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Hajebrahimi, Sakineh, Ali Janati, Morteza Arab-Zozani, Mobin Sokhanvar, Elaheh Haghgoshayie, Yibeltal Siraneh, Mohammadkarim Bahadori, and Edris Hasanpoor. "Medical visit time and predictors in health facilities: a mega systematic review and meta-analysis." International Journal of Human Rights in Healthcare 12, no. 5 (November 28, 2019): 373–402. http://dx.doi.org/10.1108/ijhrh-05-2019-0036.
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Purpose Visit time is a crucial aspect of patient–physician interaction; its inadequacy can negatively impact the efficiency of treatment and diagnosis. In addition, visit time is a fundamental demand of patients, and it is one of the rights of every patient. The purpose of this paper is to determine factors influencing the consultation length of physicians and to compare consultation length in different countries. Design/methodology/approach MEDLINE (PubMed), Web of Science, Cochrane, ProQuest, Scopus, and Google Scholar were searched. In addition, references of references were checked, and publication lists of individual scholars in the field were examined. We used data sources up to June 2018, without language restriction. We used a random-effects model for the meta-analyses. Meta-analyses were conducted using Comprehensive Meta-Analysis Version (CMA) 3.0. Findings Of 16,911 identified studies, 189 studies were assessed of which 125 cases (67 percent) have been conducted in the USA. A total of 189 studies, 164 (86.77 percent) involved face-to face-consultations. The effects of three variables, physician gender, patient gender, and type of consultation were analyzed. According to moderate and strong evidence studies, no significant difference was found in the consultation lengths of female and male doctors (Q=42.72, df=8, I2=81.27, p=0.891) and patients’ gender (Q=55.98, df=11, I2=80.35, p=0.314). In addition, no significant difference was found in the telemedicine or face-to-face visits (Q=41.25, df=5, I2=87.88, p=0.170). Originality/value In this systematic review and meta-analysis, all of physicians’ visits in 34 countries were surveyed. The evidence suggests that specified variables do not influence the length of consultations. Good relationship is essential to a safe and high-quality consultation and referral process. A high-quality consultation can improve decisions and quality of visits, treatment effectiveness, efficiency of service, quality of care, patient safety and physician and patient satisfaction.
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Roslan, Nurhanis Syazni, Muhamad Saiful Bahri Yusoff, Karen Morgan, Asrenee Ab Razak, and Nor Izzah Ahmad Shauki. "What Are the Common Themes of Physician Resilience? A Meta-Synthesis of Qualitative Studies." International Journal of Environmental Research and Public Health 19, no. 1 (January 1, 2022): 469. http://dx.doi.org/10.3390/ijerph19010469.
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In the practice of medicine, resilience has gained attention as on of the ways to address burnout. Qualitative studies have explored the concept of physician resilience in several contexts. However, individual qualitative studies have limited generalizability, making it difficult to understand the resilience concept in a wider context. This study aims to develop a concept of resilience in the context of physicians’ experience through a meta-synthesis of relevant qualitative studies. Using a predetermined search strategy, we identified nine qualitative studies among 450 participants that reported themes of resilience in developed and developing countries, various specialties, and stages of training. We utilized the meta-ethnography method to generate themes and a line-of-argument synthesis. We identified six key themes of resilience: tenacity, resources, reflective ability, coping skills, control, and growth. The line-of-argument synthesis identified resilient physicians as individuals who are determined in their undertakings, have control in their professional lives, reflect on adversity, utilize adaptive coping strategies, and believe that adversity provides an opportunity for growth. Resilient physicians are supported by individual and organizational resources that include nurturing work culture, teamwork, and support from the medical community and at home. Our findings suggest that resilience in physicians is dynamic and must be supported not only by physician-directed interventions but also by organization-directed interventions.
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Lee, Banghyun, and Kidong KIM. "Impact of cervical cancer care volume on clinical outcomes of laparoscopic radical hysterectomy: A systematic review and meta-analysis." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e17013-e17013. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e17013.
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e17013 Background: This study investigated the impact of hospital and physicain cervical cancer case volume on clinical outcomes of laparoscopic radical hysterectomy (LRH) to clarify the hypothesis that clinical outcome of cervical cancer may depend on experience of hospital and physician performing radical hysterectomy (RH). Methods: In January 2017 the PubMed search identified 556 articles. A combination of the following key words was used in the search: (cervical cancer and laparoscopy and RH) and (cervical cancer and LRH). When filtered for studies presenting operative outcomes and/or perioperative complications of LRH 59 studies including 4,367 patients met the selection criteria: high volume hospitals (HVH) (≥15 cases/year; 13 studies, 2227 patients) and low volume hospitals (LVH) (<15 cases/year; 46 studies, 2140 patients); high volume physicians (HVP) (≥10 cases/year; 7 studies, 1167 patients) and low volume physicians (LVP) (<10 cases/year; 35 studies, 1258 patients). Linear regression analysis which is weighted by the number of patients per year in each study was performed to evaluate differences between the groups using Stata/SE 14. Results: Analyses according to hospital volume showed following outcomes in HVH compared with LVH: tendency of lower operative time and blood loss; the higher number of lymph nodes (LN) retrieved; older age; and lower frequency of stage IA. Moreover, hospital stay, intra- and post-operative complications, adjuvant therapy, 5-year overall survival, disease free survival and recurrence rate, stage IB1, IB2, and IIA, LN metastasis, and lymphovascular space, parametrial and surgical margin invasion were not different between the groups. Analyses according to physician volume showed following outcomes in HVP compared with LVP: the higher number of LN retrieved; longer hospital stay; higher 5-year recurrence rate; and lower frequency of stage IA and surgical margin invasion. Moreover, other factors were not different between the groups. Conclusions: Higher hospital and physician volumes are associated with better operative outcomes. However, those might not be favorable prognostic factors for cervical cancer.
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Memedovich, K. A., D. Grigat, L. Dowsett, D. Lorenzetti, J. E. Andruchow, A. D. McRae, E. S. Lang, and F. Clement. "MP39: Characteristics of clinical decision support tools that impact physician behaviour: a systematic review and meta-analysis." CJEM 20, S1 (May 2018): S55. http://dx.doi.org/10.1017/cem.2018.193.
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Introduction: Clinical decision support (CDS) has been implemented in many clinical settings in order to improve decision-making. Their potential to improve diagnostic accuracy and reduce unnecessary testing is well documented; however, their effectiveness in impacting physician practice in real world implementations has been limited by poor physician adherence. The objective of this systematic review and meta-regression was to establish the effectiveness of CDS tools on adherence and identify which characteristics of CDS tools increase physician use of and adherence. Methods: A systematic review and meta-analysis was conducted. MEDLINE, EMBASE, PsychINFO, the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews were searched from inception to June 2017. Included studies examined CDS in a hospital setting, reported on physician adherence to or use of CDS, utilized a comparative study design, and reported primary data. All tool type was classified based on the Cochrane Effective Practice and Organization of Care (EPOC) classifications. Studies were stratified based on study design (RCT vs. observational). Meta-regression was completed to assess the different effect of characteristics of the tool (e.g. whether the tool was mandatory or voluntary, EPOC classifications). Results: A total of 3,359 candidate articles were identified. Seventy-two met inclusion criteria, of which 46 reported outcomes appropriate for meta-regression (5 RCTs and 41 observational studies). Overall, a trend of increased CDS use was found (pooled RCT OR: 1.36 [95% CI: 0.97-1.89]; pooled observational OR: 2.12 [95% CI: 1.75-2.56]).When type of tool is considered, clinical practice guidelines were superior compared to other interventions (p=.150). Reminders (p=.473) and educational interventions (p=.489) were less successful than other interventions. Multi-modal tools were not more successful that single interventions (p=.810). Lastly, voluntary tools may be supperior to than mandatory tools (p=.148). None of these results are statistically significant. Conclusion: CDS tools accompanied by a planned intervention increases physician utilization and adherence to the tool. Meta-regression found that clinical practice guidelines had the biggest impact on physician adherence although not statistically significant. Further research is required to understand the most effective intervention to maximize physician utilization of CDS tools.
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Sugibayashi, Takahiro, Shannon L. Walston, Toshimasa Matsumoto, Yasuhito Mitsuyama, Yukio Miki, and Daiju Ueda. "Deep learning for pneumothorax diagnosis: a systematic review and meta-analysis." European Respiratory Review 32, no. 168 (June 7, 2023): 220259. http://dx.doi.org/10.1183/16000617.0259-2022.
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BackgroundDeep learning (DL), a subset of artificial intelligence (AI), has been applied to pneumothorax diagnosis to aid physician diagnosis, but no meta-analysis has been performed.MethodsA search of multiple electronic databases through September 2022 was performed to identify studies that applied DL for pneumothorax diagnosis using imaging. Meta-analysisviaa hierarchical model to calculate the summary area under the curve (AUC) and pooled sensitivity and specificity for both DL and physicians was performed. Risk of bias was assessed using a modified Prediction Model Study Risk of Bias Assessment Tool.ResultsIn 56 of the 63 primary studies, pneumothorax was identified from chest radiography. The total AUC was 0.97 (95% CI 0.96–0.98) for both DL and physicians. The total pooled sensitivity was 84% (95% CI 79–89%) for DL and 85% (95% CI 73–92%) for physicians and the pooled specificity was 96% (95% CI 94–98%) for DL and 98% (95% CI 95–99%) for physicians. More than half of the original studies (57%) had a high risk of bias.ConclusionsOur review found the diagnostic performance of DL models was similar to that of physicians, although the majority of studies had a high risk of bias. Further pneumothorax AI research is needed.
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Morelli, Emanuela, Olga Mulas, and Giovanni Caocci. "Patient-Physician Communication in Acute Myeloid Leukemia and Myelodysplastic Syndrome." Clinical Practice & Epidemiology in Mental Health 17, no. 1 (December 31, 2021): 264–70. http://dx.doi.org/10.2174/1745017902117010264.
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Introduction: An effective communication is an integral part of the patient-physician relationship. Lack of a healthy patient-physician relationship leads to a lower level of patient satisfaction, scarce understanding of interventions and poor adherence to treatment regimes. Patients need to be involved in the therapeutic process and the assessment of risks and perspectives of the illness in order to better evaluate their options. Physicians, in turn, must convey and communicate information clearly in order to avoid misunderstandings and consequently poor medical care. The patient-physician relationship in cancer care is extremely delicate due to the complexity of the disease. In cancer diagnosis, the physician must adopt a communicative approach that considers the psychosocial factors, needs and patient’s preferences for information,which in turn all contribute to affect clinical outcomes. Search Strategy and Methods : This review was conducted using the Preferred Reporting Items for Systematic and Meta-analyses (PRISMA) statement. We included studies on the importance of physician-patient communication in Acute Myeloid Leukaemia and Myelodysplastic Syndrome care. We searched PubMed, Web of Sciences, Scopus, Google scholar for studies published from December 1 st , 2020 up to March 1 st , 2021. Using MeSH headings, we search for the terms “Physician and patient communication AND Acute Myeloid leukemia” or “Myelodysplastic syndrome” or “Doctor” or “Clinician”, as well as variations thereof . Purpose of the Review : This review examines the progress in communication research between patient and physician and focuses on the impact of communication styles on patient-physician relationshipin hematologic cancers, including Acute Myeloid Leukaemia and Myelodysplastic Syndromes.
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HajEbrahimi, Sakineh, Ali Janati, Edris Hasanpoor, Morteza Arab-Zozani, Mobin Sokhanvar, Fariba Pashzadeh, and Elaheh HaghGoshyie. "59: EVIDENCE BASED DECISION MAKING ABOUT FACTORS AFFECTING CONSULTATION LENGTH OF PHYSICIANS WORLDWIDE: A SYSTEMATIC REVIEW AND META-ANALYSIS." BMJ Open 7, Suppl 1 (February 2017): bmjopen—2016–015415.59. http://dx.doi.org/10.1136/bmjopen-2016-015415.59.
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Background and aims:Consultation length is a crucial aspect of patient-physician interaction that its inadequacy can negatively influence the treatment and diagnosis efficiency. The purpose was to determine factors related to consultation length of physicians and we sought to compare consultation length in different countries worldwide.Methods:We searched PubMed, Web of Science, Cochrane, ProQuest, and Scopus. Also, we searched Google Scholar for finding of the entire articles that theses related to consultation length. We used data sources up to November, 2015, without language restriction and searched the reference lists of retrieved articles. We extracted Consultation length and Factors related to it and assessments for their methodological quality using the AXIS (Appraisal tool for Cross-Sectional Studies) checklist. Meta-analyses were conducted using Comprehensive Meta-Analysis Version (CMA) 2.0. We used a random-effects model for the meta-analyses of factors.Results:Of the 16 911 identified studies, 189 met full inclusion criteria. Of 189 studies assessed, 125 cases (67%) were conducted in USA, UK, Australia and Netherlands. Only, 49 (26%) studies were strong evidence. 164 (86.77%) studies were face to face consultations. The effect of three variables physicians' gender, patients' gender and type of consultation investigated on the consultation length. According to moderate and strong evidence, no statistically significant difference was found in the consultation length in female and male doctors (p=0.891). Also, no statistically significant difference was found in the consultation length between female and male patients (p=0.314) and telemedicine and face to face (p=0.170) visits.Conclusions:According to all evidence, The results showed that no association was identified between consultation length and three factors in the random-effects model. It seems patient-physician interaction more than studied variables, influence the length of consultations.
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Bloom, Bernard S. "Effects of continuing medical education on improving physician clinical care and patient health: A review of systematic reviews." International Journal of Technology Assessment in Health Care 21, no. 3 (July 2005): 380–85. http://dx.doi.org/10.1017/s026646230505049x.
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Objectives:The objective of physician continuing medical education (CME) is to help them keep abreast of advances in patient care, to accept new more-beneficial care, and discontinue use of existing lower-benefit diagnostic and therapeutic interventions. The goal of this review was to examine effectiveness of current CME tools and techniques in changing physician clinical practices and improving patient health outcomes.Methods:Results of published systematic reviews were examined to determine the spectrum from most- to least-effective CME techniques. We searched multiple databases, from 1 January 1984 to 30 October 2004, for English-language, peer-reviewed meta-analyses and other systematic reviews of CME programs that alter physician behavior and/or patient outcomes.Results:Twenty-six reviews met inclusion criteria, that is, were either formal meta-analyses or other systematic reviews. Interactive techniques (audit/feedback, academic detailing/outreach, and reminders) are the most effective at simultaneously changing physician care and patient outcomes. Clinical practice guidelines and opinion leaders are less effective. Didactic presentations and distributing printed information only have little or no beneficial effect in changing physician practice.Conclusions:Even though the most-effective CME techniques have been proven, use of least-effective ones predominates. Such use of ineffective CME likely reduces patient care quality and raises costs for all, the worst of both worlds.
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Sollami, Alfonso, Luca Caricati, and Leopoldo Sarli. "Nurse–physician collaboration: a meta-analytical investigation of survey scores." Journal of Interprofessional Care 29, no. 3 (September 10, 2014): 223–29. http://dx.doi.org/10.3109/13561820.2014.955912.
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Emdin, Connor A., Nicholas J. Chong, and Peggy E. Millson. "Non-physician clinician provided HIV treatment results in equivalent outcomes as physician-provided care: a meta-analysis." Journal of the International AIDS Society 16, no. 1 (January 2013): 18445. http://dx.doi.org/10.7448/ias.16.1.18445.
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Stoller, James K. "Developing physician leaders: does it work?" BMJ Leader 4, no. 1 (March 2020): 1–5. http://dx.doi.org/10.1136/leader-2018-000116.
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BackgroundLeader development programmes are signature features of frontrunner multinational companies. Healthcare institutions have generally lagged behind, though attention to implementing leader development programmes in healthcare institutions is increasing. The rationale for leader development in healthcare is that leadership competencies matter and that traditional selection and training of physicians may conspire against both optimal leadership competencies and followership.MethodsThe growth of leader development in healthcare institutions begs the question: Does leader development work?ResultsIn this context, three meta-analyses have examined the impact of leader development programmes in healthcare institutions. In general, findings from these studies indicate that while studies do assess the subjective learning of participants, few studies have evaluated the organisational impact of such leader development programmes.ConclusionsThese findings suggest the need for more rigorous, objective assessment of the organisational impact of leader development programmes in healthcare institutions. Such evidence is critically needed in the current resource-constrained environment of healthcare.
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Marsters, Candace M., Lenka Stafl, Sarah Bugden, Rita Gustainis, Victoria Nkunu, Renee Reimer, Sarah Fletcher, et al. "Pregnancy, obstetrical and neonatal outcomes in women exposed to physician-related occupational hazards: a scoping review." BMJ Open 13, no. 2 (February 2023): e064483. http://dx.doi.org/10.1136/bmjopen-2022-064483.
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ObjectiveEvidence is needed to guide organisational decision making about workplace accommodations for pregnant physicians. Our objective was to characterise the strengths and limitations of current research examining the association between physician-related occupational hazards with pregnancy, obstetrical and neonatal outcomes.DesignScoping review.Data sourcesMEDLINE/PubMed, EMBASE, CINAHL/ EBSCO, SciVerse Scopus and Web of Science/Knowledge were searched from inception to 2 April 2020. A grey literature search was performed on 5 April 2020. The references of all included articles were hand searched for additional citations.Eligibility criteriaEnglish language citations that studied employed pregnant people and any ‘physician-related occupational hazards’, meaning any relevant physical, infectious, chemical or psychological hazard, were included. Outcomes included any pregnancy, obstetrical or neonatal complication.Data extraction and synthesisPhysician-related occupational hazards included physician work, healthcare work, long work hours, ‘demanding’ work, disordered sleep, night shifts and exposure to radiation, chemotherapy, anaesthetic gases or infectious disease. Data were extracted independently in duplicate and reconciled through discussion.ResultsOf the 316 included citations, 189 were original research studies. Most were retrospective, observational and included women in any occupation rather than healthcare workers. Methods for exposure and outcome ascertainment varied across studies and most studies had a high risk of bias in data ascertainment. Most exposures and outcomes were defined categorically and results from different studies could not be combined in a meta-analysis due to heterogeneity in how these categories were defined. Overall, some data suggested that healthcare workers may have an increased risk of miscarriage compared with other employed women. Long work hours may be associated with miscarriage and preterm birth.ConclusionsThere are important limitations in the current evidence examining physician-related occupational hazards and adverse pregnancy, obstetrical and neonatal outcomes. It is not clear how the medical workplace should be accommodated to improve outcomes for pregnant physicians. High-quality studies are needed and likely feasible.
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Boet, Sylvain, Cole Etherington, Pierre-Marc Dion, Chloé Desjardins, Manvinder Kaur, Valentina Ly, Manon Denis-LeBlanc, Cecile Andreas, and Abi Sriharan. "Impact of coaching on physician wellness: A systematic review." PLOS ONE 18, no. 2 (February 7, 2023): e0281406. http://dx.doi.org/10.1371/journal.pone.0281406.
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Physician wellness is critical for patient safety and quality of care. Coaching has been successfully and widely applied across many industries to enhance well-being but has only recently been considered for physicians. This review aimed to summarize the existing evidence on the effect of coaching by trained coaches on physician well-being, distress and burnout. MEDLINE, Embase, ERIC, PsycINFO and Web of Science were searched without language restrictions to December 21, 2022. Studies of any design were included if they involved physicians of any specialty undergoing coaching by trained coaches and assessed at least one measure along the wellness continuum. Pairs of independent reviewers determined reference eligibility. Risk of bias was assessed using the Cochrane Risk of Bias Tools for Randomized Controlled Trials (RCTs) and for Non-randomized Studies of Interventions (ROBINS-I). Meta-analysis was not possible due to heterogeneity in study design and outcome measures as well as inconsistent reporting. The search retrieved 2531 references, of which 14 were included (5 RCTs, 2 non-randomized controlled studies, 4 before-and-after studies, 2 mixed-methods studies, 1 qualitative study). There were 1099 participants across all included studies. Risk of bias was moderate or serious for non-RCTs, while the 5 RCTs were of lower risk. All quantitative studies reported effectiveness of coaching for at least one outcome assessed. The included qualitative study reported a perceived positive impact of coaching by participants. Evidence from available RCTs suggests coaching for physicians can improve well-being and reduce distress/burnout. Non-randomized interventional studies have similar findings but face many limitations. Consistent reporting and standardized outcome measures are needed.
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Oh, So-Young, David A. Cook, Pascal W. M. Van Gerven, Joseph Nicholson, Hilary Fairbrother, Frank W. J. M. Smeenk, and Martin V. Pusic. "Physician Training for Electrocardiogram Interpretation: A Systematic Review and Meta-Analysis." Academic Medicine 97, no. 4 (March 30, 2022): 593–602. http://dx.doi.org/10.1097/acm.0000000000004607.
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Taheri, Cameron, Abirami Kirubarajan, Xinglin Li, Andrew C. L. Lam, Sam Taheri, and Nancy F. Olivieri. "Discrepancies in self-reported financial conflicts of interest disclosures by physicians: a systematic review." BMJ Open 11, no. 4 (April 2021): e045306. http://dx.doi.org/10.1136/bmjopen-2020-045306.
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BackgroundThere is a high prevalence of financial conflicts of interest (COI) between physicians and industry.ObjectivesTo conduct a systematic review with meta-analysis examining the completeness of self-reported financial COI disclosures by physicians, and identify factors associated with non-disclosure.Data sourcesMEDLINE, Embase and PsycINFO were searched for eligible studies up to April 2020 and supplemented with material identified in the references and citing articles.Data extraction and synthesisData were independently abstracted by two authors. Data synthesis was performed via systematic review of eligible studies and random-effects meta-analysis.Main outcomes and measuresThe proportion of discrepancies between physician self-reported disclosures and objective payment data was the main outcome. The proportion of discrepant funds and factors associated with non-disclosure were also examined.Results40 studies were included. The pooled proportion of COI discrepancies at the article level was 81% (range: 54%–98%; 95% CI 72% to 89%), 79% at the payment level (range: 71%–89%; 95% CI 67% to 89%), 93% at the authorship level (range: 71%–100%; 95% CI 79% to 100%) and 66% at the author level (range: 8%–99%; 95% CI 48% to 78%). The proportion of funds discrepant was 33% (range: 2%–77%; 95% CI 12% to 58%). There was high heterogeneity between studies across all five analyses (I2=94%–99%). Most undisclosed COI were related to food and beverage, or travel and lodging. While the most common explanation for failure to disclose was perceived irrelevance, a median of 45% of non-disclosed payments were directly or indirectly related to the work. A smaller monetary amount was the most common factor associated with nondisclosure.ConclusionsPhysician self-reports of financial COI are highly discrepant with objective data sources reporting payments from industry. Stronger policies are required to reduce reliance on physician self-reporting of financial COI and address non-compliance.
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Wilson, Janet, Peter Tanuseputro, Daniel T. Myran, Shan Dhaliwal, Junayd Hussain, Patrick Tang, Salmi Noor, Rhiannon L. Roberts, Marco Solmi, and Manish M. Sood. "Characterization of Problematic Alcohol Use Among Physicians: A Systematic Review." JAMA Network Open 5, no. 12 (December 9, 2022): e2244679. http://dx.doi.org/10.1001/jamanetworkopen.2022.44679.
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ImportanceProblematic alcohol use in physicians poses a serious concern to physicians' health and their ability to provide care. Understanding the extent and characteristics of physicians with problematic alcohol use will help inform interventions.ObjectiveTo estimate the extent of problematic alcohol use in physicians and how it differs by physician sex, age, medical specialty, and career stage (eg, residency vs practicing physician).Evidence ReviewPreferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020-compliant systematic review, searching Medline, Embase, and PsychInfo from January 2006 to March 2020. Search terms included Medical Subject Headings terms and keywords related to physicians as the population and problematic alcohol use as the primary outcome. The quality of studies was assessed using the Newcastle-Ottawa Scale. We included articles where problematic alcohol use was measured by a validated tool (ie, Alcohol Use Disorders Identification Test [AUDIT], AUDIT Version C [AUDIT-C], or CAGE [Cut down, Annoyed, Guilty, and Eye-opener] questionnaire) in practicing physicians (ie, residents, fellows, or staff physicians).FindingsThirty-one studies involving 51 680 participants in 17 countries published between January 2006 and March 2020 were included. All study designs were cross-sectional, self-reported surveys. Problematic alcohol use varied widely regardless of measurement method (0 to 34% with AUDIT; 9% to 35% with AUDIT-C; 4% to 22% with CAGE). Reported problematic alcohol use increased over time from 16.3% in 2006 to 2010 to 26.8% in 2017 to 2020. The extent of problematic use by sex was examined in 19 studies, by age in 12 studies, by specialty in 7 studies, and by career stage in 5 studies. Seven of 19 studies (37%) identified that problematic alcohol use was more common in males than females. Based on the wide heterogeneity of methods for included studies, limited conclusions can be made on how problematic alcohol use varies based on physician age, sex, specialty, and career stage.Conclusions and RelevanceStudies about problematic alcohol use in physicians demonstrate a high degree of heterogeneity in terms of methods of measurement, definitions for problematic alcohol use, and cohorts assessed. Most studies are primarily self-reported, precluding the ability to determine the true prevalence among the profession. Few studies provide relevant comparisons to aid in identifying key risk groups for targeted interventions.
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Im, Hyea Bin, Jung Hye Hwang, Dain Choi, Soo Jeung Choi, and Dongwoon Han. "Patient–physician communication on herbal medicine use during pregnancy: a systematic review and meta-analysis." BMJ Global Health 9, no. 3 (March 2024): e013412. http://dx.doi.org/10.1136/bmjgh-2023-013412.
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IntroductionLack of transparent communication between patients and physicians regarding the use of herbal medicine (HM) presents a major public health challenge, as inappropriate HM use poses health risks. Considering the widespread use of HM and the risk of adverse events, it is crucial for pregnant women to openly discuss their HM use with healthcare providers. Therefore, this systematic review and meta-analysis aims to estimate the pooled prevalence of pregnant women’s HM use and disclosure to healthcare providers and to examine the relationship between HM disclosure and various maternal and child health (MCH) measures.MethodsA systematic search of five databases was conducted for cross-sectional studies on HM use during pregnancy published from 2000 to 2023. Data extraction followed a standardised approach, and Stata V.16.0 was used for data analysis. Also, Spearman’s correlation coefficient was calculated to examine the association between use and disclosure of HM and various MCH indicators.ResultsThis review included 111 studies across 51 countries on the use of HM among pregnant women. Our findings showed that 34.4% of women used HM during pregnancy, driven by the perception that HM is presumably safer and more natural than conventional medical therapies. However, only 27.9% of the HM users disclosed their use to healthcare providers because they considered HM as harmless and were not prompted by the healthcare providers to discuss their self-care practices. Furthermore, a significant correlation was observed between HM disclosure and improved MCH outcomes.ConclusionInadequate communication between pregnant women and physicians on HM use highlights a deficiency in the quality of care that may be associated with unfavourable maternal outcomes. Thus, physician engagement in effective and unbiased communication about HM during antenatal care, along with evidence-based guidance on HM use, can help mitigate the potential risks associated with inappropriate HM use.
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ADAM, Andreea Raluca, and Florinda Tinela GOLU. "Efficacy of communication-based interventions on physicians and patients’ outcome: A meta-analysis of randomised controlled trials." Romanian Journal of Medical Practice 16, no. 3 (September 30, 2021): 297–306. http://dx.doi.org/10.37897/rjmp.2021.3.1.
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Communication-based intervention on physicians are strongly linked to patient health improvement. We proceeded examine the efficiency of these programs interventions for relevant outcomes in patients life, along with study quality, publication bias and potential moderators. For this meta-analysis, we searched 2 databases, including: Web of Science and PubMed, using a comprehensive search strategy to identify the efficacy of the physician interventions on patient’s outcome studies in the literature, published from inception of 1965. Studies reporting means of health-related outcome in patients were included in the analyses. Studies quality was assessed with risk of bias tool. Meta-regression was used to explore heterogeneity of the year of published studies moderator and subgroup analysis was used to explore the medical specialty moderator. Of the 3,470 studies initially identified, 14 were eligible for inclusion. These studies had a large diversity of program interventions. The mean effect size representing the impact of communication intervention on patients physical and psychological health was not significant. The only significant mean effect was represented by psychological outcome. Significant associations were found between year of studies and general medicine specialization. In conclusion the impact of physicians’ intervention in not efficient on patients’ communication and medical outcome but it improves psychological health
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Pattni, Chandni, Michael Scaffidi, Juana Li, Shai Genis, Nikko Gimpaya, Rishad Khan, Rishi Bansal, Nazi Torabi, Catharine M. Walsh, and Samir C. Grover. "Video-based interventions to improve self-assessment accuracy among physicians: A systematic review." PLOS ONE 18, no. 7 (July 13, 2023): e0288474. http://dx.doi.org/10.1371/journal.pone.0288474.
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Purpose Self-assessment of a physician’s performance in both procedure and non-procedural activities can be used to identify their deficiencies to allow for appropriate corrective measures. Physicians are inaccurate in their self-assessments, which may compromise opportunities for self- development. To improve this accuracy, video-based interventions of physicians watching their own performance, an experts’ performance or both, have been proposed to inform their self-assessment. We conducted a systematic review of the effectiveness of video-based interventions targeting improved self-assessment accuracy among physicians. Materials and methods The authors performed a systematic search of MEDLINE, Embase, EBM reviews, and Scopus databases from inception to August 23, 2022, using combinations of terms for “self-assessment”, “video-recording”, and “physician”. Eligible studies were empirical investigations assessing the effect of video-based interventions on physicians’ self-assessment accuracy with a comparison of self-assessment accuracy pre- and post- video intervention. We defined self-assessment accuracy as a “direct comparison between an external evaluator and self-assessment that was quantified using formal statistical analysis”. Two reviewers independently screened records, extracted data, assessed risk of bias, and evaluated quality of evidence. A narrative synthesis was conducted, as variable outcomes precluded a meta-analysis. Results A total of 2,376 papers were initially retrieved. Of these, 22 papers were selected for full-text review; a final 9 studies met inclusion criteria for data extraction. Across studies, 240 participants from 5 specialties were represented. Video-based interventions included self-video review (8/9), benchmark video review (3/9), and/or a combination of both types (1/9). Five out of nine studies reported that participants had inaccurate self-assessment at baseline. After the intervention, 5 of 9 studies found a statistically significant improvement in self-assessment accuracy. Conclusions Overall, current data suggests video-based interventions can improve self-assessment accuracy. Benchmark video review may enable physicians to improve self-assessment accuracy, especially for those with limited experience performing a particular clinical skill. In contrast, self-video review may be able to provide improvement in self-assessment accuracy for more experience physicians. Future research should use standardized methods of comparison for self-assessment accuracy, such as the Bland-Altman analysis, to facilitate meta-analytic summation.
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Wiederhold, Brenda K., Pietro Cipresso, Daniele Pizzioli, Mark Wiederhold, and Giuseppe Riva. "Intervention for physician burnout: A systematic review." Open Medicine 13, no. 1 (July 4, 2018): 253–63. http://dx.doi.org/10.1515/med-2018-0039.
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AbstractBurnout is an important problem for physicians, with a strong impact on their quality of life and a corresponding decrease in the quality of care with an evident economical burden for the healthcare system. However, the range of interventions used to decrease this problem could be very fragmented and with the aim to shed some light on this issue, this study reviews and summarizes the currently available studies. We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to identify studies about intervention on physician burnout. Two authors independently searched into scientific databases to analyze and review the full papers that met the inclusion criteria. As a result, from an initial search of 11029 articles, 13 studies met full criteria and were included in this review. Of the 13 studies presented, only 4 utilized randomized controlled trials, therefore the results should be interpreted with caution. Future interventions should focus on a more holistic approach using a wider range of techniques. According to the studies selected in this review, it appears that a successful intervention for burnout should take into account the broad range of causes incorporating a variety of therapeutic tools.
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Arcimowicz, Magdalena, and Kazimierz Niemczyk. "EPOS 2020: What’s new for physician practitioners?" Polski Przegląd Otorynolaryngologiczny 9, no. 2 (June 15, 2020): 7–17. http://dx.doi.org/10.5604/01.3001.0014.2023.
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The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 also abbreviated to EPOS 2020, is the new edition of the European document devoted to the broadly understood topic of inflammation of the nasal mucosa and paranasal sinuses. The first edition appeared in 2005, followed by further editions in 2007 and 2012. In February 2020, we received the latest version, extended, somewhat modified, expanded to include the latest research and meta-analysis in the fields of: rhinology, rhinosurgery, epidemiology and reports on comorbidities. A completely new division of chronic sinusitis was presented. Recommendations based on the highest quality evaluations, resulting from the publication of the last eight years, also introduce a system based on integrated care pathways, or ICP in sinusitis. Chapters on pediatric aspects and sinus surgery have been expanded. EPOS 2020 is addressed not only to doctors, but also to: nurses, pharmacists, other healthcare workers, as well as patients themselves, who often make the first attempts at treatment with OTC preparations, frequently based on the recommendations of pharmacists. The latest EPOS also specifies directions for further lines of research in the broadly understood field of rhinosinusitis.
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Taylor, Andreea, and Sarbjit Clare. "Ultrasound for Lumbar Punctures – An Invaluable tool for the Acute Physician." Acute Medicine Journal 22, no. 2 (June 2023): 106. http://dx.doi.org/10.52964/amja.0943.
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The traditional procedure of identifying anatomical landmarks when performing lumbar punctures can lead to a failure rate of 19%. The Society of Hospital Medicine have published a statement, recommending use of ultrasound (US) guidance for all adult lumbar punctures (LP). A recent meta-analysis found several advantages of point of care US guided LP: higher success rate and diminished pain. US assisted LP is easy to learn, integrating ultrasound guided LP into Acute Medicine curriculum, could lead to better patient outcome.
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Wreyford, Leon, Raj Gururajan, and Xujuan Zhou. "When can cancer patient treatment nonadherence be considered intentional or unintentional? A scoping review." PLOS ONE 18, no. 5 (May 3, 2023): e0282180. http://dx.doi.org/10.1371/journal.pone.0282180.
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Background Treatment nonadherence in cancer patients remains high with most interventions having had limited success. Most studies omit the multi-factorial aspects of treatment adherence and refer to medication adherence. The behaviour is rarely defined as intentional or unintentional. Aim The aim of this Scoping Review is to increase understanding of modifiable factors in treatment nonadherence through the relationships that physicians have with their patients. This knowledge can help define when treatment nonadherence is intentional or unintentional and can assist in predicting cancer patients at risk of nonadherence and in intervention design. The scoping review provides the basis for method triangulation in two subsequent qualitative studies: 1. Sentiment analysis of online cancer support groups in relation to treatment nonadherence; 2. A qualitative validation survey to refute / or validate claims from this scoping review. Thereafter, framework development for a future (cancer patient) online peer support intervention. Methods A Scoping Review was performed to identify peer reviewed studies that concern treatment / medication nonadherence in cancer patients—published between 2000 to 2021 (and partial 2022). The review was registered in the Prospero database CRD42020210340 and follows the PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Searches. The principles of meta-ethnography are used in a synthesis of qualitative findings that preserve the context of primary data. An aim of meta-ethnography is to identify common and refuted themes across studies. This is not a mixed methods study, but due to a limited qualitativevidence base and to broaden findings, the qualitative elements (author interpretations) found within relevant quantitative studies have been included. Results Of 7510 articles identified, 240 full texts were reviewed with 35 included. These comprise 15 qualitative and 20 quantitative studies. One major theme, that embraces 6 sub themes has emerged: ‘Physician factors can influence patient factors in treatment nonadherence’. The six (6) subthemes are: 1. Suboptimal Communication; 2. The concept of Information differs between Patient and Physician; 3.Inadequate time. 4. The need for Treatment Concordance is vague or missing from concepts; 5. The importance of Trust in the physician / patient relationship is understated in papers; 6. Treatment concordance as a concept is rarely defined and largely missing from studies. Line of argument was drawn Treatment (or medication) nonadherence that is intentional or unintentional is often attributed to patient factors—with far less attention to the potential influence of physician communication factors. The differentation between intentional or unintentional nonadherence is missing from most qualitative and quantitative studies. The holistic inter-dimensional / multi-factorial concept of ‘treatment adherence’ receives scant attention. The main focus is on medication adherence / nonadherence in the singular context. Nonadherence that is unintentional is not necessarily passive behaviour and may overlap with intentional nonadherence. The absence of treatment concordance is a barrier to treatment adherence and is rarely articulated or defined in studies. Conclusion This review demonstrates how cancer patient treatment nonadherence is often a shared outcome. An equal focus on physican and patient factors can increase understanding of the two main types of nonadherence (intentional or unintentional). This differentation should help improve the fundamentals of intervention design.
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West, Colin P., Liselotte N. Dyrbye, Patricia J. Erwin, and Tait D. Shanafelt. "Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis." Lancet 388, no. 10057 (November 2016): 2272–81. http://dx.doi.org/10.1016/s0140-6736(16)31279-x.
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Jack, R. A., M. B. Burn, P. C. McCulloch, S. R. Liberman, K. E. Varner, and J. D. Harris. "Does experience matter? A meta-analysis of physician rating websites of Orthopaedic Surgeons." MUSCULOSKELETAL SURGERY 102, no. 1 (August 29, 2017): 63–71. http://dx.doi.org/10.1007/s12306-017-0500-1.
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Srinivasamurthy, Suresh Kumar, Ramkumar Ashokkumar, Sunitha Kodidela, Scott C. Howard, Caroline Flora Samer, and Uppugunduri Satyanarayana Chakradhara Rao. "Impact of computerised physician order entry (CPOE) on the incidence of chemotherapy-related medication errors: a systematic review." European Journal of Clinical Pharmacology 77, no. 8 (February 23, 2021): 1123–31. http://dx.doi.org/10.1007/s00228-021-03099-9.
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Abstract Purpose Computerised prescriber (or physician) order entry (CPOE) implementation is one of the strategies to reduce medication errors. The extent to which CPOE influences the incidence of chemotherapy-related medication errors (CMEs) was not previously collated and systematically reviewed. Hence, this study was designed to collect, collate, and systematically review studies to evaluate the effect of CPOE on the incidence of CMEs. Methods A search was performed of four databases from 1 January 1995 until 1 August 2019. English-language studies evaluating the effect of CPOE on CMEs were selected as per inclusion and exclusion criteria. The total CMEs normalised to total prescriptions pre- and post-CPOE were extracted and collated to perform a meta-analysis using the ‘meta’ package in R. The systematic review was registered with PROSPERO CRD42018104220. Results The database search identified 1621 studies. After screening, 19 studies were selected for full-text review, of which 11 studies fulfilled the selection criteria. The meta-analysis of eight studies with a random effects model showed a risk ratio of 0.19 (95% confidence interval: 0.08–0.44) favouring CPOE (I2 = 99%). Conclusion The studies have shown consistent reduction in CMEs after CPOE implementation, except one study that showed an increase in CMEs. The random effects model in the meta-analysis of eight studies showed that CPOE implementation reduced CMEs by 81%.
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Arora, A., C. McDonald, A. Iansavitchene, M. Brahmania, and M. Sey. "A65 ENDOSCOPIST-TARGETED INTERVENTIONS TO OPTIMIZE ADENOMA DETECTION RATE - A SYSTEMATIC REVIEW AND META-ANALYSIS." Journal of the Canadian Association of Gastroenterology 4, Supplement_1 (March 1, 2021): 25–26. http://dx.doi.org/10.1093/jcag/gwab002.063.
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Abstract Background Adenoma detection rate (ADR) has emerged as the strongest quality assurance metric that has consistently been shown to be inversely associated with the development of colorectal cancer after colonoscopy. Unfortunately, marked variability in ADR exists among endoscopists. A multitude of interventions targeted at endoscopists to optimize their ADR have been reported, including but not limited to withdrawal time, in room observers, physician report cards, and quality improvement and training programs. However, it is unclear which of them are truly effective. Aims We performed a systematic review and meta-analysis of the literature to evaluate the effectiveness of endoscopist-targeted interventions to improve adenoma detection rate (ADR) or polyp detection rate (PDR). Methods Systematic searches of major databases were conducted through to March 2018 to identify potentially relevant studies. Both randomized controlled trials and observational studies were included. Data for ADR and PDR were analyzed on the log-odds scale using a random-effects meta-analysis model using restricted maximum likelihood (with Mantel-Haenszel fixed-effect meta-analysis used for fewer than 4 studies). Statistical effect-size heterogeneity was assessed using a Chi2 test and quantifying the relative proportion of variation using the I2 statistic. Publication bias was assessed by the Harbord regression test. Results From 4299 initial studies, 24 were included in the systematic review and 13 were included in the meta-analysis representing a total of 55,090 colonoscopies. Physician report card interventions (7 studies) and withdrawal time focused interventions (6 studies) were meta-analyzed. The pooled odds ratio for ADR for report card interventions was 1.31 (95% CI: 1.15, 1.50; p<0.0001), favoring report cards to detect more adenomas. Statistical heterogeneity was detected with substantial relative effect-size variability (Chi2, p<0.0001; I2=80.1%). No statistical evidence of publication bias was found. 6 studies reported data for PDR using withdrawal time focused interventions, with 3 of these reporting data on ADR. The pooled odds ratio for ADR was 1.02 (95% CI: 0.86, 1.22; p=0.81) and for PDR was 1.07 (95% CI: 0.88, 1.31; p=0.51) which were not statistically significant. Statistical heterogeneity was detected in both groups (Chi2, p<0.001; I2=82.2% for ADR and I2=89.4% for PDR) and there was statistical evidence of publication bias. Figures 1 and 2 represent Forest plots for the effect of pre-and post-report card and withdrawal time focused interventions on ADR. Conclusions Our study provides evidence that the distribution of colonoscopy quality report cards to physicians significantly improves overall ADR and should strongly be considered as part of quality improvement programs aimed at optimizing colonoscopy performance. Funding Agencies None
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Keijzer-van Laarhoven, Angela JJM, Dorothea P. Touwen, Bram Tilburgs, Madelon van Tilborg-den Boeft, Claudia Pees, Wilco P. Achterberg, and Jenny T. van der Steen. "Which moral barriers and facilitators do physicians encounter in advance care planning conversations about the end of life of persons with dementia? A meta-review of systematic reviews and primary studies." BMJ Open 10, no. 11 (November 2020): e038528. http://dx.doi.org/10.1136/bmjopen-2020-038528.
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Importance and objectiveConducting advance care planning (ACP) conversations with people with dementia and their relatives contributes to providing care according to their preferences. In this review, we identify moral considerations which may hinder or facilitate physicians in conducting ACP in dementia.DesignFor this meta-review of systematic reviews and primary studies, we searched the PubMed, Web of Science and PsycINFO databases between 2005 and 30 August 2019. We included empirical studies concerning physicians’ moral barriers and facilitators of conversations about end-of-life preferences in dementia care. The protocol was registered at Prospero (CRD42019123308).Setting and participantsPhysicians and nurse practitioners providing medical care to people with dementia in long-term and primary care settings. We also include observations from patients or family caregivers witnessing physicians’ moral considerations.Main outcomesPhysicians’ moral considerations involving ethical dilemmas for ACP. We define moral considerations as the weighing by the professional caregiver of values and norms aimed at providing good care that promotes the fundamental interests of the people involved and which possibly ensues dilemmas.ResultsOf 1347 studies, we assessed 22 systematic reviews and 51 primary studies as full texts. We included 11 systematic reviews and 13 primary studies. Themes included: (1) beneficence and non-maleficence; (2) respecting dignity; (3) responsibility and ownership; (4) relationship and (5) courage. Moral dilemmas related to the physician as a professional and as a person. For most themes, there were considerations that either facilitated or hindered ACP, depending on physician’s interpretation or the context.ConclusionsPhysicians feel a responsibility to provide high-quality end-of-life care to patients with dementia. However, the moral dilemmas this may involve, can lead to avoidant behaviour concerning ACP. If these dilemmas are not recognised, discussed and taken into account, implementation of ACP as a process between physicians, persons with dementia and their family caregivers may fail.
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Bahar, Tamanna, and Shaila Rahman. "Depression in Physicians: An Overlooked Issue in Mental Health." Journal of Enam Medical College 10, no. 1 (January 22, 2020): 39–42. http://dx.doi.org/10.3329/jemc.v10i1.45065.
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Depression is a common mental disorder that presents with depressed mood, loss of interest, feelings of guilt or low self-esteem. It affects an estimated one in 15 adults (6.7%) in any given year. One in six people (16.6%) will experience depression at some point in their lifetime. It can strike at any time; but usually it first appears during the late teens to mid-20s. Women usually experience depression more than men. Depression is one of the most common mental health issues among physicians worldwide due to high-intensity training and work overload. Recent systematic reviews and meta-analysis indicated that the prevalence of depression among physicians worldwide was around 28.8% which is quite higher than in the rest of the general population. Depressed physician makes more medical error than others. The burden of depression could lead to a low quality of life, ultimately suicidal attempts. So identifying risk factors for depression must be addressed and solved properly with utmost priority. This article reviews the prevalence of depression in physicians based on recently published literature related to this arena.
J Enam Med Col 2020; 10(1): 39-42
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Niburski, Kacper, Elena Guadagno, and Dan Poenaru. "Shared Decision Making in Surgery: A Meta-Analysis and Full Systematic Review." International Journal of Whole Person Care 7, no. 1 (January 15, 2020): 59. http://dx.doi.org/10.26443/ijwpc.v7i1.242.
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Shared decision-making (SDM), the process where physician and patient reach an agreed-upon choice by understanding the values, concerns, and preferences inherent within each treatment option available, has been increasingly implemented in clinical practice to better health care outcomes. Despite the proven efficacy of SDM to provide better patient-guided care in medicine, its use in surgery has not been studied widely. A search strategy was developed with a medical librarian. It included nine databases from inception until December 2018. After a 2-person title and abstract screen, full-text publications were analyzed in detail. A meta-analysis was done to quantify the impact of SDM in surgical specialties. In total 5,596 studies were retrieved. After duplicates were removed, titles and abstracts were screened, and p-values were recorded, 140 (45 RCTs and 95 cross-sectional studies) were used for the systematic review and 42 for the meta-analyses. Most of the studies noted decreased intervention rate (8 of 14), decisional conflict (13 of 16), and decisional regret (3 of 3), and an increased decisional satisfaction (9 of 12), knowledge (19 of 20), SDM preference (6 of 8), and physician trust (3 of 4) when using SDM. Time increase per patient encounter was inconclusive. The meta-analysis showed that despite high heterogeneity, the results were significant. Far from obviating surgical immediacy, these results suggest that SDM is vital for the best indicators of care. With decreased conflict and anxiety, increasing knowledge and satisfaction, and creating a more whole, trusting relationship, SDM appears to be beneficial in surgery.
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Nowrouzi-Kia, Behdin, Emily Chai, Koyo Usuba, Behnam Nowrouzi-Kia, and Jennifer Casole. "Prevalence of Type II and Type III Workplace Violence against Physicians: A Systematic Review and Meta-analysis." International Journal of Occupational and Environmental Medicine 10, no. 3 (July 1, 2019): 99–110. http://dx.doi.org/10.15171/ijoem.2019.1573.
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Background: Workplace violence (WPV) in the health care sector remains a prominent, under-reported global occupational hazard and public health issue. Objective: To determine the types and prevalence of WPV among doctors. Methods: Primary papers on WPV in medicine were identified through a literature search in 4 health databases (Ovid Medline, EMBASE, PsychoINFO and CINAHL). The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for the mapping and identification of records. To assess the studies included in our review, we used the Critical Appraisal Skills Programme cohort review checklist and the Risk of Bias Assessment. Results: 13 out of 2154 articles retrieved were reviewed. Factors outlining physician WPV included (1) working in remote health care areas, (2) understaffing, (3) mental/emotional stress of patients/visitors, (4) insufficient security, and (5) lacking preventative measures. The results of 6 studies were combined in a meta-analysis. The overall prevalence of WPV was 69% (95% CI 58% to 78%). Conclusion: The impact of WPV on health care institutions is profound and far-reaching; it is quite common among physicians. Therefore, steps must be taken to promote an organizational culture where there are measures to protect and promote the well-being of doctors.
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Nugroho, Arief Priyo, and Ardanareswari Ayu Pitaloka. "PHYSICIANS AND DISRUPTION ON TELEMEDICINE: A SYSTEMATIC LITERATURE REVIEW." Jurnal Administrasi Kesehatan Indonesia 11, no. 2 (November 12, 2023): 244–353. http://dx.doi.org/10.20473/jaki.v11i2.2023.244-353.
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Background: Telemedicine has developed rapidly since the COVID-19 pandemic. Telemedicine applications have marked significant transformations in healthcare. Rapid changes in healthcare services inevitably affect health service providers, specifically physicians. Aims: This study examines physicians' responses to a disruptive era in the healthcare industry. Methods: This paper applies a systematic literature review approach to characterize physicians’ experiences, challenges, and obstacles in managing disruption in the health service delivery context. A comprehensive literature review was conducted using the Scopus database and borrowing PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method. There were 78 articles included in the analysis. Results: This study found that doctors who use telemedicine experience several types of disruption. The studies that examine physicians’ experience in health service disruption tend to be dominant in 4 (four) out of 5 (five) disruption types. First, disruption to the current delivery mode. Second, disruption to clinical practice role and responsibility. Third, disruption to clinical practice role and responsibility. Fourth, disruption to the work environment. Meanwhile, the disruption in personal life becomes less elaborated in the telemedicine studies debate. Conclusion: It is essential to pay close attention to the disruptions that have an effect on physicians' personal lives. Personal life is essential because it benefits physicians and directly supports the quality and sustainability of telemedicine services. Keywords: Disruption, Physician, and Telemedicine.
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Gates, Michelle, Aireen Wingert, Robin Featherstone, Charles Samuels, Christopher Simon, and Michele P. Dyson. "Impact of fatigue and insufficient sleep on physician and patient outcomes: a systematic review." BMJ Open 8, no. 9 (September 2018): e021967. http://dx.doi.org/10.1136/bmjopen-2018-021967.
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ObjectivesFor physicians in independent practice, we synthesised evidence on the (1) impacts of insufficient sleep and fatigue on health and performance, and patient safety and (2) effectiveness of interventions targeting insufficient sleep and fatigue.DesignWe systematically reviewed online literature. After piloting, one reviewer selected studies by title and abstract; full texts were then reviewed in duplicate. One reviewer extracted data; another verified a random 10% sample. Two reviewers assessed risk of bias. We pooled findings via meta-analysis when appropriate or narratively.Data sourcesWe searched Medline, Embase, PsycINFO, CINAHL and PubMed for published studies in April 2016; Medline was updated in November 2017. We searched Embase for conference proceedings, and hand-searched meeting abstracts, association and foundation websites.Eligibility criteria for selecting studiesEnglish or French language primary research studies published from 2000 to 2017 examining the effect of fatigue-related or sleep-related exposures or interventions on any outcome among physicians in independent practice and their patients.ResultsOf 16 154 records identified, we included 47 quantitative studies of variable quality. 28 studies showed associations between fatigue or insufficient sleep and physician health and well-being outcomes. 21 studies showed no association with surgical performance, and mixed findings for psychomotor performance, work performance and medical errors. We pooled data from six cohort studies for patient outcomes. For sleep deprived versus non-sleep deprived surgeons, we found no difference in patient mortality (n=60 436, relative risk (RR) 0.98, 95% CI 0.84 to 1.15, I2=0% (p=0.87)) nor postoperative complications (n=60 201, RR 0.99, 95% CI 0.95 to 1.03, I2=0% (p=0.45)). The findings for intraoperative complications and length of stay were considerably heterogeneous.ConclusionsFatigue and insufficient sleep may be associated with negative physician health outcomes. Current evidence is inadequate to inform practice recommendations.
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Stein, John C., Ralph Wang, Naomi Adler, John Boscardin, Vanessa L. Jacoby, Gloria Won, Ruth Goldstein, and Michael A. Kohn. "Emergency Physician Ultrasonography for Evaluating Patients at Risk for Ectopic Pregnancy: A Meta-Analysis." Annals of Emergency Medicine 56, no. 6 (December 2010): 674–83. http://dx.doi.org/10.1016/j.annemergmed.2010.06.563.
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Day, Lukejohn, Derrick Siao, John Inadomi, and Ma Somsouk. "Non-physician performance of lower and upper endoscopy: a systematic review and meta-analysis." Endoscopy 46, no. 05 (March 13, 2014): 401–10. http://dx.doi.org/10.1055/s-0034-1365310.
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Martínez-González, Nahara Anani, Ryan Tandjung, Sima Djalali, Flore Huber-Geismann, Stefan Markun, and Thomas Rosemann. "Effects of Physician-Nurse Substitution on Clinical Parameters: A Systematic Review and Meta-Analysis." PLoS ONE 9, no. 2 (February 24, 2014): e89181. http://dx.doi.org/10.1371/journal.pone.0089181.
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Tinuoye, O., J. P. Pell, and D. F. Mackay. "Meta-Analysis of the Association Between Secondhand Smoke Exposure and Physician-Diagnosed Childhood Asthma." Nicotine & Tobacco Research 15, no. 9 (March 28, 2013): 1475–83. http://dx.doi.org/10.1093/ntr/ntt033.
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Kohar, Ricky Cik, Junita Maja Pertiwi, and Finny Warouw. "Determinants of stress on resident physicians: systematic review and meta-synthesis." International Journal of Research in Medical Sciences 9, no. 12 (November 26, 2021): 3665. http://dx.doi.org/10.18203/2320-6012.ijrms20214717.
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Stress/burnout on resident physicians is common. Various determinants can be related to resident stress. This systematic review was conducted to determine how situational, personal, or professional determinants influence resident stress. We identified an English and Indonesia articles using online database including PubMed, Wiley Online Library, Google Scholar, Garba Rujukan Digital (GARUDA), and manually searching bibliographies of the included studies from January 01, 2001 until April 30, 2021. Three main search terms included are resident physician, determinant, and stress/burnout. Study selection included was peer-reviewed literatures of observational studies that discuss about stress determinants on residents from various year of training and medical specialties. Methodological quality of studies was assessed using Newcastle-Ottawa Scale adopted for cross-sectional studies. Data extraction conducted by 3 authors. All pooled synthesis were summarized based on narrative methods. Fifty-three cross-sectional, 1 prospective, and 1 combination of cross-sectional and longitudinal studies meet our inclusion criteria (n=29.031). Fifty-one percent are male, and the average age of the participants was 29 years old. The most stress/burnout validated tool used are Maslach Burnout Inventory. The average quality of study was moderate for cross-sectional studies. The main identified determinant was situational, the second was personal, and the latter was professional. The most stressor identified was ‘excessive working time per week, includes night shift, on-call, work on day off, and rotation more than 24 hours.’ Stress/burnout on residents closely related mainly to situational, followed by personal, and less by professional determinants. There was needed for an intervention to the educational program from institution in the future for better accomplishment.
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M Segal, Eve, Jill Bates, Sara L. Fleszar, Lisa M. Holle, Julie Kennerly-Shah, Michelle Rockey, and Kate D. Jeffers. "Demonstrating the value of the oncology pharmacist within the healthcare team." Journal of Oncology Pharmacy Practice 25, no. 8 (July 9, 2019): 1945–67. http://dx.doi.org/10.1177/1078155219859424.
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IntroductionAlthough many oncology pharmacists are embedded members within the healthcare team, data documenting their contributions to optimal patient outcomes are growing. The purpose of this paper is to demonstrate the value of the oncology pharmacist within the healthcare team and describe the knowledge, skills, and functions of the oncology pharmacist.MethodsA systematic literature review of articles that were published on PubMed between January 1951 and October 2018 was completed. Identified abstracts were reviewed and included if they focused on measuring the value or impact of the oncology pharmacist on provider/patient satisfaction, improvement of medication safety, improvement of quality/clinical care outcomes, economics, and intervention acceptance. Review articles, meta-analysis, and studies not evaluating oncology pharmacist activities were excluded. Studies were thematically coded into four themes (clinical care, patient education, informatics, and cost savings) by 10 oncology pharmacists.ResultsFour-hundred twenty-two articles were identified, in which 66 articles met inclusion criteria for this review. The selected literature included 27 interventional and 38 descriptive studies. The value of the oncology pharmacist was demonstrated by published articles in four key themes: clinical care, patient education, informatics, and cost savings.ConclusionWith an expected shortage of oncology physicians and the ongoing development of complex oncology therapies, the board-certified oncology pharmacist is well suited to serve as a physician extender alongside nurse practitioners and/or physician assistants as the medication expert on the oncology care team. The demonstrated value of the oncology pharmacist supports their role as frontline providers of patient care.
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Lima, KM, RA Ribeiro, P. Ziegelmann, L. Leal, F. Schmidt, and CA Polanczyk. "A Physician-Centered Intervention To Improve Control of Blood Pressure: Systematic Review And Meta-Analysis." Value in Health 18, no. 7 (November 2015): A828. http://dx.doi.org/10.1016/j.jval.2015.09.299.
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Schram, Andrew W., Gavin W. Hougham, David O. Meltzer, and Gregory W. Ruhnke. "Palliative Care in Critical Care Settings: A Systematic Review of Communication-Based Competencies Essential for Patient and Family Satisfaction." American Journal of Hospice and Palliative Medicine® 34, no. 9 (August 31, 2016): 887–95. http://dx.doi.org/10.1177/1049909116667071.
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Background: There is an emerging literature on the physician competencies most meaningful to patients and their families. However, there has been no systematic review on physician competency domains outside direct clinical care most important for patient- and family-centered outcomes in critical care settings at the end of life (EOL). Physician competencies are an essential component of palliative care (PC) provided at the EOL, but the literature on those competencies relevant for patient and family satisfaction is limited. A systematic review of this important topic can inform future research and assist in curricular development. Methods: Review of qualitative and quantitative empirical studies of the impact of physician competencies on patient- and family-reported outcomes conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines for systematic reviews. The data sources used were PubMed, MEDLINE, Web of Science, and Google Scholar. Results: Fifteen studies (5 qualitative and 10 quantitative) meeting inclusion and exclusion criteria were identified. The competencies identified as critical for the delivery of high-quality PC in critical care settings are prognostication, conflict mediation, empathic communication, and family-centered aspects of care, the latter being the competency most frequently acknowledged in the literature identified. Conclusion: Prognostication, conflict mediation, empathic communication, and family-centered aspects of care are the most important identified competencies for patient- and family-centered PC in critical care settings. Incorporation of education on these competencies is likely to improve patient and family satisfaction with EOL care.
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Castellana, Marco, Filippo Procino, Rodolfo Sardone, Pierpaolo Trimboli, and Gianluigi Giannelli. "Efficacy and safety of patient-led versus physician-led titration of basal insulin in patients with uncontrolled type 2 diabetes: a meta-analysis of randomized controlled trials." BMJ Open Diabetes Research & Care 8, no. 1 (July 2020): e001477. http://dx.doi.org/10.1136/bmjdrc-2020-001477.
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IntroductionInsulin is the most effective antihyperglycemic treatment and basal insulin is the preferred initial formulation in patients with type 2 diabetes. However, its effects are dose-dependent, so adequate titration is necessary to reach targets. We performed a meta-analysis to compare the efficacy and safety of patient-led versus physician-led titration of basal insulin in patients with uncontrolled type 2 diabetes.Research design and methodsFour databases were searched from database inception through March 2020. Randomized controlled studies with at least 12 weeks of follow-up of patients with type 2 diabetes allocated to patient-led versus physician-led titration of basal insulin were selected. Data on glycemic endpoints (hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), hypoglycemia) and other outcomes (insulin dose, body weight, patient-reported outcomes, adverse events, rescue medication, discontinuation) were extracted. Data were pooled using a random-effects model.ResultsSix studies evaluating 12 409 patients were finally included. Compared with the physician-led performance, patient-led titration was associated with a statistically significant higher basal insulin dose (+6 IU/day), leading to benefits on HbA1c (−0.1%) and FPG (−5 mg/dL), despite a higher risk of any level hypoglycemia (relative risk=1.1) and a slight increase in body weight (+0.2 kg). No difference was found for the other outcomes.ConclusionsThe present study showed that patient-led titration of basal insulin was not inferior to physician-led titration in patients with uncontrolled type 2 diabetes. Therefore, diabetes self-management education and support programs on basal insulin should be widely adopted in clinical practice and patients provided with tools to self-adjust their dose when necessary.
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Pomero, Fulvio, Valentina Borretta, Matteo Bonzini, Remo Melchio, James D. Douketis, Luigi Maria Fenoglio, and Francesco Dentali. "Accuracy of emergency physician–performed ultrasonography in the diagnosis of deep-vein thrombosis." Thrombosis and Haemostasis 109, no. 01 (2013): 137–45. http://dx.doi.org/10.1160/th12-07-0473.
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SummaryDuplex ultrasound is the first-line diagnostic test for detecting lower limb deep-vein thrombosis (DVT) but it is time consuming, requires patient transport, and cannot be interpreted by most physicians. The accuracy of emergency physician–performed ultrasound (EPPU) for the diagnosis of DVT, when performed at the bedside, is unclear. We did a systematic review and meta-analysis of the literature, aiming to provide reliable data on the accuracy of EPPU in the diagnosis of DVT. The MEDLINE and EMBASE databases (up to August 2012) were systematically searched for studies evaluating the accuracy of EPPU compared to either colour-flow duplex ultrasound performed by a radiology department or vascular laboratory, or to angiography, in the diagnosis of DVT. Weighted mean sensitivity and specificity and associated 95% confidence intervals (CIs) were calculated using a bivariate random-effects regression approach. There were 16 studies included, with 2,379 patients. The pooled prevalence of DVT was 23.1% (498 in 2,379 patients), ranging from 7.4% to 47.3%. Using the bivariate approach, the weighted mean sensitivity of EPPU compared to the reference imaging test was 96.1% (95%CI 90.6–98.5%), and with a weighted mean specificity of 96.8% (95%CI:94.6–98.1%). Our findings suggest that EPPU may be useful in the management of patients with suspected DVT. Future prospective studies are warranted to confirm these findings.
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Newmark, Jordan L. "Radiocontrast Media Allergic Reactions and Interventional Pain Practice—A Review." Pain Physician 5;15, no. 5;9 (September 14, 2012): E665—E675. http://dx.doi.org/10.36076/ppj.2012/15/e665.
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Background: Millions of interventional pain procedures are performed each year in the United States. Interventional pain physicians commonly administer radiocontrast media (RCM) under fluoroscopy for these procedures. However, RCM can cause various types of hypersensitivity or allergic type reactions, in an acute or delayed fashion. Furthermore, some patients report a prior history of hypersensitivity reactions to RCM when presenting to the interventional pain clinic. Both scenarios present challenges to the interventional pain physician. Objective: To describe the various types of hypersensitivity reactions to RCM, as well as strategies to prevent and manage these reactions, within the context of interventional pain practice. Method: A review of the literature from 1975 through 2011 regarding allergic type reactions to RCM, as well as iodine, and shellfish allergy, was undertaken in an effort to review and develop recommendations on managing these patients presenting to the interventional pain clinic. Keywords used in the literature search were: radiocontrast media, contrast allergy, contrast reaction, iodine allergy, shellfish allergy, and fluoroscopy. The included articles were concerned with the basic or clinical science of contrast allergy, including the physiology, epidemiology, diagnosis, and management of such reactions. Meta-analysis, review articles, and case reports addressing contrast media reactions were also included. Articles which discussed contrast media reactions in a peripheral fashion were excluded. Results: In reviewing the literature, it is apparent that the mechanisms and pathophysiology of RCM hypersensitivity reactions are still being characterized, which should soon lead to improved screenings, as well as prevention and treatment strategies. Many common themes are described throughout the literature regarding patient risk factors, testing, prevention, diagnosis, and treatment of RCM allergic-type reactions. Limitations: The current review did not perform a meta-analysis of the available data, as most of the available articles were trials that were randomly controlled. Therefore, the conclusions of the present article are general, and qualitative in nature. Conclusion: Although the mechanisms of various RCM allergic-type reactions are not entirely understood, the interventional pain physician should have a basic understanding of patient risk factors, prevention, diagnosis, and treatment of these reactions. The current review allowed for prevention and treatment strategies for managing patients with RCM hypersensitivity reactions. Key words: Radiocontrast media, contrast allergy, contrast reaction, iodine allergy, shellfish, allergy, fluoroscopy, interventional spine practice
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Alonazi, Ahmad Sheihan, Almutairi Mohammed Hazzaa M, Almutiri Hazaa Mohssen R, Hashim Hamed Safar Almutairi, Mohammed Dakhel S. Almutari, Sulaiman Awadh Allah A. Almutairy, Muteb Muways M. Almutairi, and Faez Saud N. Almutairi. "The Effect of Increasing the Health Practitioner’s Workload on Patients and Their Safety." Saudi Journal of Nursing and Health Care 5, no. 12 (December 20, 2022): 301–7. http://dx.doi.org/10.36348/sjnhc.2022.v05i12.001.
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The clinical healthcare system has been burdened due to various disease outbreak such as COVID 19 outbreak. Clinical Workloads on healthcare workers and practitioners lead to fatigue and mental exhaustions, causing medical errors. About 98 000 patients globally expires due to preventable medical errors in hospitals due to workload of health practitioners. (Philibert, et al., 2002) The majority of mistakes are made by well-meaning people operating under poor systems, procedures, or circumstances. The healthcare workers and physicians have been facing intense workloads due small workforce, physician working hours and financial pressures on hospitals and healthcare centers. However, very limited research has been conducted on association of workload of healthcare workers and safety of patients. Therefore, we aimed to design the systematic review on evaluation of effect of increasing the health practitioner’s workload on patients and their safety. To fulfill aims of study, we conducted a systematic review & meta-analysis by following “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)” (Selçuk, 2019) guidelines related to title which was “effect of increasing the health practitioner’s workload on patients and their safety”. About 5 databases were used for data search, collection and extraction include PubMed, MEDLINE, EMBSE, Cochrane library, and PsycInfo, on 2 November, 2022. To search data, we used MeSH keywords of “effect of workload on health practitioners”, “Healthcare workers workload” “its effects on patients’ safety, effect of workload on medical errors” “Mental stress among workers” and “patient safety” among all databases. Only those research articles were extracted that have been published during March 2020 to October 2022, keeping the COVID 19 pandemic in context. There were five qualitative studies that evaluated the value of psychological treatment for mental illness. Stress resulting from worries about infecting close relatives and anxiety and fear of getting infection worries about the health professionals were two interwoven elements in all five investigations. Our findings could be explained by an increase in resident physician workload that followed programmers’ elimination of 24-hour shifts. There is evidence to suggest that patient safety may suffer when healthcare workers and doctors care for more than more patients each day.
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Bright, Dellyse, Katherine O’Hare, Rebecca Beesley, and Hazel Tapp. "Tipping the scales: Provider perspectives on a multi-disciplinary approach to obesity." Experimental Biology and Medicine 244, no. 2 (January 19, 2019): 183–92. http://dx.doi.org/10.1177/1535370219825639.
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Obesity is a costly and complex health issue that precipitates and/or complicates many medical conditions. Clinical recommendations include a comprehensive approach to weight loss with a combination of diet, physical activity, behavioral interventions, pharmacotherapy or surgery to achieve weight loss. Care in the primary care setting is integral in obesity management. Outside of their clinical role, primary care physicians serve as role models, educators, and promoters of healthy lifestyle practices and leaders in obesity treatment. Physician recommendations have consistently been shown to exert a powerful influence on patient behavior, but there is a substantial gap between patients who would benefit from obesity care and those receiving it. Providers, especially primary care, cite many obstacles to addressing obesity including lack of time, expertise, and resources. This review focuses on describing the feasibility and evidence for tackling obesity through provider-led multidisciplinary weight management programs. A literature search was conducted in Med Line and PubMed for published articles on multidisciplinary weight management programs that included lifestyle modification (diet and exercise), behavioral modification and a physician (MD/DO) with one or more of the following multidisciplinary team members: nutritionist/registered dietician (RD), behavioral health provider (BH), case manager (CM), pharmacist (Pharm), nursing (RN), and research staff. Relevant articles from bibliographies of systematic reviews/meta-analyses were included as well. Ten studies qualified, and we organized the articles to discuss the following three themes: diet and exercise, behavioral therapies and barriers, and facilitators for clinical weight management programs. The studies in this mini-review of multidisciplinary weight programs that included physicians reiterate the guidelines for successful treatment of obesity, with more research needed to fully understand how primary care providers can assist higher risk patient populations, particularly those of lower socioeconomic status who are disproportionally impacted by obesity. Impact statement Obesity is a major multi-faceted, chronic disease that increases the risk of morbidity and mortality of children and adults particularly impacting high-risk populations and those of lower socioeconomic status. Given provider time constraints, models of care to effectively and efficiently address obesity in primary care are key. Although physician recommendations can exert a powerful influence on behavior, providers often feel powerless to adequately address obesity due to the complexity of physical and behavioral health problems. This mini-review focuses on describing the feasibility and evidence for tackling obesity through provider-led multidisciplinary weight management programs.
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Mitchell, Alex J., Nicholas Meader, and Michael Pentzek. "Clinical recognition of dementia and cognitive impairment in primary care: a meta-analysis of physician accuracy." Acta Psychiatrica Scandinavica 124, no. 3 (June 11, 2011): 165–83. http://dx.doi.org/10.1111/j.1600-0447.2011.01730.x.
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Lee, Sun Hwa, and Seong Jong Yun. "Diagnostic performance of emergency physician-performed point-of-care ultrasonography for acute appendicitis: A meta-analysis." American Journal of Emergency Medicine 37, no. 4 (April 2019): 696–705. http://dx.doi.org/10.1016/j.ajem.2018.07.025.
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Desthieux, Carole, Aurore Hermet, Benjamin Granger, Bruno Fautrel, and Laure Gossec. "Patient-Physician Discordance in Global Assessment in Rheumatoid Arthritis: A Systematic Literature Review With Meta-Analysis." Arthritis Care & Research 68, no. 12 (October 28, 2016): 1767–73. http://dx.doi.org/10.1002/acr.22902.
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Gunderson, Craig G., Victor P. Bilan, Jurgen L. Holleck, Phillip Nickerson, Benjamin M. Cherry, Philip Chui, Lori A. Bastian, Alyssa A. Grimshaw, and Benjamin A. Rodwin. "Prevalence of harmful diagnostic errors in hospitalised adults: a systematic review and meta-analysis." BMJ Quality & Safety 29, no. 12 (April 8, 2020): 1008–18. http://dx.doi.org/10.1136/bmjqs-2019-010822.
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BackgroundDiagnostic error is commonly defined as a missed, delayed or wrong diagnosis and has been described as among the most important patient safety hazards. Diagnostic errors also account for the largest category of medical malpractice high severity claims and total payouts. Despite a large literature on the incidence of inpatient adverse events, no systematic review has attempted to estimate the prevalence and nature of harmful diagnostic errors in hospitalised patients.MethodsA systematic literature search was conducted using Medline, Embase, Web of Science and the Cochrane library from database inception through 9 July 2019. We included all studies of hospitalised adult patients that used physician review of case series of admissions and reported the frequency of diagnostic adverse events. Two reviewers independently screened studies for inclusion, extracted study characteristics and assessed risk of bias. Harmful diagnostic error rates were pooled using random-effects meta-analysis.ResultsTwenty-two studies including 80 026 patients and 760 harmful diagnostic errors from consecutive or randomly selected cohorts were pooled. The pooled rate was 0.7% (95% CI 0.5% to 1.1%). Of the 136 diagnostic errors that were described in detail, a wide range of diseases were missed, the most common being malignancy (n=15, 11%) and pulmonary embolism (n=13, 9.6%). In the USA, these estimates correspond to approximately 249 900 harmful diagnostic errors yearly.ConclusionBased on physician review, at least 0.7% of adult admissions involve a harmful diagnostic error. A wide range of diseases are missed, including many common diseases. Fourteen diagnoses account for more than half of all diagnostic errors. The finding that a wide range of common diagnoses are missed implies that efforts to improve diagnosis must target the basic processes of diagnosis, including both cognitive and system-related factors.PROSPERO registration numberCRD42018115186.