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An opinion essay examines hospital immunity doctrines and alleged sham peer review, outlining legal context, patient‑safety implications, and avenues for due process.
Excessive overtime work, which is a serious problem among Chinese physicians, is the primary reason for night clinic closure policies. The aim of this study was to evaluate the effects of such policies on physicians’ workload and satisfaction. Physicians at the hospital, which closed its night clinic in 2017, were selected as the intervention group, and those at another hospital, which still operates a night clinic, were chosen as the control group. In total, 829 participating physicians self-reported their characteristics and responded to questions on three effect indicators: weekly hours worked, work–family balance, and job satisfaction; the index years were for 2016 and 2017. A pre–post-with-control-group study design and the difference-in-difference (DID) methodology were employed to evaluate the effect of night clinic closure. After adjusting for physicians’ characteristics, the effect of all variables, except hours worked per week, on work–family balance and job satisfaction remained significant. Although the adjusted effect on hours worked per week was not significant, our results suggest that minor policy changes that reduce the workload of physicians may nonetheless benefit this group. However, as the satisfaction scores remained low, other policies should be implemented to relieve the workload and improve satisfaction among physicians.
The functioning of medical professionals in their work environment is determined by many factors, among them social competence. The Aim of this Study was toanalyze how social competence is related to behaviors and experiences in the context of burnout syndrome, experienced by physicians, nurses, and paramedics in Poland with regard to sociodemographic factors. Methods. The study was conducted in 2015-2016. It involved 432 medical workers, including 29.7% physicians, 36.96% nurses, and 33.3% paramedics. The median age was 38.00. Over half (38.9%) of those surveyed were employed in hospitals, 6.9% in primary care centers, 18.3% in emergency ambulance service. The Social Competence Questionnaire (SCQ), the Work-Related Behaviour and Experience Patterns - AVEM questionnaire, and a self-developed questionnaire were applied. Results. Symptoms of burnout syndrome (Type B and A) were observed in one-fourth of medical workers. 31.8% of all participants presented Type G (p < 0.0001). Behavior types prevailing in particular groups were as follows: paramedics ― Type G and Type S; physicians ― Type A and Type B, and nurses ― Type B and Type G. The general competence level correlated with Type G (p = 0.05), and I competence correlated negatively with Type B (p = 0.02). Conclusions: The problem of burnout syndrome, diagnosed on the basis of work-related behaviors and experiences, is weighty and requires implementation of holistic therapeutic and prophylactic solutions addressed to healthcare professionals. Competence in intimate and social exposure situations, as well as competence in situations requiring assertiveness significantly protect medical workers against burnout syndrome.
Breathing has long been recognised as a vital process in Eastern traditions such as YOGA and Ayurvedic medicine, where Pranayama is regarded as a transformative practice that harmonises body and mind. While the East developed sophisticated systems of breath regulation for health and self-awareness, the West largely overlooked their significance until the late 19th and early 20th centuries. A group of pioneering physicians, sometimes referred to as "the pulmonauts", including Christian Bohr, Konstantin Buteyko, and Peter M Litchfield, explored the physiological foundations of respiration. They emphasised the benefits of slow, nasal breathing and its relationship to both physical and emotional well- being. In the 21st century, contemporary researchers and practitioners such as James Nestor, J. Patrick McKeown and Anders Olsson have expanded this understanding through the fields of biochemistry, physiology, and biomechanics. Their work has clarified the mechanisms underlying conscious breathing and refined ancient pranayama techniques. Integrating insights from both Eastern and Western traditions reveals that breathing is a central factor in maintaining homeostasis and emotional balance.
Background Prescribing appropriate analgesics with optimal dosages based on patients' pain severity is challenging, especially when multiple painkillers are involved. Tracking and analyzing the effectiveness of analgesics and their dosages over time is crucial for pain management. Existing systems lack the ability to integrate analgesic equivalent doses with temporal trends in pain scores, hindering effective decision-making. Methods We developed a Clinical Support System that calculates the daily oral morphine equivalent dose and analyzes trends in consumed equivalent doses of analgesics. The system provides a graphical user interface that displays medication prescriptions, actual medication usage, and pain scores. It offers features such as correlating analgesic drug usage with pain intensity, trend analysis of analgesic drug usage and pain intensity, and identification of effective oral morphine equivalent doses. Results The system overcomes previous barriers in drug analysis by providing real-time calculation of oral morphine equivalents and trend analysis of pain duration. It assists physicians in prescribing appropriate and safe medication dosages, enhancing medication safety for patients. Conclusions Our clinical support system offers a comprehensive solution for analyzing trends in consumed equivalent doses of analgesics. It integrates medication prescriptions, actual usage, and pain scores, providing decision-making support for pain management.
Artificial Intelligence (AI) is emerging as a transformative force across many sectors, with healthcare representing both one of the most promising and most challenging areas of application. This review summarizes current and future applications of AI in healthcare, focusing on its potential to improve diagnosis, therapy, chronic disease management, and overall patient care, while also alleviating physicians’ workload. Recent literature demonstrates that AI systems can reduce diagnostic errors/delays by mitigating cognitive biases, support imaging and pathology through improved accuracy and speed, and prevent prescribing errors by integrating pharmacogenomic and clinical data into decision-support systems. In chronic disease management, AI-powered wearable devices enable continuous monitoring and early detection of conditions such as atrial fibrillation, thereby reducing the risk of stroke and long-term disability, particularly in elderly people. Therapeutic applications include AI-driven drug discovery, personalized oncology, and tailored medicine that integrates multi-omics and lifestyle data. Beyond direct medical intervention, AI contributes by automating routine tasks, optimizing workflows, and facilitating greater patient–clinician interaction. Despite these benefits, significant challenges remain, including issues of data quality, privacy, security, equity, and the need for transparency and trust in “black box” systems. Looking ahead, the integration of multimodal data, digital twins, and robotics is expected to advance more comprehensive, equitable, and human-centered care. We conclude that, when applied ethically and responsibly, AI should not replace clinicians but rather serve as a powerful partner that enhances medicine by restoring empathy and humanity.
Objective Hypertensive crisis is an increasingly frequent medical condition in our context. Its management in medical emergencies is a real challenge for physicians. Few data on hypertensive crisis are available in Chad. The aim of this study was to investigate the epidemiological, clinical and prognostic characteristics of hypertensive crisis in the medical emergency department of Reference National Teaching Hospital in N'Djamena. Patient and methods This was a prospective cohort study running from 1er March 2020 to October 31 2020. Patients presenting with a sudden and severe rise in blood pressure (systolic ≥ 180 mmHg and/or diastolic ≥ 110 mmHg) with or without acute target-organs damage, had been consecutively included and followed up over a period of one (01) month. Epidemic and clinical characteristics on admission, and morbidity and mortality parameters during the course of the disease were collected. The Kaplan-Meier method and the Cox model were used to analyze survival and factors associated with death, with a significance level of p<0.05. Results Of the 3978 hypertensive patients admitted to medical emergencies, 252 had a hypertensive crisis, i.e. a prevalence of 6.3%. Two hundred and seventeen (217) patients were included in the study, divided into 149 cases (69%) of hypertensive emergency and 67 cases (31%) of hypertensive hypertensive urgencies. The mean age of the patients was 55.2 ± 14 years (20 and 80 years) and 67% were male. Hypertension was known in 138 patients (64%). At least one complication was present on admission in 69% of patients. Complications were classified as cardiac (50.7%), neurological (38.2%), kidney impairment (46.5%) and ocular (46.1%). The average number of antihypertensive drugs used was 2 ± 0.83 14. Calcium antagonists (86.5%), diuretics (35.5%), converting enzyme inhibitors or angiotensin II receptor antagonists (33.3%) and betablockers (18%) were the pharmacological classes prescribed. Good compliance during follow-up was observed in 124 patients. One-month survival was 84% for all patients, with a 16% mortality rate. Factors associated with death were the duration of hypertension, and the occurrence of cardiovascular, renal dysfunction and ocular disease (p < 0.05). Conclusion Hypertensive crisis is a frequent pathology in sub-Saharan Africa, with high morbidity and mortality. Prevention requires early detection and effective management of hypertension.
Background Antibiotics are the most prescribed medications worldwide. Global consumption rose by 65% in 76 low and middle-income countries between the years 2000 and 2015. According to the World Health Organization, improper administration of antibiotics occurs in over 60% of people with upper respiratory tract infections. Inadvertent antibiotic use has been identified as a contributor to antimicrobial resistance. Outpatient antibiotic use accounts for around 80-90% of all antibiotic use in patients. Clinical officers are non-physician healthcare workers who have received less training, have a more restricted scope of practice than physicians. Clinical officers are key service providers in this country especially at the primary healthcare level. Objective The study assessed the factors that influence antibiotic prescribing for upper respiratory tract infections by clinical officers. Method A prospective study was carried out at 20 public hospitals in Kiambu County, on 36 clinical officers and 600 patient prescriptions. The parameters measured were patient factors, prescriber factors, institutional factors and how they affected the antibiotic prescribing practices by either being rational or irrational. Rational prescribing was identified as prescribing the right drug, at the right frequency, in the right duration, right dose for the right indication. Prescriptions were considered irrational if they did not satisfy any of the rational indices. Data was collected via a questionnaire from the clinical officers while WHO prescription checklist was used to collect data from patient encounters. Data was analyzed using Statistical Package for Social Sciences version 22.0 (SPSS v22.0) with P-value, Confidence Interval and Odds Ratio. Results A total of 600 patient encounters were recorded and 79.8% of the 479 encounters had an antibiotic prescription for URTI, 91% of the antibiotics prescribed were the right dose, 98% had the right frequency, 75% had the right duration, and only 23% had the right indication. Patients above 65 years were more likely to receive an antibiotic prescription OR 3.98 CI 0.91,17.41 P=0.17 compared to children under 12 years old. Males were more likely to receive an antibiotic, but this was not significant OR 1.06 CI 0.70, 1.59 P=0.79. A total of 28 (4.6%) patients had fever, and all received antibiotics. A total of 36 clinical officers were sampled and only 5 (13.8%) were found to have rational prescriptions (P=0.63), prescriber age (P=0.92), prescriber level of education (P=0.99) and prescriber work experience (P=0.22) were not associated with antibiotic prescription. As per institutional factors, availability of antibiotics (P=0.026) and availability of prescription guidelines (P=0.012) were associated with rational prescription of antibiotics. Conclusion The study indicated that there was a high antibiotic prescription rate deviating from the WHO standard. It demonstrated that most antibiotic prescriptions were irrational.
Melanoma treatment has improved significantly with the development of immune checkpoint inhibition (ICI), which has greatly enhanced the survival rates of patients with metastatic melanoma. However, a significant number of patients do not respond well to ICI treatment and experience progression. This highlights the critical need for practical means to track melanoma patients' response to ICI. To address this issue, the patterns of circulating miRNAs were studied in liquid biopsies of melanoma patients. These miRNAs have the potential to provide essential information regarding the cancer stage, progression, and the presence of PD-L1 in tumor tissue. A sophisticated flow cytometric test was used to measure up to 63 different miRNAs at once. The study identified a combination of nine miRNAs that are capable of distinguishing between different stages of melanoma, particularly stage IV. Additionally, five miRNAs were pinpointed which are downregulated in patients who do not respond to ICI treatment. Furthermore, two miRNAs were found that correlate to the level of PD-L1 in tumor tissue, and low levels of miR-150-5p were linked to poorer overall survival. These findings suggest that circulating miRNAs could serve as valuable markers to predict the effectiveness of ICI, provide insights into the cancer's stage and PD-L1 status, and ultimately help physicians make better treatment decisions in the future. However, further research is needed to confirm these findings and establish their clinical usefulness.
Safe and effective antitussive therapy remains a significant area of unmet need for cough management. Antitussive drugs are commonly used cough suppressants and include centrally acting (opioids and non-opioids) cough suppressants and peripherally acting antitussives. Authors searched PubMed, Google Scholar and additional studies from reference lists via cross-referencing to identify studies assessing levodropropizine for the treatment of cough. Of the 748 studies identified, 13 were included. Recent clinical evidence, guideline recommendations and findings from this review suggest that levodropropizine is a peripheral antitussive which reduces cough intensity, frequency, and nocturnal awakenings in children and adults and provides better efficacy outcomes with a more favourable risk/benefit ratio compared to centrally acting antitussive agents which pose greater safety concerns and present an unacceptable risk–benefit profile. This review is aimed at Indian primary care physicians for making effective cough management decisions where the clinical evidence needs to be translated to clinical practice. Key Messages The usage of currently available centrally acting antitussive agent is greatly limited by their central depressing action and frequent side effect. The findings of this review indicate that levodropropizine is an effective antitussive agent and well tolerated in the management of cough in patients of all ages.
Introduction Reporting of suspected or confirmed communicable diseases is paramount. Although physicians have primary responsibility for reporting, school nurses, laboratory directors, infection control practitioners, daycare center directors, health care facilities, state institutions and any other individuals providing health care services are also required to report communicable disease. Therefore, community health needs assessment in urban communities remains an essential instrument for the rapid and accurate dissemination of epidemiological information on cases and outbreaks of diseases under the national health regulations and other communicable diseases of public health importance, including emerging or re-emerging infections. Purpose of the Study Todescribe relevant medical needs of townspeople so that treatment plans can be developed accordingly. Methods The Study was a cross-sectional with qualitative approach. In-depth interviews and focus group interviews was used as research technique. Data was categorized to look for emerging themes then further distilled to identify any abstract themes that could be understood holistically. Results Urban decision-makers need to advocate the problem of human resources in public health facilities and the mutual health insurance to revise its insurance policy to allow their clients to be received even in private clinics. Dental services was wished to be available in public health centers. Study participants suggested that new useful information could be posted in private public premises rather than to be in public institutions only. Conclusion The patient waiting time, dental services in health centers, and the way of dissemination new health information, mutual health insurance and insufficient human resources are the major concerns of townspeople that they wish improvement.
Background By the start of year 2020, the whole world was attacked by a rapidly spreading epidemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) which later was classified by WHO as Pandemic. some physicians reported multiple neurological manifestations including cerebrovascular strokes in patients with severe infection. Aim to assess the incidence of admitted stroke cases during 2019 in comparison to 2020 during COVID-19 pandemic in King Fahd Hospital, Saudi Arabia. Methodology A record based retrospective comparative study was conducted by reviewing all medical records for patients who admitted with stroke at King Fahd Hospital during March and April 2019 and March and April 2020. All data were extracted from patients’ medical files included personal data, nationality, date of admission, and stroke related data. Results The study included 121 patients whose ages ranged from 33 to 98 years with mean age of 59.9 years. At March 2019, there were 45 cases compared to 26 in March 2020. In April 2019 there were 20 admitted stroke cases compared to 30 in April 2020. Regarding clinical features of admitted stroke cases, Table 3 illustrates that 36.9% of stroke cases in 2019 were small vessel stroke compared to 58.9% of 2020 cases. Conclusions & Recommendations In conclusion, the study revealed there was no recorded significant change in the trend of admitted cases with stroke before and during COVID-19 pandemic.
Introduction Health care personnel are exposed to a variety of material occupational health hazards while handling biological material and contaminated equipment. The use of appropriate and good qualitypersonal protective equipment in work places cannot be over emphasized. Several years ago, this need was highlighted to several physicians like Sir Thomas Morrison Legye. He identified the role of the employer of labour and those of the employee in reducing workplace hazards and consequently achieving a healthy workplace environment. Objectives This study was to determine level of awareness and utilization of Personal Protective Equipment among Medical Laboratory workers. Methods A questionnaire was structured with two sections and a total of 92 were administered. A pilot study was also carried out before the administration of the questionnaire. The data collected was analyzed on Microsoft excel spreadsheet in duplicate. It was then exported into EPI info version 3.4.1. Data was presented using frequency tables and chi square. Results About 77.3%, 72.9%, and 72.7% were aware of the use of goggle, gloves, and importance of hand washing in preventing exposure to Healthcare associated infections while working on patients’ samples. However, under the socio- demographic characteristics of the respondents and awareness level at P-value < 0.5 the results were 0.02. 0.5, 0.85, 0.92 for education, gender, years in service and age respectively. Hence, there is no significant relationship between respondents’ gender, age and year in service, and level of awareness. Conclusion The hospital management should ensure regular provision and supply of Personal Protective Equipment (PPE) to ensure continual usage. Also, regular training and re-training should be conducted to keep the laboratory workers at briefs with latest innovative and benefits of PPE developments to this end.
Background Self-medication (SM) can be defined as the use of drugs to treat self-diagnosed disorders or symptoms, or the intermittent or continued use of a prescribed drug for chronic or recurrent disease or symptoms. A number of individuals in developing countries do not attend physicians for their illnesses; instead they commonly use self-medication. Self-medication could be using drugs existing in home like over the counter (OCT) drugs, traditional medicine, prescription only drug. Self-medication is not always bad, hence for the over the counter drugs it is beneficial. Inappropriate storage and use of medicines at home could have a direct influence on public health, the environment and the health-care services and it increases the risk of self-medication. Objective To assess the practice of self-medication and drug storage among South Sudanese community in Addis Ababa. Materials and Methods A cross sectional study design was conducted in Addis Ababa city from April 22 to April 26/2019. Data was collected by semi structure-questionnaire consisting questions on general demographic, socio-economic as well as on perceived illness/ symptoms in the past four weeks and actions taken for it. The data collected was screened before it is analyzed. Data analysis was done by using calculator. Results From the total 297 respondents 286 (96.2%) had reported self-medication in the last one month before the study period. The most common types of ailments for which the respondents reported to have practiced self-medication were cough, cold and sore throat 90(30.3%), followed by headache 66(22.2%), diarrhea 52(17.5%) ,abdominal pain 47(15.8%), fever 21(7.07%) and vomiting 10(3.3%). The reasons given for self-medication were; the illness was minor 226(76%) and previous experiences with similar ailments 31 (10.4%) were found to be the two major reasons given by the respondents for self-medication in this study. The majority of the respondents 242(81.4%) who practiced self-medication obtained information on self-medication from friends and 29(9.7%) obtained information from family members. The most frequently used group of drugs used for self-medication were analgesics/antipyretics 177(59.5%) and antimicrobial which account 75(25.2%) each followed by antihelmenthics 24(8.08%).The main source of drugs for SM was in pharmacy 220(74.07%) followed by leftover drugs 41(13.8%) while drug retail outlet, and neighbors and relatives were the suppliers to 12.13% respondents each. Conclusion and Recommendation A significant number of respondents (96.2%) use S/M from those perceived illness. Majority of the self-medicated individuals used due to minor illness. The most common category of drugs used was analgesics/antipyretics and antimicrobials. And the reason reported for using S/M was minor illness and previous experience with the illness. Most of respondents obtained drugs easily from pharmacy. So, pharmacies are the major sources of drugs used for S/M. The increased of drugs storage to treat similar illness/symptom and drugs left over from previous use contribute to the increase in the S/M practice. Common drugs store reported by respondents who store modern drugs were analgesic/antipyretic. Most of the respondents stored the drug in locked cabinets. A lot is need to be done in educating the public including the health care providers on the type of illnesses that can be self-diagnosed and self-treated, the type of drugs to be used for S/M, and the proper use of drugs. During dispensing of drugs emphasis should be given to all drug consumers and dispenser because of resistance and side effects of drug is the main challenging problem even in the world. Food, Medicines and Healthcare Administration and Control Authority (FMHACA) needs to effectively implement laws on drug handling and dispensing so as to take necessary measures on illegal providers of drugs.
Public health professionals working in rural communities are aware of the health disparities which result from lack of physicians, limited services, and income during the pandemic. Also they are aware that some populations are more vulnerable than others. People in the rural areas are experiencing problems on their physical, social and economic life styles because the pandemic is exacerbating some inequities. Individuals especially women and children in the rural areas are facing barriers in accessing health care services due to lack of resources and availability of health care providers in the communities. With COVID-19, women are less likely to seek services, including sexual and reproductive health services. Such services may be postponed to limit exposure to COVID-19 infection. This is particularly disturbing because in addition to the women maintaining their own health, they are also responsible for taking care of the mental, emotional and physical health needs of their families as well as all domestic responsibilities. As such, women in rural settings face special challenges as a result of these significant roles they play. Therefore, the impacts of COVID-19 are exacerbated on women by virtue of their sex and the roles they play in the family. This is a qualitative study that reviewed the reports of the 36 health care professionals under the aegis of members of COVID-19 committee working in partnership with state government to control, prevent and cushion the effects of COVID-19 in the society. This study is therefore, a summary of the observations of the COVID-19 committee members made up of 10(27.8%) females and 26(72.2%) males. The study focused on exploring how individual lifestyles in the rural areas have been affected in the face of COVID- 19 pandemic by identifying the vulnerabilities in social, political and economic systems which can amplify the impacts of the pandemic. Findings showed that preventive measures like lockdown and social distancing rules, wearing of face mask, hand washing with soap, and environmental cleanliness were not observed. The study noted that health seeking behaviours, sexual and marital life including income, education, employment and social interactions were all negatively affected. Most hospitals were battered and health care professionals boycotted the hospitals for fear of being infected. It was found that lack of health workers in the hospitals caused a good number of individuals to engage in self-medications. Also most pregnant women delivered their babies at home and few with traditional birth attendants. Some of the women who had deliveries at home experienced complications during and after delivery. Unfortunately, the report showed that governments’ financial supports to these women and their family members were insignificant as the government was more concerned with mitigating the spread of COVID-19 than assisting women to have safe deliveries. Therefore, the vulnerable groups especially women, children, and the elderly who experienced threats to their safety and wellbeing as a result of the services that were disrupted during the pandemic, should be assisted so as not to lose their lives to preventable diseases.
Immune thrombocytopenia currently called under its’ new name, immune thrombocytopenic purpura (ITP) is a disease characterized by thrombocytopenia, in which the body attacks its own platelets due to the disorders in immune system. The pathophysiology of this disease includes increased platelet destruction and most megakaryocyte production in bone marrow. The most common clinical manifestation of ITP is mild or severe progressive bleeding that could result in death. ITP is generally named as primary or secondary ITP according to thrombocytopenia severity, disease duration, bleeding status and secondary occurrence of the disease. Currently for diagnosis, despite the blood count, antiglobulin test and laboratory tests that can detect platelet-bound antibodies, they are not enough for definitive diagnosis. Like the difficulty in diagnosis, ITP treatment is quite complicated which varies depending on age, characteristics and risk of the patient. It is classified as first, second and third-line treatment options. Also, depending on the condition of patients, combined treatment might be an option which increases the complexity of the treatment. Unfortunately, discussions related to different clinical applications in diagnosis and treatments continue recently. For this reason, we considered that preparation of a review containing recent updates in diagnostic approaches and treatment options in ITP will be remarkable and beneficial for physicians interested in this subject.
Prostate specific antigen (PSA) does not provide the high reliability and precision that is required for an accurate screening for prostate cancer (PCa). The aim of our study was to search for a simple, rapid, direct, preferably non-invasive, and highly accurate biomarker and procedure for the screening for PCa. For this purpose the levels of bromine (Br) and zinc (Zn) were prospectively evaluated in expressed prostatic fluid (EPF). Also Zn/Br concentration ratio was calculated for EPF samples, obtained from 38 apparently healthy males and from 33, 51, and 24 patients with chronic prostatitis (CP), benign prostatic hyperplasia (BPH) and PCa, respectively. Measurements were performed using an application of energy dispersive X-ray fluorescent (EDXRF) microanalysis developed by us. It was found that in the EPF of cancerous prostates the levels of Zn and Zn/Br were significantly lower in comparison with those in the EPF of normal, inflamed, and hyperplastic prostates. It was shown that “Sensitivity”, “Specificity” and “Accuracy” of PCa identification using the Zn and Zn/Br levels in the EPF samples were all significantly higher than those resulting from of PSA tests in blood serum. It was concluded that the Zn and Zn/Br levels in EPF, obtained by EDXRF, is a fast, reliable, and non-invasive diagnostic tool that can be successfully used by local, non-urologist physicians at the point-of-care to provide a highly effective PCa screening and as an additional confirmatory test before a prostate gland biopsy.
Many lay people along with some so called “key opinion leaders” have a common slogan “There's no answer for cancer”. Again, mistake delays proper treatment and make situation worse, more often. Compliance is crucial to obtain optimal health outcomes, such as cure or improvement in QoL. Patients may delay treatment or fail to seek care because of high out-of- pocket expenditures. Despite phenomenal development, conventional therapy falls short in cancer management. There are two major hurdles in anticancer drug development: dose-limiting toxic side effects that reduce either drug effectiveness or the QoL of patients and complicated drug development processes that are costly and time consuming. Cancer patients are increasingly seeking out alternative medicine and might be reluctant to disclose its use to their oncology treatment physicians. But there is limited available information on patterns of utilization and efficacy of alternative medicine for patients with cancer. As adjuvant therapy, many traditional medicines shown efficacy against brain, head and neck, skin, breast, liver, pancreas, kidney, bladder, prostate, colon and blood cancers. The literature reviews non-pharmacological interventions used against cancer, published trials, systematic reviews and meta-analyses.
The medial calcaneal nerve (MCN) is the first branch of the posterior tibial nerve (PTN) in the porta pedis, enervates the skin of the heel and medial side of the foot. Heel pain is a common condition encountered by physicians, and this may have a significant clinical association with the MCN’s branching pattern. This study was to identify branching pattern variations in the medial calcaneal neurovascular bundle. This study was carried out using 60lower limbs of formalin-embalmed cadavers, using the tarsal tunnel dissection method for 30right and 30 left lower limbs. The medial calcaneal neurovascular bundle course was identified by exposing the PTN and its branches from the distal end of the leg toward the plantar surface beyond its bifurcation and resecting the skin and flexor retinaculum. Many MCN branching pattern variations (specifically concerning origins, numbers, and levels of branching) were observed. In the right foot a single branch was present in 21 specimens (70%), while two branches were observed in nine specimens (30%). In the left foot, a single branch was present in 22 specimens (73.3%) and two branches were present in 8 specimens (26.7%). In this study, two branches originate from lateral planter artery is the most common observation. This study concludes that a single MCN originating from the TN is the most common variant. Two medial calcaneal arteries (MCAs) originating from the LPA is also common.
Background Medication adherence remains a challenge for patient management. Changes in the drug regimen after a hospital stay can lead to confusion or misunderstandings. We implemented a structured patient-centered interview during which a computer-generated individualized medication plan was discussed and provided to patients at discharge. Objective To explore whether a medication plan can be a quality indicator, in terms of its content (quality) and its implementation in the resident’s workflow (feasibility). Methods An observational mixed method study with interviews of 174 patients from general internal medicine wards at 1 week and 1 month after discharge, and of 91 physicians at baseline. We report the quality of the medication plan in terms of content and state of completion. We describe feasibility for residents to complete this plan, as well as patient and resident satisfaction with the plan. Results 83% of participants received a medication plan. Physicians verified renal function (83%) to adapt doses but did not regularly assess for medication interactions (43%). Incomplete plans (61%), were due to blanks when physicians considered the information irrelevant for their patients. Error rate was <3%. Patients reported low use of their plan after discharge (64% found it useful after 1 week, whereas only 37% used it when taking their medication 1 week after discharge). Conclusion Although the plans were considered useful by both patients and physicians, their implementation could have been optimized by considering the overall process (creation to patient use). Mobile apps could help fill gaps in supporting patients for medication adherence.
Progressive increase of cardiovascular disease (CVD), with a rising costs for the society, is driving to focus on risk’s factors reduction. The importance to prevent acute events and to reduce mortality and morbility have risen the sound of the correct life style indications as the primary approach for hypertension. The new classification of hypertension has amplified an high-value of the role of the physical activity especially in the initial phase of the disease when the potential positive impact of the regular physical activity can permit to avoid the use of the pharmacological treatment. The numbers of the hypertensive subjects is increasing everywhere; however the awareness of the presence of the disease is not so frequent. Although some risk factors, such as age and hereditary factors cannot be changed, on the contrary lifestyle’s modification can prevent the CVD and hypertension. Sports Medicine physicians agree that healthcare providers need to focus on preventive and lifestyle aspects of cardiovascular care to promote individual and population health. A dedicated approach to prescribe the amount of weekly physical activity at moderate intensity can allow to control the blood pressure values avoiding the assumption of antihypertensive drugs. Aerobic and resistance exercises need to be individually established by dedicated models tailored on the basis of the specific characteristics of the people involved. Sports and Exercise Medicine can contributes to manage and to tailor the amount of programmed physical activity starting from the ”exercise prescription” guidelines.
Objective: This study aimed to assess the knowledge and attitude levels of pediatricians in terms of the pertussis vaccine. Materials and Methods: A survey study was carried out to evaluate the knowledge and attitude levels of pediatricians working in Istanbul in terms of the pertussis vaccine between May 1, 2015 and July 1, 2015. Results: A total of 104 pediatricians who comprised of 53 male and 51 female physicians, participated in this study. It was found that 35.6% of them at low-level, 51% at middle-level and 13.5% at a high-level of knowledge. The knowledge-level scores of the pediatricians who had children were significantly higher than those of pediatricians who had not a child on pertussis vaccine. Moreover, the knowledge-level scores of the specialist doctors in terms of the pertussis vaccine were significantly higher than those of the assistant doctors. It was significant that pediatricians who had children suffering from chronic diseases had greater knowledge-level scores in terms of the pertussis vaccine than those who had children without any disease. Conclusion: The knowledge and awareness of physicians in terms of the pertussis vaccine should be increased with in-service trainings, as the surveyors presented an insufficient knowledge level.
The continuous waves of refugees from Africa and the Middle East to Europe present major inter¬cultural challenges to European health professionals and to society at large. A recent workshop in Sicily brought together local physicians, nurses, psychologists and managers of governmental agencies, along with representatives from Lebanon, Israel, Iraq, Iran, Sudan, Tunisia, Jordan and the European Society of Medical Oncology (ESMO) to develop training programs aimed at formulating dialogue between regional professionals and refugees. A major barrier refugees face is a lack of verbal and cultural communication, which hinders their smooth absorption into the new society. Cultural mediators who speak Arabic and Italian and understand the refugees' faith, tradition and beliefs are vital to successfully build bridges of trust between caregivers and refugees. Most asylum seekers experience anxiety, fear, and depression upon arrival in Europe. To achieve trust, all workshop participants agreed to develop a palliative care model that would best suit the unique circumstances now facing some Mediterranean countries and assist in overcoming the suffering of refugees during their initial stay in Europe. Such a model would include bio-psychosocial elements, essential for a culturally sensitive approach and based on core ethical principles.
The number of patients with poor ovarian response (POR) for in vitro fertilization (IVF) varies from 9 to 25%, especially high in patients of advanced maternal age. Although various stimulation protocols have been developed to improve clinical outcomes in patients with POR, a typical and effective protocol remains improvement. Some physicians prefer a mild stimulation protocol, while others like hyper stimulation protocol to obtain more eggs. This study was designed to compare the efficiency of a mild stimulation protocol with hyper stimulation protocol in patients with POR, particularly focused on live birth rate after IVF. Data were collected from 30 poor responders (over 39 years old). Patients were assigned to 2 protocols at the start of ovarian stimulation: Patients in group A were treated with a hyper stimulation (GnRH-antagonist) protocol and patients in group B were treated with a mild stimulation protocol. The ovarian stimulation characteristics, gonadotropin doses, number of eggs collected, number of high quality embryos, clinical pregnancy rates and live birth rates were compared between two groups.Although number of eggs, number of high quality embryos, clinical pregnancy rates were significantly higher in group A than in group B, miscarriage rate was also higher in group A than group B, which eventually resulted in a similar live birth rate (6.7%) in both groups. However, dosages of gonadotropins were smaller and stimulation days were shorter in group B than in group A. When poorly responding patients were treated for IVF, similar live birth rates were observed with mild stimulation protocol and hyper-stimulation protocol. After considering the higher dosages of gonadotropins and longer stimulation days in patients with hyper-stimulation protocol, it is suggested that poor responders may benefit with the mild stimulation protocol for IVF.
It is crucial for the society, the government and the medical community to retrieve the full and reliable statistical information on malignant brain neoplasms (C71-C71.9 ICD-10) to adjust the medical financing, staff and equipment properly. In order to retrieve information useful for public health policies, data from the years 2006-2012 concerning relevant cases registered by the Polish public healthcare insurance provider Narodowy Fundusz Zdrowia in Lower Silesia region of Poland (NFZ) and by the Polish national neoplasms registry Krajowy Rejestr Nowotworow (KRN) were analyzed. The number of new malignant brain neoplasms cases registered by the KRN has risen slightly in the years 2006-2012. At the same time the number of cases reported by the NFZ rose dynamically, which means a significant increase in medical care intensity, and thus also workload on the medical facilities and stuff associated with the care for grossly the same amount of brain malignant neoplasms patients and, supposedly, their longer survival times. It indicates that the level of public financing of the malignant neoplasms of brain treatment shall be adjusted adequately. The study revealed growing popularity among reporting Polish physicians of the least specific malignant neoplasms of brain ICD-10 categories, despite the rapid diagnostic techniques development and availability. It is alarming since the medical statistics data quality in the field of malignant brain neoplasms is deteriorating that way and proper evaluation of treatment costs and planning future financial allocations by both the public healthcare insurance provider NFZ and the Polish government becomes difficult.
Epidemiological data concerning malignant neoplasms of meninges and central nervous system parts other than brain in Poland are reported to many medical databases run by various institutions and are incongruent with each other which makes their practical interpretation highly difficult. Data on registered cases of malignant neoplasms of meninges (C70-C70.9 ICD-10) and of spinal cord, cranial nerves and parts of central nervous system other than brain (C72-C72.9 ICD-10) in the years 2006-2012, made available by public healthcare insurance provider Narodowy Fundusz Zdrowia in Lower Silesia region of Poland (NFZ) and data on new cases from Polish national neoplasms registry Krajowy Rejestr Nowotworow (KRN), were analyzed. The study revealed that those neoplasms are rare in Lower Silesia region of Poland population, number of new cases dropped in the analyzed period, but the NFZ/KRN cases ratio increased significantly especially in case of malignant neoplasms of central nervous system parts other than brain or meninges, which suggests big, and increasing with time, amount of medical procedures needed by those patients. It points at the need of respective adjustment of the level of public financing of treatment of malignant neoplasms of meninges and other central nervous system parts than brain. The study results indicate also that epidemiological reporting system in Poland shall be improved as there is growing number of Polish physicians who report mainly unspecific broad ICD-10 categories and there are year-to-year alternations of reported numbers of cases that do not have any explanation other than formal shifting in reported ICD-10 categories.
Basic Life Support in Obstetrics (BLSO®) is a novel, simulation-based, emergency obstetrics training program for health care workers who perform deliveries infrequently, such as paramedics and nurses. Advanced Life Support in Obstetrics (ALSO®) is intended for regular maternity care providers such as physicians and certified nurse midwives. This paper describes a pre/post study of 111 learners in two ALSO and two BLSO courses taught in Addis Ababa, Bonga, and Jimma, Ethiopia in October, 2012. The study objective was to assess the effectiveness of ALSO and BLSO training programs to improve Ethiopian health care workers’ confidence in managing common obstetrical problems. A previously-validated survey tool was given immediately pre- and post-course and six months post-course. The survey tool included demographic questions and Likert scales to self-assess comfort managing 13 common obstetric emergencies including postpartum hemorrhage, maternal resuscitation, and preeclampsia. Ninety-seven ALSO and BLSO learners completed pre- and immediate post-training questionnaires. Nineteen ALSO learners completed the 6 month post-training questionnaire. Immediately post-course, participants in ALSO and BLSO courses reported increased comfort in all 13 areas assessed. ALSO participants had increased comfort at 6 months in all areas except breech delivery. Participation in a novel emergency obstetrics training program increases Ethiopian health workers’ self-assessed confidence in addressing common obstetrical emergencies. This increase in confidence persists in most topic areas for at least six months. This paper describes the first formal evaluation of BLSO and contributes to the growing body of evidence regarding the value of ALSO training in a low- and middle-income country.
Background: Health practitioners of different disciplines (physicians, paramedic personnel, pharmacists) should possess adequate ICT (Information and Communication Technology) skills and practical competence on these technologies. Pharmacy practice requires a relevant flow of information, collection and handling of which could be facilitated by ICT. The correct use of ICT requires a proper knowledge by professionals offering a public service. The purpose of this paper was to assess basic informatics background and computer uses in pharmacists practicing in Italy, with the aim to identify educational interventions for increasing their informatics abilities. Methods: A questionnaire was proposed to pharmacists working in Italian community pharmacies. The survey was articulated into 35 questions concerning computer basic knowledge, ICT facilities, computer skills, habits, and uses in pharmacy practice. Results: The questionnaire was completed by ~45% (No. 224) of responders, the 96.9% of which used computer. Only 7.8% of interviewed people employed e-mail to communicate with health authorities and less than 2% used it to be in contact with physicians or other health professionals. Less than 40% used ICT for training courses. The results revealed a relevant percentage (90.8%) of self-learners to computer use, while only 9.2% was trained by specific courses. Conclusion: Basic knowledge of community pharmacists on ICT technological infrastructure is quite low. Although pharmacists play an essential role in health services, they have apparently limited computer skills. This suggests the need of educational and training efforts for enlarging computer and ICT resources competent use in daily pharmacy practice.