COVID-19 Crisis: The Pandemic Highlights the Unique Training and Skills of Military Physicians Afforded by Military-Specific Graduate Medical Education

ABSTRACT Military physicians trained in military Graduate Medical Education programs are uniquely prepared to lead in austere and chaotic environments based on formal and informal curricula taught in military treatment facilities. The coronavirus disease-2019 pandemic highlighted this reality when military-trained physician leaders were challenged to lead change directly from the front.

The Practicality of Deep Learning Algorithms in COVID-19 Detection: Application to Chest X-ray Images

Since January 2020, the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected the whole world, producing a respiratory disease that can become severe and even cause death in certain groups of people. The main method for diagnosing coronavirus disease 2019 (COVID-19) is performing viral tests. However, the kits for carrying out these tests are scarce in certain regions of the world. Lung conditions as perceived in computed tomography and radiography images exhibit a high correlation with the presence of COVID-19 infections. This work attempted to assess the feasibility of using convolutional neural networks for the analysis of pulmonary radiography images to distinguish COVID-19 infections from non-infected cases and other types of viral or bacterial pulmonary conditions. The results obtained indicate that these networks can successfully distinguish the pulmonary radiographies of COVID-19-infected patients from radiographies that exhibit other or no pathology, with a sensitivity of 100% and specificity of 97.6%. This could help future efforts to automate the process of identifying lung radiography images of suspicious cases, thereby supporting medical personnel when many patients need to be rapidly checked. The automated analysis of pulmonary radiography is not intended to be a substitute for formal viral tests or formal diagnosis by a properly trained physician but rather to assist with identification when the need arises.

Botulinum Toxin and Fillers for Maxillofacial Esthetics

The skin undergoes major changes gradually with aging. Development of facial wrinkles and sagging of skin are common features of aging which affect facial aesthetics. Facial wrinkles are mainly caused or worsened by the repeated contraction of facial muscles and physiological changes associated with aging. Reversal of these clinical signs have been successfully achieved with Botulinum Toxin Type A and Hyaluronic acid dermal fillers. They are very safe and effective under a trained physician or surgeon for a number of therapeutic and cosmetic conditions. Knowledge of the anatomy of facial muscles and proper technique are important to achieve predictable results and avoid complications. This chapter deals with the clinical indications and various techniques of using Botulinum toxin and Fillers for cosmetic purposes.

Fairly Assessing U.S.- and Foreign-Trained Physician Performance Using 360-Degree Surveys

Background With a growing number of foreign-trained physicians joining the United States workforce, there is a need to fairly assess their job performance. The purpose of this study was to explore the fairness of a 360-degree competency assessment on U.S.- and foreign-trained physicians. Methods We conducted a non-experimental retrospective analysis on physicians working in the United States (n = 258) who participated in a physician assessment and education program between 2007 and 2017. Results There were no significant differences in performance outcomes of teamwork, motivating or discouraging behaviors, technical practice, and patient interactions based on demographic differences. Conclusions The PULSE 360 is a powerful tool that can be used to evaluate physician performance without bias in demographic differences including: gender, country of physician medical training, physician native language, or age.

THU0645-HPR ULTRASOUND EDUCATION FOR RHEUMATOLOGIST IN RUSSIA: REALITIES AND WHAT IS NEEDED TO IMPROVE.

Background:Musculoskeletal ultrasonography (MSUS) is a valuable imaging modality for the practicing rheumatologist. In everyday practice, physical examination is limited by its sensitivity and subjectivity of assessment. MSUS is inexpensive, available, and allows repeat examination as soon as necessary. Thus, MSUS has become the “third eye” of the rheumatologist, in that it allows more detailed examination of muscles, bones, and joints, just as the stethoscope provides further details about the respiratory and cardiovascular systems. Most ultrasound examinations in Russia, including abdominal and vascular sonography, echocardiography, are conducted by trained physician - radiologist, called “ultrasonography specialists”. Nevertheless, it is very difficult to perform MSUS, mainly because standardized ultrasound protocols fore same region are different for various diseases and often do not provide physicians with the information they need, and also may been mistake. The conduct of MSUS by rheumatologists themselves is limited to the need for 4-month radiology (ultrasound) certification. However, the number of rheumatologists conducting MSUS themselves is increasing. Training week small group courses are provided by VA Nasonova Research Institute of Rheumatology for the practicing rheumatologist and other physicians.Objectives:We analyzed the training and awareness of the rheumatologists and radiologists in MSUS, as well as their commitment for participation in our courses.Methods:We studied a one and a half-year period, from June 2018 to December 2019. During this time, 57 applications were submitted to participate in the courses. All participants who arrived were tested before starting the course. Test included 40 general questions about MSUS. Test results as well as commitment to training were analyzed in two groups: rheumatologists and radiologists. Nonparametric statistics were used for data processing.Results:Among 57 applications submitted for the courses, 26 were from rheumatologists and 31 from radiologists, but the courses were attended by 13 rheumatologists and 26 radiologists (68%). Thus, commitment was reliably higher in radiologists (84%) than in rheumatologists (50%). Fisher’s methods show high statistically significance (Χ2= 7,51, p = 0,006). Although the test focused on ultrasound, it was surprise for us that the median percentage of correct answers was higher in rheumatologists - 64 (54; 80)%, than radiologists (“ultrasonography specialists”) 48 (40; 62)%. Difference also were significantly (p = 0,04).Conclusion:Thus, despite better preparedness of rheumatologist, motivation to study MSUS prevails among radiologists. It is necessary to actively introduce MSUS into general rheumatologic educational programs in order to motivate rheumatologists to study MSUS. Changes in professional standard will also encourage wide use of MSUS by rheumatologists.Disclosure of Interests:None declared

The Yeti Does Exist after All

The search for the Yeti has a long history. Several expeditions tried to encounter the elusive creature and to reveal the mystery; they all failed. The one who did succeed was Fr. Franz Xaver Eichinger, missionary of the Society of the Divine Word (SVD) and trained physician, who worked in Qinghai (Northwestern China) from 1940 to 1953. On one of his medical expeditions to Tibetan nomads, Eichinger met “Yeti” by accident, and specifically an individual who possessed a deep spiritual knowledge and a natural gift of healing. Eichinger called him the “Naked Lama,” a hairy creature of the wilderness who was apparently not harmed by the cold. Eichinger explained this phenomenon by pointing to the fact that children born with a congenital hypertrichosis, due to endogamy, were frequently expelled from villages because they were believed to be possessed by evil spirits.

Mantoux test revisited: Variability in reading tuberculin test in pediatric population

Introduction: Mantoux test aids in the diagnosis of tuberculosis (TB), however its application and interpretation are dependent on multiple factors. Methodology: A prospective study enrolling 400 children (aged 2-12) suspected to have tuberculosis. All participants received Mantoux test with two different strengths (1 TU and 5 TU) of Purified Protein Derivative (PPD) on different forearms. The test was read by two readers after 48 ± 2 and 72 ± 2 hours. Primary outcome was difference in the size of induration when read by two readers (interobserver variability). Secondary outcomes were difference in the size of induration at different intervals, with different strengths of PPD and percentage positivity of Mantoux test in TB patients. Results: Statistically significant difference was seen in the size of induration when read by two different readers, with fair to moderate agreement when read at 48 and 72 hours (1 TU: p = 0.002, k = 0.52 and p = 0.1, k = 0.73 respectively, 5 TU: p = 0.001, k = 0.39 and p = 0.0009, k = 0.33 respectively). Tendency of under-reading occurred when size of induration was close to significant level (10-14 mm). Size of induration was similar when read at 48 or 72 hours (1 TU: p = 0.9, 5 TU: p = 1.0). Mantoux positivity rate in patients with TB was more with 5 TU as compared to 1 TU (61.2% vs. 16.3%). Conclusions: There is significant interobserver variability with a tendency to under-read around the cutoff point. The use of 5 TU PPD at 48 hours by a trained physician can aid in early and more reliable diagnosis of TB.

Vernacularizing Political Medicine

Christopher Hamlin describes a strand of medical thinking in nineteenth-century Britain that resisted narrow notions of disease specificity in the name of a broader, socio-economically grounded notion of ‘political medicine’. This chapter explores the vernacularization of this political medicine in Bengal in the 1870s. It focuses on the work of two specific Bengali intellectuals, viz. Dr Gopaul Chunder Roy and the Rev. Lal Behari Day. Since the former was a Glasgow-trained physician and the latter a missionary, ethnographer and novelist, the chapter also explores the differences between the literal and the literary vernacularizations of political medicine.

Resurrecting the Body Politic – Physiology’s Influence on Sir William Petty’s Political Arithmetick

Sir William Petty (1623-1687), the founder of the method of “political arithmetick,” was a trained physician and anatomist. Receiving medical education both in England and on the continent, he later turned away from an academic career and a medical practice in favour of dealing with political and social matters, becoming one of the first advocates of quantifying social phenomena in order to better govern a population. Offering his services to both Oliver Cromwell and Charles II, Petty sought to reform and transform society (in Ireland in particular), while considering the physician’s treatment of natural bodies and the political advisor’s treatment of the body politic to be analogous enterprises. In doing so, he did not refrain from suggesting serious interventions into social life – something that his contemporary peers did not consider compatible with their medical backgrounds. This article attempts to investigate how Petty’s proposals could have differed so much in their scope and content from those of his colleagues, while remaining true to their largely shared Baconian and Harveyan origins.

Anesthesiology or Perioperative Medicine

According to the Department of health services of Nepal, around 100,000 surgical patients received some form of anesthesia for surgical intervention in the year 2014. Around 55,000 were inpatient and 45,000 being outpatient. Many were straight forward, some required optimization prior to anesthesia and surgery.Anesthesiologists are primary physicians who looks patient before, during and after surgeries. Therefore, these specialists have enough knowledge and skills required to be physicians. The article gives a view on development of a specially trained physician, a perioperative physician rather than anesthesiologist and raises a view on transforming the postgraduate degree of anesthesiology from a recognized medical college or university in Nepal to a more appropriate perioperative medicine.