Background: Studying a specific illness could lead medical students to an incorrect interpretation of certain physical symptoms, so that symptoms which were previously considered normal are now regarded as a true sign of an illness. Aim: To examine the appraisal of self-health state, the existing fear of morbidity and the level of health-related anxiety among medical students throughout medical school. Methods: Anonymous questionnaires were distributed to first through sixth year medical students at the Tel-Aviv University Medical School. The questionnaires were distributed to all the students who were present on the study days. Results: We observed a significant rise in the emotional–distress process with entering the clinical years followed by a significant decrease later on. Similar pattern was seen in health anxiety and in preoccupation with and fear of illness and death. While the perceptual–cognitive process increased gradually, there was no change in interference with life scores. Conclusion: “Medical student's disease” should be regarded as a phenomenon depending on the years of learning. By breaking it down into its components, one can better characterize it and predict its onset. By defining it as a normal process, one can assist in guiding medical students to reduce their level of anxiety and distress.
27 December 2022 in Diabetes, Obesity and Metabolism
Aims: Higher doses of the glucagon‐like peptide‐1 agonist semaglutide and, more recently, tirzepatide, a dual glucose‐dependent insulinotropic polypeptide and glucagon‐like peptide‐1 agonist showed a significant reduction in body weight in patients with type 2 diabetes mellitus. However, their comparative value for money for this indication is unclear. Therefore, we aimed to establish which provides better value for money. Materials and Methods: We calculated the cost needed to treat to achieve a 1% reduction in body weight using high‐dose tirzepatide (15 mg) versus semaglutide (2.4 mg). The body weight reductions were extracted from published results of SURMOUNT‐1 and STEP 1 trials, respectively. In addition, we performed a scenario analysis to mitigate the primary differences between the two study populations. Drug costs were based on US GoodRx prices as of October 2022. Results: Using tirzepatide resulted in a weight loss of 17.8% (95% CI: 16.3%‐19.3%) compared with 12.4% (95% CI: 11.5%‐13.4%) for semaglutide. The total cost of 72 weeks of tirzepatide was estimated at $17 527 compared with $22 878 for 68 weeks of semaglutide. Accordingly, the cost needed to treat per 1% of body weight reduction with tirzepatide is estimated at $985 (95% CI: $908‐$1075) compared with $1845 (95% CI: $1707‐$1989) with semaglutide. Scenario analysis confirmed these findings. Conclusions: Tirzepatide provides better value for money than semaglutide for weight reduction.
Understanding whether a true change has occurred during the process of care is of utmost importance in lymphedema management secondary to cancer treatments. Decisions about when to order a garment, start an exercise program, and begin or end therapy are based primarily on measurements of limb volume, based on circumferences taken by physiotherapists using a flexible tape. This study aimed to assess intra-rater and inter-rater reliability of measurements taken by physiotherapists of legs and arms with and without lymphedema and to evaluate whether there is a difference in reliability when measuring a healthy versus a lymphedematous limb. The intra-rater reliability of arm and leg measurements by trained physiotherapist is very high (scaled standard error of measurements(SEMs) for an arm and a leg volume were 0.82% and 0.64%, respectively) and a cut-point of 1% scaled SEM may be recommended as a threshold for acceptable reliability. Physiotherapists can rely on the same error when assessing lymphedematous or healthy limbs. For those who work in teams and share patients, practice is needed in synchronizing the measurements and regularly monitoring their inter-rater reliability.
Urinary tract infections (UTIs) often prompt empiric outpatient antibiotic prescriptions, risking mismatches. This study evaluates the impact of “UTI Smart-Set” (UTIS), an AI-driven decision-support tool, on prescribing patterns and mismatches in a large outpatient organization. UTIS integrates machine learning forecasts of antibiotic resistance, patient data, and guidelines into a user-friendly order set for UTI management. From 6/1/2021–8/31/2022, 171,010 UTI diagnoses were recorded, with UTIS used in 75,630 cases involving antibiotic prescriptions. Overall acceptance rate of UTIS recommendations was 66.0%. Among 19,287 cases with urine cultures, antibiotic mismatch rate was significantly lower when UTIS recommendations were followed (8.9% vs. 14.2%, p < 0.0001). Among women over 18, mismatch rate was 47.5% lower, and among women over 50, 55.6% lower (p < 0.001). Additionally, an overall reduction of 80.5% in ciprofloxacin usage (6.4% vs 32.9%, p < 0.0001) was observed. UTIS improved prescribing accuracy, reduced mismatches, and minimized quinolone use, highlighting AI’s potential for personalized infection management.
Objective: Higher doses of the glucagon‐like peptide‐1 agonists liraglutide and, more recently, semaglutide have demonstrated a significant reduction in body weight. However, their comparative value for money for this indication is unclear.Methods: The cost needed to treat to achieve a 1% reduction in body weight using semaglutide or liraglutide was calculated. The body weight reductions were extracted from the published STEP 1 trial and the SCALE trial results, respectively. A scenario analysis was performed to mitigate the primary differences between the two studies' populations. Drug costs were based on US GoodRx prices as of October 2022.Results: Liraglutide in STEP 1 resulted in a weight loss of 5.4% (95% CI: 5%‐5.8%). Semaglutide in SCALE resulted in a weight loss of 12.4% (95% CI: 11.5%‐13.4%). The total cost of therapy with liraglutide during the trial was estimated at $17,585 compared with $22,878 with semaglutide. Accordingly, the cost needed to treat per 1% of body weight reduction with liraglutide is estimated at $3256 (95% CI: $3032‐$3517) compared with $1845 (95% CI: $1707‐$1989) with semaglutide.Conclusions: Semaglutide provides significantly better value for money than liraglutide for weight reduction.
1 June 2017 in International Journal of Medical Informatics