Effect of the Botanical Compound LCS101 on Chemotherapy-Induced Symptoms in Patients with Breast Cancer: A Case Series Report

The treatment of breast cancer invariably results in severe and often debilitating symptoms that can cause significant distress and severely impair daily function and quality-of-life (QOL). We treated a series of 20 female breast cancer patients with the botanical compound LCS101 as adjuvant to conventional chemotherapy. At the end of the treatment regimen, patients rated their symptoms. 70% reported that they had either no or mildly severe levels of fatigue; 60% none to mildly severe weakness; 85% none to mildly severe pain; 70% none to mildly severe nausea; and 80% none to mildly severe vomiting. Only 20% reported severe impairment of overall function, and only 40% severely impaired QOL. No toxic effects were attributed by patients to the LCS101 treatment, and 85% reported that they believed the botanical compound had helped reduce symptoms. The effects of LCS101 on clinical outcomes in breast cancer should be tested further using randomized controlled trials

Does examining job market awareness among medical students provide insight into the specialty selection process?

AbstractBackground The future composition of a country’s physician workforce depends on medical students’ choices of specialties. Students’ familiarity with the job market (the healthcare system) they are about to enter and the influence job market conditions have on their choices has not been well explored. This study focuses on whether and how the healthcare system’s employment landscape is taken into consideration by medical students and whether this facet adds information about the specialty selection process.Methods Fifth-year medical students completed a questionnaire querying their knowledge and perceptions of the national healthcare system, selection criteria for choosing a specialty and a post-residency work position. Data were analyzed with two-tailed Student’s t-tests and multivariable regression analysis.Results The questionnaire was completed by 242 students (49% women). Forty per cent were interested in a specialty where it is ‘easy to find work’ and 64% in a specialty that ‘provides job security’. Only 12% were attracted to specialties with empty positions due to a workforce shortage. A high salary was considered an important selection criterion by 45% of students, who were also not deterred by specialties with surplus workforce, especially, if accompanied by high salaries or controllable lifestyles. Only 17% thought it would be easy to find a residency in any hospital in the specialty they chose, reflecting the low rate (3%) of positive responses to the statement that ‘there are sufficient residency positions in all specialties’.Conclusions This study demonstrated the utility of querying medical students about their market awareness when investigating the specialty selection process. Students’ poor rating of selection criteria, such as specialties with ease in finding jobs because they are suffering workforce shortages and have empty positions, provide insights and concerns for healthcare leaders. It should aid them in approaching the challenge of attracting students to specialties with workforce shortfalls.KEY MESSAGESThis study demonstrated the feasibility and potential value of adding queries about market awareness when investigating the medical student specialty selection process.Medical students were more interested in a specialty that provides job security than one where it is easy to find work.It could be useful for the healthcare leadership and medical educators in all countries to learn what medical students know about their national healthcare system and whether they need to add more healthcare delivery and system subjects to their curricula

Mechanical ventilation patterns and trends over 20 years in an Israeli hospital system: policy ramifications

Abstract Background Mechanical ventilation is a life supporting modality increasingly utilized when caring for severely ill patients. Its increasing use has extended the survival of the critically ill leading to increasing healthcare expenditures. We examined changes in the hospital-wide use of mechanical ventilation over 20 years (1997–2016) in two Israeli hospitals to determine whether there were specific patterns (e.g. seasonality, weekday vs. weekend) and trends (e.g. increases or decreases) among various hospital departments and units. Methods Retrospective analysis of prospectively collected data on all mechanically ventilated patients over 20-years in a two-hospital Israeli medical system was performed. Data were collected for each hospital unit caring for ventilated patients. Time-series analysis examined short and long-term trends, seasonality and intra-week variation. Results Over two decades overall ventilator-days increased from 11,164 (31 patients/day) in 1997 to 24,317 (67 patients/day) in 2016 mainly due to more patients ventilated on internal medicine wards (1997: 4 patients/day; 2016: 24 patients/day). The increases in other hospital areas did not approach the magnitude of the internal medicine wards increases. Ventilation on wards reflected the insufficient number of ICU beds in Israel. A detailed snapshot over 4 months of patients ventilated on internal medicine wards (n = 745) showed that they tended to be elderly (median age 75 years) and that 24% were ventilated for more than a week. Hospital-wide ventilation patterns were the weighted sum of the various individual patient units with the most noticeable pattern being peak winter prevalence on the internal medical wards and in the emergency department. This seasonality is not surprising, given the greater incidence of respiratory ailments in winter. Conclusions Increased mechanical ventilation plus seasonality have budgetary, operational and staffing consequences for individual hospitals and the entire healthcare system. The Israeli healthcare leadership needs to plan and support expanding, equipping and staffing acute and chronic care units that are staffed by providers trained to care for such complex patients

Medical specialty selection criteria of Israeli medical students early in their clinical experience: subgroups

Abstract Background Israeli medical school classes include a number of student subgroups. Therefore, interventions aimed at recruiting medical students to the various specialties should to be tailored to each subgroup. Methods Questionnaires, distributed to 6 consecutive 5th-year classes of the Hebrew University – Hadassah School of Medicine, elicited information on criteria for choosing a career specialty, criteria for choosing a residency program and the importance of finding a specialty interesting and challenging when choosing a residency. Results Completed questionnaires were returned by 540 of 769 (70%) students. The decision processes for choosing a medical specialty and choosing a residency program were different. Family and colleagues had minimal influence on choosing a specialty, while family and their residential locality had much influence on choosing a residency, especially among women. Older age, marriage, and spousal influence were positively associated with choice of a specialty. Two-thirds of the students had completed military service, 20% were attending medical school prior to military service, 5% had completed national service and 9% had entered medical school without serving. Despite the pre-military subgroup being younger and having another 7 years of medical school, internship and military service before residency, they had begun thinking about which specialty to choose, just like the post-military students. When choosing a residency program, post-military women were more influenced by their families and family residential locality than their pre-military counterparts; differences ascribed to the older and often married post-military women having or wanting to begin families. This difference was reinforced by fewer post- than pre-military women willing to wait 2-3 years for a residency in the specialty that interested them most and were willing to begin residency immediately after internship in a specialty that interested them less. Conclusions Medical school classes are composed of various subgroups, each with its own characteristics. It is important to differentiate between choosing a specialty and a residency program. Choosing a specialty is a uniquely personal decision with some spousal influence among married students. It is of central importance even among pre-military students not slated to begin residency for many years. In contrast, choosing a residency program is influenced by family, where one grew up and other family-related considerations

Medical specialty selection criteria of Israeli medical students early in their clinical experience: subgroups.

BACKGROUND:Israeli medical school classes include a number of student subgroups. Therefore, interventions aimed at recruiting medical students to the various specialties should to be tailored to each subgroup. METHODS:Questionnaires, distributed to 6 consecutive 5th-year classes of the Hebrew University - Hadassah School of Medicine, elicited information on criteria for choosing a career specialty, criteria for choosing a residency program and the importance of finding a specialty interesting and challenging when choosing a residency. RESULTS:Completed questionnaires were returned by 540 of 769 (70%) students. The decision processes for choosing a medical specialty and choosing a residency program were different. Family and colleagues had minimal influence on choosing a specialty, while family and their residential locality had much influence on choosing a residency, especially among women. Older age, marriage, and spousal influence were positively associated with choice of a specialty. Two-thirds of the students had completed military service, 20% were attending medical school prior to military service, 5% had completed national service and 9% had entered medical school without serving. Despite the pre-military subgroup being younger and having another 7 years of medical school, internship and military service before residency, they had begun thinking about which specialty to choose, just like the post-military students. When choosing a residency program, post-military women were more influenced by their families and family residential locality than their pre-military counterparts; differences ascribed to the older and often married post-military women having or wanting to begin families. This difference was reinforced by fewer post- than pre-military women willing to wait 2-3 years for a residency in the specialty that interested them most and were willing to begin residency immediately after internship in a specialty that interested them less. CONCLUSIONS:Medical school classes are composed of various subgroups, each with its own characteristics. It is important to differentiate between choosing a specialty and a residency program. Choosing a specialty is a uniquely personal decision with some spousal influence among married students. It is of central importance even among pre-military students not slated to begin residency for many years. In contrast, choosing a residency program is influenced by family, where one grew up and other family-related considerations

Challenges to the Israeli healthcare system: attracting medical students to primary care and to the periphery

Abstract Background The greatest challenges facing healthcare systems include ensuring a sufficient supply of primary care physicians and physicians willing to work in rural or peripheral areas. Especially challenging is enticing young physicians to practice primary care in rural/peripheral areas. Identifying medical students interested in primary care and in residencies in Israel’s periphery should aid the healthcare leadership. It may be particularly important to do so during the clinical years, as this is the stage at which many future physicians begin to crystallize their specialty and location preferences. Methods Questionnaires, distributed to 6 consecutive 5th-year classes of the Hebrew University – Hadassah School of Medicine, from 2010 to 2016, elicited information on criteria for choosing a career specialty, criteria for choosing a residency program and whether one-time monetary grants authorized in the 2011 physicians’ union contract would attract students to residencies in the periphery. Results Completed questionnaires were returned by 511 of 740 (69%) students. Ninety-eight (19%) were interested in a primary care residency, 184 (36%) were unsure and 229 (45%) were not interested. Students interested in primary care were significantly less interested in specialties that perform procedures/surgeries and in joining a medical school faculty, while being more inclined towards specialties dealing with social problems, controllable lifestyles and working limited hours. The percentage of students interested in primary care was stable during the study period. Forty-eight of the students indicated interest in residencies in the country’s periphery, and 42% of them were also interested in primary care residencies. Overall, only 3.7% of students were interested in both a primary care residency and a residency in the periphery. Thirty percent of the students indicated that the monetary incentives tempted them to consider a residency in the periphery. Fifty-three percent of these students reported that they did not yet know the geographic area where they wished to do their residency, as compared to only 22% among those not interested in incentives. Conclusions This study provides the healthcare leadership with information on the characteristics of the students at a centrally-located medical school who tend to be more interested in primary care and in working in the periphery. Specifically, the study found that students interested in primary care desire a positive life/work balance, something that Israeli non-hospital primary care practice provides. Students considering residencies in the periphery were similarly inclined. Moreover, about a third of students had positive thoughts about monetary incentives for residencies in peripheral hospitals. These students should be identified early during their clinical experience so that attempts to recruit them to the periphery can commence before their specialty and location preferences have fully crystallized. Parallel studies should be performed at additional Israeli medical schools

Medical students’ perceptions of a career in family medicine

Abstract Background In Israel, there is a shortage of family medicine (FM) specialists that is occasioned by a shortage of students pursuing a FM career. Methods A questionnaire, based on methods adapted from marketing research, was used to provide insight into the medical specialty selection process. It was distributed to 6th-year medical students from two Israeli medical schools. Results A response rate of 66% resulted in collecting 218 completed questionnaires. Nineteen of the students reported that they were interested in FM, 68% of them were women. When compared to students not interested in FM, the selection criteria of students interested in FM reflected greater interest in a bedside specialty which provides direct long-term patient care. These latter students were also more interested in a controllable lifestyle that allowed time to be with family and children and working outside the hospital especially during the daytime. These selection criteria aligned with their perceptions of FM, which they perceived as providing them with a controllable lifestyle, allowing them to work limited hours with time for family and having a reasonable income to lifestyle ratio. The students not interested in FM, agreed with those interested in FM, that the specialty affords a controllable lifestyle and the ability to work limited hours Yet, students not interested in FM more often perceived FM as being a boring specialty and less often perceived it as providing a reasonable income to lifestyle ratio. Additionally, students not interested in FM rated the selection criteria, academic opportunities and a prestigious specialty, more highly than did students interested in FM. However, they perceived FM as neither being prestigious nor as affording academic opportunities Conclusion This study enriches our understanding of the younger generation's attitudes towards FM and thus provides administrators, department chairs and residency program directors with objective information regarding selection criteria and the students’ perceptions of FM. We identified the disconnect between the selection criteria profiles and the perceptions of FM of students not inclined to pursue a residency in FM. This allowed for recommendations on how to possibly make FM more attractive to some of these students

Postoperative pain management in Latino families: parent beliefs about analgesics predict analgesic doses provided to children

BACKGROUND/OBJECTIVES: The present study examined whether parental perceptions of children’s pain impacted home-based pain management following outpatient surgery in a sample of Latino families from low socioeconomic backgrounds. METHODS: Latino parents of children (n = 161) who underwent outpatient surgery were recruited for this study and completed measures assessing attitudes on pain and analgesic use (Parental Pain Expression Perceptions and Medication Attitudes Questionnaire) before their child’s surgery. Parents also rated their child’s pain after their child’s surgery using the Parent Postoperative Pain Measure and collected data on the amount of analgesics they gave to their child on the first postoperative day. Hierarchical regression analyses examined whether parental attitudes predicted pain assessment and management at home. RESULTS: A majority of parents reported multiple misconceptions regarding children’s pain and fears of side effects as well as avoidance of analgesic use. For example, over 80% reported believing that a child always tells their parents when they are in pain. Hierarchical regression analyses found that more fear and avoidance regarding analgesic use for children’s pain predicted parents’ providing fewer doses of analgesic to their children on the first postoperative day (β = −0.21, p = 0.028). CONCLUSIONS: Preoperative parents’ beliefs regarding analgesics for treatment of children’s pain may adversely impact parent postoperative analgesic administration at home in Latino families