Trends in the number of patients linked to potential vet-shopping behavior in the United States (2014-2019)

OBJECTIVE To estimate the number of patients linked to vet-shopping behavior (the solicitation of controlled substance prescriptions from multiple veterinarians for misuse) in the United States using 2014–2019 data and characterize mandates for veterinarians to examine prescription drug monitoring programs (PDMPs) before prescribing controlled substances as of April 2021. SAMPLE National database reporting prescription dispensing from 92% of US pharmacies from 2014 through 2019. PROCEDURES The annual number of patients with dispensed prescriptions for opioid analgesics, opioid cough-and-cold medications, or benzodiazepines from ≥ 4 veterinarians was calculated. State veterinary medical associations were contacted for information on veterinarian PDMP use mandates. RESULTS From 2014 through 2019, the number of patients with prescriptions for any class of controlled substances from ≥ 4 veterinarians tripled from 935 to 2,875 (+207.5%). The number of patients with opioid cough-and-cold medication prescriptions from ≥ 4 veterinarians rose from 150 to 1,348 (+798.9%). The corresponding number for benzodiazepines rose from 185 to 440 (+137.8%). The corresponding number for opioid analgesics peaked at 868 in 2016 before decreasing to 733 in 2019. In April 2021, 10 states mandated veterinarians to examine PDMP records of owners or animals before prescribing controlled substances; 3 mandates excluded benzodiazepines. CLINICAL RELEVANCE Vet shopping in the US may be increasingly common. Mandates for veterinarians to examine PDMPs before prescribing controlled substances might facilitate detection of this behavior. However, benefits of mandates should be weighed against their potential burden on veterinarians.

Pulmonary embolism in Bujumbura

Relevance . Pulmonary embolism constitutes a diagnostic and therapeutic emergency. In Africa, data are still difficult to obtain. Thus, the objectives of this work is to describe epidemiological, clinical, therapeutic aspects and short-term outcomes of pulmonary embolism confirmed by thoracic angioscan at Kira hospital in Bujumbura, the biggest city of Burundi with population about 375 000. Patients and Methods . This was a descriptive study of 18 patients who had a pulmonary embolism confirmed by thoracic angioscan in Bujumbura from January 1st, 2015 to December 31st, 2018. We included in our study any patient with pulmonary embolism consenting to participate and processing personal data after some clarified explanations in accordance with the World Medical Associations Declaration of Helsinki. For each registered patient, we collected socio-demographic, past history of cardiac disease and factors risk, clinical, echocardiographic and scannographic findings with Wells score. Variables were presented as means and percentages. Results and Discussion. The average age was 53.5 12.3 years with a sex ratio of 1.25 in favor of women. The modal class was the 50 to 59 age group (33.3%). The clinical probability pre-test by simplified Wells score was high in 66.6% and medium in 33.3% of cases. A history of venous thromboembolic disease was the most common risk factor. Dyspnea was the most reason of consultation with 94.4% of cases. One patient died (5.6%) during hospitalization. Six months after discharge from the hospital, we recorded 3 cases (16.7%) of death, 6 cases (33.3%) of pulmonary heart, 3 cases (16.7%) of recurrent pulmonary embolism and one case of vitamin K antagonist overdose with minor bleeding. Conclusion. Pulmonary embolism is common in relatively young population with a predominance of females and chronic no communicable diseases as risk factors. Examination of a patient with an angioscanner is a sensitive and specific clinical study of pulmonary embolism. The outcome is favorable under appropriate treatment in short term.

Vaccination against new coronavirus infection in patients with cardiovascular and autoimmune diseases

The review article is devoted to a discussion of the issues of vaccination against a new coronavirus infection in patients with cardiovascular and autoimmune diseases. Presented at the time of this writing are data on domestic vaccines safety in the Russian Federation: combined vector vaccines “Gam-COVID-Vac” and “Gam-COVID-Vac-Lyo”, peptide-based vaccine “EpiVacCorona”, concentrated, purified and inactivated whole-virion “KoviVac” vaccine, and a standalone vaccine/booster shot “Sputnik Light”. The analysis of the main contraindication applicable to the vaccines in different categories of patients has been carried out. A number of consensus documents published by Russian and foreign professional medical associations and communities on the issues of vaccination of patients with cardiovascular and autoimmune diseases are considered in detail.

The transition of cannabis into the mainstream of Australian healthcare: framings in professional medical publications

Background Medicinal cannabis has been legalised for use for a range of specified medical conditions in Australia since 2016. However, the nature of the government regulations and the subsequent complexity of prescribing, as well as doctors’ safety uncertainties and the stigma of the plant, remain contributing barriers to patient access. Media representations can offer insights into the nature of the discourse about new medical products and therapies and how ideas and understandings about social phenomena become constructed. Focusing on professional medical publications, this study sought to investigate how medicinal cannabis is being represented in professional medical publications. Methods Using a content analysis approach, we investigated articles about medicinal cannabis from 2000 to the end of 2019 in the Medical Journal of Australia, Australian Doctor, Medical Observer, Australian Journal of General Practice, Australian Family Physician, and Australian Medicine. Articles were coded according to article type, framings of cannabis, headline and article tone, and key sources used in the article. We also used manifest textual analysis to search for word frequencies, and specific conditions referred to in the articles retrieved. Results A total of 117 articles were retrieved for analysis, the majority of which were news stories for a physician audience. Across the longitudinal period, we found that most reports carried a positive tone towards medicinal cannabis. Cannabis is most frequently framed as a legitimate therapeutic option that is complex to prescribe and access, does not have a strong evidence base to support its use, and also carries safety concerns. At the same time, the outlook on cannabis research data is largely positive. Primary sources most frequently used in these reports are peer-reviewed journals or government reports, voices from medical associations or foundations, as well as government and university researchers. Chronic pain or pain were the conditions most frequently mentioned in articles about cannabis, followed by epilepsy, cancer or cancer pain, and nausea and chemotherapy. Conclusions This analysis offers evidence that medicinal cannabis is being framed as a valid medicine advocated by the community, with potential for addressing a range of conditions despite the lack of evidence, and a medicine that is not free of risk.

How full is the glass? A perspective on women in medical leadership in Canada

What do we really know about the representation of female physicians in medical leadership in Canada? Female representation on the current boards of the Canadian Medical Association and provincial/territorial medical associations is 23% and 40%, respectively. Identified barriers to female medical leadership include gendered organizational and workplace culture, gender bias, inflexible work practices, unequal childcare and domestic responsibilities, and biased performance assessment criteria and recruitment practices. Identified enablers include flexible tenure policies, systematic parental leave policies, greater inclusivity in the workplace, and formal mentorship structures. More has been written about the costs of leadership for female physicians rather than the benefits.

Integration of complementary and integrative medicine competencies in general practice postgraduate education – development of a novel competency catalogue in Germany

Background Complementary and integrative medical procedures (CIM) play an important role in general practice (GP). Consequently, in some countries (e.g. USA, Australia) specific curricula for the integration of CIM competencies in GP postgraduate education exist. Although Germany is one of the countries where CIM is strongly integrated in general practice, no such catalogue exists up to date. The aim of this study was to define a set of CIM competencies that are seen as relevant and feasible for postgraduate education in the German general practice setting. Methods We used a multi-step, peer-based approach combining four different steps. Firstly, a survey among GP trainees (n = 138) was performed in order to assess needs and attitudes towards CIM. Then, existing competency-based CIM curricula were identified in international literature, translated into German and compared with the needs assessment from the survey. In a next step, we performed a survey among the CIM working group of the German Society for General Medicine and Family Medicine (DEGAM). As a last step, in a peer-based survey, GP trainers, GP trainees, and members of professional CIM associations (n = 131) evaluated a list of CIM competencies according to relevance and feasibility for general practice. Results Within this multistage process, a final catalogue of 16 competencies was defined, covering the following areas: Medical knowledge, patient care and communication, practice-based learning, professionalism, and competencies based on the German healthcare system. Conclusion The final catalogue of CIM competencies is intended to serve for GP training complementing the German competency-based curriculum for general practice. These competencies cover basic skills and are not intended to replace existing additional qualifications awarded by the medical associations in specific CIM methods, such as acupuncture or manual medicine. Therefore, a list of relevant competencies on CIM is available in order to serve as add-on for postgraduate education in general practice in Germany.

Effect of dental education on knowledge and clinical behavior of turkish dentists’ regarding oral-systemic health of geriatric patients

Objective: The aim is to evaluate the perspectives of dentists’ clinical approaches in terms of their knowledge and education regarding oral-systemic health relation of geriatric patients with a digital survey. Materials and Methods: The demographics, oral-systemic health-related lectures in participants' dentistry education, the level of awareness of the oral-systemic health relationship, and behaviors related to clinical applications were investigated on a digital platform with 49 multiple-choice questions. The results were analyzed with the SPSS 24.0 program. Results: Of a total of 410 dentists (206 women and 204 men), 23% have doctoral and/or specialty titles. While 93.1% of dentists had taken systemic health-related lectures, 21.3% of them rated these courses as “adequate” and 49.3% as weak. 72% of the participants received medical history only at the initial appointment, while 17.9% of them received it at each appointment. Dentists more often associate diabetes and cardiovascular diseases with periodontitis, compared to the development of dental caries. Dentists who think that they should work with physicians in the treatments of geriatric patients with systemic diseases refer more patients to physicians per year (p < 0.001). Conclusions: Dentists have found the lectures on the relationship between oral-systemic health of geriatric patients in dentistry education inadequate. Besides, there is a lack of information on the effects of systemic diseases on caries development, intra-oral findings, and knowledge on treatment approaches. Dentists believe that defining a curriculum that emphasizes interdisciplinary work and organizing scientific activities in partnership with medical associations will play an important role in establishing awareness of oral-systemic health. Keywords Dental education; Dental health survey; Geriatric dentistry; Interdisciplinary communication; Oral health.

Tratamiento del síndrome de intestino irritable por gastroenterólogos: resultados de un estudio de corte transversal a partir de una encuesta elaborada por expertos

Introduction. Irritable bowel syndrome (IBS) accounts for a significant deterioration in the quality of life of patients who suffer from it and is a common reason for consultation in gastroenterology. The treatment of this syndrome includes a wide variety of medications and recommendations based on different factors of its physiopathology. However, the results are usually variable and sometimes unsatisfactory for either the patient or the treating physician. The main objective of the present work is to describe the different treatments used by gastroenterologists in the management of IBS in Argentina. Materials and methods. Questionnaire of forty-seven questions, prepared by experts, distributed by medical associations of gastroenterology in Argentina and answered by specialists via Google Forms. Results. 304 responses, 157 from women (51.6%) and 147 from men (48.4%). The mean age was 44 and 49.9 years, respectively. 87.5% consider improvement of quality of life as the main goal of treatment. Regarding physiopathology of diarrhea variant irritable bowel syndrome (IBS-D), 49.5% considered emotional stress, while for constipation variant irritable bowel syndrome (IBS-C), 42.8% considered it multifactorial, with a predominance of slow colonic transit. No treatment option was rated as very effective by more than 50% of the respondents. Rifaximin was considered the most effective treatment in IBS-D, while polyethylene glycol was for IBS-C. Statistical significant differences were observed among gastroenterology subspecialties in the treatment of IBS-D with respect to the efficacy of diet, amitriptyline and antibiotics other than rifaximin, and regarding the effectiveness for bisacodyl/picosulfate and antibiotics in the treatment of IBS-C. Conclusion. The most common pathophysiological mechanismin IBS-D is stress. The vast majority of respondents consider that the main goal of treatment is the improvement of the quality of life, over symptomatic relief. None of the drugs is considered very effective in the treatment of the different IBS variants by at least 50% of those surveyed. Statistically significant differences were observed in the proportion of monthly consultations for IBS regarding to age and in the effectiveness considered for some treatments in relation to the subspecialty of physicians. The therapeutic approach to IBS by Argentine gastroenterologists is varied and somewhat heterogeneous, resulting in a still inappropriate management of this condition.

In Service of the Society? Medical Associations as Agents of Social Change—Implication for Health Policy and Education in Israel

This study aims to explore what medical associations in Israel do to promote public health, what values underpin their activities, and how their actions can be interpreted. For this purpose, an analysis of both individual and organizational levels was applied in an effort to yield a more nuanced understanding of the relationship between society and the medical profession. In-depth interviews with senior physicians were conducted, combined with a review of policy and public initiatives of medical associations between 2008 and 2018. The findings of this study reveal that medical associations engage in a range of social and policy initiatives designed to promote public health, but, at the same time, they tend to construct socially related health issues as medical problems in a manner that fits their sectorial agendas. This may reflect organized medicine’s efforts to extend its dominance over society through the application of the biomedical model to social issues. It is necessary to integrate biosocial training with medical education to ensure that future physicians are equipped with the skills needed to implement social medicine.