The multi-sited practices (MSP) policy in China is expected to exert found implications upon uneven distribution of high-quality medical resources,coupled with the widespread phenomenon of physician's informal pra...The multi-sited practices (MSP) policy in China is expected to exert found implications upon uneven distribution of high-quality medical resources,coupled with the widespread phenomenon of physician's informal practices on multiple sites.Since 2009,the Chinese government has upheld a policy that allows medical doctors to take on secondary jobs for the purpose of encouraging talented physicians to work in medical institutions and underdeveloped areas where their expertise is badly needed.This paper focuses on the MSP policy in China by examining how it has been implemented at the national and provincial levels through a review of government documents,statistical information,academic papers,and newspaper accounts.Despite the MSP policy is to offer incentive to physicians at first-tier public hospitals to work in primary care centers or areas where their expertise,the evidence is hard to find.This paper identifies several outstanding challenges to the MSP policy:(1) The importance of the MSP policy which is made by the central government is perceived differently at the provincial level by health officials and hospital administrators;(2) Interest in implementing the policy varies among physicians and hospitals;(3) Concerns about quality control and legal responsibilities for medical doctors to take on secondary jobs are widespread.China's MSP policy differs from the 'dual practice' policy in many countries because of its top-down approach,with its emphasis on government's role and administrative intervention.This paper's findings may be useful for other developing countries where medical expertise is unevenly distributed due to market forces.On the special occasion of the Alma Ata Declaration's 40th anniversary and for the sake of promoting Universal Health Coverage,this paper also aims at sharing with other countries China's experience in trying to develop an adequate force of primary care professionals.At the end of this paper,a four-point proposal is made for policy makers in China.展开更多
Background: The aim of this study is to gain a better understanding of the true importance of trust in clinical practice by looking at how it is formed, how it affects clinical practice, and how to improve it. Methods...Background: The aim of this study is to gain a better understanding of the true importance of trust in clinical practice by looking at how it is formed, how it affects clinical practice, and how to improve it. Methods: Using the PRISMA-ScR checklist, a review of the literature was performed to identify research evaluating the importance of trust in the doctor-patient relationship. After thorough screening and removal of duplicates, 21 articles were used in the literature review. Results: The classifying themes that emerged in the selected articles were What Makes Trust and Effects of Trust. The theme of What Makes Trust garnered two subthemes as well: Impact of Doctor-Patient Relationship on Trust and Impact of Shared Decision-Making on Trust. Further to that, the overarching themes found were slightly more specific. They were Traits of Trust, Mistrust and Barriers to Trust, Positive Effects of Trust and the Effects of a Lack of Trust. We found that the best way to improve trust was to improve communication between the patient and the doctor. Additionally, we found that the biggest barrier to a trusting doctor patient relationship was a stigmatised condition, followed by a perception of a financially-motivated doctor. Finally, we found that a lack of trust can prevent patients from seeking and receiving proper treatment. Conclusions: With a better understanding of how trust is built and the extent of the role it plays in clinical practice, we hope that this growing knowledge can improve the practice of many doctors in the future. It is certain that more research needs to be done in this area, especially focusing on vulnerable and stigmatised populations such as chronic pain patients.展开更多
A cross-sectional online survey was conducted.A high proportion of the Chinese breast cancer(BC)physician respondents(n=77)would prescribe extended adjuvant endocrine therapy(AET)with aromatase inhibitors(AI)beyond 5 ...A cross-sectional online survey was conducted.A high proportion of the Chinese breast cancer(BC)physician respondents(n=77)would prescribe extended adjuvant endocrine therapy(AET)with aromatase inhibitors(AI)beyond 5 years for postmenopausal females with BC,especially those with higher risk.Respondents with≥15 years of clinical experience were more likely to prescribe a longer duration of AET for low-risk patients.Half of the respondents considered intermittent letrozole as an acceptable option.Most respondents would prescribe adjuvant chemotherapy to genomic high-intermediate risk[Oncotype DX recurrence score(RS)21-25]females aged≤50 years regardless of the clinical risk classification.展开更多
Doctors who request imaging must be well trained in deciding whether diagnostic imaging is indicated and have an accurate knowledge of the associated risks. Although radiological doses are low and the chance of late e...Doctors who request imaging must be well trained in deciding whether diagnostic imaging is indicated and have an accurate knowledge of the associated risks. Although radiological doses are low and the chance of late effect is minimal, it should be kept as low as reasonably achievable. This cannot be achieved without a proper knowledge and adherence to safe practices. This cross-sectional study investigates the level of physicians’ knowledge about radiation safety and their attitude towards radiation protection. A self-administered questionnaire, for radiation safety was sent to a purposive sample of 120 physicians at Suez Canal University Hospital. Eighty questionnaires were filled by participants (response rate;66.7%). The sample included 22 radiologists, 15 oncologists, 25 surgeons and 18 orthopedists. Most participants did not receive any radiation safety-related training (88.8%). Radiologists and oncologists were exposed to ionizing radiation more frequently;however, their knowledge was as low as that of other physicians. The overall knowledge score ranged from 40% - 60% (mean;56.5 ± 15.2), with a low score among surgeons and orthopedics. The most deficient knowledge was in the dose of background radiation and the radiation dose received by patients in each type of radiation procedure. Adherence to safe radiation practices was violated by most of participants, especially surgeons and orthopedics, but they attributed it to the poor applicability of the protective measures during performing the procedures. This study concluded that physicians at the Suez Canal University Hospital had deficient knowledge, unsafe practices and negative attitude towards radiation safety policies & precautions.展开更多
Background: Electroencephalography (EEG) is established for evaluating several acute and chronic medical conditions of neurological basis. In much of Nigeria and Africa, it is largely unavailable and underutilized due...Background: Electroencephalography (EEG) is established for evaluating several acute and chronic medical conditions of neurological basis. In much of Nigeria and Africa, it is largely unavailable and underutilized due to scarcity of neurologists and high costs of the equipment. It offers a relatively simple and efficient way to help manage many encephalopathies if well utilized in trained hands. Aim: This study aimed to determine how physicians practicing in Enugu perceive and utilize electroencephalography routinely. Method: Physicians attending a statewide meeting in Enugu in August 2018 were consecutively recruited and a pretested questionnaire was administered after obtaining prior consent. Sociodemographic data as well as their knowledge, attitude and practice of electroencephalography were documented and analyzed. Results: There were 486 respondents (males 335: females 151) and 345 (71%) were specialists in various disciplines while 141 (29%) were general practitioners. Only 7 doctors (1.4%) claimed ignorance of electroencephalography and 6 (1.2%) stated it was not useful. Majority, 333 doctors (69.1%) believed it had no impact on routine patient management. This perception was highest for Dental Surgery (100%) and lowest for Internal Medicine (23%) specialists. Most doctors (425, 87.4%) agreed that neurologists should analyze recordings. Most physicians had no access to electroencephalography (61.7%) and had no interest in acquiring the machine (50.8%). Conclusion: Electroencephalography is an underappreciated investigative modality amongst physicians in Enugu, despite a high burden of neurological diseases in the population. More education, training and awareness of its utility are needed for medical students and doctors to reverse the trend.展开更多
Background: Many clinical entities manifest early characteristic changes in the fundus of the eye. The value of fundoscopy cannot be overemphasized and every medical doctor is expected to be able to use the ophthalmos...Background: Many clinical entities manifest early characteristic changes in the fundus of the eye. The value of fundoscopy cannot be overemphasized and every medical doctor is expected to be able to use the ophthalmoscope to detect common pathological changes. However, more often than not fundoscopy is seen as an exclusive specialized skill of the ophthalmologist. Aim: The aim of this study was to evaluate knowledge and practice of fundoscopy among the physicians present at the Ordinary General Meeting of the Nigerian Medical Association (Rivers State branch) held in Port Harcourt on 30<sup>th</sup> June 2014. Methods: A self administered questionnaire about their knowledge and practice of fundoscopy was administered to 125 medical doctors attending the Ordinary General Meeting of the Nigerian Medical Association (Rivers State branch) held in Port Harcourt on 30<sup>th</sup> June 2014. Questions asked tested the Knowledge and Practice of the physicians on matters related to fundoscopy. Participants’ knowledge and practice were graded as Good for scores of 75% and above, Fair for 50% - 74% score and Poor for scores less than 50%. Respondents’ demographic data, responses and corresponding scores were entered into computer software—Scientific Package for Social Sciences (SPSS) version 20 and subsequently analyzed. Results: The study participants were 125 physicians;86 males and 39 females (M:F = 2.2:1). Twenty-eight percent of the study participants had good knowledge of fundoscopy while only 15% had good practice. Seventy eight physicians representing 62.4% of the participants could correctly refer patients with the need for fundoscopy to an ophthalmologist, whereas 11 (8.8%) worked in facilities without basic instrument for fundoscopy (ophthalmoscope). Conclusion: Our study demonstrates that knowledge and practice of fundoscopy among medical practitioners in Port Harcourt is poor and far from ideal. Therefore, refresher courses emphasizing the acquisition of the skill in fundoscopy and the provision of ophthalmoscopes in our General Practitioners’ clinics are necessary.展开更多
Introduction: Intraoperative nerve monitoring is used in otolaryngology to assist in identification of nerves at risk. It is hoped that this will lead to lower rates of nerve injury. The objective of this study was to...Introduction: Intraoperative nerve monitoring is used in otolaryngology to assist in identification of nerves at risk. It is hoped that this will lead to lower rates of nerve injury. The objective of this study was to quantify the use of monitoring technology in current clinical practice. Method: An electronic survey was distributed to 376 registered fellows of the Australian Society of Head and Neck Surgery. Results: One-hundred and twenty-five responses were obtained. The majority of respondents report using monitoring at least some of the time during thyroid, parotid, and mastoid surgery (80%, 87%, and 73% respectively). Predictors of use include experience with intraoperative monitoring during training, and high caseloads in parotid surgery. Practice setting did not predict use. Conclusion: Despite equivocal evidence that intraoperative nerve monitoring is associated with a reduction in nerve injuries, this study demonstrates that the technology is widely used amongst otolaryngologists.展开更多
目的近年来,临床规范化培训中住培医师职业倦怠度及其影响因素受到广泛关注,而其与心理弹性的关联仍缺乏正式研究;因此,该研究旨在调查骨科住培医师心理弹性和职业倦怠的关联性以及探究改善职业倦怠的方法。方法2021年6月—2022年1月,...目的近年来,临床规范化培训中住培医师职业倦怠度及其影响因素受到广泛关注,而其与心理弹性的关联仍缺乏正式研究;因此,该研究旨在调查骨科住培医师心理弹性和职业倦怠的关联性以及探究改善职业倦怠的方法。方法2021年6月—2022年1月,采用中国成年人心理弹性量表(resilient trait scale for Chinese adults,RTSCA)和马斯拉奇职业倦怠综合量表(Maslach burnout inventory general survey,MBI-GS)分别用于评估华东地区3所医院(浙江大学医学院附属第二医院、上海交通大学附属第六人民医院和苏州大学附属第一医院)总计400名骨科住培医师的心理弹性和职业倦怠水平。结果本次调查共完成322份在线和纸质调查,其中纸质调查回应率为42.0%(168/400)。心理内控性是情绪衰竭和人格障碍的重要预测因子(P<0.001);与男性相比,女性更容易体验情绪衰竭(P<0.001),可能与应对问题的方式不同有关(P<0.05);善于接受和运用社会支持以及良好的心理接纳性有助于防止人格障碍的发生(P<0.001);而注重问题解决的应对和乐观性能够提升个人成就感(P<0.001)。结论该研究揭示了骨科住培医师心理弹性和职业倦怠度现状以及二者之间的关系,以期为提高医生心理弹性、改善临床医生职业倦怠水平提供必要的建议和理论支持。展开更多
AIM: To investigate Chinese physicians' awareness of the 2010 guidelines on the treatment of chronic hepatitis B virus(HBV) infection.METHODS: This was a quantitative survey that investigated the characteristics a...AIM: To investigate Chinese physicians' awareness of the 2010 guidelines on the treatment of chronic hepatitis B virus(HBV) infection.METHODS: This was a quantitative survey that investigated the characteristics and practices of physicians who were treating patients with hepatitis B, the profile of their patients and physician practices regarding the diagnosis and treatment of HBV at the time of the survey. Participants were randomly selected from available databases of Chinese physicians and requested to complete either an online or paper-based survey. Data from the survey responses were analysed. For data validation and interpretation, qualitative in-depth interviews were conducted with 39 of the respondents.RESULTS: Five-hundred completed surveys, from 663 physicians were available for analysis. A mean of 175 chronic hepatitis B(CHB) patients was seen by each physician every month, of whom 85(49%) were treated in line with therapeutic indications stated in the 2010 guidelines. A total of 444(89%) physicians often(> 60% of the time) adhered to the guidelines. Most physicians used antiviral medications as recommended. For patients with compensated and decompensated cirrhosis, 342(68%) and 336(67%) of physicians, respectively, often followed the recommendation to use potent nucleos(t)ide analogues with a high genetic barrier to resistance, using the appropriate treatment more than 60% of the time. Physicians from infectious disease or liver disease departments were better informed than those from gastrointestinal or other departments.CONCLUSION: The majority of Chinese physicians often adhere to Chinese 2010 CHB guidelines and are well-informed about the use of antiviral medications for hepatitis B.展开更多
文摘The multi-sited practices (MSP) policy in China is expected to exert found implications upon uneven distribution of high-quality medical resources,coupled with the widespread phenomenon of physician's informal practices on multiple sites.Since 2009,the Chinese government has upheld a policy that allows medical doctors to take on secondary jobs for the purpose of encouraging talented physicians to work in medical institutions and underdeveloped areas where their expertise is badly needed.This paper focuses on the MSP policy in China by examining how it has been implemented at the national and provincial levels through a review of government documents,statistical information,academic papers,and newspaper accounts.Despite the MSP policy is to offer incentive to physicians at first-tier public hospitals to work in primary care centers or areas where their expertise,the evidence is hard to find.This paper identifies several outstanding challenges to the MSP policy:(1) The importance of the MSP policy which is made by the central government is perceived differently at the provincial level by health officials and hospital administrators;(2) Interest in implementing the policy varies among physicians and hospitals;(3) Concerns about quality control and legal responsibilities for medical doctors to take on secondary jobs are widespread.China's MSP policy differs from the 'dual practice' policy in many countries because of its top-down approach,with its emphasis on government's role and administrative intervention.This paper's findings may be useful for other developing countries where medical expertise is unevenly distributed due to market forces.On the special occasion of the Alma Ata Declaration's 40th anniversary and for the sake of promoting Universal Health Coverage,this paper also aims at sharing with other countries China's experience in trying to develop an adequate force of primary care professionals.At the end of this paper,a four-point proposal is made for policy makers in China.
文摘Background: The aim of this study is to gain a better understanding of the true importance of trust in clinical practice by looking at how it is formed, how it affects clinical practice, and how to improve it. Methods: Using the PRISMA-ScR checklist, a review of the literature was performed to identify research evaluating the importance of trust in the doctor-patient relationship. After thorough screening and removal of duplicates, 21 articles were used in the literature review. Results: The classifying themes that emerged in the selected articles were What Makes Trust and Effects of Trust. The theme of What Makes Trust garnered two subthemes as well: Impact of Doctor-Patient Relationship on Trust and Impact of Shared Decision-Making on Trust. Further to that, the overarching themes found were slightly more specific. They were Traits of Trust, Mistrust and Barriers to Trust, Positive Effects of Trust and the Effects of a Lack of Trust. We found that the best way to improve trust was to improve communication between the patient and the doctor. Additionally, we found that the biggest barrier to a trusting doctor patient relationship was a stigmatised condition, followed by a perception of a financially-motivated doctor. Finally, we found that a lack of trust can prevent patients from seeking and receiving proper treatment. Conclusions: With a better understanding of how trust is built and the extent of the role it plays in clinical practice, we hope that this growing knowledge can improve the practice of many doctors in the future. It is certain that more research needs to be done in this area, especially focusing on vulnerable and stigmatised populations such as chronic pain patients.
文摘A cross-sectional online survey was conducted.A high proportion of the Chinese breast cancer(BC)physician respondents(n=77)would prescribe extended adjuvant endocrine therapy(AET)with aromatase inhibitors(AI)beyond 5 years for postmenopausal females with BC,especially those with higher risk.Respondents with≥15 years of clinical experience were more likely to prescribe a longer duration of AET for low-risk patients.Half of the respondents considered intermittent letrozole as an acceptable option.Most respondents would prescribe adjuvant chemotherapy to genomic high-intermediate risk[Oncotype DX recurrence score(RS)21-25]females aged≤50 years regardless of the clinical risk classification.
文摘Doctors who request imaging must be well trained in deciding whether diagnostic imaging is indicated and have an accurate knowledge of the associated risks. Although radiological doses are low and the chance of late effect is minimal, it should be kept as low as reasonably achievable. This cannot be achieved without a proper knowledge and adherence to safe practices. This cross-sectional study investigates the level of physicians’ knowledge about radiation safety and their attitude towards radiation protection. A self-administered questionnaire, for radiation safety was sent to a purposive sample of 120 physicians at Suez Canal University Hospital. Eighty questionnaires were filled by participants (response rate;66.7%). The sample included 22 radiologists, 15 oncologists, 25 surgeons and 18 orthopedists. Most participants did not receive any radiation safety-related training (88.8%). Radiologists and oncologists were exposed to ionizing radiation more frequently;however, their knowledge was as low as that of other physicians. The overall knowledge score ranged from 40% - 60% (mean;56.5 ± 15.2), with a low score among surgeons and orthopedics. The most deficient knowledge was in the dose of background radiation and the radiation dose received by patients in each type of radiation procedure. Adherence to safe radiation practices was violated by most of participants, especially surgeons and orthopedics, but they attributed it to the poor applicability of the protective measures during performing the procedures. This study concluded that physicians at the Suez Canal University Hospital had deficient knowledge, unsafe practices and negative attitude towards radiation safety policies & precautions.
文摘Background: Electroencephalography (EEG) is established for evaluating several acute and chronic medical conditions of neurological basis. In much of Nigeria and Africa, it is largely unavailable and underutilized due to scarcity of neurologists and high costs of the equipment. It offers a relatively simple and efficient way to help manage many encephalopathies if well utilized in trained hands. Aim: This study aimed to determine how physicians practicing in Enugu perceive and utilize electroencephalography routinely. Method: Physicians attending a statewide meeting in Enugu in August 2018 were consecutively recruited and a pretested questionnaire was administered after obtaining prior consent. Sociodemographic data as well as their knowledge, attitude and practice of electroencephalography were documented and analyzed. Results: There were 486 respondents (males 335: females 151) and 345 (71%) were specialists in various disciplines while 141 (29%) were general practitioners. Only 7 doctors (1.4%) claimed ignorance of electroencephalography and 6 (1.2%) stated it was not useful. Majority, 333 doctors (69.1%) believed it had no impact on routine patient management. This perception was highest for Dental Surgery (100%) and lowest for Internal Medicine (23%) specialists. Most doctors (425, 87.4%) agreed that neurologists should analyze recordings. Most physicians had no access to electroencephalography (61.7%) and had no interest in acquiring the machine (50.8%). Conclusion: Electroencephalography is an underappreciated investigative modality amongst physicians in Enugu, despite a high burden of neurological diseases in the population. More education, training and awareness of its utility are needed for medical students and doctors to reverse the trend.
文摘Background: Many clinical entities manifest early characteristic changes in the fundus of the eye. The value of fundoscopy cannot be overemphasized and every medical doctor is expected to be able to use the ophthalmoscope to detect common pathological changes. However, more often than not fundoscopy is seen as an exclusive specialized skill of the ophthalmologist. Aim: The aim of this study was to evaluate knowledge and practice of fundoscopy among the physicians present at the Ordinary General Meeting of the Nigerian Medical Association (Rivers State branch) held in Port Harcourt on 30<sup>th</sup> June 2014. Methods: A self administered questionnaire about their knowledge and practice of fundoscopy was administered to 125 medical doctors attending the Ordinary General Meeting of the Nigerian Medical Association (Rivers State branch) held in Port Harcourt on 30<sup>th</sup> June 2014. Questions asked tested the Knowledge and Practice of the physicians on matters related to fundoscopy. Participants’ knowledge and practice were graded as Good for scores of 75% and above, Fair for 50% - 74% score and Poor for scores less than 50%. Respondents’ demographic data, responses and corresponding scores were entered into computer software—Scientific Package for Social Sciences (SPSS) version 20 and subsequently analyzed. Results: The study participants were 125 physicians;86 males and 39 females (M:F = 2.2:1). Twenty-eight percent of the study participants had good knowledge of fundoscopy while only 15% had good practice. Seventy eight physicians representing 62.4% of the participants could correctly refer patients with the need for fundoscopy to an ophthalmologist, whereas 11 (8.8%) worked in facilities without basic instrument for fundoscopy (ophthalmoscope). Conclusion: Our study demonstrates that knowledge and practice of fundoscopy among medical practitioners in Port Harcourt is poor and far from ideal. Therefore, refresher courses emphasizing the acquisition of the skill in fundoscopy and the provision of ophthalmoscopes in our General Practitioners’ clinics are necessary.
文摘Introduction: Intraoperative nerve monitoring is used in otolaryngology to assist in identification of nerves at risk. It is hoped that this will lead to lower rates of nerve injury. The objective of this study was to quantify the use of monitoring technology in current clinical practice. Method: An electronic survey was distributed to 376 registered fellows of the Australian Society of Head and Neck Surgery. Results: One-hundred and twenty-five responses were obtained. The majority of respondents report using monitoring at least some of the time during thyroid, parotid, and mastoid surgery (80%, 87%, and 73% respectively). Predictors of use include experience with intraoperative monitoring during training, and high caseloads in parotid surgery. Practice setting did not predict use. Conclusion: Despite equivocal evidence that intraoperative nerve monitoring is associated with a reduction in nerve injuries, this study demonstrates that the technology is widely used amongst otolaryngologists.
文摘目的近年来,临床规范化培训中住培医师职业倦怠度及其影响因素受到广泛关注,而其与心理弹性的关联仍缺乏正式研究;因此,该研究旨在调查骨科住培医师心理弹性和职业倦怠的关联性以及探究改善职业倦怠的方法。方法2021年6月—2022年1月,采用中国成年人心理弹性量表(resilient trait scale for Chinese adults,RTSCA)和马斯拉奇职业倦怠综合量表(Maslach burnout inventory general survey,MBI-GS)分别用于评估华东地区3所医院(浙江大学医学院附属第二医院、上海交通大学附属第六人民医院和苏州大学附属第一医院)总计400名骨科住培医师的心理弹性和职业倦怠水平。结果本次调查共完成322份在线和纸质调查,其中纸质调查回应率为42.0%(168/400)。心理内控性是情绪衰竭和人格障碍的重要预测因子(P<0.001);与男性相比,女性更容易体验情绪衰竭(P<0.001),可能与应对问题的方式不同有关(P<0.05);善于接受和运用社会支持以及良好的心理接纳性有助于防止人格障碍的发生(P<0.001);而注重问题解决的应对和乐观性能够提升个人成就感(P<0.001)。结论该研究揭示了骨科住培医师心理弹性和职业倦怠度现状以及二者之间的关系,以期为提高医生心理弹性、改善临床医生职业倦怠水平提供必要的建议和理论支持。
文摘AIM: To investigate Chinese physicians' awareness of the 2010 guidelines on the treatment of chronic hepatitis B virus(HBV) infection.METHODS: This was a quantitative survey that investigated the characteristics and practices of physicians who were treating patients with hepatitis B, the profile of their patients and physician practices regarding the diagnosis and treatment of HBV at the time of the survey. Participants were randomly selected from available databases of Chinese physicians and requested to complete either an online or paper-based survey. Data from the survey responses were analysed. For data validation and interpretation, qualitative in-depth interviews were conducted with 39 of the respondents.RESULTS: Five-hundred completed surveys, from 663 physicians were available for analysis. A mean of 175 chronic hepatitis B(CHB) patients was seen by each physician every month, of whom 85(49%) were treated in line with therapeutic indications stated in the 2010 guidelines. A total of 444(89%) physicians often(> 60% of the time) adhered to the guidelines. Most physicians used antiviral medications as recommended. For patients with compensated and decompensated cirrhosis, 342(68%) and 336(67%) of physicians, respectively, often followed the recommendation to use potent nucleos(t)ide analogues with a high genetic barrier to resistance, using the appropriate treatment more than 60% of the time. Physicians from infectious disease or liver disease departments were better informed than those from gastrointestinal or other departments.CONCLUSION: The majority of Chinese physicians often adhere to Chinese 2010 CHB guidelines and are well-informed about the use of antiviral medications for hepatitis B.
