Articles de revues sur le sujet « Physicians – anecdotes »
Pour voir les autres types de publications sur ce sujet consultez le lien suivant : Physicians – anecdotes.
Créez une référence correcte selon les styles APA, MLA, Chicago, Harvard et plusieurs autres
Consultez les 50 meilleurs articles de revues pour votre recherche sur le sujet « Physicians – anecdotes ».
À côté de chaque source dans la liste de références il y a un bouton « Ajouter à la bibliographie ». Cliquez sur ce bouton, et nous générerons automatiquement la référence bibliographique pour la source choisie selon votre style de citation préféré : APA, MLA, Harvard, Vancouver, Chicago, etc.
Vous pouvez aussi télécharger le texte intégral de la publication scolaire au format pdf et consulter son résumé en ligne lorsque ces informations sont inclues dans les métadonnées.
Parcourez les articles de revues sur diverses disciplines et organisez correctement votre bibliographie.
1
Furrow, Barry R. « Broadcasting Clinical Guidelines on the Internet : Will Physicians Tune In ? » American Journal of Law & ; Medicine 25, no 2-3 (1999) : 403–21. http://dx.doi.org/10.1017/s0098858800010960.
Texte intégralRésumé :
Modern American medicine is far from ideal. Physicians practice by rules learned in medical school, rules often based on anecdotes or untested hypotheses. Medical opinion leaders shape practice by their own experience even though anecdotes are no substitute for clinical studies. Pressures to diagnose and treat come from pharmaceutical companies, equipment manufacturers, hospitals and managed care organizations (MCOs). The end result is often too much medicine or too little, but rarely the appropriate amount. Patients can end up suffering iatrogenic effects of infections picked up during hospital stays, complications from surgery or drug side effects or “cascade effects” that occur when several interventions fail in succession.
2
Sharma, Om P. « Medicine in Dr Samuel Johnson's Dictionary of the English Language ». Journal of Medical Biography 19, no 4 (novembre 2011) : 171–76. http://dx.doi.org/10.1258/jmb.2011.011014.
Texte intégralRésumé :
When compiling the Dictionary of the English Language, Johnson read and annotated over two hundred thousand passages from innumerable English authors of various disciplines across four centuries. Most of the literary anecdotes came from Shakespeare, Milton, Dryden and Pope. The medical and scientific anecdotes came from 31 scientists, physicians, pharmacologists and surgeons. This reflects Johnson's admiration for science and its benefit to the public. He told Boswell, ‘Why Sir, if you have but one book with you upon a journey let it be a book of science. When you read through a book of entertainment, you know it, and it can do no more for you, but a book of science is inexhaustible’.
3
Brantley, Meredith, et Cheryl Niekamp. « Workshops that Work : Physician Involvement in Service Training ». Journal of Patient Experience 1, no 2 (novembre 2014) : 28–31. http://dx.doi.org/10.1177/237437431400100206.
Texte intégralRésumé :
Physician involvement in service training initiatives can have a significant impact on the patient experience. This paper highlights some of the key components of what makes physician involvement in training engagements successful and includes anecdotes and data to support the findings. Our service training program emerged from a desire to help clinic sections improve the patient experience. Our workshops contained customized materials that addressed service priority areas, as identified by patient satisfaction survey results, for individual clinic sections and included opportunities to practice the concepts introduced in each session. However, we were missing one key ingredient in the recipe for a successful training program — physician involvement. This paper focuses on a best practice in which two physicians took an active role in creating, customizing and delivering service training for their clinic section and made a tremendous impact on their overall patient satisfaction scores and section morale.
4
Rasouli, Melody A., Alyssa D. Brown, Alexander Zoroufy, Morgan S. Levy, Vineet Arora, Arghavan Salles, Tiffany J. Sinclair et Torie C. Plowden. « PUTTING NUMBERS BEHIND THE ANECDOTES : INFERTILITY AND PREGNANCY COMPLICATIONS AMONG PHYSICIANS AND MEDICAL STUDENTS ». Fertility and Sterility 120, no 4 (octobre 2023) : e127. http://dx.doi.org/10.1016/j.fertnstert.2023.08.397.
Texte intégral
5
Ching, Leslie M., Ashley Watson, Tyler Watson et Philip Ridgway. « The Osteopathic Approach During the 1918 Influenza Pandemic, Featuring Newly Analyzed Case Reports ». AAO Journal 31, no 2 (1 juin 2021) : 9–16. http://dx.doi.org/10.53702/2375-5717-31.2.9.
Texte intégralRésumé :
Abstract Osteopathic physicians played a pivotal role in treating patients suffering from the H1N1 influenza A virus of the 1918 Influenza Pandemic. This article focuses on case reports and questionnaire answers from the Journal of the American Osteopathic Association (JAOA), now the Journal of Osteopathic Medicine (JOM), and Osteopathic Physician concerning the modalities, techniques, and efficacy of osteopathic treatments of the 1918 pandemic. There are 19,565 patients who are represented in this analysis. The results are compared to the often-cited 110,120 patient cases reported by the JOM in 1920. Several different approaches, including lymphatic and visceral techniques, were widely used at the time, and their historic incorporation into patient treatment is explored. There is a discussion of the geographic location and characteristics of the practices. Statistical breakdown of mortality rate, the most commonly used approaches, somatic dysfunctions commonly treated, physician anecdotes, and other common remedies used by osteopathic physicians, are noted additionally. A comparison is done of the literature regarding the osteopathic approach for COVID-19. The newly analyzed case reports in this article demonstrate a similar mortality rate as in the 1920 JAOA article and illustrate the geographical distribution, treatment approaches, and personal stories of osteopaths during the pandemic.
6
Murthy, Vivek K., et Scott M. Wright. « Osler Centenary Papers : Would Sir William Osler be a role model for medical trainees and physicians today ? » Postgraduate Medical Journal 95, no 1130 (21 novembre 2019) : 664–68. http://dx.doi.org/10.1136/postgradmedj-2019-136646.
Texte intégralRésumé :
If Sir William Osler were alive and practising as one of our contemporary colleagues, would he be viewed as a role model by medical trainees and other physicians? Recently published literature has sought to define clinical excellence; this characterisation of physician performance establishes a context in which role models in medicine can be appraised. Building on this framework, we present rich anecdotes and quotes from Sir William Osler himself, his colleagues, and his students to consider whether Osler would have been regarded as a role model for clinical excellence today. This paper illustrates convincingly that William Osler indeed personified clinical excellence and would have been appreciated as a consummate role model if he were alive and on a medical school’s faculty today. However, a century has passed since his death, and he is not sufficiently visible today to serve as a role model to modern medical trainees and physicians. Moreover, we speculate that Osler himself would not have wanted to be a role model for today’s trainees, as he emphasised that medicine is best learned from teachers at the bedside—a place where he cannot be. Reanimating Osler through rich stories and inspiring quotes, and translating his example of clinical excellence into modern clinical practice, can remind us all to carry Oslerian virtues with us in our professional work.
7
Wright, Scott. « 10 Osler as a role model for today ». Postgraduate Medical Journal 95, no 1130 (21 novembre 2019) : 688.1–688. http://dx.doi.org/10.1136/postgradmedj-2019-fpm.10.
Texte intégralRésumé :
If Sir William Osler were alive and practicing as one of our contemporary colleagues, would he be viewed as a role model by medical trainees and other physicians? Recently published literature has sought to define clinical excellence; this characterization of physician performance establishes a context upon which role models in medicine can be appraised. Building on this framework, we present rich anecdotes and quotes from Sir William Osler himself, his colleagues, and his students to consider whether Osler would have been regarded as a role model for clinical excellence today.This manuscript illustrates convincingly that William Osler indeed personified clinical excellence and would have been appreciated as a consummate role model if he were alive and on a medical school’s faculty today. However, a century has passed since his death, and he is not sufficiently visible today to serve as a role model to modern medical trainees and physicians. Moreover, we speculate that Osler himself would not want to be a role model for today’s trainees, as he emphasized that medicine is best learned from teachers at the bedside – a place where he cannot be. Reanimating Osler through rich stories and inspiring quotes, and translating his example of clinical excellence into modern clinical practice, can remind us all to carry Oslerian virtues with us in our professional work.
8
VIGLIANI, MARGUERITE B., et ANNA I. BAKARDJIEV. « INTRACELLULAR ORGANISMS AS PLACENTAL INVADERS ». Fetal and Maternal Medicine Review 25, no 3-4 (novembre 2014) : 332–38. http://dx.doi.org/10.1017/s0965539515000066.
Texte intégralRésumé :
In an era of evidence-based medicine, physicians sometimes forget the value of anecdotes in stimulating thought about clinical problems. Our recent report on typhoid fever in a pregnant woman at 12 weeks of gestation is a good example. In spite of culture-proven diagnosis and appropriate treatment of the mother with antibiotics, fetal loss occurred at 16 weeks of gestation. Salmonella typhi was found in the fetal lung on autopsy, consistent with vertical transmission of the organism. None of the clinicians caring for the patient had imagined that gram-negative bacteria could cross the placenta and kill the fetus in spite of early diagnosis and treatment with appropriate antibiotics.
9
Chow, Candace, Carrie L. Byington, Lenora M. Olson, Karl Ramirez, Shiya Zeng et Ana Maria Lopez. « 2175 ». Journal of Clinical and Translational Science 1, S1 (septembre 2017) : 45. http://dx.doi.org/10.1017/cts.2017.164.
Texte intégralRésumé :
OBJECTIVES/SPECIFIC AIMS: Knowing how to deliver culturally responsive care is of increasing importance as the nation’s patient population diversifies. However, unless cultural competence is taught with an emphasis on self-awareness (Wear, 2007) and critical consciousness (Kumagai and Lypson, 2009) learners find this education ineffective (Beagan, 2003). This study examines how physicians perceive their own social identities (eg, race, socio-economic status, gender, sexual orientation, religion, years of experience) and how these self-perceptions influence physician’s understandings of how to practice culturally responsive care. METHODS/STUDY POPULATION: This exploratory study took place at a university in the Intermountain West. We employed a qualitative case study method to investigate how academic physicians think about their identities and approaches to clinical care and research through interviews and observations. In total, 25 participants were enrolled in our study, with efforts to recruit a diverse sample with respect to gender and race as well as years of experience and specialty. Transcriptions of interviews and observations were coded using grounded theory. One major code that emerged was defining experiences: instances where physicians reflected on both personal and professional life encounters that have influenced how they think about themselves, how they understand an aspect of their identity, or why this identity matters. RESULTS/ANTICIPATED RESULTS: Two main themes emerged from an analysis of the codes that show how physicians think about their identities and their approaches to practice. (1) Physicians with nondominant identities (women, non-White) could more easily explain what these identities mean to them than those with dominant identities (men, White). For example, women in medicine had much to say about being a woman in medicine, but men had barely anything to say about being a man in medicine. (2) There was a positive trend between the number of defining experiences a physician encountered in life and the number of connections they made between their identities and the manner in which they practiced, both clinically and academically. It appeared that physicians who have few defining experiences made few connections between identity and practice, those with a moderate number of experiences made a moderate number of connections, and those with many experiences made many connections. Physicians who mentioned having many defining experiences were more likely to be able to articulate how those experiences were incorporated into their approaches to patient care. DISCUSSION/SIGNIFICANCE OF IMPACT: (1) According to literature in multicultural education, those with dominant identities do not think about their identities because they do not have to (Johnson, 2001). One privilege of being part of the majority is not having to think about life from a minority perspective. This helps to explain why women and non-White physicians in this study had more anecdotes to share about these identities—because they have had defining experiences that prompt reflection on these identities. (2) We propose that struggles and conflict are what compel physicians to reflect on their practice (Eva et al., 2012). Our findings suggest that physicians are more prepared to apply what they have learned from their own identity struggles in delivering culturally responsive care when they have had more opportunities to reflect on these identities and situations. Findings from this study have implications for transforming approaches to medical education. We suggest that medical education should provide learners with the opportunity to reflect on their life experience, and that providers may need explicit instruction on how to make connections between their experiences and their practice.
10
Gussner, Anna, Matthew Rohde, Danika Baskar, Theodore Ganley et Kevin Shea. « Evaluating Pediatric ACL Injury-Related Content Across Various Social Media Platforms ». Journal of the Pediatric Orthopaedic Society of North America 4, no 1 (28 janvier 2022) : 1–6. http://dx.doi.org/10.55275/jposna-2022-0008.
Texte intégralRésumé :
Background: Anterior Cruciate Ligament (ACL) tears are common in young athletes who rely on social media as a primary source of information. Evaluation of the information being shared across social media sites about pediatric ACL injuries has yet to be investigated. The purpose of this study was to investigate the content related to pediatric ACL tears across various social media platforms including Facebook, Instagram, YouTube, and TikTok. Methods: The search terms “pediatric ACL,” “pediatric ACL tear,” and “ACL recovery” were used to identify relevant groups and postings. Each of these search terms was entered into each platform to find content with the highest number of followers, views, and/or posts. This content was then analyzed and categorized based on common themes of focus. Results: Across four identified Facebook groups, there were over 13,000 members collectively with 950 posts shared from May 12, 2021, to June 12, 2021. Posts were shared by caregivers of adolescents searching for a community of support from those who have undergone similar injuries and treatments. Related Instagram hashtags revealed 1.5 million posts centered mainly on athletes returning to play after sustaining ACL injuries. The top two Instagram pages together had more than 42,600 followers focused on successful recovery anecdotes. The top five YouTube videos total 523,000 views and share educational content, surgical techniques, and patient stories. The top four TikTok hashtags have over 64 million total views with videos about personal experiences before and after ACL surgery. Conclusion: Our findings revealed widespread sharing of anecdotal experiences after ACL injury. The advice shared may be valuable from a community support perspective. The relatively limited physician presence and monitoring of these social media sites may compromise the quality of medical information. Providers caring for pediatric athletes may benefit from increased knowledge about social media resources widely used by young athletes. Physicians may consider novel approaches to monitoring these sites and offering higher-quality information to patients and families to support better decision-making.
11
Wasserman, Richard C., Bruce M. Hassuk, Paul C. Young et Marshall L. Land. « Health Care of Physicians' Children ». Pediatrics 83, no 3 (1 mars 1989) : 319–22. http://dx.doi.org/10.1542/peds.83.3.319.
Texte intégralRésumé :
In anecdotal reports, problems have been cited in the health care of physicians' children, but no systematic study of this issue has been attempted. Pediatricians in a community of high physician density were interviewed to determine whether and how the health care of physicians' children differs from that of children of equivalent socioeconomic status. Of the community's 33 pediatricians, 94% responded to items in a 45-minute structured interview, for which test-retest reliability was demonstrated. Systematic differences in the care of physicians' children included delayed help seeking and increased self-referral to specialists by parents, and poor documentation of psychosocial history, less detailed instruction giving, and a reluctance to discuss problem behavior by pediatricians. Reasons cited by pediatricians for these problems included inappropriate assumptions concerning the medical knowledge of the physician's family, confusion between the roles of healer and help seeker, and embarrassment about discussing personal issues with colleagues. Pediatricians and physician parents need to become aware of and communicate about the potential for problems in the health care of physicians' children.
12
Bayless, Theodore M. « Gut-Brain Interactions in Inflammatory Bowel Disease : A Clinician’s Perspective ». Canadian Journal of Gastroenterology 9, no 5 (1995) : 273–76. http://dx.doi.org/10.1155/1995/956818.
Texte intégralRésumé :
While most physicians and some patients consider psychosocial factors important in aggravating already existing inflammatory bowel disease (IBD), most of the information is based on a few recent scientific studies, varied anecdotal observations and a tendency for patients and some physicians to view psychosocial and stress-related issues with speculation, bias and some stigmatization. Patients with proctitis who have experienced recrudescence of mucosal friability and rectal bleeding within a day of a severe life stress provide a dramatic example of such anecdotes. Time-lag studies have indicated that stress, especially major life events, precedes illness aggravation in patients with IBD but that stress is not disease-specific. The symptoms studied, pain and diarrhea, were more likely to be physiological responses to acute stress rather than reflections of increased disease activity. Current scientific research supposes the prospect that environmental factors influence disease susceptibility through the central nervous system. Stress is associated with alterations in both humoral and cellular immune mechanisms in humans and in experimental animals. While psychosocial factors may not initiate inflammation in IBD, it is possible that they lead to alterations in the immune response and thereby alter disease activity. Mind-gut interactions affect salivation, gastric secretion, gastric motility and colonic motility, as well as numerous other gastrointestinal functions. These ‘physiological’ responses are expected in the IBD patient and perhaps will be accentuated by inflammation and its multiple effects on gut function. Because 10 to 13% of the general population have a tendency to suffer from irritable bowel syndrome (IBS), it is expected that the same percentage of IBD patients will have both IBD and IBS. An example of clinically relevant alterations in pathophysiology is the association of acute proctosigmoiditis with an increase in IBS symptoms in the left colon. Pain and diarrhea based on distension of an irritable left colon after ileocolonic resection result from excessive distension of the left colon by the larger stool volume following loss of absorptive surface of the ileum and right colon. Patients with IBS are also more symptomatic with small amounts of unabsorbed carbohydrates, such as fructose, sorbitol and lactose. Patients with severe IBS have an irritable small bowel, especially when it is formed into a closed reservoir, such as an ileoanal pouch; these patients have at least eight to 10 bowel movements per day because of the spasticity and small capacity of the ileoanal pouch. The stomach to pouch transit time may also be quite rapid. Explaining the coexistence of IBD and IBS to the patient is often quite helpful to the patient and to the doctor. One hopes that the scientific explanations of these mind-gut interactions are forthcoming.
13
McLeod, Hugh. « Popular Catholicism in Irish New York, c1900 ». Studies in Church History 25 (1989) : 353–73. http://dx.doi.org/10.1017/s0424208400008779.
Texte intégralRésumé :
In 1905 was published one of the most interesting books ever written about New York. It was a study by Elsa Herzfeld of twenty-four working-class families living on Manhattan’s West Side. All too briefly, yet with many tantalizing quotations and anecdotes, she discussed a whole series of themes that most previous students of New York life had taken for granted, or perhaps regarded as too trivial to be worth recording: the pictures people had on their walls, the music they liked, relations between spouses and between parents and children, beliefs about good and bad luck, funeral customs, and attitudes to physicians and hospitals. The families all included at least two generations, the older of which was predominantly European born. Most were of Irish or German descent. The purpose of the volume was to identify the distinguishing characteristics of what it termed Tenement-House Man’. There is thus a tendency to stress what is common to the families studied, and to suggest a shared pattern of life. Time and time again, though, there are hints that religion was a differentiating factor within this allegedly homogeneous culture. In particular there are frequent references to Catholics as in some sense a group apart—a very large group apart, as they made up about 40 per cent of the city’s population at that time.
14
Halasy, Michael P. « Anecdotes, Decisions, and Physician Assistant Education ». Journal of Physician Assistant Education 30, no 2 (juin 2019) : 77. http://dx.doi.org/10.1097/jpa.0000000000000249.
Texte intégral
15
Davignon, Phil, Aaron Young et David Johnson. « Medical Board Complaints against Physicians Due to Communication : Analysis of North Carolina Medical Board Data, 2002–2012 ». Journal of Medical Regulation 100, no 2 (1 juin 2014) : 28–31. http://dx.doi.org/10.30770/2572-1852-100.2.28.
Texte intégralRésumé :
ABSTRACT Anecdotal evidence suggests that communication issues are one of the primary reasons for physician complaints, but quantitative studies have yet to examine this assertion. The North Carolina Medical Board's Complaint Department maintains data on physician complaints and categorizes each complaint based on its primary cause. Using data from 2002–2012, our research focused on complaints against physicians licensed by the North Carolina board to determine the extent to which communication issues contribute to complaints against physicians. An analysis of this data reveals that physician complaints based on communication issues are consistently the most prevalent reason for complaints against physicians in the state of North Carolina. In addition, communication-based complaints account for more than one in five complaints made against North Carolina physicians. These results are discussed in light of their implications for the field of medicine as it seeks to improve patient care.
16
Mulindwa, Frank, Irene Andia, Kevin McLaughlin, Pritch Kabata, Joseph Baluku, Robert Kalyesubula, Majid Kagimu et Ponsiano Ocama. « A quality improvement project assessing a new mode of lecture delivery to improve postgraduate clinical exposure time in the Department of Internal Medicine, Makerere University, Uganda ». BMJ Open Quality 11, no 2 (mai 2022) : e001101. http://dx.doi.org/10.1136/bmjoq-2020-001101.
Texte intégralRésumé :
BackgroundThe Masters in Internal Medicine at the Makerere University College of Health Sciences is based on a semester system with a blend of lectures and clinical work. The programme runs for 3 years with didactic lectures set mostly for mornings and clinical care thereafter. Anecdotal reports from attending physicians in the department highlighted clinical work time interruption by didactic lectures which was thought to limit postgraduate (PG) students’ clinical work time. We set out to evaluate the clinical learning environment and explore avenues to optimise clinical exposure time.MethodsBaseline data in form of time logs documenting first-year PG activities was collected by intern doctors without the awareness of the PGs. In addition, a PG and attending physician survey on PG ward performance was carried out. These data informed a root cause analysis from which an intervention to change the mode of lecture delivery from daily lecturers across the semester to a set of block lectures was undertaken. Postimplementation time logs and survey data were compared with the pre-intervention data.ResultsPost-intervention, during a period of 50 ward round observations, PGs missed 3/50 (6%) ward rounds as compared with 10/50 (20%) pre-intervention. PGs arrived on wards before attending physicians 18/24 (75%) times post-intervention and on average had 59 min to prepare for ward rounds as compared with 5/26 (19.2%) times and 30 min, respectively, pre-intervention. Both PGs and physicians believed PGs had enough time for patient care post-intervention (17/17 (100%) vs 4/17 (23.5%) and 7/8 (87.5%) vs 2/8 (25%)), respectively.ConclusionThe baseline data collected confirmed the anecdotal reports and a change to a block week lecture system led to improvements in PGs’ clinical work time and both resident and physician approvals of PG clinical work.
17
SHAPIRO, ROBYN S., KRISTEN A. TYM, JEFFREY L. GUDMUNDSON, ARTHUR R. DERSE et JOHN P. KLEIN. « Managed Care : Effects on the Physician-Patient Relationship ». Cambridge Quarterly of Healthcare Ethics 9, no 1 (janvier 2000) : 71–81. http://dx.doi.org/10.1017/s0963180100901075.
Texte intégralRésumé :
Over the past several years, healthcare has been profoundly altered by the growth of managed care. Because managed care integrates the financing and delivery of healthcare services, it dramatically alters the roles and relationships among providers, payers, and patients. While analysis of this change has focused on whether and how managed care can control costs, an increasingly important concern among healthcare providers and recipients is the impact of managed care on the physician–patient relationship. The literature includes a number of theoretical articles and anecdotal accounts of managed care's impact on the doctor–patient relationship, but little data have been collected and analyzed. We designed a survey for distribution to Wisconsin physicians to analyze the prevalence and types of managed care arrangements in the state, and the impact of these arrangements on physicians and their relationships with patients.
18
Tran, Anna, Kerstin De Wit et Darshana Seeburruth. « Physician and Patient Beliefs and Preferences in Pulmonary Embolism and Deep Vein Thrombosis Testing in People with Cancer ». Blood 138, Supplement 1 (5 novembre 2021) : 4265. http://dx.doi.org/10.1182/blood-2021-153688.
Texte intégralRésumé :
Abstract Introduction It is unclear whether evidence-based diagnostic protocols are followed when cancer patients are tested for venous thromboembolism (VTE). Evidence-based protocols reduce unnecessary diagnostic imaging, offer a patient-centered approach, and have the potential to standardize practice across medical specialties and settings. However, anecdote suggests that specialists who test people with cancer for VTE may prefer diagnostic imaging over clinical probability scoring and D-dimer testing. The aim of this study was to identify physician and patient knowledge, beliefs, values and preferences for VTE testing in cancer. This study was part of a program of research to set International Society of Thrombosis and Haemostasis standards for VTE testing in people with cancer. Methods This was an international qualitative interview study following COREQ guidelines. Semi-structured interviews with physicians and cancer patients were conducted via Zoom. We used purposive sampling to ensure inclusion of physicians from all specialties who test people with cancer for VTE, practicing across all continents. We invited people treated for cancer who had and did not have experience of VTE testing. We used grounded theory to create a conceptual framework which explains physician and patient values and preferences for VTE testing. Transcripts were coded by three researchers independently, who met to discuss their findings and agree on common codes. Researchers were a Thrombosis physician and two undergraduate students who ensured reflexivity was incorporated into their analysis. Results A total of 32 physicians and 6 cancer patients were invited to interview. Of those invited, 23 physicians and 6 patients across 6 continents completed an interview. Interviews lasted between 21 and 86 minutes. Our derived conceptual model can be seen in the attached Figure. Physicians reported a low threshold to test for VTE in people with cancer compared to those without cancer, because VTE was considered a fatal disease and highly prevalent in this patient population. Imaging was generally the only test used for VTE testing in cancer patients. Many participants relied on their Gestalt estimation of VTE probability when deciding whether to order imaging for pulmonary embolism or deep vein thrombosis. Most thought that low Wells score in combination with a negative D-dimer was not sufficiently sensitive to exclude VTE and anticipated the Wells score and D-dimer to be elevated. The Wells scores had poor face validity because they do not include cancer-specific variables and participants hoped to see a more nuanced formal score for VTE testing in cancer patients. Participants believed that their colleagues would support their diagnostic approach. Patients reported they were used to having tests and CT scans. Patients felt it was important for their physicians to prioritize testing for VTE. Patients had full trust and confidence in their physicians' testing decisions, particularly in decisions made by their oncologists. Conclusion Physicians have a low threshold to test people with cancer for VTE and tend not to use clinical probability assessment and D-dimer. Patients are comfortable having diagnostic imaging, feel VTE testing is important and have full trust in their physicians. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.
19
Cronrath, Corey. « The Power of Hard Work, Opportunity, and Time : A Physician’s Personal Leadership Journey ». Physician Leadership Journal 11, no 1 (janvier 2024) : 19–22. http://dx.doi.org/10.55834/plj.6002711894.
Texte intégralRésumé :
The author shares his personal leadership journey as a physician, highlighting the importance of hard work, embracing opportunities, and the role of randomness in shaping our lives. Through personal anecdotes, he hopes to inspire others to believe in their potential and embrace the unpredictable nature of life’s path.
20
Akbar, Fatema, Gloria Mark, Stephanie Prausnitz, E. Margaret Warton, Jeffrey A. East, Mark F. Moeller, Mary E. Reed et Tracy A. Lieu. « Physician Stress During Electronic Health Record Inbox Work : In Situ Measurement With Wearable Sensors ». JMIR Medical Informatics 9, no 4 (28 avril 2021) : e24014. http://dx.doi.org/10.2196/24014.
Texte intégralRésumé :
Background Increased work through electronic health record (EHR) messaging is frequently cited as a factor of physician burnout. However, studies to date have relied on anecdotal or self-reported measures, which limit the ability to match EHR use patterns with continuous stress patterns throughout the day. Objective The aim of this study is to collect EHR use and physiologic stress data through unobtrusive means that provide objective and continuous measures, cluster distinct patterns of EHR inbox work, identify physicians’ daily physiologic stress patterns, and evaluate the association between EHR inbox work patterns and physician physiologic stress. Methods Physicians were recruited from 5 medical centers. Participants (N=47) were given wrist-worn devices (Garmin Vivosmart 3) with heart rate sensors to wear for 7 days. The devices measured physiological stress throughout the day based on heart rate variability (HRV). Perceived stress was also measured with self-reports through experience sampling and a one-time survey. From the EHR system logs, the time attributed to different activities was quantified. By using a clustering algorithm, distinct inbox work patterns were identified and their associated stress measures were compared. The effects of EHR use on physician stress were examined using a generalized linear mixed effects model. Results Physicians spent an average of 1.08 hours doing EHR inbox work out of an average total EHR time of 3.5 hours. Patient messages accounted for most of the inbox work time (mean 37%, SD 11%). A total of 3 patterns of inbox work emerged: inbox work mostly outside work hours, inbox work mostly during work hours, and inbox work extending after hours that were mostly contiguous to work hours. Across these 3 groups, physiologic stress patterns showed 3 periods in which stress increased: in the first hour of work, early in the afternoon, and in the evening. Physicians in group 1 had the longest average stress duration during work hours (80 out of 243 min of valid HRV data; P=.02), as measured by physiological sensors. Inbox work duration, the rate of EHR window switching (moving from one screen to another), the proportion of inbox work done outside of work hours, inbox work batching, and the day of the week were each independently associated with daily stress duration (marginal R2=15%). Individual-level random effects were significant and explained most of the variation in stress (conditional R2=98%). Conclusions This study is among the first to demonstrate associations between electronic inbox work and physiological stress. We identified 3 potentially modifiable factors associated with stress: EHR window switching, inbox work duration, and inbox work outside work hours. Organizations seeking to reduce physician stress may consider system-based changes to reduce EHR window switching or inbox work duration or the incorporation of inbox management time into work hours.
21
Fafat, Vijay. « Once Upon A Party - An Anecdotal Investigation ». Journal of Humanistic Mathematics 11, no 1 (janvier 2021) : 485–92. http://dx.doi.org/10.5642/jhummath.202101.30.
Texte intégralRésumé :
Mathematicians and Physicists attending let-your-hair-down parties behave exactly like their own theories. They live by their theorems, they jive by their theorems. Life imitates their craft, and we must simply observe the deep truths hiding in their party-going behavior...
22
C. David, Gary, Donald Chand et Balaji Sankaranarayanan. « Error rates in physician dictation : quality assurance and medical record production ». International Journal of Health Care Quality Assurance 27, no 2 (3 mars 2014) : 99–110. http://dx.doi.org/10.1108/ijhcqa-06-2012-0056.
Texte intégralRésumé :
Purpose – The purpose of the paper is to determine the instance of errors made in physician dictation of medical records. Design/methodology/approach – Purposive sampling method was employed to select medical transcriptionists (MTs) as “experts” to identify the frequency and types of medical errors in dictation files. Seventy-nine MTs examined 2,391 dictation files during one standard work day, and used a common template to record errors. Findings – The results demonstrated that on the average, on the order of 315,000 errors in one million dictations were surfaced. This shows that medical errors occur in dictation, and quality assurance measures are needed in dealing with those errors. Research limitations/implications – There was no potential for inter-coder reliability and confirming the error codes assigned by individual MTs. This study only examined the presence of errors in the dictation-transcription model. Finally, the project was done with the cooperation of MTSOs and transcription industry organizations. Practical implications – Anecdotal evidence points to the belief that records created directly by physicians alone will have fewer errors and thus be more accurate. This research demonstrates this is not necessarily the case when it comes to physician dictation. As a result, the place of quality assurance in the medical record production workflow needs to be carefully considered before implementing a “once-and-done” (i.e. physician-based) model of record creation. Originality/value – No other research has been published on the presence of errors or classification of errors in physician dictation. The paper questions the assumption that direct physician creation of medical records in the absence of secondary QA processes will result in higher quality documentation and fewer medical errors.
23
Wong, Lucas, Kristen Wortman, Lisa J. Go, Paul TIpton, Juhee Song et Takeshi Wajima. « Study on Physician Ordering Behavior on Hypercoaguable Screening Tests ». Blood 116, no 21 (19 novembre 2010) : 4745. http://dx.doi.org/10.1182/blood.v116.21.4745.4745.
Texte intégralRésumé :
Abstract Abstract 4745 Background: We can now identify hereditary and acquired risk factors in patients with a venous thrombotic event. Hereditary factors include factor V Leiden; prothrombin G 20210A mutation; or deficiencies of antithrombin, protein C, or protein S. But considerable uncertainty exists in hypercoagulable testing. Clinical criteria (Bauer, 2002) guidelines are available and laboratory evaluation can confirm the diagnosis. But we know of anecdotal stories where physicians ignored the testing pathways. Even when correctly utilized, testing was inappropriately timed after the thrombotic event. There are many scenarios for thrombosis with no single test to identify these risk factors. We need to re-examine the use of these screening tests for inherited and acquired thrombosis syndromes. Materials and Methods: Retrospectively, 200 patient charts were reviewed on the use of hypercoagulable screening panels, patient characteristics, and physician characteristics. The hypercoaguable screening tests contain prothrombin time, partial thromboplastin time, thrombin time, fibrinogen, antithrombin, plasminogen, activated protein C resistance, protein C, protein S, and lupus anticoagulant. Factor V Leiden and prothrombin G 20210A mutation results were reviewed if available. Data reviewed included age, gender, location of thrombosis (arterial vs. venous), malignancy, connective tissue disorder, diabetes, hypertension, nephrotic syndrome, liver disease, active infections, recent surgery, trauma, anticoagulation medications, obstetric history, family history, hypercoaguable screening test results, physician specialty, training level, and indications for the tests. Results: Patient age range was 18–91; 79 males and 12 females. Among 200 cases, 23 were positive from the hypercoaguable screening tests but only 4 were true positive for hereditary thrombophilia (Factor V Leiden, prothrombin G 20210A, antithrombin deficiency and protein C and S deficiency, respectively). False positive results (low levels of antithrombin, protein C, protein S) were due to coumadin. Ordering physicians were diverse (internal medicine, general medicine, family medicine, hematology/oncology, cardiology, pulmonary, rheumatology, nephrology, neurology, general surgery, vascular surgery, and pediatrics). Reason for ordering tests were varied: family history of thrombosis, recurrent deep vein thrombosis, myocardial infarction, pulmonary embolus, stroke, malignancy, myeloproliferative disorders, connective tissue disorders, inflammatory bowel disease, liver disease, diabetes, nephrotic syndrome, arteriovenous shunt operation, and fetal loss. Few cases fit the clinical criteria. Ordering tests were inconsistent with the indications for hereditary thrombophilia, with no relation to the clinical history, physician training level, or specialty. Discussion and Conclusion: Why these irregularities in behavior exist, we are not sure. From our literature review, there were few papers available on discrepancies in physician reasoning for utilizing laboratory tests. Wertman (1980) identified no single reason for test ordering behavior of physicians. Axt-Adams (1993) suggested that motivators, other than physician education, had a higher correlation of influencing physician ordering behavior when over-utilizing laboratory tests. These motivators included 1) fear of failure to diagnose, 2) fear of criticism, 3) inability to cope with diagnostic uncertainty, 4) eagerness to complete the screening evaluation while in the hospital, 5) desire to be complete in evaluation, 6) hope that additional follow-up testing provides the correct diagnosis, 7) provide reassurance for patient, 8) collective ordering, and 9) ignorance of costs and diagnostic significance of tests and their sensitivity, specificity, and predictability. In many cases, the diagnostic criteria for ordering hypercoagulable screenings were not followed. We did not have the opportunity to interview the ordering physicians about their rationale which may have provided more insight. More education is necessary on hereditary thrombophilia, limitations of coagulation tests, acquired conditions for thrombosis, and the costs of these specialized tests. More studies are necessary to understand physician behaviors in ordering these expensive tests. Disclosures: No relevant conflicts of interest to declare.
24
Allan, Kate E. « 1205. Vaccine Hesitancy in Paediatric Practice and Predictors of Physician-Reported Vaccine Compliance ». Open Forum Infectious Diseases 8, Supplement_1 (1 novembre 2021) : S693. http://dx.doi.org/10.1093/ofid/ofab466.1397.
Texte intégralRésumé :
Abstract Background This study explores the frequency with which Canadian paediatricians encounter vaccine hesitancy in their clinical practice, the most common approaches to parent resistance, impact of hesitancy practice and predictors of physician-reported vaccine compliance. Methods This analysis used data collected from Canadian paediatricians and paediatric subspecialists via a one-time survey distributed by the Canadian Paediatric Surveillance Program in the fall of 2015. Descriptive analyses were conducted to determine the frequency of hesitancy, approaches to parent resistance and impact on clinical practice. A classification tree was generated to determine the most important predictors of physician-reported vaccine compliance. Results A total of 669 paediatricians completed the survey. Eighty-nine percent (n=588) of respondents indicated they had encountered hesitancy in their practice, with the top concerns including: Autism, too many vaccines, risk of a weakened immune system, and vaccine additives. The most common responses to parent resistance included discussing risks of non-vaccination, restating the vaccine recommendation and referring to reliable patient resources. Forty-five percent (n=301) of physicians indicated that hesitancy impacted their practice. Overall, the best predictor of physician-reported vaccine compliance was the use of a personal endorsement or anecdote (x2=6.955,df=1, adj.p< 0.01). Among physicians who did not use a personal endorsement, the next best predictor of vaccine compliance was spending 10 minutes or more discussing vaccination (x2=7.418, df=1,adj.p< 0.05). Conclusion This study contributes to a nascent body of literature related to paediatricians’ experience with vaccine hesitancy in a Canadian context, particularly as it relates to the impact of hesitancy on practice. This study demonstrates the ubiquity of hesitancy in clinical practice, the profound impact of hesitancy on paediatricians and highlights promising responses to parental hesitancy that may improve vaccine compliance. Future research should explore potential hesitancy interventions including using a personal endorsement and prolonged engagement using more rigorous methods of evaluation. Disclosures Kate E. Allan, PhD, Pfizer (Other Financial or Material Support, Postdoctoral Fellowship at the Centre for Vaccine-Preventable Diseases (at University of Toronto) is funded by Pfizer.)
25
Leung, A., Z. Gong, B. Chen et M. Duic. « LO009 : Impact of physician navigators on measures of emergency department efficiency ». CJEM 18, S1 (mai 2016) : S33. http://dx.doi.org/10.1017/cem.2016.46.
Texte intégralRésumé :
Introduction: The Physician Navigator (PN) is a novel position created to manage patient flow in real-time at a very-high volume emergency department (ED). When paired with an emergency physician, PNs actively track patient wait times, and direct the physician to see and re-assess patients in a particular order to improve measures of emergency department efficiency, and maximize patient flow. Anecdotal evidence has shown that PNs decrease length-of-stay times for non-resuscitative patients in the setting of increased patient volumes, and without additional nursing or physician hours. The objective was to study the operational impact of PN on emergency department patient flow. Methods: A 48-month pre-/post-intervention retrospective chart review at an urban community emergency department from September 2011 to September 2015. The PN program started on March 1, 2013. The main outcome is emergency department length-of-stay (LOS). Secondary outcomes include time to physician-initial-assessment (PIA), left-without-being-seen rates (LWBS), left-against-medical-advice (LAMA), and physician satisfaction rates. Autoregressive integrated moving average models were generated for Canadian Triage and Acuity Scale (CTAS) 2 to 5 patients to quantify the immediate impact of the intervention on the outcome levels, and whether the impact was sustained over time. Results: Interim results are provided. 399,958 patients attended the ED during the study period. Daily patient volumes increased 11.2% during the post-intervention period. There were no significant increases in the number of physicians shifts/day, and physician hours/day during the post-intervention period. Post-intervention, for CTAS 2-5 patients, there was a reduction in average LOS by 0.04 hours/PN (p<0.05), and 90th-percentile LOS by 0.14 hours/PN (p<0.05). For secondary outcomes, there was a decrease in overall average PIA by 6.37 minutes/PN (p<0.05), and 90th-percentile PIA by 8.29 minutes/PN (p<0.05). LWBS rates decreased by 40.8% (p<0.05). There were no significant changes in LAMA rates. Conclusion: The implementation of Physician Navigators is associated with significant reductions in LOS, PIA, and LWBS rates for non-resuscitative patients at a very-high volume emergency department.
26
Winchester, David E., Ivette M. Freytes, Magda Schmitzberger, Kimberly Findley et Rebecca J. Beyth. « Physician thoughts on unnecessary noninvasive imaging and decision support software : A qualitative study ». Clinical Ethics 15, no 3 (25 mai 2020) : 141–47. http://dx.doi.org/10.1177/1477750920927166.
Texte intégralRésumé :
Objective Gather information from physicians about factors contributing to unnecessary noninvasive imaging and impact of possible solutions. Methods Qualitative study of 14 physicians using a phenomenological approach and the Theoretical Domains Framework. Results Most participants ( n = 9) self-reported that >10% of the imaging tests they order are unnecessary. External sources of pressure included: peer-review, patient demands, nursing expectations, specialist requests (social demands), as well as prior experience with patient advocates, and the compensation and pension system (environmental context). Internal sources of pressure included reliance on anecdote (emotion), self-doubt about diagnoses (beliefs about capabilities), and fear of missing a diagnosis and of professional liability (beliefs about consequences). Participants expressed both optimism and concern about potential solutions, such as adopting decision support software. Conclusion Physicians are under pressure from multiple sources to order unnecessary imaging. Peer review, nursing expectations, and perceptions about Veteran compensation and pension are newly reported contributing factors.
27
Nathan, Karthik, Maechi Uzosike, Uriel Sanchez, Alexander Karius, Jacinta Leyden, Nicole Segovia, Sara Eppler, Katherine G. Hastings, Robin Kamal et Steven Frick. « Deciding without data : clinical decision-making in pediatric orthopedic surgery ». International Journal for Quality in Health Care 32, no 10 (27 septembre 2020) : 658–62. http://dx.doi.org/10.1093/intqhc/mzaa119.
Texte intégralRésumé :
Abstract Objective Identifying when and how often decisions are made based on high-quality evidence can inform the development of evidence-based treatment plans and care pathways, which have been shown to improve quality of care and patient safety. Evidence to guide decision-making, national guidelines and clinical pathways for many conditions in pediatric orthopedic surgery are limited. This study investigated decision-making rationale and quantified the evidence supporting decisions made by pediatric orthopedic surgeons in an outpatient clinic. Design/Setting/Participants/Intervention(s)/Main Outcome Measure(s) We recorded decisions made by eight pediatric orthopedic surgeons in an outpatient clinic and the surgeon’s reported rationale behind the decisions. Surgeons categorized the rationale for each decision as one or a combination of 12 possibilities (e.g. ‘Experience/anecdote,’ ‘First principles,’ ‘Trained to do it,’ ‘Arbitrary/instinct,’ ‘General study,’ ‘Specific study’). Results Out of 1150 total decisions, the most frequent decisions were follow-up scheduling, followed by bracing prescription/removal. The most common decision rationales were ‘First principles’ (n = 310, 27.0%) and ‘Experience/anecdote’ (n = 253, 22.0%). Only 17.8% of decisions were attributed to scientific studies, with 7.3% based on studies specific to the decision. As high as 34.6% of surgical intervention decisions were based on scientific studies, while only 10.4% of follow-up scheduling decisions were made with studies in mind. Decision category was significantly associated with a basis in scientific studies: surgical intervention and medication prescription decisions were more likely to be based on scientific studies than all other decisions. Conclusions With increasing emphasis on high value, evidence-based care, understanding the rationale behind physician decision-making can educate physicians, identify common decisions without supporting evidence and help create clinical care pathways in pediatric orthopedic surgery. Decisions based on evidence or consensus between surgeons can inform pathways and national guidelines that minimize unwarranted variation in care and waste. Decision support tools and aids could also be implemented to guide these decisions.
28
Bhate, T., S. Dowling et N. Collins. « P132 : Optimizing a physician surge protocol to address emergency department wait times during times of increased patient demand ». CJEM 22, S1 (mai 2020) : S112. http://dx.doi.org/10.1017/cem.2020.336.
Texte intégralRésumé :
Background: Emergency Department overcrowding remains a significant problem. Interventions have often focused on areas external to the ED, with patient flow in the ED receiving less attention. Efforts to address ED flow are complicated by daily fluctuations in patient volume and acuity. Our local protocol brings in additional physicians when internal metrics indicate patient demand can't be met by current physician resources (a ‘surge’ period). However, anecdotal evidence suggests a lack of satisfaction and efficacy. We therefore undertook a project to improve our local management of these surge periods. Aim Statement: To improve the effectiveness of an ED Physician Surge Protocol to allow for a physician scheduling strategy that is reflective of the needs of the ED. Measures & Design: This project consists of 3 phases. Phase 1 was an analysis of current surge metrics (including frequency, temporal patterns and physician response), with concurrent literature search to identify any best practices or easily addressable protocol changes, with first planned PDSA cycle. Phase 2 is a mixed methods survey of local staff to identify barriers and enablers of our current protocol, concurrent with a national survey of current practices. Phase 3 will be the implementation of a revised protocol, followed by a second mixed methods survey and analysis of metrics of interest. Evaluation/Results: Analysis of surge data (Oct 2018-Oct 2019) demonstrated a high volume of surges per month (78.7 +/- 10.9), highest at Foothills Medical Centre (94.3). Across all sites, afternoon periods had highest frequency of surges (absolute peak 1400 - 1500) with a secondary peak 2200–2300, both peaks occurring most frequently on weekends (Fri-Sun) However, physician response to surge calls was < 10% (5.8-9.1%), with no discernable temporal pattern, even accounting for the significant number of automatic surge calls cancelled by clinicians. Analysis of data, in addition to literature review and engagement with senior administration suggested no immediate protocol changes, therefore project moved to 2nd phase. This phase is currently in progress, with planned analysis using Pareto Chart methodology. Discussion/Impact: Our initial data clearly demonstrates that current procedures are inadequate to address this ongoing issue, with no readily apparent solutions. Analysis of local barriers and enablers is currently underway, in addition to a national survey, with the results expected to inform an extensive redesign of current procedures.
29
Halpern, Michael T., Heather Kane, Stephanie Teixeira-Poit, Corey Ford, Barbara Giesser, June Halper, Shana Johnson, Nicholas G. LaRocca, Aaron Miller et Steven P. Ringel. « Projecting the Adequacy of the Multiple Sclerosis Neurologist Workforce ». International Journal of MS Care 20, no 1 (1 janvier 2018) : 35–43. http://dx.doi.org/10.7224/1537-2073.2016-044.
Texte intégralRésumé :
Abstract Background: Anecdotal reports suggest shortages among neurologists who provide multiple sclerosis (MS) patient care. However, little information is available regarding the current and future supply of and demand for this neurologist workforce. Methods: We used information from neurologist and neurology resident surveys, professional organizations, and previously reported studies to develop a model assessing the projected supply and demand (ie, expected physician visits) of neurologists providing MS patient care. Model projections extended through 2035. Results: The capacity for MS patient visits among the overall neurologist workforce is projected to increase by approximately 1% by 2025 and by 12% by 2035. However, the number of individuals with MS may increase at a greater rate, potentially resulting in decreased access to timely and high-quality care for this patient population. Shortages in the MS neurologist workforce may be particularly acute in small cities and rural areas. Based on model sensitivity analyses, potential strategies to substantially increase the capacity for MS physicians include increasing the number of patients with MS seen per neurologist, offering incentives to decrease neurologist retirement rates, and increasing the number of MS fellowship program positions. Conclusions: The neurologist workforce may be adequate for providing MS care currently, but shortages are projected over the next 2 decades. To help ensure access to needed care and support optimal outcomes among individuals with MS, policies and strategies to enhance the MS neurologist workforce must be explored now.
30
Steeb, Glen, Yi-Zarn Wang, Brett Siegrist et J. Patrick O'Leary. « Infections within the Peritoneal Cavity : A Historical Perspective ». American Surgeon 66, no 2 (février 2000) : 98–104. http://dx.doi.org/10.1177/000313480006600202.
Texte intégralRésumé :
Physicians in antiquity dreaded abdominal infections. Despite the fact that peritonitis was extremely common, reports of successful surgical interventions were only anecdotal before the past century. Medicine's comprehension of the pathophysiology of the peritoneal cavity is still evolving. The history of our understanding of the process could be considered to be as recent as the current literature. Despite this, the mortality rates for patients with secondary peritonitis have fallen in the last century from almost 100 per cent to less than 10 per cent.
31
Parker, Gordon B., et Matthew P. Hyett. « Management of Depression by General Practitioners : Impact of Physician Gender ». Australian & ; New Zealand Journal of Psychiatry 43, no 4 (1 janvier 2009) : 355–59. http://dx.doi.org/10.1080/00048670902721178.
Texte intégralRésumé :
Objective: The aim of the present study was to determine whether anecdotal claims of gender differences in the treatment of depression by general practitioners (GPs) existed in practice. Method: Referral letters from 100 GPs to a specialized psychiatric depression clinic were analysed by word count and gender of referrer. Second, a Web-based survey of 517 participants examined the impact of GP gender in terms of levels of management nuances. Results: The first study established that female GPs wrote distinctly longer referral letters. The second study identified that female GPs were seen as distinctly more caring over a range of parameters and identified the impact of some GP–patient gender differences. Conclusions: Reasons why female GPs are viewed as more caring – and any impact on the management of those with a depressive disorder – would benefit from refined investigation.
32
Jatoi, A., K. Rowland, J. A. Sloan, H. M. Gross, P. A. Fishkin, S. P. Kahanic, P. J. Novotny, P. L. Schaefer, S. R. Dakhil et C. L. Loprinzi. « Does tetracycline prevent/palliate epidermal growth factor receptor (EGFR) inhibitor-induced rash ? A phase III trial from the North Central Cancer Treatment Group (N03CB) ». Journal of Clinical Oncology 25, no 18_suppl (20 juin 2007) : LBA9006. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.lba9006.
Texte intégralRésumé :
LBA9006 Purpose: Many patients who receive EGFR inhibitors develop an acneiform rash, and anecdotal reports suggest tetracycline is effective in treating it. To our knowledge, however, no rigorous trials have ever been published to substantiate this approach. This double- blinded, placebo-controlled trial was conducted to assess the role of tetracycline in preventing EGFR inhibitor-induced rash and/or reducing its severity. Methods: 61 patients were randomly assigned to tetracycline 500 mg orally twice a day×4 weeks versus an identical, similarly prescribed placebo. Eligibility criteria required all patients to have begun an EGFR inhibitor </= 7 days prior with no rash at study entry. Patients were to be followed for 8 weeks. Physician assessments of rash incidence, severity, and adverse events, occurred at 4 and 8 weeks. Patients completed a weekly rash diary, quality of life questionnaire (SKINDEX-16), and EGFR inhibitor compliance questionnaire. Thirty patients per group provides 90% power to detect a difference in rash incidence (the primary endpoint) of 40% between groups and of rejecting the null hypothesis of equal proportions with a type I error of 5% (2-sided). Results: Treatment arms were balanced on baseline characteristics, drop out rates, and rates of discontinuation of the EGFR inhibitor. Rash incidence was comparable across arms. Physicians reported that 16 tetracycline-treated patients (70%) and 22 placebo-exposed patients (76%) developed a rash (p=0.61). However, tetracycline appears to have lessened rash severity. By week 4, physician-reported grade 2 rash occurred in 17% of tetracycline-treated patients (n=4) and 55% of placebo- exposed patients (n=16); (p=0.04). Tetracycline-treated patients reported better scores on certain quality of life parameters (SKINDEX-16), such as skin burning or stinging, skin irritation, and being bothered by a persistence/recurrence of a skin condition. Adverse events were comparable across arms. Conclusion: Tetracycline did not prevent EGFR inhibitor-induced rashes. However, diminished rash severity and improved quality of life suggest this antibiotic merits further study. No significant financial relationships to disclose.
33
Williamson, Theresa, Keying Wang, Syntia Hadis, Emily Duerr, Taylor Mitchell, Aimee DeGaetano, Ben Lovett, Elad I. Levy et Xiaodong Lin. « 508 Preparing Physicians For Failures : A Needs Assessment ». Neurosurgery 70, Supplement_1 (avril 2024) : 155–56. http://dx.doi.org/10.1227/neu.0000000000002809_508.
Texte intégralRésumé :
INTRODUCTION: Although anecdotal evidence points to high levels of stress among neurosurgeons and trainees, there is little systematic research documenting the nature of stress in detail. METHODS: We conducted a detailed survey of neurosurgeons and trainees, obtaining 22/26 responses (85% response rate) with 2 responses removed for missingness. Participants were purposefully sampled from two academic center neurosurgery programs. RESULTS: Participants reported more high-arousal negative emotions (particularly frustration and anxiety) than low-arousal negative emotions (e.g., helplessness, discouragement), suggesting relatively high levels of motivation. Within training levels, sources of stress varied considerably, suggesting the need for tailored approaches to stress management. Attendings reported quite a lot of stress from patient expectations and administrative constraints, whereas trainees focused more on teamwork and difficult patients. A focus on processes and specific mechanisms of problems at work was associated with more high-arousal emotions, whereas a focus on outcomes was associated with low-arousal emotions; this pattern is consistent with prior research on other populations. As expected, residents were most likely to use coping strategies that reflected a lack of control over one’s schedule (e.g., immersing oneself in work) whereas attendings were most likely to use healthy strategies, particularly physical exercise. Only one of the 20 participants reported seeking professional support due to stress; residents were most likely to attribute this to a lack of time or resources but most participants did not feel a need to seek professional help. Attendings were least likely to report ideas for what education or training they could have benefited from to better cope with stress. CONCLUSIONS: This work points to key ways dealing with failure and stress contributes to individual well-being as well as neurosurgical culture.
34
Duffin, Jacalyn. « Library Adventures in a Digital Age : Observations and Questions ». RBM : A Journal of Rare Books, Manuscripts, and Cultural Heritage 15, no 2 (1 septembre 2014) : 98–110. http://dx.doi.org/10.5860/rbm.15.2.423.
Texte intégralRésumé :
Libraries have been essential to my role as a physician-historian working for twenty-six years in an academic health sciences center. They are the repositories of thousands of years of medical evidence, even if it comes in forms that are increasingly disparaged: paper and anecdote. While writing my dissertation in Paris, I fell in love with old books and manuscripts. Reading, holding, and touching those beautiful—if barely legible—papers instilled a joyful and durable eagerness to work with them and to expose my students to their power.The university librarians and archivists are my closest colleagues. Always grateful for their . . .
35
Vladimir V., Yakovlev. « John Bell's accounts on prince Alexander Bekovich-Cherkassky and his campaign to Khiva ». Kavkazologiya 2024, no 2 (30 juin 2024) : 188–201. http://dx.doi.org/10.31143/2542-212x-2024-2-188-201.
Texte intégralRésumé :
The article examines two accounts dedicated to the Khivan campaign of Prince Alexander Bekovich-Cherkassky, by the contemporary Scottish physician and diplomat John Bell. One of them was included in Bell’s book “Travels from St. Petersburg through Russia to Various Parts of Asia” (in Volume 1, containing the notes on the trip to Persia) published in 1763 and translated into Russian in 1776. Researchers have not widely known about the other account until now, as it is only contained in the unpublished (not even in English) manuscript entitled “Sundry Anecdotes of Peter the First,” preserved in the archives of the National Library of Scotland (Glasgow). Both texts are presented in the article in toto. The one from the travel book – in a new translation made especially for this article; the one from the collection of anecdotes about Peter the Great is pub-lished for the first time. A brief analysis is provided, involving documents and publications dedi-cated to this topic. The significance of these accounts lies in the fact that they belong to a person who was a contemporary to the event: J. Bell was in Persia when they occurred (it was there that the soldiers of Bekovich’s detachment who had escaped captivity managed to flee), and the major-ity of accounts of the event known in the literature were recorded and published half a century and more after the campaign.
36
Levine, Aaron D., et Leslie E. Wolf. « The Roles and Responsibilities of Physicians in Patients' Decisions about Unproven Stem Cell Therapies ». Journal of Law, Medicine & ; Ethics 40, no 1 (2012) : 122–34. http://dx.doi.org/10.1111/j.1748-720x.2012.00650.x.
Texte intégralRésumé :
Stem cell science, using both embryonic and a variety of tissue-specific stem cells, is advancing rapidly and offers promise to improve medical care in the future. Yet, with the notable exception of hematopoietic stem cell transplantation, a long-established approach to treating certain cancers of the blood system, this promise is long term and most stem cell research focuses on basic scientific questions or the collection of pre-clinical data. Although some clinical trials are underway, most are focused on safety, and novel effective therapy is likely a long way off. Despite the preliminary nature of most stem cell research, however, numerous clinics around the world offer stem cell “therapies” to patients today outside the context of a clinical trial. Although the number of patients who have received these stem cell-based interventions (SCBIs) is unknown, anecdotal reports suggest a substantial population of patients is willing to try them, despite unresolved questions about their safety and efficacy.
37
Bhatt, Archit, Adnan Safdar, Dhara Chaudhari, Diane Clark, Amber Pollak, Arshad Majid et Mounzer Kassab. « Medicolegal Considerations with Intravenous Tissue Plasminogen Activator in Stroke : A Systematic Review ». Stroke Research and Treatment 2013 (2013) : 1–6. http://dx.doi.org/10.1155/2013/562564.
Texte intégralRésumé :
Background.Intravenous tPA (tissue plasminogen activator) therapy remains underutilized in patients with Acute Ischemic Stroke (AIS). Anecdotal data indicates that physicians are increasingly liable for administering and for failure to administer tPA.Methods.An extensive search of Medline, Embase, Westlaw, LexisNexis Legal, and Google Scholar databases was performed. Case studies that involved malpractice litigation in ischemic stroke and thrombolytic therapy were analyzed systematically.Results.We identified 789 ischemic stroke litigation cases, of which 46 cases were related to intravenous tPA and stroke litigation. Case descriptions of 40 cases were available. Data for verdicts were available for 38 patients. The most frequent plaintiff claim was related to failure to administer intravenous tPA (38, 95%). Only 2 (5.0%) claim involved complications of treatment with tPA. Hospitals were defendants in majority of the 36 cases. Physicians were involved in 33 cases. While ED physicians were involved in 25 (60.52%) cases, neurologists were involved in 8 (20.0%) cases. There were 26 (65%) defendant-favored and 12 (30%) plaintiff-favored verdicts.Conclusion.Physicians and hospitals are at an increased risk of litigation in patients with AIS when in IV-tPA is being considered for treatment. While majority of the cases litigated were cases where tPA was not administered, only about 1 in 20 cases was litigated when complications occurred.
38
Flores-Franco, René A., et Nancy E. Limas-Frescas. « The Overused Airway : Lessons from a Young Trumpet Player ». Medical Problems of Performing Artists 25, no 1 (1 mars 2010) : 35–28. http://dx.doi.org/10.21091/mppa.2010.1007.
Texte intégralRésumé :
Young trumpet players are predisposed to certain performance-related health risks. Nevertheless, the published experience with specific disorders is considered confusing and anecdotal. In the context of a review of the literature, we analyze a case report of a young patient who presented with two different disorders typically related to trumpet playing. After considering the diagnoses that had been made elsewhere, we were able to make the correct diagnoses and choose the correct treatment. We conclude that physicians need to be aware of these disorders, because they could be mistakenly attributed to instrumental performance itself or misinterpreted as serious conditions that require medical intervention.
39
Connelley, LK, SM Dinehart et R. McDonald. « Onychocryptosis associated with the treatment of onychomycosis ». Journal of the American Podiatric Medical Association 89, no 8 (1 août 1999) : 424–26. http://dx.doi.org/10.7547/87507315-89-8-424.
Texte intégralRésumé :
With the advent of effective oral therapies for onychomycosis, there have been anecdotal reports of an increased incidence of onychocryptosis associated with the use of these new agents. The authors undertook a chart review of 100 consecutive patients treated for onychomycosis in a private medical practice to determine the incidence of onychocryptosis. A total of 37 of these patients (37%) developed paronychia ranging from simple pain to a severe inflammatory response with redness, drainage, and granuloma formation. Of these, 19 patients (19%) required surgical procedures to control onychocryptotic symptoms. Podiatric physicians should be aware that ingrown toenails may be an adverse consequence of effective treatment for onychomycosis.
40
Sajdeya, Ruba, Anna Shavers, Jennifer Jean-Jacques, Brianna Costales, Sebastian Jugl, Carly Crump, Yan Wang et al. « Practice Patterns and Training Needs Among Physicians Certifying Patients for Medical Marijuana in Florida ». Journal of Primary Care & ; Community Health 12 (janvier 2021) : 215013272110427. http://dx.doi.org/10.1177/21501327211042790.
Texte intégralRésumé :
Background: Little is known about the clinical training or practice experiences among physicians who certify patients for medical marijuana. The objective of this study was to determine information sources, factors influencing recommendations, clinical practices in patient assessment, communications, and recommendations, and priority areas for additional training among physicians who certify patients for medical marijuana. Methods: A cross-sectional state-wide anonymous survey of registered medical marijuana physicians in Florida between June and October 2020 was administered. Numerical responses were quantified using counts and percentages. The frequencies for “often” and “always” responses were aggregated when appropriate. Results: Among 116 respondents, the mean (standard deviation) age was 57 (12) years old, and 70% were male. The most frequently used information sources were research articles (n = 102, 95%), followed by online sources (n = 99, 93%), and discussions with other providers and dispensary staff (n = 84, 90%). Safety concerns were most influential in patient recommendations (n = 39, 39%), followed by specific conditions (n = 30, 30%) and patient preferences (n = 26, 30%). Ninety-three physicians (92%) reported they “often” or “always” perform a patient physical exam. Eighty-four (77%) physicians provided specific administration route recommendations. Half (n = 56) “often” or “always” provided specific recommendations for Δ-9-tetrahydrocannabinol: cannabidiol ratios, while 69 (62%) “often” or “always” provided specific dose recommendations. Online learning/training modules were the most preferred future training mode, with 88 (84%) physicians “likely” or “very likely” to participate. The top 3 desired topics for future training were marijuana-drug interactions (n = 84, 72%), management of specific medical conditions or symptoms (n = 83, 72%), and strategies to reduce opioids or other drugs use (n = 78, 67%). Conclusions: This survey of over 100 medical marijuana physicians indicates that their clinical practices rely on a blend of research and anecdotal information sources. While physicians report clinical factors as influential during patient recommendation, patient assessment practices and treatment regimen recommendations vary substantially and rely on experimental approaches. More research is needed to inform evidence-based practice and training, especially considering details on drug interactions, risk-benefit of treatment for specific clinical conditions, and strategies to reduce opioid use.
41
Litwin, Robert J., Johanna L. Chan et Steven Y. Huang. « Malignant Gastrointestinal Obstruction : Options for Decompression and Nutrition ». Digestive Disease Interventions 04, no 03 (septembre 2020) : 311–22. http://dx.doi.org/10.1055/s-0040-1718390.
Texte intégralRésumé :
AbstractMalignant bowel obstruction (MBO) is a relatively common condition affecting patients with advanced malignancy. Therapeutic interventions should be aimed at maintaining quality of life. Given the lack of prospective controlled studies in this patient population, patient management is often based on local practice patterns and anecdotal experience. To foster a collaborative approach among the members of the patient care team involving internal medicine, oncology, palliative care, clinical nutrition, surgery, gastroenterology, and interventional radiology physicians, it is important to improve our understanding of MBO. The purpose of this article is to describe the clinical presentation, pathophysiology, as well as medical, surgical, and nonsurgical palliative options available to patients with MBO for purposes of decompression and nutrition.
42
Tran, Bryant Winston, Sabrina Kaur Dhillon, Astrid Regina Overholt et Marc Huntoon. « Social media for the regional anesthesiologist : can we use it in place of medical journals ? » Regional Anesthesia & ; Pain Medicine 45, no 3 (11 novembre 2019) : 239–42. http://dx.doi.org/10.1136/rapm-2019-100835.
Texte intégralRésumé :
The regional anesthesia community regularly uses social media for advocacy and education. Well-known leaders in the field are willing to share their opinions with colleagues in a public forum. Some visionaries predict that the influence of social media will soon transcend that of the traditional academic journal. While physicians support the use of social media, an trend may exist toward anecdotal information. Does a lack of online regulation along with a bias towards self-promotion cloud meaningful discussion? In order to avoid the pitfalls of social media, thoughtful communication will help regional anesthesiologists promote their subspecialty. Mindful dialog, promotion of academic journals, and professional etiquette will help maintain a collegial environment.
43
Kunjibettu, Suprabha, Kiran Vinayak Kale et Saketh Ram Thrigulla. « Illuminating Pathways : A chronicle of the life of Prof. (Vaidya) C. P. Shukla ». Journal of Research in Ayurvedic Sciences 8, Suppl 1 (mai 2024) : S27—S31. http://dx.doi.org/10.4103/jras.jras_319_23.
Texte intégralRésumé :
Abstract This article delves into the life of Professor Vaidya Chandrakant Prabhushankar Shukla, a prominent figure in the field of Ayurveda from Gujarat. The primary objective of this article is to acquaint readers with one of the remarkable visionaries who have made substantial contributions and dedicated themselves to the field of Ayurveda. This article highlights Vaidya C. P. Shukla’s pivotal role in translating the Charaka Samhita, his devotion to Ayurveda education, and his significant impact on academic reforms. Furthermore, the aim of this article is also to showcase his unique approach to Ayurvedic practice, which integrates traditional wisdom with modern medical knowledge. He has left a lasting impact on Ayurveda, emphasizing his role as an exceptional teacher, physician, and administrator. Through interviews with family members, the article captures personal insights, anecdotes, and the versatile dimensions of Vaidya C. P. Shukla’s life. Ultimately, this article aspires to inspire the younger generation by shedding light on this luminary’s achievements, challenges, and unwavering commitment to Ayurveda.
44
Priya, N. K., A. Binitha et P. P. Jigeesh. « An Exploration to Age-old Wisdom – A Book Review on Geriatrics in Ayurveda ». International Research Journal of Ayurveda & ; Yoga 7, no 1 (31 janvier 2024) : 102–4. http://dx.doi.org/10.48165/irjay.2024.70117.
Texte intégralRésumé :
“Geriatrics in Ayurveda” is authored by experts from both the fields of Ayurveda and modern medicine, seamlessly blending anecdotes from both medical systems. Geriatrics is Emerging as a challenging speciality, because of ever growing population of Aged people all over the world including India. In near Future, Every physician has to “treat’ a large Number of Aging Problems of our Ripe and Senior citizens in their CLINICS. Ayurveda system of Medicine (ASM) offers an Excellent Line of Management for these i.e. Aging problems under Rasayana and ‘Rasa’ therapies. In fact ‘Jara’ is an exclusive therapy for old-age related complaints. Keeping all these concepts in view, a systematic search to gather the relevant and useful information on “Geriatrics in Ayurveda” has been attempted along with inputs from (MODERN) Geriatrics, so as to have a comprehensive book on GERITRICS with Practical and clinical applications.The presented book was studied, analyzed, and compared with other contemporary works on a similar subject.
45
ROBBINS, KENNETH M. « Managed Care ». Pediatrics 90, no 2 (1 août 1992) : 279. http://dx.doi.org/10.1542/peds.90.2.279.
Texte intégralRésumé :
To the Editor.— At a time when many of us are trying to understand and evaluate the effects of the influence of managed care on medical practice, it was with significant dismay that I read the unscientific, anecdotal, and frankly inflammatory report that formed the second article in the February 1992 issue of Pediatrics.1 The article, based solely on a self-reporting physician survey, conduded that some managed care patients were denied benefits for some referrals and admissions (surprise!—that is what managed care is expected to do) and that some doctors didn't like having their decisions questioned (also no surprise).
46
Gharagozli, Kurosh, Maziar Shojaei, Ali Amini Harandi, Nayyereh Akbari et Manouchehr Ilkhani. « Myasthenia Gravis Development and Crisis Subsequent to Multiple Sclerosis ». Case Reports in Medicine 2011 (2011) : 1–3. http://dx.doi.org/10.1155/2011/291731.
Texte intégralRésumé :
During the last decade, sporadic combination of multiple sclerosis (MS) and myasthenia gravis (MG) has been reported repeatedly. Although these are anecdotal, they are important enough to raise concerns about co-occurrence of MG and MS. Here, we present a case of an MS patient who developed an MG crisis. She had received interferon for relapsing remitting MS. Interestingly, she developed an MG crisis 4 years after the diagnosis of MS. MS and MG have relatively the same distribution for age, corresponding to the younger peak of the bimodal age distribution in MG. They also share some HLA typing characteristics. Furthermore, some evidences support the role of systemic immune dysregulation due to a genetic susceptibility that is common to these two diseases. The association may be underdiagnosed because of the possible overlap of symptoms especially bulbar manifestations in which either MG or MS can mimic each other, leading to underestimating incidence of the combination. The evidence warrants physicians, especially neurologists, to always consider the possibility of the other disease when encountering any patients either with MS or MG. Anecdotal and sporadic reports of combination of multiple sclerosis (MS) and myasthenia gravis (MG) have been raised concerns about co-occurrence of them.
47
N, Kurniadi, Davis J, Kitchen-Andren K, Mullen C et Rolin S. « A-239 Cost of Neuropsychological Evaluation Comparable to Neuroimaging in the Eastern USA ». Archives of Clinical Neuropsychology 35, no 6 (28 août 2020) : 1034. http://dx.doi.org/10.1093/arclin/acaa068.239.
Texte intégralRésumé :
Abstract Objective Anecdotal evidence indicates a belief among physicians that neuropsychological evaluation is more expensive than brain imaging procedures. Another concern is that neuropsychological evaluations are a limited resource to be utilized sparingly, likely due to insurance limits on the annual allowable units of neuropsychological evaluation. This study aimed to contextualize the cost of neuropsychological evaluation relative to common neuroimaging studies used in conditions seen by neuropsychologists. Data Selection Publically available fee schedules from 27 hospitals in the eastern U.S. were reviewed to identify standard costs of head CT, brain MRI, and 5- and 8-hour neuropsychological evaluations conducted with technicians. Data Synthesis Head CT averaged $2963 (range $282–$6007) and brain MRI averaged $4857 (range $834–$11,524). Five-hour evaluations using technicians averaged $2080 (range $698–$4165). Eight-hour evaluations using technicians averaged $3289 (range $1104–$6657). Conclusions Contrary to anecdotal concerns, neuropsychological evaluations do not appear more expensive than brain neuroimaging procedures in several eastern U.S. hospitals. Focused neuropsychological evaluations comparable to or less than head CT procedure cost. Comprehensive neuropsychological evaluations are comparable to or less than MRI brain procedure cost. These preliminary findings may dispel the notion that neuropsychological evaluations are more costly than brain imaging. Additional research is needed in all regions of the U.S.
48
Kothari, Saroj. « EFFECTS OF DANCE AND MUSIC THERAPY ». International Journal of Research -GRANTHAALAYAH 3, no 1SE (31 janvier 2015) : 1–8. http://dx.doi.org/10.29121/granthaalayah.v3.i1se.2015.3389.
Texte intégralRésumé :
Arts have consistently been part of life as well as healing throughout the history of humankind. Today, expressive therapies have an increasingly recognized role in mental health, rehabilitation and medicine. The expressive therapies are defined as the use of art, music, dance/movement drama, poetry/creative writing, play and sand play within the context of psychotherapy, counseling, rehabilitation or health care.Through the centuries, the healing nature of these expressive therapies has been primarily reported in anecdotes that describe a way of restoring wholeness to a person struggling with either mind or body illness. The Egyptians are reported to have encouraged people with mental illness to engage in artistic activity (Fleshman & Fryrear, 1981); the Greeks used drama and music for its reparative properties (Gladding, 1992); and the story of King Saul in the Bible describes music’s calming attributes. Later, in Europe during the Renaissance, English physician and writer Robert Burton theorized that imagination played a role in health and well-being, while Italian philosopher de feltre proposed that dance and Play was central to children’s healthy growth and development (Coughlin, 1990).
49
Milgrom, Henry, et Bruce Bender. « Behavioral Side Effects of Medications Used to Treat Asthma and Allergic Rhinitis ». Pediatrics In Review 16, no 9 (1 septembre 1995) : 333–35. http://dx.doi.org/10.1542/pir.16.9.333.
Texte intégralRésumé :
Parents, teachers, and physicians are concerned that medicines may alter children's mood, behavior, and ability to learn. In clinical practice, adverse reactions to drugs and the perceptions associated with them influence prescribing patterns and undermine compliance. In the treatment of chronic disorders such as asthma, where successful management requires that patients take medications consistently over prolonged periods of time, factors affecting compliance become profoundly important. Asthma medications have been associated with behavioral, affective, and neuropsychological changes in children. Oral corticosteroids exacerbate depression and impair verbal memory, and there are anecdotal reports of severe reactions to inhaled steroids among children, including psychotic behavior. Oral beta agonists have been reported to cause psychotic reactions in adult patients. In children, inhaled albuterol frequently induces a short-term hand tremor, but does not compromise more complex psychomotor functions. Theophylline improves concentration and results in slightly increased hand tremor and feelings of anxiety. Medicines for allergic rhinitis and those used for cough and colds frequently are administered by parents without the supervision of physicians. Many of these preparations, given not only to children who have allergic disease but also to those who have self-limiting respiratory symptoms, are available over the counter (OTC). This confusing array of combination antihistamines, decongestants, expectorants, and anticholinergic agents constitutes the largest group of drugs taken by children.
50
Kroshus, Emily, Christine M. Baugh, Daniel H. Daneshvar, Julie M. Stamm, R. Mark Laursen et S. Bryn Austin. « Pressure on Sports Medicine Clinicians to Prematurely Return Collegiate Athletes to Play After Concussion ». Journal of Athletic Training 50, no 9 (1 septembre 2015) : 944–51. http://dx.doi.org/10.4085/1062-6050-50.6.03.
Texte intégralRésumé :
Context Anecdotal and qualitative evidence has suggested that some clinicians face pressure from coaches and other personnel in the athletic environment to prematurely return athletes to participation after a concussion. This type of pressure potentially can result in compromised patient care. Objective To quantify the extent to which clinicians in the collegiate sports medicine environment experience pressure when caring for concussed athletes and whether this pressure varies by the supervisory structure of the institution's sports medicine department, the clinician's sex, and other factors. Design Cross-sectional study. Setting Web-based survey of National College Athletic Association member institutions. Patients or Other Participants A total of 789 athletic trainers and 111 team physicians from 530 institutions. Main Outcome Measure(s) We asked participants whether they had experienced pressure from 3 stakeholder populations (other clinicians, coaches, athletes) to prematurely return athletes to participation after a concussion. Modifying variables that we assessed were the position (athletic trainer, physician) and sex of the clinicians, the supervisory structure of their institutions' sports medicine departments, and the division of competition in which their institutions participate. Results We observed that 64.4% (n = 580) of responding clinicians reported having experienced pressure from athletes to prematurely clear them to return to participation after a concussion, and 53.7% (n = 483) reported having experienced this pressure from coaches. Only 6.6% (n = 59) reported having experienced pressure from other clinicians to prematurely clear an athlete to return to participation after a concussion. Clinicians reported greater pressure from coaches when their departments were under the supervisory purview of the athletic department rather than a medical institution. Female clinicians reported greater pressure from coaches than male clinicians did. Conclusions Most clinicians reported experiencing pressure to prematurely return athletes to participation after a concussion. Identifying factors that are associated with variability in pressure on clinicians during concussion recovery can inform potential future strategies to reduce these pressures.