The use of melatonin: an information paper

The use of melatonin has been a topic of debate for the past several years. Patients frequently ask their physicians about its use, and many physicians are at a loss about what to tell them. Aviators who have trouble sleeping may choose to buy melatonin and use it since it is a "natural" substance. However, they may lack proper education about its use and the issues of concern. Flight surgeons can help educate their patients in the use of melatonin. This paper will briefly discuss the role of melatonin in humans, its effects on circadian rhythms, its sleep-inducing properties, its effects on mood and performance, and issues pertaining to safety. Flight surgeons and other physicians cannot "prescribe" melatonin, but they at least can offer information about its effects and what is not known about melatonin at this time to the aviators who may ask questions concerning this product.     

The knowledge of cancer patients about their disease

160 patients suffering from malignant tumors were interviewed by means of a questionnaire. Most of them had been treated by radiotherapy in a curative intent. The treatment had been finished about one year before, all patients submitted to curative therapy were free from recurrences. 80% out of them knew about their diseases, benignity or malignancy, sites of the primary tumors, and extent of lymph node metastases. Only 5% of the patients had to be informed about their disease at the Radio-oncology Hospital, 88% had been informed already by the physicians before. About 90% of the patients were of the opinion that a complete information was suitable and desired by them. As our patients got older, their desire for information diminished considerably. Even one year after the end of their disease, 34% did not speak frankly with other persons about their disease. The study showed furthermore that the hope of being cured is not affected by information. In this context, 90% of the patients were of the opinion that information should not exceed a certain degree.     

Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks

PURPOSE: To determine the awareness level concerning radiation dose and possible risks associated with computed tomographic (CT) scans among patients, emergency department (ED) physicians, and radiologists. MATERIALS AND METHODS: Adult patients seen in the ED of a U.S. academic medical center during a 2-week period with mild to moderate abdominopelvic or flank pain and who underwent CT were surveyed after acquisition of the CT scan. Patients were asked whether or not they were informed about the risks, benefits, and radiation dose of the CT scan and if they believed that the scan increased their lifetime cancer risk. Patients were also asked to estimate the radiation dose for the CT scan compared with that for one chest radiograph. ED physicians who requested CT scans and radiologists who reviewed the CT scans were surveyed with similar questions and an additional question regarding the number of years in practice. The chi(2) test of independence was used to compare the three respondent groups regarding perceived increased cancer risk from one abdominopelvic CT scan. RESULTS: Seven percent (five of 76) of patients reported that they were told about risks and benefits of their CT scan, while 22% (10 of 45) of ED physicians reported that they had provided such information. Forty-seven percent (18 of 38) of radiologists believed that there was increased cancer risk, whereas only 9% (four of 45) of ED physicians and 3% (two of 76) of patients believed that there was increased risk (chi(2)(2) = 41.45, P <.001). All patients and most ED physicians and radiologists were unable to accurately estimate the dose for one CT scan compared with that for one chest radiograph. CONCLUSION: Patients are not given information about the risks, benefits, and radiation dose for a CT scan. Patients, ED physicians, and radiologists alike are unable to provide accurate estimates of CT doses regardless of their experience level.     

Genetics decision-making: a template for problems with informed consent

Developments in information technology and advances in genetics present challenges to physicians in terms of providing adequate informed consent. Genetic mechanisms and related therapies are very complex and involve a number of uncertainties. Yet, physicians have very little training in genetics or in dealing with uncertainty. Further, genetic decisions impact others, yet physicians are trained to see the patient as an individual, independent decision-maker. Cultural, ethnic, gender, religious and other differences influence patients in their genetic decision-making, but physicians have little training in understanding these kinds of influences. Genetic information also gives knowledge about disease and dysfunction where no therapeutic intervention is available. Physicians are trained to heal in crisis situations, to engage in therapeutic intervention and not always to deal with chronic or unresolved illness. They may find this situation difficult to handle in an informed consent context. All ofthese difficulties pose the possibility that physicians will not be "informed" enough to facilitate good informed consent in genetic decision-making. Given all of this we need to address fundamental changes in medical education.     

基于大脑皮层信息传输理论的局灶性癫痫脑电研究

目的了解正常人及癫痫病人在不同生理状态下的脑电图的信息传输量的规律性,比较在不同条件下信息传输的差异.方法引用一种称为"信息传输”的理论来计算局灶性癫痫患者脑电的皮层信息传输序列,并计算该序列的复杂度,用复杂度来描述信息传输序列的信息含量.比较了正常人和局灶性癫痫病患者以及患者在诱发癫痫发作的不同时期的大脑皮层信息传输.结果发现局灶性癫痫病人的大脑皮层信息传输有非常特殊的现象.正常人各导联间的信息传输量趋于随机,未发现特别规律;而局灶性癫痫病人痫性导联与其它导联的皮层信息传输量在癫痫发作前3～7s有所增加(P＜0.05);在患者病情发作时期,痫性导联之间的信息传输量有明显增加(P＜0.01),同时,该信息传输量也比正常人有显著增大(P＜0.01);相反,非痫性导联之间的信息传输量有显著降低.结论认为这个方法在研究和理解人脑功能时可能是一个有潜力的方法,可能用于预报癫痫发作,是研究和诊断局灶性癫痫的一个新途径.     

Burnout among physicians working in a pandemic hospital during the COVID-19 pandemic

This study aimed to investigate burnout among physicians during the first phase of the COVID-19 pandemic. This research was conducted in a pandemic hospital which is among the largest hospital complexes in Turkey. Internal medicine physicians actively working in many departments under the severe conditions in the diagnosis and treatment processes were included. Among the physicians constituting the study population, residents, attendings, and subspecialists from different fields were included. These physicians were working in the quarantine services, inpatient services, intensive care units, and polyclinics. A short and easy face-to-face survey, in which included questions on demographic information, medicolegal subjects, and questions from the Maslach Burnout Inventory, was used to collect data. While 58.2% of the physicians stated that they were extremely worried about malpractice in the pandemic period, 82.1% stated they needed training on medicolegal subjects, and 25.4% stated they were exposed to violence during work. Three sub-dimensions within the burnout inventory were compared with other parameters. The Cronbach alpha value was found highly reliable in the evaluation of the answers' internal consistency. The notable significance of burnout was interesting regarding physicians' anxiety on medicolegal issues and exposure to violence (p < 0.05). The findings obtained in this study suggest that healthcare workers' motivations will increase if they feel valued, their working conditions have been improved, and if they are in mentally well. This mental wellness may contribute to fighting public health crises such as a pandemic more efficiently with the lowest number of casualties.     

An ethical imperative: genetics education for physicians and patients

The Human Genome project will result in a rapid increase in information about genetically based disease and possible genetically based therapies and cures. In light of this, radical changes in medical education may be necessary. Patients rely on physicians for medical advice about genetic ills and treatments and yet there is mounting evidence that physicians are not well informed about genetics and indeed that they are misinformed. There is also evidence that informed consent is not always honored in the context of genetic testing and indeed that coercion to test and even to act on test information is a practice. Misinformation and the mishandling of genetic information can cause physical, psychological and social harm to persons and intentional and non-intentional violations of informed consent, confidentiality, and privacy are causes for alarm. It is an ethical imperative that genetic literacy and education for physicians be fully and quickly addressed.     

A study of the opinions and behaviors of physicians with regard to informed consent and refusing treatment

OBJECTIVE: To examine the opinions and the self-reported behaviors of physicians regarding the issues of informed consent and refusing treatment. DESIGN: This study was performed between July and September 2003, with 51 physicians selected by simple random sampling. The data were collected by using a questionnaire. SETTING: A training hospital of medicine faculty. PARTICIPANTS: Fifty-one clinicians working in the branches of internal medicine and surgery. RESULTS: Although the majority (80.4%) of the participants think that information about diagnosis and treatment should always be disclosed to patients, 60.8% reported that they always disclose information about the diagnosis and 49% did the same for information about treatment. A total of 84.3% think that patients' consent should always be obtained before diagnostic and therapeutic procedures, whereas 47% reported that they always obtain consent in their clinical practice. It was also seen that physicians have doubts concerning the comprehension of the information they disclose to their patients. In addition, most (86.3%) of the participants think that a competent patient always has the right to refuse treatment, regardless of the disease and the outcomes. CONCLUSIONS: Although opinions favoring the duties implied by informed consent are in the majority, these do not always reflect the behaviors in daily clinical practice, and there may be problems in carrying out the duties implied by the elements of informed consent. Some recommendations that could be beneficial in addressing these problems are presented at the end of the study.     

Bioethics committees and examining consent within the patient-physician relationship in Turkey

Clinical exercises include questions about a physician's behaviour, decision making process, values, rights and responsibilities, as much as the scientific-technical questions concerning the disease. Some of these questions may be easily answered, for there are well-constructed activity options that have found widespread acceptance regarding what has to be done. However, it is quite difficult to answer the questions with problematic options, or the ones on which a compromised attitude is not present. Patient participation in treatment-related decision-making has been promoted as being ethically and clinically desirable in Western countries. Several studies have indicated that patient participation in decision-making has a positive influence on their health outcomes, thereby increasing patient satisfaction regarding medical care and promoting patient autonomy. Over the last decade, patient involvement in treatment-related decision-making has been widely advocated in Turkey, where patient-physician encounters are still under the influence of the long-standing tradition of paternalism. Despite this profound change in clinical practice, studies investigating the actual preferences of Turkish people regarding involvement in treatment-related decision-making are limited. In Turkey, to protect the rights of patients, current Govermental requirements mandate that all human biomedical research and medical intervention be accompanied by a consent form that contains the information necessary for an informed decision. In addition, they require that the information provided to the subject or the representative shall be explained in appropriate language. Especially after the new regulations in the Turkish Penal Code, physicians and nurses have started to be more sensitive towards informed consent and have become more conscious about their responsibilities. It has started to be questioned more, and as a result, the problems experienced about patient consent in medical applications created new ethical dilemmas. Informed consent is acknowledged to be the most essential constituent of patient rights today. In this paper, after introducing a general overview of the significance and requirements of informed consent, we will consecutively discuss the decision making and informed consent process, legal arrangements concerning this issue in Turkey, the approaches of physicians and patients towards the topic, and regarding informed consent, we will discuss the responsibilities of hospital ethics committees.     

加强介入治疗围手术期处理能力

介入放射学是一门新兴学科,从事这一学科的医师应该具有扎实的影像学基础、娴熟的操作技能和丰富的临床经验.这三方面足每一位从事介入放射诊疗的医师都必须为此而努力的.许多从影像诊断转做介入治疗的医师,他们有扎实的影像学知识,也努力学习介入诊疗操作,但是往往缺乏临床知识,对介入围手术期的处理缺乏相应的临床经验.而介入围手术期是介入治疗的重要组成部分,规范的介入治疗的术前准备能有效减少术后并发症,科学的术后处理能使患者获得最佳的手术效果.     

Physician Burnout and Barriers to Care on Professional Applications

Abstract

We surveyed New York physicians to study their perceptions of reporting requirements related to their own mental health care on professional applications, including whether they were experiencing symptoms of burnout. Over half of the responding physicians reported experiencing symptoms of burnout and these physicians were at increased odds of perceiving a barrier to seeking mental health care if they had to report such care on professional applications and renewals for medical licensure, malpractice, and hospital privileges and credentialing compared to physicians not experiencing symptoms of burnout. As state medical boards, hospitals, and insurers seek information to help assess risks posed by physicians, it is essential to strike an appropriate balance between their duty to protect the public and the physician’s right to confidentiality. This balance can be assessed based on the questions that are asked on various professional applications and how information gleaned through physician responses is used. Overly intrusive questions, though well intentioned to protect the public, may run counter to current interpretations of federal law and may inhibit care-seeking among physicians, which is critical to both patient safety and physician health.     

精神病病人家属健康教育需求调查分析

目的　探讨精神病病人家属对健康教育的需求状况。方法　采用问卷方式对 160例住院治疗结束后的精神病病人家属进行健康获得观念、教育内容、方式需求调查。结果　家属有一定的健康信息储量 ,缺乏较深层次的健康知识指导 ;部分家属不相信精神病可以得到长期控制 ,对精神病人的康复训练缺乏热情 ;对健康教育内容需求较多 ,教育方式多选用个别交谈 ,咨询方式以电话咨询最受欢迎。结论家庭健康教育需加强知识的深度和广度 ,重视教育内容与形式的研究 ,加强家属的心理支持 ,需要得到全社会的共同关注     

Looking for solutions: vision and a call-for-attention for radiation research scientists

Abstract

Purpose: The concept of benefit-risk assessment has often been propagated for clinical professionals for deciding the radiological exam for the patient. A detailed look into how to use this concept leads to several unanswered questions. The purpose of this article is to bring forth questions which have remained unanswered for several decades. These questions pertain to our inability to provide needed information to physicians for making benefit-risk assessment for deciding a frequent imaging modality like the computed tomography (CT) such as non-applicability of risk estimates to an individual patient, the concept of cumulative risk at low doses, accounting for the time gap between series of CT scans, risk variation with age, gender and disease condition. In the absence of concrete information on these, it becomes essentially benefit assessment rather than benefit-risk. The article also provides a motivation to think that there are a large number of patients getting exposed every year to radiation doses over 100 mSv of effective dose and several tens of mGy of organ doses. This may provide a very large cohort for radiation effect studies. Further, a series of ideas are presented as a vision for future studies.

Conclusions: The article emphasizes the need to create a research agenda to deal with day-to-day questions faced in medical practice and provides a call-for-attention. Further, it provides some challenging ideas as outside of the box thinking points that may provide research direction for future years.     

E-learning is a well-accepted tool in supplementary training among medical doctors: an experience of obligatory radiation protection training in healthcare

PURPOSE: To evaluate the possibilities of Internet-based radiation protection training among referring physicians. MATERIAL AND METHODS: 324 referring physicians underwent an Internet-based radiation protection training course (www.prewise.com/radiationsafetytraining). Two hundred ten of them (96 female, 114 male, aged 25-64 years) filled out the questionnaire, which included questions regarding their expectations for the course, its scope and schedule, and the benefit they derived from the course. In addition, we asked whether it was difficult to learn using the Internet, whether e-learning saved time, and whether they learned more or less effectively in comparison to conventional lectures. RESULTS: 75% found e-learning to be an easy way to study. Nineteen percent had previous experience in e-learning. Sixty-one percent found that it saved time, and 57% stated that they learned more effectively using e-learning in comparison to conventional lectures (22% chose "could not say"). Ninety-one percent found that the course fulfilled their expectations, and the scope and schedule were found convenient by 91% and 55% of subjects, respectively. Eighty-four percent stated that they benefited from the course, and 94% were willing to study using the Internet in the future. No sex or age differences were found. Subjects working in the open ward (P = 0.028) and hospital (P = 0.004) found the course to be more timesaving than subjects working elsewhere. CONCLUSION: Finnish medical doctors are very positive about Internet-based learning. E-learning seems to be a well-accepted and practical learning method in healthcare.     

Evaluation of a workshop to teach clinical bioethics in the clinical setting

That the teaching of medical ethics must extend into the clinical years in order for medical students to effectively acquire the knowledge and skills required for dealing with clinical bioethical issues has been widely recognized. A limiting factor has been the lack of physicians able to teach bioethics in the clinical setting. This paper describes the structure and evaluation of a workshop for teaching clinicians how to teach bioethics in the clinical setting. 80 physicians participated in 4 workshops in which they were provided with the ethical principles needed to deal with clinical bioethical issues and appropriate teaching methods. Methods such as paper cases, videotaped standardized patient interactions and live standardized patients were presented. The workshops have been highly evaluated. Post workshop evaluation showed that a significant number of physicians taught ethical issues during rounds and seminars. The frequency of teaching ranged from once per month to one or more times per week.     

Some ethical dilemmas faced by Jewish doctors during the Holocaust

The discourse on physicians and ethics in the Nazi regime usually refers to the violation of medical ethics by Nazi doctors who as a guild and as individuals applied their professional knowledge, training and status in order to facilitate murder and medical "experimentation". In the introduction to this article I will give a brief outline of this vast subject. In the main article I wish to bear witness to the Jewish physicians in the ghettos and the camps who tried to the best of their ability to apply their professional training according to ethical principles in order to prolong life as best as they could, despite being forced to exist and work under the most appalling conditions. These prisoner doctors were faced with impossible existential, ethical and moral dilemmas that they had not encountered beforehand. This paper addresses some of these ethical quandaries that these prisoner doctors had to deal with in trying to help their patients despite the extreme situations they found themselves in. This is an overview of some of these ethical predicaments and does not delve into each one separately for lack of space, but rather gives the reader food for thought. Each dilemma discussed deserves an analysis of its own in the context of professionalism and medical ethics today.     

AIDS and drug abuse: some aspects of psychiatric consultation

Current research in Buenos Aires shows that approximately 35 per cent of intravenous users are HIV positive. These patients have behaviour disorders. Usually they are sent from one specialist to another, which increases their anxiety that originated in their suspicion of a serious prognosis. They are listened to when they discuss their disease but not enough when they try to talk about themselves as people with doubts about their future. Unconsciously physicians are trying to avoid involvement in the anxiety of the patient by means of a referral to a psychiatric consultation. The psychiatrist must handle this situation as a crisis in the doctor-patient relationship (both need help) to preventing further acts, additional anxiety and psychotic reactions. These patients need strong support not only because of the seriousness of the disease but also because of the situation of abstinence. Global treatment of a patient should be unified and managed by a physician with psychological training or assessed by one liaison psychiatrist, trying to avoid any split in the health team.     

A snapshot of patients' awareness of radiation dose and risks associated with medical imaging examinations at an Australian radiology clinic

BackgroundCumulative radiation exposure is linked to increasing the lifetime attributable risk of cancer. To avoid unnecessary radiation exposure and facilitate shared decision making, patients should be aware of these issues. This paper examines patients' awareness of radiation dose and risks associated with medical imaging examinations.MethodsConsecutive patients attending a private radiology clinic over a nine week period in 2014 in Metropolitan Melbourne were surveyed while waiting to undergo an imaging examination. Patients who were under 18 years of age, did not speak English and/or were referred for interventional imaging procedures were excluded from participation. Survey questions addressed patients' awareness of radiation dose associated with various imaging modalities' and patients' experience and preferences regarding communication of information about radiation. Data was analysed using SPSS (Ver 20.1).ResultsA total of 242 surveys were completed. Most participants were male (143/239, 59.8%) and aged between 33 and 52 years (109/242, 45%). Over half of participants were not concerned about radiation from medical imaging (130/238, 54.6%). Only a third of participants (80/234, 34.2%) correctly reported that CT has a higher radiation dose than X-ray. Very few participants correctly identified mammography, DEXA, PET and PET/CT as radiation emitting examinations. The majority of participants (202/236, 85.6%) indicated that they were not informed about radiation dose and risks by their referring doctor in advance.ConclusionThis paper provides information relevant to a single private radiology clinic in Australia. Nevertheless, our results have shown that patients presenting for medical imaging have little awareness of radiation dose and risks associated with these examinations and received little information by their referring physicians or staff at the radiology clinic.     

Yuppie scans from head to toe: unethical entrepreneurism.

Our responsibility as Canadian radiologists is the same as the responsibility of physicians irrespective of the health care system they serve or the country where they work. "Our modern society does not value properly the intellectual effort, and the time studying the problems of patients and deciding on their solutions. Much higher rewards are placed on the use of sophisticated medical technology. Changing this way of practice requires much more than an academic call to order. As members of our modern society we physicians have a tough time isolating ourselves from prevalent values. But, we do have the duty to point out inconsistencies of the present societal values regarding medical activities, striving to change this state of affairs for the benefits of medicine, patients and society as a whole."     

Patient information preferences among breast and prostate cancer patients

Preferences for information about their disease and treatment were collected from 392 patients who had been treated for either breast or prostate cancer an average of 2 years previously. Type of information that they had received, their ratings of its value to them and their preferred format for further information were examined. The most common and most preferred form of information was through doctor interview, followed by educational booklets. Prostate cancer patients preferred videotapes; breast cancer patients tended to prefer individualized approaches including a tour of the department. Effects of age, educational levels, occupational backgrounds and self-reports for anxiety and depression at the time of the survey and at time of diagnosis were analysed. Prostate cancer patients who were most severely depressed showed a preference for not receiving any information at all, perhaps reflecting a tendency towards withdrawal.