapeutic medicine.

Students underrepresented in higher education often require unique support throughout their career and college planning. Rural Appalachian youth characterize a large population of underrepresented students. This article describes a theory-based multiweek career education curriculum aimed at increasing career and college readiness that was delivered to over 1,300 high school students in two rural Appalachian counties. Evaluation data from 867 of these students, as well as from the program staff, are provided. Findings suggest that participants found the intervention useful, learned new information about postsecondary planning and career exploration, and received assistance planning for their futures. Implications for school-based career education with underrepresented students, in general, are discussed.

An experiment for the synthesis of N-acyl derivatives of natural amino acids has been developed as part of the Distributed Drug Discovery (D3) program. Students use solid-phase synthesis techniques to complete a three-step, combinatorial synthesis of six products, which are analyzed using LC-MS and NMR spectroscopy. This protocol is suitable for introductory organic laboratory students and has been successfully implemented at multiple academic sites internationally. Accompanying prelab activities introduce students to SciFinder and to medicinal chemistry design principles. Pairing of these activities with the laboratory work provides students an authentic and cohesive research project experience.

"The Science and Business of Medicinal Chemistry" was developed to provide nonscience majors with an in-depth perspective into the pharmaceutical industry. As a lecture course with a laboratory component, topics discussed include an introduction to the basic concepts of medicinal chemistry, such as drug discovery, development, and commercialization; a discussion of chemical bonding and the organic functional groups found in drug molecules; and an examination of the physiochemical properties related to drug action. Student scientific literacy of the public policy debates surrounding the pharmaceutical industry and the commercialization of science was enhanced through class discussions and group-based projects. The details of this course, its implementation, and assessment are discussed.