Total and partial clinical inertia of general physicians with type 2 diabetes mellitus patients in Central Bosnia Canton

BackgroundThe goal of this study was to determine the frequency and predictive factors of partial (PCI) and total clinical inertia (TCI) of general physicians (GPs) in Central Bosnia Canton in the care of type 2 diabetes mellitus patients.Material and MethodsA longitudinal study was conducted with a prospective data collection. Total of 541 subjects of over 40 years of age with type 2 diabetes mellitus of both genders were included in the study. Total of 532 subjects completed the study. Questionnaires for physicians and patients and the Perceived Stress Scale were used, as well as anthropometric measurements and measurements of the glucose level in plasma, HbA1c, triglycerides, AST, ALT, creatinine and eGFR, which were examined on the day of study entry, after 6 months and after one year.ResultsTCI was 5.8% and PCI was 25.6%. Patients with poorly regulated glycaemia and elevated triglyceride levels had the highest probability of PCI and TCI. Patients with an unaccomplished targeted level of blood pressure were more likely to experience PCI. Patients treated by both an internist and a general physician were more likely to have TCI as compared to patients treated only by an internist.ConclusionsPatients with poor glycemic control experience PCI and TCI more often. In our study, referring to a diabetologist was observed as a non-inert procedure, which resulted in lower PCI and TCI, compared to studies where clinical inertia was defined only as non-intensification of medication therapy.     

国内住培中医患沟通研究现状的分析与思考

目的通过文献计量法分析国内住院医师规范化培训(简称住培)中关于医患沟通的研究现状,为提高住培过程中医患沟通能力提出建设性对策。方法应用文献检索策略,在中文期刊全文数据库搜索并导出自2000年1月1日—2020年2月29日以来有关住培中医患沟通的全部文献,以文献标题、发表时间和研究内容等构建Excel数据库,并进行统计分析。结果查到住培相关医患沟通的相关文献共70篇,均于2009年以后发表,文献研究数量逐年增加;文献作者所在地域分布不均匀;作者单位主要以大学附属医院为主;文献多出自于教育类、临床类和管理类期刊;文献的研究方法主要以理论论述为主,缺乏干预性研究;文献的被引次数较低,文献质量相对较差;文献的研究内容主要对医患沟通的重要性、内涵建设、现状与挑战和提高医患沟通措施方面进行了阐述。结论医患沟通培训在住培中并未受到充分重视,需在住培期间加强医患沟通教育,培养医患沟通能力,为创建新型医患关系奠定坚实的基础。     

Physician and nurse satisfaction with an Electronic Medical Record system

Electronic Medical Records (EMRs) are intended to support clinical activity, improve efficiency, and reduce error. Reluctance to use EMRs may exist among clinicians. The purpose of this study was to assess physician and nurse satisfaction with an Emergency Department (ED) EMR. We surveyed Emergency Medicine (EM) physicians and nurses at a large urban teaching hospital after implementation of an Emergency Department EMR. The questionnaire assessed: 1) computer background and experience; 2) perceptions regarding EMR use; and 3) concerns about impact upon quality of patient care. The clinicians find the EMR easy to use and are generally satisfied with the impact on their work. However, they report that the EMR has no positive impact on patient care. They report confusion in following the sequence of screens, and are concerned with the amount of time it takes to use the EMR and the confidentiality of patient information. Similar results were found between physicians and nurses. Nurses, but not physicians, report that they are able to finish work much faster than before implementation (p < 0.05). We were unable to correlate computer background and experience with satisfaction with an EMR. This survey suggests that EM physicians and nurses favor the use of an EMR and suggests opportunities for EMR enhancement.     

关于针灸推拿专业学位研究生住院医师规范化培训的思考

中医专业学位研究生住院医师规范化培训(以下简称"规培")是对临床型研究生教育的重大改革,是提高专业学位研究生教育水平的重大举措,对提高我国临床医师的整体职业素质具有重要意义.现阶段我校专业学位研究生规培教学工作刚刚起步,在科室安排、培训考核、课程设置及导师带教等方面尚存在一些问题,需逐步探索和完善.本文以我校针灸推拿专业临床型研究生规培为例,针对培训实施过程中存在的突出问题进行分析并提出具体的有针对性的建议,以期规范研究生规培工作,提高我校研究生培训质量,培养出高素质、高层次医学专业人才.     

Three waves,three vaccines,three COVID-19 infections - Saga of a frontline health care worker during the pandemic

The COVID-19 pandemic affected millions around the globe, with front line healthcare workers (HCW) amongst the most vulnerable. The Emergency Department (ED) was the first line of care for all patients infected with the virus, making HCWs in the ED one of the most exposed populations during the pandemic. We highlight the case of a 35-year-old ED physician who developed COVID-19 infections on three separate instances during the peaks of each wave despite the usage of personal protective equipment and being triple vaccinated.     

The relationship between attendance at birth and maternal mortality rates: an exploration of United Nations' data sets including the ratios of physicians and nurses to population, GNP per capita and female literacy

The relationship between attendance at birth and maternal mortality rates: an exploration of United Nations' data sets including the ratios of physicians and nurses to population, GNP per capita and female literacy. BACKGROUND: This is the third and final paper drawing on data taken from United Nations (UN) data sets. The first paper examined the global distribution of health professionals (as measured by ratios of physicians and nurses to population), and its relationship to gross national product per capita (GNP) (Wharrad & Robinson 1999). The second paper explored the relationships between the global distribution of physicians and nurses, GNP, female literacy and the health outcome indicators of infant and under five mortality rates (IMR and u5MR) (Robinson & Wharrad 2000). In the present paper, the global distribution of health professionals is explored in relation to maternal mortality rates (MMRs). The proportion of births attended by medical and nonmedical staff defined as "attendance at birth by trained personnel" (physicians, nurses, midwives or primary health care workers trained in midwifery skills), is included as an additional independent variable in the regression analyses, together with the ratio of physicians and nurses to population, female literacy and GNP. AIM: To extend our earlier analyses by considering the relationships between the global distribution of health professionals (ratios of physicians and nurses to population, and the proportion of births attended by trained health personnel), GNP, female literacy and MMR. physicians, and numbers of nurses, per 1000 population, the proportion of births attended by trained health personnel, GNP per capita and female literacy as independent variables and MMRs as the dependent variable. RESULTS: Linear regression analyses show positive associations for MMRs and the ratios of physicians to population (73%, n=136), ratios of nurses to population (56%, n=137), and the proportion of births attended by trained health personnel (83%, n=118). Multiple regression analyses reveal a more complex picture, with nurses disappearing altogether when regressed with physicians, GNP, female literacy and MMR. The three variables, attendance at birth by trained personnel, GNP and physicians per 1000 population explained 87% of the variation in MMR (n=112) when included in the multiple regression analysis. CONCLUSIONS: As in the previous papers, caution is required regarding the validity and reliability of the UN data sources used in these analyses. Maternal mortality rates are particularly susceptible to inaccuracies. Nevertheless, the strength of the positive correlations suggests that real relationships are identified between the independent variables and the dependent variable of MMR. The strength of the linear and multiple correlations between births attended by trained personnel and lower MMRs indicates that maternal deaths are substantially reduced when a high proportion of births are attended by health professionals, including primary health care workers trained in midwifery skills, with the maintenance of an aseptic environment, the identification of maternal and foetal complications, and the opportunity when necessary to transfer parturient mothers to centres with higher level skills and facilities.     

The profiles of adults who consult alternative health practitioners and/or general practitioners

OBJECTIVE: To compare the profiles of people visiting only a general practitioner (GP), those visiting only a practitioner of complementary and alternative medicine (CAM), and those visiting both (GP&CAM). DESIGN: A comparative total population health survey in central Norway (HUNT 2). SUBJECTS: A total of 54,448 persons 20 years of age and over who answered questions about their use of health services during the previous 12 months. VARIABLES: Sociodemographic characteristics, self-perceived health, subjective health complaints, and a variety of common diseases. RESULTS: Some 34,854 (64.0%) of those who answered the health service use question had visited only a GP, 837 (1.5%) only a CAM practitioner, and 4563 (8.4%) both during the last 12 months. The likelihood of being a CAM-only user as compared to a GP-only user was significantly increased (p < 0.005) if the participant was male; aged between 30 and 69; and without cardiovascular disease. The likelihood of being a GP&CAM user compared with a GP-only user was significantly increased (p < 0.005) for those who were female; aged between 30-59; had a higher education level; were non-smokers; had lower perceived global health; had a limiting chronic complaint; had experienced a health complaint during the last 12 months; had musculoskeletal disease; had a psychiatric complaint; and had hay fever. CONCLUSION: There were few CAM-only users and they differ from GP-only users by being male, aged 30-69, and without cardiovascular disease. Users of both GP&CAM were less healthy with more complaints and poorer self-reported health than GP- and CAM-only users.     

Salary and Quality Compensation for Physician Practices Participating in Accountable Care Organizations

BACKGROUNDThe accountable care organization (ACO) is a new organizational form to manage patients across the continuum of care. There are numerous questions about how ACOs should be optimally structured, including compensation arrangements with primary care physicians.METHODSUsing data from a national survey of physician practices, we compared primary care physicians’ compensation between practices in ACOs and practices that varied in their financial risk for primary care costs using 3 groups: practices not participating in a Medicare ACO and with no substantial risk for primary care costs; practices not participating in an ACO but with substantial risk for primary care costs; and practices participating in an ACO regardless of their risk for primary care costs. We measured physicians’ compensation as the percentage of compensation based on salary, productivity, clinical quality or patient experience, and other factors. Regression models estimated physician compensation as a function of ACO participation and risk for primary care costs while controlling for other practice characteristics.RESULTSPhysicians in ACO and non-ACO practices with no substantial risk for costs on average received nearly one-half of their compensation from salary, slightly less from productivity, and about 5% from quality and other factors. Physicians not in ACOs but with substantial risk for primary care costs received two-thirds of their compensation from salary, nearly one-third from productivity, and slightly more than 1% from quality and other factors. Participation in ACOs was associated with significantly higher physician compensation for quality; however, participation was not significantly associated with compensation from salary, whereas financial risk was associated with much greater compensation from salary.CONCLUSIONAlthough practices in ACOs provide higher compensation for quality, compared with practices at large, they provide a similar mix of compensation based on productivity and salary. Incentives for ACOs may not be sufficiently strong to encourage practices to change physician compensation policies for better patient experience, improved population health, and lower per capita costs.     

Symptom-based approach to colorectal cancer: survey of primary care physicians in Italy

Background. Colorectal cancer is a frequent cause of mortality in Western countries, including Italy, where a definite screening policy has not yet been adopted. It is likely that most patients with colorectal cancer refer, first of all, to their primary care physician at onset of symptoms.

Aim. To perform a survey on the approach, of primary care physicians, to patients with symptoms suggesting the presence of colorectal cancer.

Methods. A total of 280 consecutive symptomatic patients without previous diagnosis of organic colon disease or recent colon investigation in whom, after consulting, 159 primary care physicians in Lazio (Italy) prescribed colonoscopy or double-contrast barium enema.

Results. Most frequent presenting symptoms were lower abdominal pain (79.6%), bloating (59.6%), constipation (47.8%), diarrhoea (30.3%), iron deficiency anaemia (24.6%), change in bowel habits (20.3%) and weight loss (15%). Colonoscopy and barium enema were equally advised by physicians to rule out the presence of cancer (56% versus 44%, P=ns). Cancer was found in 14.6% of patients. Age >50 years and iron deficiency anaemia were the only independent variables associated with colorectal cancer (Odds ratios 9.0 and 8.8 at multivariate analysis, respectively).

Conclusion. The symptom-based selection criteria used by primary care physicians have been shown to be scarcely effective. Colonic investigation should be requested, irrespective to the symptoms, in patients aged >50 years with iron deficiency anaemia.