Search Results (129)

Background/Objectives: Cervical cancer is widely recognized as a preventable disease; however, participation in screening programs remains insufficient in many transitional health systems. In the Georgia, organized screening services are available, yet utilisation remains low, indicating barriers to screening extend beyond access alone. This study, therefore, examined physician-level factors influencing the promotion of cervical cancer screening in the Adjara region of Georgia, with focus on routine clinical practice and organizational conditions. Methods: A cross-sectional survey was carried out among physicians providing outpatient and preventive services in six municipalities of the Adjara region. The analysis was guided by a socio-ecological framework and examined individual, inter-personal, and organizational factors in relation to physicians’ recent cervical cancer screening recommendation practices. Multivariable logistic and ordinal regression analyses were used to identify factors associated with screening promotion. Results: Despite a generally high level of support for cervical cancer screening among physicians, regular screening recommendations were not consistently reported. Limited consultation time, uncertainty regarding screening-related harms, and rural practice settings were independently associated with a lower probability of having recently recommended screening. In contrast, favourable attitudes toward screening on their own were not sufficient to translate into routine preventive practice. Conclusions: These findings indicate that gaps between physician attitudes and screening promotion are largely driven by structural and organizational factors rather than a lack of professional support. Efforts to reduce workflow constraints, improve clarity around screening guidance, and integrate preventive counselling into routine clinical practice may be essential for improving screening uptake in similar healthcare system contexts. Full article

Objectives: Temporomandibular disorders (TMDs) are common but often underrecognized and inadequately managed in primary healthcare, which may delay diagnosis and appropriate care. This study aimed to compare TMD-related knowledge, awareness, and clinical practices between dentists and physicians working in primary care and to identify factors associated with higher diagnostic confidence. Methods: A cross-sectional survey was conducted among dentists and physicians working in Croatian primary healthcare. TMD-related knowledge, clinical confidence, screening practices, and referral patterns were assessed using a structured questionnaire. Results: Dentists demonstrated significantly higher overall knowledge scores than physicians (15.6 ± 1.7 vs. 13.2 ± 4.1; p < 0.001), as well as greater diagnostic and therapeutic confidence (all p < 0.001). Routine TMD screening was reported by only 21.8% of participants, more frequently by dentists than physicians (36.1% vs. 8.2%; p < 0.001). Most respondents preferred referral rather than independent management. Regression analysis identified profession as the only independent predictor of higher TMD-related knowledge (p = 0.003). Insufficient knowledge, experience, and lack of confidence were the most reported barriers, particularly among physicians. Conclusions: The findings indicate clinically relevant gaps in TMD preparedness within primary healthcare, especially among physicians, despite frequent patient contact. Strengthening undergraduate and continuing education, promoting interdisciplinary training, and establishing clearer referral pathways may enhance early recognition and improve primary-level management of TMD. Full article

Background: Despite well-established treatment and follow-up protocols for the management of colorectal cancer patients, recurrences are frequent. Post curative therapy, ctDNA-based molecular residual disease assessment has the ability to stratify patients into higher and lower risks of recurrence. Large-scale clinical trials are necessary to establish utility at a broad level, but physicians also need real-world evidence and case reports before utilizing MRD testing in routine practice. Methods: We analyzed real-world utilization patterns of Guardant Reveal in patients with CRC across stages by collating information from the test request form after the test was ordered as a part of routine practice in the AMEA region. Results: We report that 92% of the tests were utilized for stage II and stage III patients. The timing of the first MRD test order varies between stages, with a higher proportion of tests being ordered within the first 12 weeks of surgery for stage II (71.8%), while for stage III (50%) and stage IV oligometastatic (72%), the first test was ordered after 12 weeks of surgery. Conclusions: Case reports delineate physicians’ perspectives on actions taken on the basis of MRD test results and outcomes. Full article

Background/Objectives: The ethical climate in a healthcare institution encompasses the shared perceptions of how ethical issues are managed in everyday practice. Our prior survey at the University Hospital of Split, Croatia, showed a simultaneous predominance of the “Rules” and “Laws and professional codes” ethical climates. Building on these findings, we explored how these climates manifest in everyday practice, how they align with staff values and guide their ethical decision-making, and how they are shaped by external factors. Methods: We conducted seven focus groups with 31 participants: nurses, residents, specialists, and members of the Hospital Ethics Committee (HEC). We identified patterns in the data using Graneheim and Lundman’s qualitative content analysis. Results: Three themes emerged from our analysis. We observed that the ethical climate was shaped predominantly by healthcare professionals themselves based on shared professional values and informal norms, rather than explicit institutional rules. Nurses, positioned as frontline workers, felt particularly exposed to ethical dilemmas, reporting perceived subordination to physicians, increased pressures from patients, and vulnerability in ethically ambiguous situations. The participants generally believed that institutional leadership insufficiently utilised existing tools, bodies, and mechanisms to support ethical behaviour and sanction misdemeanors, resulting in gaps in human resource management, a lack of practical protocols, and a weak HEC. Conclusions: To strengthen the ethical climate, institutional leadership should provide clear and practical guidelines, effectively utilise regulating bodies and support services, establish dedicated mechanisms to support nurses, and consistently enforce sanctions for unethical behaviour. Full article

Background: Lip aging is a heterogeneous and visually complex process, yet a standardized morphological classification applicable to clinical practice is still lacking. Current approaches mainly focus on volumetric loss or perioral rhytids, while the geometric features of the lips, including borders, projection, and eversion, remain poorly codified. Methods: Fifty anonymized lip images acquired under standardized conditions using digital facial imaging were independently evaluated by five physicians experienced in esthetic medicine. Images were classified according to three predefined morphotypes representing distinct patterns of lip aging. Inter-rater reliability was assessed using Fleiss’s kappa statistic. Results: Three recurrent morphotypes were consistently identified: devolumized lips, central lips, and chapped lips. Overall, 87% of images were assigned to one of the three morphotypes by at least four of five evaluators, while 13% were classified as undefined due to mixed features. Inter-rater agreement was substantial (κ = 0.89; 95% CI 0.79–0.99), confirming high reproducibility of the proposed classification. Conclusions: This study proposes a simple and reproducible image-based morphotypic classification of lip aging that captures recurrent visual patterns within this cohort. The framework may facilitate standardized clinical communication, support personalized rejuvenation strategies, and provide a foundation for future quantitative imaging studies and AI-based phenotype recognition in esthetic and reconstructive practice. Full article

Contamination of agricultural water poses significant health risks that are often underrecognized in clinical practice. This review synthesizes peer-reviewed literature from biomedical and environmental sciences. It examines the pathways by which nitrates and zoonotic pathogens contaminate rural drinking water and delineates the resulting spectrum of acute and chronic health risks relevant to primary care. Agricultural practices are a primary source of nitrates and pathogens (e.g., Escherichia coli, Cryptosporidium, Giardia) in rural water supplies. Nitrate nitrogen exposure is linked not only to acute infant methemoglobinemia but also to chronic conditions like colorectal and thyroid cancers and adverse birth outcomes. These risks are observed at concentrations below the current United States Environmental Protection Agency regulatory limit of 10 mg L⁻¹ NO₃⁻–N. Pathogen exposure leads to acute gastrointestinal illness and can trigger long-term sequelae, including irritable bowel syndrome. Agricultural communities are uniquely vulnerable because they rely heavily on unregulated private wells, which are more prone to contamination than public systems. Evidence suggests a substantial and often underrecognized burden of waterborne disease in agricultural communities. The findings highlight a critical need for clinical vigilance regarding low-level nitrate nitrogen exposure and long-term post-infectious syndromes. By identifying these patterns, family physicians serve as essential sentinels for both individual patient safety and community public health. Full article

Background/Objectives: Shared decision-making is a central principle in pediatric practice, yet its implementation becomes challenging in the context of alternative family configurations. Stepparents have substantial caregiving roles, but Belgian legislation does not include them in medical information or decision-making authority, creating a gap between legal frameworks and clinical realities. The objective of this study was to explore pediatricians’ perspectives on the involvement of stepparents in medical information sharing and decision-making for minors, and to identify factors influencing whether and how stepparents are included. Methods: A qualitative study was conducted using six semi-structured focus group interviews with 30 pediatricians from six hospitals across Flanders, Belgium. Participants were purposively sampled based on clinical experience. The interviews explored experiences with consent, confidentiality, and stepparent involvement in pediatric care. Data were audio-recorded, transcribed verbatim, and analyzed using constant comparative analysis to identify overarching themes. Results: Three overarching themes emerged. First, the medical context strongly shaped decisions: medical information and minor decision-making were frequently shared, while major decision-making often involved consultation with the legal guardian. Second, relational dynamics, including the quality of the stepparent–child relationship, co-parenting conflict, and physicians’ intuitive assessments, influenced the extent to which stepparents were involved. Third, vulnerability was a recurring theme across all actors: physicians felt legally exposed, children risked fragmented care, legal guardians feared loss of control, and stepparents lacked recognition despite significant caregiving roles. Conclusions: This study shows the importance of a better alignment between clinical practice and legal reality. Aligning legal frameworks with contemporary family patterns may support more consistent, child-centered decision-making in pediatric practice. Full article

Background/Objectives: Irritable Bowel Syndrome (IBS) is a widely prevalent chronic disorder of brain–gut interaction which represents a clinical challenge due to its complex underlying causes and the lack of a standardized treatment approach. This cross-sectional research collected real-world data (RWD) on the effectiveness, safety, and usage pattern of a natural substance-based medical device, Colilen IBS, indicated for the treatment of IBS. Methods: Surveys were conducted both in Italy and Germany with 6101 participants, including 4425 patients, 1014 pharmacists, and 662 physicians using a structured GxP web platform that allows voluntary participants to share their experiences with the device. The validated platform was designed to comply with post-market surveillance requirements of EU Regulation 2017/745. Statistical analyses included descriptive evaluations of responses to gauge overall effectiveness and safety of the device. Results: The effectiveness reported with the medical device was judged extreme or great by 79.2% of patients, with 89.2% of whom observed symptom improvement within one month. Both safety and tolerability were rated extreme or great by 90.7% of patients. Healthcare professionals reported a similar rate on the overall effectiveness, with 94.9% of pharmacists and 95.9% of physicians indicating it extreme or great. Similarly, the safety profile was corroborated by nearly all pharmacists (97.0%) and physicians (98.2%) reporting extreme or great satisfaction with both safety and tolerability of the medical device. Conclusions: This research provides RWD supporting the effectiveness and safety of the product for treating IBS. The strong coherence among patients, pharmacists, and physicians in positively rating the device’s performance suggests that this medical device represents a therapeutic option that effectively addresses patient needs while minimizing safety concerns. Continuous RWD collection is essential, as it offers insights into real-world practice and ensures ongoing confirmation of the product’s safety and effectiveness. Ultimately, this will advance IBS patient care by integrating real-world evidence into clinical management. Full article

Psychosis is a frequent and disabling non-motor complication of Parkinson’s disease (PD). Clozapine and quetiapine are widely used in the treatment of Parkinson’s disease psychosis (PDP). We conducted an exploratory study to compare patient experiences with physician prescribing practices. Patients with PDP hospitalized at a university center completed semi-structured interviews on perceived efficacy, adverse effects, and daily functioning. Neurologists and geriatricians attending training sessions completed a structured questionnaire on prescribing patterns, attitudes toward clozapine, and perceived treatment burden. Data were analyzed thematically and triangulated across cohorts. Eleven patients (mean age 81 years; nine treated with quetiapine, two with clozapine) were included. Most quetiapine-treated patients reported persistent hallucinations, sedation, dizziness, and reduced autonomy. Fourteen physicians completed the survey and most preferred quetiapine, citing monitoring logistics and agranulocytosis risk as barriers to clozapine. Overall, patient priorities centered on symptom control and independence, whereas physician decisions emphasized feasibility and safety. Facilitating clozapine monitoring and incorporating patient-reported outcomes into routine care may improve patient-centered PDP management. Full article

Background/Objectives: Temperature control after cardiac arrest remains a recommended component of post-cardiac arrest care, yet substantial practice variability persists. Conflicting evidence regarding optimal temperature targets and mixed interpretations of recent trials, such as TTM2, may contribute to inconsistent bedside implementation. Understanding physician knowledge, attitudes, and practice patterns is essential for aligning post-cardiac arrest management with evolving evidence. This study aimed to characterize international physician perceptions of temperature control, patterns of use, understanding of neurologic injury, and the influence of emerging literature. Methods: A 39-item web-based survey was developed through iterative expert review and pilot testing and disseminated to members of critical care, neurology, and emergency medicine societies between September 2021 and January 2022. The instrument assessed demographics, temperature control practices, interpretation of new literature, and post-cardiac arrest management. Responses were analyzed using descriptive statistics in R Studio, with proportions reported for categorical variables and mode responses for ranked questions. Results: Among 501 respondents, 471 (94%) completed the survey. Most were attending-level physicians (73%), primarily practicing intensive care medicine (75%), and based in academic centers (60%). Targeted temperature management (TTM) was commonly initiated by the admitting intensivist (66%), most often because guidelines recommended it (67%). The most influential factors driving initiation were institutional protocols (21%), perceived neurologic prognosis (17%), and arrest etiology (14%). The most frequently selected temperature target was 36 °C (44%). Awareness of the TTM2 trial was high (70%), though only 31% reported altering their practice in response. Neurologists were more likely to individualize temperature targets and select lower temperatures, while physicians caring for higher cardiac arrest volumes also favored lower targets. Community clinicians more commonly selected lower temperature targets compared with those in academic settings. Conclusions: Substantial heterogeneity exists in the practice and rationale for temperature control after cardiac arrest. Physician specialty, cardiac arrest volume, and local practice environment influence the temperature target selection and attitudes toward emerging evidence. Despite awareness of new data, institutional protocols remain the dominant factor guiding implementation. Standardized, evidence-based institutional pathways may help reduce practice variability and promote consistent post-cardiac arrest care. Full article

Purpose/Objective(s): Adjuvant radiation therapy (RT) is an effective treatment in the management of patients with breast cancer. Evidence supports both standard fractionation and, more recently, moderate hypofractionation and ultra hypofractionation leading to a potential diversity of clinical practice. Whether or not physicians at main academic centers adopt hypofractionated regimens more readily than those working at community centers is not known. Practice patterns were analyzed within our large healthcare network comprising one main and eight community sites before and after 2020. Materials/Methods: Patients treated with adjuvant breast RT between 2017 and 2022 in our radiation oncology department were identified. Treatment techniques were evaluated: standard fractionation (25–28 fractions to 50–50.4 Gy), moderate hypofractionation (15–16 fractions to 40.05–42.56 Gy), and ultra hypofractionation (5 fractions of 26–30 Gy) for intact breast, partial breast, and chest wall cases. Use of each technique was compared between the main academic center (Main) versus eight community sites (Community) in two time periods, 2017–2019 and 2020–2022. Differences were assessed using z-ratios for the difference between independent proportions. Results: There was a statistically significant decrease in the use of standard fractionation for intact breast and chest wall cases from the early to the late period at both the community sites and the main center; however, a higher proportion of patients were treated with standard fractionation at the community sites versus the main center in the late period (7.8% community versus 2.0% main, p < 0.01 for intact breast and 80.7% community versus 37.4% main, p < 0.01 for chest wall). There was a statistically significant increase in the use of hypofractionation for intact breast and chest wall cases from the early to the late period at both the community sites and the main center; however, a higher proportion of patients were treated with hypofractionation at the main center versus the community sites during the late period (92.2% community versus 98.0% main, p < 0.01 for intact breast and 19.3% community versus 62.6% main, p < 0.01). Conclusions: The present study shows that recent trial evidence supporting the use of shorter RT treatments changed practice among providers more rapidly at our main academic center versus our community sites. The reasons for this difference are not known; however, standardization of treatment by implementation of an adjuvant RT treatment algorithm may facilitate uniform care among patients with breast cancer and we are investigating the impact of this approach. Full article

Background and Objectives: Large language models (LLMs) offer promising applications in healthcare, including drafting referral letters. However, access to LLMs specifically designed for medical practice remains limited. While ChatGPT is widely available, its ability to generate comprehensive and clinically appropriate neurology referral letters remains uncertain. This study aimed to systematically evaluate the completeness and quality of neurology referral letters generated by ChatGPT for standardized clinical scenarios. Materials and Methods: Five standardized clinical scenarios representing common neurological complaints encountered in family medicine settings (headache, memory problems, stroke/TIA, tremor, radiculopathy) were used. Using a consistent prompt, ChatGPT (GPT-4o, 2025 release) generated 10 referral letters per scenario (50 letters in total). A dual board-certified neurologist and family physician scored the letters using a 30-point rubric across multiple domains: completeness (demographics, chief complaint, history of present illness, physical exam findings, management, and consultation questions) and quality (language level, structure, and letter length). Descriptive statistics and inferential analyses (ANOVA and Kruskal–Wallis tests) were applied to assess performance across scenarios. Results: The mean total score was 25.76/30 (95% CI: 24.85–26.67). Completeness averaged 87%, while language and structure consistently scored above 90%. Content gaps appeared in 36 out of 50 letters (72%), mainly in the history of present illness and physical examination sections. Variability was observed across letters, though not statistically significant between scenarios (ANOVA: F = 1.14, p = 0.352; Kruskal–Wallis: H = 3.52, p = 0.475). Conclusions: ChatGPT produced neurology referral letters of high linguistic quality but variable completeness, especially for clinically complex content. The variability pattern among letters reflected model inconsistency rather than case type. The reliance on a single rater and use of a non-validated rubric represent limitations. Future studies should include multiple raters, inter-rater reliability testing, and validated scoring frameworks. Ultimately, access to tailored LLMs exclusively trained for medical documentation could improve outcomes while safeguarding patient privacy. Full article

Background and Objectives: Artificial intelligence (AI) and extended reality (XR) are reshaping telemedicine, yet physician-level adoption depends on perceived value, training needs, and specialty context. We quantified attitudes toward AI/XR, identified barriers/benefits, and tested advanced relationships (moderation and mediation). Methods: Cross-sectional survey of Romanian physicians (n = 43) across anesthesiology and ICU, surgical, medical, and dentistry. Items were translated into English and mapped to 5-point scales. A 10-item Telemedicine Acceptance Index (TAI; α = 0.86) and a 2-item XR Utility Index (XUI) were computed. Moderation by specialty (Training Priority × Specialty) and bootstrap mediation (2000 resamples) of Future Potential → XUI → TAI were performed. Results: Overall acceptance and perceived utility of XR were moderate to high across specialties; participants most frequently identified technical and financial constraints as barriers and time efficiency and improved access as key benefits. Acceptance patterns were similar across specialties and aligned most strongly with beliefs about future system-level potential and the priority assigned to hands-on training. Conclusions: Physicians reported favorable acceptance of AI/XR-enabled telemedicine. Perceived future system-level value and prioritization of hands-on training were the most consistent correlates of acceptance across specialties. Technical and financial constraints remained the primary barriers, while time efficiency and access emerged as leading perceived benefits. Acceptance appears to be driven more by beliefs about system-level potential and practical upskilling than by specialty identity. Full article

Background: Previous research showed that the majority of the variation in providers’ practice patterns is unexplained by patient, physician, and primary care practice characteristics. This study assessed physicians’ personal behavioral characteristics as explanatory components of medical practice variation (MPV). Methods: In this cross-sectional study, primary care physicians from Clalit Health Services in southern Israel were interviewed using validated surveys assessing risk-taking, tolerance for ambiguity, stress due to uncertainty, fear of malpractice, and empathy. We analyzed how much these traits explained MPV compared to patient, physician demographic, occupational, and practice characteristics using generalized linear mixed models and Nakagawa’s R². Results: Of the 160 physicians approached, 146 (91.3%) participated. The median practicing time was 22 years; 48% were male, with a median age of 49. The median number of patients per practice was 1135. Overall, 40.4% of MPV was explained, mostly by patient characteristics (18.9%), practice characteristics (10.2%), and physician demographics (8.3%). Physician behavioral traits explained only 2.3%. Conclusions: Personal behavior characteristics explain a minority of MPV, leaving 60% of the MPV unexplained. This suggests either limitations in survey assessments or that these traits are not key drivers of MPV. Full article

Background and Objectives: Urban–rural health disparities reflect differences in health outcomes, healthcare access, and socio-economic conditions between populations. In Serbia, limited research has quantified how socio-demographic and socio-economic characteristics influence settlement type and healthcare utilization. The aim of this study was to examine the relationship between settlement type and socio-demographic/socio-economic factors, and to assess whether these differences are reflected in patterns of healthcare utilization. Materials and Methods: Data were drawn from the 2019 Serbian National Health Survey, a nationally representative, stratified, two-stage random sample including 12,439 adults aged ≥20 years. Settlement type (urban vs. rural) was the primary dependent variable. Descriptive statistics, Chi-square and t-tests, and bivariate and multivariate logistic regression models were used to assess associations. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, with significance set at p < 0.05. Results: Urban residence was more likely among unmarried individuals, those living in Šumadija/Central Serbia, and those with higher education. Primary or lower education reduced the odds of urban residence, and middle-income groups were less likely to live in urban areas compared to the richest. Settlement type was not significantly associated with hospital or day hospital use. However, rural residents had lower use of prescribed medicines, higher use of non-prescribed medicines, and more frequent physiotherapy visits. Private practice use was over twice as likely in urban settlements. Conclusions: To address urban–rural healthcare disparities in Serbia, targeted strategies could include enhancing health literacy in rural areas, incentivizing physicians to work in underserved regions, expanding telemedicine and mobile health services, improving access to prescribed medications, and strengthening public–private healthcare integration to ensure equitable access across all settlement types. Full article