A Consensus-Based Checklist for Reporting of Survey Studies (CROSS)

Preferences on the Use of Prokinetic Agents in Adult Intensive Care Unit Patients-An International Survey

INTRODUCTION

Feeding intolerance complicates enteral nutrition in intensive care unit (ICU) patients but is poorly defined. Prokinetic agents are administered to facilitate the uptake of enteral nutrition, but preferences for their use among clinicians in ICUs are unknown.

METHODS

We conducted an international electronic survey targeting ICU doctors. The survey included 76 questions that focused on symptoms considered when assessing feeding intolerance, preferences for using prokinetic agents, and willingness to participate in a future randomised trial on prokinetic agents.

RESULTS

We received 830 responses from 17 countries, with an overall response rate of 29%. Most respondents were specialists working in mixed ICUs. Feeding intolerance was assessed by 90% of respondents in their clinical work, though only 36% considered it well defined. Gastric residual volume and vomiting were symptoms most frequently used for defining feeding intolerance. Metoclopramide was the preferred prokinetic agent (54% of respondents), followed by erythromycin (42%). Four out of five considered using combination therapy, primarily a combination of metoclopramide and erythromycin (89%). Concerns about side effects were reported for all agents, with extrapyramidal symptoms and QT prolongation being the most common across agents. The majority (91%) of respondents supported a future randomised trial comparing prokinetic agents to placebo.

CONCLUSION

This international survey found practice variations in the symptoms reportedly used to assess feeding intolerance. Metoclopramide was the preferred prokinetic agent, followed by erythromycin. Most respondents supported a future randomised trial.

The 2023 World delirium awareness and quality Survey: A Canadian substudy

OBJECTIVE

This study aimed to evaluate the proportion of screened patients with delirium and the strategies used for its management in Canadian hospitals caring for critically ill children or adults.

METHODS

This is a secondary analysis of a cross-sectional study completed on World Delirium Awareness Day (March 15, 2023). Respondents completed a 35-question survey on the proportion of screened patients with delirium (at 8:00 am and 8:00 pm), treatment, and management strategies employed.

RESULTS

A total of 27 ICUs (22 adult and 5 pediatric) participated. Among adult ICU patients assessed for delirium, 18 % (n = 34/194) had delirium at 8:00 am and 18 % (32/181) had delirium at 8:00 pm. In pediatric ICUs, the proportion of screened patients with delirium was higher, with 50 % (n = 8/16) at 8:00 am and 44 % (n = 7/16) at 8:00 pm. Delirium management strategies varied: with non-pharmacological approaches such as multi-professional rounds (100 %), pain management (96 %), and mobilization (85 %) being most common. The most reported written delirium management protocols included spontaneous breathing trials in adult ICUs and physical restraint and sedation management in PICUs. Few ICUs reported written protocols for family engagement and empowerment.

CONCLUSIONS

Delirium remains a prevalent issue in Canadian ICUs, with variability in assessment and management strategies. Gaps in family engagement and pediatric-specific protocols persist. Addressing barriers like staff shortages and lack of training is critical to improving care.

IMPLICATIONS FOR CLINICAL PRACTICE

Improving delirium management requires standardized protocols, especially in PICUs, and better integration of family engagement in care. Addressing workforce challenges (e.g., staff shortages and educating new staff on delirium) will be crucial for enhancing delirium prevention and treatment in Canadian ICUs. Further research should focus on pediatric-specific interventions and pharmacological management.

Infection prevention knowledge related to central line infections and ventilator-associated pneumonias: A survey of Finnish intensive care units

BACKGROUND

Health care-associated infections pose a significant risk for the patients in intensive care due to the use of medical instrumentation required for care.

METHODS

We conducted a cross-sectional, nationwide survey on awareness of recommended infection prevention practices involving central venous catheters and invasive ventilators in intensive care units.

RESULTS

A total of 810 (50% of those surveyed) nurses and physicians participated in the survey. We found that 8% of the respondents had good knowledge of infection prevention in central venous care, while 24% had good knowledge of ventilator-associated pneumonia prevention practices.

DISCUSSION

The overall level of knowledge measured with this nationwide survey was suboptimal. The level varied between units, and depending on individual questions for particular professions. The displayed knowledge may have partially been based on tradition rather than on up-to-date evidence-based guidelines.

CONCLUSIONS

Educational training in evidence-based infection prevention is needed for practical implementation to be improved.

Availability and Practice Patterns of Videolaryngoscopy and Adaptation of Apneic Oxygenation in Pediatric Anesthesia: A Cross-Sectional Survey of Pediatric Anesthesiologists

BACKGROUND

Videolaryngoscopy (VL) and apneic oxygenation are highly recommended and increasingly used in pediatric anesthesia practice; yet, availability, use in recommended clinical settings (e.g., neonates, airway emergencies, and out-of-operating-room tracheal intubation), and the association of VL availability with how pediatric anesthesiologists define difficult intubation have not been explored.

METHOD

An electronic survey was distributed to the members of several international pediatric anesthesia societies to examine the availability and practice patterns of VL and to explore the criteria used to define a difficult tracheal intubation in children in the context of VL.

RESULTS

The response rate was 12.9%. VL was reported to be "most likely available" in main pediatric operating rooms and offsite locations 93% and 80.1% of the time, respectively. Fifty-seven percent of participants would select VL first when anticipating a difficult tracheal intubation; nearly 30% of respondents would choose direct laryngoscopy first and VL as a backup in this scenario. One-third of subjects would select VL as their first choice for nonoperating room (non-OR) emergency tracheal intubation and for premature or newborn infants, regardless of anticipated difficulty with intubation. Thirty percent of subjects reported using apneic oxygenation during difficult laryngoscopy. Institutional VL availability was not associated with how providers defined difficult tracheal intubation.

CONCLUSION

VL is highly available, but the adoption of VL and apneic oxygenation for managing difficult tracheal intubation was lower than expected, given recent recommendations by pediatric anesthesia societies. There was heterogeneity in how difficult intubation was defined, resulting in a possible patient safety risk.

Preliminary Assessment of Post-traumatic Stress Disorder Symptoms Among Emergency Medicine Physicians During the COVID-19 Outbreak

Objectives

The COVID-19 pandemic has caused significant increases in work-related emotional stress and emergency department (ED) volumes. Our study aimed to provide a preliminary assessment of posttraumatic stress disorder (PTSD) symptoms among emergency medicine (EM) physicians in the United States following the COVID-19 pandemic and explore related factors and predictors of PTSD symptoms.

Methods

Participants were recruited using a convenience sampling approach via professional listservs from national and state EM societies. Eligible participants included board-certified or board-eligible EM physicians, EM residents, and non-EM physicians working in an EM setting during the pandemic. The survey was distributed online using Qualtrics, ensuring anonymity and data security, from September 2020 to April 2021, with active recruitment during 2 periods: September to October 2020 and March to April 2021. To optimize clarity, the survey was prepiloted and measures were included to prevent duplicate responses. Descriptive analyses were reported with percentages, means, and medians using RStudio, PBC.

Results

A total of 362 surveys were distributed, of which 315 (87%) were completed and included in the analysis. Participants were predominantly aged 35 to 50 years (46%), White (86%), and board-certified in EM (70%), with most practicing in urban level 1 trauma centers (45%). Geographic representation included 40 states, with the largest proportions from the South (33%) and Midwest (29%). Overall, 92% of participants reported experiencing PTSD symptoms, with 41% classified as minimal, 22% mild, 18% moderate, 12% severe, and 7% very severe. The median PTSD Symptom Scale (PSS-I-5) score was 13 (IQR, 23). Factors associated with more severe PTSD symptoms included prior mental health diagnoses, female sex, and working in rural settings.

Conclusions

The study highlights the widespread occurrence of PTSD symptoms, with 92% of EM physicians reporting symptoms during the COVID-19 pandemic. Demographic and workplace factors, such as prior mental health diagnoses, female sex, and rural practice settings, contributed to greater symptom severity. These findings underscore the need for targeted mental health interventions and resources tailored to the specific needs of this at-risk group.

Evaluating the role of traditional and nontraditional educational resources in point-of-care ultrasound training: A cross-sectional survey of educator preferences and practices

Background

Recently, nontraditional educational resources like podcasts, blogs, and online media have gained prominence in medical education and are abundant within the field of point-of-care ultrasound (POCUS). However, the extent to which POCUS educators utilize online resources compared to traditional resources, like textbooks, journal articles, and in-person workshops, is unknown. We aim to define which types of educational resources are used and preferred by POCUS educators to teach trainees.

Methods

An expert working group developed a survey aimed to characterize the types of materials used by POCUS educators and their perceived importance on a 6-point forced ranking scale. We administered the survey to POCUS educators at the 2023 Society for Clinical Ultrasound Fellowships conference. Responses were analyzed using random-effects regression analyses.

Results

Sixty-two participants completed the questionnaire. In-person workshops (mean importance 5.1, 95% confidence interval [CI] 4.8-5.4) and online media (mean importance 4.8, 95% CI 4.4-5.1) were ranked as the most important resources for POCUS education overall, though not statistically different from each other (p > 0.001). Journal articles (mean importance 3.4, 95% CI 2.2-4.6), eBooks (mean importance 2.9, 95% CI 1.4-4.4), and podcasts (mean importance 2.8, 95% CI 1.5-4.1) were found to be of moderate importance and were not statistically different from each other. Respondents reported that textbooks were of least importance (mean importance 2.1, 95% CI 0.7-3.5).

Conclusions

POCUS educators view nontraditional educational materials with great importance, though in-person workshops remain the mainstay of POCUS education. POCUS educators utilize nontraditional educational materials and consider them more important than textbooks within POCUS curricula.

What do we need for a successful model of care to promote physical activity after stroke? Results from two web-based surveys of physiotherapists and exercise professionals in Singapore

OBJECTIVES

A collaborative model of care between physiotherapists (PTs) and exercise professionals (EPs) is needed to increase physical activity (PA) after stroke. We investigated the knowledge, attitudes and practices of PA promotion among PTs, the interest of EPs, and the barriers and facilitators to PA promotion faced by PTs and EPs in Singapore.

DESIGN

We conducted two web-based surveys between August and November 2019, and January and July 2021.

PARTICIPANTS

Eligible participants were PTs who saw at least one stroke survivor in the last three months, and certified EPs who saw at least one client in the last six months. We reported categorical data using frequencies and percentages.

RESULTS

Of 102 PTs and 44 EPs who initiated the surveys, 71 (70%) PTs and 35 (80%) EPs completed the surveys. Most knowledge questions were answered correctly. Almost all PTs perceived PA promotion as part of their role but only half (38/71;54%) practiced this often. Few (11/71;15%) used formal PA assessments. Most used goal setting (66/71;93%), advice/counselling (58/71;82%) and identification of barriers and solutions (51/71;72%). There was great interest from EPs to work with health professionals (30/35;86%) and stroke survivors (28/35;80%). While PTs faced barriers such as lack of time and resources, EPs faced barriers such as lack of referrals, knowledge and skills in stroke and exercise prescription.

CONCLUSION

Our study identified elements useful for informing a model of care between PTs and EPs in promoting post-stroke PA. Future research should focus on developing resources, pathways and training programs specific to stroke. CONTRIBUTION OF THE PAPER.

Critical care nurses' intention to leave and related factors: Survey results from 5 European countries

OBJECTIVES

To determine the nursing intention to leave in critical care units and explore related factors along with work environment and sociodemographic variables.

DESIGN AND SETTING

Quantitative cross-sectional study in five European countries (Spain, Poland, Croatia, Cyprus and Romania) through a self-administered survey in 2021.

METHODS

The "AACN Critical elements of a healthy work environment scale. National Survey of Critical-Care Nurse Work Environments" by the American Association of Critical Care Nurses was distributed to all nurses working in intensive care units through a convenience sampling method. The questionnaire included questions about healthy work environment, burnout, violence, intention to leave and sociodemographics.

RESULTS

1033 responses were analysed. Participants from each country varied between 75 and 275 nurses. Mean age was 37.3 years old (SD 9.9) with a mean nursing experience in critical care of 10.8 (9.2) years. Despite 83.1 % of the nurses were satisfied with their current job, 22.8 % planned to leave their position. Intention to leave was independently associated with the country, gender, age, satisfaction with current job and frequency of moral distress (p < 0.05) along with several work-related variables, such as lower perception of a healthy work environment. Among the reasons to reconsider leaving the job, the most rated were higher salary and benefits (87.2 %), better staffing (85.3 %) and meaningful recognition (82 %). Conversely, the most relevant reasons that kept nurses working in their organisation, were salary and benefits and the people they work with.

CONCLUSION

Almost one out of three critical care nurses are considering leaving their job. Many aspects of the work environment that influence the intention to leave are modifiable.

IMPLICATIONS FOR CLINICAL PRACTICE

Managers need to prioritise the retention of registered nurses, not only recruiting new personnel. Many aspects of the working environment need to be addressed in other to retain critical care nurses.

RESCUE - Rapid, Effective, Safe Communication in Emergency Departments: A cross-sectional e-survey

BACKGROUND

Effective staff-to-staff and patient-provider communication in the Emergency Department (ED) is essential for safe, quality care. Routine wearing of Personal-Protective-Equipment (PPE) has introduced new challenges to communication. We aimed to understand the perspectives of ED staff about communicating while wearing PPE, and to identify factors contributing to communication success, breakdown, and repair.

METHODS

Study design was a descriptive cross-sectional online survey with convenience sampling. Categorical data were analysed using descriptive statistics and qualitative data analysed using content thematic analysis.

RESULTS

Across nursing, medical and allied health, 78 staff responded with mean age= 38.8 years and mean ED clinical experience= 8.8 years). Respondents reported PPE impacted communication with patients/family members (81 %) and staff (61 %), with almost three-quarters of patient interactions rated as "somewhat difficult" or "extremely difficult". Content themes were: (i) impacts of mask-wearing on communication, (ii) impacts of mask-wearing on patient care quality and safety, and (iii) strategies for repairing communication breakdown. Health impacts of communicating in PPE (50 %) included voice fatigue, skin irritation, and throat dryness.

CONCLUSION

ED staff perceived that wearing PPE impacted communication and compromised safe and efficient quality care delivery. Staff reported using increased voice volume, repetition, gestures, increased proximity, and emphasised facial movements to enhance their communication.

Nurses' and midwives' knowledge and safe-handling practices related to hazardous drugs: A cross-sectional study

Background

Hazardous drugs are inherently toxic and can present an occupational exposure risk to healthcare professionals. Hazardous drugs are regularly prescribed for people to treat a variety of medical conditions.

Aim

To explore nurses' and midwives' knowledge and practices related to the safe handling of hazardous drugs. Also, to discover if controls of risk are available to support nurses and midwives to implement best practices when handling hazardous drugs in health care settings and if there are any obstacles to using these controls.

Method

This was a cross-sectional study using a convenience sample of nurses and midwives at six Australian hospitals from a metropolitan health care service. In the self-administered, validated online questionnaire, participants were asked to identify hazardous drugs and their use of hazard controls, including personal protective equipment. Variables for self-efficacy, perceived barriers, perceived risk, interpersonal influences, and workplace safety climate were also measured.

Results

A total of 217 nurses and midwives reported they handled hazardous drugs. The questionnaire was completed in full by 156 participants (71.9 %). Participants predominantly identified as women (196/217, 90.3 %) and had completed a bachelor's of nursing (139/217, 64.1 %). The hazardous drugs chloramphenicol, colchicine, and dutasteride were frequently not identified as hazardous (80.6 %, 73.8 %, and 68.2 %, respectively). A total of 78 (35.9 %) participants reported having received hazardous drug handling training, of which 34 (43.6 %) stated it was in the past 12 months. Participants (181/203, 89.2 %) agreed or strongly agreed that they were confident that they could use personal protective equipment correctly and were provided with the best available personal protective equipment (163/203, 80.3 %). Despite this, personal protective equipment was never worn by approximately a third of participants who reported being involved in preparing, administering, and disposing of hazardous drugs (32.2 %, 29.8 %, and 30.9 %, respectively).

Conclusion

Nurses and midwives did not always recognise hazardous drugs, and, although they were confident in using appropriate personal protective equipment, some reported never wearing it. A multi-faceted multidisciplinary intervention is needed to improve both knowledge and practice for handling both cytotoxic and non-cytotoxic drugs by nurses and midwives.

Roles and Tasks of Physiotherapists in Nursing Homes: A Survey

BACKGROUND AND PURPOSE

Physiotherapists in nursing homes perform a diversity of roles and tasks. But the delivery of physiotherapy services varies widely between organizations and between individual physiotherapists. This depends on both organizational and personal factors. This study aims to investigate to what extent physiotherapists in Dutch nursing homes agree on the scope and content of their professional roles and tasks.

METHODS

We performed a cross-sectional survey study of a convenience sample of physiotherapists in nursing homes. The questions were divided into five themes: (1) care and functional problems (falls, incontinence, physical strain, decubitus, inactivity/immobility, pain, problems with lying and sitting, the use of physical restraints, malnutrition and sarcopenia, overweight, behavioral problems, oedema, joint contractures), (2) referrals and accessibility, (3) assessments and examinations, (4) interventions and actions, and (5) organizational matters. We asked the participants to answer the questions on a five-point Likert scale. We defined consensus when ≥75% of the participants rated the question with a Likert-score of 4 or 5 or with a Likert-score of 1 or 2.

RESULTS AND DISCUSSION

Sixty-five physiotherapists returned the survey. They agreed that physiotherapists play an essential role in the management of prevention of falls, mobility problems, transfer problems, ergonomic advice, physical strain, pain, problems with sitting and lying, sarcopenia, and joint contractures. There was a discrepancy in consensus regarding what a physiotherapist should do in the specific cases versus what they actually do.

CONCLUSION

Physiotherapists in nursing homes agreed they have an important role in a variety of care and functional problems. However, there was a difference between what needs to be done versus what is actually done by the physiotherapists. Future research should focus on the underlying reasons for this inconsistency.

The prevalence of intimate partner violence in Australia: a national survey

OBJECTIVES

To estimate the prevalence in Australia of intimate partner violence, each intimate partner violence type, and multitype intimate partner violence, overall and by gender, age group, and sexual orientation.

STUDY DESIGN

National survey; Composite Abuse Scale (Revised)-Short Form administered in mobile telephone interviews, as a component of the Australian Child Maltreatment Study.

SETTING

Australia, 9 April - 11 October 2021.

PARTICIPANTS

8503 people aged 16 years or older: 3500 aged 16-24 years and about 1000 each aged 25-34, 35-44, 45-54, 55-64, or 65 years or older.

MAIN OUTCOME MEASURES

Proportions of participants who had ever been in an intimate partner relationship since the age of 16 years (overall, and by gender, age group, and sexual orientation) who reported ever experiencing intimate partner physical, sexual, or psychological violence.

RESULTS

Survey data were available for 8503 eligible participants (14% of eligible persons contacted), of whom 7022 had been in intimate relationships. The prevalence of experiencing any intimate partner violence was 44.8% (95% confidence interval [CI], 43.3-46.2%); physical violence was reported by 29.1% (95% CI, 27.7-30.4%) of participants, sexual violence by 11.7% (95% CI, 10.8-12.7%), and psychological violence by 41.2% (95% CI, 39.8-42.6%). The prevalence of experiencing intimate partner violence was significantly higher among women (48.4%; 95% CI, 46.3-50.4%) than men (40.4%; 95% CI, 38.3-42.5%); the prevalence of physical, sexual, and psychological violence were also higher for women. The proportion of participants of diverse genders who reported experiencing intimate partner violence was high (62 of 88 participants; 69%; 95% CI, 55-83%). The proportion of non-heterosexual participants who reported experiencing intimate partner violence (70.2%; 95% CI, 65.7-74.7%) was larger than for those of heterosexual orientation (43.1%; 95% CI, 41.6-44.6%). More women (33.7%; 95% CI, 31.7-35.6%) than men (22.7%; 95% CI, 20.9-24.5%) reported multitype intimate partner violence. Larger proportions of participants aged 25-44 years (51.4%; 95% CI, 48.9-53.9%) or 16-24 years (48.4%, 95% CI, 46.1-50.6%) reported experiencing intimate partner violence than of participants aged 45 years or older (39.9%; 95% CI, 37.9-41.9%).

CONCLUSIONS

Intimate partner violence is widespread in Australia. Women are significantly more likely than men to experience any intimate partner violence, each type of violence, and multitype intimate partner violence. A comprehensive national prevention policy is needed, and clinicians should be helped with recognising and responding to intimate partner violence.

Workforce Recommendations to Address Distress and Burnout in Australian Children's Cancer Nurses

BACKGROUND

Pediatric cancer nursing is a deeply fulfilling yet highly stressful profession as nurses support families during times of intense emotional distress. This study examined the factors influencing job satisfaction among pediatric cancer nurses across Australia and their recommendations to address workplace challenges. Method: A cross-sectional survey was conducted between November 2021 and February 2022, targeting cancer nurses across Australia. The survey included 68 items assessing various aspects of job satisfaction, work environment, and professional development as well as free-text responses. Both quantitative and qualitative responses from nurses who self-identified as pediatric cancer nurses were analyzed to identify significant predictors of job satisfaction and thematic insights from free-text comments. Results: The analysis included responses from 113 pediatric cancer nurses. Key predictors of job satisfaction included opportunities for professional development, the ability to utilize full skill sets, organizational leadership, and intent to remain in the profession. Thematic analysis of free-text comments supported the quantitative findings. Respondents highlighted the need for better leadership, recognition of the high workload, and greater support for professional development. Discussion: Addressing organizational leadership and providing opportunities for professional growth are critical to improving job satisfaction among pediatric cancer nurses. Developing evidence-based interventions and policy initiatives that focus on these areas will enhance the well-being of nurses and the quality of care provided to patients.

A cross-sectional survey reporting nurses' perspectives of person-centred care at emergency department triage and waiting room in Australia

BACKGROUND

A person-centred care approach is widely considered a standard for quality healthcare and has been adopted in various acute care settings. However, emergency department (ED) triage presents unique challenges to operationalising person-centred care and provision in this setting is unclear. This study aimed to explore nurses' perspectives of person-centred care at ED triage and waiting room.

METHODS

A cross-sectional study of triage nurses across Australia was conducted to understand nurses' knowledge, attitudes and provision of person-centred care. Quantitative data were analysed using descriptive statistics. Responses to open-ended questions were analysed inductively and deductively using the Picker principles of person-centred care.

RESULTS

176 survey responses from nurses across a range of EDs were received. Nurses reported they understood concepts and benefits of person-centred care, yet provision of it varied. Time constraints, high volumes of patients, inadequate staffing and environmental constraints were common barriers. Nurses reported using communication and interpersonal skills, patient involvement and nurse-initiated interventions as strategies for person-centred care.

CONCLUSIONS

System and organisational-level factors challenge the provision of person-centred care, despite individual efforts by triage nurses. To facilitate person-centred care at ED triage and in the waiting room, consideration of the ED triage context, processes and outcomes is necessary.

Nutritional care practices in ALS: perspectives of healthcare professionals and people with ALS

Objective: To map nutritional care provided to people with ALS, PMA and PLS (pwALS) and identify barriers encountered by healthcare professionals and pwALS. Methods: Two online questionnaires, addressing current nutritional management of ALS in the Netherlands, were sent to healthcare professionals of the 36 certified ALS care teams and pwALS drawn from a population-based registry. Topics were: 1) contact between pwALS and their ALS care team, 2) monitoring nutritional status, 3) nutritional advice provided or received, and 4) satisfaction with current nutritional care and barriers encountered. Results: In total, 100 healthcare professionals and 372 pwALS completed the questionnaires. Dietitian responses (n = 36/100) showed that 28% utilized malnutrition screening tools and 17% measured body composition. Dietitians used different predictive equations to estimate energy and protein requirements. Patient responses showed that 50% had contact with a dietitian, 7% indicated body composition had been measured and 25% reported never being weighed or weighing themselves. Healthcare professionals and pwALS highlighted the need for comprehensive, up-to-date information on nutrition and ALS, national consensus on nutritional advice and monitoring methods, patient information material, training for healthcare professionals and personalized nutritional advice for pwALS. Conclusions: Practice variation was observed in the assessment and monitoring of nutritional status and the provision of nutritional advice. Suboptimal monitoring of nutritional status and estimation of nutritional requirements may result in delayed detection of malnutrition and inaccurate dietary recommendations. Further research and national consensus on monitoring methods and nutritional advice is required.

Assessment and management of midfoot osteoarthritis by podiatrists in Australia: a cross-sectional survey of current practice

Midfoot osteoarthritis (OA) is a common and disabling condition, yet lacks clinical guidelines for its assessment and management. This study aimed to investigate strategies used by Australian podiatrists to assess and manage midfoot OA. An exploratory cross-sectional survey of podiatrists working in Australia was conducted. Respondents were invited through professional organisations to complete an online questionnaire on their usual assessment and management practices for midfoot OA, based on a vignette. Between November 2022 and July 2023, 103 participants (52% women, mean age 40 years) with an average of 15 years of clinical experience responded. Physical assessments (including history taking and musculoskeletal assessments) (96%) and medical imaging (90%) were commonly used diagnostic methods, with palpation (96%), passive movement testing (95%) and x-ray imaging (62%) frequently reported. Associated impairments were assessed with range of motion testing of the midfoot (96%), gait analysis (95%), functional tests (83%), muscle strength (72%), and observation of static alignment (71%), including foot posture (69%). Most participants assessed comorbidities (93%), body composition (66%) and cognitive/psychosocial impairments (62%). Treatment approaches included footwear advice (97%), orthotic therapy (85%), strapping/taping (81%), education (79%), and exercise therapy (75%). One-third (34%) expected a 'satisfactory' treatment response within two months, and 36% would refer to another healthcare practitioner for co-management between two and three months if treatment was ineffective. A wide range of approaches are used to assess and manage midfoot OA. These findings have potential to inform the design of future studies in developing valid assessment approaches and effective interventions for this condition.

Interobserver variability in lymph node evaluation with endoscopic ultrasonography in cholangiocarcinoma

Background and study aims

Accurate preoperative lymph node (LN) assessment is crucial for patients with intrahepatic cholangiocarcinoma (iCCA) and perihilar cholangiocarcinoma (pCCA) because presence of LN metastases significantly reduces survival rates and can contraindicate surgical resection. Endoscopic ultrasound (EUS) provides a reliable method for LN assessment with the advantage of enabling tissue acquisition for pathological confirmation. This study aimed to assess interobserver agreement among endosonographers in evaluating LN characteristics in patients with iCCA and pCCA.

Methods

A cross-sectional survey study was conducted among 24 endosonographers. Participants reviewed 42 EUS images from iCCA and pCCA patients, classifying LNs based on six characteristics (demarcation, shape, echogenicity, homogeneity, suspiciousness, and need to retrieve tissue). Interobserver agreement was determined using Light's kappa statistics. Accuracy, sensitivity, and specificity in identifying malignant LNs were calculated.

Results

Overall kappa values indicated moderate to fair agreement on LN characteristics, with Kappa values of 0.24 for demarcation, 0.45 for shape, 0.38 for echogenicity, 0.52 for homogeneity, and 0.36 for suspiciousness. Overall accuracy of endosonographers in correctly identifying malignant LNs was 62%, with individual accuracy ranging from 44 to 75%. Sensitivity was 60% (range: 29%-90%) and specificity was 64% (range: 28%-89%).

Conclusions

Endosonographic assessment of LN morphology and characterization demonstrates considerable variability among endosonographers. Thus, there is a clear need for standardization in preoperative LN evaluation, including establishing consensus about when to perform tissue acquisition, based on objective criteria such as short-axis diameter. Further research is required to refine and optimize these guidelines.

Post-stroke health-related quality of life following lower-extremity constraint-induced movement therapy - An observational survey study

Lower- extremity constraint-induced movement therapy (LE-CIMT) has proven effective in overcoming physical disabilities. Participating in the LE-CIMT requires some independent walking ability without aids that indicates a higher level of motor function than for the entire stroke population. However, only few studies evaluated health-related quality of life (HRQoL) after LE-CIMT. This study aimed to compare HRQoL of people who had participated in LE-CIMT post-stroke to the general population and evaluate whether descriptive characteristics and clinical result were associated with their HRQoL. An observational survey study with a questionnaire including the Swedish RAND-36 and Saltin-Grimby Physical Activity Level Scale was sent to 162 people. Reference data from the Mid-Health Survey in Sweden was used for norm-based comparisons of RAND-36. Respondents' result from six-minute walk test post-LE-CIMT were used in the univariate analyse. The response rate was 65% (n = 106; 69 males and 37 females with a mean age of 62 ± 12 years). Ninety percent of the respondents could move around indoors and outdoors independently, despite this, 21% considered themselves physically inactive. The respondents had significantly reduced HRQoL compared to the general population in four of eight domains in the RAND-36: physical functioning (p = 0.001), role-functioning (physical; p < 0.001), general health (p = 0.010), and social functioning (p < 0.001). Regression analysis showed that longer walking distance significantly was associated with the RAND-36 physical functioning domain (β = 6.45, 95% confidence interval = 2.03-10.87, p = 0.005). People in the chronic phase post-stroke who had previously participated in LE- CIMT had reduced HRQoL compared to the general population regarding physical functioning, role-functioning physical, general health, and social functioning. A longer walking distance was associated with higher HRQoL in physical functioning domain, emphasising the importance of mobility training in post-stroke rehabilitation.

Loneliness among family medicine providers and its impact on clinical and teaching practice

Social isolation and loneliness (SIL) are increasingly recognized as health risks. This study examines family medicine providers' personal experiences with SIL, their perspectives on its importance in clinical practice, and their readiness to incorporate it into medical education. A cross-sectional survey was conducted by the Council of Academic Family Medicine Educational Research Alliance (CERA) among members of major U.S. academic family medicine organizations between October and November 2024. Responses on the 3-item UCLA Loneliness Scale and items assessing attitudes toward SIL in clinical practice and medical education were analyzed using descriptive and bivariate statistics. Among 1,004 respondents (response rate 20.7%), 27.8% had sum scores ≥ 6 on the UCLA-3 item scale indicating considerable loneliness. SIL was particularly prevalent among women (31.1%), underrepresented minorities (36.1%), and Black/African American respondents (40.3%). While 54.1% rated SIL as important in family medicine and 68.2% supported regular screening, only 32.5% agreed that managing SIL falls within clinicians' responsibility. Providers experiencing SIL themselves reported less frequent patient discussions about loneliness (23.7% vs. 32.0%, p = 0.023) and fewer community partnerships. Most respondents (71.0%) reported inadequate resources in their clinics to address SIL. Family medicine educators experience substantial rates of loneliness, particularly among minority groups, at levels exceeding those of their patients and the general population. Personal experiences with SIL appear to influence clinical practices and teaching. Before implementing widespread screening initiatives, the profession must address both providers' own social connectedness needs and the development of practical clinical resources.

The most bothersome symptoms in neuromuscular diseases: the ERN EURO NMD Survey

BACKGROUND

Neuromuscular diseases (NMDs) comprise a range of genetic and acquired rare disorders that affect motor neurons, peripheral nerves, neuromuscular junctions and skeletal muscles, leading to significant impairments such as muscle weakness and fatigue resulting in functional limitations. This study aims to investigate the prevalence and severity of disease-related symptoms in adult patients with NMDs registered in the European Reference Network (ERN) EURO-NMD. A cross-sectional electronic survey was conducted with 1,253 participants who reported the severity of 28 symptoms, which were scored using multi-criteria decision analysis (MCDA).

RESULTS

The results identified muscle fatigue, weakness and impaired physical function/activity as the most severe and prevalent symptoms in all NMD groups, followed by coordination and/or balance problems, muscle stiffness, mental fatigue, and pain. Notably, the analysis highlighted differences in symptom severity between disease subtypes and underlined the need for standardised patient-reported outcome measures (PROMs) to address the broad heterogeneity of NMDs.

CONCLUSIONS

The findings stress the critical importance of capturing patient perspectives to guide clinical care, research priorities and therapeutic development. This work argues for the development of uniform PROMs to better assess disease impact, natural history and treatment efficacy, contributing to improved patient-centred care across diverse NMD populations.

Establishing Core Competencies for Antimicrobial Stewardship Teams: A Consensus Development Using the Modified Delphi Technique; an ESGAP position paper

OBJECTIVES

This study aimed to identify and develop a standard set of competencies needed for members of an AMS team.

METHODS

A panel of experts in AMS utilized a survey based on a modified Delphi technique to establish consensus on AMS competencies.

RESULTS

The authors identified 88 competencies covering 15 domains with strong agreement by 58 international experts. The identified domains were: the objectives of AMS; management of infection; microbiology diagnostics; pharmacology of antimicrobial agents; general principles of antibiotic use; the structure and the position of AMS; antimicrobial stewardship interventions; AMS in special settings; surveillance and monitoring; behavior change and communication; infection prevention and control; quality management and patient safety; IT support; communication with patients and general public and governance/policy framework. The consensus-based list of competencies was ratified by ESGAP Executive Committee.

CONCLUSIONS

The identified competencies can be used as a tool in planning of AMS training and to develop and optimize AMS programmes worldwide.

Perception of the ethical climate among hospital employees in a public healthcare system: a cross-sectional survey at the University Hospital of Split, Croatia

BACKGROUND

In this cross-sectional study, we assessed the ethical climate at the University Hospital of Split in Croatia and investigated its potential indicators.

METHODS

We used a validated Croatian translation of the 36-item Ethical Climate Questionnaire, which we distributed online (via an e-mail sent by the hospital administration to hospital employees) and as a paper and pen survey directly to all hospital departments. We compared ECQ scores between doctors of medicine (MDs)/doctors of dental medicine (DMDs) and other employees; MDs/DMDs and nurses; employees working with patients and those not working with patients; and employees working in the ICU versus those not working in the ICU using the Mann-Whitney U test. We used linear regression to explore the relationship of each ethical climate with gender, age, degree level, and years spent working in the hospital.

RESULTS

We collected 325 physical and 222 online questionnaires (547 responses in total), after which we excluded 146 incomplete responses. This left 401 questionnaires for analysis, primarily from doctors (n = 175; 43.6%) and nursing staff (n = 131; 32.7%). The two dominant climates were 'Company rules' and 'Laws and professional codes'. Stratified by profession, we observed higher scores for 'Personal morality' among doctors of medicine or dental medicine, whereas the group comprising other health professionals and non-medical staff had higher scores for 'Team interests', 'Efficiency', 'Social responsibility', and 'Laws and professional codes'. In comparing nurses and doctors of medicine/dental medicine, we observed the former group had higher scores for 'Social responsibility', 'Efficiency', and 'Team interest', while the latter had higher scores for 'Personal morality'. Those who worked outside of the ICU had higher scores for 'Social responsibility' compared to those who did not. In the regression analyses, age was a significant positive predictor of the 'Laws and professional codes' climates, and years spent working in the hospital acted as a positive predictor of the 'Self-interest' climate.

CONCLUSION

A large university hospital center in a fully publicly funded national healthcare system has a positive ethical work climate, which could be further developed by further development and implementation of codes of ethics to outline expected behaviors from all employees.

Radiographic classification of mandibular osteoradionecrosis: A blinded prospective multi-disciplinary interobserver diagnostic performance study

BACKGROUND & PURPOSE

Osteoradionecrosis (ORN) of the jaw is a severe complication affecting up to 15% of head and neck cancer patients treated with radiotherapy. The ClinRad system, endorsed by ASCO/ISOO/MASCC, incorporates radiographic features for ORN severity classification, but variability in imaging use and specialty expertise may impact diagnostic accuracy. This study benchmarks physician performance in diagnosing and staging ORN across specialties and imaging modalities.

MATERIALS & METHODS

A retrospective diagnostic validation study was conducted at MD Anderson Cancer Center, involving 20 physicians from oral oncology, radiation oncology, surgery, and neuroradiology. Participants reviewed 85 de-identified imaging sets (CT and orthopantogram (OPG)) from 30 patients with confirmed ORN, diagnosing and staging cases using the ClinRad system. ROC analysis assessed diagnostic accuracy, while intra- and inter-observer agreement was measured using Cohen's and Fleiss kappa statistics.

RESULTS

Paired CT-OPG imaging significantly improved diagnostic performance across specialties (p < 0.001), with AUC values ranging from 0.79 (residents) to 0.98 (surgeons). However, inter- and intra-rater agreement remained low, with median Fleiss kappa values of 0.22, 0.13, and 0.05 for ClinRad stages 0/1, 2, and 3, respectively. No specialty demonstrated significantly superior diagnostic accuracy (p > 0.05).

CONCLUSION

This study establishes a benchmark for radiographic ORN detection, revealing diagnostic variability across specialties. Findings emphasize the need for standardized imaging protocols, interdisciplinary training, and multimodal imaging to improve diagnostic accuracy.

Patient perspectives on surgical handover quality: a mixed-methods survey

BACKGROUND

In-hospital handover of patient care is an essential but high-risk professional activity that often lacks transparency for patients. The purpose of this survey was to gain insight into surgical patients' perceptions of handover communications between doctors, incorporating patient and public involvement to enhance accessibility and understanding.

METHODS

A cross-sectional, mixed-methods survey was developed with patient and public involvement and distributed to general surgery patients in two University Teaching Hospitals between 24 October 2023 and 21 July 2024. Comparative analyses of quantitative data were performed using McNemar's test for paired nominal data and Wilcoxon rank-sum test for continuous data. Free-text responses underwent thematic analysis to validate and expand on quantitative findings. Patient and public involvement partners contributed to study design, methodology, and the final manuscript.

RESULTS

In total, 208 responses were received (52.3%). Significantly more patients reported having prior knowledge of nursing handovers (73.1%) compared to doctors' handovers (63.9%; x2 = 14.53, p = 0.0002). Patient perceptions of the handover process were generally positive; although satisfaction declined significantly with weekend handovers (p < 0.05). Thematic analysis identified four themes: (1) the impact of poor inter-professional communication, (2) the importance of teamwork, (3) external factors influencing handover effectiveness, and (4) patient nonchalance about their care. The use of patient and public involvement in this study improved survey accessibility and understanding of the concept and importance of handover.

CONCLUSIONS

This study shows limited prior awareness of handover between doctors among surgical patients, especially the potential hazards that can arise if performed poorly. Patient and public involvement improved accessibility and understanding of the topic; however, challenges such as adequate training for meaningful engagement remain.

Valid consent in the acute hospital setting: perspectives of nursing and medical professionals from a survey-based study

BACKGROUND

In healthcare, consent refers to the act of granting permission or agreement for treatment and care, investigation, receiving or utilising a service, or participating in research or teaching. Consent should be an ongoing process that involves clear communication about the proposed intervention, including its nature, benefits, and potential risks.

AIM

This survey-based study gathered experiences from junior doctors and nurses in a large acute teaching hospital about current consent practices and suggestions for improvement.

METHOD

Two surveys were developed and distributed to junior doctors in 2022 and nurses in 2023.

RESULTS

The response rate for junior doctors (n = 58) was 21% (interns) and 57% (senior house officers) and 10% of the total nursing population responded (n = 184). Descriptive statistics and content analysis were used to analyse the results. Both junior doctors and nursing professionals believed there were areas for improvement in terms of consent processes and practices including in relation to better information for patients and more education and training for healthcare professionals.

CONCLUSIONS

The process of informed consent is central in the planning and provision of safe, effective person-centred healthcare as it encompasses healthcare professionals and patients communicating about and together deciding on and agreeing to medical interventions. This survey-based study looked at the experiences, attitudes, and perceived needs of junior doctors and nursing professionals in relation to the informed consent process in clinical practice at an acute hospital and informed the development of recommendations for improvement.

Bringing reproductive, pelvic and breast health to light: insights from the Health of Elite Retired Australian female athletes survey (HER-Aus)

OBJECTIVES

To describe the reproductive, pelvic and breast health of retired elite Australian female athletes.

METHODS

Data were collected as part of a larger online cross-sectional survey that was cocreated with female athletes and disseminated to Australian retired elite (international-level and national-level) female athletes aged ≥18 years old and retired from elite competition ≥2 years.

RESULTS

199 retired female athletes (mean (SD) age 44 (10) years; retired for 16 (9) years; competed for 10 (5) years) across 31 different sports responded to the survey. 23% (46/199) experienced primary amenorrhoea, and 48% (95/197) reported ever experiencing secondary amenorrhoea. Of athletes with pregnancy difficulties (n=45), 42% reported menstrual cycle irregularity during their career. Of athletes who gave birth (n=98), 19% had difficulties conceiving, requiring fertility treatments. The majority of athletes reported current symptoms of urinary incontinence (70% (140/198)) and faecal incontinence (54% (106/197)). 18% (33/188) reported that they currently experience exercise-related breast pain; however, 87% (164/188) reported that breast pain never negatively impacts their current physical activity.

CONCLUSIONS

A high prevalence of reported menstrual irregularities, pelvic floor dysfunction and fertility issues highlights the need for early prevention and intervention measures to address long-term health and the unique challenges faced by female athletes during and after their sporting careers.

Exploring the lived experience of women with gestational diabetes: A cross-sectional Irish national survey

AIM

Gestational diabetes (GDM) poses risks of short- and long-term complications for mother and infant, emphasising the importance of antenatal and postpartum education and support. We aimed to understand the experiences and views of women with GDM in the Republic of Ireland.

METHODS

Women with current or previous GDM were invited to complete an online cross-sectional survey (April-June 2022). Recruitment utilised social media, local media and personal networks. The survey addressed demographics, GDM knowledge and experiences, breastfeeding and weight management during pregnancy and post-pregnancy GDM support needs. Descriptive statistics were conducted, and between-group comparisons were undertaken using the chi-square test. Content analysis was applied to free text data.

RESULTS

Amongst 231 respondents, most were aged 35-39 (42%); 70% experienced a single GDM pregnancy. Only 6% correctly identified their increased level of risk for developing type 2 diabetes. Under half (44.5%) of respondents reported sufficient time with health professionals to address GDM-related questions. Just over half (54.3%) reported attending for diabetes screening at 6-12 weeks postpartum. The majority (66%) expressed a desire for postpartum information, particularly on healthy eating and physical activity. Having a more recent GDM experience was associated with a stronger preference for weaning (p ≤ 0.001) and weight management information (p = 0.025). Qualitative analysis identified inconsistencies in healthcare messaging, significant concerns about a GDM diagnosis' impact on the pregnancy experience, and financial costs of diagnosis.

CONCLUSIONS

The findings underscore women's desire for appropriate information and support during and after pregnancy with GDM. Future interventions should address these needs to effectively promote chronic disease prevention after GDM.

Musculoskeletal Ultrasound Practices of Graduates of a Blended-Learning Program: A Survey of Rheumatologists From the United States

OBJECTIVE

Not much is known regarding musculoskeletal ultrasound (MSUS) practices of rheumatologists in the United States. We sought to determine the current use of MSUS among past participants of the Ultrasound School of North American Rheumatologists (USSONAR) training program and, by extension, MSUS-practicing rheumatologists and to understand barriers to its MSUS use.

METHODS

An online survey was sent to 374 participants in the eight-month USSONAR blended course (Fundamentals in Musculoskeletal Ultrasound and Train the Trainer) between 2009 and 2020. Each respondent had a unique identifier linked to their total number of submitted practice scans and examination scores during training.

RESULTS

The survey response rate was 28.1% (105 of 374), comprising 82% adult and 18% pediatric rheumatologists. Of the respondents, 71% were MSUS certified: 86.7% performed and/or interpreted diagnostic MSUS, 81.0% performed/interpreted procedural MSUS, 59.8% billed for at least 50% of diagnostic studies, and 78.8% billed for at least 50% of procedural studies. The top reasons for not doing diagnostic and procedural ultrasonography were lack of administrative support and limited time, respectively. For 25% of diagnostic ultrasonography and 12.9% of procedural ultrasonography, billing was done <50% of the time. Of the respondents, 78.0% reported that USSONAR training made them better rheumatologists.

CONCLUSION

Most USSONAR-trained rheumatologists are certified, practicing both diagnostic and procedural MSUS and billing for most of their work. However, a substantial number of studies are not being billed due to time constraints, limited administrative support, and legal liability. Participants agreed that USSONAR training made them better rheumatologists.

Strategies for Providing Research Information to Participants in Multicentre Adult Critical Care Studies: A Survey of Chief Investigators

The recruitment of participants in adult critical care studies is often challenging. We surveyed chief investigators of UK multicentre adult critical care studies in this cross-sectional survey to evaluate what strategies they used to provide study information to potential participants. Of 61 eligible responses, we received completed surveys from 35 investigators (response rate 57%). Most chief investigators reported using a written participant information sheet (n = 34, 97%), but the uptake of alternative strategies was limited to 9 studies (26%). Only 6 studies (17%) utilized digital methods. Most chief investigators (63%) reported that they planned to adopt alternative strategies in their next study. RELEVANCE TO CLINICAL PRACTICE: This cross-sectional online survey study explores the strategies currently used by chief investigators for providing research information in critical care and explores how likely chief investigators are to adopt alternative strategies.

Knowledge, attitude, and practice toward Helicobacter pylori among residents in Northeast China‌

The primary aim of this study was to investigate the knowledge, attitude, and practice(KAP) concerning Helicobacter pylori (H. pylori) and the factors influencing them among northeast China individuals. A questionnaire regarding H. pylori, grounded in the KAP theoretical framework, was tailored for northeast China individuals. The questionnaire was conducted online and analyzed statistically. Additionally, structural equation modeling was applied to verify the interconnections among social media usage, knowledge, attitude, and practice. A total of 712 valid questionnaires were analyzed. The mean scores were 2.69 ± 1.03 for knowledge, 4.09 ± 0.81 for attitude, and 3.40 ± 0.73 for practice. Various factors including sex, occupation, and social media usage influenced knowledge, attitude, and practice scores, with social media usage exerting a notable impact on all facets. The structural equation modeling analysis demonstrated that social media usage promoted higher levels of knowledge, attitude, and practice regarding H. pylori. Individuals possessing a higher level of knowledge and attitude concerning H. pylori demonstrated superior preventive practice. Northeast China residents have limited H. pylori knowledge but show a positive attitude and good preventive practice. The utilization of social media has significantly improved the population's knowledge, attitude, and practice concerning H. pylori.

Assessing barriers to meditation in patients with substance use disorder

BACKGROUND AND PURPOSE

Individuals living with substance use disorder (SUD) often face unique challenges that can hinder their engagement in beneficial practices like meditation, which has been shown to support recovery and well-being. This study aimed to explore the perceived barriers to meditation with SUD, identify key obstacles, and inform future interventions that promote the adoption of a personal practice.

MATERIALS AND METHODS

We conducted a cross-sectional analytic study with a convenience sample of participants attending a treatment center for SUD. Data collected included demographics, SUD history, health challenges, meditation knowledge, and previous meditation practice. Barriers to meditation were evaluated using the Determinants of Meditation Practice Inventory (DMPI) and its revised version, DMPI-R. Overall frequencies, proportions, and measures of central tendency were calculated. Participants currently practicing meditation were compared to those not meditating by using Fisher's exact test, Student's t-test, and Wilcoxon rank-sum test.

RESULTS

One hundred sixteen individuals completed the survey. Survey respondents were an average of 45 years (standard deviation, SD, 11.46), majority female (67.0 %), and White (90.3 %). Only 28.7 % of respondents were informed of meditation by their healthcare provider, yet 81.7 % were interested in learning about meditation. Among survey respondents, "prayer is my form of meditation," followed by "I can't stop my thoughts," were most agreed upon.

CONCLUSION

Individuals living with SUD are interested in education on meditation techniques; however, additional research is needed to understand the determinants of meditation practice and discern the barriers that could help facilitate the adoption and long-term practice of this method.

[How to: correctly read scientific articles : Research design and methodology]

Criteria for assessment of the significance of scientific articles are presented. The focus is on research design and methodology, illustrated by the classical study on prehospital volume treatment of severely injured individuals with penetrating torso injuries by Bickell et al. (1994). A well-thought out research design is crucial for the success of a scientific study and is documented in a study protocol beforehand. A hypothesis is a provisional explanation or prediction and must be testable, falsifiable, precise, and relevant. There are various types of randomization methods, with the randomized controlled trial being the gold standard for clinical interventional studies. When reading a scientific article it is important to verify whether the research design and setting align with the research question and whether potential sources of error have been considered and controlled. Critical scrutiny should also be applied to references, the funding and expertise of the researchers.

Global Practice Variation in the Management of Clostridioides difficile Infections: An International Cross-Sectional Survey of Clinicians

Background

Clostridioides difficile infections (CDIs) are associated with significant morbidity, mortality, and economic burden globally. International guidelines conflict on various aspects of management, so we conducted a clinician survey to evaluate global practice variability on CDI diagnosis, treatment, and prophylaxis to inform future clinical trials.

Methods

An anonymous online survey through REDCap was distributed through multiple channels. Attending physicians, infectious disease pharmacists, and fellows in infectious diseases or medical microbiology who had managed ≥3 cases of CDI in the preceding year were eligible. Responses were compared across continents by chi-square test.

Results

Three hundred fifty-nine survey responses were collected from 31 countries and 6 continents (North America 80.5%, Europe 11.7%, other continents 7.8%). A 2-step CDI diagnostic algorithm was used by 75.8% of respondents with heterogeneity in assay type. Similarly, there was significant variability in first-line agents for the treatment of first episodes and first recurrences of uncomplicated CDI and a lack of consensus on treatments for fulminant CDI. Secondary CDI prophylaxis during antibiotic re-exposure was most commonly used in North America (84.1%), followed by other continents (50.0%) and Europe (31.0%; P < .001). Oral vancomycin was the most frequently used agent (96.3%), with significant variability in the dose (125-500 mg daily) and duration (1-28 days; P < .01).

Conclusions

Substantial global variability exists with respect to CDI diagnosis, treatment, and secondary prophylaxis, likely due to divergent guidelines and a paucity of robust evidence. These findings highlight critical knowledge gaps and areas of clinical equipoise and underscore the need for further randomized controlled trials to establish harmonized international best practices for CDI.

Neurologists' understanding of reproductive medicine options for genetic forms of motor neuron disease

OBJECTIVES

To examine the knowledge, confidence and practice of motor neuron disease (MND) clinicians toward discussing reproductive options with people who carry a causal variant in an MND gene (both clinically affected and asymptomatic).

METHODS

An online cross-sectional survey was distributed nationwide to UK MND clinicians and clinical geneticists and genetic counselors. The survey assessed respondents' understanding on reproductive medicine techniques; their confidence in discussing reproductive medicine options and their access to information resources.

RESULTS

Seventy six clinicians responded to the online survey (45 neurology clinicians and 31 clinical geneticists). MND clinicians had limited knowledge and low confidence in discussing reproductive medicine options. Geneticists were more likely to carry out reproductive genetic counseling with very few MND clinicians reporting undertaking these discussions. Further, 57% of the 45 MND clinicians surveyed reported to have never made a referral for reproductive genetic counseling. Multiple barriers to offering reproductive counseling or referral were identified including a lack of knowledge, lack of awareness of the different options, lack of clinic time and uncertainty around issues such as funding for PGT and whose responsibility it comes under.

CONCLUSIONS

There is a need for training and education on reproductive options and referral for these options needs to be integrated within the health system. Developing more resources for both clinicians and patients is required as MND clinicians reported a lack of resources.

People Living with Chronic Pain Experience a High Prevalence of Decision Regret in Canada: A Pan-Canadian Online Survey

Background(1) To estimate the prevalence of decision regret in chronic pain care, and (2) to identify factors associated with decision regret.DesignWe conducted a pan-Canadian cross-sectional online survey and reported the results following the Checklist for Reporting of Survey Studies guidelines. We recruited a sample of adults experiencing chronic noncancer pain. We used a stratified proportional random sampling based on the population and chronic pain prevalence of each province. We measured decision regret with the Decision Regret Scale (DRS) and decisional needs with the Ottawa Decision Support Framework. We performed descriptive analysis to estimate the prevalence and level of decision regret and multilevel multivariable regression analysis to identify factors associated with regret according to the STRengthening Analytical Thinking for Observational Studies recommendations.ResultsWe surveyed 1,649 people living with chronic pain, and 1,373 reported a most difficult decision from the 10 prespecified ones, enabling the collection of a DRS score. On a scale ranging from 0 to 100 where 1 reflects the presence of decision regret and 25 constitutes important decision regret, the mean DRS score in our sample was 28.8 (s = 19.6). Eighty-four percent of respondents experienced some decision regret and 50% at an important level. We identified 15 factors associated with decision regret, including 4 personal and 9 decision-making characteristics, and 2 consequences of the chosen option. Respondents with low education level and higher decisional conflict experienced more decision regret when the decision was deemed difficult.ConclusionsThis pan-Canadian survey highlighted a high prevalence and level of decision regret associated with difficult decisions for pain care. Decision making in pain care could be enhanced by addressing factors that contribute to decision regret.HighlightsWe conducted an online pan-Canadian survey and collected responses from a wide diversity of people living with chronic pain.More than 84% of respondents experienced decision regret and approximately 50% at an important level.We identified 15 factors associated with decision regret, including 4 personal and 9 decision-making characteristics, and 2 consequences of the chosen option.Our pan-Canadian survey reveals an urgent need of a shared decision-making approach in chronic pain care that can be potentiated by targeting multiple factors associated with decision regret.

Exploring communication challenges with children and parents among pharmacists in Saudi Arabia: A cross-sectional study

OBJECTIVES

To identify trends and challenges in pharmacists' communication with pediatric patients in Saudi Arabia. It also studies the potential factors affecting their overall performance.

METHODS

A cross-sectional survey of 170 pharmacists working in different healthcare settings in Saudi Arabia was carried out. A novel comprehensive 38-item survey questionnaire was utilized. The questionnaire comprised 2 main sections: demographic data and potential influencing factors and communication skills with children. The communication domain assessed the degree to which the pharmacist could communicate with a child in 7 main areas. Comparisons of communication performance were carried out by Chi-square tests, and associations with 24 factors were determined by logistic regression analyses.

RESULTS

Approximately 76% of pharmacists demonstrated unsatisfactory communication with children (p=8.47×10-10). Approximately 91% of pharmacists depended on speaking to parents rather than directly talking to children, even when present (p=7.791×10-26). In addition, although 88.23% of pharmacists expressed high confidence in their communication skills (p=9.899×10-24), their actual performance with children in different age groups showed that 63.52% performed poorly, while only 36.46% demonstrated good performance (p=4.2×10-4). Factors which might be associated with pharmacists' performance were identified.

CONCLUSION

Pharmacists in Saudi Arabia face significant challenges in communicating with pediatric patients. Targeted training is needed to improve communication skills, medication adherence, and children's health outcomes.

Incidence of oral tie diagnosis and treatment in Southwestern Ontario: A survey study

BACKGROUND

Ankyloglossia describes a short lingual frenulum restricting tongue mobility. There are no universally accepted diagnostic criteria, and the rate of diagnosis and treatment are increasing. Many frenotomies are performed in the outpatient setting, making it difficult to estimate ankyloglossia incidence. This study aims to estimate the rate of diagnosis and common indications cited for treatment of ankyloglossia in a large catchment in Southwestern Ontario, Canada.

METHODS

A survey was administered to all patients presenting to a pediatric otolaryngology clinic and five community pediatric clinics querying oral tie diagnosis, indications for treatment communicated to parents, recommended treatments, providers involved, procedure-related complications, and cost.

RESULTS

Of the 266 respondents, 53.0 % (n = 141) were diagnosed with an oral tie. The most common reason to seek assessment was breast feeding difficulties (69.7 %, n = 92). The majority (78.8 %, n = 104) of patients diagnosed with a tongue tie were recommended to receive treatment, primarily frenotomy (69.7 %, n = 92). Complications included pain (24.2 %) and mild/moderate bleeding (11.0 %). Most patients paid out-of-pocket for this procedure, with only 22.6 % (n = 21) of procedures being covered by provincial insurance and 19.4 % (n = 18) by private insurance. Overall, 84.4 % (n = 76) of parents were satisfied or very satisfied with their decision to pursue treatment.

CONCLUSION

The rate of tongue tie diagnosis in survey respondents was more than double the national rate (22.6 %), possibly representing over diagnosis or overtreatment in Southwestern Ontario. Public health and education efforts may be required to ensure patients are appropriately selected for frenotomy procedures, to limit adverse outcomes and cost to patients.

Research priorities for diagnosis, prognosis, and rehabilitation following concussion: results from a national survey of Australian health professionals

PURPOSE

Recently, the Concussion James Lind Alliance Priority Setting Partnership (JLAPSP) (Canada) identified serious research gaps regarding diagnosis, management, and access to effective rehabilitation for concussion/mild traumatic brain injury (mTBI). Our aim was to determine if the same research priorities are important to Australian health professionals working in the concussion/mTBI field.

MATERIALS AND METHODS

A survey was distributed via professional networks, social media, professional group listservs, a research project noticeboard, and at conferences. It comprised of 25 of the highest ranked concussion research questions from the JLAPSP. We examined how professionals ranked the research questions and analyzed variation in ranking by clinical role and concussion/mTBI work experience.

RESULTS

Our sample of 187 participants included medical and allied health professionals. Most participants were occupational therapists (22%), physiotherapists (18%), neuropsychologists (17%), and worked in Victoria (47%), New South Whales (18%), or Queensland (15%) in metropolitan areas. Health professionals ranked three research questions highest: identifying methods to predict prolonged recovery; effectiveness of early referral and treatment by a specialized concussion/mTBI team; and implementation studies on upskilling healthcare workers.

CONCLUSIONS

The research priorities identified can guide research efforts to improve the assessment, management, and rehabilitation of individuals with concussion/mTBI in Australia.

Artificial Intelligence in Radiology: A Leadership Survey

PURPOSE

Surveys to assess views about artificial intelligence (AI) of various diagnostic radiology constituencies have revealed interesting combinations of enthusiasm, caution, and implementation priorities. We surveyed academic radiology leaders about their views on AI and how they intend to approach AI implementation in their departments.

MATERIALS AND METHODS

We conducted a web survey of Society of Chairs of Academic Radiology Departments members between October 5 and October 31, 2023, to solicit optimism or pessimism about AI, target use cases, planned implementation, and perceptions of their workforce. P values are provided only for descriptive purposes and have not been adjusted for multiple testing in this exploratory research.

RESULTS

The survey was sent to the 112 Society of Chairs of Academic Radiology Departments members and 43 responded (38%). Chairs were optimistic, with no statistical difference between views of AI in general versus generative AI. Chairs plan to implement AI to improve quality and efficiency (43 of 43, 100%), burnout (41 of 43, 95%), health care costs (22 of 43, 51%), and equity (27 of 43, 63%) and most likely will target the postprocessing (26 of 43, 60%), interpretation workflow (26 of 43, 60%), and image acquisition (18 of 43, 42%) steps in the imaging value chain. Chairs perceived that radiologists (36 of 43, 84%) and technologists (38 of 43, 88%) were not particularly worried about being displaced but saw trainees as slightly less confident (31 of 43, 72%). Free text responses revealed concerns about the cost of AI and emphasized trade-offs that needed to be balanced.

CONCLUSION

Radiology chairs are optimistic about AI and poised to tackle departmental challenges. Concerns about generative AI and workforce replacement are minimal.

Preferred content, construct, and duration of a fellowship structure in HPB surgery: a cross-sectional, pan-European survey among trainees and trainers

BACKGROUND

Fellowships in HPB surgery are lacking across Europe. The aim of this survey was to investigate preferences towards an HPB-fellowship structure among trainees and trainers.

METHODS

A cross-sectional pan-European survey of trainees and consultants in HPB across Europe. Preferred content, duration and construct of a fellowship program was explored.

RESULTS

Responses from 221 eligible participants were analysed, covering all European regions (40 % trainees, of which 31 % women). Preferred duration was 2 years (53 %), international availability (71 %) and in English language (by two-thirds overall; 74 % among trainees). A majority About two-thirds (63 %) preferred an official fellowship teaching curriculum provided by the E-AHPBA. Most The vast majority of participants (n = 211; 95 %) supported accreditation of HPB-fellowships by the E-AHPBA. Trainees reported higher priorities towards technical training (i.e. time in operating room; first surgeon opportunity; minimal-invasive technique training) than consultants, while time for non-operative activities (i.e. ward rounds; responsibility for multidisciplinary team meetings etc) was valued higher by consultants.

CONCLUSIONS

We identified preferences and needs towards construct and competence in HPB fellowships with strong support for involvement of E-AHPBA in providing a involvement teaching curriculum and accreditation. A unified HPB fellowship construct and registry across Europe guided by E-AHPBA may take this into consideration.

The Trauma Coordinator in Italy: A National Survey on Knowledge, Attitude, Barriers, and Facilitators to Implementation of the Role

INTRODUCTION

The management of patients with major trauma is complex and encompasses the entire clinical pathway. The trauma coordinator role has been introduced to enhance communication and coordination. Despite the clinical benefits of trauma coordinators, their implementation in Italy is currently limited.

METHODS

We conducted a national online survey from May to July 2023 consisting of 6 sections: (1) the trauma centers, (2) the knowledge of the trauma coordinator, (3a) trauma coordinator characteristics, (3b) characteristics that the trauma coordinator should have, (4) trauma coordinator's role and duties, (5) trauma coordinator organizational characteristics, and (6) barriers and opportunities. We performed a descriptive statistics and tested the agreement among raters for sections 2 and 6 using Cohen's or Fleiss' kappa.

RESULTS

Fifty-five respondents from 26 trauma centers participated in the survey. Sixty percent of respondents indicated that a trauma coordinator exists in their trauma center, but only 31% reported that the trauma coordinator is formally recognized. Most trauma coordinators had experience in critical care (69%), but 45% of respondents noted that no rewards were provided for their function. The barriers to trauma coordinator implementation were the absence of a job description (40%) and a lack of human resources (45%). For opportunities, enhanced communication among providers was the most reported benefit. Full agreement on the knowledge of trauma coordinators was found in only 3 centers.

CONCLUSION

This survey highlights the need for a more structured integration of trauma coordinators into trauma care teams. Emphasizing clear role descriptions, formal recognition, and appropriate compensation is essential to maximize the impact of trauma coordinators on patient outcomes.

Factors Affecting Genomic Testing in Prostate Cancer: Results From the Decision-Making, Experience, and Confidence In Determining Genomic Evaluation (DECIDE) Survey

PURPOSE

Genomic testing for prostate cancer (PCa) clinical management and hereditary cancer assessment has grown in clinical impact; however, challenges remain regarding optimal implementation and end-user confidence. The Decision-making, Experience, and Confidence In Determining Genomic Evaluation (DECIDE) survey was designed to collect information regarding utility and understanding of genomic testing from PCa health care providers, researchers, and stakeholders.

METHODS

The DECIDE survey was administered online from October 2022 to January 2023 with 18 multiple-response questions. Survey domains included self-confidence with ordering and interpreting germline and somatic genomic tests, process of testing and use of results, decision-making factors, and barriers to testing. Data were summarized by evaluating counts and percentages of responses, and the results were presented by descriptive statistics.

RESULTS

One hundred twenty-two participants completed the survey. The majority were medical oncologists (70%) and at academic medical centers (89%). Self-confidence was high in knowing indications for genomic testing (82% respondents) but lower in interpretation of results, especially from circulating tumor DNA (52%). Confidence varied in interpreting pathogenic variants (65% high confidence), variants of unknown significance (47%), and incidental findings from genomic tests (35%). Common barriers to testing were difficulty obtaining tissue (71%) and cost (35%). Testing utility was sometimes limited by inability to obtain the recommended treatment (33%). Most of the respondents (55%) agreed that lack of education and training of health care professionals regarding genomic testing is impeding clinical translation.

CONCLUSION

The DECIDE survey provided critical insights into challenges with genomic testing, from provider confidence in interpretating results to testing and practice barriers. The results inform next steps to further educate PCa providers and to collectively improve testing and result reporting for enhanced implementation of PCa genomic testing.

Perspectives and Experiences With Large Language Models in Health Care: Survey Study

BACKGROUND

Large language models (LLMs) are transforming how data is used, including within the health care sector. However, frameworks including the Unified Theory of Acceptance and Use of Technology highlight the importance of understanding the factors that influence technology use for successful implementation.

OBJECTIVE

This study aimed to (1) investigate users' uptake, perceptions, and experiences regarding LLMs in health care and (2) contextualize survey responses by demographics and professional profiles.

METHODS

An electronic survey was administered to elicit stakeholder perspectives of LLMs (health care providers and support functions), their experiences with LLMs, and their potential impact on functional roles. Survey domains included: demographics (6 questions), user experiences of LLMs (8 questions), motivations for using LLMs (6 questions), and perceived impact on functional roles (4 questions). The survey was launched electronically, targeting health care providers or support staff, health care students, and academics in health-related fields. Respondents were adults (>18 years) aware of LLMs.

RESULTS

Responses were received from 1083 individuals, of which 845 were analyzable. Of the 845 respondents, 221 had yet to use an LLM. Nonusers were more likely to be health care workers (P<.001), older (P<.001), and female (P<.01). Users primarily adopted LLMs for speed, convenience, and productivity. While 75% (470/624) agreed that the user experience was positive, 46% (294/624) found the generated content unhelpful. Regression analysis showed that the experience with LLMs is more likely to be positive if the user is male (odds ratio [OR] 1.62, CI 1.06-2.48), and increasing age was associated with a reduced likelihood of reporting LLM output as useful (OR 0.98, CI 0.96-0.99). Nonusers compared to LLM users were less likely to report LLMs meeting unmet needs (45%, 99/221 vs 65%, 407/624; OR 0.48, CI 0.35-0.65), and males were more likely to report that LLMs do address unmet needs (OR 1.64, CI 1.18-2.28). Furthermore, nonusers compared to LLM users were less likely to agree that LLMs will improve functional roles (63%, 140/221 vs 75%, 469/624; OR 0.60, CI 0.43-0.85). Free-text opinions highlighted concerns regarding autonomy, outperformance, and reduced demand for care. Respondents also predicted changes to human interactions, including fewer but higher quality interactions and a change in consumer needs as LLMs become more common, which would require provider adaptation.

CONCLUSIONS

Despite the reported benefits of LLMs, nonusers-primarily health care workers, older individuals, and females-appeared more hesitant to adopt these tools. These findings underscore the need for targeted education and support to address adoption barriers and ensure the successful integration of LLMs in health care. Anticipated role changes, evolving human interactions, and the risk of the digital divide further emphasize the need for careful implementation and ongoing evaluation of LLMs in health care to ensure equity and sustainability.

Psychosocial Well-Being and Healthy Eating in Cardiac Rehabilitation: A National Survey of Cardiac Rehabilitation Practitioners Self-Reported Practices

BACKGROUND

Psychosocial well-being and nutritional counselling are important components of cardiac rehabilitation endorsed by national and international guidelines. However, both areas can be complex for cardiac rehabilitation practitioners to navigate. This study aimed to examine whether practitioners have implemented standardised program content for psychosocial well-being and healthy eating and explore attitudes to these components.

METHOD

Cardiac rehabilitation practitioners were recruited to complete a 32-item cross-sectional survey via convenience sampling. The survey was developed by a team of researchers and practitioners to assess practices, practitioner approaches, and any barriers to implementation. Quantitative results were explored using descriptive statistics, and qualitative responses were coded and classified.

RESULTS

Participants (n=98) represented approximately 89 (22%) cardiac rehabilitation services across Australia. Results suggested that most participants were familiar with standardised program content (92.3%). However, there were inconsistencies about the implementation. For example, although 93.9% of practitioners stated that their programs routinely screen for psychosocial well-being, only 47.2% repeat screening at program completion. On healthy eating, 99% of practitioners report providing healthy dietary advice-however, just over half offered individualised consultations with an expert professional such as an Accredited Practising Dietitian. Practitioners considered psychosocial well-being and healthy eating important components of the program.

CONCLUSIONS

Practitioners reaffirm the importance of psychosocial well-being and nutritional counselling in cardiac rehabilitation programs. However, practitioners inconsistently assess psychosocial well-being at cardiac rehabilitation completion, and individualised dietary counselling by experts is uncommon.

Evaluating trauma awareness in health care: Insights from the AAST and Trauma Prevention Coalition Survey

BACKGROUND

Trauma-informed care (TIC) is a framework designed to understand and address the impacts of trauma, ensuring physical, psychological, and emotional safety for all involved. It seeks to prevent retraumatization and promote a sense of control and empowerment across diverse populations.

METHOD

This Trauma Prevention Coalition survey study assessed TIC implementation among members from 13 of the 16 participating organizations, focusing on prevalence, awareness, and training gaps.

RESULTS

Out of 948 participants, 91% (n = 861) were affiliated with trauma centers. In adult trauma centers: 19.3% were from Level I, 9.4% from Level II, 5.4% from Level III, 3.1% from Level IV, and 1.2% from Level V. In addition, 1.2% were from nonadult trauma centers, and 2.5% worked in centers serving both adult and pediatric patients. In pediatric centers: 18.6% were from Level I, 13.0% from Level II, 1% from Level III, and 67.0% from nonpediatric centers. Trauma-informed care principles were integrated into the core values of 35.5% of trauma centers, while 64.5% had not adopted them. Only 17.0% had TIC training plans, with 57.7% lacking or unaware of such plans. Bivariate regression analysis indicated that TIC integration decreased for Level II, Level IV, and nontrauma centers compared with Level I adult trauma centers, but increased for Level III. In pediatric centers, TIC integration decreased for Level II, Level III, Level IV, and nontrauma centers compared with Level I. Pediatric trauma centers showed a higher TIC integration rate (71.6%) compared with adult centers (39.4%, p < 0.01).

CONCLUSION

TIC adoption varies significantly across trauma center levels, with higher prevalence in pediatric and Level I centers. The study underscores the need for comprehensive TIC training within trauma care systems.

LEVEL OF EVIDENCE

Therapeutic/care management; Level IV.

[Physiotherapeutic research activities at German university hospitals: An online survey among the heads of physiotherapy departments]

INTRODUCTION

German university hospitals, with their three pillars of research, teaching, and care, enjoy a special status in the health care and science system. Alongside care and teaching, the research pillar has also become increasingly relevant for physiotherapy at university hospitals. Nevertheless, there has been no comprehensive study to date of the status of physiotherapy research activities at German university hospitals. This study aims to provide an overview of research activities and their framework conditions.

METHODS

A cross-sectional online survey was conducted among the heads of physiotherapy departments at all 36 German university hospitals in order to collect data on physiotherapy research activities. The questionnaire used for this purpose was developed in advance with the help of a systematic literature review and an expert survey. The survey was analyzed descriptively.

RESULTS

With a response rate of 58%, eight of the 21 university hospitals included in the survey have been conducting physiotherapy research, in some cases for over a decade. The most frequently reported obstacles to research are lack of financial resources (n = 10) and lack of interest or appreciation from other professions (n = 7). Most frequently, research projects are conducted in the medical specialties of orthopedics and trauma surgery (n = 10), intensive care medicine (n = 8), pediatrics (n = 6), and the outpatient sector (n = 6). Clinical research accounts for 58% (n = 18) of research activities. Interprofessional research is more common (n = 13, 72%) than intraprofessional research (n = 5, 28%). In addition to the CRediT roles of resources (n = 6) and investigation (n = 6), the role of conceptualization in the research process (n = 6) is also among the most common. Over the two-year period, a median of three articles was published with first or last authorship assigned to physiotherapists.

CONCLUSION

The online survey shows that there is little physiotherapy research activity at German university hospitals. In order to strengthen physiotherapy research, changes in professional and scientific policy and financial support are needed.

Cancer researchers' experiences with and perceptions of research data sharing: Results of a cross-sectional survey

BACKGROUND

Despite wide recognition of the benefits of sharing research data, public availability rates have not increased substantially in oncology or medicine more broadly over the last decade.

METHODS

We surveyed 285 cancer researchers to determine their prior experience with sharing data and views on known drivers and inhibitors.

RESULTS

We found that 45% of respondents had shared some data from their most recent empirical publication, with respondents who typically studied non-human research participants, or routinely worked with human genomic data, more likely to share than those who did not. A third of respondents added that they had previously shared data privately, with 74% indicating that doing so had also led to authorship opportunities or future collaborations for them. Journal and funder policies were reported to be the biggest general drivers toward sharing, whereas commercial interests, agreements with industrial sponsors and institutional policies were the biggest prohibitors. We show that researchers' decisions about whether to share data are also likely to be influenced by participants' desires.

CONCLUSIONS

Our survey suggests that increased promotion and support by research institutions, alongside greater championing of data sharing by journals and funders, may motivate more researchers in oncology to share their data.

Evidence-based practice usage, knowledge and attitudes of healthcare professionals: a nationwide survey in the Maldives

OBJECTIVES

Evidence-based practice (EBP) is considered an essential principle to arrive at and ensure high-quality healthcare. This study aimed to determine the current knowledge, attitude and awareness among doctors, nurses and allied healthcare workers in the Maldives regarding the principles of EBP and the barriers experienced when practising EBP.

DESIGN AND SETTING

A nationwide, cross-sectional, semiquantitative, digital survey was conducted in 2023 among nurses, doctors and allied healthcare professionals currently working in any healthcare setting in the Maldives. The survey was based on the validated McColl and BARRIERS questionnaires. In addition, basic demographic characteristics of the participants were collected.

RESULTS

Out of the more than 1000 healthcare professionals invited, 418 responded. The vast majority were female nurses. About half of the respondents worked in a tertiary hospital and had obtained a bachelor's degree in nursing. EBP was considered (very) useful and relevant for clinical practice, but the attitude towards and promotion of EBP was considered insufficient. Respondents preferred research utilisation through evidence-based guidelines. Slightly over half (52.1%) of the respondents had followed some course in literature searching or EBP. Only one in six respondents thought they had access to PubMed. The highest scoring barriers for EBP were related to organisational challenges; lack of knowledge, reluctance to change among healthcare professionals and management, and lack of time or high workload.

CONCLUSION

Maldivian healthcare professionals welcome EBP but face organisational and practical challenges to implement this principle in clinical practice. A multidisciplinary team of EBP champions appears useful to promote EBP awareness and skills on a national scale.

Impact of a Surgical Skills Curriculum on Medical Student Procedural Experience and Confidence

INTRODUCTION

There is a documented decline in formal procedural skill training in undergraduate medical education. We evaluated a simulation-based skills curriculum before the core surgical clerkship at a large academic institution on its concordance with the skills students perform during the clerkship and its impact on procedural confidence.

METHODS

Between August 2021 and August 2022, students underwent a 2-d simulation-based orientation before the core surgery clerkship. Upon completion of their surgical clerkship, we surveyed medical students on their experience (simulating and/or performing) and confidence in 36 procedural skills considered important by clerkship leadership.

RESULTS

Of 121 eligible medical students, 36 (30%) completed the survey. Median age was 26 y (Q1-Q3 25-26), 69% identified as female, 74% as White, and 17% as Hispanic. There was a significant difference between procedures students simulated before their clerkship and those performed during their clerkship for 16 procedures (P < 0.05). Procedural confidence significantly increased after the skills orientation (P < 0.001), as well as after the duration of the clerkship (P < 0.001). Competence, as measured by skills competition times, did not differ by gender (P > 0.05) and was higher in students bound for surgical residencies (P < 0.001).

CONCLUSIONS

We highlight the value of a skills orientation before the surgery clerkship, as it significantly increases students' procedural confidence. However, we identified a gap between the skills students receive orientation training for and those they are expected to perform on the rotation. Our findings support the need for curricular changes that better prepare students for the surgical clerkship.

Prevalence, risk and protective factors of burnout among Korean hospitalists

BACKGROUND

Burnout among healthcare professionals is a critical factor which affects patient safety, treatment outcomes, and the quality of care. This is especially important for hospitalists who manage inpatient care, yet no studies have been conducted on this issue in Korea. This study aimed to investigate burnout and psychiatric symptoms among hospitalists in Korea, as well as to identify the risk and protective factors associated with these issues.

MATERIALS AND METHODS

A cross-sectional online survey was conducted targeting all hospitalists in Korea (n=303), and 24.1% (n=79) completed the survey. The Maslach Burnout Inventory-Human Services Survey was used to measure burnout; the Depression, Anxiety, and Stress Scales was used to assess psychiatric symptoms; and the Insomnia Severity Index was used to evaluate sleep disturbances. Risk and protective factors against burnout were assessed using a 5-point Likert scale.

RESULTS

More than half of the respondents reported high graded burnout for two domains: depersonalization (50.6%) and reduced personal accomplishment (57%). Conflicts with caregivers, excessive workload, and long working hours were common risk factors for both burnout domains. The satisfaction with nonclinical work was identified as protective factor in depersonalization, and the availability of a research mentor and cap on daily inpatient load per hospitalist were protective factors in reduced personal accomplishment. In the correlation analysis, the maximum number of inpatients and hospitalists per hospital was a significant factor in reducing burnout.

CONCLUSIONS

This study revealed a high graded burnout rate of more than 50% in depersonalization and reduced personal accomplishments domain among Korean hospitalists, and found the risk and protective factors against burnout. The development of targeted interventions to mitigate burnout based on this study could enhance the mental well-being of healthcare professionals and improve the overall quality of medical care.