Can Chatbot Artificial Intelligence Replace Infectious Diseases Physicians in the Management of Bloodstream Infections? A Prospective Cohort Study.

BACKGROUND: The development of chatbot artificial intelligence (AI) has raised major questions about their use in healthcare. We assessed the quality and safety of the management suggested by Chat Generative Pre-training Transformer 4 (ChatGPT-4) in real-life practice for patients with positive blood cultures. METHODS: Over a 4-week period in a tertiary care hospital, data from consecutive infectious diseases (ID) consultations for a first positive blood culture were prospectively provided to ChatGPT-4. Data were requested to propose a comprehensive management plan (suspected/confirmed diagnosis, workup, antibiotic therapy, source control, follow-up). We compared the management plan suggested by ChatGPT-4 with the plan suggested by ID consultants based on literature and guidelines. Comparisons were performed by 2 ID physicians not involved in patient management. RESULTS: Forty-four cases with a first episode of positive blood culture were included. ChatGPT-4 provided detailed and well-written responses in all cases. AI's diagnoses were identical to those of the consultant in 26 (59%) cases. Suggested diagnostic workups were satisfactory (ie, no missing important diagnostic tests) in 35 (80%) cases; empirical antimicrobial therapies were adequate in 28 (64%) cases and harmful in 1 (2%). Source control plans were inadequate in 4 (9%) cases. Definitive antibiotic therapies were optimal in 16 (36%) patients and harmful in 2 (5%). Overall, management plans were considered optimal in only 1 patient, as satisfactory in 17 (39%), and as harmful in 7 (16%). CONCLUSIONS: The use of ChatGPT-4 without consultant input remains hazardous when seeking expert medical advice in 2023, especially for severe IDs.

Review of advanced practice nurse role in infection throughout the hematopoietic stem cell transplant journey.

BACKGROUND: Prolonged periods of immunosuppression during hematopoietic stem cell transplant (HSCT) can result in serious infectious complications and contribute to transplant-related morbidity and mortality. Adherence to standardized pre and postinfection screening guidelines, prescribed medications, and early identification of infectious symptoms through comprehensive patient and family education are crucial to minimizing infectious complications. Advanced practice nurses (APNs) are key members of the multidisciplinary care team in the HSCT specialty, maintaining a specialized skillset and scope of practice which includes a holistic based, preventative medicine and risk mitigation approach. METHODS: This review sought to describe the role of the APN in HSCT care and to further examine existing APN led models of care which focus on infection prevention and education throughout the HSCT treatment journey. RESULTS: No studies specifically examined the APN role in infectious diseases risk assessment, screening, and management throughout the HSCT journey were identified throughout our review, however, there was considerable evidence to demonstrate the benefits of APN led care in the oncology and solid organ transplantation specialty which led to improvements in continuity of care, overall patient outcomes, and multidisciplinary team collaboration. The key themes identified in our review, were the role of the APN in the delivery of comprehensive patient and family education, the role of the APN in supporting, mentoring, and educating junior medical and nursing teams, the collaboration between the APN and the multidisciplinary care team, and the role of the APN in prompt recognition, triage, and management of treatment related complications, such as infection.

Task redistribution from general practitioners to nurses in acute infection care: A prospective cohort study.

AIM: To examine the impact of implementing nurse-led consultations compared to physician-led consultations on the frequency of follow-up contacts within 14 days following an acute infectious consultation. DESIGN: Monocentric, prospective cohort study. METHODS: The study was conducted in a multidisciplinary, capitation-based general practice in Belgium. Through analysis of patient files, the number of follow-up contacts within 14 days after an infection consultation was investigated to determine any difference between physician-led or nurse-led consultations. Secondary outcomes included pharmacological interventions and the prescribing behaviour of medical leave certificates. RESULTS: A total of 352 consultations were analysed, of which 174 conducted by physicians and 178 by nurses. No significant difference was found in the number of follow-up contacts. However, the probability of a pharmacological intervention by a physician was revealed to be significantly higher. The presence or absence of such pharmacological intervention did not significantly influence the number of follow-up contacts. CONCLUSION: This study demonstrates that nurses can be safely and efficiently utilized in acute infection care within a general practice setting. Although these results are promising, more extensive research is needed which incorporates the experiences of patients and healthcare providers. Furthermore, it is advisable to consider the experience and education of the nurses and incorporate them into the analyses. IMPACT: This study addressed the high workload on general practitioners by researching a task shift in the acute infectious, primary health care. The results demonstrate the feasibility of this task shift, which may have an impact on primary health care professionals (whose workload may be reorganized), as well as on patients for whom primary care may become more accessible. PATIENT OR PUBLIC CONTRIBUTION: This study includes direct patient data from people who presented themselves with acute infectious complaints in a primary healthcare practice.

A multi-country mixed-method study identifying the association between perceived ethical work climate and problems among critical care nurses.

BACKGROUND: Given the grave ethical tension and dilemmas posed continuously which are aggravated in the intensive care unit context and its related caregiving provision, combined with their impact on critical care nurses' job satisfaction and work-related risks, exploring and analyzing these tensions and conflicts is crucial. This study was conducted to examine the relationship between perceived ethical work climate and problems among critical care nurses in addition to exploring their perspectives on the ethical work climates while caring for patients with infectious diseases. DESIGN AND METHOD: A mixed-method research design was used to conduct this study among 635 participants, comprising 170 from Egypt, 144 from Jordan, 161 from Saudi Arabia, and 160 from the United Arab Emirates. Online or paper-based survey forms were distributed to all eligible critical care nurses who agreed to take part in the study. The survey contained both quantitative and qualitative data that were analyzed separately and integrated during the discussion. The study was reported following the STROBE guidelines. FINDINGS: The overall ethical work climate was fairly good and was significantly associated with ICU nurses' personal and professional characteristics. The findings also identified three main themes: (1) an ethical sense of failure, (2) environmental condemnation, and (3) an instant action plan for resolving ethical conflicts. CONCLUSIONS: ICU nurses perceived that ICU ethical climate was fairly good. The results indicated that ICU nurses generally had a relatively fair perception of the ethical work climate, with implications for addressing ethical issues and conflicts in various settings. IMPACT: Mentorship and/or close supervision concerning ethical resilience, consultation, and decision-making is crucial in the ICU milieu. Metacognitive strategies to reinforce problem-solving and decision-making ICU nurses' skills could help them overcome the different ethical challenges. Adequate resources, teamwork, and organizational support are promising tactics to improve ICU nurses' ethical skills. TRIAL REGISTRATION: Not applicable.

School Nurses' Experiences and Needs in COVID-19 Pandemic Response: A Qualitative Study.

The coronavirus disease 2019 pandemic drastically shifted the public health burden onto the school health system. We, therefore, explored the school nurses' experiences and needs for confronting the pandemic in school settings across Korea. This qualitative investigation enrolled 30 participants after their written consent. A written interview conducted through email and focus group interviews using an online meeting application verified participants' opinions and experiences. Collected data were subjected to text-mining and content analysis. The school nurse was found to be responsible for many tasks, including education on preventive measures with unclear quarantine guidelines. Content analysis identified three key themes: "aggravated difficulties owing to lack of support resulted in burnout," "reflection on supportive resources; direct provisions were helpful," and "needs and suggestions to safeguard students' health in the event of another pandemic." Recommendations should all be considered to keep schools and students safe from future pandemics.

Achille Sclavo (1861-1930) and His Innovative Contributions to Italian Preventive Medicine and Healthcare Policy.

Achille Sclavo was a scientist with a multifaceted personality; throughout his life, he steadfastly maintained his commitment to research and teaching, while also gaining precious experience as an educator, politician and entrepreneur. He carried forward these various activities with the aim of bringing relief to a country smitten by epidemic diseases, of spreading the gospel of hygiene, and of creating and training medical and healthcare personnel that would be able to tackle the difficult problem of public health in Italy at the beginning of the twentieth century. In this regard, Achille Sclavo can undoubtedly be considered a precursor of modern public health and preventive medicine.

A eulogy for Dr Francisco Miguel Marty Forero.

As some of those who were lucky enough to have been mentored by Dr Francisco Marty in transplant infectious diseases, we stand with the larger medical community in mourning his untimely death and in commemorating him as a uniquely exceptional and talented physician, investigator, teacher, mentor, friend, artist, and human being.

One Health/EcoHealth capacity building programs in South and South East Asia: a mixed method rapid systematic review.

BACKGROUND: Although One Health (OH) or EcoHealth (EH) have been acknowledged to provide comprehensive and holistic approaches to study complex problems, like zoonoses and emerging infectious diseases, there remains multiple challenges in implementing them in a problem-solving paradigm. One of the most commonly encountered barriers, especially in low- and middle-income countries, is limited capacity to undertake OH/EH inquiries. A rapid review was undertaken to conduct a situation analysis of the existing OH/EH capacity building programs, with a focused analysis of those programs with extensive OH engagement, to help map the current efforts in this area. METHODS: A listing of the OH/EH projects/initiatives implemented in South Asia (SA) and South East Asia (SEA) was done, followed by analysis of documents related to the projects, available from peer-reviewed or grey literature sources. Quantitative data was extracted using a data extraction format, and a free listing of qualitative themes was undertaken. RESULTS: In SEA, 13 unique OH/EH projects, with 37 capacity building programs, were identified. In contrast, in SA, the numbers were 8 and 11 respectively. In SA, programs were oriented to develop careers in program management, whereas, in SEA, the emphasis was on research. Two thirds of the programs in SEA had extensive OH engagement, whereas only one third of those in SA did. The target for the SEA programs was wider, including a population more representative of OH stakes. SEA program themes reveal utilization of multiple approaches, usually in shorter terms, and are growing towards integration with the traditional curricula. Such convergence of themes was lacking in SA programs. In both regions, the programs were driven by external donor agencies, with minimal local buy-in. CONCLUSIONS: There is limited investment in research capacity building in both SA and SEA. The situation appears to be more stark in SA, whilst SEA has been able to use the systematic investment and support to develop the OH/EH agenda and strategize capacity building in the core competencies. In order to effectively address the disease emergence hotspots in these regions, there needs to be strategic funding decisions targeting capacity building in the core OH/EH competencies especially related to transdisciplinarity, systems thinking, and adaptive management.

Incidence and risk factors of COVID-19 in a tertiary hospital and the effectiveness of booster vaccination among health care workers: A retrospective cohort study, January 2020 to June 2022.

BACKGROUND: Health care workers (HCWs) face a higher risk of infection and may transmit pathogens to patients during a pandemic. This study aims to evaluate infection-control measures by analyzing the incidence and risk factors of COVID-19 and estimating vaccine effectiveness (VE) at a tertiary hospital in Seoul, Republic of Korea. METHODS: This study included 2,516 HCWs from January 1, 2020, to June 30, 2022. Data were analyzed to determine the incidence density and cumulative incidence; the results were compared by the age- and gender-specific standardized incidence ratios (SIR). VE was estimated with multivariate Cox proportional-hazard models as 1-adjusted hazard ratio × 100%. RESULTS: SIR indicated a lower COVID-19 risk in the hospital population than in the general Korean population (SIR, 0.81; 95% confidence interval [CI]: 0.76-0.87). Multivariate Cox analysis indicated that, compared to doctors, nonmedical service supporters and other HCWs (excluding doctors and nurses) were high-risk groups (adjusted hazard ratio [95% CI], 1.72 [1.04-2.83] and 1.76 [1.20-2.58], respectively). Compared to the outpatient unit, the emergency department was a high-risk department (1.70 [1.16-2.50]). The VE of the booster dose was 55.47%, compared to no or incomplete vaccination (95% CI: 22.63-74.37). CONCLUSIONS: Besides encouraging HCWs vaccination, effective infection-control measures should target high-risk groups and departments.

Prevalence of Latent Tuberculosis Infection Among Nurses Working in Critical Areas at a Tertiary Care Hospital in Riyadh, Saudi Arabia.

Introduction Tuberculosis is a critical health issue worldwide. Most infected persons are asymptomatic and categorized as having a latent tuberculosis infection (LTBI). Healthcare workers (HCWs) are more prone to being infected with tuberculosis and should be enrolled in a screening program for early detection. Objectives The study aims to estimate the prevalence of LTBI among nurses working in critical areas which include adult intensive care units, pediatric intensive care units, emergency departments, oncology departments, dialysis departments, tuberculosis labs, isolation rooms, and cardiac center intensive care units. Methods A record-based cross-sectional survey measured the prevalence of LTBI among nurses working in critical areas at Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia. We reviewed the occupational health records of all nurses working in critical areas from June 1, 2021, to June 1, 2022. We recorded the data reviewed throughout the year in the Occupational Health Department at PSMMC. We excluded all participants with previously documented positive tuberculin skin test (TST) from the study. We analyzed the sociodemographic data, working years, working location, job title, and TST results. Results We included a total of 771 out of 2025 nurses in this study. Participants were mostly women (88%) and in the 26-35-year age group (67.7%). Most of the participants were originally from the Philippines (66.3%). The overall LTBI prevalence among nurses was 34.5%. The highest prevalence of LTBI was among nurses working in the cardiac intensive care unit (53.5%), and the lowest prevalence was among nurses working in the isolation department (8.9%; p-value <0.0001). Those who worked more in the hospital were significantly more infected with LTBI (p-value <0.04). Conclusion LTBI remains a significant health risk worldwide and in the Middle East as well as among HCWs. This underscores the necessity of comprehensive pre-hiring screening, annual screening, infection control protocols, and active management of HCWs with LTBI.

Mastering your fellowship: Part 1, 2024.

The series, 'Mastering your Fellowship', provides examples of the question formats encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians (South Africa) (FCFP [SA]) examination. The series is aimed at helping family medicine registrars (and their supervisors) in preparing for this examination.

Investigation and Analysis on Occupational Exposure Causes and Mental Status of Infectious Diseases in Pre-Hospital Emergency Medical Personnel.

Background: We aimed to probe into the occupational exposure causes and mental status of infectious diseases in pre-hospital emergency medical personnel. Methods: Forty medical personnel with occupational exposure to infectious diseases who participated in pre-hospital emergency work in 120 emergency center of The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China were selected as respondents from February 2018 to February 2021. The occupational exposure modes, exposure degrees, exposure sites, exposure sources and exposure causes of infectious diseases were summarized, and the mental status of emergency medical personnel after occupational exposure to infectious diseases was analyzed. Results: In the occupational exposure modes of infectious diseases, needle stick injuries were overtly higher than mucosal pollution, hematic and humoral pollution and incised wound by glass (P<0.05). In exposure degrees, slight bleeding was notably higher than excessive bleeding, bleeding and no bleeding (P<0.05). The hand was distinctly higher than the eye in exposure sites (P<0.05). In exposure sources, hepatitis B virus was visibly higher than hepatitis C virus, HIV, syphilis, intravenous drug, hemorrhagic fever and unknown cause (P<0.05). The scores of somatic symptoms, anxiety, depression, fear, interpersonal sensitivity, hostility, compulsion and paranoia in medical personnel were clearly higher than the norm in Chinese adults after occupational exposure to infectious diseases (P<0.05), with no statistical significance in the comparison of psychotic scores. Conclusion: The occupational exposure risk of infectious diseases among pre-hospital emergency medical personnel is high. It is necessary to strengthen pre-job training and education and improve standardized management for protection.

Nazi functionary or oppositionist in disguise? The complex life of the anatomist Enno Freerksen (1910-2001).

Enno Freerksen (1910-2001) is one of the most prominent German anatomists of his time, as evidenced by numerous international awards. His political role in the Third Reich, however, remains controversial. While some authors describe him an avowed National Socialist, Karl-Werner Ratschko recently speculated about a late turn of Freerksen towards political resistance. The present work takes these contradictions as an occasion for a comprehensive source-based analysis of Freerksen's activities in the Third Reich. For the first time, a synoptic evaluation of primary sources from eight different archives is undertaken. The study is supplemented by a systematic re-analysis of all available research contributions on Freerksen. The study demonstrates that Freerksen not only joined numerous Nazi organizations - partly even before Hitler came to power -, but also took on several important functions in the Nazi apparatus and worked on National Socialist research topics (e.g. racial hygiene). It can also be shown that his steep scientific career was closely linked to his political activities. The thesis that Freerksen opposed Nazi ideology towards the end of the war, on the other hand, must be clearly rejected. On the contrary: The sources show Freerksen as a National Socialist polyfunctionary, who did not self-critically reflect on his role in the Third Reich even after 1945.

Antimicrobial stewardship for nurse practitioners and physician assistants: enhancing patient safety through education.

Background: As nurse practitioners and physician assistants (APPs) become more prevalent in delivering pediatric care, their involvement in antimicrobial stewardship efforts increases in importance. This project aimed to create and assess the efficacy of a problem-based learning (PBL) approach to teaching APPs antimicrobial stewardship principles. Methods: A PBL education initiative was developed after communication with local APP leadership and focus group feedback. It was offered to all APPs associated with Lurie Children's Hospital of Chicago. Participants completed a survey which assessed opinions on antimicrobial stewardship and included knowledge-based questions focused on antimicrobial stewardship. Prescriptions for skin and soft tissue infections associated with APPs were recorded via chart review before and after the education campaign. Results: Eighty APPs participated in the initial survey and teaching initiative with 44 filling out the 2-week follow-up and 29 filling out the 6-month follow-up. Subjective opinions of antimicrobial stewardship and comfort with basic principles of AS increased from pre-intervention. Correct responses to knowledge-based assessments increased from baseline after 2-week follow-up (p < 0.01) and were maintained at the 6-month follow-up (p = 0.03). Simple skin and soft tissue infection prescriptions for clindamycin went from 44.4% pre-intervention to 26.5% (p = 0.2) post-intervention. Conclusions: A PBL approach for APP education on antimicrobial stewardship can be effective in increasing knowledge and comfort with principles of antimicrobial stewardship. These changes are maintained in long-term follow-up. Changes in prescribing habits showed a strong trend towards recommended empiric therapy choice. Institutions should develop similar education campaigns for APPs.

A Cross-Sectional Descriptive Study on the Attitudes Towards Patient Safety and Influencing Factors of Nurses in Infectious Diseases Wards.

Background: Patient safety is an important aspect of healthcare delivery and is critical to healthcare quality. An assessment of the attitudes of nursing staff in infectious diseases wards towards patient safety may identify deficiencies and allow for the development of educational programmes to train nursing staff to participate in good patient safety practices. Objective: To explore the current situation and influencing factors on nurses' attitudes towards patient safety in infectious diseases wards. Methods: This cross-sectional study enrolled 446 nurses from infectious diseases wards in eight hospitals in the Hebei Province to participate in an electronic questionnaire survey from October to December 2020. The Chinese version of the safety attitude questionnaire was used to gather the opinions of these participants, and SPSS 22.0 statistical software was used to analyse the data. Results: The average score of safety attitudes towards patients was 3.59 ± 0.30. The scores for each dimension, from high to low, were as follows: management perception: 3.77 ± 0.42 points, pressure perception: 3.77 ± 0.42 points, safety atmosphere: 3.57 ± 0.43 points, job satisfaction: 3.57 ± 0.43 points, teamwork: 3.55 ± 0.50 points and working conditions: 3.50 ± 0.45 points. The results of the multiple stepwise regression analysis showed that the influential factors on nurses' attitudes towards patient safety in infectious diseases wards were as follows: night shift working (ß = 11.885, P = 0.000), years of nursing experience (ß = 2.862, P = 0.001), education level (ß = 4.462, P = 0.001) and marital status (ß = 3.871, P = 1.002), which together explained 33.5% of the total variance. Conclusion: Nurses' attitudes towards patient safety in infectious diseases wards were moderately high. Night shift work, years of nursing experience, education level and marital status affected nurses' attitudes towards patient safety. Managers should focus on these groups of nurses and improve their working conditions and job satisfaction to further enhance patient safety.

Monkeypox: A Contemporary Review for Healthcare Professionals.

The ongoing 2022 multicountry outbreak of monkeypox is the largest in history to occur outside of Africa. Monkeypox is an emerging zoonotic disease that for decades has been viewed as an infectious disease with significant epidemic potential because of the increasing occurrence of human outbreaks in recent years. As public health entities work to contain the current outbreak, healthcare professionals globally are aiming to become familiar with the various clinical presentations and management of this infection. We present in this review an updated overview of monkeypox for healthcare professionals in the context of the ongoing outbreaks around the world.

Diagnosis and management of monkeypox in primary care.

The monkeypox virus outbreak continues to evolve worldwide. While most people recover without treatment, primary care clinicians may be the first point of contact for those affected. Prompt assessment, diagnosis, isolation, treatment and prophylaxis will reduce the risk of community transmission. The current public health advice is to test suspected cases and monitor close contacts. If individuals test positive for the monkeypox virus, self-isolation at home is recommended for most people with mild symptoms. If patients report severe symptoms, referral and admission to hospital will be needed, where further interventions such as antivirals may be administered. The infection can spread through close contact; therefore, healthcare professionals must take precautions, such as using appropriate personal protective equipment for possible or probable cases.

Sleep quality status, anxiety, and depression status of nurses in infectious disease department.

Objective: To investigate the current status of sleep quality and influencing factors of clinical nurses in infectious disease hospitals, and to provide basis and reference for improving their sleep status and providing psychological support. Methods: Using convenience sampling method, clinical nurses from a tertiary hospital for infectious diseases were selected as the survey subjects in September 2021. General information questionnaire, Pittsburgh Sleep Quality Questionnaire (PSQI), Generalized Anxiety Disorder Scale (GAD-7), Depression Screening Scale (PHQ-9) were used for questionnaire surveys, and multiple linear regression was used to analyze the impact of decreased sleep quality in clinical nurses factor. Results: A total of 460 questionnaires were returned, of which 442 were valid, effective rate is 96.09%. The Pittsburgh sleep quality index (PSQI) score of 442 clinical nurses was 7.07 ± 2.14, of which 60 (13.57%) had sleep disorders; the Generalized Anxiety Disorder Scale (GAD-7) score was 4.77 ± 3.50, of which 182 (41.18%) had varying degrees of anxiety; The score of PHQ-9 was 5.95 ± 3.79, of which 187 (42.31%) had different degrees of depressive symptoms. The stepwise multiple linear regression analysis which involved PHQ-9 and GAD-7 scores showed that: both the PHQ-9 score and the GAD-7 score were positively correlated with the sleep quality score, and the PHQ-9 score increased every time 1 point, sleep quality score increased by 0.239 points; GAD-7 score increased by 1 point, sleep quality score increased by 0.150 points. The overall model test (F = 109.760, P < 0.001) regression model is meaningful. Conclusion: Decreased sleep quality is common among clinical nurses in infectious disease hospitals, and the sleep status of nurses is positively correlated with anxiety and depression. Nursing managers pay attention to sleep quality of clinical nurses in infectious disease hospitals and carry out effective interventions to improve the sleep quality of nurses.

Key articles and guidelines for the pediatric clinical pharmacist from 2019 and 2020.

PURPOSE: To summarize recently published research reports and practice guidelines deemed to be significantly impactful for pediatric pharmacy practice. SUMMARY: Our author group was composed of 8 board-certified pediatric pharmacists. Eight major themes were identified: critical care, hematology/oncology, medication safety, general pediatrics, infectious diseases, neurology/psychiatry, gastrointestinal/nutrition, and neonatology. The author group was assigned a specific theme(s) based on their practice expertise and were asked to identify articles using MEDLINE and/or searches of relevant journal articles pertaining to each theme that were published from January 2019 through December 2020 that they felt were "significant" for pediatric pharmacy practice. A final list of compiled articles was distributed to the authors, and an article was considered significant if it received a vote from 5 of the 8 authors. Thirty-two articles, including 16 clinical practice guidelines or position statements and 16 review or primary literature articles, were included in this review. For each of these articles, a narrative regarding its implications for pediatric pharmacy practice is provided. CONCLUSION: Given the heterogeneity of pediatric patients, it is difficult for pediatric pharmacists to stay up to date with the most recent literature, especially in practice areas outside their main expertise. Over the last few years, there has been a significant number of publications impacting the practice of pediatric pharmacists. This review of articles that have significantly affected pediatric pharmacy practice may be helpful in staying up to date on key articles in the literature.