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BACKGROUND:  Telemedicine expanded rapidly during the COVID-19 pandemic, as key policy changes, financial support, and pandemic fears tipped the balance toward internet-based care. Despite this increased support and benefits to patients and clinicians, telemedicine uptake was variable across clinicians and practices. Little is known regarding physician and institutional characteristics underlying this variability. OBJECTIVE:  This study aimed to evaluate factors influencing telemedicine uptake among frontline physicians in the early pandemic response. METHODS:  We surveyed a national stratified sample of frontline clinicians drawn from the American Medical Association Physician Professional Data in June or July 2020. The survey inquired about the first month and most recent month (June 2020) of pandemic telemedicine use; sample data included clinician gender, specialty, census region, and years in practice. Local pandemic conditions were estimated from county-level data on COVID-19 rates at the time of survey response. Data were analyzed in a weighted logistic regression, controlling for county-specific pandemic data, and weighted to account for survey data stratification and nonresponse. RESULTS:  Over the first 3-4 months of the pandemic, the proportion of physicians reporting use of telemedicine in >30% of visits increased from 29.2% (70/239) to 35.7% (85/238). Relative to primary care, odds of substantial telemedicine use (>30%) both during the first month of the pandemic and in June 2020 were increased among infectious disease and critical care physicians and decreased among hospitalists and emergency medicine physicians. At least minimal prepandemic telemedicine use (odds ratio [OR] 11.41, 95% CI 1.34-97.04) and a high 2-week moving average of local COVID-19 cases (OR 10.16, 95% CI 2.07-49.97) were also associated with substantial telemedicine use in June 2020. There were no significant differences according to clinician gender, census region, or years in practice. CONCLUSIONS:  Prepandemic telemedicine use, high local COVID-19 case counts, and clinician specialty were associated with higher levels of substantial telemedicine use during the early pandemic response. These results suggest that telemedicine uptake in the face of the pandemic may have been heavily influenced by the level of perceived threat and the resources available for implementation. Such understanding has important implications for reducing burnout and preparation for future public health emergencies.

BackgroundIn 2011, the American Board of Medical Specialties established clinical informatics (CI) as a subspecialty in medicine, jointly administered by the American Board of Pathology and the American Board of Preventive Medicine. Subsequently, many institutions created CI fellowship training programs to meet the growing need for informaticists. Although many programs share similar features, there is considerable variation in program funding and administrative structures.ObjectivesThe aim of our study was to characterize CI fellowship program features, including governance structures, funding sources, and expenses.MethodsWe created a cross-sectional online REDCap survey with 44 items requesting information on program administration, fellows, administrative support, funding sources, and expenses. We surveyed program directors of programs accredited by the Accreditation Council for Graduate Medical Education between 2014 and 2021.ResultsWe invited 54 program directors, of which 41 (76%) completed the survey. The average administrative support received was $27,732/year. Most programs (85.4%) were accredited to have two or more fellows per year. Programs were administratively housed under six departments: Internal Medicine (17; 41.5%), Pediatrics (7; 17.1%), Pathology (6; 14.6%), Family Medicine (6; 14.6%), Emergency Medicine (4; 9.8%), and Anesthesiology (1; 2.4%). Funding sources for CI fellowship program directors included: hospital or health systems (28.3%), clinical departments (28.3%), graduate medical education office (13.2%), biomedical informatics department (9.4%), hospital information technology (9.4%), research and grants (7.5%), and other sources (3.8%) that included philanthropy and external entities.ConclusionCI fellowships have been established in leading academic and community health care systems across the country. Due to their unique training requirements, these programs require significant resources for education, administration, and recruitment. There continues to be considerable heterogeneity in funding models between programs. Our survey findings reinforce the need for reformed federal funding models for informatics practice and training.

ABSTRACT Background Aim Methods Results Conclusions Radiant skin is a common patient request and the result of multiple contributing factors. Currently, there is no standardized methodological approach that facilitates assessment of skin quality from a holistic perspective.To develop a holistic methodological process to assess skin quality using a scale that helps identify treatment priorities, facilitates conversation with the subject, and helps manage expectations, supports long‐term treatment plans, and tracks treatment progress over time.Ten global experts (dermatologists and esthetic physicians) identified the main measurable aspects that contribute to skin quality, and these were combined to form the Skin Quality Assessment Scale (SQS). The scale comprises four overarching skin quality domains containing nine measurable aspects: texture (pores, lines, scars); discoloration (redness, pigmentation, dullness); firmness (laxity); and hydro‐lipid balance (oiliness, dryness). Each aspect is graded on a 4‐point severity scale (0 = none to 3 = severe). The SQS was validated by a large group of practicing clinicians.Practicing clinicians (> 40, 78% dermatologists) were surveyed; prior to reviewing the scale, 67% did not use any scale but 81% believed a holistic SQS was needed. After reviewing the scale, 100% agreed the scale provides a holistic assessment of skin quality. In addition, 95% agreed the scale helps assess all key aspects of skin quality with subjects and 98% deemed it valuable for their clinic.The SQS represents a holistic assessment tool that engages with and manages subjects' expectations, identifies treatment priorities, creates a long‐term treatment plan, and visualizes the skin quality improvement over time. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions A 45‐min interval from injury to intubation has been proposed as a performance indicator for severe trauma patient management. In the Sydney pre‐hospital system a previous change in case identification systems was associated with activation delay. We aimed to determine if this also decreased the proportion of patients intubated within this benchmark.Retrospective cohort study of patients intubated by a helicopter emergency medical service (HEMS) over two time periods. Period 1 dispatch was via HEMS crew directly screening the computerised dispatch system, and period 2 was via paramedics in a central control room. Times from emergency call to intubation were compared.In the HEMS crew screening period 46/58 (79.31%) intubations met the target, compared with 137/314 (43.6%) in the central control period (P < 0.001). The median (interquartile range) time to intubation in the direct crew screening period was 33 (25–41) min, versus the central control period at 47 (38–60) min (P < 0.001).On multivariate modelling, distance to the scene was related to time to intubation (P < 0.001; Incident Rate Ratio = 1.018, 95% confidence interval 1.015–1.020) as was dispatch system, entrapment/access difficulty and indication for intubation (all P < 0.001).Time from emergency call to intubation was significantly shorter in the HEMS screening period where all non‐trapped cases less than 50 km distant were intubated within the 45‐min benchmark. There was no distance where intubation within 45 min could be assured for non‐trapped patients in the central control period due to dispatch delays. [ABSTRACT FROM AUTHOR]

Introduction: Emergencies are increasingly prevalent, necessitating specialized management to address significant social disruption. Effective management of health emergencies requires resilience from governments and health institutions, as these emergencies are becoming more common and have wide-ranging consequences on health, society, and the economy. Due to the interconnected nature of our global society, events in one location can have international or even global impacts, as demonstrated by the COVID-19 pandemic. Objective: This study aims to assess disaster management preparedness among nurses and physicians during pandemics. Methods: This study used an online survey conducted in late 2022 to collect primary data through a purposive sampling method, involving both government and private hospitals in Palestine. The participants included 512 nurses and 241 physicians from various hospital units. Results: The findings indicate varying levels of knowledge among participants, with a significant portion (67%) reporting no prior experience with real disaster situations. Additionally, 63% lacked prior disaster response experience. Regarding training courses, 17.8% of nurses and physicians prioritized emergency preparedness, trauma mass casualty response, and triage disaster management systems. Despite some understanding of disaster management, the study emphasizes the importance of hospital managers implementing national standards, engaging healthcare professionals in continuous education, and addressing gaps in perceived competence. Conclusion: While participants demonstrated some knowledge of disaster management, the study suggests the importance of hospital managers adopting national standards, engaging healthcare professionals in continuous learning activities, and addressing perceived competence gaps. [ABSTRACT FROM AUTHOR]

Aim: Medical Certificates of Cause of Death (MCCD) play a pivotal role in shaping national health statistics and public health initiatives. This study investigates the quality of MCCD completion at a Tertiary Care Institute in India, focusing on certification errors made by physicians while issuing death certificates. Methods: Using a retrospective, cross-sectional approach, 1603 MCCDs issued during the study period were analyzed for formal correctness and mistakes. The study employed predefined categories to assess the nature and impact of these errors. While this research did not verify the factual accuracy of the MCCDs against patients' medical records, it categorized errors into major and minor, based on their potential to influence the accurate classification of the underlying cause of death. Results: The study showed the presence of errors in all 1603 death certificates examined, categorizing them as major, minor, or both. Notably, 99.2% of cases lacked the mention of the time interval between death and the morbid condition. Analysis of major errors indicated that in 64.6% of cases, competing causes of death were mentioned, while 77.4% featured multiple causes of death. Furthermore, improper sequencing of the cause of death was identified in 11.2%, whereas 7.9% had poorly defined conditions as the cause of death. Conclusion: To improve the quality of healthcare data and public health management, these findings highlight the necessity for precise MCCD reporting and the significance of comprehending mortality patterns. For informed decision-making and changes to the healthcare system, addressing the found errors and patterns is essential. [ABSTRACT FROM AUTHOR]

Objectives: Dyslipidemia is a well-established risk factor for atherosclerotic cardiovascular disease (ASCVD). ASCVD prevalence among people living with HIV (PLWH) is twice that of the general population. This study aimed to evaluate the infectious diseases (ID) physicians' attitudes on dyslipidemia management in PLWH. Methods: This observational, cross-sectional study was conducted as online survey among ID physicians between November 2023 and February 2024. An e-mail with the survey link, title and purpose of the study was sent to physicians through the local ID societies. The survey included questions about physicians' demographic characteristics and their attitudes toward treating dyslipidemia in PLWH. Results: A total of 242 physicians responded to the survey, of whom 59.9% (n = 145) were ID specialists and 40.1% (n = 97) were ID residents. Forty-one percent (n = 100) of physicians reported that they did not follow a guideline, and 26% of physicians reported that they did not use a cardiovascular risk calculator in their clinical practice. Specialists (69%) were more likely than residents (43.3%) to follow clinical guidelines for dyslipidemia management (p < 0.001). Seventy-two percent (n = 174) of physicians doubted the need to treat dyslipidemia, and 73% (n = 177) of physicians were affected by the patient skepticism. Workload and lack of time were identified by 68.6% of physicians as barriers to implementing dyslipidemia guideline recommendations. Conclusion: A considerable number of Turkish ID physicians did not prefer using clinical guidelines for dyslipidemia and ASCVD risk calculators. Statin prescribing of physicians was influenced by workload, lack of time, patient skepticism, and lack of knowledge. Training ID physicians in primary prevention of ASCVD and management of dyslipidemia in PLWH is paramount. [ABSTRACT FROM AUTHOR]

In the practical activity, in the process of carrying out the physical examination, a various spectrum of issues is discovered, mostly related to the correct and uniform application of the provisions of the criminal procedure law. By virtue of this fact, we can state with certainty that the regulation of physical examination, as a criminal prosecution action, requires review and improvement. Among the most topical questions with respect to carrying out this criminal prosecution action are: the possibility of applying coercion to the person subject to physical examination; the procedure and specificity of drawing up the minutes of the physical examination carried out by a physician; the possibility of discovering, removing and recording micro-objects during the physical examination; the admissibility of carrying out the physical examination at the stage of starting the criminal prosecution. Besides, as we often observe, the criminal procedure requirements pertaining to carrying out physical examination are not respected at the appropriate level, the records of the results of this criminal prosecution action registering substantial deviations from the provisions of the criminal procedure law. Therefore, an analysis and an additional and detailed research of the criminal procedural character of the physical examination is necessary. [ABSTRACT FROM AUTHOR]

Understanding physicians as actors who implemented the early modern ideal of collective empiricism into their practices within the local contexts of everyday life, the paper explores two cases from imperial cities in southern Germany in the 1720s and 1780s in which anatomical studies were contested. By analyzing the strategies and arguments that the two physicians used to justify and continue their anatomical dissections, it focuses on their references to different kinds of (local) community and relates these references to another type of collective: membership in a scientific academy. To examine references to community, it is proposed, offers an opportunity to better understand the spread and practice of the ideal of the study of nature as a collective project and how it was intertwined with concepts and structures of order and society in the Holy Roman Empire. [ABSTRACT FROM AUTHOR]

AbstractObjectivesDesignSettingSubjectsMain outcome measurementsResultsConclusion\nKEY POINTSTo explore the perceptions and views of remote consultations and patient care of primary care physicians (PCPs) who work remotely regularly and have experience performing remote consultations.A qualitative study using thematic analysis.Four online focus group interviews with 17 PCPs, working with one private health care provider, with public and private primary care patients.PCPs who had performed video or online chat consultations with primary care patients for at least 6 months.PCPs’ perceptions and views working remotely in online chat and video consultations.Two main themes describing how PCPs perceived remote consultations emerged: 1) remote consultations have an impact on the way physicians work, and 2) remote consultations have an impact on the service system and patients. The subthemes of the first main theme included the physicians’ new way of working, impacts on physicians’ well-being, and impacts on communication and physician competences. The subthemes for the second main theme were the importance of smoothness of services for the patients, patient suitability, and technical liabilities.Remote consultations provide PCPs with a new way of working that could improve work-life balance. However, it is important to maintain sufficient clinical competence through versatile work. Digital consultations can make contacting healthcare smoother and easier for patients if the patient selection is performed carefully. Online chat seems suitable for singular contacts and simple issues, but remote consultations could be used to sustain continuity of care.PCPs perceived that remote consultations had an impact on the PCP’s work and the service systemPCPs felt that remote consultations gave them a new way of working and had a positive impact on their workPCPs perceived that working remotely required skills from the PCP, such as sufficient previous clinical experience in face-to-face consultations and communication skillsPCPs felt that patient selection for remote consultations was importantPCPs considered that lack of continuity of care limited the issues that could be dealt with in a remote consultation.PCPs felt that technical liabilities must be considered.PCPs perceived that remote consultations had an impact on the PCP’s work and the service systemPCPs felt that remote consultations gave them a new way of working and had a positive impact on their workPCPs perceived that working remotely required skills from the PCP, such as sufficient previous clinical experience in face-to-face consultations and communication skillsPCPs felt that patient selection for remote consultations was importantPCPs considered that lack of continuity of care limited the issues that could be dealt with in a remote consultation.PCPs felt that technical liabilities must be considered. [ABSTRACT FROM AUTHOR]

Background and purpose: The process by which family physicians refer patients to specialized levels of the healthcare system is presented. In other words, the referral system can assure us that the clients of health care services are optimally allocated at the specialized level of services. In addition to providing proper time and providing proper health care for health benefits. The referral process is a specialized outpatient consulting process that determines the course and communication of the individual in three levels of the health system to provide the integrity and continuity of services this study aimed to determine the quality of referral and feedback forms in the medical family physician of Mazandaran province in 2019. Materials and methods: This descriptive cross-sectional study was conducted to examine the form of insurance referral of social security insurance by physicians of urban families and feedback from experts. After receiving the code of ethics and obtaining permission from the relevant organization the researcher paid the social security organization 1397 issued by the physicians in the province. The statistical population consisted of all forms of reference and the feedback from experts to the social security insurance organization to get the right According the report of the department of medical record department of the social security insurance organization of Mazandaran province in1397 has been handed over to that organization in a total of 151075 reference sheets completed to obtain the right of the specialists. the collected data were entered into Excel software for statistical analysis was performed in descriptive statistics using central dices (mean, median, mode) and dispersion index(variance, standard deviation, range of changes, coefficients of variation ) for quantitative variables, and index, percentage, and prevalence for qualitative data. The data were analyzed by using SPSS-25 software. Results: The study of 3200 cases of referral and referral forms of family physicians and specialists showed that among the Physicians 2321(72.5) were male and 879(27.5) were female. The patient's records in 586(%18.3) were incomplete. Clinical findings Were found in 98(2.7%) cases and paraclinical findings were incomplete in 22 cases (0.7%) and complete in 171 cases (5.3%). in 884 cases (27.6%) the papers were illegible the cause of referral was written in 560(17.5%). the reason for further referral in 187 cases (5.8%) was written by experts. In addition, 1454 cases (45.4%) of the return sheets completed by specialists were illegible. Conclusion: The results obtained in this study show that the status of the quality of completion of the referral form by the family doctors and also the status of providing feedback by the specialist doctors are not suitable. to improve this situation the implementation of face-to-face and non-face-to-face training programs for both groups and using electronic referral forms can be put on the agenda. [ABSTRACT FROM AUTHOR]

There have been two waves of equity-based investment in physician practices. Both used a combination of public and private sources but in different mixes. The first investment wave, in the 1990s, was led by public equity and physician practice management companies, with less involvement by private equity (PE). The second investment wave followed the Affordable Care Act and was led by PE firms. It has generated concerns of wasteful spending, less cost-effective care, and initiatives harmful to patient welfare. This article compares the two waves and asks if they are parallel in important ways. It describes the similarities in the players, driving forces, acquisition dynamics, spurs to consolidation, types of equity involved, models to organize physicians, and levels of market penetration achieved. The article then tackles three unresolved issues: Does PE investment differ from other investment vehicles in concerning ways? Does PE possess capabilities that other investment vehicles lack and confer competitive advantage? Does physician practice investment offer opportunities for supernormal profits? It then discusses ongoing trends that may disrupt PE and curtail its practice investment. It concludes that past may be prologue, that is, what happened during the 1990s may well repeat, suggesting the PE threat is overblown. [ABSTRACT FROM AUTHOR]

Purpose: Identifying the factors associated with comfort level when prescribing medications is important for tailoring education and training. This study aimed to explore factors associated with the comfort level of healthcare professionals regarding dispensing and adjusting prescriptions for the treatment of chronic pain (CP). Methods: A cross-sectional survey was conducted among licensed physicians, pharmacists, and nurse practitioners across the province of Quebec, Canada. Comfort level regarding dispensing and/or adjusting prescriptions for CP treatment was measured on a 0– 10 rating scale (0 = very uncomfortable, 10 = very comfortable). Results: In total, 207 prescribers participated in this study (83 physicians, 58 pharmacists, and 66 nurse practitioners). 56.5% reported a comfort level in dispensing and/or adjusting prescriptions for the treatment of CP < 6/10. The median comfort level score was 6 (interquartile range - IQR: 2). Differences in median scores were found between physicians (6), pharmacists (7) and nurses (5; p < 0.001). Multivariable logistic regression revealed that the factors associated with an increased likelihood of reporting a high comfort level (≥ 6/10) were: being a pharmacist, having a relative living with CP, a greater percentage of past year continuing educational activities about CP management, and higher perception of short-acting opioids risks. Factors associated with lower comfort levels were as follows: being a nurse practitioner, having fewer years of experience, living in a remote region, living with CP, and a higher perception of long-acting opioids risks. The practice setting and sex at birth were also associated with comfort level. Conclusion: The comfort level regarding prescribing for CP varies according to socioeconomic/professional factors, which can lead to disparities in the quality of care and outcomes for patients. Our results reinforce the importance of investing in initial training and continuing education of prescribers. [ABSTRACT FROM AUTHOR]

This study aims to shed light on the role of Solomon ben Nathan Ashkenazi, an Ottoman Jewish physician, in Ottoman diplomacy. Despite being a German-born Jew and practicing medicine for several years, Ashkenazi played a crucial part in Ottoman relations with Venice and Poland after arriving in Istanbul. The study explores how Ashkenazi, a physician by profession, attained the position of diplomat and examines the reasons behind his involvement in Ottoman foreign relations. While it is common for Ottoman Jewish physicians to be involved in Ottoman foreign affairs, Ashkenazi's example provides valuable insight into the mechanisms and motivations behind their participation in Ottoman diplomacy. The study shows that Jewish physicians in the Ottoman Empire contributed to Ottoman medicine with their medical expertise and played a significant role in bridging the gap in Ottoman-European relations with their diplomatic skills. [ABSTRACT FROM AUTHOR]

Copyright of Bulletin of Legal Medicine / Adli Tıp Bülteni is the property of Galenos Yayinevi Tic. LTD. STI 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.)

Copyright of Bulletin of Legal Medicine / Adli Tıp Bülteni is the property of Galenos Yayinevi Tic. LTD. STI 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.)

This issue of the Journal contains an article by Gynning et al (1) on the impact of work-life interference on burnout and job discontent in a sample of 1575 physicians in Sweden. The authors measured work-life interference and burnout at baseline in 2021, followed participants for one year, and then measured burnout again. Higher levels of work-life interference in 2021 were associated with an increased risk of high burnout in 2022, after adjustment for sex, occupational rank, family situation, work hours, overtime work, work with COVID-19 patients, and high burnout in 2021. The estimates for the association were substantial, with odds ratios of 3.67 [95% confidence interval (CI) 2.78-4.83] and 1.53 (95% CI 1.05-2.25) in the crude and the adjusted analysis, respectively. Work-life interference in 2021 was also associated with risk of job dissatisfaction and turnover intention in 2022. Whereas the design of the study was simple and straightforward, the researched phenomena, both the exposure − work-life interference − and the outcome − burnout − are anything but simple and straightforward. Work-life interference Work-life interference and related concepts, such as work-life balance or work-family conflict, have been viewed and understood differently, depending on historical and other contexts. In the beginning of the Industrial Revolution, the demand for a healthy balance between work and life might have been best expressed in the slogan “eight hours labor, eight hours recreation, eight hours rest”, allegedly coined by the British textile manufacturer and social reformer Robert Owen (1771–1858). Although the link between number of working hours and work-life balance persisted in the 21st century − as illustrated in a review by Albertsen et al (2) on working hours and work-life balance published in this journal in 2008 − new aspects emerged, such as the role of gender and gender disparities. Albertsen et al reported in their review that long working hours were strongly associated with a risk of lower work-life balance among women, whereas among men the association was much less clear. Today, there is a substantial literature studying and critically discussing concepts such as work-life interference and work-life balance from a feminist and post-feminist perspective (3, 4). In recent years, a generational perspective has been added to the research on work-life interference. It has been argued that workers from Generation Y (Gen Y or Millennials), comprising those born between the early 1980s and the mid-to-late 1990s, and Gen Z, those born between the mid-to-late 1990s and early 2010s, are more sensitive about the negative effects of work on life and focused on protecting themselves from work that interferes with life than previous generations (such as Gen X or Baby Boomers) (5, 6). Other researchers, though, have strongly criticized the generational perspective and argue there are little-to-no generational effects and that the apparent differences between the generations are actually due to age and period effects (7). An important period effect might be that in this day and age, the distinction between work and life is becoming less clear compared to earlier days of industrialized societies. Whether this is good or not for workers’ physical and mental health is not easy to answer. For many workers, and in particular but not limited to highly educated professionals (such as us, academic researchers), work is a major part of life and a key contributor to identity and self-esteem. The domains of work and life are often so much entangled that terms such as “interference” or “balance” may not be adequate to describe the relation between the two. The distinction between work and life may be further blurred because of technological advancements that allow a growing proportion of workers to work from home. Burnout The term burnout emerged in the 1970s from research on physical and mental exhaustion among volunteer workers in the USA (8). It gained popularity in particular due to the work by Christina Maslach, professor of psychology at the University of California at Berkeley, and the development of the Maslach Burnout Inventory (9). Maslach conceptualized burnout with three dimensions: emotional exhaustion, depersonalization (also termed cynicism), and reduced personal accomplishment (also termed reduced professional efficacy) (9). While the Maslach burnout inventory is by far the most widely-used instrument to assess burnout, it has also been criticized and controversially discussed, in particular with regard to the dimensions of depersonalization and reduced personal accomplishments (10, 11). Several other instruments, definitions, and conceptualizations of burnout have been proposed over the decades (12). A few years ago, the Network on the Coordination and Harmonisation of European Occupational Cohorts (OMEGA-NET) set up a panel of 50 researchers and healthcare professionals, with the aim of developing a consensual definition of occupational burnout. The results were published in the Journal in 2021 (12). The consensus definition was: “In a worker, occupational burnout or occupational physical AND emotional exhaustion state is an exhaustion due to prolonged exposure to work-related problems” (12). This brief consensus definition was the result of the panel`s impressive work that included reviews of the literature, critical discussions of the findings, and thoughtful deliberations. However, already in the next issue of the Journal, the consensus definition was challenged. In an editorial, Wilmar Schaufeli concluded that several questions regarding burnout still remain unsolved (13). One question is whether “exhaustion” is sufficient to define burnout, as the panel argued, or, as Schaufeli argued, that the burnout concept requires the inclusion of both the inability to spend effort at work (exhaustion) and the unwillingness to spend this effort (what Schaufeli termed “mental distancing”). Gynning et al (1) seem to have followed Schaufel`s reasoning and used in their study the Burnout Assessment Tool 12 (BAT-12) (14), a measurement that includes items both on exhaustion and mental distancing (see the supplementary material of their article for the wording of the items). Prevalence of burnout among physicians When one searches the Web of Science for the topics “work-life interference" OR "work-life balance”, remarkably, the top-five cited articles that show up are all about burnout among physicians (15–19). It is further notable that each of these five articles had more than 1000 citations even though they were relatively recently published: in 2018 (two articles), 2016, 2015, and 2012, respectively. Thus, it seems fair to conclude that the study by Gynning et al addresses an area of great contemporary interest. Is prevalence of burnout particularly high among physicians compared to other occupational groups? The seminal article by Shanafelt et al (15) reported that 45.8% of the physicians showed at least one burnout symptom on the Maslach Burnout Inventory. For comparison with a US population control sample, Shanafelt and colleagues used a 2-item burnout measure that yielded a burnout prevalence of 37.9% among physicians and 27.8% among controls. Recently, Møller et al (20, 21) presented results from a burnout study that invited all 104 active vascular surgeons (including vascular surgeons in training) employed at a department of vascular surgery in a Danish hospital. Of those 104 surgeons, 85 completed the survey, yielding an astonishing response rate of 82%. Burnout was measured with the Copenhagen Burnout Inventory, which assesses exhaustion (but not mental distancing) on three separate scales: personal burnout (exhaustion without attribution to a cause), work-related burnout (exhaustion attributed to work), and client/patient-related burnout (exhaustion attributed to work with clients or patients (10). The prevalence of moderate or severe burnout was 28%, 16% and 4% for personal, work-related, and client/patient-related burnout, respectively (20). Compared to the burnout prevalence reported by Shanafelt et al (15) and Møller et al (20), the burnout prevalence reported by Gynning et al is rather low (4.5% and 5.8% in 2021 and 2022, respectively). There might be many explanations for these huge differences in burnout prevalence across the three studies, such as different response rates and bias due to selective non-response or differences in working conditions between the USA, Denmark and Sweden. The most likely explanation, though, is probably the use of different instruments to measure burnout and thereby different definitions of burnout used in the three studies. Thus, for comparative studies, across countries, industries, or job group, a harmonization of burnout measurements is needed. Mechanisms As delineated above, work hours and overtime work are seen as crucial components of work-life interference in the literature (2). It is therefore remarkable that Gynning et al reported that the association between work-life interference and burnout remained, even after adjusting for work hours and overtime work. So, what is it in work that is interfering with life if not work hours and overtime? The five items to measure work-life interference in the study by Gynning et al are rather general: (i) feeling tired when coming home from work; (ii) private life is not as desired because of work; (iii) overlook personal problems because of demands at work; (iv) personal life suffers because of work; (v) change and adapt personal life to demands at work (see the Supplementary Material of the article for the exact wording of the items). The demands at work that are mentioned in the items could be quantitative demands, including work intensity, but also emotional demands, which tend to be high among physicians (22). It is also possible, though, that the respondents viewed “demands” more broadly and subsumed under the term interpersonal conflicts at work or poor work organization. In an invited commentary to Møller et al`s (21) study on burnout among vascular surgeons, Jonathan Meizoso, a US-American physician, discussed possible explanations for the high burnout prevalence in the study (23). He first expressed his puzzlement that so many Danish vascular surgeons reported burnout, in particular since the working conditions of the Danish physicians seem to be so much better compared to their US-American counterparts (37-hour regular work week, paid overtime work, paid sick leave, paid maternity and paternity leave, six weeks of paid vacation). But then he pointed to adverse working conditions listed in the article that sounded familiar to him as a physician practicing in the USA, such as “increasing bureaucracy, rising requirements of documentation, and an unfavorable electronic health record system”(23). On a theoretical level, these factors seem to be related to the concepts of “unnecessary and unreasonable tasks” in the “Stress as Offense to Self” framework (24). Future studies on work-life interference and burnout might want to examine these and other work organizational factors as potential determinants of work-life interference. These studies could also investigate the extent to which a possible effect of work organizational factors on the risk of burnout is due to work-life interference and the extent to which such an effect occurs via other mechanisms. References 1. Gynning BE, Christiansen F, Lidwall U, Brulin E. Impact of work-life interference on burnout and job discontent: A one-year follow-up study of physicians in Sweden. Scand J Work Environ Health 2024 Aug;4181. https://doi.org/10.5271/sjweh.4181 2. Albertsen K, Rafnsdóttir GL, Grimsmo A, Tómasson K, Kauppinen K. Workhours and worklife balance. Scand J Work Environ Health 2008; Supplement 5:14–21. 3. Rosa R. The trouble with ‘work-life balance’ in neoliberal academia: a systematic and critical review. J Gend Stud 2022;31(1):55–73. https://doi.org/10.1080/09589236.2021.1933926 4. Sørensen SØ. The performativity of choice: postfeminist perspectives on work-Life balance. Gend Work Organ 2017;24(3):297–313. https://doi.org/10.1111/gwao.12163 5. Campbell WK, Campbell SM, Siedor LE, Twenge JM. Generational differences are real and useful. Ind Organ Psychol 2015;8(3):324–31. https://doi.org/10.1017/iop.2015.43 6. Twenge JM, Campbell SM, Hoffman BJ, Lance CE. Generational differences in work values: leisure and extrinsic values increasing, social and intrinsic values decreasing. J Manage 2010;36(5):1117–42. https://doi.org/10.1177/0149206309352246 7. Schröder M. Work motivation Is not generational but depends on age and period. J Bus Psychol 2024;39(4):897–908. https://doi.org/10.1007/s10869-023-09921-8 8. Freudenberger HJ. Staff Burn-Out. J Soc Issues 1974;30(1):159–65. https://doi.org/10.1111/j.1540-4560.1974.tb00706.x 9. Maslach C, Jackson SE. The measurement of experienced burnout. J Occup Behav 1981;2(2):99–113. https://doi.org/10.1002/job.4030020205 10. Kristensen TS, Borritz M, Villadsen E, Christensen KB. The Copenhagen Burnout Inventory. A new tool for the assessment of burnout. Work Stress 2005;19(3):192–207. https://doi.org/10.1080/02678370500297720 11. Schaufeli WB, Taris TW. The conceptualization and measurement of burnout: common ground and worlds apart. Work Stress 2005;19(3):256–62. https://doi.org/10.1080/02678370500385913 12. Guseva Canu I, Marca SC, Dell’Oro F, Balázs Á, Bergamaschi E, Besse C et al. Harmonized definition of occupational burnout: A systematic review, semantic analysis, and Delphi consensus in 29 countries. Scand J Work Environ Health 2021 Mar;47(2):95–107. https://doi.org/10.5271/sjweh.3935 13. Schaufeli W. The burnout enigma solved? Scand J Work Environ Health 2021 Apr;47(3):169–70. https://doi.org/10.5271/sjweh.3950 14. Schaufeli WB, De Witte H, Hakanen JJ, Kaltiainen J, Kok R. How to assess severe burnout? Cutoff points for the Burnout Assessment Tool (BAT) based on three European samples. Scand J Work Environ Health 2023 May;49(4):293–302. https://doi.org/10.5271/sjweh.4093 15. Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 2012 Oct;172(18):1377–85. https://doi.org/10.1001/archinternmed.2012.3199 16. Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc 2015 Dec;90(12):1600–13. https://doi.org/10.1016/j.mayocp.2015.08.023 17. West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. J Intern Med 2018 Jun;283(6):516–29. https://doi.org/10.1111/joim.12752 18. West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet 2016 Nov;388(10057):2272–81. https://doi.org/10.1016/S0140-6736(16)31279-X 19. Rotenstein LS, Torre M, Ramos MA, Rosales RC, Guille C, Sen S et al. Prevalence of burnout among physicians: a systematic review. JAMA 2018 Sep;320(11):1131–50. https://doi.org/10.1001/jama.2018.12777 20. Møller CM, Clausen T, Aust B, Eiberg JP. A cross-sectional national study of burnout and psychosocial work environment in vascular surgery in Denmark. J Vasc Surg 2022 May;75(5):1750–1759.e3. https://doi.org/10.1016/j.jvs.2021.11.042 21. Møller CM, Clausen T, Aust B, Budtz-Lilly JW, Eiberg JP. Burnout and its consequences among vascular surgeons and trainees: a Danish national survey. J Am Coll Surg 2023 Dec;237(6):874–83. https://doi.org/10.1097/XCS.0000000000000853 22. Framke E, Sørensen JK, Nordentoft M, Johnsen NF, Garde AH, Pedersen J et al. Perceived and content-related emotional demands at work and risk of long-term sickness absence in the Danish workforce: a cohort study of 26 410 Danish employees. Occup Environ Med 2019 Dec;76(12):895–900. https://doi.org/10.1136/oemed-2019-106015 23. Meizoso JP. Invited Commentary: Burnout among surgeons: a pandemic in its own right. J Am Coll Surg 2023 Dec;237(6):883–4. https://doi.org/10.1097/XCS.0000000000000858 24. Semmer NK, Tschan F, Jacobshagen N, Beehr TA, Elfering A, Kälin W et al. Stress as Offense to Self: a promising approach comes of age. Occup Health Sci 2019;3(3):205–38. https://doi.org/10.1007/s41542-019-00041-5

OBJECTIVES: In recent years, increased physician workload has led to higher levels of interference between work and private life with increasing stress and job discontent. The objective of this paper was to study if the experience of work–life interference (WLI) is associated with a high risk of burnout and discontent with work (turnover intention and job dissatisfaction) the following year among physicians in Sweden. METHODS: The study applied data for 2021 and 2022 from the Longitudinal Occupational Health survey for Health Care professionals in Sweden study. The data comprised a representative sample of physicians (N=1575) working in Sweden. Descriptive analyses included frequencies and estimates of prevalence with Chi-square and McNemar tests. Analyses of association were assessed through logistic regression reporting odds ratios (OR) and 95% confidence intervals (CI) adjusting for demographics and work-related factors. RESULTS: Higher levels of WLI in 2021 were associated with 1.53 (95% CI 1.05–2.25) times higher odds of reporting a high risk of burnout, 2.06 (95% CI 1.68–2.54) times higher odds of reporting job dissatisfaction, and 1.72 (95% CI 1.47–2.00) times higher odds of reporting turnover intention in 2022. CONCLUSIONS: Experiencing WLI negatively affects mental well-being and work satisfaction among physicians in Sweden. This could ultimately impact the quality of care and necessitates further research to clarify the role of WLI among healthcare workers in Sweden.

OBJECTIVES: Physicians have been shown to have lower mortality compared to the general population, particularly regarding lifestyle-associated causes of death. Prior literature is divided on whether this is due to higher socioeconomic position (SEP), healthier lifestyle, or other specific occupational characteristics. This study analyzed the mortality of Austrian physicians compared to the general population and other (health) professionals with a similar SEP, and investigated patterns of lifestyle-associated mortality among physicians. METHODS: Data from professional associations and cause-of-death statistics were collated to determine causes of death for all occupational groups. Gender-specific age-standardized mortality rates (ASMR) and standardized rate ratios (SRR) were calculated to compare main causes of death [cancer, cardiovascular disease (CVD), external causes] among physicians to other (health) professionals and the general population. Standardized mortality ratios (SMR) were calculated for more detailed causes of death in physicians compared to the general population. RESULTS: Physicians had lower all-cause mortality than the general population [SRR 0.45, 95% confidence interval (CI) 0.41–0.49 for males and SRR 0.60, 95% CI 0.54–0.66 for females] and health professionals (SRR 0.72, 95% CI 0.60–0.88 for males and SRR 0.77, 95% CI 0.63–0.93 for females), mostly due to low CVD and cancer mortality. SMR for detailed causes of death among physicians exhibited a pattern of particularly low mortality in lifestyle-associated causes of death and an increased SMR for suicide among female physicians (SMR 1.58, 95% CI 1.22–2.02). CONCLUSIONS: This study confirmed lower mortality among physicians compared to the general population and compared to other (health) professionals. Low physician mortality can be primarily explained by lifestyle-associated causes of death.

Background and purpose: The process by which family physicians refer patients to specialized levels of the healthcare system is presented. In other words, the referral system can assure us that the clients of health care services are optimally allocated at the specialized level of services. In addition to providing proper time and providing proper health care for health benefits. The referral process is a specialized outpatient consulting process that determines the course and communication of the individual in three levels of the health system to provide the integrity and continuity of services this study aimed to determine the quality of referral and feedback forms in the medical family physician of Mazandaran province in 2019. Materials and methods: This descriptive cross-sectional study was conducted to examine the form of insurance referral of social security insurance by physicians of urban families and feedback from experts. After receiving the code of ethics and obtaining permission from the relevant organization the researcher paid the social security organization 1397 issued by the physicians in the province. The statistical population consisted of all forms of reference and the feedback from experts to the social security insurance organization to get the right According the report of the department of medical record department of the social security insurance organization of Mazandaran province in1397 has been handed over to that organization in a total of 151075 reference sheets completed to obtain the right of the specialists. the collected data were entered into Excel software for statistical analysis was performed in descriptive statistics using central dices (mean, median, mode) and dispersion index(variance, standard deviation, range of changes, coefficients of variation ) for quantitative variables, and index, percentage, and prevalence for qualitative data. The data were analyzed by using spss-25 software. Results: The study of 3200 cases of referral and referral forms of family physicians and specialists showed that among the Physicians 2321(72.5) were male and 879(27.5) were female. The patient's records in 586(%18.3) were incomplete. Clinical findings Were found in 98(2.7%) cases and paraclinical findings were incomplete in 22 cases (0.7%) and complete in 171 cases (5.3%). in 884 cases (27.6%) the papers were illegible the cause of referral was written in 560(17.5%). the reason for further referral in 187 cases (5.8%) was written by experts. In addition, 1454 cases (45.4%) of the return sheets completed by specialists were illegible. Conclusion: The results obtained in this study show that the status of the quality of completion of the referral form by the family doctors and also the status of providing feedback by the specialist doctors are not suitable. to improve this situation the implementation of face-to-face and non-face-to-face training programs for both groups and using electronic referral forms can be put on the agenda.

Jamile A Ashmore,1,2 Anthony C Waddimba,2– 4 Megan E Douglas,5 Stacey V Coombes,6 Tait D Shanafelt,7 J Michael DiMaio2,4,8 1Office of Professionalism and Well-Being, Baylor Scott & White-The Heart Hospital, Plano, TX, USA; 2College of Medicine, Texas A&M University, Dallas, TX, USA; 3Division of Surgical Research, Department of Surgery, Baylor University Medical Center, Dallas, TX, USA; 4Research Development & Analytics Core, Baylor Scott and White Research Institute, Dallas, TX, USA; 5Trauma Research Consortium, Baylor Scott and White Research Institute, Dallas, TX, USA; 6OrganizationRx, Los Angeles, CA, USA; 7Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; 8Division of Cardiothoracic Surgery, Baylor Scott & White-The Heart Hospital, Plano, TX, USACorrespondence: Jamile A Ashmore, Office of Professionalism and Well-being, Baylor Scott & White-The Heart Hospital, 1100 Allied Drive, Plano, TX, 75093, Tel +1469814-4289, Email Jamile.Ashmore@BSWHealth.orgImportance: Physician burnout has reached crisis levels. Supportive leadership is one of the strongest drivers of physician well-being, and monitoring supervisor support is key to developing well-being focused leadership skills. Existing measures of leader support were designed within “direct report” supervision structures limiting their applicability to matrixed leadership reporting structures where direct reports are not the predominant norm. Antecedently, no measure of leadership support is validated specifically for implementation in matrixed leadership structures.Objective: Adapt and validate the Mayo Leadership Impact Index (MLII) for settings with matrixed leadership structures.Design: A psychometric validation study utilizing classical test theory and item response theory.Setting: A tripartite hospital system in the southwestern US.Participants: Physician-respondents to a 2023 cross-sectional survey.Main Outcomes and Measures: After pilot testing, the adapted MLII was examined using a unidimensional graded response model and confirmatory factor analyses. Convergent validity was investigated via correlations with professional fulfillment, perceived autonomy support, self-valuation, and peer connectedness/respect. Divergent validity was tested via correlations with burnout.Results: Of the three candidate revisions of the MLII, the 9-item adaptation was selected for its superior validity/reliability indices. Standardized Cronbach’s and Ordinal alpha coefficients were 0.958 and 0.973, respectively. CFA loadings exceeded 0.70 (p < 0.001), and coefficients of variation (R2) exceeded 0.60 for all items. GRM slope parameters indicated “high” to “very high” item discrimination. Items 2, 5, and 8 were the most informative. Positive correlations of the adapted MLII with professional fulfillment, perceived autonomy support, and peer connectedness/respect were observed, supporting convergent validity. Negative correlation with overall burnout supports divergent validity.Conclusions and Relevance: The findings provide evidence of the adapted MLII’s validity, reliability, and appropriateness for implementation within matrixed leadership settings. Prior to this study, no leadership support measure had been validated for use among the growing number of healthcare systems with matrixed leadership reporting structures.Plain Language Summary: Question: What is the validity and reliability of a well-being centered leadership measure adapted for use in healthcare systems with matrixed, multiform reporting structures?Findings: Classical test theory and item response theory analyses of cross-sectional survey data from 158 physician-respondents supported the adapted measure’s construct validity. All reliability coefficients were strong. Leadership ratings positively correlated with professional fulfillment, autonomy support, self-valuation, and peer connectedness/respect, and negatively correlated with burnout.Meaning: Findings support the adapted measure’s validity and reliability. This study is the first to demonstrate a valid empirical measure of well-being centered leadership behaviors in settings with multiform, matrixed leadership structures.Keywords: physician, psychometrics, well-being, burnout, leader support

Objective: Child abuse and neglect (CAAN) is a serious public health problem that causes serious injuries and even deaths in exposed children. The level of knowledge and awareness of physicians about CAAN is very important in diagnosis and prevention of injuries and deaths. The aim of this study was to measure the level of knowledge and awareness of physicians working in Family Health Centers in Sivas province center about child abuse and neglect. Methods: In this descriptive and cross-sectional study, the study population consisted of 105 general practitioner family physicians and family medicine specialists working in Sivas city center. A 17-question Descriptive Information Form questioning the sociodemographic characteristics of the participants and the “Scale for the Identification of Symptoms and Risks of Child Abuse and Neglect” were used. Data were analyzed using SPSS 25.0 statistical package program. Statistical significance was accepted as a p value below 0.05. Results: Women who participated in our study were found to be more knowledgeable in recognizing the characteristics of children prone to CAAN than men. Physicians aged 40 years and younger were found to be more successful in recognizing child and parent characteristics in CAAN compared to other age groups. Family medicine specialists were more successful in recognizing CAAN than general practitioners. Conclusion: Considering that every individual is the first source of application in the health care system implemented in our country, physicians working in family health centers are health care practitioners who are likely to encounter child abuse and neglect. Therefore, it should be ensured that the awareness and knowledge levels of physicians remain adequate and effective after medical education by increasing and encouraging effective in-house continuing medical education, including current innovations to be made periodically on the subject.

Objective: Violent incidents in healthcare institutions are situations that negatively affect all healthcare professionals, especially physicians. This research was planned to determine the frequency of physicians’ exposure to workplace violence, their reactions to violence, the causes of violence, and solutions to violence. Methods: In this regard, the study group of the research consists of a total of 290 volunteer physicians between the ages of 24-72 working in the city center of Sivas. In this study, data was collected using a survey consisting of 49 questions, including the sociodemographic characteristics of physicians, information about their working status, variables related to the violence that physicians were exposed to, and physicians’ thoughts about the causes, consequences, and solution suggestions of violence. Results: The rate of physicians who were exposed to violence at least once in the working environment was 57.9%. Female physicians, physicians who worked in internal branches, and physicians who had a career of over 16 years were more likely to be exposed to violence. 49.4% of physicians who were subjected to violence filed a complaint. Psychological/verbal violence was the most common (82.1%) among the types of violence. The perpetrators of violence were primarily patients and their relatives. Conclusion: In order to prevent violent incidents and their adverse effects, adequate security measures should be taken, legal regulations should be made to deter acts of violence, and the level of awareness of violent incidents should be increased. Healthcare workers should be given support and training on the effects of violence and coping with it, and the working conditions of physicians should be improved.

Background: Physicians usually have a high responsibility in caring for people. Many times, they encounter work-life imbalances that can impact both their personal health and the quality of medical services they provide. Objective: To evaluate the works and health habits of Thai physicians. Methods: Thai physicians who participated in the hospital’s Corporate Social Responsibility “Save Doctors’ Heart” project, conducted between February 14, 2022 and October 31, 2022, were invited to participate in the study. Data collected was personal data, work habits, including workplace, work hours, and health habits, including fiber in the diet, exercise, sense of well-being, history of health surveillance, and health coverage system. The characteristic features associated with their work and health habits were studied Results: The responses to each question varied among the 1,244 physicians who agreed to join the study. The median age was 45.0 years (IQR 39,56 years). Almost all (98.6%) were still active in medical practice, with >1 workplace in 14.7%. Nearly half (44.5%) worked >40 hours per week. Most reported a moderate to high fiber diet (80.8%), but only 29.7% exercised >3 days per week. Some degree of stress was revealed in 82.1%, being moderate to severe in 25.8%. The younger physicians with less exercise were significantly associated with moderate/severe stress. Only slightly more than half (53.0%) had a good sense of well-being. Nearly 30% had irregular health surveillance. The two most common reasons were unavailability/no time and having no symptoms. Conclusion: Thai participating physicians were still active professionally and had mixed health habits. Most consumed a moderate to high fiber diet and had regular health surveillance; however, with less exercise and some degree of stress. More than half were self-assessed to have a good sense of well-being.

Abstract Diagnosis improvement requires physician-nurse collaboration. This study explored nurses’ concerns regarding physicians’ diagnoses and how they were communicated to physicians. This cross-sectional study, employing a web-based questionnaire, included nurses registered on Japan’s largest online media site from June 26, 2023, to July 31, 2023. The survey inquired whether participants felt concerned about a physician’s diagnosis within a month, if they communicated their concerns once they arose, and, if not, their reasons. The reasons for not being investigated were also examined. The nurses’ frequency of feeling concerned about a physician’s diagnosis and the barriers to communicating these concerns to the physician were evaluated. Overall, 430 nurses answered the survey (female, 349 [81.2%]; median age, 45 [35–51] years; median years of experience, 19 [12–25]). Of the nurses, 61.2% experienced concerns about a physician’s diagnosis within the past month; 52.5% felt concerned but did not communicate this to the physician. The most common reasons for not communicating included concern about the physician’s pride, being ignored when communicating, and the nurse not believing that a diagnosis should be made. Our results highlight the need to foster psychologically safe workplaces for nurses and create educational programs encouraging nurse involvement in diagnosis.

Abstract Introduction In healthcare settings, physical and verbal attacks are commonly encountered in the workplace among healthcare providers. Patients and patients’ relatives and friends have been reported to be the perpetrators of workplace violence. Among all healthcare settings, emergency department (ED) have been designated as high-risk settings for violence, where more than one-quarter of emergency physicians reported that they were victims of physical assault. This study aimed to report the prevalence of workplace violence against emergency medicine physicians in military and non-military hospitals in Jeddah city. Methodology A cross-sectional design has been used in this study. An electronic questionnaire was developed through the Google Form Platform and it included demographic data, the occurrence of verbal or physical violence in the workplace to participants, how many times they experienced this violence, the time of incidents, the location either inside or outside the hospital, whether the perpetrators were mostly patients, patient families, or friends, and whether they reported any violence or not. Categorical variables were used to describe frequencies and percentages, while descriptive statistics such as mean and 95% Confidence Interval (95% CI) were used to summarize the scale variables. P

Abstract Background The healthcare system is currently in a state of tension due to a shortage of physicians, the early retirement of health care professionals and an increasing need for care within an (aging) society. Therefore, the aim of the present study was to examine physicians’ attitudes towards retirement and possible influencing factors on their motivation to work. Method Data were collected as part of a baseline survey of a long-term study. The sample includes a variety of physicians (n = 625), working in outpatient or inpatient care, who have not yet reached the retirement age of 67. The primary outcome was to survey attitudes towards retirement using the Motivation to Work scale. Work-related characteristics (e.g., with regard to contract or working hour) as well as job satisfaction, overall health, and burnout were also included in the analyses (correlations and linear regression models). Results According to the results, sociodemographic characteristics are not significantly related to motivation to work, whereas the other parameters (satisfaction, health, and burnout) influence attitudes towards retirement significantly. Conclusions The results underline the need to improve the occupational conditions of physicians across different medical settings. More research is needed to understand physicians‘ decision-making with regard to retirement, especially in terms of work-related characteristics and differences.

Abstract This study aimed to assess the impact of the COVID-19 pandemic on general practitioner (GP), specialist, and dentist visits among 40 million Iranians covered by the Social Security Organization (SSO). A monthly interrupted time series analysis was conducted over a period of 72 months, including—47 months before the pandemic and 25 months after its onset. The outcomes variables were monthly number of GP, specialist, and dentist visits per 1000 SSO-insured individuals. The analysis was performed by total visits, visits to the SSO direct sector, and visits to the indirect sectors. The study found that in the first month of the pandemic, the number of visits per 1000 insured individuals significantly decreased for visits to GPs (by 51.12, 95% CI −64.42 to −37.88), visits to specialists (by 39.11, 95% CI −51.61 to −26.62), and visits to dentists (by 6.67, 95% CI −8.55 to −4.78). However, during the subsequent months of the pandemic, there was a significant increase in the number of monthly visits for all three categories, with GPs experiencing the highest increase (1.78 visits per 1000 insured), followed by specialists (1.32 visits per 1000 insured), and dentists (0.05 visits per 1000 insured). Furthermore, prior to the pandemic, the number of monthly GP visits per 1000 insured individuals was statistically significantly lower in the indirect sector compared to the direct sector (45.79, 95% CI −52.69 to −38.89). Conversely, the direct sector exhibited lower rates of specialist visits (25.84 visits per 1000 insured individuals, 95% CI 22.87 to 28.82) and dentist visits (0.75 visits per 1000 insured individuals, 95% CI 0.12 to 1.36) compared to the indirect sector. Additionally, the study found that in the first month of the pandemic, the monthly number of GP visits in the indirect sector significantly increased by 34.44 times (95% CI 24.81 to 44.08) compared to the direct sector. For specialist visits and dentist visits, the increase was 3.41 (95% CI −5.87 to 12.69) and 5.01 (95% CI 3.48 to 6.53) per 1000 insured individuals, respectively. Overall, the findings of this study demonstrate statistically significant disruptions in GP, specialist, and dentist visits during the COVID-19 pandemic, although some recovery was observed. Both the direct and indirect sectors experienced decreased visits.

One of the effective ways to increase the level of population coverage with medical services is health insurance. The paper aims to determine what type of health insurance (compulsory, social, or voluntary) has the greatest impact on a country’s ability to provide large-scale and timely medical services to citizens, as measured by the number of unmet needs for medical examination, treatable and preventable mortality. The control variables included a country’s population size, the level of economic well-being, and the scale of the public health system (number of doctors and hospital beds) based on EUROSTAT data for all 27 EU countries in 2012–2021. Modelling (regression models of panel data with fixed and random effects in STATA 18, Wald test, Hausman test, Breusch and Pagan test) proved that only one of three researched types of insurance – voluntary health insurance – positively influences a country’s ability to provide large-scale and timely medical services to citizens: an increase in its volume by 1% leads to a decrease in unmet needs in medical examination on average across all EU countries by 0.26%, treatable mortality rate by 0.08%, preventive mortality rate by 0.27%. The influence of the other two types – compulsory and social – was not confirmed (received regression coefficients for these variables are not statistically significant). This emphasizes the importance of citizens’ conscious attitude to their health (due to the increase in voluntary health insurance) both in strengthening public health and in ensuring faster and better access to medical services.

Abstract Background Assisted death, including euthanasia and physician-assisted suicide (PAS), is under debate worldwide, and these practices are adopted in many Western countries. Physicians’ attitudes toward assisted death vary across the globe, but little is known about physicians’ actual reactions when facing a request for assisted death. There is a clear gap in evidence on how physicians act and respond to patients’ requests for assisted death in countries where these actions are not legal. Methods A survey including statements concerning euthanasia and PAS and an open question about their actions when facing a request for assisted death was sent to all Finnish physicians. Quantitative data are presented as numbers and percentages. Statistical significance was tested by using the Pearson chi-square test, when appropriate. The qualitative analysis was performed by using an inductive content analysis approach, where categories emerge from the data. Results Altogether, 6889 physicians or medical students answered the survey, yielding a response rate of 26%. One-third of participants agreed or partly agreed that they could assist a patient in a suicide. The majority (69%) of the participants fully or partly agreed that euthanasia should only be accepted due to difficult physical symptoms, while 12% fully or partly agreed that life turning into a burden should be an acceptable reason for euthanasia. Of the participants, 16% had faced a request for euthanasia or PAS, and 3033 answers from 2565 respondents were achieved to the open questions concerning their actions regarding the request and ethical aspects of assisted death. In the qualitative analysis, six main categories, including 22 subcategories, were formed regarding the phenomenon of how physicians act when facing this request. The six main categories were as follows: providing an alternative to the request, enabling care and support, ignoring the request, giving a reasoned refusal, complying with the request, and seeing the request as a possibility. Conclusions Finnish physicians’ actions regarding the requests for assisted death, and attitudes toward euthanasia and PAS vary substantially. Open discussion, education, and recommendations concerning a request for assisted death and ethics around it are also highly needed in countries where euthanasia and PAS are not legal.

Diagnosis improvement requires physician-nurse collaboration. This study explored nurses' concerns regarding physicians' diagnoses and how they were communicated to physicians. This cross-sectional study, employing a web-based questionnaire, included nurses registered on Japan's largest online media site from June 26, 2023, to July 31, 2023. The survey inquired whether participants felt concerned about a physician's diagnosis within a month, if they communicated their concerns once they arose, and, if not, their reasons. The reasons for not being investigated were also examined. The nurses' frequency of feeling concerned about a physician's diagnosis and the barriers to communicating these concerns to the physician were evaluated. Overall, 430 nurses answered the survey (female, 349 [81.2%]; median age, 45 [35–51] years; median years of experience, 19 [12–25]). Of the nurses, 61.2% experienced concerns about a physician's diagnosis within the past month; 52.5% felt concerned but did not communicate this to the physician. The most common reasons for not communicating included concern about the physician's pride, being ignored when communicating, and the nurse not believing that a diagnosis should be made. Our results highlight the need to foster psychologically safe workplaces for nurses and create educational programs encouraging nurse involvement in diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: In healthcare settings, physical and verbal attacks are commonly encountered in the workplace among healthcare providers. Patients and patients' relatives and friends have been reported to be the perpetrators of workplace violence. Among all healthcare settings, emergency department (ED) have been designated as high-risk settings for violence, where more than one-quarter of emergency physicians reported that they were victims of physical assault. This study aimed to report the prevalence of workplace violence against emergency medicine physicians in military and non-military hospitals in Jeddah city. Methodology: A cross-sectional design has been used in this study. An electronic questionnaire was developed through the Google Form Platform and it included demographic data, the occurrence of verbal or physical violence in the workplace to participants, how many times they experienced this violence, the time of incidents, the location either inside or outside the hospital, whether the perpetrators were mostly patients, patient families, or friends, and whether they reported any violence or not. Categorical variables were used to describe frequencies and percentages, while descriptive statistics such as mean and 95% Confidence Interval (95% CI) were used to summarize the scale variables. P < 0.05 was considered for statistically significant differences. Results: Among the 100 participants, 76 experienced either physical or verbal violence, or both. The remaining 24 did not experience any sort of violence. 83% of the physicians who have been physically violated were working in non-military hospitals. Of the 72 participants who had experienced verbal violence, 51 (70.8%) were working in a non-military hospital, while 21 (29.2%) were in a military hospital. The most common reason for not reporting was that the participants felt that reporting the violence incidence was useless. Moreover, 92% of participants chose "Train healthcare workers to deal with violent attacks" as a suggested helpful factor in decreasing the number of work-related violence. In addition, "Education of the public" and "Raising awareness of healthcare workers" were chosen as helpful factors as well by 91% and 90% of participants, respectively. Conclusion: This revealed that physicians in non-military hospitals experience higher levels of violence compared to their military counterparts. However, it is concerning that instances of violence are substantially under-reported across both military and non-military healthcare facilities. [ABSTRACT FROM AUTHOR]

Background: The healthcare system is currently in a state of tension due to a shortage of physicians, the early retirement of health care professionals and an increasing need for care within an (aging) society. Therefore, the aim of the present study was to examine physicians' attitudes towards retirement and possible influencing factors on their motivation to work. Method: Data were collected as part of a baseline survey of a long-term study. The sample includes a variety of physicians (n = 625), working in outpatient or inpatient care, who have not yet reached the retirement age of 67. The primary outcome was to survey attitudes towards retirement using the Motivation to Work scale. Work-related characteristics (e.g., with regard to contract or working hour) as well as job satisfaction, overall health, and burnout were also included in the analyses (correlations and linear regression models). Results: According to the results, sociodemographic characteristics are not significantly related to motivation to work, whereas the other parameters (satisfaction, health, and burnout) influence attitudes towards retirement significantly. Conclusions: The results underline the need to improve the occupational conditions of physicians across different medical settings. More research is needed to understand physicians' decision-making with regard to retirement, especially in terms of work-related characteristics and differences. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Burnout is frequent among intensive care unit (ICU) healthcare professionals and may result in medical errors and absenteeism. The COVID‐19 pandemic caused additional strain during working hours and also affected off‐duty life. The aims of this study were to survey burnout levels among ICU healthcare professionals during the first year of COVID‐19, describe those who reported burnout, and analyse demographic and work‐related factors associated with burnout.This was a national prospective longitudinal cohort study of 484 nurses, physicians and leaders working in intensive care units with COVID‐19 patients in Norway. Burnout was measured at 6‐ and 12‐month follow‐up, after a registration of baseline data during the first months of the COVID epidemic. The Copenhagen Burnout Inventory (CBI), was used (range 0–100), burnout caseness defined as CBI ≥50. Bi‐ and multivariable logistic regression analyses were performed to examine baseline demographic variables and work‐related factors associated with burnout caseness at 12 months.At 6 months, the median CBI score was 17, increasing to 21 at 12 months (p = .037), with nurses accounting for most of the increase. Thirty‐two per cent had an increase in score of more than 5, whereas 25% had a decrease of more than 5. Ten per cent reported caseness of burnout at 6 months and 14% at 12 months (n.s.). The participants with burnout caseness were of significantly lower age, had fewer years of experience, reported more previous anxiety and/or depression, more moral distress, less perceived hospital recognition, and more fear of infection in the bivariate analyses. Burnout was the single standing most reported type of psychological distress, and 24 out of 41 (59%) with burnout caseness also reported caseness of anxiety, depression and/or post‐traumatic stress disorder (PTSD) symptoms. Multivariate analysis showed statistically significant associations of burnout caseness with fewer years of professional experience (p = .041) and borderline significance of perceived support by leader (p = .049).In Norway, a minority of ICU nurses, physicians and leaders reported burnout 1 year into the pandemic. A majority of those with burnout reported anxiety, depression and/or PTSD symptoms combined. Burnout was associated with less years of professional experience. [ABSTRACT FROM AUTHOR]

This study aimed to assess the impact of the COVID-19 pandemic on general practitioner (GP), specialist, and dentist visits among 40 million Iranians covered by the Social Security Organization (SSO). A monthly interrupted time series analysis was conducted over a period of 72 months, including—47 months before the pandemic and 25 months after its onset. The outcomes variables were monthly number of GP, specialist, and dentist visits per 1000 SSO-insured individuals. The analysis was performed by total visits, visits to the SSO direct sector, and visits to the indirect sectors. The study found that in the first month of the pandemic, the number of visits per 1000 insured individuals significantly decreased for visits to GPs (by 51.12, 95% CI −64.42 to −37.88), visits to specialists (by 39.11, 95% CI −51.61 to −26.62), and visits to dentists (by 6.67, 95% CI −8.55 to −4.78). However, during the subsequent months of the pandemic, there was a significant increase in the number of monthly visits for all three categories, with GPs experiencing the highest increase (1.78 visits per 1000 insured), followed by specialists (1.32 visits per 1000 insured), and dentists (0.05 visits per 1000 insured). Furthermore, prior to the pandemic, the number of monthly GP visits per 1000 insured individuals was statistically significantly lower in the indirect sector compared to the direct sector (45.79, 95% CI −52.69 to −38.89). Conversely, the direct sector exhibited lower rates of specialist visits (25.84 visits per 1000 insured individuals, 95% CI 22.87 to 28.82) and dentist visits (0.75 visits per 1000 insured individuals, 95% CI 0.12 to 1.36) compared to the indirect sector. Additionally, the study found that in the first month of the pandemic, the monthly number of GP visits in the indirect sector significantly increased by 34.44 times (95% CI 24.81 to 44.08) compared to the direct sector. For specialist visits and dentist visits, the increase was 3.41 (95% CI −5.87 to 12.69) and 5.01 (95% CI 3.48 to 6.53) per 1000 insured individuals, respectively. Overall, the findings of this study demonstrate statistically significant disruptions in GP, specialist, and dentist visits during the COVID-19 pandemic, although some recovery was observed. Both the direct and indirect sectors experienced decreased visits. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic started in Alberta in March 2020 and significantly increased telehealth service use and provision reducing the risk of virus transmission. We examined the change in the number and proportion of virtual visits by physician specialty and condition (chronic obstructive pulmonary diseases [COPD], heart failure [HF], colorectal and lung cancers), as well as associated changes in physician compensation. Methods: A population-based design was used to analyze all processed physician claims comparing the number and proportion of virtual visits and associated physician billings relative to in-person between pre- (2019/2020) and intra-pandemic (2020/2021). Physician compensations were the claim amounts paid by the health insurance. Results: Pre-pandemic (intra-), there were 8,981 (8,897) lung cancer, 9,245 (9,029) colorectal, 37,558 (36,292) HF, and 68,270 (52,308) COPD patients. Each patient had totally 2.3–4.7 (of which 0.4–0.6% were virtual) general practitioner (GP) visits and 0.9–2.3 (0.2–0.7% were virtual) specialist visits per year pre-pandemic. The average number and proportion of per-patient virtual visits to GPs and specialists grew significantly pre- to intra-pandemic by 2,138–4,567%, and 2,201–7,104%, respectively. Given the lower fees of virtual compared with in-person visits, the reduction in physician compensation associated with the increased use of virtual care was estimated at $3.85 million, with $2.44 million attributed to specialist and $1.41 million to GP. Discussion: Utilization of telehealth increased significantly, while the physician billings per patient and physician compensation declined early in the pandemic in Alberta for the four chronic diseases considered. This study forms the basis for future study in understanding the impact of virtual care, now part of the fabric of health care delivery, on quality of care and patient safety, overall health service utilization (such as diagnostic imaging and other investigations), as well as economic impacts to patients, health care systems, and society. [ABSTRACT FROM AUTHOR]

Background: Telemedicineis use of remote based online technology to provide medical consultation to the patients by Physicians. The Covid-19 Pandemic has increased the use of virtual care since last two years. There is a need to analyze its effectiveness and usefulness among the Physician community so that we can get good benefits from it even in the future and address if any difficulties are being faced by them. Hence a study is done to assess the doctors’ perception about Telemedicine especially during the Covid-19 Pandemic at Basaveshwar teaching and general hospital attached to M R medical college in Kalaburagi City, Karnataka. Aim: 1.To assess the perception of telemedicine among Physicians. 2.To study the utilization of telemedicine during Covid-19 pandemic. Methods and material: Cross sectional study using Questionnaire based Google form survey answered by 100 doctors at Basaveshwar Teaching and General hospital attached to M R Medical College for a duration of 3 months from July to September 2021. Results: 58% responded that telemedicine gave desirable results in diagnosis and treatment. 100% agreed the flow increased during pandemic. 98% agreed that telemedicine is beneficial for their practice. Conclusion: There are benefits and drawbacks of telemedicine but in the present scenario benefits are substantial. Some patients and doctors still like physical examination and not all procedures can be performed online. In cases where patients can’t visit their doctors’ in-person as during pandemic and didn’t require a physical exam, telemedicine can be a good alternative. [ABSTRACT FROM AUTHOR]

Copyright of Pasado y Memoria. Revista de Historia Contemporánea is the property of Pasado y Memoria 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.)

Dr Google has evolved with time from being a medical infopedia to an artificial intelligence (AI) powered provider capable of interacting with patients in real-time due to the involvement of social media and AI chatbots. Dr Google is not only consulted as a pre-visiting health information searching tool but also provides health monitoring and treatment plans. With the help of social media, people can connect and share medical information through health forums and YouTube videos and seek help. However, it can create new challenges for medical providers through rapport building, challenging preconceived notions, and managing unnecessary patient demands. The involvement of Google can have advantages and disadvantages from patients’ and doctors’ viewpoints and can affect the physician scoring system and insurance reimbursement. Hence, it is critical to review the pros and cons of Google’s involvement in medicine and understand the possible future implications. [ABSTRACT FROM AUTHOR]

Introduction: The complexity of healthcare is increasing, mainly due to the prevalence of multimorbidity in an ageing population. Complex care for patients with multimorbidity requires a multidisciplinary approach. Traditional physician-centered hospital structures do not facilitate the necessary multidisciplinary collaboration. European hospitals are implementing process-based hospital designs with patient- and process-oriented units to stimulate multidisciplinary collaboration. Patient-oriented units are formed based on shared patient groups and focus on care trajectories, while process-oriented units are formed based on having similar processes and focus on efficiency. Purpose: This study has two aims. First, to study the effect of introduction of these units on multidisciplinary collaboration and perceived impact (efficiency, innovation, and effectiveness). Second, to study whether there are differences between patient- and process-oriented units. Methods: A survey-based longitudinal evaluation study was conducted in 2020 and 2022 among physicians in a Dutch hospital to measure multidisciplinary collaboration (relational coordination) and perceived impact (efficiency, innovation, and effectiveness). In addition, open questions were used to enrich the data. Results: Quantitative and qualitative data together suggest that physicians in patient-oriented units notice benefits from the redesign to multidisciplinary units, they perceive higher impact over time. Physicians in process-oriented units achieve a better relationship with the physicians in their unit over time, but they do not perceive impact as high as physicians in patient-oriented units. Conclusion: A process-based design with patient- and process-oriented units is supportive of multidisciplinary collaboration and perceived impact, especially for physicians in patient-oriented units. Physicians in patient-oriented units are positive about the introduction of these units as they feel it contributes to better multidisciplinary patient care. As the results for physicians in process-oriented units may be less directly visible in terms of quality of care, they are less likely to see positive effects, even though their relationships are improving. [ABSTRACT FROM AUTHOR]

Social media are new tools that can be used for facilitating health information management. However, social media's benefits and challenges for information documentation have not been identified well. This study sought to identify the benefits and challenges of Instagram to information documentation based on Iranian physicians' viewpoints. In this qualitative study, a semi-structure interview was administered to 28 Iranian physicians, and data were collected using purposive and snowball sampling method. The data analysis was done using the thematic analysis method by MAXQDA 10. Based on the findings of this study, six benefits for information documentation over Instagram were identified include sharing lessons learned, developing incidental learning, empowering communications, supporting decision-making, managing personal brand and translating knowledge. Also, based on Iranian physicians' viewpoints, three challenges were found for information documentation in Instagram include ethical and privacy challenges, poor information quality and damaging professional image. Iranian physicians have different attitudes towards using Instagram for information documentation. For control challenges, regulatory and security issues must be addressed to protect physicians' privacy and more education is required for the health professionals to make them more aware of the nature of using social media. [ABSTRACT FROM AUTHOR]

People living with serious illness and their care partners rely on team-based specialty hospice and palliative care (HPC) in order to achieve high quality end of life outcomes. In HPC, physician and nurse practitioner (NP) scope of practice has significant overlap so training together may offer benefits to clinicians and patients. Assessment of clinical competencies in a post-graduate training program consisting of NPs and physicians training and learning side-by-side. A crosswalk assured NP and physician HPC clinical competencies were captured in evaluation questions used by interprofessional program faculty to observe and assess trainees. Six clinical competencies were calculated based on aggregated evaluations for each physician and NP HPC post-graduate trainee at 3, 6, 9, and 12 months annually for 3 years. For NPs and physicians, the mean slopes of the best fit lines, the final numeric score, and the mean net change between 12 and three month competencies were compared. Learner experience was captured qualitatively. There was no statistical difference in the change of competency scores, the final competency scores, or the trajectory of improvement in the six competencies between physician to NP trainees. Adding NP trainees was considered by post-graduate trainees as a strength of the program, and did not detract from physician competence achievement. Assessing an IPE post-graduate training program in HPC was possible using a shared clinical competency framework, and revealed similar clinical gains for NPs and physicians enrolled in the program. [ABSTRACT FROM AUTHOR]

Objective To compare the differences in the competency of the students in the standardized training of residents with different learning styles, and explore more effective clinical teaching strategies. Methods Kolb learning style and clinician post competency of resident trainees in the First Affiliated Hospital of Kunming Medical University were investigated with a questionnaire, and the differences of resident trainees with different learning styles in clinician post competency were compared. Results The main learning style was aggregation (46.1%), followed by adjustment (23.2%) and divergence (17.1%), and absorption (13.7%). There were statistically significant differences in post competence, basic clinical ability, doctor-patient communication ability, mastering and applying medical knowledge, teamwork ability and academic research ability of clinicians with different learning styles ( P < 0.05) . Among them, absorptive learning style of clinical medicine student clinician post competency was the highest. Conclusion Through the understanding of learning style, the teaching teachers can carry out targeted teaching design to improve the post competence of clinical doctors in Pearson Residence. [ABSTRACT FROM AUTHOR]

It is seen that the understanding of the social state and health in Turkey has gradually given way to neoliberal dynamics in parallel with the developments in the world in the last fifty years. The health field has been reorganized with the Health Transformation Program since 2002. In this study, it is aimed to examine the physician strikes and actions at the beginning of 2022. One of the qualitative research methods, Interpretive Phenomenological Analysis was used. It is seen that they started their physician actions with the withdrawal of the legal regulation that caused the personal rights to be discussed in public from the General Assembly of the Parliament. It is commonly stated by spokespersons that the strikes are discontents caused by working conditions and spiritual reasons rather than financial reasons. As a result, the weight of working conditions created by health policies and violence come to the fore in discourses. Security and violence account for 17.4% of all coding. [ABSTRACT FROM AUTHOR]

Chronic spontaneous urticaria (CSU) is a debilitating inflammatory skin condition, often impacting quality of life. International guidelines recommend omalizumab, an anti-immunoglobulin E antibody, for second-line treatment. Our objective was to understand patient characteristics associated with prescription of omalizumab, and assess real-world outcomes in patients with CSU treated with omalizumab. We analyzed data from the Adelphi Real World CSU Disease Specific Programme, a cross-sectional survey with retrospective data collection (December 2020–October 2021) from physicians and patients with CSU in the United States. Data from allergists (n = 45), dermatologists (n = 51), and primary care physicians (PCPs; n = 20) were included. At the time of data collection, one-third of patients were receiving omalizumab (n = 220) and 67% were eligible for but not receiving omalizumab (n = 455). Using logistic regression, the odds of receiving omalizumab were higher in patients whose entire bodies were affected by hives [odds ratio (OR) = 2.551; 95% confidence interval (CI) 1.502–4.333; p < 0.001] or with deteriorating/unstable prognoses at treatment initiation [OR = 2.219; 95% CI 1.031–4.777; p = 0.042], and lower in patients managed by PCPs [OR = 0.276; 95% CI 0.130–0.584; p < 0.001]. Estimates from an inverse probability weighted regression adjustment model indicated that patients receiving omalizumab had higher treatment satisfaction, improvements in itching, hives, angioedema, insomnia, and anxiety, and lower impact on work productivity, compared with patients not receiving omalizumab. Around two-thirds of patients with CSU considered eligible for omalizumab were not receiving the guideline-recommended therapy. Patients receiving omalizumab had better real-world outcomes compared with patients not receiving omalizumab. Ensuring patients receive the most appropriate treatment could benefit patients with CSU. People with a skin rash known as chronic spontaneous urticaria (also called long-lasting hives) have itchy spots that last longer than 6 weeks. People with long-lasting hives may be treated with a medicine called omalizumab to help their itching. We asked doctors why they gave some people omalizumab. We found that only one out of every three people with long-lasting hives were given omalizumab. Doctors gave some people omalizumab because they had long-lasting hives on their whole body or their hives were getting worse. Other people received omalizumab because they were seeing a specialist doctor (allergist) instead of a primary care physician (also called a general practitioner). When compared with people who received other medicines, people being treated with omalizumab had reduced itching, less anxiety, and better well-being. These findings could help doctors choose the right medicine for people with long-lasting hives. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to examine the KAP of physicians regarding targeted drug therapy for lung cancer in China. Methods: This cross-sectional study enrolled physicians working in hospitals in Nanyang. A self-administered questionnaire was developed (Cronbach's α=0.912) to collect the demographic information and KAP. Results: This study included 191 valid questionnaires. Most participants were male (70.2%) and aged 36– 50 (55.5%). The median knowledge score was 29 (24– 31) (/36, 80.6%), the mean attitude score was 42 (39– 44) (/50, 84.0%), and the mean practice score was 28 (26– 29) (/30, 93.3%), indicating sufficient knowledge, positive attitudes, and proactive practice. The female gender (OR=5.291, 95% CI: 1.426– 19.634, P=0.013), working in non-public tertiary hospitals (OR=0.053, 95% CI: 0.008– 0.360, P=0.003), and working in medical oncology (OR=10.764, 95% CI: 2.638– 43.922, P=0.001) were independently associated with adequate knowledge. Only the knowledge scores (OR=1.121, 95% CI: 1.036– 1.212, P=0.004) were independently associated with a positive attitude. Only the attitude scores (OR=1.895, 95% CI: 1.333– 2.694, P< 0.001) were independently associated with proactive practice. Conclusion: Physicians working in thoracic surgery, respiratory medicine, or medical oncology displayed sufficient knowledge, positive attitude, and proactive practice toward targeted therapy for lung cancer. [ABSTRACT FROM AUTHOR]

Copyright of Bylye Gody is the property of Cherkas Global University Press 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.)

This study addresses the mechanism of the commitment to disclosure. Both professionals and physicians bear the crucial responsibility of providing information that is not only accurate but also understandable and appropriate for the intended patient or consumer. By mirroring its international counterparts, Algerian law mandates this duty, attaching legal consequences for its breach. Before any medical intervention, a doctor must obtain the patient’s consent, fulfi lling an essential preliminary step. Likewise, before initiating a sales process, a professional must inform the consumer about all necessary details regarding the product or goods. This paper delineates the extensive aspects of this obligation, including its defi ning features, evidentiary requirements, and the nature of the resultant damages from non-adherence. The aim is to recalibrate the balance of power within medical and consumer interactions, thereby augmenting the safeguarding of patients and consumers. This duty is considered one of the fundamental rights of patients and consumers, linked to ethical and humanitarian responsibilities, and is a precursor to obtaining consent. [ABSTRACT FROM AUTHOR]