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Interview Questions for the Physician Candidate

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182. Management of Hepatitis C

| 11 Management of hepatitis C 5 Referral Referral to specialist care should be considered for all patients with active HCV infection (HCV RNA positive) and not be restricted to potential candidates for antiviral therapy. Specialist clinics are often a source of information for patients and relatives, including health promotion and methods of avoiding secondary transmission of the virus. Modelling suggests that 90% of individuals with HCV in Scotland are current or former IDU. 1 Factors associated (...) (3.5%). 59 Levels of alanine aminotransferase (AL T) twice the upper limit of normal are found in 50% of infected children. 59 D Children infected with HCV should be monitored to identify the minority who are at risk of progressive fibrosis during childhood, and who may be candidates for treatment. Children infected with HCV should be assessed clinically every 6-12 months, and have blood taken for tests of liver function. Those with clinical or ultrasound abnormalities, or with serum AL T

2013 SIGN

183. Imbalanced ‘Saved by the Scan’ campaign neglects big concerns over lung cancer screening

of the Association of Health Care Journalists. A screengrab from the “Saved by the Scan” public service announcement. Everyone who has ever smoked cigarettes should take this because “Lung cancer screening could save your life,” according to the American Lung Association’s (ALA) new “ ” campaign. But after taking that quiz, almost all current or former smokers (roughly 9 out of 10) will learn that they’re not good candidates for screening. Why isn’t screening for everyone? The campaign materials don’t say (...) mention anything that would give them a reason to hesitate! And the reality is that with lung cancer screening, there are plenty of reasons why a reasonable person might say, “Thanks, but no thanks”. Who is a candidate for screening? The American Lung Association and others estimate that about 9 million people in the US meet the guidelines for CT screening based on the . These include only “high-risk” people who are: 55-80 years of age Have a 30 pack-year history of smoking AND, are a current smoker

2017 HealthNewsReview

184. PCSK9 Inhibitors for Treatment of High Cholesterol: Effectiveness, Value, and Value-Based Price Benchmarks

evidence into action provide the foundation for a more effective, efficient, and just health care system. More information about ICER is available at http://www.icer- review.org About New England CEPAC The New England Comparative Effectiveness Public Advisory Council (CEPAC) is an independent, regional body of practicing physicians, methodological experts, and leaders in patient advocacy and engagement that provides objective, independent guidance on the application of medical evidence to clinical (...) outcome trials that are currently in progress (ODYSSEY OUTCOMES, FOURIER). 4.3 Summary and Comment Our analyses demonstrate that the existing evidence provides moderate certainty that PCSK9 treatment provides an incremental or substantial net health benefit for all of the patient subpopulations included in the scope of this review. There is no question that the drugs improve intermediate risk factors for cardiovascular disease. They substantially reduce LDL-C, total cholesterol, and lipoprotein

2015 California Technology Assessment Forum

185. Headline vs. study: Bait and switch?

: This qualitative study is based on interviews of 54 people in England with “long-term” mental illness, 25 of whom are pet owners who consider their pets part of their social network. The scientists asked who they went to when they needed help or advice, where they gained emotional support and encouragement and how they spent their days. Sixty percent of the people who considered pets to be a part of their social networks placed them in the central, most important circle — the same place many people put close (...) family and social workers. 20 percent placed pets in the second circle. : The “headline is based on the self-reporting of 25 patients in the United Kingdom who already own pets and consider them part of their social network.” That’s a small, biased group from which to be drawing the broad conclusion that “pets help manage the pain of serious mental illness.” Not all people with serious mental disorders are good candidates for pet ownership and many likely would not be helped by an animal companion

2017 HealthNewsReview

186. Dr. Kelly Brogan’s e-book “Vaccines and Brain Health”: A cornucopia of antivaccine misinformation and pseudoscience

to understand how vaccines work, who is recommending them, and why – and to ask questions. Because no one should be threatened by the process of further inquiry . Excuse me, Dr. Brogan, but I think you have a typo. I think you meant “ ,” that perversion of informed consent favored by antivaxers in which the risks of vaccines are amplified by many orders of magnitude and their efficacy downplayed by orders of magnitude, all through the citation of and , as well as the misrepresentation of real studies. Note (...) ever-growing entirety . Additionally, vaccine formulations have never been studied against a true placebo for FDA approval. These studies can be even further compressed since the introduction of ‘fast- tracking’ in 1992, a method that pharmaceutical companies can pay extra for to accelerate FDA approval of their vaccine candidates, like Gardisil. These fast- tracked vaccines are often studied against false ‘placebos,’ like aluminum or another vaccine, raising the background rate of adverse events

2017 Respectful Insolence

187. The Trump administration versus “seven dirty words” at the CDC

could best . Trump himself, of course, has a of expressing a number of antivaccine views that he’s expressed on Twitter and in interviews many times and encompassing—of course!—the scientifically . So when Donald Trump was and then when he was , a number of physicians and a huge number of scientists were appalled—and rightly so, as it turns out. Who knew that George Carlin’s immortal routine about the seven dirty words you can’t say on TV would become the basis for government policy, only (...) killing me not to lay into them. ] Ever since Donald Trump’s last year, many of us who advocate for the view that medicine and public policy should be based on the best evidence and science have been increasingly disturbed by just how little science and evidence mean to the Trump administration. Our concern began well before the actual election, based on the dangerous antivaccine politics on display in the Republican primary races, in which several of the candidates seemed to be competing over who

2017 Respectful Insolence

188. Gwyneth Paltrow and Goop double down on quackery by featuring an HIV/AIDS denialist and antivaccine quack at its upcoming Goop Summit

, the idea that HIV is the cause of AIDS a “meme”—a fleeting cultural concept or catchphrase passed around the internet—rather than the established fact that health authorities worldwide consider it. “Drug toxicity associated with AIDS treatment may very well be what accounts for the majority of deaths,” Brogan wrote. Asked about those statements in the blog post, which is still available , in an interview with Newsweek, Brogan called the link between HIV and AIDS an “assumption.” That assertion directly (...) women around the world with a medication so toxic, it kills mother and their unborn. She raises questions about assumptions we have come to believe are truths – That HIV is a meaningful diagnosis (she references the false positive testing likelihood in pregnancy, the unstandardized lab standards from country to country, and the abandonment of even those criteria in Africa where an HIV diagnosis can be conferred based on symptoms like malaise and diarrhea alone). That HIV causes AIDS (a syndrome

2017 Respectful Insolence

189. A pharma sales army aims to increase ‘fibroid awareness’; women’s health experts brace for collateral damage

. Allergan is boasting to investors that it’s planning “a lot of education” to pump up sales of the drug, marketed in Europe as Esmya. reported in an interview with Allergan’s marketing chief, Bill Meury, that the company is planning to deploy an “army” of 300 sales reps to call on obstetrician/gynecologists and a direct-to-consumer ad campaign including TV, print and social media that will put its drug “front and center.” Allergan is laying groundwork by a patient advocacy group, , which is trying (...) their fertility, and are perfect targets for marketing campaigns that offer new products and services to help them do so,” Carlson said. “It’s unclear whether the [Allergan] campaign will veer in the direction of pushing ‘early detection’ (and treatment) of fibroids to protect future fertility, but to the extent that it does, that will raise questions about whether its intent is to raise awareness or sell its product.” An Allergan spokesman wouldn’t say whether the company intends to market ulipristal

2017 HealthNewsReview

190. Prescription Monitoring Programs in Canada: Best Practice and Program Review

the abstracts and summaries identified to determine their relevance for inclusion and the full text articles were retrieved and reviewed. Appendix 1 includes the details for these search strategies. Information on the features and practices of the PMPs in Canada was obtained by reviewing program websites and telephone interviews conducted with key contacts from each program. Appendix 2 includes the list of contacts. Canadian Centre on Substance Abuse • Centre canadien de lutte contre les toxicomanies Page 5 (...) Prescription Monitoring Programs in Canada: Best Practice and Program Review Prescription Monitoring Program Practices PMPs cover a range of features and practices. Different PMPs may vary in models of administrative oversight, specific drugs targeted for monitoring, methods of data collection, types of interventions, and level of information sharing. These programs are housed variably in government departments of health, physician or pharmacy regulatory or licensing authorities, and less commonly in law

2015 Canadian Centre on Substance Abuse

191. Opinion: Who should lead WHO?

nominated by WHO member states were announced in September 2016. During October and November, the candidates presented their vision for WHO to member states and responded to their questions. In January 2017, the WHO executive board short listed 5 candidates, who then presented their manifestos and were interviewed by the board. The top three finalists were selected and have been put forward to the world health assembly to be held in May 2017, where member states will cast their votes and elect the next (...) in Uncategorized Source: The views expressed in this blog post belong solely to its author and do not necessarily reflect the views of PLOS or the PLOS journals. By Zaeem Ul Haq, MBBS MPH Over the past several months, many colleagues in global health have asked who I think should be the next Director General of the . I’ve also been subtly encouraged to campaign on behalf of one candidate or another. So far, I have more or less remained neutral, not only because of some conflicting loyalties (see below

2017 PLOS Blogs Network

192. Is PSA now “OK”? What the task force really said about the evidence on prostate cancer screening

outweigh the benefits.”) to a “C (which means that physicians should “Offer or provide this service for selected patients depending on individual circumstances,” and that “There is at least moderate certainty that the net benefit is small.”) The main point is that men who are candidates for testing (ages 55 to 69) should discuss the benefits and harms of the test with their doctors and make a personal decision about whether to take it. Some news outlets engaged in grade inflation HealthNewsReview.org (...) The formed the basis for earlier thinking that PSA testing offered no benefit. However, that study was later dismissed as flawed since about 90 percent of the control group had been screened, rendering the results unreliable. The new evidence considered by the USPSTF has problems of its own, Hoffman warns. The UK’s , for example , included patients who had intermediate-risk prostate cancers and would not be considered candidates for active surveillance in the US, Hoffman said. In the US, we’re still

2017 HealthNewsReview

193. Why Mentors Matter: Global Health Research Mentorship in LMICs #WorldHealthDay2017

to serve as a mentor to a fellow Mozambican medical student (PV) who was studying in the local medical school. Research has not been a central part of the medical school curriculum in Eduardo Mondlane Medical School, partly as a result of the great need for physicians who are primarily focused on clinical care given the dearth of physicians in the country. Furthermore, the physical infrastructure for biomedical research is not available in Mozambique to the extent that it is in the United States (...) , it is fair to wonder why research is important at all, a question I was confronted with early on in our work. Thus, validating research as a means to create evidence-based change was part of the many discussions PV and I had together. We designed a research protocol to study pediatric burn injuries and the socioeconomic factors related to these, and worked through the ethics board approval at the university in Maputo, as well as in Los Angeles. Ultimately, we collaborated together to design the survey

2017 PLOS Blogs Network

194. Federal biomedical science policy under Donald Trump, nearly 100 days in

Congressman, Dr. Tom Price, to run HHS. Price, as you might recall, masquerading as a professional society, the (AAPS). The AAPs, you might recall, fetishizes physician "autonomy" and the "patient-physician relationship" above all else, which doesn't sound bad on the surface, until you realize that this stance is married to an extreme anti-regulatory stance that opposes nearly all constraints, particularly government constraints, on physician "autonomy" and a free market fundamentalist approach to health (...) that is not supported by science, as well as papers promoting HIV/AIDS denialism. Indeed, as , the descriptors of articles published in JPANDS are often quite indicative of the political and ideological stance of the organization: Criminalization Of medicine, eco-imperialism, government arrogance, incremental socialism, left illusions, medical herdology, physician slavery, police state of medicine, and, of course, socialized medicine. Indeed, AAPS very much views itself as an organization of doctors who don't

2017 Respectful Insolence

195. Substance Abuse in Canada: The Effects of Cannabis Use during Adolescence (Report)

for Cannabis Use Disorders? 62 Aimee McRae-Clark and Kevin Gray 5 Cannabis and Youth — A Summary of Key Findings and Major Questions, 76 and a Call to Action Harold Kalant Principal Editors Tony George, MD, FRCPC, Professor, Co-Director, Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, and Chief, Schizophrenia Division, Centre for Addiction and Mental Health Franco Vaccarino, PhD, FCAHS, President and Vice-Chancellor, and Professor of Psychology, University of Guelph (...) developmental years can lead to or protect against later-life substance use disorders and concurrent mental and physical health problems. The 2014 SAIC report highlighted important questions about the connection of mental health issues, environmental factors and substance abuse in younger children and adolescents. As we are all aware, adolescence is a time of significant development and change. It is also the period when substance use most commonly begins. In Canada, the drug of choice for young people

2015 Canadian Centre on Substance Abuse

196. Heart Failure Management in Skilled Nursing Facilities

in SNFs to improve patient-centered outcomes and reduce hospitalizations. This statement addresses unique issues of SNF care and adapts HF guidelines and other recommendations to this setting. Methods This scientific statement on HF management in SNFs was developed by a writing group of experts representing nursing, medicine (cardiology, geriatrics, nursing home physicians, and palliative medicine), pharmacology, physical therapy, dietary clinical management, research, and quality of care. Sponsors (...) measurement and the need to adjust the distance added based on patient position, because the distance between the sternal angle and the right atrium may change with patient position. , In addition to needing advanced training in fluid volume assessments, all licensed nursing staff require education about HF medications, assessment of HF exacerbations, and when to notify the physician or other care provider (eg, nurse practitioner or physician assistant) regarding changes in condition or weight. Figure

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2015 American Heart Association

197. Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence

of motivational interviewing strategies to assist an individual in goal setting and improved adherence to written contracts with the lifestyle counselor. Other techniques used over the subsequent years to keep participants engaged and motivated and to promote weight loss maintenance included refresher courses, campaigns, and incentives such as prizes for campaign winners. At 4 years, participants in the intensive lifestyle arm of Look AHEAD lost 4.7% of initial weight compared with 1.1% in the usual care (...) , body mass index (BMI), insulin resistance, inflammation, and coronary heart disease (CHD) risk scores. The association of smoking cessation, an important CVD prevention strategy, with weight gain deserves specific mention. A previously unanswered question was whether the weight gain of 3 to 6 kg that occurs after smoking cessation would be associated with an increased cardiovascular risk in those with diabetes mellitus. A recent observational study found that, despite a mean weight increase of 3.6

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2015 American Heart Association

198. The Agenda for Familial Hypercholesterolemia (PubMed)

and reviews of progress with regard to diagnosis and treatment. Patient perspectives are critical to optimizing care because patients have to live with fears concerning premature heart disease, implications of genetic diagnosis, and lifelong pharmacological care for a condition that has no symptoms before a coronary event. Genetic diagnosis and genotype/phenotype correlations have created questions related to diagnosis, particularly with regard to the meaning of heterozygosity and homozygosity (...) of risk stratification specific to heterozygous FH that include atherosclerosis imaging and stress evaluation. Current clinical studies are effective in documenting the extent of atherosclerosis in FH patients and in clinical practice. The identification of an FH patient with more advanced disease than expected may lead to lifesaving therapy. However, current research does not answer the question of how to successfully incorporate subclinical atherosclerosis imaging into regular clinical care. Imaging

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2015 American Heart Association

199. 2015 ACC/AHA/HRS Advanced Training Statement on Clinical Cardiac Electrophysiology (A Revision of the ACC/AHA 2006 Update of the Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion)

observation, procedure logbooks, simulation, conference presentations, and multisource (360°) evaluations, among others. For practicing physicians, these tools may also include professional society registry or hospital quality data, peer-review processes, and patient satisfaction surveys. A second feature of a competency-based training program is the recognition that learners develop some competency components at different rates. For multiyear training programs, assessment of selected representative (...) they perform ≥1 of the following roles: cardiovascular training program directors; EP training program directors; early-career experts; general cardiologists; EP specialists representing both the academic and community-based practice settings as well as small, medium, and large institutions; specialists in all aspects of CCEP, including catheter ablation, device management, antiarrhythmic drug therapy, lead extraction, and left atrial appendage occlusion/ligation; physicians experienced in training

2015 American Heart Association

200. Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: Management of asymptomatic disease and claudication

, highlighting specific questions where recommendations were needed and appropriate. Each section was then reviewed and revised by the remainder of the writing group and the two co-chairs. All guideline recommendations were reviewed by the full committee and finalized via an iterative, consensus process. In considering available treatment modalities, we focused on options currently available to patients and physicians in the United States (U.S.). The Grades of Recommendation Assessment, Development (...) amount of resources in the United States health care system. Overall rates of intervention for PAD have been rising steadily in recent years. Changing demographics, evolution of technologies, and an expanding database of outcomes studies are primary forces influencing clinical decision making in PAD. The management of PAD is multidisciplinary, involving primary care physicians and vascular specialists with varying expertise in diagnostic and treatment modalities. PAD represents a broad spectrum

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2015 Society for Vascular Surgery

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