Aprendizagem baseada em projeto e a formação médica: relato de experiência introduzindo questões para o debate interprofissional / Project-based learning and medical education: experience report introducing issues for interprofessional debate / El aprendizaje basado en proyecto y la formación médica: informe de experiencia que introduce cuestiones para el debate interprofesional

A aprendizagem baseada em projeto orientada pelos fundamentos da educação interprofissional é um modelo que pode contribuir para a formação de relacionamentos interpessoais, criatividade, empatia e colaboração na educação médica, por meio de uma colaboração mútua com profissionais de saúde da rede. Muito se fala da efetividade desse método no campo do ensino e aprendizagem médica, mas há a necessidade de incluir a importância do desenvolvimento de habilidades interprofissionais, com equipes colaborativas, em ações extensionistas, diante das necessidades locais no contexto da atenção primária, pensando na melhoria dos resultados de saúde. O objetivo deste trabalho é apresentar um relato de experiência de aprendizagem baseada em projeto de estudantes de Medicina no contexto da Estratégia Saúde da Família. Participaram deste trabalho estudantes do Módulo Integração Ensino, Serviço e Comunidade da Faculdade de Medicina da Universidade Federal dos Vales do Jequitinhonha e Mucuri que executaram, em colaboração com uma equipe interprofissional o projeto sobre a saúde do homem. Como resultado da análise qualitativa do feedback entre os integrantes, observaram-se mudanças no comportamento dos estudantes, com melhorias na comunicação, empatia e nas relações interpessoais, por meio do trabalho colaborativo com a equipe interprofissional. Esta experiência poderá ser adaptada para implementar o ensino e aprendizagem no projeto pedagógico orientado pela educação interprofissional na atenção primária.

Project-based learning guided by the fundamentals of interprofessional education is a model that can contribute to the formation of interpersonal relationships, creativity, empathy and collaboration within medical education, through mutual collaboration with health professionals in the health network. Much has been said about the effectiveness of this method in medical teaching and learning, but there is a need to include the importance of developing interprofessional skills, with collaborative teams, within extension actions, in view of local needs in the context of primary care, thinking about the improved health outcomes. The objective of this work was to present a report of a project-based learning experience of medical students in Family Health Strategy. Students from the Teaching, Service and Community Integration Module of the Faculty of Medicine of Universidade Federal dos Vales do Jequitinhonha e Mucuri participated in this work, executing in collaboration with an interprofessional team a project about men's health. As a result of the qualitative analysis of the feedback among the members, changes in student behavior were observed with improvements in communication, empathy and interpersonal relationships through collaborative work with the interprofessional team. This experience can be adapted to implement teaching and learning in the pedagogical project guided by interprofessional education in primary care.

El aprendizaje basado en proyectos y guiado por los fundamentos de la educación interprofesional es un modelo que puede contribuir a la formación de relaciones interpersonales, creatividad, empatía y colaboración dentro de la educación médica, a través de la colaboración mutua con los profesionales de la salud en la red de salud. Mucho se habla de la efectividad de este método dentro de la enseñanza y el aprendizaje médico, pero es necesario incluir la importancia del desarrollo de habilidades interprofesionales, con equipos colaborativos, dentro de las acciones de extensión, frente a las necesidades locales en el contexto de la atención primaria, pensando sobre los mejores resultados de salud. El objetivo de este trabajo es presentar un informe de experiencia de aprendizaje basado en proyectos de estudiantes de medicina en la Estrategia de Salud Familiar. Participaron en este trabajo estudiantes del Módulo Integración Enseñanza, Servicio y Comunidad de la Facultad de Medicina de la Universidade Federal dos Vales do Jequitinhonha e Mucuri que ejecutaron en colaboración con un equipo interprofesional el proyecto sobre la salud del hombre. Como resultado del análisis cualitativo de la retroalimentación entre los integrantes, se observaron cambios en el comportamiento de los estudiantes con mejoras en la comunicación, la empatía y las relaciones interpersonales a través del trabajo colaborativo con el equipo interprofesional. Esta experiencia puede adaptarse para implementar la enseñanza y el aprendizaje en el proyecto pedagógico guiado por la educación interprofesional en atención primaria.

A experiência de profissionais da saúde de um Centro de Saúde Escola do estado de São Paulo na pandemia da Covid-19 / The experience of health professionals from the Centro de Saúde Escola in the state of São Paulo during the Covid-19 pandemic

Em 2020, a Atenção Primária à Saúde do Sistema Único de Saúde cumpriu função de protagonista no combate à Covid-19 como primeiro acesso aos serviços de saúde, que foi considerada Emergência de Saúde Pública e doença pandêmica, exigindo desses serviços e dos profissionais uma reorganização, com fortalecimento do trabalho em equipe para garantir cuidado integral e de qualidade à população. Objetivo: compreender a experiência de profissionais da saúde da Atenção Primária na pandemia. Métodos: estudo qualitativo na abordagem compreensiva, decorrente de projeto maior e aprovado com o Parecer Consubstanciado. Coleta de dados: entre agosto de 2021 e fevereiro de 2022, por entrevistas individuais, síncronas, pela plataforma Google Meet; gravadas pela própria plataforma, transcritas e analisadas segundo referencial metodológico de Bardin, vertente temática. Das unidades de significação originaram categorias e temas propostos. Resultados: cinco categorias: reorganização do processo de trabalho da unidade de saúde; sentimentos demonstrados por profissionais e população; conflito população-profissionais da saúde na adesão à vacinação influenciada pela mídia; indicadores do processo de trabalho durante a pandemia; e (des)conhecimento. Três temas foram identificados: Processo de trabalho da equipe multidisciplinar da unidade de saúde durante a pandemia de 2020 e 2021; Enfrentamento/sentimento dos profissionais e pacientes; Mídia influenciando comportamento da população. Considerações finais: as contribuições do estudo corroboram para desenvolver alternativas para melhorar o cuidado ao paciente; proporcionar condições de apoio aos profissionais, tornando-se necessário que a unidade de saúde forneça suporte psicológico aos profissionais e que os gestores considerem as vivências dos trabalhadores para fortalecer o trabalho em equipe.

In 2020, Primary Health Care (PHC) of the Sistema Único de Saúde (SUS) played a leading role in the fight against Covid-19 as the first access to health services. Covid-19 was considered a Public Health Emergency and a pandemic disease, which required all services and health professionals to reorganize and strengthen teamwork to ensure comprehensive and quality care for the population. Objective: to understand the experience of health professionals working in Primary Care in the Covid-19 pandemic. Methods: qualitative study with a comprehensive approach, resulting from a larger project approved with Embodied Opinion number 4,731,629. Data collection: took place from August 2021 to February 2022, through individual interviews, synchronous, through the Google Meet platform. These were recorded by the platform itself, transcribed and analyzed according to Bardin's Content Analysis methodological framework, thematic approach. From the units of meaning originated the proposed categories and themes. Results: five categories: reorganization of the health unit's work process; feelings shown by professionals and population; conflict population-health professionals in adherence to vaccination influenced by the media; Indicators of the work process during the pandemic and (lack of) knowledge. Three themes were identified: The work process of the health unit's multidisciplinary team during the 2020 and 2021 pandemic; The coping/feeling of professionals and patients; Media influencing population behavior. The study's contributions support the development of alternatives to improve patient care; provide support conditions for professionals. Final considerations: the study's contributions support the development of alternatives to improve patient care; provide support conditions for professionals, making it necessary for the health unit to provide psychological support to professionals and for managers to consider the experiences of workers to strengthen teamwork.

Tehran private hospitals-identifying and prioritizing factors affecting employer branding.

BACKGROUND: Employer branding (EB) is a collection of ideas and beliefs that influence the perspectives of current and prospective employees regarding an organization and their employment experiences, serving as a strategic tool in the competition to attract talent. Positive EB can help retain current employees and attract new talents, making it an important issue in human resource management. This study aimed to identify and prioritize the factors affecting the EB of private hospitals in Tehran. MATERIALS AND METHODS: The study is applied in purpose and descriptive and analytical in terms of data analysis. Eleven hospitals were selected from 55 private hospitals in Tehran using non-probability and theoretical sampling methods. An expert from each hospital was purposively selected and interviewed. The experts held doctoral degrees in medical specialties and hospital administration experience. In-depth, unstructured interviews with experts constituted the primary method of data collection. Theoretical saturation was reached following the interview with the 11th expert. The entire research process lasted one year, from 2021 to 2022. The method of pairwise comparison matrix with triangular fuzzy numbers was utilized to rank factors contributing to hospital EB. RESULTS: By using a fuzzy method of identification and prioritization, it was found that the most significant factors influencing the EB of private hospitals in Tehran were the level of industry competitiveness, an empowering work environment based on a coaching approach, cooperation with strong suppliers of drugs and hospital and surgery consumables, a generation-based focus on value, and a competitive advantage in EB. CONCLUSIONS: This study provides valuable insights into the factors that contribute to EB in private hospitals in Tehran, which can be used to inform health policy making. The identified factors, such as industry competitiveness, an empowering work environment, and cooperation with strong suppliers, can help private hospitals attract and retain talented employees, ultimately improving the quality of healthcare services provided in the region.

The Prevalence and Determinants of Mental Health Problems in Lebanon: A Meta-Analytic Study of 3957 Healthcare Workers. / Lübnan'da Ruh Sagligi Sorunlarinin Yayginligi ve Belirleyici Etkenler: 3957 Saglik Çalisani ile Gerçeklestirilen Bir Meta-Analiz Çalismasi.

OBJECTIVE: Healthcare workers are continuously exposed to challenging environments, making them liable for poor mental health. The COVID-19 pandemic exacerbated this problem, however available data in Lebanon is scarce. We conducted this investigation to provide comprehensive evidence on the mental health of Lebanese healthcare workers. METHODS: In this systematic review, we analyzed 3957 workers reported in 15 cross-sectional studies (10 during and five before the pandemic), identified after searching four databases. Examined mental health problems included depression, anxiety, stress, posttraumatic stress disorder (PTSD), and poor sleep quality. STATA software was used to pool the prevalence across studies. Subgroup analyses were performed based on the pandemic status, severity of mental health problems, and healthcare worker type. Gender and marital status were analyzed as potential risk factors. The methodological quality of all included studies was good as per the National Institute of Health risk of bias tool. RESULTS: Anxiety, depression, stress, PTSD, insomnia, and poor sleep quality were reported in 50%, 52%, 50%, 35%, 45%, and 41% of the population, respectively. Most cases had mild anxiety (40%), mild depression (45%), but severe stress (27%). Depression and anxiety were highest among pharmacists (69% and 56%) and nurses (49% and 45%), respectively. Compared to the pre-pandemic period, depression (36% vs. 62%) and anxiety (30% vs. 56%) rates were higher during the pandemic, while stress levels were lower (62% vs. 45%). Both gender and marital status were insignificant predictors of depression, anxiety, stress, or PTSD. CONCLUSIONS: Depression, anxiety, posttraumatic stress, insomnia, and poor sleep quality are experienced by approximately one in every two Lebanese healthcare workers. The rate of depression and anxiety almost doubled during the pandemic with higher rates among pharmacists and nurses than physicians and residents. Both gender and marital status were deemed insignificant predictors of reported mental health problems.

Health Professionals' Views on the Use of Conversational Agents for Health Care: Qualitative Descriptive Study.

BACKGROUND: In recent years, there has been an increase in the use of conversational agents for health promotion and service delivery. To date, health professionals' views on the use of this technology have received limited attention in the literature. OBJECTIVE: The purpose of this study was to gain a better understanding of how health professionals view the use of conversational agents for health care. METHODS: Physicians, nurses, and regulated mental health professionals were recruited using various web-based methods. Participants were interviewed individually using the Zoom (Zoom Video Communications, Inc) videoconferencing platform. Interview questions focused on the potential benefits and risks of using conversational agents for health care, as well as the best way to integrate conversational agents into the health care system. Interviews were transcribed verbatim and uploaded to NVivo (version 12; QSR International, Inc) for thematic analysis. RESULTS: A total of 24 health professionals participated in the study (19 women, 5 men; mean age 42.75, SD 10.71 years). Participants said that the use of conversational agents for health care could have certain benefits, such as greater access to care for patients or clients and workload support for health professionals. They also discussed potential drawbacks, such as an added burden on health professionals (eg, program familiarization) and the limited capabilities of these programs. Participants said that conversational agents could be used for routine or basic tasks, such as screening and assessment, providing information and education, and supporting individuals between appointments. They also said that health professionals should have some oversight in terms of the development and implementation of these programs. CONCLUSIONS: The results of this study provide insight into health professionals' views on the use of conversational agents for health care, particularly in terms of the benefits and drawbacks of these programs and how they should be integrated into the health care system. These collective findings offer useful information and guidance to stakeholders who have an interest in the development and implementation of this technology.

Knowledge and acceptance of artificial intelligence and its applications among the physicians working in military medical centers affiliated with Aja University: A cross-sectional study.

BACKGROUND: The use of artificial intelligence (AI) in medical sciences promises many benefits. Applying the benefits of this science in developing countries is still in the development stage. This important point depends considerably on the knowledge and acceptance levels of physicians. MATERIALS AND METHODS: This study was a cross-sectional descriptive-analytical study that was conducted on 169 medical doctors using a purposive sampling method. To collect data, questionnaires were used to obtain demographic characteristics, a questionnaire to investigate the knowledge of AI and its applications, and an acceptability questionnaire to investigate AI. For data analysis, SPSS (Statistical Package for the Social Sciences) version 22 and appropriate descriptive and inferential statistical tests were used, and a significance level of < 0.05 was considered. RESULTS: Most of the participants (102) were male (60.4%), married (144) (85.20%), had specialized doctorate education (97) (57.4%), and had average work experience of 10.78 ± 6.67 years. The mean and standard deviation of knowledge about AI were 9.54 ± 3.04, and acceptability was 81.64 ± 13.83. Multiple linear regressions showed that work history (P = 0.017) and history of participation in AI training courses (P = 0.007) are effective in knowledge and acceptability of AI. CONCLUSION: The knowledge and acceptability of the use of AI among the studied physicians were at an average level. However, due to the importance of using AI in medical sciences and the inevitable use of this technology in the near future, especially in medical sciences in crisis, war, and military conditions, it is necessary for the policymakers of the health system to improve the knowledge and methods of working with this technology in the medical staff in addition to providing the infrastructure.

Behavior, attitude, perception, and knowledge regarding fertility preservation among Chinese pediatric oncologists: a survey in China.

PURPOSE: Clinical specialists are supposed to inform childhood cancer patients of infertility risk and conduct fertility preservation (FP). However, little is known about whether doctors in China are fully prepared. This study aimed to investigate behavior, attitude, perception, and knowledge regarding FP among pediatric oncological specialists in a nation wide survey, to set the stage for improvements in current clinical practice patterns. METHODS: This study was conducted on physicians and surgeons specialized in pediatric oncology using a questionnaire through the WeChat platform. The behavior, attitude, perception, and knowledge were assessed by Likert questions and results were quantified to obtain scores. Data were then described and analyzed using R and GraphPad. RESULTS: Totally 373 specialists in pediatric tumors were included in the analysis. Hematologists, oncological surgeons, and reproductive medicine specialists won most trusts to be responsible for FP job. Most respondents did not have habits of delivering FP information or cooperating with FP specialists during treatment though they were well equipped with FP knowledge and desired for uniform national guideline for FP procedures. The severity of illness was regarded as the primary barrier of FP delivery. When a doctor was more educated and experienced, he was more likely to have better performance in FP. The total score, the knowledge score, and the single score concerning frequency of patients' inquiry showed aggregational trend on geographic distribution. CONCLUSION: Chinese pediatric oncologists demonstrated unsatisfactory practice behaviors based upon this self-reporting survey, although their attitude towards FP was generally positive.

Communicating with transgender people within health care settings: clinical perspectives.

Transgender persons need to regularly interact with health services and practitioners for both gender-transition purposes and routine care. Communication between clinicians and patients is a key element of health care. However, barriers to communication with transgender people in the health care context are usual. They typically include a lack of willingness among health staff to care for trans patients, an adherence to cisnormativity and misgendering by clinicians, and the existence of a displeasing climate during the interaction. Miscommunication generates a series of adverse consequences, including the avoidance of health care by patients and the social marginalization of transgender people. The implementation of novel health policies and organizational restructuring are important steps to create a safe environment for the trans population within health systems. Modification of administrative procedures as well as training and advice for health practitioners are also necessary to facilitate communication with trans people and improve health outcomes among this underprivileged population. The establishment of a society with equal rights among its members and a life without discriminations is the ultimate goal.

Factors associated with health personnel-chaplain interactions in the hospital setting: a cross-sectional survey study.

Health personnel may seek chaplain support to discuss stressors related to complex patient cases, difficult team dynamics, and personal issues. In this survey study of 1376 healthcare interprofessional clinicians, participants reported interacting with chaplains most frequently over patient-related stressors in the prior 12 months. Factors associated with chaplain interactions to discuss all three stressors included: reporting chaplains provide spiritual support to health personnel, more years of service, seeking professional help to deal with stressors, and higher levels of secondary traumatic stress. Being a registered nurse (RN) and working in a critical care specialty were associated with increased odds of interactions with a chaplain to discuss patient-related stressors while identifying as Catholic or Protestant was associated with chaplain interactions to discuss team-related and personal stressors. Chaplains should tailor interventions to promote health personnel's spiritual well-being based on patient-related, team-related, and personal stressors. Healthcare institutions which do not employ chaplains should advocate for this resource. Leaders in healthcare settings with chaplains should promote increased staff awareness that chaplains are available to support wellbeing by discussing patient, team, or personal stressors.

The scholarly and practice profile of respiratory therapists in Canada: A cross-sectional survey.

Introduction: Respiratory therapists (RTs) are expected to provide high-quality care for patients with chronic and acute cardiopulmonary conditions across the lifespan by staying abreast of emerging scientific evidence and effectively integrating it into clinical practice. This integration of evidence is encompassed within the competency of scholarly practice. However, there is currently a limited understanding of RTs' scholarly practice. Furthermore, despite RTs' widespread presence in the Canadian healthcare system, comprehensive studies describing the profiles of RTs are lacking. This study aimed to describe the demographic characteristics, scholarly and practice profiles of the respiratory therapy profession in Canada. Methods: A cross-sectional survey was distributed via the national professional association and regulatory bodies. The survey contained seven sections with 52 items. We calculated means and standard deviations, or medians and interquartile ranges for continuous variables and frequencies and proportions for categorical variables. Open-ended questions were analyzed using summative content analysis. Results: We analyzed data from 832 participants (6.8% response rate) from Ontario (17.8%), Québec (15.7%), and Alberta (13.3%), and across other provinces. Nearly 40% had completed an undergraduate degree beyond their respiratory therapy diploma. Few participants had authored or co-authored peer-reviewed publications. RTs reported reading approximately 2.2 peer-reviewed publications monthly. Most participants agreed on the importance of critical reflection in practice (93.1%) and that having a supportive work environment was vital. Almost three-quarters of participants (73.4%) reported that they believe that RTs are valued members of interprofessional teams, and 78% agreed that understanding research enables them to engage in patient advocacy. Conclusion: This survey provides a portrait of the practice and scholarly profile of the respiratory therapy profession in Canada. While the profession shows potential for growth, concerns persist regarding limited engagement in activities related to scholarly practice. Addressing these challenges and nurturing a culture of scholarly practice are likely necessary to support the development of scholarly practice in the profession. Creating supportive environments, providing access to resources, and encouraging professional development activities may advance the scholarly practice of RTs. Future national surveys could employ random sampling strategies to achieve a more representative sample of the profession.

Characteristics of health care workers with SARS-CoV-2 at a COVID-19 hospital in Türkiye: Homologous versus heterologous vaccination.

Objective: Given the limited studies on types of vaccination and infection rates among health care workers (HCWs) in Türkiye, we analyzed the demographic, clinical, and vaccination characteristics as well as the attitudes of HCWs who have been infected with COVID-19. Methods: We retrospectively analyzed demographic and clinical data on breakthrough COVID-19 infections in HCWs from hospital surveillance data collected between April 5, 2020, and November 1, 2022. The comparison was based on four subgroups that consisted of unvaccinated, one-shot-vaccinated, homologous vaccinated, and heterologous vaccinated individuals. Participants who received various combinations of Sinovac/CoronaVac and/or BioNTech/Pfizer vaccines were compared for detection of COVID-19. Results: During a 33-month period of 744 HCWs who contracted COVID-19, women (65.3%) and nurses (28.9%) were the most affected, followed by doctors (25.8%). Of the infected HCWs, only 1.3% required hospitalization, 0.3% required ICU support, and 98.4% were outpatients. By vaccination status, 143 of the HCWs (19.2%) were unvaccinated, 292 (39.2%) were homologously vaccinated, 294 (39.5%) were heterologously vaccinated, 15 (2%) received a single shot, 206 (27.7%) received two shots, and 165 (22.2%) received three shots. All HCWs contracted COVID-19 at a mean of 134-days (range:1-539) after vaccination. While the proportions of homologously and heterologously vaccinated HCWs were similar, the time elapsed from vaccination to contracting COVID-19 varied (mean 143.4±106.7 vs.126.4±82.43 days). Conclusions: Among both outpatients and inpatients with COVID-19, women HCWs outnumbered men HCWs. HCWs who received homologous vaccination contracted COVID-19 later than those who received heterologous vaccination.

Prevalence of latent tuberculosis infection (LTBI) in healthcare workers in Latin America and the Caribbean: systematic review and meta-analysis.

Background: Tuberculosis remains a significant global health concern, and healthcare workers (HCWs) face a high risk of acquiring latent tuberculosis infection (LTBI) through occupational exposure. In the Latin American and Caribbean (LAC) region, where the burden of tuberculosis is substantial, understanding the prevalence of LTBI among HCWs is crucial for effective infection control measures. Therefore, we conducted a systematic review and meta-analysis to estimate the prevalence of LTBI among HCWs in LAC countries. Methods: Our search included MEDLINE, Scopus, EMBASE, Web of Science, and Google Scholar databases, focusing on relevant English-language records. We looked for observational studies from inception until December 2023. Results: Our analysis included 38 studies representing 15,236 HCWs and 6,728 LTBI cases. These studies spanned the period from 1994 to 2023 and were conducted in Brazil, Peru, Cuba, Colombia, Trinidad and Tobago, Mexico, and Chile. The mean prevalence of LTBI among HCWs was 35.32% (range 17.86-56.00%) for interferon-gamma release assay (IGRA) and 43.67% (range 6.68-70.29%) for tuberculin skin test (TST). The pooled prevalence of LTBI among HCWs was 34.5% (95% CI 25.4-44.1%) for IGRA and 43.0% (95% CI 35.5-50.7%) for TST. When considering both IGRA and TST tests, the overall prevalence of LTBI among HCWs was 40.98% (95% CI 34.77-47.33%). LTBI was associated with longer lengths of employment and exposure to patients, family members, or any person with TB. Additionally, older HCWs faced a higher risk of LTBI. Specific professional roles (such as nurses, nurse technicians, or physicians), smoking, and deficient TB infection control measures increased the likelihood of LTBI. However, information regarding gender and BCG vaccination status showed discordance among studies. Conclusion: Our findings underscore a substantial burden of LTBI among HCWs in LAC countries. Implementing adequate infection control measures is essential to prevent and control transmission within healthcare settings.

Provider perception of presentations with nonspecific back pain in the emergency department and primary care practices: a semi-structured interview study.

BACKGROUND: Increasing numbers of patients treated in the emergency departments pose challenges to delivering timely and high-quality care. Particularly, the presentation of patients with low-urgency complaints consumes resources needed for patients with higher urgency. In this context, patients with non-specific back pain (NSBP) often present to emergency departments instead of primary care providers. While patient perspectives are well understood, this study aims to add a provider perspective on the diagnostic and therapeutic approach for NSBP in emergency and primary care settings. METHODS: In a qualitative content analysis, we interviewed seven Emergency Physicians (EP) and nine General Practitioners (GP) using a semi-structured interview to assess the diagnostic and therapeutic approach to patients with NSBP in emergency departments and primary care practices. A hypothetical case of NSBP was presented to the interviewees, followed by questions on their diagnostic and therapeutic approaches. Recruitment was stopped after reaching saturation of the qualitative content analysis. Reporting this work follows the consolidated criteria for reporting qualitative research (COREQ) checklist. RESULTS: EPs applied two different strategies for the workup of NSBP. A subset pursued a guideline-compliant diagnostic approach, ruling out critical conditions and managing pain without extensive diagnostics. Another group of EPs applied a more extensive approach, including extensive diagnostic resources and specialist consultations. GPs emphasized physical examinations and stepwise treatment, including scheduled follow-ups and a better knowledge of the patient history to guide diagnostics and therapy. Both groups attribute ED visits for NSBP to patient related and healthcare system related factors: lack of understanding of healthcare structures, convenience, demand for immediate diagnostics, and fear of serious conditions. Furthermore, both groups reported an ill-suited healthcare infrastructure with insufficiently available primary care services as a contributing factor. CONCLUSIONS: The study highlights a need for improving guideline adherence in younger EPs and better patient education on the healthcare infrastructure. Furthermore, improving access and availability of primary care services could reduce ED visits of patients with NSBP. TRIAL REGISTRATION: No trial registration needed.

The Effectiveness of Leadership Interventions on Cardiologists' Performance Using Benchmarking as a Tool.

BACKGROUND: Aligned with the Health Sector Transformation Strategy of Saudi Vision 2030, the study analyzed the attitudes and behaviors of cardiologists toward change and identified factors that could either facilitate or hinder the success of leadership interventions. At our cardiac center, the cath lab department is at the forefront of operations, accounting for 80% of the procedures. Our team members may not be fully equipped with the necessary attitudes and behaviors to drive successful improvement projects. Therefore, our top priority is ensuring they remain productive and engaged throughout the process. This is especially crucial because 60% of our budget is allocated to the cath lab department. OBJECTIVES: The study aimed to assess the effectiveness of a leadership intervention on cardiologists' performance in terms of safety, speed, and cost. The research analyzed the behavior and attitude of cardiologists towards change and encouraged progress and collaborative learning between doctors, using benchmarking as a tool. Besides, the study sought to determine the contribution of the interventions used to overall efficiency in performing interventions. This case study focuses on four main aspects of the program. First, it aims to explore an innovative approach to improving the PSCCQ cath lab for patients. Second, it assesses the collective effort of all participants involved in the program. Third, it analyzes the program results and compares them with those of international experiences. And finally, it examines the program's potential benefits for our patients. METHODS: The study's objectives were evaluated through qualitative analysis of in-depth interviews and quantitative data analysis of three variables in the cath lab: radiation dose, time, and inventory. The reason for using mixed methods was to comprehensively understand the same concept from different angles. RESULTS: According to the study, participants improved the safety and effectiveness of our cath lab by reducing the radiation dose and its cost. The study revealed a 52% decrease in the radiation dose for diagnostic cases and an 11% decrease for interventional cases. Similarly, the cost of the radiation dose decreased by 28% for diagnostic cases and 11% for interventional cases. During the observation, it was noted that the participants were highly engaged and willing to adapt to the situation. Some even viewed it as an opportunity for personal growth and improvement in the cath lab. However, they stressed the significance of awareness as a crucial element in improving their behavior and reinforcing it as the foundation for maintaining progress. Furthermore, the study revealed that collaborative work among the participants could have been more optimal. CONCLUSION: The study concludes that implementing innovative improvements to the cath lab was a necessary yet complex undertaking. Participants were more inclined to embrace the changes when they were easily understandable and motivating. The study recommends the appointment of a change agent, the establishment of benchmarks, and the creation of a collaborative working environment between leaders and staff. Above all, the leader should support and sponsor the change to facilitate the transition at various levels.

Improving Antibiotic Use in Nursing Homes by Infection Prevention and Control and Antibiotic Stewardship (IMAGINE): Protocol for a Before-and-After Intervention and Implementation Study.

BACKGROUND: Despite the extensive use of antibiotics and the growing challenge of antimicrobial resistance, there has been a lack of substantial initiatives aimed at diminishing the prevalence of infections in nursing homes and enhancing the detection of urinary tract infections (UTIs). OBJECTIVE: This study aims to systematize and enhance efforts to prevent health care-associated infections, mainly UTIs and reduce antibiotic inappropriateness by implementing a multifaceted intervention targeting health care professionals in nursing homes. METHODS: A before-and-after intervention study carried out in a minimum of 10 nursing homes in each of the 8 European participating countries (Denmark, Greece, Hungary, Lithuania, Poland, Slovakia, Slovenia, and Spain). A team of 4 professionals consisting of nurses, doctors, health care assistants, or health care helpers are actively involved in each nursing home. Over the initial 3-month period, professionals in each nursing home are registering information on UTIs as well as infection and prevention control measures by means of the Audit Project Odense method. The audit will be repeated after implementing a multifaceted intervention. The intervention will consist of feedback and discussion of the results from the first registration, training on the implementation of infection and prevention control techniques provided by experts, appropriateness of the diagnostic approach and antibiotic prescribing for UTIs, and provision of information materials on infection control and antimicrobial stewardship targeted to staff, residents, and relatives. We will compare the pre- and postintervention audit results using chi-square test for prescription appropriateness and Student t test for implemented hygiene elements. RESULTS: A total of 109 nursing homes have participated in the pilot study and the first registration audit. The results of the first audit registration are expected to be published in autumn of 2024. The final results will be published by the end of 2025. CONCLUSIONS: This is a European Union-funded project aimed at contributing to the battle against antimicrobial resistance through improvement of the quality of management of common infections based on evidence-based interventions tailored to the nursing home setting and a diverse range of professionals. We expect the intervention to result in a significant increase in the number of hygiene activities implemented by health care providers and residents. Additionally, we anticipate a marked reduction in the number of inappropriately managed UTIs, as well as a substantial decrease in the overall incidence of infections following the intervention. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/60099.

Comparisons of healthcare personnel relating to awareness, concern, motivation, and behaviours of climate and health: A cross-sectional study.

AIM(S): To describe a sample of healthcare professionals' responses to the valid and reliable Climate and Health Tool and compare participant characteristics relating to Climate and Health Tool subscales. DESIGN: Observational, cross-sectional, multi-site study. METHODS: An electronic survey containing the Climate and Health Tool was administered to healthcare professionals across a large, multi-state health system in the Western United States with a committed effort to reducing carbon emissions. RESULTS: One thousand three hundred and sixty-three participants reported moderately elevated levels of awareness and concern around climate impacts on health and motivation to participate in climate protective actions. Respondents reported moderate levels of climate-protecting behaviours at home and low levels at work. Females were more concerned and motivated. Medical staff and respondents reporting familiarity with system environmental initiatives reported more awareness and behaviours at home to preserve climate health. CONCLUSION: Healthcare professionals are concerned and motivated to decrease climate impacts on health yet take little action at work to preserve the climate. Because of the intersection of climate change, health, and healthcare, healthcare organizations should prioritize and support meaningful action for healthcare professionals to meet community climate health needs. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Healthcare organizations committed to contributing to climate solutions can use this research to increase healthcare professionals' education, engagement, and impact to preserve the climate and health of communities. IMPACT: Healthcare is a major contributor to carbon emissions, yet healthcare professionals' awareness, motivation, concern, and behaviours related to climate change and health were not clear. Our research showed healthcare professionals are aware and concerned about climate impacts on health but reported low levels of workplace behaviours to protect the climate. The findings of our research will impact healthcare professionals and healthcare organizations to focus efforts on climate-preserving behaviours. REPORTING METHOD: This manuscript followed the STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: None.

Identifying actions taken by health care professionals during procedures involving children with autism spectrum disorders in a high technological environment: Using critical incident technique.

PURPOSE: To explore actions taken by health care professionals during a procedure with a child with autism spectrum disorder DESIGN AND METHOD: Critical incident technique was used, which is a technique with a qualitative descriptive retrospective design, to capture situations experienced by health care professionals during a procedure in an anaesthesia or radiology department. Health care professionals from anaesthesia and radiology departments (n = 20) were interviewed about situations affecting the procedure. RESULTS: The findings revealed a broad range of actions (n = 205) taken by the health care professionals during a procedure with a child with autism spectrum disorder. The analysis resulted in two main areas: Finding a way to facilitate a procedure in a high technology environment and Creating a trustful relationship with a child with autism spectrum disorder. The most common action in the first area, was to adjust routines. In the second area the most common action was to take one step at a time and not force or rush the child during the procedure. PRACTICE IMPLICATIONS: The health care professionals used a broad range of different actions to facilitate a procedure in the high technology environment for a child with ASD, which indicates the need for a flexible approach. The actions taken included both adjustments to the environment and enhancing interactions with the child.

The right care in the right place: a scoping review of digital health education and training for rural healthcare workers.

BACKGROUND: Digital health offers unprecedented opportunities to enhance health service delivery across vast geographic regions. However, these benefits can only be realized with effective capabilities and clinical leadership of the rural healthcare workforce. Little is known about how rural healthcare workers acquire skills in digital health, how digital health education or training programs are evaluated and the barriers and enablers for high quality digital health education and training. OBJECTIVE: To conduct a scoping review to identify and synthesize existing evidence on digital health education and training of the rural healthcare workforce. INCLUSION CRITERIA: Sources that reported digital health and education or training in the healthcare workforce in any healthcare setting outside metropolitan areas. METHODS: We searched for published and unpublished studies written in English in the last decade to August 2023. The databases searched were PubMed, Embase, Scopus, CINAHL and Education Resources Information Centre. We also searched the grey literature (Google, Google Scholar), conducted citation searching and stakeholder engagement. The JBI Scoping Review methodology and PRISMA guidelines for scoping reviews were used. RESULTS: Five articles met the eligibility criteria. Two case studies, one feasibility study, one micro-credential and one fellowship were described. The mode of delivery was commonly modular online learning. Only one article described an evaluation, and findings showed the train-the-trainer model was technically and pedagogically feasible and well received. A limited number of barriers and enablers for high quality education or training of the rural healthcare workforce were reported across macro (legal, regulatory, economic), meso (local health service and community) and micro (day-to-day practice) levels. CONCLUSIONS: Upskilling rural healthcare workers in digital health appears rare. Current best practice points to flexible, blended training programs that are suitably embedded with interdisciplinary and collaborative rural healthcare improvement initiatives. Future work to advance the field could define rural health informatician career pathways, address concurrent rural workforce issues, and conduct training implementation evaluations. REVIEW REGISTRATION NUMBER: Open Science Framework: https://doi.org/10.17605/OSF.IO/N2RMX .

What clinicians could consider in providing group interventions for people with cognitive impairments: a scoping review.

This study identified evidence and considerations for allied health clinicians in providing group interventions for people with cognitive impairment. A scoping review was conducted by searching the MEDLINE (Ovid), CINHAL (EBSCOhost), Scopus (Elsevier), Embase (Ovid) and TROVE databases from 2016. Articles of any study design in which group interventions were performed by an allied health professional with participants with cognitive impairment were included. Data on physical, cognitive, psychological, and quality of life measures were extracted from the selected articles. Standardised mean changes (SMC) were calculated. Ten articles were included in the study. No article directly compared group interventions versus one-to-one interventions. The results of the meta-analysis showed significant improvements after the intervention in the physical (SMC = 0.42, P = 0.013), cognitive (SMC = 0.43, P = 0.005), psychological (SMC = 0.14, P = 0.005), and quality of life domains (SMC = 0.28, P = 0.002). This review identified considerations for clinicians when developing group interventions for people with cognitive impairments, including specific participant criteria, increasing support, modifications to intervention difficulty, and environmental considerations. Group intervention for people with cognitive impairments demonstrated moderate effectiveness in improving physical and cognitive domains and a small effect in improving psychological and quality of life domains. Specific considerations are recommended when clinicians provide group interventions for people with cognitive impairments.