Responsibility of follow-up regarding medical recommendations in primary care and challenging patients: The perspective of doctors, nurses, pharmacists, and administrative staff.

Objective: This study examines the way healthcare staff describe challenging patients and perceive responsibility for follow-up of patients with chronic conditions.

Methods: Interviews were conducted with 46 healthcare staff (15 primary care physicians/12 nurses/15 administrative staff/4 pharmacists) at 12 clinics in Israel. They were audiotaped, transcribed, and thematically analyzed using Atlas qualitative data analysis software.

The effects of shared decision making on health outcomes, health care quality, cost, and consultation time: An umbrella review.

Objective: To review the effects of shared decision making (SDM) on health outcomes, health care quality, cost, and consultation time METHODS: We conducted an umbrella review and searched systematic reviews on SDM from PubMed, CINHAL, and Web of Science. We included reviews on SDM interventions used in a health care setting with patients. We assessed the eligibility of retrieved articles and evaluated whether the review addressed Consolidated Framework for Implementation Research (CFIR) characteristics.

Greater temporal regularity of primary care visits was associated with reduced hospitalizations and mortality, even after controlling for continuity of care.

Background: Previous studies have shown that more temporally regular primary care visits are associated with improved patient outcomes.

Objective: To examine the association of temporal regularity (TR) of primary care with hospitalizations and mortality in patients with chronic illnesses. Also, to identify threshold values for TR for predicting outcomes.

Patient-level predictors of temporal regularity of primary care visits.

Background: Patients with chronic diseases should meet with their primary care doctor regularly to facilitate proactive care. Little is known about what factors are associated with more regular follow-up.

Methods: We studied 70,095 patients age 40 + with one of three chronic conditions (diabetes mellitus, heart failure, chronic obstructive pulmonary disease), cared for by Leumit Health Services, an Israeli health maintenance organization.

How does work environment relate to diagnostic quality? A prospective, mixed methods study in primary care.

Objectives: The quest to measure and improve diagnosis has proven challenging; new approaches are needed to better understand and measure key elements of the diagnostic process in clinical encounters. The aim of this study was to develop a tool assessing key elements of the diagnostic assessment process and apply it to a series of diagnostic encounters examining clinical notes and encounters' recorded transcripts. Additionally, we aimed to correlate and contextualise these findings with measures of encounter time and physician burnout.

Developing a Framework and Electronic Tool for Communicating Diagnostic Uncertainty in Primary Care: A Qualitative Study.

Importance: Communication of information has emerged as a critical component of diagnostic quality. Communication of diagnostic uncertainty represents a key but inadequately examined element of diagnosis.

Objective: To identify key elements facilitating understanding and managing diagnostic uncertainty, examine optimal ways to convey uncertainty to patients, and develop and test a novel tool to communicate diagnostic uncertainty in actual clinical encounters.

Exploring relationships between physician stress, burnout, and diagnostic elements in clinician notes.

Objectives: To understand the relationship between stressful work environments and patient care by assessing work conditions, burnout, and elements of the diagnostic process.

Methods: Notes and transcripts of audiotaped encounters were assessed for verbal and written documentation related to psychosocial data, differential diagnosis, acknowledgement of uncertainty, and other diagnosis-relevant contextual elements using 5-point Likert scales in seven primary care physicians (PCPs) and 28 patients in urgent care settings. Encounter time spent vs time needed (time pressure) was collected from time stamps and clinician surveys.

Vaccine hesitancy among health-care professionals in the era of COVID-19.

Health-care professionals (HCPs) are key trusted figures in addressing coronavirus disease 2019 (COVID-19) challenges. They are thought to influence others' health decisions by personal example. However, during the COVID-19 crisis, some HCPs hesitated to be vaccinated.

Pharmacists' role in detection and evaluation of adverse drug reactions: Developing proactive systems for pharmacosurveillance.

Purpose: To identify current challenges in detection of medication-related symptoms, and review technology-based opportunities to increase the patient-centeredness of postmarketing pharmacosurveillance to promote more accountable, safer, patient-friendly, and equitable medication prescribing.

Summary: Pharmacists have an important role to play in detection and evaluation of adverse drug reactions (ADRs). The pharmacist's role in medication management should extend beyond simply dispensing drugs, and this article delineates the rationale and proactive approaches for pharmacist detection and assessment of ADRs.

Improving diagnosis: adding context to cognition.

Background: The environment in which clinicians provide care and think about their patients is a crucial and undervalued component of the diagnostic process.

Content: In this paper, we propose a new conceptual model that links work conditions to clinician responses such as stress and burnout, which in turn impacts the quality of the diagnostic process and finally patient diagnostic outcomes. The mechanism for these interactions critically depends on the relationship between working memory (WM) and long-term memory (LTM), and ways WM and LTM interactions are affected by working conditions.

Anatomy of diagnosis in a clinical encounter: how clinicians discuss uncertainty with patients.

Background: Studies consider the clinical encounter as linear, comprising six phases (opening, problem presentation, history-taking, physical examination, diagnosis, treatment and closing). This study utilizes formal conversation analysis to explore patient-physician interactions and understanding diagnostic utterances during these phases.

Methods: This study is a qualitative sub-analysis that explores how the diagnosis process, along with diagnostic uncertainty, are addressed during 28 urgent care visits.

Power dynamics in doctor-patient relationships: A qualitative study examining how cultural and personal relationships facilitate medication requests in a minority with collectivist attributes.

Introduction: This study examines personal patient-doctor relationships in a minority with collectivist attributes that facilitate medically inappropriate requests of patients.

Methods: Personal interviews were conducted with 56 (27 family doctors/ 29 patients) members of the Arab minority in Israel. The interviews were transcribed, and thematically analyzed by two coders.

'Nesef Doctora'-When mothers are considered to be 'half-doctors': Self-medication with antibiotics and gender roles in the Arab society in Israel.

This qualitative study focuses on self-medication with antibiotics as it relates to gender roles and traditions in the Arab society in Israel, a collectivist minority with defined traditional gender norms. Its findings draw on the analysis of 116 face-to-face interviews with 60 pharmacists, 27 primary care physicians and 29 community members, mainly mothers and unmarried women, from different geographical localities. The findings describe how mothers are assigned the role of the family health caretakers, expected to abide to a hierarchical power structure, and listen to the advice of 'senior mothers'.

Assessing the usefulness of a novel MRI-based breast density estimation algorithm in a cohort of women at high genetic risk of breast cancer: the UK MARIBS study.

Introduction: Mammographic breast density is one of the strongest known risk factors for breast cancer. We present a novel technique for estimating breast density based on 3D T1-weighted Magnetic Resonance Imaging (MRI) and evaluate its performance, including for breast cancer risk prediction, relative to two standard mammographic density-estimation methods.

Methods: The analyses were based on MRI (n = 655) and mammography (n = 607) images obtained in the course of the UK multicentre magnetic resonance imaging breast screening (MARIBS) study of asymptomatic women aged 31 to 49 years who were at high genetic risk of breast cancer.

A pilot study of compositional analysis of the breast and estimation of breast mammographic density using three-dimensional T1-weighted magnetic resonance imaging.

Purpose: A method and computer tool to estimate percentage magnetic resonance (MR) imaging (MRI) breast density using three-dimensional T(1)-weighted MRI is introduced, and compared with mammographic percentage density [X-ray mammography (XRM)].

Materials And Methods: Ethical approval and informed consent were obtained. A method to assess MRI breast density as percentage volume occupied by water-containing tissue on three-dimensional T(1)-weighted MR images is described and applied in a pilot study to 138 subjects who were imaged by both MRI and XRM during the Magnetic Resonance Imaging in Breast Screening study.

Multiscale analysis of MR-mammography data.

In this work we propose a method for automatically discriminating between different types of tissue in MR mammography datasets. This is accomplished by employing a wavelet-based multiscale analysis. After the data has been wavelet-transformed unsupervised machine learning methods are employed to identify typical patterns in the wavelet domain.

Occult micro medullary thyroid carcinoma: therapeutic strategy and follow-up.

Twenty micro medullary thyroid carcinomas (MTCs) were found in histologic specimens of 19 patients in our department from 1990 to 1998. There were 14 women and 5 men, with a median age of 63 years. The indication for surgery was goiter in 12 patients and a solitary nodule in 7 patients (three differentiated cancers).

[Surgery for primary hyperparathyroidism in 1998. Apropos of 66 patients and 3 methods of approach].

Study Aim: The aim of this prospective study was to assess the advantages and disadvantages of cervicotomy, selective lateral approach and video-assisted surgery in the treatment of primary hyperparathyroidism (HPT 1).

Patients And Methods: During 1998, 66 patients were operated on for HPT 1 in the same center. There were 48 women and 18 men (mean age: 58 years, range: 21-84), familial HPT 1 or MEN1 excluded.

[Diagnosis and treatment of hydatid cysts of the liver. Apropos of 87 cases operated on between 1980 and 1992].

Human echinococcosis is still endemic in some areas of the world, including Mediterranean countries and Lebanon. Because there is no effective medical therapy, surgery remains the principal mode of treatment. A consecutive series of 87 patients operated on for liver hydatid disease between January 1980 and March 1992 in the division of General Surgery at Saint George's Hospital, Beirut, were analyzed.