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Background: Social media posts by clinicians are not bound by the same rules as peer-reviewed publications, raising ethical concerns that have not been extensively characterized or quantified., Objective: We aim to develop a scale to assess ethical issues on medical social media (SoMe) and use it to determine the prevalence of these issues among posts with 3 different hashtags: #MedTwitter, #IRad, and #CardioTwitter., Methods: A scale was developed based on previous descriptions of professionalism and validated via semistructured cognitive interviewing with a sample of 11 clinicians and trainees, interrater agreement, and correlation of 100 posts. The final scale assessed social media posts in 6 domains. This was used to analyze 1500 Twitter posts, 500 each from the 3 hashtags. Analysis of posts was limited to original Twitter posts in English made by health care professionals in North America. The prevalence of potential issues was determined using descriptive statistics and compared across hashtags using the Fisher exact and χ 2 tests with Yates correction., Results: The final scale was considered reflective of potential ethical issues of SoMe by participants. There was good interrater agreement (Cohen κ=0.620, P<.01) and moderate to strong positive interrater correlation (=0.602, P<.001). The 6 scale domains showed minimal to no interrelation (Cronbach α=0.206). Ethical concerns across all hashtags had a prevalence of 1.5% or less except the conflict of interest concerns on #IRad, which had a prevalence of 3.6% (n=18). Compared to #MedTwitter, posts with specialty-specific hashtags had more patient privacy and conflict of interest concerns., Conclusions: The SoMe professionalism scale we developed reliably reflects potential ethical issues. Ethical issues on SoMe are rare but important and vary in prevalence across medical communities., (©Vongai Christine Mlambo, Eric Keller, Caroline Mussatto, Gloria Hwang. Originally published in JMIR Infodemiology (https://infodemiology.jmir.org), 27.03.2024.)

Background: Numerous studies have highlighted the inequitable access to medical and psychiatric care that people experiencing homelessness (PEH) face, yet the surgical needs of this population are not well understood. We sought to assess evidence describing surgical care for PEH and to perform a thematic analysis of the results., Methods: Ovid MEDLINE, Embase, and Web of Science were searched using the terms "surgery" AND "homelessness." Grey literature was also searched. We used a stepwise scoping review methodology, followed by thematic analysis using an inductive approach., Results: We included 104 articles in our review. Studies were included from 5 continents; 63% originated in the United States. All surgical specialties were represented with varying surgical conditions and procedures for each. Orthopedic surgery (21%) was the most frequently reported specialty. Themes identified included characteristics of PEH receiving surgical care, homeless-to-housed participants, interaction with the health care system, educational initiatives, barriers and challenges, and interventions and future strategies., Conclusion: We identified significant variation and gaps, representing opportunities for further research and interventions. Further addressing the barriers and challenges that PEH face when accessing surgical care can better address the needs of this population., Competing Interests: Competing interests:: None declared., (© 2024 CMA Impact Inc. or its licensors.)

Objectives: To synthesise research investigating data and code sharing in medicine and health to establish an accurate representation of the prevalence of sharing, how this frequency has changed over time, and what factors influence availability., Design: Systematic review with meta-analysis of individual participant data., Data Sources: Ovid Medline, Ovid Embase, and the preprint servers medRxiv, bioRxiv, and MetaArXiv were searched from inception to 1 July 2021. Forward citation searches were also performed on 30 August 2022., Review Methods: Meta-research studies that investigated data or code sharing across a sample of scientific articles presenting original medical and health research were identified. Two authors screened records, assessed the risk of bias, and extracted summary data from study reports when individual participant data could not be retrieved. Key outcomes of interest were the prevalence of statements that declared that data or code were publicly or privately available (declared availability) and the success rates of retrieving these products (actual availability). The associations between data and code availability and several factors (eg, journal policy, type of data, trial design, and human participants) were also examined. A two stage approach to meta-analysis of individual participant data was performed, with proportions and risk ratios pooled with the Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis., Results: The review included 105 meta-research studies examining 2 121 580 articles across 31 specialties. Eligible studies examined a median of 195 primary articles (interquartile range 113-475), with a median publication year of 2015 (interquartile range 2012-2018). Only eight studies (8%) were classified as having a low risk of bias. Meta-analyses showed a prevalence of declared and actual public data availability of 8% (95% confidence interval 5% to 11%) and 2% (1% to 3%), respectively, between 2016 and 2021. For public code sharing, both the prevalence of declared and actual availability were estimated to be <0.5% since 2016. Meta-regressions indicated that only declared public data sharing prevalence estimates have increased over time. Compliance with mandatory data sharing policies ranged from 0% to 100% across journals and varied by type of data. In contrast, success in privately obtaining data and code from authors historically ranged between 0% and 37% and 0% and 23%, respectively., Conclusions: The review found that public code sharing was persistently low across medical research. Declarations of data sharing were also low, increasing over time, but did not always correspond to actual sharing of data. The effectiveness of mandatory data sharing policies varied substantially by journal and type of data, a finding that might be informative for policy makers when designing policies and allocating resources to audit compliance., Systematic Review Registration: Open Science Framework doi:10.17605/OSF.IO/7SX8U., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at https://www.icmje.org/disclosure-of-interest/ and declare: support from the Australian Research Council during the conduct of this research for the submitted work; some authors had support from research institutions listed in the funding statement; some authors received financial support to attend an international congress to present preliminary results of this project; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: There have been few large-scale nationally representative studies on the prevalence of substance use among doctors. In addition, the association of different medical specialties with the use of different substances requires further research., Aims: To investigate how the use of alcohol, tobacco and illicit drugs varied between junior doctors enrolled in different specialty training programmes., Methods: A secondary analysis was conducted on a national survey of 12 252 Australian doctors. The population of interest was junior doctors currently enrolled in a specialty training programme, termed vocational trainees (VT; n = 1890; 15.4% of the overall sample). Self-report prevalence of current alcohol, tobacco and illicit drug use were assessed and hazardous alcohol use was assessed using the Alcohol Use Disorders Identification Test. Logistic regression was used to examine the association between specialty and substance use, adjusting for demographic characteristics when required., Results: One in six VT reported hazardous levels of alcohol use (n = 268; 17.3%). After adjusting for confounders, the association between the prevalence of alcohol use and the specialties of emergency medicine/intensive care unit (odds ratio (OR) 2.15; 95% confidence interval (CI) 1.40-3.32; P < 0.001), anaesthetics (OR 2.53; 95% CI 1.35-4.76; P = 0.004) and obstetrics/gynaecology (OR 1.89; 95% CI 1.19-3.02; P = 0.007) remained significant. No significant associations were found between tobacco use/illicit drug use/hazardous alcohol use and medical specialty., Conclusions: While rates of substance use and hazardous alcohol use in VT are similar, if not lower, than the general population, it poses a concern that there are higher rates of alcohol use in certain medical specialties., (© 2022 Royal Australasian College of Physicians.)

Background: Women physicians remain a minority in most medical specialties and are at higher risk of workplace harassment than men. This research examines the relationship between a medical specialty's gender composition and physicians' workplace harassment experience. Materials and Methods: We used the Association of American Medical Colleges' National Sample Survey of Physicians 2019 ( n  = 6000). Participants self-reported harassment experiences in the 12 months preceding the survey, including threats of physical harm, physical harm, offensive and sexist remarks, and unwanted sexual advances from patients and coworkers. We used data from the American Medical Association to determine medical specialties' gender composition. We used multiple logistic regression to assess the relationship between harassment experiences and specialty gender composition. Results: Women and men physicians reported threats and harm at similar rates. However, women reported offensive, sexist remarks and unwanted sexual advances more frequently. We found greater representation of women within a specialty is associated with a lower prevalence of harassment experienced by men and women physicians ( e.g. , threats of physical harm, odds ratio [OR] = 0.973 [women] and 0.984 [men], and unwanted sexual advances, OR = 0.976 [women] and 0.981 [men]). Also, as women's representation in a specialty increases, the gender gap in experiences of most types of harassment decreases. Conclusions: Greater representation of women within a medical specialty is associated with a safer environment for both men and women physicians and narrower gender gaps in harassment experience. Our findings support efforts to increase gender diversity across the specialties and illuminate the dire need for antiharassment solutions in specialties with low women's representation.

BACKGROUND This systematic review used the Copenhagen (CBI) and the Maslach (MBI) Burnout Inventories and its scales to assess and compare studies that involved students and workers in all medical specialties. MATERIAL AND METHODS PubMed, ScienceDirect, Scopus, Wiley Library, and Web of Science databases were searched using keywords and Medical Subject Headings. Identified studies were in English, published between 2008 and 2022, measured the burnout of healthcare workers and students by using CBI and MBI, and observed adverse patient outcomes. RESULTS A total of 38 studies were included in the current review. All included studies assessed and evaluated subjects and participants by observing clinical measures, personal and demographic data, countries where the study was conducted, and study type used. Fifty percent of CBI papers were conducted in Saudi Arabia and other Arab countries, whereas the majority of MBI papers (10) were conducted in Europe, followed by 9 studies conducted in Saudi Arabia and other Arab countries and 6 studies conducted in the USA and Canada. The overall percentage of burnout in CBI studies (53%) was higher than that in MBI studies (35%). Also, the types and domains in CBI were marginally higher than those in MBI. CONCLUSIONS Studies that used CBI scales recorded higher burnout compared with studies that used MBI. Females, higher education levels, and marriage status of the tested subjects showed higher CBI and MBI scale scores in comparison to their counterparts. Higher significant differences percentages in burnout types and genders were recorded in CBI than in MBI.

Background/objectives: Poor food intake is a major etiological factor of malnutrition. This research aims to describe the prevalence of recent and current low food intake (LI RC ) and to identify factors associated with LI RC in adult hospital patients from different medical specialities., Subject/methods: 1865 patients participating in the nutritionDay survey 2016-2020 in Germany were included. LI RC was defined by decreased eating both on nutritionDay and in the week before hospitalisation. Multivariate binary logistic regression was used to identify factors associated with LI RC overall and in different specialities., Results: LI RC was observed in 21.1% of all patients, with the highest prevalence in Gastroenterology (26.6%) and the lowest in Neurology (11.2%). Weight loss within three months before nutritionDay (OR 2.62 [95% CI 1.93-3.56]), (very) poor self-rated health (2.17 [1.62-2.91]), female sex (1.98 [1.50-2.61]), uncertain weight loss (1.90 [1.03-3.51]), digestive disease (1.90 [1.40-2.56]), inability to walk without assistance (1.55 [1.14-2.12]) and emergency admission (1.38 [1.02-1.86]) were associated with increased risk, cardiac insufficiency (0.55 [0.37-0.83]) and being in a neurological ward (0.51 [0.28-0.92]) with decreased risk in the total sample. In Gastroenterology and Oncology, estimates were higher than in the entire sample; no significant associations were found in Neurology and Geriatrics, presumably due to the low prevalence of LI RC in Neurology and limited data quality in Geriatrics., Conclusion: LI RC is common in German hospital patients and associated with female sex, poor health and decreased functional status. Interdisciplinary differences suggest a discipline-specific approach to dealing with malnutrition., (© 2022. The Author(s).)

Background: Nursing home residents tend to have lower medical specialist utilization than other groups of older people; however, as yet there is little evidence whether nursing home residents obtain adequate medical specialist care. This study investigated whether nursing home residents receive adequate oral health care, ophthalmological care, otorhinolaryngologist care and neurological care. The unmet needs of the nursing home population in Germany was extrapolated., Material and Methods: Audiometry, eye examinations and oral visual inspection were performed in 409 residents from 44 nursing homes. Medical care in the previous 12 months as well as existing diagnoses were retrieved from the nursing documentation. Teams of physicians evaluated for each resident based on all collected data if the resident obtained specialist care that was adequate to the needs., Results: Between 15% and 45% of the residents with need for medical specialist care did not receive adequate specialist care. Of all residents 27% had unmet need of specialist care in at least one of the investigated medical specialties. It is projected that up to 205,000 nursing home residents in Germany do not receive adequate medical specialist care., Conclusion: Given a considerable proportion of nursing home residents with unmet need of specialist care, interventions should be developed that help reduce the level of unmet needs., (© 2021. The Author(s).)

Background: Informal medicine, entailing undocumented medical advice, has been described in diverse medical disciplines and geographical regions. We assessed the current prevalence and characteristics of informal medical consulting, the reasons physicians provide it, and their attitudes toward it., Methods: We conducted a survey among family physicians in Israel, a country with a national health insurance system. A questionnaire was emailed to all primary care physicians in the two largest HMOs in southern Israel. Fifteen questions addressed the prevalence, practice and attitudes to informal medical consulting. Ten questions assessed demographics and professional experience., Results: Of 143 respondents (mean age 41 years), 55% were women. Ninety-five percent of the respondents reported requesting informal medical consulting from other physicians. Fifty-four percent reported often providing informal consulting to family and friends; and an additional 27% reported doing so under exceptional circumstances. The main reasons given for informal consulting requests were availability and accessibility (81% of respondents), and not financial savings. Only 17.5% stated being in favor of informal consulting for family and friends. Only 11% expressed feeling satisfaction after providing such consultation; 49% expressed discomfort. Sixty-six percent thought a position paper on informal consulting to family and friends is needed., Conclusions: Our survey of primary care physicians shows very frequent informal medical consulting, despite high dissatisfaction with such, and an interest in receiving guidelines on this practice.

Introduction: Disorders of iron metabolism are very common pathological conditions. Iron deficiency, with or without anemia, is estimated to affect more than 2 billion people.The aim of this study was to determine the prevalence of iron deficiency and anemia and their predisposing factors in a group of premenopausal women, university students of the School of Medicine of the University of the Republic in Uruguay., Methods: An observational cross-sectional study was carried out, including women of reproductive age, university students of the Faculty of Medicine. They were interviewed in order to collect clinical data and monthly menstrual volume was recorded through a pictogram. A hemogram was performed and ferritin levels were determined., Results: 196 women aged from 18 to 37 years were included. The prevalence of iron deficiency was 8.7% (n = 17) and the prevalence of anemia was 2.1% (n = 4). The presence of iron deficiency was associated with a lower consumption of red meat (p = 0.024), a higher menstrual volume (p = 0.018) and a higher frequency of abnormal uterine bleeding (p = 0.019)., Conclusions: This study shows the high frequency of iron deficiency in healthy women in relation to abnormal uterine bleeding and low consumption of red meat, which raises the need to implement programs that promote educational measures in order to promote early consultation and avoid anemia and iron deficiency in these women of reproductive age., (Universidad Nacional de Córdoba.)

Purpose: The objective of the current study was to determine the prevalence and practice of unused and expired medicine among Saudi adults. Subjects and Methods . The study used cross-sectional web-based design to collect the data, over a period of 4 months among people who are living in Riyadh, Saudi Arabia., Results: A total of 337 questionnaires were obtained during the study period. The majority of respondents were university graduates n = 251 (74.7%). The prevalence of unused medicine was n = 301 (89.3%). The most commonly used drugs were nonsteroidal anti-inflammatory drugs n = 272 (80.7%) and antibiotics n = 164 (48.7%). Of the participants, 186 (55.2%) checked the expiry date of the medicine before they purchase. Most of them n = 305 (90.5%) obtained medicine through prescription. About n = 219 (65%) of them keep the medicine until it expired; 48.1% throw away in the household garbage while only 18 (5.4%) of the respondents said to give it back to the medical store., Conclusion: The study revealed a high prevalence of unused medications among Saudi community. However, the disposable practice among the Saudi community was inadequate. Increasing awareness through education programs about proper disposable guidelines is necessary for controlling the medication wastage., Competing Interests: The authors declare no conflict of interest., (Copyright © 2020 Syed Wajid et al.)

Background: Australian National human immunodeficiency virus (HIV) Testing policy recommends HIV indicator condition-based testing, adapted from the European AIDS Clinical Society (EACS) guidelines., Aim: To evaluate the extent that Australian non-HIV specialty guidelines mention and recommend HIV testing in HIV indicator conditions., Methods: EACS guidelines were reviewed to produce a list of 24 AIDS-defining conditions (ADC) and 31 indicator conditions (IC) where HIV prevalence >0.1%, and 5 IC where HIV non-diagnosis would have adverse effect on patients' management. Australian guidelines for these conditions were identified from websites of specialty societies, electronic Therapeutic Guidelines, National Health and Medical Research Council (NHMRC), state governments, MEDLINE and Google searches. We identified eight key IC as that were part of the HIDES I study., Results: Overall, 51 ADC and IC had Australian guidelines: 24/51(47%) mention association with HIV and 14/51 (27%) recommend HIV testing. Twenty-five out of 51 (49%) Australian guidelines were for ADC: 18/25(72%) mention association with HIV and 5/25 (20%) recommend testing. Twenty-five out of 51 (49%) were guidelines IC with HIV prevalence of 0.1%: 6/25 (24%) mention HIV association and 8/25 (32%) recommend HIV testing. Two of eight (25%) key IC had no Australian guidelines and 3/8 (38%) do not mention HIV association or recommend HIV testing., Conclusions: Although almost half of HIV non-HIV guidelines for ADC and IC mention HIV association, only 27% specifically recommend HIV testing. This suggests partnership with guideline development and specialist groups may be useful to ensure patients diagnosed with ADC/IC are tested for HIV., (© 2019 Royal Australasian College of Physicians.)

Objective: To assess demographic data and characteristics of children and adolescents with pediatric chronic diseases (PCD), according to the number of specialties/patient., Methods: We performed a cross-sectional study with 16,237 PCD patients at outpatient clinics in one year. Data were analyzed by an electronic data system, according to the number of physician appointments for PCD. This study assessed: demographic data, follow-up characteristics, types of medical specialty, diagnosis (International Statistical Classification of Diseases and Related Health Problems - ICD-10), number of day hospital clinic visits, and acute complications., Results: Patients followed by ≥3 specialties simultaneously showed a significantly higher duration of follow-up compared to those followed by ≤2 specialties [2.1 (0.4-16.4) vs. 1.4 (0.1-16.2) years; p<0.001] and a higher number of appointments in all specialties. The most prevalent medical areas in patients followed by ≥3 specialties were: Psychiatry (Odds Ratio - OR=8.0; confidence interval of 95% - 95%CI 6-10.7; p<0.001), Palliative/Pain Care (OR=7.4; 95%CI 5.7-9.7; p<0.001), Infectious Disease (OR=7.0; 95%CI 6.4-7.8; p<0.001) and Nutrology (OR=6.9; 95%CI 5.6-8.4; p<0.001). Logistic regressions demonstrated that PCD patients followed by ≥3 specialties were associated with high risk for: number of appointments/patient (OR=9.2; 95%CI 8.0-10.5; p<0.001), day hospital clinic visits (OR=4.8; 95%CI 3.8-5.9; p<0.001), emergency department visits (OR=3.2; 95%CI 2.9-3.5; p<0.001), hospitalizations (OR=3.0; 95%CI 2.7-3.3; p<0.001), intensive care admissions (OR=2.5; 95%CI 2.1-3.0; p<0.001), and deaths (OR=2.8; 95%CI 1.9-4.0; p<0.001). The diagnosis of asthma, obesity, chronic pain, and transplant was significantly higher in patients followed by ≥3 specialties., Conclusions: The present study showed that PCD patients who required simultaneous care from multiple medical specialties had complex and severe diseases, with specific diagnoses.

Background: Post-traumatic stress disorder (PTSD) has been shown to be more common in surgical residents than the general population. This may be due to the rigors of a surgical residency. This study aims to compare the prevalence of screening positive for PTSD (PTSD+) among 7 medical specialties. Further, we intend to identify independent risk factors for the development of PTSD., Methods: A cross-sectional national survey of residents (n = 1904) was conducted from September 2016 to May 2017. Residents were screened for PTSD. Traumatic stressors were identified in those who reported symptoms of PTSD. Potential risk factors for PTSD were assessed using multivariate regression analysis with stepwise backward elimination against 30 demographic, occupational, psychological, work-life balance, and work-environment variables., Results: Residents from anesthesiology (n = 180), emergency medicine (n = 222), internal medicine (n = 473), general surgery (n = 464), obstetrics and gynecology (n = 226), psychiatry (n = 208), and surgical subspecialties (n = 131) were surveyed. No statistical difference was found in the prevalence of PTSD between specialties. Prevalence ranged from 14% to 23%. Eight independent risk factors for the development of PTSD+ were identified: higher postgraduate year, female gender, public embarrassment, emotional exhaustion, feeling unhealthy, job dissatisfaction, hostile hospital culture, and unsafe patient load., Conclusions: The prevalence of PTSD in surgery residents was not statistically different when compared to those in other medical specialties. However, the overall prevalence of PTSD (20%) remains more than 3 times that of the general population. Overall, 8 risk factors for PTSD were identified. These risk factors varied by specialty. This may highlight the unique challenges of training in each discipline. Specialty specific interventions to improve resident wellness should be emphasized in the development of our young physicians., (Copyright © 2019 Association of Program Directors in Surgery. All rights reserved.)

Objective: Pediatric aerodigestive programs appear to be rapidly proliferating and provide multidisciplinary, coordinated care to complex, medically fragile children. Pediatric subspecialists are considered essential to these programs. This study evaluated the state of these programs in 2017 by surveying their size, composition, prevalence, and the number of patients that they serve., Methods: The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Aerodigestive Special Interest Group leadership distributed an 11-question survey to the Pediatric Gastroenterology International Listserv. The mean time of the programs' existence, number of half-day clinics, number of procedure days, number of patients evaluated, and the lead primary specialty were evaluated., Results: Thirty-four programs responded. Twenty-five were based in academic centers. Thirty-one programs were located across the United States. The average time of program existence was 5.3 years (standard deviation [SD] = 4.3; range 1-17 years). Approximately 64.7% were started in the past 5 years. Twelve programs were based in the division of gastroenterology. The average number of gastroenterologists serving aerodigestive programs was 2 (SD = 1.1). The mean number of half-day clinic sessions and procedure days were 2.8 (SD = 2.9) and 2.6 (SD = 2), respectively. New and follow-up visits per year in each program averaged 184 (SD = 168; range 10-750)., Conclusions: Pediatric aerodigestive programs are prevalent, proliferating, and serve a large number of complex patients across North America and the world. This survey demonstrated that programs are predominantly based in academic settings. The number of patients cared for by aerodigestive centers varies widely depending on size and age of program.

Introduction: Effective smoking cessation medications are readily available but may be underutilized in hospital settings. In our large, tertiary care hospital, we aimed to (1) characterize patient tobacco use prevalence across medical specialties, (2) determine smoking cessation pharmacotherapy prescription variation across specialties, and (3) identify opportunities for improvement in practice., Methods: Using electronic health records at Barnes Jewish Hospital, we gathered demographic data, admitting service, admission route, length of stay, self-reported tobacco use, and smoking cessation prescriptions over a 6-year period, from 2010 to 2016. We then compared tobacco use prevalence and smoking cessation prescriptions across medical specialties using a cross-sectional, retrospective design., Results: Past 12-month tobacco use was reported by patients in 27.9% of inpatient admissions; prescriptions for smoking cessation pharmacotherapy were provided during 21.5% of these hospitalizations. The proportion of patients reporting tobacco use was highest in psychiatry (55.3%) and lowest in orthopedic surgery (17.1%). Psychiatric patients who reported tobacco use were most likely to receive pharmacotherapy (71.8% of admissions), and plastic surgery patients were least likely (4.7% of admissions). Compared with Caucasian tobacco users, African American patients who used tobacco products were less likely to receive smoking cessation medications (adjusted odds ratio [aOR] = 0.65; 95% confidence interval [CI] = 0.62 to 0.68)., Conclusions: Among hospitalized tobacco users, safe and cost-effective pharmacotherapies are under-prescribed. We identified substantial variation in prescribing practices across different medical specialties and demographic groups, suggesting the need for an electronic medical record protocol that facilitates consistent tobacco use cessation pharmacotherapy treatment., Implications: Tobacco use cessation pharmacotherapy is underutilized during hospitalization, and prescription rates vary greatly across medical specialties and patient characteristics. Hospitals may benefit from implementing policies and practices that standardize and automate the offer of smoking pharmacotherapy for all hospitalized patients who use tobacco., (© The Author(s) 2018. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: To evaluate the prevalence and number of potentially inappropriate medications (PIMs) in hospitalized older adults, comparing prescription patterns of medical specialties., Design: Retrospective cohort study., Setting: Tertiary general hospital., Participants: All older adults hospitalized from January through May 2015 (N = 1,900)., Measurements: Information on medications prescribed during the first and last days of hospitalization was collected and evaluated regarding PIMs using Beers and Screening Tool of Older People's Prescriptions (STOPP) criteria. Medical specialties (internal medicine, cardiology, gastroenterology, infectious disease, nephrology, neurology, pneumology) were compared regarding the prevalence of PIMs and the increase in the number of PIMs during hospitalization., Results: The number of individuals with PIMs increased significantly according to both criteria (62.3% to 66.6% according to Beers criteria, 43.4% to 50.0% according to STOPP criteria). The most common PIMs were sliding-scale insulin (26.9%), clonazepam (9.5%), and periciazine (6.4%) using Beers criteria and spironolactone (10.3%), acetylsalicylic acid (9.8%), and periciazine (8.7%) using STOPP criteria. Neurology, infectious disease, and pneumology had the highest numbers of PIMs, and neurology, pneumology, and cardiology had a greater increase in PIMs during hospitalization than the other specialties., Conclusion: This study demonstrates the high and growing prevalence of PIMs in the hospital environment, according to Beers and STOPP criteria. Educational measures and specific pharmaceutical interventions for each specialty are needed to change this situation., (© 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.)

Our aim was to systematically review the prevalence of body dysmorphic disorder (BDD) in a variety of settings. Weighted prevalence estimate and 95% confidence intervals in each study were calculated. The weighted prevalence of BDD in adults in the community was estimated to be 1.9%; in adolescents 2.2%; in student populations 3.3%; in adult psychiatric inpatients 7.4%; in adolescent psychiatric inpatients 7.4%; in adult psychiatric outpatients 5.8%; in general cosmetic surgery 13.2%; in rhinoplasty surgery 20.1%; in orthognathic surgery 11.2%; in orthodontics/cosmetic dentistry settings 5.2%; in dermatology outpatients 11.3%; in cosmetic dermatology outpatients 9.2%; and in acne dermatology clinics 11.1%. Women outnumbered men in the majority of settings but not in cosmetic or dermatological settings. BDD is common in some psychiatric and cosmetic settings but is poorly identified., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Introduction: This study measured the following: violence rates against chronic pain care providers (CPCPs), character/context/risk factors for violence and CPCPs' mitigation strategies., Method: An e-mail survey was sent to members of the American Society of Interventional Pain Physicians (ASIIP) to collect demographics, rates/type of violence, injury, risk mitigation, and context of violence. Correlation with demographic factors calculated using one-way ANOVA and χ2 test (Fisher test)., Results: Security was called by 64.85% of CPCPs and 51.52% received threats. The threats involved a gun 7.05% of the time. Injury was reported by 2.73% of CPCPs. The most common risk mitigation was discharging patient (85.33%). Others used protective equipment (16.89%) of which a significant percentage carried a gun (54%). Opioid management was the highest context for violence (89.9%; P < 0.0001). Those who practiced part-time were more likely to be harmed (P = 0.0290). Females were less likely to be threatened (P = 0.0507). Anesthesiology was the most threatened vs other specialties (P = 0.0215). Urban practices were less likely to move or close the practice (P = 0.0292)., Conclusion: CPCPs were at high risk for violence. Risk factors were older age, male, working part time, and anesthesiology. Risk was highest in the context of opioid management and disability. Discharging patient was the most common risk mitigation. A significant number of physicians carried firearms., (Wiley Periodicals, Inc.)

Objectives: Electronic physician claims databases are widely used for chronic disease research and surveillance, but quality of the data may vary with a number of physician characteristics, including payment method. The objectives were to develop a prediction model for the number of prevalent diabetes cases in fee-for-service (FFS) electronic physician claims databases and apply it to estimate cases among non-FFS (NFFS) physicians, for whom claims data are often incomplete., Design: A retrospective observational cohort design was adopted., Setting: Data from the Canadian province of Newfoundland and Labrador were used to construct the prediction model and data from the province of Manitoba were used to externally validate the model., Participants: A cohort of diagnosed diabetes cases was ascertained from physician claims, insured resident registry and hospitalisation records. A cohort of FFS physicians who were responsible for the diagnosis was ascertained from physician claims and registry data., Primary and Secondary Outcome Measures: A generalised linear model with a γ distribution was used to model the number of diabetes cases per FFS physician as a function of physician characteristics. The expected number of diabetes cases per NFFS physician was estimated., Results: The diabetes case cohort consisted of 31,714 individuals; the mean cases per FFS physician was 75.5 (median = 49.0). Sex and years since specialty licensure were significantly associated (p < 0.05) with the number of cases per physician. Applying the prediction model to NFFS physician registry data resulted in an estimate of 18,546 cases; only 411 were observed in claims data. The model demonstrated face validity in an independent data set., Conclusions: Comparing observed and predicted disease cases is a useful and generalisable approach to assess the quality of electronic databases for population-based research and surveillance., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objective: The objective of this study is to estimate the amount of severe drug-drug interaction warnings per medical specialist group triggered by prescribed drugs of a patient before and after the introduction of a nationwide eMedication system in Austria planned for 2015., Methods: The estimations of interaction warnings are based on patients' prescriptions of a single health care professional per patient, as well as all patients' prescriptions from all visited health care professionals. We used a research database of the Main Association of Austrian Social Security Organizations that contains health claims data of the years 2006 and 2007., Results: The study cohort consists of about 1 million patients, with 26.4 million prescribed drugs from about 3,400 different health care professionals. The estimation of interaction warnings show a heterogeneous pattern of severe drug-drug-interaction warnings across medical specialist groups., Conclusion: During an eMedication implementation it must be taken into consideration that different medical specialist groups require customized support.

Purpose of Review: Lifestyle medicine is a new discipline that has recently emerged as a systematized approach for management of chronic disease. The practice of lifestyle medicine requires skills and competency in addressing multiple health risk behaviours and improving self-management. Targets include diet, physical activity, behaviour change, body weight control, treatment plan adherence, stress and coping, spirituality, mind body techniques, tobacco and substance abuse. This review focuses on the impact of a healthy lifestyle on chronic disease, the rarity of good health and the challenges of implementing a lifestyle medicine programme., Recent Findings: Unhealthy lifestyle behaviours are at the root of the global burden of noncommunicable diseases and account for about 63% of all deaths. Over the past several years, there has been an increased interest in evaluating the benefit of adhering to 'low-risk lifestyle' behaviours and ideal 'cardiovascular health metrics'. Although a healthy lifestyle has repeatedly been shown to improve mortality, the population prevalence of healthy living remains low., Summary: Lifestyle medicine presents a new and challenging approach to address the prevention and treatment of noncommunicable diseases, the most important and prevalent causes for increased morbidity and mortality worldwide.

Background: The prevalence of atrial fibrillation (AF) continues to increase; however, there are limited data describing the division of care among practitioners in the community and whether care differs depending on provider specialty., Methods and Results: Using the Outcomes Registry for Better Informed Treatment of AF (ORBIT-AF) Registry, we described patient characteristics and AF management strategies in ambulatory clinic practice settings, including electrophysiology (EP), general cardiology, and primary care. A total of 10 097 patients were included; of these, 1544 (15.3%) were cared for by an EP provider, 6584 (65.2%) by a cardiology provider, and 1969 (19.5%) by an internal medicine/primary care provider. Compared with those patients who were cared for by cardiologists or internal medicine/primary care providers, patients cared for by EP providers were younger (median age, 73 years [interquartile range, IQR, 64, 80 years, Q1, Q3] versus 75 years [IQR, 67, 82 years] for cardiology and versus 76 years [IQR, 68, 82 years] for primary care). Compared with cardiology and internal medicine/primary care providers, EP providers used rhythm control (versus rate control) management more often (44.2% versus 29.7% and 28.8%, respectively, P<0.0001; adjusted odds ratio [OR] EP versus cardiology, 1.66 [95% confidence interval, CI, 1.05 to 2.61]; adjusted OR for internal medicine/primary care versus cardiology, 0.91 [95% CI, 0.65 to 1.26]). Use of oral anticoagulant therapy was high across all providers, although it was higher for cardiology and EP providers (overall, 76.1%; P=0.02 for difference between groups)., Conclusions: Our data demonstrate important differences between provider specialties, the demographics of the AF patient population treated, and treatment strategies-particularly for rhythm control and anticoagulation therapy.

The aim of this article is to make a contribution to the regional reflection with regard to autism spectrum disorders (ASDs) at a key moment in which the authorities are requested by the users, professionals in the fields of health, pedagogy and education to put forward a structured answer to a multitude of expressed needs. The question for the creation of a competence pole of an academic tertiary level is posed in order to advise in the best possible way the families who do not know how to orient themselves in the maze and contradictions of the proposed solutions and to help the professionals who are submerged by an ever increasing demand of services exceeding the means of the existing institutions and who cannot justify their choices among the various existing theoretical and scientific models.

Understanding the prevalence of cancer-related visits by physician specialty may help target educational and quality improvement initiatives. Using the 1997-2006 National Ambulatory Medical Care Survey, adult ambulatory visits (N = 161,278) were classified by cancer diagnosis and patients' characteristics and compared with physician specialty. The prevalence of cancer visits within each specialty varied from 0% to 62%. Aside from hematology/oncology (hem/onc) specialties, nine surgical specialties and four medical specialties had more than 1% cancer visits. Cancer patients with private insurance or Medicaid coverage were less likely to see hem/onc specialists compared to Medicare patients. Whereas hem/onc specialists primarily see cancer patients, general surgeons and primary care physicians provide a large amount of cancer services, particularly to underinsured patients. Thus, when trying to contact cancer patients or their physicians, health administrators, researchers, and practitioners should consider targeting general surgeons and primary care physicians in addition to hem/onc specialists.

Objective: To investigate the role of clinical and socioeconomic variables as determinants of adherence to recommended diabetes care guidelines and assess differences in the process of care between diabetologists and general practitioners., Research Design and Methods: We identified diabetic residents in Torino, Italy, as of 31 July 2003, using multiple independent data sources. We collected data on several laboratory tests and specialist medical examinations registered during the subsequent 12 months and performed regression analyses to identify associations with quality-of-care indicators based on existing guidelines., Results: After 1 year, only 35.8% of patients had undergone a comprehensive assessment. In the multivariate models, factors independently and significantly associated with lower quality of care were age >or=75 years (prevalence rate ratio [PRR] 0.66 [95% CI 0.61-0.70]) and established cardiovascular disease (0.89 [0.86-0.93]). Disease severity (PRR for insulin-treated patients 1.45 [1.38-1.53]) and diabetologist consultation (PRR 3.34 [3.17-3.53]) were positively associated with high quality of care. No clear association emerged between sex and socioeconomic status. These differences were strongly reduced in patients receiving diabetologist care compared with patients receiving general practitioner care only., Conclusions: Despite widespread availability of guidelines and simple screening procedures, a nonnegligible portion of the diabetic population, namely elderly individuals and patients with less severe forms of the disease, are not properly cared for. As practitioners in diabetes centers are more likely to adhere to guidelines than general practitioners, quality in the diabetes care process can be improved by increasing the intensity of disease management programs, with greater participation by general practitioners.

Objectives: There have been relatively few detailed reports on the sociodemographic and clinical characteristics of bipolar disorder in large outpatient clinical samples. This paper reports on findings from the Black Dog Institute Bipolar Disorders Clinic (BDI-BDC) and compares this dataset with the predominantly outpatient Stanley Foundation Bipolar Disorders Network (SFBN) and Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) samples., Methods: A total of 217 patients with DSM-IV bipolar disorder were assessed in detail in the BDI-BDC using a series of standardized and non-standardized structured interviews. Ninety per cent had bipolar I disorder, and 10% bipolar II disorder. This sample was compared with the SFBN and STEP-BD datasets., Results: The sociodemographic characteristics of the three samples were remarkably similar. Female gender and younger age were overrepresented compared to the general population. Functional impairment, indicated by marital status and labour force participation, was clearly more common among the study subjects than in the general population. In all three samples, prior educational attainment was higher than the general population. With respect to clinical features, approximately half of each sample was euthymic and approximately one-third was in a DSM-IV episode of depression at study entry. One-half reported depression as their first episode of mood disturbance. Similar proportions identified positive family histories of bipolar disorder (40%) and unipolar depression (55%). Other clinical characteristics demonstrated more variation between the samples. The STEP-BD population reported an earlier age of onset. The SFBN subjects reported higher numbers of overall episodes, but psychotic features and suicide attempts were less common than in the BDI-BDC sample., Conclusions: This report highlights the marked commonalities of the sociodemographic and clinical characteristics of patients with bipolar disorder recruited predominantly in the outpatient setting in three different continents, that is, Australia, North America and Europe. It also demonstrates some critical distinctions between such samples, emphasizing the need to be aware of these differences when interpreting findings, such as treatment outcome, from different bipolar disorder datasets.

Objectives: To describe the prevalence of burnout syndrome according to medical specialty and to examine the impact of work psychosocial risk factors, job satisfaction and professional characteristics on burnout syndrome among specialist physicians throughout Spain., Methods: A cross-sectional survey was carried out among 1,021 Spanish physicians. The outcome variables were the 3 dimensions of burnout syndrome: emotional exhaustion, depersonalization, and personal accomplishment. The explanatory variables were work psychosocial risk factors and job satisfaction evaluated by a stress scale specifically designed for physicians. Adjusted odds ratios and their 95% confidence intervals were calculated by logistic regression., Results: The probability of high emotional exhaustion and depersonalization were greater in physicians exposed to a high level of contact with suffering and death and to a negative impact of work on home life. The probability of high emotional exhaustion was greater among physicians with a high work overload. The risk of low personal accomplishment was higher among physicians with low professional satisfaction and those without training activities. Dissatisfaction with relationships with patients and relatives had a negative effect on the 3 dimensions of burnout., Conclusions: Psychosocial work environment and job satisfaction have a negative effect on burnout syndrome, especially on emotional exhaustion and depersonalization.

Objectives: To estimate the extent, nature and consequences of adverse events in a large National Health Service (NHS) hospital, and to evaluate the reliability of a two-stage casenote review method in identifying adverse events., Design: A two-stage structured retrospective patient casenote review., Setting: A large NHS hospital in England., Population: A random sample of 1006 hospital admissions between January and May 2004: surgery (n = 311), general medicine (n = 251), elderly (n = 184), orthopaedics (n = 131), urology (n = 61) and three other specialties (n = 68)., Main Outcome Measures: Proportion of admissions with adverse events, the proportion of preventable adverse events, and the types and consequences of adverse events., Results: 8.7% (n = 87) of the 1006 admissions had at least one adverse event (95% CI 7.0% to 10.4%), of which 31% (n = 27) were preventable. 15% of adverse events led to impairment or disability which lasted more than 6 months and another 10% contributed to patient death. Adverse events led to a mean increased length of stay of 8 days (95% CI 6.5 to 9). The sensitivity of the screening criteria in identifying adverse events was 92% (95% CI 87% to 96%) and the specificity was 62% (95% CI 53% to 71%). Inter-rater reliability for determination of adverse events was good (kappa = 0.64), but for the assessment of preventability it was only moderate (kappa = 0.44)., Conclusion: This study confirms that adverse events are common, serious and potentially preventable source of harm to patients in NHS hospitals. The accuracy and reliability of a structured two-stage casenote review in identifying adverse events in the UK was confirmed.

Objective: To assess the opinion of pediatric infectious disease (PID) specialists regarding the management of culture-negative acute hematogenous osteomyelitis., Methods: A questionnaire that included a hypothetical case scenario of a 4-year-old boy with culture-negative osteomyelitis was distributed via a Web-based system to PID specialists across the United States., Results: Of 481 eligible participants surveyed, 147 (31%) responded. For initial therapy of osteomyelitis, 37% of respondents chose a beta-lactam, 24% chose clindamycin, 10% chose vancomycin as the sole therapy, and 29% chose a combination of these. The initial choice of antibiotics was correlated with the reported incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in the institution (P < 0.01). In areas where the prevalence of CA-MRSA was intermediate (between 25% and 50%), the choice of antibiotics was more heterogeneous. For change from intravenous to oral therapy, approximately 70% of respondents would change to oral therapy sooner than 3 weeks depending on clinical, laboratory, and social factors. After significant clinical and laboratory (sedimentation rate and C-reactive protein) improvements, most respondents (69%) chose to treat for a total duration (intravenous and oral) of 3 to 4 weeks., Conclusions: This study illustrates that the empiric choice of antibiotics for treatment of acute hematogenous osteomyelitis was driven by the local prevalence of CA-MRSA. When the prevalence of CA-MRSA was intermediate, the recommendations for management of bone infections were more heterogeneous. Clinical trials are needed to compare the effect of different management strategies on outcome, side effects, and costs., Level of Evidence: Level V.

Objectives: To evaluate the familiarity with and utilization of tobacco treatment resources among physicians., Methods: The NJ State Physician Census was mailed to 30,639 physicians with 8150 responding (26.6%). Data from 4598 direct patient-care physicians were analyzed., Results: Pulmonologists, cardiologists, and family physicians had the highest levels of familiarity and referral, whereas psychiatrists, neurologists, ophthalmologists, and surgeons had the lowest. Physicians who were younger, female, who had more teaching hours, and who accepted fewer new patients all had higher familiarity., Conclusions: Familiarity with tobacco dependence treatment resources varies by physician characteristics. Increasing physicians' utilization of these resources is an important research priority.

Background: Migraine is one of the commonest of headache disorders presenting to neurologists the world over. Though the precise etiopathogenesis of migraine is still not completely understood, there are various studies speculating on the role of different genetic loci and various patterns of inheritance., Objective: The present study was conducted to characterize the migraineurs presenting to a referral hospital in India and understand their possible modes of inheritance by clinical evaluation of family pedigree., Methods: A questionnaire based, prospective study including consecutive patients was conducted in the department of Neurology at a tertiary referral center in India. All patients fulfilling the diagnostic criteria for migraine were enrolled and their characteristics noted. Other family members of those with a positive history of headache were also interviewed., Results: A total of 198 migraineurs were interviewed from March 2001 to July 2002. The proportion of female migraineurs was higher, comprising 72% of the study group, with an average age of onset of symptoms of 23.3 years. The characteristics of migraine noted revealed certain rare factors aggravating headache. A positive family history of headache was observed in 24.7% of probands with a possible maternal inheritance on clinical grounds in 29 of 41 families (70.7%)., Conclusions: This is an observational study from an Indian centre on the clinical characteristics of migraineurs in India. It revealed that migraineurs presented a relatively low frequency of family history of headache. Though a definite pattern of inheritance can't be commented on, majority with a positive family history of headache had a trend to possible maternal inheritance.

Objective: To examine the characteristics of alcohol and other drug (AOD) specialist treatment agencies, their workforce and workforce development issues., Methods: A national survey of AOD specialist treatment agency managers was conducted using the Clients of Treatment Service Agencies (COTSA) database as the sampling framework. Agency managers across Australia were surveyed by phone or electronically between April and October 2002. Qualitative and quantitative data were collected. Two hundred and thirty-four managers participated, representing 318 agencies, and a response rate of 65%. More than 50% of managers from each State and Territory participated in the study., Results: The study found a high prevalence of alcohol-related problems. Managers estimated 45% of clients nominated alcohol as their primary problematic drug and that 53% of poly-drug clients identified alcohol-related problems. Managers reported increasingly complex client needs such as co-occurring substance and mental health issues. A harm minimisation treatment approach was supported by more than three-quarters of AOD agencies. The majority of the AOD workforce were trained professionals and consisted of nurses (26%), general AOD workers (19%) and psychologists (9%). Approximately half the sample had been in their current managerial role for less than five years. Key workforce development issues identified were education and training, funding, and staff recruitment and retention., Conclusion: More information is required on the key characteristics of the AOD workforce and their workforce development needs. Such information can contribute to policies and strategies that develop the capacity of the AOD sector to manage and treat the increasingly complex needs of clients.

Background: Plantar fasciitis is a relatively common disorder of the foot, yet little is known about its prevalence, what types of physicians see patients with the disorder, or how, on a national scale, patients are typically managed. The purpose of this study was to generate national estimates of the volume of patient visits and characteristics of care given to patients diagnosed with plantar fasciitis by medical doctors., Methods: Data from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) for the years 1995-2000 were studied. These are multistage probability sample surveys of visits to office-based physicians (NAMCS) and visits to nonfederal, short-stay, and general hospitals (NHAMCS) to consult doctors of medicine and doctors of osteopathy. Sample data have been weighted to produce national estimates. Data describing the number of patient visits for plantar fasciitis and the characteristics of the care given during those visits were summarized using univariate analyses. Data were combined for the 6-year period to increase the reliability of the estimates, and figures are presented as annual averages., Results: Approximately 1 million patient visits per year were made to office-based physicians and hospital outpatient departments for the diagnosis and treatment of plantar fasciitis during 1995-2000. Approximately 62% of all visits were made to primary care practitioners, and 31% were made to orthopaedic surgeons. Patient visits for plantar fasciitis accounted for approximately 1% of all patient visits to orthopedic surgeons. Pain medication, including nonsteroidal anti-inflammatory drugs (NSAIDs), was the most frequently used intervention (47% of visits). Exercise counseling was cited at 26% of visits, and physical therapy was ordered or provided at 19% of visits., Conclusions: This research suggests that plantar fasciitis is a relatively common disorder that is seen by several physician specialties. The disorder is not managed in a consistent way. Rather, there appears to be a large amount of variation in the way that these patients are managed. These findings support the argument that additional research is needed to identify effective interventions for plantar fasciitis and to determine if physician specialty influences treatment outcome.

Objectives: The aims of this study were to examine emotional distress and infertility-related concerns in male and female members of couples referred to a specialist infertility clinic and to determine changes in these over time., Methods: A prospective cohort study with a 6-month follow-up. Emotional distress was measured using the Hospital Anxiety and Depression Scale, and concerns by a specially designed questionnaire., Results: The response rate achieved was 38%. At baseline, 25.7% of women and 8.9% of men had scores of greater than 10 on the Hospital Anxiety and Depression Scale (HADS) Anxiety subscale, and 2.7% of women and 1.8% of men had scores of greater than 10 on the HADS Depression subscale. At 6-month follow-up the HADS scores were substantially unchanged. Females reported a significantly greater infertility-related concerns regarding life satisfaction, sexuality, self-blame, self-esteem and avoidance of friends compared with males., Conclusions: The prevalence of emotional disorder identified was low. There were gender differences in the nature of the specific concerns reported. The degree of distress and concerns did not change significantly over time. There are a minority of patients, mainly females, with clinically significant distress and infertility-related concerns amongst patients attending infertility clinics who deserve psychological attention.

Background: Treatment of the cancer patient is multifaceted. In addition to treating the cancer itself, there are additional important, "noncancer" issues to consider concomitantly, such as the patient's coexistent diseases, their health behaviors, and preventive care measures. While the need for coordination among surgeons, oncologists, and radiation oncologists has been well documented for treatment of the cancer, little attention has been paid to the importance of "noncancer" issues. In an attempt to characterize such issues, we performed a study to describe the prevalence of comorbid diseases as well as other "noncancer" issues (i.e., presence of poor health habits and use of preventive care measures) for four common, surgically related cancers. Finally, we describe the use of provider resources for these cancer patients., Methods: Using a large population-based, nationwide patient survey, a cross-sectional analysis of lung, prostate, breast, and colon cancer patients who were less than 3 years from their diagnosis was performed. Prevalence of comorbid disease, health behaviors, receipt of preventive health care services, and contact with the health care system were characterized. Comparisons were made with a cohort of age-matched controls without cancer., Results: Three hundred one cancer patients (29 lung, 88 prostate, 119 breast, 65 colon) and 6745 control patients were analyzed. Among the cancer patients, 81% had a coexistent disease, with 59% reporting cardiovascular comorbidity and 17% reporting pulmonary comorbidity. The range of comorbidities was substantial: hypertension (24-48%), coronary disease (8-24%), angina (4-10%), myocardial infarction (8-31%), arrhythmia (8-19%), stroke (3-8%), emphysema (4-10%), asthma (5-12%), diabetes (8-18%), bronchitis (8-13%), renal insufficiency (3-6%), severe arthritic symptoms (34-57%). Of note, 27-39% of cancer patients continued to smoke tobacco (P = 0.03 vs controls), of whom 85% continued to smoke daily. Finally, the rates of preventive care influenza vaccinations in high-risk individuals for the cancer cohort was no higher than the rate in controls, even though the cancer patients saw a health professional significantly more often. Of note, the frequency of "specialists" and surgeon visits was significantly higher for the cancer cohort., Conclusion: To optimize cancer outcomes, successful treatment of both the cancer and the "noncancer" issues is required. This study demonstrates that the burden of coexistent diseases is considerable. We also found the prevalence of continued poor health behaviors (i.e., use of tobacco) as well as suboptimal performance of preventive care measures to be notable. Since cancer patients see specialists twice as often as controls, it appears paramount that specialists (surgeons included) maintain diligence in addressing patient comorbidities, health habits, and other "noncancer" measures. If the substantial rates of smoking and suboptimal performance of preventive care measures are an indication of the "noncancer" quality of care that is being provided to the typical cancer patient, then a more concerted effort by all providers needs to be made regarding these and other "noncancer" issues.

In this study, the authors used the University of Toronto's Health Survey self-administered questionnaire to determine discriminant validity of multiple chemical sensitivity definitions. The authors distributed a total of 4,126 questionnaires to adults who attended general, allergy, occupational, and environmental health practices. The authors then matched responses to features selected from existing case definitions posited by Thomson et al.; the National Research Council; Cullen; Ashford and Miller; Randolph; Nethercott et al.; and the 1999 Consensus (references 4-7, 2, 9, and 10, respectively, herein). The overall response rate was 61.7%. The prevalence of reported symptoms was lowest in general practices, was intermediate in occupational health and allergy practices, and was highest in environmental health practices. Features from the definitions presented by Nethercott et al. and the 1999 Consensus (references 9 and 10, respectively, herein) correctly identified more than 80% of environmental health practice patients and more than 70% of general practice patients. Combinations of 4 symptoms (i.e., having a stronger sense of smell than others, feeling dull/groggy, feeling "spacey," and having difficulty concentrating) also discriminated successfully. In summary, features from 2 of 7 case definitions assessed by the University of Toronto Health Survey achieved good discrimination and identified patients with an increased likelihood of multiple chemical sensitivity.

Objectives: This study aimed to estimate the prevalence and risk factors for medically unexplained symptoms across a variety of specialities., Methods: A cross-sectional survey was conducted at two general hospitals in southeast London between 1995 and 1997. Eight hundred and ninety consecutive new patients from seven outpatient clinics were included. Demographic and clinical characteristic variables were assessed., Results: Five hundred eighty-two (65%) of the subjects surveyed returned completed questionnaires. A final diagnosis was available in 550 (62%). Two hundred twenty-eight (52%) fulfilled criteria for medically unexplained symptoms. The highest prevalence was in the gynecology clinic (66%). After adjustment for confounders, medically unexplained symptoms were associated with being female, younger, and currently employed. Psychiatric morbidity per se was not associated with the presence of medically unexplained symptoms, but was more likely in those complaining of multiple symptoms. Those with medically unexplained symptoms were less disabled, but more likely to use alternative treatment in comparison with those whose symptoms were medically explained. Patients with medically unexplained symptoms were more likely to attribute their illness to physical causes as opposed to lifestyle factors., Conclusions: Medically unexplained symptoms are common across general/internal medicine and represent the most common diagnosis in some specialities. Medical behavior, training, and management need to take this into account.

Objective: The researchers tested the hypothesis that the frequency with which patients present to primary care physicians with certain types of health problems is inversely related to the chances of specialty referral during an office visit., Study Design: Cross-sectional analysis., Population: The researchers used a data set composed of 78,107 primary care visits from the 1989 to 1994 National Ambulatory Medical Care Surveys. The physicians completed questionnaires after office visits., Outcomes Measured: The frequency of a health problem's presentation to primary care (practice prevalence) was defined as the percentage of all visits made to family physicians, general internists, and general pediatricians for that particular problem. The researchers estimated the correlation between a condition's practice prevalence and its referral ratio (percentage of visits referred to a specialist) and used logistic regression to estimate the effect of practice prevalence on the chances of referral during a visit., Results: The practice prevalence of a condition and its referral rate had a strong inverse linear relationship (r=-0.87; P<.001). Compared with visits made for the uncommon problems, the odds of referral for those with intermediate or high practice prevalence were 0.49 (P=.004) and 0.22 (P<.001), respectively. Surgical conditions were referred more often than medical conditions, and a greater burden of comorbidities increased the odds of referral., Conclusions: Primary care physicians are more likely to make specialty referrals for patients with uncommon problems than those with common conditions This finding highlights the responsible judgment primary care physicians employ in recognizing the boundaries of their scope of practice. Practice prevalence is a defining feature of the primary care-specialty care interface.

Self-reported past year use of alcohol, tobacco, marijuana, cocaine, and two controlled prescription substances (opiates, benzodiazepines); and self-reported lifetime substance abuse or dependence was estimated and compared for 12 specialties among 5,426 physicians participating in an anonymous mailed survey. Logistic regression models controlled for demographic and other characteristics that might explain observed specialty differences. Emergency medicine physicians used more illicit drugs. Psychiatrists used more benzodiazepines. Comparatively, pediatricians had overall low rates of use, as did surgeons, except for tobacco smoking. Anesthesiologists had higher use only for major opiates. Self-reported substance abuse and dependence were at highest levels among psychiatrists and emergency physicians, and lowest among surgeons. With evidence from studies such as this one, a specialty can organize prevention programs to address patterns of substance use specific to that specialty, the specialty characteristics of its members, and their unique practice environments that may contribute risk of substance abuse and dependence.

The prevalence and causes of 'burnout' and psychiatric disorder among senior oncologists and palliative care specialists have been measured in a national questionnaire-based survey. All consultant non-surgical oncologists in the UK were asked to participate. Sources of work-related stress and satisfaction were measured using study-specific questions which were aggregated into factors. Psychiatric disorder was estimated using the 12-item General Health Questionnaire. The three components of 'burnout'--emotional exhaustion, depersonalisation and low personal accomplishment--were assessed using the Maslach Burnout Inventory. Three hundred and ninety-three out of 476 (83%) consultants returned their questionnaires. The estimated prevalence of psychiatric disorder in cancer clinicians was 28%, and this is similar to the rate among British junior house officers. The study group had equivalent levels of emotional exhaustion and low personal accomplishment to those found in American doctors and nurses, but lower levels of depersonalisation. Among cancer clinicians, 'burnout' was more prevalent among clinical oncologists than among medical oncologists and palliative care specialists. Psychiatric disorder was independently associated with the stress of feeling overloaded (P < 0.0001), dealing with treatment toxicity/errors (P < 0.004) and deriving little satisfaction from professional status/esteem (P = 0.002). 'Burnout' was also related to these factors, and in addition was associated with high stress and low satisfaction from dealing with patients, and with low satisfaction from having adequate resources (each at a level of P < or = 0.002). Clinicians who felt insufficiently trained in communication and management skills had significantly higher levels of distress than those who felt sufficiently trained. If 'burnout' and psychiatric disorder among cancer clinicians are to be reduced, increased resources will be required to lessen overload and to improve training in communication and management skills.

Objective: This study compares substance use by medical specialty among resident physicians., Method: The authors estimated the prevalence of substance use of 11 medical specialties from a national sample of 1,754 U.S. resident physicians., Results: Emergency medicine and psychiatry residents showed higher rates of substance use than residents in other specialties. Emergency medicine residents reported more current use of cocaine and marijuana, and psychiatry residents reported more current use of benzodiazepines and marijuana. Contrary to recent concerns, anesthesiology residents did not have high rates of substance use. Family/general practice, internal medicine, and obstetrics/gynecology were not among the higher or lower use groups for most substances. Surgeons had lower rates of substance use except for alcohol. Pediatric and pathology residents were least likely to be substance users., Conclusions: The authors' previous research indicates that residents overall have lower rates of substance use than their age peers in society. Yet resident substance use patterns do differ by specialty. Residents in some specialties are more likely to use specific classes of drugs, to use a greater number of drug classes, and to be daily users of alcohol or cigarettes.