The role of Physician Assistant emerged in 1960s America and their number has increased to become a significant component of the health care workforce in that country. On the eve of a new policy regulating Physician Associates in the United Kingdom, the role of key actors in shaping the development of regulatory policies in the two countries is critically compared against a backdrop of very different political contexts and health care systems, to reveal the factors that might help or hinder the deployment of Physician Associates/Assistants and ameliorate workforce shortages.

Background/Objectives: Since the outbreak of Coronavirus Disease 2019, virtual clinics served as the cornerstone modality of telehealth in many health institutions. This study aimed to examine patients’ and physicians’ perceptions of audio-only gynecology virtual clinics’ integration. Methods: A cross-sectional study was conducted in a tertiary hospital in Jeddah, Saudi Arabia. A convenient sampling technique was followed for physicians and patients. The questionnaires utilized were validated. Results: During March 2021-March 2022, a total of 220 subjects participated in the study. Physicians accounted for 24.5% (n=54), while patients accounted for 75.5% (n=166). Overall, only 55.5% of the physicians agreed virtual clinics should continue after the pandemic, while 84.6% and 76.0% of the patients reported satisfaction and the wish to use virtual clinics again, respectively. Physicians who seldom found physical examination to be indicated, seldom requested patients to attend physically to the clinic, and who had a positive outlook on virtual clinics were more likely to desire continuing virtual clinics after the pandemic, p<0.001. Patients who had positive outlooks regarding virtual clinics were shown to be more satisfied with virtual clinics, p<0.001. Conclusions: Audio-only gynecology virtual clinics are accepted by both physicians and patients with higher satisfaction among patients. Physicians’ positive outlook yet reluctance to continue virtual clinics suggests the need to modify the conduction of virtual clinics and necessitates larger-scaled prospective studies in this topic.

Physicians exposed to a risky environment experience burnout, which negatively impacts patient care, stress decreases compassion, harms patient-doctor communication and may jeopardize patient safety. Patients are directly exposed to their physicians' overload and can sense their exhaustion, making them a sensitive seismograph of burnout. This study aimed to compare patients' standpoints towards physicians' burnout before and during the COVID-19 pandemic, characterizing patients' perceptions according to the 4 components of burnout. Two cross-sectional surveys (February-March 2018 and 2021) were conducted. 314 responders, 133 in 2018 and 181 in 2021. Physician burnout, accountability, empathy towards doctors ("mirror reflection") and the expected patient-doctor partnership were measured. Patients' perception of physicians' burnout was significantly associated with urban community, education and religiosity. Perceived accountability was associated with female gender and education. Empathy was associated with employment and gender. Patients described physicians' burnout as significantly higher prior to the COVID-19 pandemic. Physicians' accountability, empathy for doctors, and perceived partnership were more intense in 2021, implying that the emergency emphasized the physician's role and the patient-doctor relationship. Global disasters may have an unexpected positive effect on how patients understand the role and duty of physicians and the health system.

Despite epidemiological findings of improvements in cardiovascular risk factors with a light-to-moderate intake of alcohol, many misconceptions remain regarding alcohol intake and the risks and benefits of consumption. We sought to examine physician attitudes and recommendations regarding alcohol intake in a cohort of Argentine physicians and to establish their sources of knowledge. An online national survey was distributed through the Argentine Federation of Cardiology (FAC) to cardiologists, internal medicine specialists, general and other subspecialty physicians in Argentina. The survey was completed by 745 physicians, of whom 671 (90%) were cardiologists. In total, 35% of physicians viewed moderate alcohol intake to be beneficial for cardiovascular health, 36% believed only wine offered such benefits, 24% viewed any intake to be harmful, and 5% had other opinions. More than half (57%) self-reported their knowledge to come from academic sources. Regarding knowledge of drinking guidelines, only 41% of physicians were aware of the concept of ‘standard drink’. Physicians were generally not comfortable converting ‘standard drinks’ into other metric units, however men tended to be more comfortable than women (p=0.052). Physicians were not satisfied with their knowledge of drinking guidelines (3.01 ± 2.73, on a 0-10 scale). Physicians were generally comfortable in counselling patients regarding safe-limits of consumption (6.22 ± 3.20, on a 0-10 scale). Argentine physicians were not satisfied with their knowledge of alcohol consumption guidelines or their understanding of the reported metrics. Only one-third of study participants viewed moderate alcohol intake as beneficial for cardiovascular health. This study shows the necessity to optimize the sources of knowledge.

Background and Objectives: ACTION-France (Awareness, Care and Treatment In Obesity MaNagement in France) aims to identify the perceptions, attitudes, behaviors, and potential barriers to effective obesity management in France and guide collaborative actions. Methods: ACTION-France is a cross-sectional survey of people with obesity (PwO) and healthcare professionals (HCPs), in France. The PwO and HCP questionnaires ran from 27/09/2022 to 01/02/2023 and from 19/12/2022 to 31/03/2023, respectively. Results: The study, encompassing 1226 PwO and 166 HCPs, reveals a shared recognition of obesity as a chronic condition. However, despite being requested by most PwO, weight-related discussions are surprisingly infrequent, leading to delayed diagnosis and care. PwO and HCPs held different views as to why: HCPs often attributed it to PwO’s lack of motivation or disinterest, whereas PwO avoided them because they felt weight managing was their own responsibility and were uncomfortable discussing it. When weight was discussed, primarily with general practitioners (GPs), discussions mostly focused on physical activity and dietary. However, results identified a strong psychosocial impact of obesity: 42% of respondents reported anxiety-depressive symptoms, and many more hesitated to engage in certain social activities because of their weight. Psychotherapy was only discussed by 55% of HCPs. Pharmaceutical options were also rarely discussed (19.5% of HCPs), though 56.1% of PwO reported they would want to. Conclusions: HCPs’ and PwO’s perceptions differed significantly and need to converge through enhanced communication. A holistic approach, integrating comprehensive training for GPs and psychological comorbidities, would help to bridge perceptual gaps effectively and foster more empathetic and effective patient care.

Background: dementia is a significant health issue worldwide. Mild cognitive impairment (MCI) can transform into dementia over time. General practitioners may be the first to notice the cognitive deficit, so they may need a screening test in the event of suspicion, which they must be able to use under great time pressure. We examined the usability of the Hungarian Test Your Memory (TYM-Hun) self-administered dementia test in general practice, and with the results of the received tests, we tried to draw conclusions regarding the population. Methods: In the four Hungarian cities with medical universities, general practitioners filled out 368 questionnaires with their clients over 50 years of age. Results: the total scores of the test showed a significant correlation with education and the type of occupation, while a significant negative correlation with age. We found the clock drawing test and recall indicates cognitive decline the earliest. Based on the TYM-Hun results, the prevalence levels for MCI and dementia are slightly higher in Hungary than globally. Conclusion: the test can sensitively indicate MCI and early-stage dementia as a screening test, and two of its subtests can raise the possibility of cognitive impairment at an earlier age than the others.

Laryngopharyngeal reflux (LPR) is a prevalent disease in the general population and may have acute or chronic clinical presentation. LPR may be misdiagnosed in primary care medicine regarding the lack of gastroesophageal reflux disease symptoms and the lack of findings at the gastrointestinal endoscopy. Depending on the physician field of expertise and experience, LPR may be clinically over- or under-diagnosed. The management of LPR is possible in primary care medicine but primary care physician has to consider some red flags that requires to address the patient to otolaryngologist or gastroenterologist. The use of patient-reported outcome questionnaire such as reflux symptom score-12 and the consideration of some oral and pharyngeal findings visualized through the mouth opening may help the primary care physician to evaluate the LPR findings at the diagnosis time and throughout treatment. In this review, we provide a practical algorithm of management of LPR for primary care physician or other specialists that cannot perform fiberoptic examination. In this algorithm, physician has to exclude some confounding conditions such as allergy or other causes of pharyngolaryngitis and red flags. Physician may prescribe an empirical treatment based on diet and behavioral changes with or without medication, depending on the complaint severity of the patient. In case of prescription of medication, proton pump inhibitors and alginate have to be considered in association to protect the upper aerodigestive tract mucosa from acid, weakly acid and alkaline pharyngeal reflux events.

Emily Howard Jennings Stowe is acclaimed as Canada’s first female school principal, physician to practice medicine, and a founding Canadian suffragette. Yet, relatively little has been investi-gated regarding the life-changing events permitting her to pioneer in these chosen fields. To reveal relationships among the life-changing events in Emily Stowe’s life, a unique narrative research process is engaged to take Stowe’s story and develop it into a particular point of view based on responses to questions posed regarding her life, ranging from those most objective and specific to those that are subjective and more general. This is accomplished by following a prescribed order of question-asking: when, where, who, what, how, and why. The aim is to facilitate a comparison and interpretation of the connections regarding twenty-two of her life-changing events. Four dis-tinct aspects of her life are noted: personal, teacher, physician, and suffragette. It is found that much of Stowe’s success originated from her family’s Establishment connections, her studious intellectual ability, and her decision to obtain her medical education in the United States. There were notable periods in her life that might have ended her career. However, the aforementioned protective features of her status permitted the successful withstanding of these difficulties.

Risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are not well-defined in resident physicians and fellows (trainees). We aimed to identify sociodemographic, occupational and community factors associated with SARS-CoV-2 infection among trainees during the first wave of the coronavirus disease 2019 (COVID-19) pandemic in New York City (NYC). In this retrospective cohort study, we administered an electronic survey between June 26 and August 31, 2020 to trainees at the Mount Sinai Health System in NYC to assess risk factors for SARS-CoV-2 infection between February 1 and June 30, 2020. We used Bayesian generalized linear mixed effect regression and structural equation models to examine associations. SAR-CoV-2 infection was determined by self-reported IgG antibody and reverse transcriptase-polymerase chain reaction results and confirmed with laboratory results. Among 2354 trainees invited to participate, 328 (14%) completed the survey and reported test results. The cumulative incidence of SARS-CoV-2 infection was 20.1%. Assignment to medical-surgical units (odds ratio [OR], 2.51; 95% CI, 1.18-5.34), and training in emergency medicine, critical care and anesthesiology (OR, 2.93; 95% CI, 1.24-6.92) were independently associated with infection. Deployment to care for unfamiliar patient populations was protective against infection (OR, 0.16; 95% CI, 0.03-0.73). Community factors were not significantly associated with infection after adjustment for occupational factors. Our findings may inform tailored infection prevention strategies for trainees responding to the COVID-19 pandemic.

The access to cardiac rehabilitation (CR) is contingent upon physician referrals, yet these are often inadequate, particularly in low-resource settings. This multi-method study aimed to translate, culturally adapt, and validate the Portuguese version of the Provider Attitudes toward CR and Referral (PACRR-P) scale, as well as to identify key factors influencing CR referral in a Latin American context for the first time. The PACRR was translated into Brazilian-Portuguese through a rigorous process involving independent translation, back-translation, and expert panel review to ensure face, content, and cross-cultural validity. A total of 44 Brazilian physicians completed the questionnaire, allowing for an assessment of internal consistency, criterion validity, and convergent validity. The findings confirmed the face, content, and cultural validity of the 20 translated items, with a mean item clarity rating of 4.8/5. The final version included 17 of the original 19 PACRR-P items, with a Cronbach’s alpha of 0.73. Referral rates were significantly associated with specific PACRR-P items, supporting the scale's criterion validity, while correlations with ReCaRe scores further supported convergent validity. The most prominent barriers to referral were a lack of familiarity with CR site locations, absence of a standard referral form, and lack of automatic referral processes. The PACRR's validity and reliability among Portuguese-speaking providers are preliminarily supported.

Background/Objectives: Physician-scientists are crucial in bridging gaps in medical knowledge and improving clinical care. Training for physician-scientists is critical in developing research skills and fostering advancements in healthcare. However, the number of physician-scientists is declining due to various challenges. This study aims to explore these challenges, identify solutions, and promote the integration of research into the medical profession and education. Methods: A nationally representative structured survey was conducted among physicians and residents at one of Lebanon’s central university hospitals to explore the perceptions, challenges, and outlook of physician-scientists. Multiple Correspondence Analysis (MCA) was used to further explore relationships among the key variables. Results: A total of 78 physicians and residents agreed to participate. The study underscores the importance of medical research, particularly clinical, in improving care and advancing science. MCA analysis highlighted distinct clusters of challenges including time constraints, limited funding, and balancing clinical duties with research commitments. Strategies to overcome these hurdles and better integrate research into medical education are proposed, emphasizing the importance of securing grants, institutional support, and early research integration into the medical curriculum. A positive association between physicians’ evaluation of research, their active practice, and encouragement of students, is highlighted. Conclusions: The study emphasizes the importance of medical research in improving care and advancing knowledge, identifies barriers to its integration into medical education, and proposes solutions. The perception of research's value positively influences its incorporation into practice and teaching, underlining the need for greater support for physician-scientists.

Background/Objectives: Informed consent for anesthesia poses both legal challenges and problems of understandable communication. Fulfilling all requirements through anesthesiologists directly interacting with patients is a time- and staff-consuming strategy. Given today's smart technologies, notably including virtual reality (VR), we explored in a prospective randomized study whether 'VR-assisted informed consent' could improve this situation. Methods: Fifty patients scheduled for orthopedic surgery were randomized. In the control group, informed consent was obtained via patient-specialist dialogs only. The patients in the study group, wearing a head-mount display, watched an 8-minute immersive 3D movie with standard explanations of general anesthesia, followed by a patient-specialist dialog to address open question. The time spent on the dialogs in both groups was evaluated as primary outcome variable. As secondary variables, we analyzed both a three-item Likert scale on patient satisfaction with the VR experience and cost differences between both groups. Results: Patient-specialist dialogs were carried on for median (IQR) durations of 93 (20–182) seconds in the study group versus 665 (261–829) seconds in the control group (P<0.001). All patients exposed to VR rated this experience as favorable (87.5%) or neutral (12.5%). Based on anesthesiologists' incomes in the US and UK, our approach would reduce the staff expenditure for each patient-specialist dialog by median amounts of ≈40 or ≈11 US dollars, respectively (2× P<0.001). Conclusions: 'VR-assisted informed consent' for anesthesia is well accepted by patients and reduces the time requirements for patient-specialist dialogs, thus pointing out a potential avenue towards increasing the work-time efficiency of anesthesiologists.

Background: Media coverage of Lyme disease (LD) has led to an increase in consultations for presumed LD in Europe. However, LD is confirmed in only 10-20% of patients, with a significant number remaining in a diagnostic dead-end. Objectives: To reach a deeper understanding of how patients themselves contribute to the diagnostic process. To describe the genesis of the LD hypothesis in care pathways. Methods: In 2019, 30 patients from a prospective cohort consulting in the infectious diseases department at University Hospital in Marseille for presumed LD were recruited for semi-structured interviews. The inclusion criteria were : suffering from subjective symptoms for 6 months, no clinical or paraclinical argument suggesting current LD. The patients’ medical trajectories were collected using a biographical approach. Results: The diagnosis of Lyme disease was primarily triggered by identification with personal testimonies found on the internet. Most of patients were leading their own diagnostic investigation. The majority of participants were convinced they had LD despite the lack of medical evidence and the scepticism of their referring GP. Conclusion: GPs should first systematically explore patients’ etiologic representations in order to improve adherence to the diagnosis especially in the management of medically unexplained symptoms. Long COVID-19 syndrome challenge offers an opportunity to promote active patient involvement in diagnosis.

The role of vitamin D in the prevention and treatment of non-skeletal health issues has received significant media and research attention in recent years. Costs associated with clinical management of low vitamin D (LVD) have increased exponentially. However, no clear evidence supports vitamin D screening to improve health outcomes. Authoritative bodies and professional societies recommend against population-wide vitamin D screening in community-dwelling adults who are asymptomatic or at low risk of LVD. In order to assess patterns of physician management of LVD in this conflicting environment, we conducted a scoping review of three electronic databases and gray literature. Thirty-eight records met inclusion criteria and were summarized in an evidence table. Results from seven countries showed a consistent increase in vitamin D lab tests and related costs. Many vitamin D testing patterns reflected screening rather than targeted testing for individuals at high risk of vitamin D deficiency or insufficiency. Interventions aimed at managing inappropriate clinical practices related to LVD were effective in the short term. Variability and controversy were pervasive in many aspects of vitamin D management, shining light on physician practices in the face of uncertainty. Future research is needed is needed to inform better clinical guidelines and to assess implementation practices that encourage evidence-based management of LVD in adult populations.

Access to medical care is a global issue. Technology-aided approaches have been applied in addressing this. Interventions have however not focused on medical diagnosis as a fully automated procedure and available applications employ mainly text-based inputs rather than conversation in natural language. We explored the utility of ontology-based chatbot technology for the design of intelligent agents for medical diagnosis through a systematic review of the most recent related literature. English articles published in 2011-2016 returned 233 hits which yielded 11 relevant articles after a 3-stage screening. Findings showed that the creation of expert systems had been the focus of many the studies which utilize the physician-system-patient framework with system training based mostly on expert knowledge for designing web- or mobile phone-based applications that serve assistive purposes. Findings further indicated gaps in the design and evaluation of more effective systems deployable as standalone applications, for example, on an embodied robotic system. The need for technology supporting the physical examination part of diagnosis, connection to data sources on patients’ vitals and medical history are also indicated in addition to the need for more qualitative work on natural language-based interaction. The system should be one that is continuously learning. Future works should also be directed towards the building of more robust knowledge base as well as evaluation of theory-based diagnostic methodological options

Background/Objectives: Clinical decision support systems (CDSS) consisting of computerized physician order entry (CPOE) and oncology pathways serve as the foundation of high-quality cancer care. However, the resources needed to develop and maintain these systems have not been characterized for oncology enterprises. Methods: Missing CPOEs for oncology treatments were identified by comparing current CPOEs to those in the Elsevier ClinicalPath treatment pathways. New FDA oncology drug approvals were used to estimate ongoing CPOE build needs. The impacts of missing orders on clinicians and pharmacists were surveyed. Benchmarking from two other large oncology enterprises supported new resource needs to build and maintain CPOE in our EPIC Beacon system. A program to manage oncology pathways and CPOE for an enterprise using EPIC was developed and implemented. Results: Resources and impacts of CDSS for oncology enterprises are described. Program management is described. Conclusions: Updating and maintaining CDSS for an oncology enterprise requires program management and resources for which a framework has not been previously reported. We present this work as a framework for others to understand the components and resources for budgeting and management of CDSS. We report on the work of the City of Hope enterprise using the EPIC electronic health record.

The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 01.01.2009 to 01.01.2017, all adult victims of asystolic OHCA in Geneva, Switzerland, were retrospectively included. Patients with signs of "obvious death" or with a Do-Not-Attempt-Resuscitation order were excluded. Patients were categorized as having received ALS if this was mentioned in the medical record, or, failing that, if at least one dose of adrenaline had been administered during cardio-pulmonary resuscitation (CPR). Prognostic factors known at the time of EP's decision were included in a multivariable logistic regression model. 784 patients were included. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR=2.14, 95%CI1.43–3.20) and bystander CPR (OR=4.10, 95%CI2.28–7.39). Traumatic aetiology (OR=0.04, 95%CI0.02–0.08), age >80 years (OR=0.14, 95%CI0.09–0.24) and a Charlson comorbidity index greater than 5 (OR=0.12, 95%CI0.06–0.27) were the factors most strongly associated with the decision not to attempt ALS. Factors influencing the EP’s decision to attempt ALS in asystolic OHCA are the relatively young age of the patients, few comorbidities, presumed medical aetiology, witnessed OHCA and bystander CPR.