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1.
Methods ; 225: 38-43, 2024 May.
Article in English | MEDLINE | ID: mdl-38499262

ABSTRACT

Systematic reviews represent a fundamental study design, providing the highest level of evidence across diverse research inquiries, encompassing both public health and clinical research and practice. However, for healthcare professionals, the process of selecting, synthesizing, and interpreting evidence can be challenging, and requires specialized skills. Therefore, it is imperative to explore innovative solutions aimed at simplifying and making the traditional systematic review process more accessible while ensuring the validity and reliability of results. In this perspective, our research objective is to develop a systematic review framework that, while maintaining a rigorous methodological approach, streamlines the process for healthcare professionals. This study describes such approach in every phase, from the collection of evidence to the writing of the text, creating a guide for the healthcare professional who approaches this type of research. The qualitative and organizational analysis tools are also described, providing useful information for the use of non-paid programs. This systematic review aims to develop a framework with a rigorous methodological approach that allows simplify the process for clinicians and healthcare professionals. The implementation of this methodology in clinical practice offers new perspectives to ensure a thoughtful consideration and application of scientific evidence and opens the way to innovative and easily accessible solutions to facilitate the conduct of systematic reviews in the clinical care setting.


Subject(s)
Health Personnel , Research Design , Systematic Reviews as Topic , Humans , Systematic Reviews as Topic/methods , Reproducibility of Results
2.
J Gen Intern Med ; 39(11): 1962-1968, 2024 Aug.
Article in English | MEDLINE | ID: mdl-38273069

ABSTRACT

BACKGROUND: There are no consistent data on US primary care clinicians and primary care practices owing to the lack of standard methods to identify them, hampering efforts in primary care improvement. METHODS: We develop a pragmatic framework that identifies primary care clinicians and practices in the context of the US healthcare system, and applied the framework to the IQVIA OneKey Healthcare Professional database to identify and profile primary care clinicians and practices in the USA. RESULTS: Our framework prescribes sequential steps to identify primary care clinicians by cross-examining clinician specialties and organizational affiliations, and then identify primary care practices based on organization types and presence of primary care clinicians. Applying this framework to the 2021 IQVIA data, we identified 365,751 physicians with a primary specialty in primary care, and after excluding those who further specialized (24%), served as hospitalists (5%), or worked in non-primary care settings (41%), we determined that 179,369 (49%) of them were actually practicing primary care. We identified 287,506 nurse practitioners and 134,083 physician assistants and determined that 88,574 (31%) and 29,781 (22%), respectively, were delivering primary care. We identified 94,489 primary care practices, and found that 45% of them were with one primary care physician, 15% had two physicians, 12% employed nurse practitioners or physician assistants only, and 19% employed both primary care physicians and specialists. CONCLUSIONS: Our approach offers a pragmatic and consistent alternative to the diverse methods currently used to identify and profile primary care workforce and organizations in the USA.


Subject(s)
Physicians, Primary Care , Primary Health Care , Humans , Primary Health Care/organization & administration , United States , Databases, Factual
3.
J Gen Intern Med ; 39(12): 2179-2186, 2024 Sep.
Article in English | MEDLINE | ID: mdl-38228990

ABSTRACT

BACKGROUND: Opioid use disorder (OUD) is a chronic condition that requires regular visits and care continuity. Telehealth implementation has created multiple visit modalities for OUD care. There is limited knowledge of patients' and clinicians' perceptions and experiences related to multi-modality care and when different modalities might be best employed. OBJECTIVE: To identify patients' and clinicians' experiences with multiple visit modalities for OUD treatment in primary care. DESIGN: Comparative case study, using video- and telephone-based semi-structured interviews. PARTICIPANTS: Patients being treated for OUD (n = 19) and clinicians who provided OUD care (n = 15) from two primary care clinics within the same healthcare system. APPROACH: Using an inductive approach, interviews were analyzed to identify patients' and clinicians' experiences with receiving/delivering OUD care via different visit modalities. Clinicians' and patients' experiences were compared using a group analytical process. KEY RESULTS: Patients and clinicians valued having multiple modalities available for care, with flexibility identified as a key benefit. Patients highlighted the decreased burden of travel and less social anxiety with telehealth visits. Similarly, clinicians reported that telehealth decreased medical intrusion into the lives of patients stable in recovery. Patients and clinicians saw the value of in-person visits when establishing care and for patients needing additional support. In-person visits allowed the ability to conduct urine drug testing, and to foster relationships and trust building, which were more difficult, but not impossible via a telehealth visit. Patients preferred telephone over video visits, as these were more private and more convenient. Clinicians identified benefits of video, including being able to both hear and see the patient, but often deferred to patient preference. CONCLUSIONS: Considerations for utilization of visit modalities for OUD care were identified based on patients' needs and preferences, which often changed over the course of treatment. Continued research is needed determine how visit modalities impact patient outcomes.


Subject(s)
Opioid-Related Disorders , Qualitative Research , Telemedicine , Humans , Male , Female , Adult , Opioid-Related Disorders/therapy , Middle Aged , Attitude of Health Personnel , Telephone , Primary Health Care , Patient Satisfaction , Videoconferencing
4.
BMC Cancer ; 24(1): 514, 2024 Apr 23.
Article in English | MEDLINE | ID: mdl-38654313

ABSTRACT

BACKGROUND: Medical consortiums have been extensively established to facilitate the integration of health resources and bridge the technical gap among member institutions. However, some commonly appropriate technologies remain stagnant in subordinate hospitals, although they have been routinely applied in leading hospitals. Besides, the mechanism underlying differences in clinicians' adoption behavior at different levels of institutions was unknown. Therefore, this study aimed to investigate the differences in influencing mechanisms of clinicians' hepatic contrast-enhanced ultrasound technology (CEUS) utilization behavior between leading and subordinate hospitals within medical consortiums, thus providing clues for expanding effective and appropriate technologies within integrated care systems. METHODS: A self-designed scale was developed based on the theory of planned behavior (TPB). A multistage sampling method was applied to investigate clinicians who were aware of CEUS and worked in liver disease-related departments within the sampled medical institutions. The final sample size was 289. AMOS 24.0 software was used to construct multi-group structural equation modeling (SEM) to validate the hypotheses and determine the mechanism of hepatic CEUS utilization. RESULTS: It revealed that behavioral intention significantly influenced adoption behavior, regardless of whether it was in leading hospitals or subordinate hospitals (ß = 0.283, p < 0.001). Furthermore, behavioral attitude (ß = 0.361, p < 0.001) and perceived behavioral control (ß = 0.582, p < 0.001) exerted significant effects on adoption behavior through behavioral intention. However, in leading hospitals, subjective norm had a significant positive effect on behavioral intention (ß = 0.183, p < 0.01), while it had a significant negative impact on behavioral intention in the subordinate hospitals (ß = -0.348, p < 0.01). CONCLUSION: To effectively translate the adoption intention into actual behavior, it is recommended to elucidate the demand and facilitators involved in the process of health technology adoption across leading and subordinate hospitals. Additionally, bolstering technical support and knowledge dissemination within subordinate hospitals while harnessing the influential role of key individuals can further enhance this transformative process.


Subject(s)
Early Detection of Cancer , Liver Neoplasms , Humans , Liver Neoplasms/psychology , Liver Neoplasms/diagnostic imaging , Male , Female , Early Detection of Cancer/psychology , Early Detection of Cancer/methods , Attitude of Health Personnel , Ultrasonography/methods , Hospitals , Adult , Surveys and Questionnaires , Contrast Media , Practice Patterns, Physicians'
5.
BMC Gastroenterol ; 24(1): 215, 2024 Jul 04.
Article in English | MEDLINE | ID: mdl-38965460

ABSTRACT

BACKGROUND: Gastrointestinal (GI) motility disorders are common in clinical settings, but physicians still lack sufficient understanding and effective management of these conditions. METHODS: This research assessed Egyptian physicians' knowledge, practices, and attitudes towards GI motility disorders. A cross-sectional survey employing a self-administered questionnaire was carried out among physicians in Egypt. The questionnaire addressed various aspects of physicians' understanding, practices, and attitudes regarding GI motility disorders. Data analysis was conducted using descriptive statistics and presented as frequencies and percentages. RESULTS: A total of 462 physicians took part in the study. Although nearly two-thirds of them knew about GI motility studies, a notable proportion lacked adequate knowledge about GI motility disorders. Notably, 84.2% correctly identified dysphagia as a critical symptom suggestive of an upper GI motility disorder. However, 13.4% incorrectly linked hematemesis with an upper GI motility disorder, and 16.7% expressed uncertainty. In terms of practice, around half of the participants encountered a small number of patients with GI motility disorders (less than 5 per week or even fewer). Only 29.7% felt confident in managing patients with motility disorders. Most participating physicians expressed a willingness to participate in training programs focused on motility disorders. CONCLUSIONS: This study underscores a knowledge gap among Egyptian physicians concerning GI motility disorders. It suggests the necessity of tailored education and training programs to improve their competency and practice in this domain.


Subject(s)
Attitude of Health Personnel , Gastrointestinal Diseases , Gastrointestinal Motility , Health Knowledge, Attitudes, Practice , Humans , Egypt , Cross-Sectional Studies , Male , Female , Gastrointestinal Diseases/psychology , Gastrointestinal Diseases/therapy , Surveys and Questionnaires , Clinical Competence , Adult , Physicians/psychology , Middle Aged , Practice Patterns, Physicians'
6.
Support Care Cancer ; 32(4): 241, 2024 Mar 21.
Article in English | MEDLINE | ID: mdl-38512594

ABSTRACT

PURPOSE: As narrative medicine interventions are integrated increasingly into medical practice, growing evidence indicates benefits for healthcare professionals. Presently, the prevalence and impact of narrative medicine interventions in the field of oncology remain unknown. This systematic review synthesizes published data on narrative medicine interventions in oncology and reports current knowledge on feasibility, acceptability, and impact on cancer care professionals. METHODS: Following PRISMA guidelines, we searched Ovid Medline, Embase, Scopus, Web of Science, Cochrane, and ClinicalTrials.gov databases from inception through February 2024. Eligible articles were published in English and contained original data on feasibility, acceptability, and/or impact of a narrative medicine intervention for oncology professionals. Database searches identified 2614 deduplicated articles, from which 50 articles were identified for full-text assessment and 11 articles met inclusion criteria. Two additional articles were identified through manual review of references. RESULTS: Thirteen articles described 12 unique narrative medicine interventions targeting cancer care professionals. All studies described their respective interventions as feasible, acceptable, and impactful for participants. Interventions involved writing, reading, reflection, and other narrative-based strategies. Standardized validated tools evaluated outcomes including burnout, empathy expression, secondary trauma, quality of humanistic care, and well-being. Participants reported appreciation of opportunities for reflection, perspective sharing, and bearing witness, which they perceived to strengthen wellness and community. CONCLUSION: Narrative medicine interventions are feasible and acceptable and may bolster oncology clinicians' functioning across domains. Multi-site, prospective, randomized studies are needed to investigate the broader impact of narrative medicine interventions and advance the science of narrative medicine in oncology. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: CRD42022369432.


Subject(s)
Medical Oncology , Narrative Medicine , Humans , Narrative Medicine/methods , Medical Oncology/methods , Neoplasms/therapy , Neoplasms/psychology , Health Personnel/psychology , Burnout, Professional/prevention & control , Empathy
7.
Support Care Cancer ; 32(9): 627, 2024 Sep 02.
Article in English | MEDLINE | ID: mdl-39222247

ABSTRACT

PURPOSE: Clinical guidelines recommend early palliative care for patients with advanced lung cancer. In rural and underserved community oncology practices with limited resources, both primary palliative care from an oncologist and specialty palliative care are needed to address patients' palliative care needs. The aim of this study is to describe community oncology clinicians' primary palliative care practices and perspectives on integrating specialty palliative care into routine advanced lung cancer treatment in rural and underserved communities. METHODS: Participants were clinicians recruited from 15 predominantly rural community oncology practices in Kentucky. Participants completed a one-time survey regarding their primary palliative care practices and knowledge, barriers, and facilitators to integrating specialty palliative care into advanced-stage lung cancer treatment. RESULTS: Forty-seven clinicians (30% oncologists) participated. The majority (72.3%) of clinicians worked in a rural county. Over 70% reported routinely asking patients about symptom and physical function concerns, whereas less than half reported routinely asking about key prognostic concerns. Roughly 30% held at least one palliative care misconception (e.g., palliative care is for only those who are stopping cancer treatment). Clinician-reported barriers to specialty palliative care referrals included fear a referral would send the wrong message to patients (77%) and concern about burdening patients with appointments (53%). Notably, the most common clinician-reported facilitator was a patient asking for a referral (93.6%). CONCLUSION: Educational programs and outreach efforts are needed to inform community oncology clinicians about palliative care, empower patients to request referrals, and facilitate patients' palliative care needs assessment, documentation, and standardized referral templates.


Subject(s)
Lung Neoplasms , Medical Oncology , Palliative Care , Humans , Palliative Care/methods , Male , Female , Middle Aged , Lung Neoplasms/therapy , Medical Oncology/methods , Medical Oncology/organization & administration , Kentucky , Attitude of Health Personnel , Adult , Surveys and Questionnaires , Practice Patterns, Physicians'/statistics & numerical data , Rural Health Services/organization & administration , Primary Health Care/organization & administration
8.
Support Care Cancer ; 32(7): 490, 2024 Jul 06.
Article in English | MEDLINE | ID: mdl-38970661

ABSTRACT

PURPOSE: Recent guidelines for prognostic evaluation recommend clinicians' prediction of survival (CPS) for survival prediction in patients with advanced cancer. However, CPS is often inaccurate and optimistic. Studies on factors associated with overestimation or underestimation of CPS are limited. We aimed to investigate the factors associated with the overestimation and underestimation of CPS in patients with far-advanced cancer. METHODS: The current study was a secondary analysis of an international multicenter prospective cohort study, which enrolled newly admitted patients with advanced cancer in palliative care units (PCUs) in Japan, Korea, and Taiwan from 2017 to 2018. We obtained the temporal CPS at enrollment and performed multivariate logistic regression analysis to identify the factors associated with "underestimation (less than 33% of actual survival)" and "overestimation (more than 33% of actual survival)." RESULTS: A total of 2571 patients were assessed and admitted in 37 PCUs between January 2017 and September 2018. Older age (adjusted odds ratio [aOR] 1.01; 95% confidence interval [CI] 1.01-1.02; P < 0.01) and reduced oral intake (aOR 0.68; 95% CI 0.51-0.89; P < 0.01) were identified as significant factors associated with underestimation. Dyspnea (aOR 1.28; 95% CI 1.06-1.54; P = 0.01) and hyperactive delirium (aOR 1.34; 95% CI 1.05-1.72; P = 0.02) were identified as significant factors associated with overestimation. CONCLUSION: Older age was related to underestimation, while dyspnea and hyperactive delirium were related to overestimation of CPS for patients with weeks of survival. However, reduced oral intake was less likely to lead to underestimation.


Subject(s)
Neoplasms , Humans , Male , Female , Aged , Prospective Studies , Middle Aged , Neoplasms/mortality , Prognosis , Palliative Care/methods , Palliative Care/statistics & numerical data , Japan/epidemiology , Taiwan/epidemiology , Aged, 80 and over , Cohort Studies , Republic of Korea/epidemiology , Adult , Logistic Models
9.
J Pediatr Psychol ; 49(8): 571-579, 2024 Aug 01.
Article in English | MEDLINE | ID: mdl-38872281

ABSTRACT

OBJECTIVE: Presentations for self-harm and suicidal behaviors are increasing in children and young people, although less is known about these presentations in children aged 12 years and under. This study aims to understand how mental health clinicians in public health services conceptualize, identify and respond to self-harm and suicidal behaviors in children. METHODS: 26 mental health clinicians provided their perspectives through interviews or focus groups. Participant responses were analyzed using reflexive thematic analysis. RESULTS: Mental health clinicians described how self-harm and suicidal behaviors may present differently in children compared with adolescents, particularly with the methods used. Using developmentally appropriate language and including parents or carers when screening for self-harm and suicidal behaviors was recommended by clinicians. The inclusion of parents or carers throughout the treatment process was important for clinicians, including helping parents understand their child's behavior and manage their own distress. Clinicians also highlighted the benefit of collaborating with schools to support children, yet noted primary school staff require training in responding to child self-harm and suicidal behavior. The limited services available for children 12 years and under including emergency care services, was identified as a problem. CONCLUSIONS: Findings highlight the importance of timely assessment and interventions which include mental health and medical clinicians, parents, carers, and school staff to support children with self-harm and suicidal behaviors.


Subject(s)
Self-Injurious Behavior , Humans , Self-Injurious Behavior/psychology , Child , Male , Female , Adolescent , Mental Health Services , Focus Groups , Suicidal Ideation , Qualitative Research , Attitude of Health Personnel , Adult , Parents/psychology
10.
BMC Psychiatry ; 24(1): 106, 2024 Feb 07.
Article in English | MEDLINE | ID: mdl-38326817

ABSTRACT

BACKGROUND: Suicide is the leading cause of death in mothers postpartum and one of the most common causes of death during pregnancy. Mental health professionals who work in perinatal services can offer insights into the factors they perceive as being linked to mothers' suicidal ideation and behaviour, support offered to mothers and improvements to current practices. We aimed to explore the experiences and perceptions of perinatal mental health professionals who have worked with suicidal mothers during the perinatal period. METHOD: Semi-structured interviews were conducted face-to-face or via telephone with mental health professionals working in perinatal mental health inpatient or community services across England. Data were analysed using reflexive thematic analysis. RESULTS: From the professionals' (n = 15) accounts three main themes were developed from their interview data. The first, factors linked to suicidal ideation and behaviour, overarched two sub-themes: (1.1) the mother's context and (1.2) what the baby represents and what this means for the mother. These sub-themes described factors that professionals assessed or deemed contributory in relation to suicidal ideation and behaviour when a mother was under their care. The second main theme, communicating about and identifying suicidal ideation and behaviour, which outlined how professionals enquired about, and perceived, different suicidal experiences, encapsulated two sub-themes: (2.1) how to talk about suicide and (2.2) types of suicidal ideation and attempts. The third main theme, reducing suicidal ideation through changing how a mother views her baby and herself, focused on how professionals supported mothers to reframe the ways in which they viewed their babies and in turn themselves to reduce suicidal ideation. CONCLUSION: Professionals highlighted many factors that should be considered when responding to a mother's risk of suicide during the perinatal period, such as the support around her, whether the pregnancy was planned and what the baby represented for the mother. Professionals' narratives stressed the importance of adopting a tailored approach to discussing suicidal experiences with mothers to encourage disclosure. Our findings also identified psychological factors that professionals perceived as being linked to suicidal outcomes for mothers, such as self-efficacy; these factors should be investigated further.


Subject(s)
Mothers , Suicidal Ideation , Humans , Pregnancy , Female , Mothers/psychology , Mental Health , Parturition/psychology , Postpartum Period/psychology
11.
Hum Resour Health ; 22(1): 43, 2024 Jun 24.
Article in English | MEDLINE | ID: mdl-38915096

ABSTRACT

BACKGROUND: Physicians and associate (non-physician) clinicians conduct cesarean sections in Tanzania and Malawi. Urogenital fistulas may occur as complications of cesarean section. Location and circumstances can indicate iatrogenic origin as opposed to ischemic injury following prolonged, obstructed labor. METHODS: This retrospective review assessed the frequency of iatrogenic urogenital fistulas following cesarean sections conducted by either associate clinicians or physicians in Tanzania and Malawi. It focuses on 325 women with iatrogenic fistulas among 1290 women who had fistulas after cesarean birth in Tanzania and Malawi between 1994 and 2017. An equivalence test compared the proportion of iatrogenic fistulas after cesarean sections performed by associate clinicians and physicians (equivalence margin = 0.135). Logistic regression was used to model the occurrence of iatrogenic fistula after cesarean section, controlling for cadre, date, maternal age, previous abdominal surgery and parity. RESULTS: Associate clinicians attended 1119/1290 (86.7%) cesarean births leading to fistulas, while physicians attended 171/1290 (13.3%). Iatrogenic fistulas occurred in 275/1119 (24.6%) cesarean births by associate clinicians and in 50/171 (29.2%) cesarean births by physicians. The risk difference and 90% confidence interval were entirely contained within an equivalence margin of 13.5%, supporting a conclusion of equivalence between the two cadres. The odds of iatrogenic fistula after cesarean section were not statistically significantly different between associate clinicians and physicians (aOR 0.90; 95% CI 0.61-1.33). CONCLUSIONS: Associate clinicians appear equivalent to physicians performing cesarean sections in terms of iatrogenic fistula risk. Lower iatrogenic proportions for associate clinicians could reflect different caseloads. The occurrence of iatrogenic fistulas illustrates the importance of appropriate labor management and cesarean section decision-making, irrespective of health provider cadre. Given the noninferior performance and lower costs of employing associate clinicians, other countries with insufficient and/or unequally distributed health workforces could consider task-shifting cesarean sections to associate clinicians.


Subject(s)
Cesarean Section , Iatrogenic Disease , Physicians , Humans , Female , Cesarean Section/adverse effects , Malawi/epidemiology , Tanzania/epidemiology , Retrospective Studies , Pregnancy , Adult , Iatrogenic Disease/epidemiology , Young Adult , Fistula/etiology , Fistula/epidemiology
12.
BMC Anesthesiol ; 24(1): 188, 2024 May 27.
Article in English | MEDLINE | ID: mdl-38802780

ABSTRACT

BACKGROUND: Ethiopia made a national licensing examination (NLE) for associate clinician anesthetists a requirement for entry into the practice workforce. However, there is limited empirical evidence on whether the NLE scores of associate clinicians predict the quality of health care they provide in low-income countries. This study aimed to assess the association between anesthetists' NLE scores and three selected quality of patient care indicators. METHODS: A multicenter longitudinal observational study was conducted between January 8 and February 7, 2023, to collect quality of care (QoC) data on surgical patients attended by anesthetists (n = 56) who had taken the Ethiopian anesthetist NLE since 2019. The three QoC indicators were standards for safe anesthesia practice, critical incidents, and patient satisfaction. The medical records of 991 patients were reviewed to determine the standards for safe anesthesia practice and critical incidents. A total of 400 patients responded to the patient satisfaction survey. Multivariable regressions were employed to determine whether the anesthetist NLE score predicted QoC indicators. RESULTS: The mean percentage of safe anesthesia practice standards met was 69.14%, and the mean satisfaction score was 85.22%. There were 1,120 critical incidents among 911 patients, with three out of five experiencing at least one. After controlling for patient, anesthetist, facility, and clinical care-related confounding variables, the NLE score predicted the occurrence of critical incidents. For every 1% point increase in the total NLE score, the odds of developing one or more critical incidents decreased by 18% (aOR = 0.82; 95% CI = 0.70 = 0.96; p = 0.016). No statistically significant associations existed between the other two QoC indicators and NLE scores. CONCLUSION: The NLE score had an inverse relationship with the occurrence of critical incidents, supporting the validity of the examination in assessing graduates' ability to provide safe and effective care. The lack of an association with the other two QoC indicators requires further investigation. Our findings may help improve education quality and the impact of NLEs in Ethiopia and beyond.


Subject(s)
Anesthetists , Patient Satisfaction , Quality of Health Care , Humans , Ethiopia , Longitudinal Studies , Male , Female , Adult , Quality of Health Care/standards , Anesthetists/standards , Middle Aged , Anesthesiology/standards , Clinical Competence/standards , Educational Measurement/methods , Educational Measurement/standards
13.
Ophthalmic Physiol Opt ; 44(1): 17-22, 2024 Jan.
Article in English | MEDLINE | ID: mdl-37921119

ABSTRACT

PURPOSE: The accurate diagnosis of age-related macular degeneration (AMD) represents an important step in delaying and preventing vision loss and achieving optimal patient care. Therefore, this pilot study aimed to estimate the diagnostic accuracy of community optometrists for identifying AMD using colour fundus photographs (CFPs) to support sample size calculations for subsequent definitive studies. METHODS: Five practising community optometrists were invited to classify a total of 1023 CFPs for the (1) presence of AMD, and, if applicable, (2) stage of AMD (early/intermediate/late geographic atrophy/late neovascular AMD). Diagnosis by referral centre clinicians formed the reference standard. Diagnostic accuracy was assessed by the area under the receiver operating characteristic curve (aROC). Sensitivity, specificity, positive and negative predictive values were also calculated. RESULTS: Of the 1023 CFPs included in the study, 226 images were of AMD and 797 images were of other ocular conditions or no abnormal findings. Participating community optometrists had a mean (SD) age of 30.2 (8.9) years, 60.0% (3/5) were female and the mean number of years practising in primary eye care was 5.4 (5.4) years. Community optometrists demonstrated excellent performance for diagnosing AMD, with an aROC of 0.86 (95% CI 0.83 to 0.89), sensitivity of 84.5% (95% CI 79.1 to 89.0) and specificity of 88.0% (95% CI 85.5 to 90.1). The aROC (95% CI) for diagnosing early, intermediate, late geographic atrophy and late neovascular AMD was 0.82 (0.73 to 0.91), 0.76 (0.72 to 0.81), 0.69 (0.49 to 0.90) and 0.55 (0.34 to 0.75), respectively. CONCLUSIONS: These results justify the need for an appropriately powered definitive study to assess community clinicians' diagnostic accuracy for AMD.


Subject(s)
Geographic Atrophy , Optometrists , Wet Macular Degeneration , Humans , Female , Adult , Male , Pilot Projects , Geographic Atrophy/diagnosis , Angiogenesis Inhibitors , Color , Visual Acuity , Vascular Endothelial Growth Factor A
14.
BMC Health Serv Res ; 24(1): 217, 2024 Feb 16.
Article in English | MEDLINE | ID: mdl-38365679

ABSTRACT

BACKGROUND: Promoting appropriate pharmacotherapy requires understanding the factors that influence how clinicians prescribe medications. While prior work has focused on patient and clinician factors, features of the organizational setting have received less attention, though identifying sources of variation in prescribing may help identify opportunities to improve patient safety and outcomes. OBJECTIVE: To evaluate the relationship between the number of clinicians who prescribe medications in a facility and facility prescribing intensity of six individual medication classes by clinician specialty: benzodiazepines, antipsychotics, antiepileptics, and antidepressants by psychiatrists and antibiotics, opioids, antiepileptics, and antidepressants by primary care clinicians (PCPs). DESIGN: We used 2017 Veterans Health Administration (VHA) administrative data. SUBJECTS: We included patient-clinician dyads of older patients (> 55 years) with an outpatient encounter with a clinician in 2017. Patient-clinician data from 140 VHA facilities were included (n = 13,347,658). Analysis was repeated for years 2014 to 2016. MAIN MEASURES: For each medication, facility prescribing intensity measures were calculated as clinician prescribing intensity averaged over all clinicians at each facility. Clinician prescribing intensity measures included percentage of each clinician's patients prescribed the medication and mean number of days supply per patient among all patients of each clinician. KEY RESULTS: As the number of prescribing clinicians in a facility increased, the intensity of prescribing decreased. Every increase of 10 facility clinicians was associated with a significant decline in prescribing intensity for both specialties for different medication classes: for psychiatrists, declines ranged from 6 to 11%, and for PCPs, from 2 to 3%. The pattern of more clinicians less prescribing was significant across all years. CONCLUSION: Future work should explore the mechanisms that link the number of facility clinicians with prescribing intensity for benzodiazepines, antipsychotics, antiepileptics, antidepressants, antibiotics, and opioids. Facilities with fewer clinicians may need additional resources to avoid unwanted prescribing of potentially harmful or unnecessary medications.


Subject(s)
Analgesics, Opioid , Anticonvulsants , Humans , Analgesics, Opioid/therapeutic use , Anticonvulsants/therapeutic use , Anti-Bacterial Agents/therapeutic use , Psychotropic Drugs/therapeutic use , Benzodiazepines/therapeutic use , Antidepressive Agents , Practice Patterns, Physicians'
15.
BMC Health Serv Res ; 24(1): 1091, 2024 Sep 18.
Article in English | MEDLINE | ID: mdl-39294727

ABSTRACT

BACKGROUND: Virtual Reality in mental health treatment has potential to address a wide spectrum of psychological and neurocognitive disorders. Despite the proven benefits, integration into clinical practice faces significant challenges. There is a critical need for research into clinicians' perceptions of virtual reality due to the gap between rapid technological advancements and their adoption in mental health services. METHOD: A scoping review was conducted to comprehensively understand clinicians' perspectives on the application of immersive virtual reality technologies within mental health settings. 4 data bases were searched, from inception, with the search areas of clinicians', technology, perspectives and mental health. The scoping review followed the PRISMA-ScR checklist. All results were thematically analysed to identify and categorise themes with a focus on qualitative analyses of clinicians' experiences and perceptions of VR applications in therapeutic contexts. RESULTS: 17 articles were selected, encompassing a range of mental health settings. The findings indicate that the integration of VR in clinical environments is heavily influenced by clinicians' knowledge and experience, with unfamiliarity often leading to scepticism. Positive attitudes towards VR, bolstered by direct experience and training, were found to drive acceptance, as clinicians' acknowledged its potential to complement traditional therapies. However, there are still gaps in understanding VR's therapeutic applications, particularly concerning its impact on human interaction and its suitability for specific patient groups. Balancing VR's clinical benefits with ethical and safety concerns is crucial, especially when working with vulnerable populations. Furthermore, structural and administrative support is essential to overcoming the financial and logistical challenges of VR implementation, ensuring its safe and effective integration into mental health care. CONCLUSION: While VR holds significant potential for enhancing mental health care, its successful integration into clinical practice necessitates addressing existing gaps in knowledge, training, and structural support. By carefully balancing its clinical benefits with ethical, practical, and safety considerations, VR can be effectively utilised as a valuable tool in mental health treatment, providing innovative solutions while ensuring that patient care remains paramount.


Subject(s)
Attitude of Health Personnel , Mental Health Services , Virtual Reality , Humans , Mental Disorders/therapy , Mental Health Services/organization & administration
16.
BMC Health Serv Res ; 24(1): 348, 2024 Mar 16.
Article in English | MEDLINE | ID: mdl-38493290

ABSTRACT

BACKGROUND: The job performance of clinicians is a clear indicator of both hospital capacity and the level of hospital service. It plays a crucial role in maintaining the effectiveness and quality of medical care. Clinical pathways are a systematic method of quality improvement successfully recommended by broader healthcare systems. Since clinicians play a key role in implementing clinical pathways in public hospitals, this study aims to investigate the effect of the satisfaction of clinicians in public hospitals with clinical pathway implementation on their job performance. METHODS: A cross-sectional study design was used. Questionnaires were administered online. A total of 794 clinicians completed the questionnaires in seven tertiary public hospitals in Sichuan Province, China, of which 723 were valid for analysis. Questionnaires contained questions on social demographic characteristics, satisfaction with clinical pathway implementation, work engagement, and job performance. Structural Equation Model (SEM) was used to test the hypotheses. RESULTS: The satisfaction of clinicians in public hospitals with clinical pathway implementation was significantly positively correlated with work engagement (r = 0.570, P < 0.01) and job performance (r = 0.522, P < 0.01). A strong indirect effect of clinicians' satisfaction with clinical pathway implementation on job performance mediated by work engagement was observed, and the value of this effect was 0.383 (boot 95%CI [0.323, 0.448]). CONCLUSION: The satisfaction of clinicians in public hospitals with clinical pathway implementation not only directly influences their job performance, but also indirectly affects it through the mediating variable of work engagement. Therefore, managers of public hospitals need to pay close attention to clinicians' evaluation and perception of the clinical pathway implementation. This entails taking adequate measures, such as providing strong organizational support and creating a favorable environment for the clinical pathway implementation. Additionally, focusing on teamwork to increase clinicians' satisfaction can further enhance job performance. Furthermore, managers should give higher priority to increasing employees' work engagement to improve clinicians' job performance.


Subject(s)
Critical Pathways , Work Performance , Humans , Cross-Sectional Studies , Job Satisfaction , Work Engagement , Surveys and Questionnaires , Hospitals, Public , China
17.
Int J Qual Health Care ; 36(3)2024 Jul 11.
Article in English | MEDLINE | ID: mdl-38860772

ABSTRACT

Patient safety is a fundamental of good quality and also a high priority for the health-care system. Maintaining patient safety reduces errors and harm that patients can suffer during health care. The operating room clinicians have a vital role in ensuring patient safety. The general objective of this study was to assess attitudes towards perioperative safety and associated factors among the operation room clinicians at the University of Gondar Comprehensive Specialized Hospital (UoGCSH), Northwest Ethiopia, 2022. A cross-sectional study was conducted on operation room clinicians at UoGCSH. The data were collected by using a self-administered structured questionnaire that included the Safety Attitude Questionnaire (SAQ). Binary logistic regression analysis was employed, and the strength of association was described in adjusted odds ratios with a 95% confidence interval (CI). A total of 260 (76% response rate) operation room clinicians have participated in this study. The mean ± SD of attitude toward perioperative safety was 57.8 ± 0.9. Only 32 (12.3%) operation room clinicians have shown a favorable attitude toward perioperative safety. Most of the clinicians were found to have unfavorable attitudes toward all domains of SAQ except the stress recognition domain. Age >30 years [adjusted odds ratios (AOR): 3.1, CI: 1.1, 8.7, P = .035], working for ≥40 h/week (AOR: 3.9, CI: 1.4, 11.1, P = .01), working in ophthalmologic (AOR: 12.0, CI: 3.8, 38.8, P < .001) and gynecologic (AOR: 3.6, CI: 1.1, 12.7, P = .04) operation rooms, and having training on perioperative safety (AOR: 2.6, CI: 1.1, 6.5, P < .03) were found associated with having favorable attitude toward perioperative safety. Most operation room clinicians had an unfavorable attitude toward perioperative safety and all the domains of SAQ except the stress recognition domain. Older age ≥ 30 years, working for ≥40 h/week, having safety-related training, and working in ophthalmologic and gynecologic operation rooms were found associated with having a favorable attitude toward perioperative safety.


Subject(s)
Attitude of Health Personnel , Hospitals, University , Operating Rooms , Patient Safety , Humans , Ethiopia , Cross-Sectional Studies , Female , Male , Adult , Surveys and Questionnaires , Middle Aged
18.
Reprod Health ; 21(1): 133, 2024 Sep 13.
Article in English | MEDLINE | ID: mdl-39272100

ABSTRACT

BACKGROUND: Proponents of abortion restriction cite advancements in contraceptive technology as a reason against the need for abortion care today, most recently through oral arguments in the Supreme Court of the United States case, Dobbs v. Jackson Women's Health. However, consistent and correct use of contraception requires reproductive health literacy. Our objectives were to quantify contraceptive risk events and assess contraceptive history and preferences among a population well-equipped to evade contraceptive risks, family planning specialists following initiation of their medical training. "Risk events" are defined as reported episodes of contraceptive failure, emergency contraception use and/or unprotected or underprotected intercourse. METHODS: This was a cross-sectional study among current members of a professional organization of family planning specialists. Inclusion criteria included: status as a current or retired clinician, consensual penile-vaginal intercourse and personal or partner capacity to become pregnant since the start of medical training. Descriptive statistics were performed. This study was IRB exempt. RESULTS: Among 229 respondents, 157 (69%) reported experiencing a contraceptive risk event since training. Twenty-nine (13%) respondents reported an occurrence within the last year. By category, 47% (108/229; 3 reported unknown) reported under- or unprotected intercourse, 35% (81/229) reported emergency contraception use, and 52% of participants (117/227; 2 unknown) reported known or suspected contraceptive failure. The mean number of contraceptive methods used was 3.7 (SD 1.7) out of the 13 methods listed. Almost all (97%) participants reported at least one method was not an acceptable option, with a mean of 5.6 (SD 2.7) of the 13 listed methods. CONCLUSIONS: The majority of family planning specialists have experienced contraceptive risk events during times of active pregnancy prevention since their medical training. Contraceptive method change is common and most respondents were limited in the number of methods that were personally acceptable to them. Dialogue idealizing the role of contraception in minimizing or eliminating abortion need is simplistic and inaccurately represents the lived realities of pregnancy-capable individuals and their partners, including among those with exceptional contraceptive literacy and access.


ANTECEDENTES: Los que apoyan la restricción del aborto citan los avances en la tecnología anticonceptiva como una razón en contra de la necesidad de la atención del aborto hoy en día, más recientemente a través de los argumentos orales en el caso de la Corte Suprema de los Estados Unidos, Dobbs v. Jackson Women's Health. Sin embargo, el uso sistemático y indicado de los anticonceptivos requiere unos conocimientos sobre salud reproductive. Nuestros objetivos eran cuantificar los eventos de riesgo anticonceptivo y evaluar los antecedentes y las preferencias entre una población bien equipada para eludir los riesgos anticonceptivos, los especialistas en planificación familiar tras el inicio de su formación médica. Los "eventos de riesgo" se definen como episodios reportados de fallo anticonceptivo, uso de anticoncepción de emergencia y/o relaciones sexuales sin protección o con protección insuficiente. MéTODOS: Este fue un estudio transversal entre miembros actuales de una organización profesional de especialistas en planificación familiar. Los criterios de inclusión incluyeron: condición de clínico/a en activo/a o jubilado/a, relaciones sexuales consentidas pene-vagina desde el inicio de la formación médica y capacidad personal o de la pareja para quedarse embarazada. Se realizaron estadísticas descriptivas. Este estudio estaba exento de IRB. RESULTADOS: De las 229 encuestadas, 157 (69%) declararon haber sufrido un evento de riesgo anticonceptivo desde la formación. Veintinueve (13%) encuestadas declararon haberlo sufrido un incidente en el último año. Por categoría, el 47% (108/229; 3 informaron de forma desconocida) informaron de relaciones sexuales sin protección o con poca protección, el 35% (81/229) informaron del uso de anticonceptivos de emergencia y el 52% de los participantes (117/227; 2 informaron de forma desconocida) informaron de un fallo anticonceptivo conocido o sospechado. El promedio de métodos anticonceptivos utilizados fue 3,7 (DE 1,7) de los 13 métodos enumerados. Casi todas las participantes (97%) informaron de que al menos un método no era una opción aceptable, con un promedio de 5,6 (DE 2,7) de los 13 métodos enumerados. CONCLUSIONES: La mayoría de los especialistas en planificación familiar han experimentado eventos de riesgo anticonceptivo en momentos de prevención activa del embarazo desde su formación médica. El cambio de método anticonceptivo es frecuente y la mayoría de los encuestados tenían un número limitado de métodos que les resultaban personalmente aceptables. El diálogo que idealiza el papel de la planificación familiar a la hora de minimizar o eliminar la necesidad de abortar es simplista y representa de forma inexacta las realidades vividas por las personas con capacidad de embarazo y sus parejas, incluso entre aquellas con conocimientos y acceso excepcionales a la anticoncepción.


Subject(s)
Family Planning Services , Humans , Female , Cross-Sectional Studies , Adult , Contraception/statistics & numerical data , Contraception/methods , Male , Middle Aged , Pregnancy , Contraception Behavior/statistics & numerical data , Abortion, Induced/statistics & numerical data , Contraception, Postcoital/statistics & numerical data
19.
BMC Med Ethics ; 25(1): 8, 2024 01 18.
Article in English | MEDLINE | ID: mdl-38238736

ABSTRACT

BACKGROUND: It is a common ethical challenge for ambulance clinicians to care for patients with impaired decision-making capacities while assessing and determining the degree of decision-making ability and considering ethical values. Ambulance clinicians' ethical competence seems to be increasingly important in coping with such varied ethical dilemmas. Ethics rounds is a model designed to promote the development of ethical competence among clinicians. While standard in other contexts, to the best of our knowledge, it has not been applied within the ambulance service context. Thus, the aim of this study was to describe ambulance clinicians' experiences of participating in ethics rounds. METHODS: This was a qualitative descriptive study, evaluating an intervention. Data were collected through sixteen interviews with ambulance clinicians who had participated in an intervention involving ethics rounds. The analysis was performed by use of content analysis. RESULTS: Two themes describe the participants' experiences: (1) Reflecting freely within a given framework, and (2) Being surprised by new insights. The following categories form the basis of the themes; 1a) Gentle guidance by the facilitator, 1b) A comprehensible structure, 2a) New awareness in the face of ethical problems, and 2b) Shared learning through dialogue. CONCLUSION: Incorporating structured ethics rounds seems to create a continuous development in ethical competence that may improve the quality of care in the ambulance service. Structured guidance and facilitated group reflections offer ambulance clinicians opportunities for both personal and professional development. An important prerequisite for the development of ethical competence is a well-educated facilitator. Consequently, this type of ethics rounds may be considered a useful pedagogical model for the development of ethical competence in the ambulance service.


Subject(s)
Ambulances , Humans , Qualitative Research
20.
J Med Internet Res ; 26: e54607, 2024 Jun 26.
Article in English | MEDLINE | ID: mdl-38764297

ABSTRACT

This study evaluated the capabilities of the newly released ChatGPT-4V, a large language model with visual recognition abilities, in interpreting electrocardiogram waveforms and answering related multiple-choice questions for assisting with cardiovascular care.


Subject(s)
Electrocardiography , Electrocardiography/methods , Artificial Intelligence
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