Usabilidade de um aplicativo móvel de apoio aos profissionaisde saúde para cálculos de doses de vancomicina / Usability of a mobile application supporting healthprofessionals on vancomycin dosing calculation

O aplicativo móvel CalcVAN foi desenvolvido para auxiliar os profissionais de saúde para otimizar as doses de vancomicina em pacientes hospitalizados. Porém, é imprescindível avaliar a sua usabilidade antes de disponibilizá-lo para prática clínica. Assim, o objetivo do estudo é avaliar a usabilidade do aplicativo móvel na perspectiva dos profissionais de saúde. Trata-se de um estudo descritivo, de avaliação heurística da usabilidade de um aplicativo móvel. Foram convidados profissionais da área de saúde com expertise no tema de gerenciamento de antimicrobianos e vancomicina. O instrumento validado Smartphone Usability questionnaiRE (SURE) foi utilizado para mensuração da usabilidade por meio de um questionário on-line. Vinte e um especialistas participaram do estudo, com média de idade de 32,6 anos, sendo a maioria de mulheres (n = 14, 66,7%), profissionais farmacêuticos (n = 13, 61,9%), com pós-graduação lato sensu (n = 10, 47,6%), que trabalhavam em hospitais públicos ou privados (n = 15, 71,4%) e com média de experiência em 9,7 anos. Com base na interpretação dos resultados obtidos pelo instrumento SURE, a média de usabilidade geral do CalcVAN foi de 83 pontos, com escore menor de 78 e maior de 90 pontos. O teste de usabilidade foi enquadrado nos dois últimos níveis, 70 e 80, onde os profissionais de saúde passaram a concordar fortemente e totalmente, indicando que o aplicativo móvel apresenta uma usabilidade satisfatória. O CalcVAN atingiu uma usabilidade satisfatória e atende as necessidades e exigências dos profissionais de saúde, mostrando--se eficiente para realizar as funções propostas.

The CalcVAN app was developed to assist healthcare professionals in optimizing vancomycin doses for hospitalized patients. However, the usability test before making it available for clinical practice is essential. Therefore, the study aims to evaluate the usability of the app from the perspective of health professionals. A descriptive study, a heuristic evaluation of the usability of a mobile application was conducted. Healthcare professionals with expertise in antimicrobial management and vancomycin were invited to participate. The validated Smartphone Usability questionnaiRE (SURE) was used to measure usability through an online questionnaire. Twenty-one experts participated in the study, with a mean age of 32.6 years, mostly of them women (n = 14, 66.7%), pharmacists (n = 13, 61.9%), with postgraduate education (n = 10, 47.6%), working in private or public hospitals (n = 15, 71.4%), and a mean experience of 9.7 years. Overall usability score for CalcVAN was 83 points, ranging from a minimum of 78 to a maximum of 90 points. The usability test registered within the last two levels, 70 and 80, with users expressing strongly and fully agreed, indicating that the app demonstrates satisfactory usability. CalcVAN achieved satisfactory usability, fulfilling the needs and requirements of health professionals, proving to be efficient in performing the intended functions.

Positive vaccine beliefs linked to reduced mental stress in healthcare professionals during COVID-19: a retrospective study.

Background and aim: The COVID-19 pandemic has led to a significant adverse effect on the mental health of healthcare professionals. This study aims to assess the effects of the prolonged pandemic on burnout and mood disorders and to evaluate the influence of positive vaccination beliefs on these factors at a medical center during the extended COVID-19 pandemic. Methods: This retrospective study analyzed the results of an online questionnaire survey including burnout status and mood disorders from 2020 to 2022. The factors related to mood moderate/severe disorders and the impact of the positive vaccine belief were also explored. Results: The initial analysis revealed that healthcare professionals continued to experience significant levels of personal and work-related burnout, along with mood disorders. However, the scores and the percentage of moderate to severe burnout gradually decreased. Notably, the percentage of individuals with moderate to severe mood disorders also gradually declined (2020: 13.4%, 2021: 12.3%, 2022: 11.1%). The number of participants who need professional interventions decreased from 56.2% in 2020 to 45.9% in 2021, and 46% in 2022. Multivariate analysis revealed a positive vaccine belief was associated with a lower risk of moderate/severe mood disorders, with odd ratios (OR) and 95% confidence intervals (95% CI) of 0.38 (0.28 - 0.52) and 0.41 (0.30 - 0.52) in the 2021 and 2022 cohorts, respectively. Further investigation revealed that age over 50 was linked to a positive vaccine belief in 2021 and 2022. Within the 2022 cohort, working as nurses was identified as the independent factor associated with a less positive belief, with the OR and 95% CI of 0.49 (0.27 - 0.90). Conclusion: The findings of the present study suggest burnout and mood disorders are still significant during the pandemic. A positive vaccine belief may mitigate pandemic-related mental distress. Further interventions to enhance the belief combined with other supporting measures are important in a long fight against the pandemic.

Peer-to-peer training among health care professionals working in dialysis clinics: an education approach from the GoodRENal project.

BACKGROUND: Lifestyle interventions aiming to improve dietary habits, increase physical activity level, and improve emotional well-being can positively impact clinical outcomes in patients with chronic kidney disease (CKD). Educational material for health care professionals working with CKD patients that focuses on why and how to promote lifestyle changes is lacking. The present study aims to depict the material and dissemination methods for the peer-to-peer training program developed for health care professionals working in the dialysis clinics of the four countries engaged in the GoodRENal project: Spain, Greece, Sweden, and Belgium. METHODS: This is an ERASMUS + project funded by the European Union (number 2020-1-ES01-KA2014-083141, http://goodrenal.eu/ ) named GoodRENal. The educational material was developed in English by a multidisciplinary team integrating the GoodRENal project (dietitian, physiotherapist, psychologist, and nephrologist). The material was then translated to Greek, Spanish, Swedish and Dutch and is available for download at the GoodRENal webpage ( https://goodrenal.es/results-3/ ). After training, the health care professionals filled in an anonymous questionnaire regarding their degree of satisfaction with the training. RESULTS: In total, 138 health care professionals in the four dialysis clinics joined the peer-to-peer training, representing 50% to 92% of the health care professionals in each clinic. From the total sample, 78 health care professionals responded to the satisfaction questionnaire. The answers showed that most participants were very satisfied or satisfied with the peer-to-peer training and that they found this approach useful in their clinical practice. CONCLUSION: The educational material developed for health care professionals working with patients on hemodialysis (HD) obtained good satisfaction scores from the participants.

Assessing the Quality of Life of Healthcare Professionals in High-Stress Units at a Tertiary Health Centre in South-eastern Nigeria.

INTRODUCTION: Work serves as a fundamental pillar of human life, shaping both individual livelihoods and societal engagements. The intricacies of the work environment play a pivotal role in determining the Quality of Life (QoL), with increasing emphasis on creating conducive workspaces that enhance employee satisfaction and productivity. Healthcare professionals, in particular, face various factors that contribute to occupational stress and such stressors can adversely affect their health and diminish their QoL. OBJECTIVE: This study sought to assess the quality of life of healthcare professionals in the Intensive Care Units (ICUs) and other stressful units in Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi. METHODOLOGY: A cross-sectional study was conducted involving 296 consenting participants after approval from the ethics and research committees at NAUTH, Nnewi. They were selected using a two-stage sampling approach. Data were collected with a structured self-administered questionnaire adopted from the World Health Organization Quality of Life scale (WHOQOL-BREF) and analysed using Statistical Package for Social Sciences (SPSS) version 25.0. The level of significance was set at P < 0.05. RESULTS: The results showed the mean overall quality of life score was 74.62 ± 14.0, the mean score for the physical domain (59.15 ± 12.49), the psychological domain (70.16 ± 13.46), the social domain (65.82 ± 18.19), and the environmental domain (53.90 ± 15.49). The majority 268 (90.5%), of the respondents had good quality of life. The profession (X2 =12.44, p<.05), years of work experience (X2 = 25.85, p<.05), and income level (X2 = 19.56, p<.05), show a statistically significant association with quality of life. CONCLUSION: The result obtained from this study shows that the majority of the respondents report a good quality of life. Most respondents with poor quality of life were attributed to their profession, years of work experience and income.

INTRODUCTION: Le travail est un pilier fondamental de la vie humaine, qui façonne à la fois les moyens de subsistance individuels et les engagements sociétaux. Les subtilités de l'environnement de travail jouent un rôle essentiel dans la détermination de la qualité de vie (QoL), et l'accent est mis de plus en plus sur la création d'espaces de travail propices à l'amélioration de la satisfaction et de la productivité des employés. Les professionnels de la santé, en particulier, sont confrontés à divers facteurs qui contribuent au stress professionnel et ces facteurs de stress peuvent nuire à leur santé et diminuer leur qualité de vie. OBJECTIF: Cette étude visait à évaluer la qualité de vie des professionnels de la santé dans les unités de soins intensifs (USI) et autres unités stressantes du Nnamdi Azikiwe University Teaching Hospital (NAUTH) de Nnewi. MÉTHODOLOGIE: Une étude transversale a été menée auprès de 296 participants consentants, après approbation des comités d'éthique et de recherche du NAUTH, à Nnewi. Ils ont été sélectionnés à l'aide d'une méthode d'échantillonnage en deux étapes. Les données ont été recueillies à l'aide d'un questionnaire structuré auto-administré adopté à partir de l'échelle de qualité de vie de l'Organisation mondiale de la santé (WHOQOL-BREF) et analysées à l'aide du logiciel SPSS (Statistical Package for Social Sciences) version 25.0. Le niveau de signification a été fixé à P < 0,05. RÉSULTATS: Les résultats ont montré que le score global moyen de qualité de vie était de 74,62 ± 14,0, le score moyen pour le domainephysique (59,15 ± 12,49), le domaine psychologique (70,16 ± 13,46), le domaine social (65,82 ± 18,19) et le domaine environnemental (53,90 ±15,49). La majorité des 268 (90,5%) répondants avaient une bonne qualité de vie. La profession (X2 = 12,44, p<0,05), les années d'expérience professionnelle (X2 = 25,85, p<0,05) et le niveau de revenu (X2 = 19,56, p<0,05) présentent une association statistiquement significative avec la qualité de vie. CONCLUSION: Les résultats de cette étude montrent que la majorité des personnes interrogées déclarent avoir une bonne qualité de vie. La plupart des répondants ayant une mauvaise qualité de vie sont attribués à leur profession, au nombre d'années d'expérience professionnelle et à leur revenu. MOTS CLÉS: Qualité de vie (QoL) ; Professionnels de la santé ; Unités à haut niveau de stress ; Centre de santé ; Nigeria.

Disrupted Candidacy: A Longitudinal Examination of the Constrained Healthcare-Access Journeys of National Health Service Workers in Scotland Seeking Supports for Long COVID Illness.

INTRODUCTION: Evidence examines how persons experiencing Long COVID (LC) struggle to secure healthcare for symptoms. However, few studies examine healthcare workers experiencing LC, nor the complex and multiple difficulties faced when seeking and receiving healthcare. METHODS: This study is based on two phases of longitudinally conducted qualitative interviews, 6 months apart, with National Health Service (NHS) workers experiencing LC, from different occupational roles at NHS locales in Scotland (first interviews, n = 50; second interviews, n = 44). RESULTS: Multiple factors restricted healthcare access, including worries about pressuring the NHS and concerns over LC being legitimised. When healthcare was sought, workers struggled to secure support, referrals and treatment. The following reasons were included: (1) context: the restrictive pandemic healthcare context; (2) illness climate: low GP knowledge surrounding LC and how this could be treated, trends for ascribing symptoms to other causes and reluctance to diagnose LC; (3) sense-making of LC: healthcare availability linked to occupational role identity. To visualise and examine healthcare barriers, candidacy theory is applied, drawing inferences between healthcare context, illness climate, sense-making and identities. CONCLUSION: NHS workers' complex journeys represent Disrupted Candidacy, intersecting challenges across candidacy domains, restricting the seeking and receiving of LC healthcare. Findings provide insights into why NHS workers resisted and withdrew from healthcare-seeking, and the barriers they faced when attempting to secure LC support. This study presents a pathway for future LC illness research to use a modified candidacy theory framework. PATIENT AND PUBLIC CONTRIBUTION: This research focuses on amplifying and learning from lived experiences, and the voices of NHS workers in Scotland experiencing LC. Interviews represent primary data for this study; thus, participants and their healthcare journeys are centred in this research and all aspects of production, reporting and output. Explicit discussions of stakeholder group involvement are highlighted in the methods section.

Characteristics of a Successful Nurse Peer Champion in the Implementation of Innovative Digital Technologies in Hospitals: A Qualitative Study.

Objectives: Using the Motivational Theory of Role Modelling as a framework, this study explores which attributes nurses deem essential for an effective peer champion, particularly in digital transformation processes within hospitals. Methods: A qualitative study was conducted with semi-structured interviews. Transcripts were coded using a hybrid approach of inductive and deductive coding and analysed using thematic analysis. Results: Ten nurses from Germany participated. The attributes most often mentioned were competence, taking on responsibility, a positive and passionate attitude, transferring knowledge and supporting aspirants in applying it, and leadership skills. Four types of champions were identified: a pragmatic and structured champion, a passionate innovator, a social and outgoing team leader, and a calm and empathetic team leader. Conclusions: The findings largely align with the body of literature on peer champion characteristics in other populations and should therefore be used to guide peer champion application in hospitals to enhance effective implementation of innovations. Innovation: The identification of four unique champion types offers an innovative contribution to the field. Highlighting the unique requirements of nurses when implementing innovative technologies in healthcare, this study emphasises the importance of involving end-users in the design and implementation process of new technologies, a crucial step towards a more sustainable and user-centred digital health ecosystem.

District health information system 2 data utilization among health professionals in Amara region private hospitals, Ethiopia.

Background: Globally, health information systems have been improved by District Health Information System Version 2 (DHIS2), which promotes consistency and integrity in collecting data, processing, and utilization. This success has been attributed to its user-friendly interface and incorporation of advanced data analysis and validation features. Objective: This study aimed to assess DHIS2 data utilization among health professionals working at private hospitals in the Amara region. Methods: An Institution-based cross-sectional study design was conducted from 9 May to 30 June 2022. A simple random sampling technique was used to select participants, with a total of 395 health professionals participating. Data was collected using a self-administered paper-based questionnaire. Data entry was performed using the Kobo Collect tool, and data analysis was conducted using STATA version 14.0. Bivariable and multivariable logistic regression analyses were used and p < .05 with a 95% CI was considered to measure statistically significant variables. Result: Out of 395 participants, about 37.72% of the participants had good DHIS2 data utilization. Had good data analysis skills (adjusted odds ratio (AOR) = 6.5, 95% CI [3.1-13.8]), regular supportive supervision and feedback (AOR = 5.2, 95% CI [2.8-9.5]), monthly salary > 5000 ETB (AOR = 2.0, 95% CI [1.1-3.7]), ease of use (AOR = 5.4, 95% CI [2.8-10.2]), and district health information system training (AOR = 4.2, 95% CI [2.2-7.3]) were enabling factors for utilization of DHIS2 data. Conclusion: Private healthcare providers had limited utilization of DHIS2 data. It is highly recommended to provide DHIS2 training, supervision, and feedback focused on private health facilities. Additionally, enhancing data analysis skills and prioritizing ease of use are crucial to improving DHIS2 data utilization.

Designing an Intervention to Improve Medication Safety for Nursing Home Residents Based on Experiential Knowledge Related to Patient Safety Culture at the Nursing Home Front Line: Cocreative Process Study.

BACKGROUND: Despite years of attention, avoiding medication-related harm remains a global challenge. Nursing homes provide essential health care for frail older individuals, who often experience multiple chronic diseases and polypharmacy, increasing their risk of medication errors. Evidence of effective interventions to improve medication safety in these settings is inconclusive. Focusing on patient safety culture is a potential key to intervention development as it forms the foundation for overall patient safety and is associated with medication errors. OBJECTIVE: This study aims to develop an intervention to improve medication safety for nursing home residents through a cocreative process guided by integrated knowledge translation and experience-based codesign. METHODS: This study used a cocreative process guided by integrated knowledge translation and experience-based co-design principles. Evidence on patient safety culture was used as an inspirational source for exploration of medication safety. Data collection involved semistructured focus groups to generate experiential knowledge (stage 1) to inform intervention design in a multidisciplinary workshop (stage 2). Research validation engaging different types of research expertise and municipal managerial representatives in finalizing the intervention design was essential. Acceptance of the final intervention for evaluation was aimed for through contextualization focused on partnership with a municipal advisory board. An abductive, rapid qualitative analytical approach to data analysis was chosen using elements from analyzing in the present, addressing the time-dependent, context-bound aspects of the cocreative process. RESULTS: Experiential knowledge was represented by three main themes: (1) closed systems and gaps between functions, (2) resource interpretation and untapped potential, and (3) community of medication safety and surveillance. The main themes informed the design of preliminary intervention components in a multidisciplinary workshop. An intervention design process focused on research validation in addition to contextualization resulted in the Safe Medication in Nursing Home Residents (SAME) intervention covering (1) campaign material visualizing key roles and responsibilities regarding medication for nursing home residents and (2) "Medication safety reflexive spaces" focused on social and health care assistants. CONCLUSIONS: The cocreative process successfully resulted in the multifaceted SAME intervention, grounded in lived experiences shared by some of the most important (but often underrepresented in research) stakeholders: frontline health care professionals and representatives of nursing home residents. This study brought attention toward closed systems related to functions in medication management and surveillance, not only informing the SAME intervention design but as opportunities for further exploration in future research. Evaluation of the intervention is an important next step. Overall, this study represents an important contribution to the complex field of medication safety. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/43538.

How to meet coping strategies and preferences of children during invasive medical procedures: perspectives of healthcare professionals.

Children with negative procedural experiences have an increased risk of fear and distress, with psychological consequences for subsequent procedures and future healthcare behaviors. Gaining control and feeling trust are important aspects for children to decrease fear. To enable professionals providing personal care during medical procedures, a systematic, evidence-based approach that supports children in expressing their preferences is needed. This study will gain insight into the experiences and needs of professionals involved in small invasive medical procedures to meet the coping strategies and preferences of children undergoing these procedures. A qualitative design was used to gain insight into professionals' perspectives. Data were collected through online focus groups with various professionals involved in medical procedures, such as anesthetists, laboratory staff, nurses, and pediatricians. Five interdisciplinary focus groups, with a total of 32 participants, were held. One overarching theme was revealed: "Balancing between different actors within the context of the hospital." Professionals reported they had to deal with different actors during a medical procedure: the child, the parent, the colleague, and themselves. Each actor had its own interests. They were aware of the child and parents' priority to gain control and feel trust. Nevertheless, they perceive organizational and personal aspects that hinder addressing these needs. CONCLUSION: To provide personalized care, professionals experience balancing between the needs and interests of diverse actors during medical procedures. The findings underscore the importance of a policy supporting HCPs in integrating patient-centered care into practice through practical tools and training initiatives such as scenario training. WHAT IS KNOWN: • Unresolved pain and stress arising from medical procedures can have significant short- and long-term impacts on children. Empowering children to gain control and fostering a sense of trust are crucial factors in reducing fear associated with medical procedures. • Children and parents expect to receive child-tailored care from professionals including respect for their own, unique needs, and boundaries. Professionals should build trustful relationships and provide appropriately tailored autonomy around medical procedures. WHAT IS NEW: • Healthcare professionals vary in their awareness of children's needs during a medical procedure. Beside this, the organizational dynamics of the hospital, along with the presence of actors such as the child, parent, colleague, and oneself, collectively influence the conduct of medical procedures. • Providing person-centered care during medical procedures can present challenges. The results highlight the significance of a policy to assist healthcare professionals in incorporating patient-centered care into their practice through practical tools and a culture of self-reflections regarding patient-centered values.

[Translation, adaptation and initial validation of the Oldenburg Burnout Inventory (OLBI) in Río de la Plata health personnel] / Traducción, adaptación y validación inicial de Oldenburg Burnout Inventory (OLBI) en personal de salud rioplatense.

The study addresses the translation, cross-cultural adaptation and initial validation of the Oldenburg Burnout Inventory (OLBI) questionnaire into Spanish, particularly for the context of health personnel. The OLBI, based on the Job Demands - Resources Model, evaluates burnout and job disengagement. After a rigorous methodological process, two versions of the questionnaire were carried out, followed by a pilot test and cognitive interviews. Comprehension problems were identified in a question related to work disconnection. Adjustments were made to the final version, which was validated with a multiprofessional pediatric palliative care group. The results showed adequate reliability for the Exhaustion scale and acceptable for the Disconnection scale. The importance of considering the particularities of the work context in adapting the instrument was highlighted. Although limitations, such as sample size, are acknowledged, it is suggested that the OLBI ­ UY version is promising and can be used in future studies for a more comprehensive psychometric analysis. This study represents an original contribution by addressing the adaptation of a relevant instrument for measuring burnout in Spanish-speaking health personnel in the Río de la Plata.

El estudio aborda la traducción, adaptación transcultural y validación inicial del cuestionario Oldenburg Burnout Inventory (OLBI) al español, en particular para el contexto del personal de salud. El OLBI, basado en el Modelo Demandas del Trabajo - Recursos, evalúa agotamiento y desconexión laboral. Tras un proceso metodológico riguroso, se realizaron dos versiones del cuestionario, seguidas de una prueba piloto y entrevistas cognitivas. Se identificaron problemas de comprensión en una pregunta relacionada con la desconexión laboral. Se realizaron ajustes en la versión final, que fue validada con un grupo multiprofesional de cuidados paliativos pediátricos. Los resultados mostraron adecuada confiabilidad para la escala de Agotamiento y aceptable para la de Desconexión. Se destacó la importancia de considerar las particularidades del contexto laboral en la adaptación del instrumento. Aunque se reconocen limitaciones, como el tamaño de la muestra, se sugiere que la versión OLBI - UY es prometedora y puede utilizarse en estudios futuros para un análisis psicométrico más exhaustivo. Este estudio representa un aporte original al abordar la adaptación de un instrumento relevante para la medición del burnout en personal de salud de  habla hispana del Río de la Plata.

Ethical self-efficacy among healthcare professionals caring for people with dementia: a brief pre- and post-report on the CARE intervention.

BACKGROUND: Interventions targeting healthcare professionals' confidence in managing ethical issues in dementia care are limited despite documented positive effects of educational programs on staff knowledge and self-efficacy. However, inconsistencies in the literature regarding the impact of educational programs underscore the need for targeted interventions. The CARE intervention, specifically designed to enhance confidence in ethical decision-making, aims to address this gap. This study evaluates the effectiveness of the CARE intervention in enhancing the ethical self-efficacy of healthcare professionals caring for people with dementia, particularly those with initially low levels of self-efficacy. METHODS: Using a non-experimental pre-post evaluation design, the CARE intervention was administered to healthcare professionals (n = 86), measuring ethical self-efficacy pre-and post-intervention. We hypothesized significant differences in ethical self-efficacy mean scores pre- and post-intervention for all participants, particularly those with low pre-measurement scores, whom we expected to benefit most from the intervention. Statistical analysis included paired t-tests and Wilcoxon tests for the low pre-measurement subgroup analysis. RESULTS: While no significant change was observed in the entire sample, participants with low initial self-efficacy showed a statistically significant improvement post-intervention. CONCLUSIONS: The CARE intervention holds promise in improving ethical self-efficacy among healthcare professionals with initial low confidence levels. Targeted interventions are essential in addressing confidence gaps in managing ethical challenges in dementia care, with implications for professional well-being and quality of care. Further research should explore long-term effects and expand sample size to enhance generalizability and sustainability of findings.

Multidisciplinary Collaboration in Combatting Antimicrobial Resistance: Insights and Outcomes From the National Alliance of Medical Professionals on Antimicrobial Resistance (NAMP-AMR) Initiative.

Antimicrobial resistance (AMR) poses a critical global health challenge, requiring a coordinated and vigorous response. Despite numerous global and national efforts, a unified multidisciplinary approach has been missing. The National Alliance of Medical Professionals on Antimicrobial Resistance (NAMP-AMR), led by the Indian Medical Association in collaboration with key stakeholders such as NITI Aayog and the Ministry of Health, seeks to address this gap. This alliance unites 52 medical specialty organizations and associations to enhance efforts across various sectors, developing comprehensive strategies for awareness, surveillance, infection control, and optimization of antimicrobial use. The foundational meeting of NAMP-AMR on July 7, 2024, established a collaborative roadmap, promising to bolster India's efforts against AMR and support the forthcoming National Action Plan on AMR 2.0. The meeting concentrated on six key areas: improving AMR awareness and advocacy; strengthening laboratory capacities and surveillance; enhancing infection prevention and control (IPC); optimizing antimicrobial use through stricter regulations and stewardship programs; advancing AMR research and innovation; and fostering strong national and international collaborations. This initiative marks a significant advancement in combating AMR and positions India as a leader in global health efforts against this critical issue.

Results of the Italian cross-sectional web-based survey "Nutrition and breast cancer, what would you like to know?" An attempt to collect and respond to patients' information needs, through social media.

Introduction: Several studies have demonstrated that, following a breast cancer (BC) diagnosis, patients are eager to obtain information on cancer and nutrition, in order to ameliorate both their quality of life (QoL) and disease outcome. To avoid BC survivors to get wrong information from unreliable sources, healthcare providers need to be aware of patients' needs, to guide them toward optimal nutrition recommendations, aimed at preventing tumor recurrence and increasing survival rates. Material and methods: The cross-sectional web-based survey "Nutrition and breast cancer, what would you like to know?" has been conceived and conducted, in Italy, between the 2nd and the 25th of June 2023. The link to the 19-items questionnaire, structured in 6 sections, was distributed via social media (Facebook and Instagram), newsletter, institutional websites, and printed flyers. Patients' responses were collected and analyzed, reporting absolute and relative frequencies. Results: A total of 1616 participants (98.9% female and 1.1% male), with an average age of 47.5 years, answered the survey. Only subjects who declared having previously received a BC diagnosis (N=1159, 71.7%) were included in the present analysis. Overall, the respondents showed a wide interest in understanding whether nutrition might help to manage therapy side effects, as well as knowing how specific diets, foods, nutrients, and supplements could affect disease onset, progression and prognosis. Importantly, the need to receive evidence-based information from the "referring physician/specialist" and "nutritionist/dietitian" was expressed by 95.8% and 88.8% of them, respectively. Discussion: In this study, we primarily aimed at intercepting nutrition information needs and sources of an Italian BC survivors' group. Based on that, we first organized a proactive digital intervention, to respond via Instagram live broadcasts to patients' "cancer and nutrition"-related questions. Secondly, we arranged a healthcare providers dedicated-workshop focused on the latest evidence-based knowledge on nutrition and BC. It is crucial, in fact, that once healthcare professionals capture patients' information needs, they can respond with appropriate nutritional guidance, counseling and education programs, while counteracting misleading and incorrect messages.

Truth to Action: Lived Experiences of Indigenous Healthcare Professionals Redressing Indigenous-Specific Racism.

STUDY BACKGROUND: The experience of discrimination through stereotyping, profiling, and bias-informed care not only leads to poor access to healthcare services, but low retention rates of Indigenous health professionals (IHP). As health systems transformation evolves, a significant gap remains in supporting IHP to safely address racism, to be supported culturally to bring their authentic selves and voices to work, and to attend to one's own intellectual, physical, relational, cultural and spiritual wellness within a westernized model of care. PURPOSE: The aim of the study was to investigate the experiences of IHP working in mainstream healthcare in order to understand how their work environment impacts the delivery of cultural safe practices. What is reported in this manuscript, as an exercise in truth-telling, is findings about lived experiences of IHP working in one mainstream provincial healthcare region, and not the whole context and outcomes of the study. METHODS: Using Indigenous research methodologies, we embodied our Indigeneity into every facet of the research process. We facilitated three talking circles with participants grounded in a distinct cultural and ceremonial context following Secwepemc protocols. RESULTS: The collective voices of IHP revealed the following common experiences: confronting genocide; addressing Indigenous-specific racism; uprooting toxicity and inequities; and upholding Indigenous human rights while enhancing accountability of systems transformation. CONCLUSIONS: The experience of IHP working in health systems goes beyond mere individual employment obligations, its often about a families and communities advocacy for Indigenous rights, culturally safe working environments and access to dignified and respectful healthcare service. This study highlights the need for IHP to be actively involved in health system transformation to ensure the redesigning and restructuring of healthcare service delivery by and for Indigenous Peoples remains centered on Indigenous health and human rights.

Does organisational myopia mediate the effect of occupational health and safety practices on the risk of occupational accidents in Turkish healthcare institutions?

Occupational health and safety (OHS) policies in healthcare institutions must be well managed, because healthcare practice involves many physical, biological, ergonomic, chemical, and psychosocial hazards that can affect the health of healthcare workers. In addition, their work performance may be affected by the so-called organisational myopia. In this context, the aim of our study was to determine how organisational myopia affects OHS practices in healthcare institutions and whether it increases the risk of occupational accidents. The study population consisted of a convenience sample of 420 healthcare professionals working throughout Turkey who completed a questionnaire addressing these three domains: organisational myopia, OHS practices, and risk of occupational accidents. Their responses were analysed with exploratory factor analysis, reliability analysis, and Spearman's correlation to assess the adequacy of measurement tools and identify relationships between variables, followed by mediation analysis. We found that OHS practices mitigate organisational myopia and the risk of occupational accidents. We also found no significant effect of organisational myopia on the risk of occupational accidents. Our findings underscore the importance of OHS practices in healthcare institutions and that organisational myopia should be evaluated in special contexts such as working time, experience, or routinisation.

GPT-4o vs. Human Candidates: Performance Analysis in the Polish Final Dentistry Examination.

Background This study aims to evaluate the performance of OpenAI's GPT-4o in the Polish Final Dentistry Examination (LDEK) and compare it with human candidates' results. The LDEK is a standardized test essential for dental graduates in Poland to obtain their professional license. With artificial intelligence (AI) becoming increasingly integrated into medical and dental education, it is important to assess AI's capabilities in such high-stakes examinations. Materials and methods The study was conducted from August 1 to August 15, 2024, using the Spring 2023 LDEK exam. The exam comprised 200 multiple-choice questions, each with one correct answer among five options. Questions spanned various dental disciplines, including Conservative Dentistry with Endodontics, Pediatric Dentistry, Dental Surgery, Prosthetic Dentistry, Periodontology, Orthodontics, Emergency Medicine, Bioethics and Medical Law, Medical Certification, and Public Health. The exam organizers withdrew one question. GPT-4o was tested on these questions without access to the publicly available question bank. The AI model's responses were recorded, and each answer's confidence level was assessed. Correct answers were determined based on the official key provided by the Center for Medical Education (CEM) in Lódz, Poland. Statistical analyses, including Pearson's chi-square test and the Mann-Whitney U test, were performed to evaluate the accuracy and confidence of ChatGPT's answers across different dental fields. Results GPT-4o correctly answered 141 out of 199 valid questions (70.85%) and incorrectly answered 58 (29.15%). The AI performed better in fields like Conservative Dentistry with Endodontics (71.74%) and Prosthetic Dentistry (80%) but showed lower accuracy in Pediatric Dentistry (62.07%) and Orthodontics (52.63%). A statistically significant difference was observed between ChatGPT's performance on clinical case-based questions (36.36% accuracy) and other factual questions (72.87% accuracy), with a p-value of 0.025. Confidence levels also varied significantly between correct and incorrect answers, with a p-value of 0.0208. Conclusions GPT-4o's performance in the LDEK suggests it has potential as a supplementary educational tool in dentistry. However, the AI's limited clinical reasoning abilities, especially in complex scenarios, reveal a substantial gap between AI and human expertise. While ChatGPT demonstrates strong performance in factual recall, it cannot yet match the critical thinking and clinical judgment exhibited by human candidates.

Clinicians' roles and necessary levels of understanding in the use of artificial intelligence: A qualitative interview study with German medical students.

BACKGROUND: Artificial intelligence-driven Clinical Decision Support Systems (AI-CDSS) are being increasingly introduced into various domains of health care for diagnostic, prognostic, therapeutic and other purposes. A significant part of the discourse on ethically appropriate conditions relate to the levels of understanding and explicability needed for ensuring responsible clinical decision-making when using AI-CDSS. Empirical evidence on stakeholders' viewpoints on these issues is scarce so far. The present study complements the empirical-ethical body of research by, on the one hand, investigating the requirements for understanding and explicability in depth with regard to the rationale behind them. On the other hand, it surveys medical students at the end of their studies as stakeholders, of whom little data is available so far, but for whom AI-CDSS will be an important part of their medical practice. METHODS: Fifteen semi-structured qualitative interviews (each lasting an average of 56 min) were conducted with German medical students to investigate their perspectives and attitudes on the use of AI-CDSS. The problem-centred interviews draw on two hypothetical case vignettes of AI-CDSS employed in nephrology and surgery. Interviewees' perceptions and convictions of their own clinical role and responsibilities in dealing with AI-CDSS were elicited as well as viewpoints on explicability as well as the necessary level of understanding and competencies needed on the clinicians' side. The qualitative data were analysed according to key principles of qualitative content analysis (Kuckartz). RESULTS: In response to the central question about the necessary understanding of AI-CDSS tools and the emergence of their outputs as well as the reasons for the requirements placed on them, two types of argumentation could be differentiated inductively from the interviewees' statements: the first type, the clinician as a systemic trustee (or "the one relying"), highlights that there needs to be empirical evidence and adequate approval processes that guarantee minimised harm and a clinical benefit from the employment of an AI-CDSS. Based on proof of these requirements, the use of an AI-CDSS would be appropriate, as according to "the one relying", clinicians should choose those measures that statistically cause the least harm. The second type, the clinician as an individual expert (or "the one controlling"), sets higher prerequisites that go beyond ensuring empirical evidence and adequate approval processes. These higher prerequisites relate to the clinician's necessary level of competence and understanding of how a specific AI-CDSS works and how to use it properly in order to evaluate its outputs and to mitigate potential risks for the individual patient. Both types are unified in their high esteem of evidence-based clinical practice and the need to communicate with the patient on the use of medical AI. However, the interviewees' different conceptions of the clinician's role and responsibilities cause them to have different requirements regarding the clinician's understanding and explicability of an AI-CDSS beyond the proof of benefit. CONCLUSIONS: The study results highlight two different types among (future) clinicians regarding their view of the necessary levels of understanding and competence. These findings should inform the debate on appropriate training programmes and professional standards (e.g. clinical practice guidelines) that enable the safe and effective clinical employment of AI-CDSS in various clinical fields. While current approaches search for appropriate minimum requirements of the necessary understanding and competence, the differences between (future) clinicians in terms of their information and understanding needs described here can lead to more differentiated approaches to solutions.

Reducing work-related stress among health professionals by using a training-based intervention programme for leaders in a cluster randomised controlled trial.

Healthcare organisations worldwide are affected by the shortage of health professionals due to work-related stress and health professional leaders play an important role by implementing effective strategies. Therefore, this study aims to investigate whether the STRAIN intervention program (using evidence-based training for health professional leaders) can reduce work-related stress among health professionals. This study is based on a cluster randomised controlled trial, consists of three measurements and includes 165 participating hospitals, nursing homes and home care organisations. A total of 206 health professional leaders took part in the intervention programme and 19,340 health professionals participated in the study. Results showed no significant differences (p > 0.05) between the intervention and control group regarding the effort-reward imbalance ratio, quantitative demands, opportunities for development, bond with the organisation, quality of leadership, social community, role clarity, rewards, difficulties with demarcation and work-private life conflict. Pre-/post-test analysis revealed a tendency for significant positive results (p < 0.05) for stressors, stress symptoms and long-term consequences for organisations with a leaders' participation rate of ≥ 75%. Leaders' awareness, commitment and readiness is essential to implement effective strategies reducing work-related stress.

Prevalence and disparities in receiving medical advice to quit tobacco use in the US adult population.

Introduction: Evidence suggests that advice from health care professionals (HCP) increases the likelihood of quit attempts and successful quitting of tobacco use. However, previous studies primarily focussed on cigarette smoking and did not include all forms of tobacco products. This study aimed to investigate the prevalence and disparities in receiving HCP's advice to quit tobacco use (combustible or noncombustible) in the US adult population. Methods: Using the 2022 National Health Information Survey (NHIS) data, we examined 4,424 adults who reported (i) any tobacco product use within the past 12 months and (ii) having seen an HCP within the past 12 months. The outcome variable included the receipt of advice to quit tobacco use from an HCP, and predictors included sociodemographic variables. Weighted prevalence estimates were calculated, and multivariable regression analyses were conducted. Results: Over 38% of tobacco users who visited an HCP were advised to quit. The odds of receiving such advice were lower among Hispanics (AOR: 0.625; 95% confidence interval (CI) [0.464-0.843];p = 0.002), males (AOR: 0.767; 95% CI [0.659-0.893], p = 0.001), those above the poverty level (AOR: 0.795; 95% CI [0.641-0.987];p = 0.037), foreign-born (AOR: 0.664; 95% CI [0.496-0.888]; p = 0.006), those with a bachelor's degree or higher educational level (AOR: 0.477; 95% CI [0.349-0.653]; p < 0.001) and those aged less than 45 years (AOR: 0.404; 95% CI: [0.344-0.473]; p < 0.001). Conclusion: The prevalence of receiving HCP's advice to quit tobacco use remains suboptimal and disparate among sociodemographic groups. Our findings call for strategic implementation of the USPHS's recommendation on treating tobacco use and taking further actions to equip HCPs with the training and resources needed to provide appropriate advice to quit tobacco.

A Psychological Service Dedicated to Work-Related Stress: the Experience at Perugia General Hospital.

INTRODUCTION: The characteristics of the working environment significantly influence the mental well-being of workers, and the presence of unfavorable conditions in the workplace can have a negative impact on mental health. Healthcare professionals are particularly exposed to the risk of burnout and the development of psychiatric, and particularly affective, symptoms. This paper aims to describe the activity of a psychological support service dedicated to work-related stress at the General Hospital of Perugia, Italy. SUBJECTS AND METHODS: In June 2022, a free and anonymous psychological service dedicated to healthcare professionals was established at the Perugia General Hospital. The main objectives of the service were to promote overall well-being of workers, to provide psychological support, and to address professionals towards specific pathways to care. RESULTS: The activity of the service consisted of clinical consultations with psychiatrists and psychologists who also administered psychometric tools to better characterize the overall clinical picture. After the clinical evaluation process, healthcare professionals who accessed the service were addressed to specific pathways of care, when needed. The data collection carried out from June 2022 to April 2024 showed a total number of 139 accesses to the Service, with a majority of requests from women (80%) and mainly belonging to nursing staff (53%). CONCLUSIONS: Preliminary data from the psychological service dedicated to healthcare professionals confirms the high prevalence of work-related stress, especially in specific settings. In the near future, psychological support services are expected to identify work-related stress situations as soon possible, possibly contributing to the reduction of stigma and to the built of healthier working environments.