Physician manager

BACKGROUND AND OBJECTIVES: Many adolescents with undiagnosed focal epilepsy seek evaluation in emergency departments (EDs). Accurate history-taking is essential to prompt diagnosis and treatment. In this study, we investigated ED recognition of motor vs nonmotor seizures and its effect on management and treatment of focal epilepsy in adolescents. METHODS: This was a retrospective analysis of enrollment data from the Human Epilepsy Project (HEP), an international multi-institutional study that collected data from 34 sites between 2012 and 2017...

BACKGROUND: Sex differences (SDs) in pharmacology of cardiovascular (CV) drugs have been described previously; however, paradoxically, there are scarce recommendations in therapy based on these differences. It is of utmost importance to identify whether these SDs determine a modified clinical response and the potential practical implications for this, to provide a base for personalized medicine. AREA OF UNCERTAINTY: The aim of this article was to outline the most important pharmacological drivers of cardiovascular drugs that differ between women and men, along with their implications and challenges in clinical practice...

PURPOSE OF REVIEW: This article summarizes recent developments in the application of telemedicine, specifically tele-critical care (TCC), toward enhancing patient care during various types of emergencies and patient rescue scenarios when there are limited resources in terms of staff expertise (i.e., knowledge, skills, and abilities), staffing numbers, space, and supplies due to patient location (e.g., a non-ICU bed, the emergency department, a rural hospital) or patient volume as in pandemic surges...

PURPOSE OF REVIEW: This article summarizes recent developments in the application of telemedicine, specifically tele-critical care (TCC), toward enhancing patient care during various types of emergencies and patient rescue scenarios when there are limited resources in terms of staff expertise (i.e., knowledge, skills, and abilities), staffing numbers, space, and supplies due to patient location (e.g., a non-ICU bed, the emergency department, a rural hospital) or patient volume as in pandemic surges...

Adaptation of the heart is often a blessing for the patient, but sometimes a diagnostic challenge for the responsible physician. The clinical difficulty may be enhanced when employing diagnostic tools that are hard to interpret. Ratio-based metrics are notorious in this respect, and particularly risky in the follow-up evaluation of heart transplant patients. However, measures expressed as physical units contribute to a comprehensive clinical evaluation and guide proper patient management.

Introduction Being the first in-line care providers, primary healthcare (PHC) physicians may encounter all forms of medical emergencies, ranging from minor complaints to major life-threatening events; therefore, this study aims to assess the PHC physicians' knowledge and attitude related to the diagnosis and management of emergency cases as well as their preferences for emergency medicine training courses and their preferred methods of training. Methods A descriptive cross-sectional study was conducted among physicians working at PHC in Al-Ahsa, Saudi Arabia, between November and December 2023, excluding those who do not work at PHC...

In this editorial, we proceed to comment on the article by Chua et al , addressing the management of metastatic lateral pelvic lymph nodes (mLLN) in stage II/III rectal cancer patients below the peritoneal reflection. The treatment of this nodal area sparks significant controversy due to the strategic differences followed by Eastern and Western physicians, albeit with a higher degree of convergence in recent years. The dissection of lateral pelvic lymph nodes without neoadjuvant therapy is a standard practice in Eastern countries...

BACKGROUND: Mahana™ IBS is a Food and Drug Administration-cleared prescription mobile application designed to deliver 3 months of gut-directed cognitive behavioral therapy (CBT) to adults ≥22 years old with irritable bowel syndrome (IBS). We assessed whether gut-directed CBT delivered digitally improved outcomes in IBS management. METHODS: We studied users who had a dispensed physician prescription for Mahana™ IBS between August 2021 and August 2023...

INTRODUCTION: With the rising use of immune checkpoint inhibitors ( ICIs ) in oncology, emergency physicians are increasingly confronted with their immune-related adverse events ( irAEs ). We described the types of irAEs presenting to the ED of a Belgian cancer centre and determined associations with the development of an irAE and other patient's characteristics. Secondary objectives describe the therapeutic management and determine 7 and 30-day mortality. METHODS: A retrospective chart review of ED visits of patients on ICI from 15 December 2016 to 6 December 2020 was performed...

Pulmonary rehabilitation (PR) is a highly effective intervention for persons with chronic respiratory diseases, resulting in improvement in exercise capacity, dyspnea, health-related quality of life, mood, reduced hospitalization, and improved survival and cost savings post-COPD hospitalization. Despite demonstrated effectiveness, PR is underutilized in part due to lack of awareness, limited access, and inadequate PR reimbursement. Poor payment is a long-standing barrier to PR's financial stability and access...

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are the most common manifestations of venous thromboembolism (VTE). Most DVTs affect the lower-extremity veins. Since the symptoms of DVT are non-specific, a prompt and standardised diagnostic work-up is essential to minimise the risk of PE in the acute phase and to prevent thrombosis progression, post-thrombotic syndrome and VTE recurrence in the long-term. Only recently, the AWMF S2k guidelines on Diagnostics and Therapy of Venous Thrombosis and Pulmonary Embolism have been revised...

PHENOMENON: Despite the importance of diet in the prevention and management of many common chronic diseases, nutrition training in medicine is largely inadequate in medical school and residency. The emerging field of culinary medicine offers an experiential nutrition learning approach with the potential to address the need for improved nutrition training of physicians. Exploring this innovative nutrition training strategy, this scoping review describes the nature of culinary medicine experiences for medical students and resident physicians, their impact on the medical trainees, and barriers and facilitators to their implementation...

Empyema is the collection of pus in the pleural cavity and most times, it occurs unilaterally. It is often associated with underlying pneumonia, but other causes have been identified as well. When it occurs after an esophageal perforation, which in itself is also rare, morbidity and mortality are even higher. Esophageal perforation can cause life-threatening complications due to its close proximity to the vital organs of the mediastinum, necessitating its timely diagnosis and aggressive management. Bacteria forming part of the normal esophageal and oral flora are the most common causative pathogens for empyema from an esophageal perforation...

The aim of this study was to analyse the reasons health professionals refer to sport and exercise physicians (SEPs) and to define what service gap the specialty fills. This was a qualitative study design using thematic analysis. Online focus group interviews consisting of 4-6 participants in each group were conducted separately with physiotherapists, emergency clinicians, general practitioners and orthopaedic surgeons practising in New Zealand. Thematic analysis of the focus group interviews was then used for the identification of common themes around referral tendencies towards SEPs...

BACKGROUND: Food protein-induced enterocolitis syndrome (FPIES) is being increasingly recognized as a non-IgE mediated food allergy; however, it remains unclear if and how the presentation, diagnosis and management of this disease has changed in recent years. OBJECTIVE: To reappraise the FPIES cohort at a large United States pediatric tertiary referral center. METHODS: We performed a retrospective chart review of pediatric FPIES patients (ICD-10: K52...

CONTEXT: Recent studies show increasing use of mechanical ventilation among people living with dementia. There are concerns that this trend may not be driven by patient preferences. OBJECTIVES: To better understand decision-making regarding mechanical ventilation in people living with dementia. METHODS: This was an electronic health record-based retrospective cohort study of older adults with dementia (n=295) hospitalized at one of two teaching hospitals between 2015 and 2019 who were supported with mechanical ventilation (n=191) or died without mechanical ventilation (n=104)...

BACKGROUND: Deprescribing is an effective strategy to manage polypharmacy and improve patient outcomes. The notion of a potential role for pharmacists in a multidisciplinary team approach to deprescribing has been identified in quantitative and qualitative literature. However, stakeholders' perceptions of this role, and factors that may impede or facilitate the pharmacist's involvement have not been elucidated. The application in ambulatory care also requires clarification. Understanding stakeholders' views is essential to optimise involvement of the pharmacist in deprescribing and improve practice...

PURPOSE: The presence of chronic health conditions (CHCs), without sufficient personal and job resources, can impede one's ability to effectively perform work tasks and manage job demands. The aim of this study was to evaluate the level of job burnout and perceptions of work health management interference (WHMI) and organizational health climate (OHC) among employees with varied levels of work ability (WA). We also examined relationships among these variables and with sociodemographic and job-related variables (e...

Several aspects of clinical management of 46,XX congenital adrenal hyperplasia (CAH) remain unsettled and controversial. The North American Disorders/Differences of Sex Development (DSD) Clinician Survey investigated changes, over the last two decades, in clinical recommendations by specialists involved in the management of newborns with DSD. Members of the (Lawson Wilkins) Pediatric Endocrine Society and the Societies for Pediatric Urology participated in a web-based survey at three timepoints: 2003-2004 (T1, n = 432), 2010-2011 (T2, n = 441), and 2020 (T3, n = 272)...

INTRODUCTION: Lifelong learning is the foundation for professionals to maintain competence and proficiency in several aspects of economy and medicine. Until now, there is no evidence of overconfidence (the belief to be better than others or tested) and clinical tribalism (the belief that one's own group outperforms others) in the specialty of health economics. We investigated the hypothesis of overconfidence effects and their relation to learning motivation and motivational patterns in healthcare providers regarding healthcare economics...