Hypertension Attitude PersPEctives and Needs (HAPPEN): A Real-World Survey of Physicians and Patients With Hypertension in China.
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SUBMITTER: Feldman RD
PROVIDER: S-EPMC5347891 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundGeneralized restriction of movement due to the COVID-19 pandemic, together with unprecedented pressure on the health system, has disrupted routine care for non-COVID-19 patients. Telemedicine should be vigorously promoted to reduce the risk of infections and to offer medical assistance to restricted patients.ObjectiveThe purpose of this study was to understand physicians' attitudes toward and perspectives of telemedicine during and after the COVID-19 pandemic, in order to provide support for better implementation of telemedicine.MethodsWe surveyed all physicians (N=148), from October 17 to 25, 2020, who attended the clinical informatics PhD program at West China Medical School, Sichuan University, China. The physicians came from 57 hospitals in 16 provinces (ie, municipalities) across China, 54 of which are 3A-level hospitals, two are 3B-level hospitals, and one is a 2A-level hospital.ResultsAmong 148 physicians, a survey response rate of 87.2% (129/148) was attained. The average age of the respondents was 35.6 (SD 3.9) years (range 23-48 years) and 67 out of 129 respondents (51.9%) were female. The respondents come from 37 clinical specialties in 55 hospitals located in 14 provinces (ie, municipalities) across Eastern, Central, and Western China. A total of 94.6% (122/129) of respondents' hospitals had adopted a telemedicine system; however, 34.1% (44/129) of the physicians had never used a telemedicine system and only 9.3% (12/129) used one frequently (≥1 time/week). A total of 91.5% (118/129) and 88.4% (114/129) of physicians were willing to use telemedicine during and after the COVID-19 pandemic, respectively. Physicians considered the inability to examine patients in person to be the biggest concern (101/129, 78.3%) and the biggest barrier (76/129, 58.9%) to implementing telemedicine.ConclusionsTelemedicine is not yet universally available for all health care needs and has not been used frequently by physicians in this study. However, the willingness of physicians to use telemedicine was high. Telemedicine still has many problems to overcome.
| S-EPMC8171288 | biostudies-literature
Project description:Coronavirus disease 2019 (COVID-19) has put a tremendous pressure over health care systems worldwide. Physicians were faced to fight this novel, emerging disease, without evidence-based recommendations. Our aim was to investigate physicians' point of view regarding the new coronavirus disease. We designed an on-line survey with 30 questions to assess physicians' perception of personal impact as well as epidemiology, clinical features, management, and outcome in COVID-19. A total of 194 physicians from 43 countries, of which 42.3% were male, 45.4% had more than 5 years' experience and 10.8% were heads of department/professors, filled-out the questionnaire. Although 47.4% of the physicians were currently treating patients, over 80% thought that they might get in contact with COVID-19 patients. A total of 36.6% physicians thought that they are not and 30.9% were not sure if they were being protected by the ongoing procedures. A total of 21.1% of the doctors felt that they are avoided by the persons with whom they usually interact in daily life and 24.7% were isolated from the household members they usually live with. A total of 72.7% of physicians considered that COVID-19-free patients are currently neglected. The results of the current survey raise awareness about the impact of COVID-19 on physicians' practice.
| S-EPMC7551682 | biostudies-literature
Project description:ObjectiveResearch suggests recently graduated urology residents do not feel ready for independent practice. We conducted a study to determine if Accreditation Council for Graduate Medical Education (ACGME) minimum case requirements, resident case logs, and graduating resident perceived readiness for practice are aligned with the procedural demand and needs of the current urology workforce.DesignCorrelative study comparing the association between (1) workforce demand and ACGME case requirements, and (2) workforce demand and perceived resident competency. Three distinct datasets were used; (1) the 2017 Medicare Part B National Summary Data File; (2) the 2017 National Data Report published by the ACGME; and (3) a graduating resident survey from Okhunov et al. SETTING: N/A.ParticipantsN/A.ResultsIn 2017, there were a total of 6,784,696 urologic cases performed through Medicare. We found nonsignificant positive associations between resident case logs (rho = 0.16, p = 0.5784), ACGME minimum procedure requirements (rho = 0.42, p = 0.1255), and Medicare procedural demand. Our 15 index procedures accounted for 21.1% (n = 1,431,775) of all Medicare cases, with a median number of 7706 procedures. Endopyelotomy was the least common procedure (n = 98), while cystoscopy was the most common (n = 980,623). Medicare case volume was positively correlated with graduating residents' procedural confidence (r = 0.86, p < 0.0001). We identified four categories with varied alignment of training and demand: (1) high volume and high confidence, (2) high volume and low confidence, (3) low volume and high confidence, and (4) low volume and low confidence.ConclusionsOptimizing urology residency training is time-sensitive and important. Using national Medicare data coupled with recently graduated urology resident survey results, we provide a guiding framework for improving the alignment of training with workforce demand. Informed by these results, we recommend altering training requirements to reflect these needs.
| S-EPMC7546236 | biostudies-literature
Project description:BackgroundHeadache disorders are widely prevalent and pose a considerable economic burden on individuals and society. Globally, misdiagnosis and inadequate treatment of primary headache disorders remain significant challenges, impeding the effective management of such conditions. Despite advancements in headache management over the last decade, a need for comprehensive evaluations of the status of primary headache disorders in China regarding diagnosis and preventative treatments persists.MethodsIn the present study, we analyzed the established queries in the Survey of Fibromyalgia Comorbidity with Headache (SEARCH), focusing on previous diagnoses and preventative treatment regimens for primary headache disorders. This cross-sectional study encompassed adults diagnosed with primary headache disorders who sought treatment at 23 hospitals across China between September 2020 to May 2021.ResultsThe study comprised 2,868 participants who were systematically examined. Migraine and tension-type headaches (TTH) constituted a majority of the primary headache disorders, accounting for 74.1% (2,124/2,868) and 23.3% (668/2,868) of the participants, respectively. Medication overuse headache (MOH) affected 8.1% (231/2,868) of individuals with primary headache disorders. Over half of the individuals with primary headache disorders (56.6%, 1,624/2,868) remained undiagnosed. The previously correct diagnosis rates for migraine, TTH, TACs, and MOH were 27.3% (580/2,124), 8.1% (54/668), 23.2% (13/56), and 3.5% (8/231), respectively. The misdiagnosis of "Nervous headache" was found to be the most prevalent among individuals with migraine (9.9%, 211/2,124), TTH (10.0%, 67/668), trigeminal autonomic cephalalgias (TACs) (17.9%, 10/56), and other primary headache disorders (10.0%, 2/20) respectively. Only a minor proportion of individuals with migraine (16.5%, 77/468) and TTH (4.7%, 2/43) had received preventive medication before participating in the study.ConclusionsWhile there has been progress made in the rate of correct diagnosis of primary headache disorders in China compared to a decade ago, the prevalence of misdiagnosis and inadequate treatment of primary headaches remains a veritable issue. As such, focused efforts are essential to augment the diagnosis and preventive treatment measures related to primary headache disorders in the future.
| S-EPMC10472552 | biostudies-literature
Project description:Improving work as part of clinical practice is challenging. Plans for improvement are often made, but not followed through. A recent experience of failure in an ICU led to a change in approach. Members of the multi-professional team committed to meet weekly to learn about quality improvement by working on improvement projects. The group selected four topics they wanted to work on. These were: a bundle for patients admitted with septic shock; early (≤4 hours) sedation vacation after admission to ICU to allow titration of sedation to effect; achieving ≥ 20 minutes of mobilisation per day in ventilated patients; and medicines reconciliation. This quality improvement meeting was built into another regular weekly meeting. Initially the meeting ran for 30 minutes; each week some focused quality improvement teaching was provided in addition to talking about each individual project. The team found the meeting useful, they saw the progress they were making but felt the allotted time was too short. After 6 weeks, the initial early results persuaded the team to increase the duration of this meeting to 45 minutes. At the start reliability of each process was low (between 10% and 38%). All four projects achieved their stated process reliability aim. This took between 165 and 334 days for each project. Many tests of change ideas were required to achieve this. We have been able to improve multiple topics in a short period and produce sustainable change. The weekly meeting provided the focus to this improvement work. The teaching and coaching on quality improvement methodology that occurred as part of this meeting helped accelerate our rate of progress. We believe this experience and the learning we have gained will help provide ideas for others who also want to improve healthcare delivery in different settings.
| S-EPMC4850863 | biostudies-other
Project description:The aim of this article is to help develop a common understanding of the current status, challenges, and future perspectives of real-world data (RWD) and real-world evidence (RWE) in Japan. RWD and RWE are very widely used terms, but standardized definitions are lacking. Given broad and growing applications of RWD/RWE from the perspective of clinical development and medical affairs, the PhRMA Japan Medical Affairs Committee Working Group 1 have proposed the following definitions: "RWD are the data relating to patient health status and/or the delivery of health care routinely collected from a variety of sources" and "RWE is the evidence derived from analysis of RWD." The key challenges for RWD and RWE in Japan include restricted access and linkage of RWD, as well as a lack of universally accepted methodological approaches, which reduces the potential for patient and healthcare benefits. These challenges for RWD/RWE are by no means unique to Japan and similar challenges exist for countries in Europe and the USA. The quality of data and analysis, study design, and the transparency of reporting should be discussed more to ensure credibility and acceptance by decision-makers as the demand for RWD and RWE increases. The future developments around Japan's RWD and RWE are expected to include improved RWD access, data linkage, and increased acceptance by decision-makers, all supported by innovative technology. Improvements in RWD access and database linkage will enable both public and private sectors to assemble more comprehensive health information in Japan.
| S-EPMC8605941 | biostudies-literature
Project description:Large-scale studies have not addressed the knowledge level of US resident physicians regarding osteoporosis management. We gauged the knowledge level of family medicine, internal medicine, and obstetrics and gynecology resident physicians regarding osteoporosis management. In 2019, we sent an anonymous survey via e-mail to all program directors of Accreditation Council for Graduate Medical Education-accredited residency programs in family medicine, internal medicine, and obstetrics and gynecology for distribution to resident physicians. Knowledge items assessed osteoporosis screening, diagnosis, and treatment. We received responses from 182 family medicine, 275 internal medicine, and 122 obstetrics and gynecology programs. Of 582 resident physician respondents, 31% were family medicine residents, 47% were internal medicine residents, and 21% were obstetrics and gynecology residents. Although 77% of respondents correctly selected the T-score threshold for the diagnosis of osteoporosis among persons aged 50 years and older (-2.5), only 20% of respondents correctly identified minimal-trauma hip fracture as being diagnostic of osteoporosis. One-third of respondents correctly identified which medications were demonstrated in clinical trials to decrease hip fracture risk. Fifteen percent of respondents correctly identified that denosumab and alendronate are associated with osteonecrosis of the jaw; and 40% of respondents correctly identified that decline in bone density is more rapid after discontinuation of denosumab than after discontinuation of bisphosphonates. Less than half of resident physicians knew that bisphosphonate-associated atypical femoral fractures are duration-dependent. One-quarter of respondents felt not at all prepared to manage osteoporosis. In this nationwide survey of resident physicians, knowledge regarding osteoporosis diagnosis and treatment was poor, with a striking lack of knowledge regarding the two most serious adverse effects of osteoporosis pharmacotherapy (osteonecrosis of the jaw and atypical femoral fractures). The undertreatment of osteoporosis is unlikely to improve without increased education of resident physicians. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
| S-EPMC8328797 | biostudies-literature
Project description: Not available
| S-EPMC5797980 | biostudies-literature
Project description:BackgroundPhysicians rely on blood culture to diagnose bloodstream infections (BSI) despite its limitations. As new technologies emerge for rapid BSI diagnosis, optimization of their application to patient care requires an understanding of clinicians' perspectives on BSI diagnosis and how a rapid test would influence medical decisions.MethodsWe administered a 26-question survey to practitioners in infectious diseases/microbiology, critical care, internal medicine, and hematology/oncology services in USA and Germany about current standards in diagnosing and treating BSI and a hypothetical rapid BSI test.ResultsResponses from 242 providers had roughly equal representation across specialties. For suspected BSI patients, 78% of practitioners would administer empiric broad spectrum antibiotics although they estimated, on average, that 31% of patients received incorrect antibiotics while awaiting blood culture results. The ability of blood culture to rule in or rule out infection was very/extremely acceptable in 67% and 36%, respectively. Given rapid test results, 60-87% of practitioners would narrow the spectrum of antimicrobial therapy depending on the microorganism detected, with significantly higher percentages when resistance determinants were also tested. Over half of respondents felt a rapid test would be very/extremely influential on clinical practice.ConclusionsLimitations of blood culture were perceived as a barrier to patient care. A rapid test to diagnose BSI would impact clinical practice, but the extent of impact may be limited by prevailing attitudes and practices. Opportunities exist for interventions to influence practitioners' behaviors in BSI management particularly with emergence of newer diagnostic tests.
| S-EPMC4374856 | biostudies-literature
Project description:BackgroundChildren and adolescents are at particular risk for adverse drug reactions (ADRs). We investigated physicians' perceptions on ADRs in pediatric routine care.MethodsIn this exploratory study from April to November 2020, we invited physicians treating pediatric patients across Germany to complete an online questionnaire consisting mainly of closed questions.ResultsCompletion rate was 98% (127/129). Of all participants, 23% (29/127) stated they were not able to estimate how many of their pediatric patients experienced ADRs during drug therapy. The remaining physicians estimated that 7.5% (median; Q25/Q75 3%/20%) of their pediatric patients were affected by ADRs. Regarding counseling on ADRs, 61% (77/127) stated they do not ask regularly the extent to which parents want to be informed. In total, 26% (33/127) stated they avoid counseling on ADRs concerning commonly used approved therapies, whereas only 4% (5/127) did so concerning off-label use (P < 0.001). Altogether, 16% (20/127) stated they rather prescribe new medicines as they hope for better effectiveness; 72% (91/127) said they are cautious about doing so owing to yet unknown ADRs. Of all respondents, 46% (58/127) stated they do not report ADRs to the authorities. Concerning the black triangle symbol, a European pharmacovigilance measure, 11% (14/127) stated they knew it and 6% (7/127) stated they reported any suspected ADR for drugs with that symbol.ConclusionsPhysicians' perspectives on ADRs were ambivalent: ADRs influenced their parent counseling and drug prescribing; yet, they struggled to estimate the impact of ADRs on their patients and were not aware of specific pharmacovigilance measures.
| S-EPMC8761136 | biostudies-literature