Aspects Of Patient Care Research Articles

Empathy Among Medical Students: An Exploratory Cross-Sectional Survey.

Context In the context of healthcare, effective communication and empathy are fundamental skills for physicians, as empathy correlates positively with patient satisfaction, compliance, treatment adherence, and lower rates of physician burnout, depression and anxiety. This study aimed to assess empathy levels and related factors among undergraduate medical students. Methods A cross-sectional study in a Central Indian medical institute examined empathy levels and factors associated with it among medical students, utilizing various scales and statistical analyses. Results This study found that while empathy levels were relatively high among undergraduate students, there was a decline as they progressed through medical education, particularly after the first year of clinical exposure. The study identified several factors associated with empathy levels, including perceived stress, emotional separation, and social support. Notably, individuals experiencing higher levels of stress and emotional separation tended to have higher empathy levels. Conclusions The study's findings suggest that medical education should incorporate interventions to enhance empathy, including addressing stress, providing social support, and exposing students to the emotional aspects of patient care.

Implementation of quality indicators for vulvar cancer in gynaecological cancer centres certified by the German Cancer Society (DKG)

PurposeIn 2018, the first guideline-based quality indicators (QI) for vulvar cancer were implemented in the data-sheets of certified gynaecological cancer centres. The certification process includes guideline-based QIs as a fundamental component. These indicators are specifically designed to evaluate the level of care provided within the centres. This article aims to give an overview of the developing process of guideline based-QIs for women with vulvar cancer and presents the QIs results from the certified gynaecological cancer centres.MethodsThe QIs were derived in a standardized multiple step process during the update of the 2015 S2k guideline “Diagnosis, Therapy, and Follow-Up Care of Vulvar Cancer and its Precursors” (registry-number: no. 015/059) and are based on strong recommendations.ResultsIn total, there are eight guideline-based QIs for vulvar cancer. Four QIs are part of the certification process. In the treatment year 2021, 2.466 cases of vulvar cancer were treated in 177 centres. The target values in the centres for pathology reports on tumour resection and lymphadenectomy as well as sentinel lymph nodes have increased since the beginning of the certification process and have been above 90% over the past three treatment years (2019–2021).DiscussionQIs based on strong guideline recommendations, play a crucial role in measuring and allowing to quantify essential aspects of patient care. By utilizing QIs, centres are able to identify areas for process optimization and draw informed conclusions. Over the years the quality of treatment of vulvar cancer patients measured by the QIs was improved. The certification system is continuously reviewed to enhance patient care even further by using the outcomes from QIs revaluation.

The Knowledge and Practice of ICU Nurses Regarding Enteral Nutrition

Background: Enteral nutrition is a critical aspect of care for patients in intensive care units (ICUs) who cannot consume food orally. Understanding the practices and knowledge of ICU nurses regarding enteral nutrition is essential for ensuring effective patient care and outcomes. Objective: This study aimed to assess the knowledge and practices of ICU nurses regarding enteral nutrition and identify any gaps that could potentially impact patient care. Methods: A cross-sectional study was conducted at Jinnah Hospital, Lahore, using purposive sampling to recruit 142 ICU nurses. Data were collected over a nine-month period using a validated questionnaire designed to evaluate the nurses' knowledge and practices concerning enteral nutrition. Statistical analysis was performed using SPSS software version 25, focusing on descriptive and inferential statistics to understand the trends and associations within the data. Results: The study revealed that 65% of nurses correctly identified pancreatitis as an indication for starting enteral nutrition. However, 73% incorrectly believed that a continuous drip method of enteral feeding does not require a pump. Furthermore, 63% recognized tube dislodgement as a complication, yet 57% either did not know or incorrectly handled protocols for flushing enteral feeding tubes before use. The assessment of nasogastric tube placement every 24 hours was misunderstood by 57% of the participants. Conclusion: The findings indicate a considerable deficiency in the knowledge and practices of ICU nurses regarding enteral nutrition, with significant implications for patient care. There is a clear need for targeted educational programs and updated protocols to enhance the skills and understanding of nurses in this crucial area.

Overview of the role of medical robotics in day-to-day healthcare services: A paradigm shift in clinical operations

Background: Medical robotics has become an integral part of day-to-day healthcare services, revolutionizing the way medical procedures are performed and improving patient outcome. Aim: This study explored the role of medical robotics in healthcare, focusing on its impact on various aspects of patient care. Methodology: The methodology used in this study involved a comprehensive review of existing literature on medical robotics and its applications in healthcare settings. Results: The findings reveals that medical robotics has significantly enhanced the precision, efficiency, and safety of medical procedures, leading to reduced invasiveness, and faster recovery times for patients. Additionally, medical robotics has enabled healthcare providers to perform complex surgeries with greater accuracy and minimal invasiveness, ultimately improving the quality of care for patients. The findings obtained from this study also showed that robotic surgery results in fewer complications and shorter hospital stays compared to traditional surgical methods. This results in a growing adoption of robotic-assisted surgery in various medical specialties, such as urology, gynaecology, and orthopaedics. In addition to surgical procedures, medical robotics is also being used in diagnostic and therapeutic applications. For example, robotic systems are being developed for minimally invasive procedures, such as biopsies and drug delivery. Furthermore, robotic devices are being used in rehabilitation and physical therapy to assist patients in regaining mobility and function. Conclusion: One of the main concerns is the cost of implementing and maintaining robotic systems, which can be prohibitive for some healthcare facilities. Also, there are concerns about the potential for errors and malfunctions in robotic systems, which could compromise patient safety. Overall, the integration of medical robotics in day-to-day healthcare services has proven to be a game-changer, offering new possibilities for the future of healthcare delivery.

PATIENT EDUCATION: Counseling of oral cancer patients

The purpose of this manuscript is to summarize key aspects of care for patients with advanced oral cancer, metastatic to the head and neck region. Patients with advanced oral cancer are treated with multimodal treatment. Surgical intervention leads to limitation in speech and swallowing abilities while adverse effects of chemotherapy and radiation treatment can include nausea, vomiting, diarrhea, mucositis, cystitis, dehydration, nephrotoxicity, skin dermatitis, myelosuppression, and nutritional deficiencies leading to weight loss. These toxicities could be overcome through self-care measures practiced by the patient. Oncology nurses could impart knowledge about self-care measures via patient and family counseling. Keywords: advanced oral cancer, head and neck cancer, counseling, self-care measures

Comparing attitudes towards compulsory interventions in severe and persistent mental illness among psychiatrists in India and Switzerland.

Psychiatrists face a major ethical challenge when deciding whether to make use of coercive measures in the treatment process of patients suffering from severe and persistent mental illness (SPMI). As India and Switzerland show major cultural, political and financial differences, it is hypothesized that attitudes towards coercive measures among Indian and Swiss psychiatrists will vary too. Exploring differences in attitudes between cultures strengthens the critical reflection on one's own stances and in consequence, on our way of action. Especially when it comes to situations involving power imbalances between patients and health practitioners, self-reflection is essential to prevent ethically inappropriate behavior. An online survey on aspects of care for patients with SPMI was sent to 3'056 members of the Indian Psychiatric Society between April and June 2020 and to 1'311 members of the Swiss Society for Psychiatry and Psychotherapy between February and March 2016. The respondents' answers were compared. This article deals with the questionnaire's items on autonomous decision making and the implementation of coercive measures in clinical practice. More precisely, participating psychiatrists were asked to rate the importance of patient's autonomy in general and their willingness to apply coercive measures regarding two specific case vignettes depicting a patient with schizophrenia and one with depression. The statistical analysis, namely descriptive data analysis and calculation of arithmetic means, Shapiro Wilks tests and Mann-Whitney U tests, was carried out using IBM SPSS Statistics version 27. Answers were received from 206 psychiatrists in India and 457 psychiatrists in Switzerland. Indian participants tended to value autonomous decision making as slightly less important than Swiss participants (62.2% vs. 91%, p =.01). Regarding a case of severe and persistent depression, psychiatrists in the Indian group were on average more in favor of acting against the wishes of the patient (55% vs. 34.1%, p <.0001) as well as of accepting a temporary decrease in quality of life due to coercion (40% vs. 23%, p =.008). Answers concerning a case of schizophrenia revealed that Indian participants were more in favor of acting against the patient's wishes than Swiss participants (39% vs. 37%, p =.007), whereas the comparison whether to accept a temporary decrease in quality of life regarding this case showed no significant difference (p =.328). The significant difference in attitudes towards coercive measures among Indian compared to Swiss psychiatrists found in this study might arise from a predominantly more collectivist society in India compared to Switzerland. Moreover, differences in financial resources, the organization of the health care system, and the historical background might have an influence. Continuous and critical reflection on one's own views and behavior is essential, especially if ethical principles and individual rights could be violated through a power imbalance, as in the case of coercive measures.

Bridging Gaps in Oncology Nutrition Education and Teaching: A Comprehensive Analysis of Resident Physicians in China.

Residents are actively involved in patient assessment and all aspects of patient care, and they are critical in providing nutritional support education and treatment for patients with cancer. This study aims to assess the nutritional knowledge and performance of resident physicians, providing insights into existing gaps in awareness and practices related to cancer nutrition. A total of 300 resident physicians undergoing standardized residency training in China participated in this study. An anonymous online questionnaire covering demographic characteristics, nutritional knowledge, clinical practice, and training requirements was designed and administered through the "Wenjuanxing" platform. Data were collected from June 1, 2023, to July 31, 2023. Among the participants, only 40.00% demonstrated adequate knowledge of cancer nutrition, and merely 32.00% exhibited proficient performance in nutritional care. Socio-demographic analysis revealed that residents without affiliations and those specializing in obstetrics and gynecology had superior knowledge, while surgery specialists showed significantly worse performance. Most participants expressed a lack of exposure to cancer nutrition education during academic and standardized residency training. The study highlights the demand for enhanced education and the preference for case-based teaching methods. The findings underscore an urgent need for comprehensive oncology nutrition education within China's standardized residency training. Targeted interventions and curriculum enhancements are essential to improve medical talent development and enhance patient care outcomes in oncology. The study emphasizes the critical role of practical, case-based teaching methods in addressing identified gaps in nutritional knowledge and practices among resident physicians.

Lived experiences of healthcare. Putting the person in person centred care in the medical radiation sciences

IntroductionContemporary healthcare models recognise person-centred care (PCC) as a fundamental principle of quality, safe care. While substantial literature exists on PCC in healthcare generally, there is less evidence on how this relates to medical imaging and radiation therapy.Embedding patient-lived experiences of healthcare into healthcare education has promise in enhancing students’ confidence in delivering PCC. Digital storytelling (DST) of patient-lived experiences can help improve reflection, understanding, critical thinking and empathy. MethodsAuthentic patient-lived experiences were extracted from students’ clinical workbooks, transformed into first person vignettes and integrated into the curriculum. Students were invited to attend focus groups to explore the impact the activity had on the student. ResultsThematic analysis identified three themes. (1) Enhancing PCC; (2) Mode of Delivery (Scaffolded Learning); and (3) Collaborative Learning. PCC was the strongest theme with students stating this is the first time they engaged in an activity focused on the psychosocial aspect of patient care. The majority of students indicated the mode of delivery was engaging and unique, whereby the vignettes were presented incrementally. Collaborative learning was identified by over half of the students where learning took place in a safe and supportive environment. ConclusionThis project explored students’ perspectives of integrating patient-lived experiences into the curriculum via DST. Students who engaged with the activities felt better prepared to deliver quality safe PCC. Implications for practiceProviding healthcare students with opportunities to develop skills to deliver PCC before they enter the workforce can enhance their confidence in delivering effective PCC.

Exploring attitudinal barriers to participation in inpatient fall risk assessment using the Theoretical Domains Framework: A survey of providers.

Lack of provider (physicians and advanced practice providers)participation in fall risk assessment was theorized to be contributing to rising rates of falls with injury at our institution. This project sought to identify if attitudinal barriers to inpatient provider participation in fall risk assessment were similar to those identified in other clinical settings. Barriers to provider participation in fall risk assessment were identified in the literature. These were mapped to the Theoretical Domains Framework (TDF) domains to assist with interpretation of the data. A 10-item survey using a 5-point Likert scale (strongly agree to strongly disagree) with two open-ended questions was developed using these barriers. The survey was distributed via email to all providers on the Medical Staff in July 2021. The response rate was 9.1% (188/2062). 72.6% (95% confidence interval [CI]: 65.6, 78.5) of providers at our institution did agree that fall risk assessment was within their role and 72% (95% CI: 66.1, 78.5) agreed that assessment can prevent falls. Nearly half felt that they lacked formal training in fall risk assessment (48.1% [95% CI: 41.1, 55.1]) and 52.2% (95% CI: 44.6, 58.6) agreed that other aspects of patient care took priority over fallsassessment. These barriers correlated best with the TDF domains of Beliefs about Capabilities and Beliefs about Consequences. Survey results indicate that interventions focused on increasing provider motivation and capability regarding fall risk assessment and helping providers prioritize fall risk assessment are potential targets for future quality improvement projects.

The Impact of Changing From a 6+2 to a 3+1 Residency Block Schedule on Patient Access and Other Outcomes.

Background The "X+Y" residency scheduling model includes "X" weeks of uninterrupted inpatient or subspecialty rotations, followed by "Y" week(s) of uninterrupted outpatient rotations. The optimal ratio of X to Y is unclear. Objective Determine the impact of moving from a 6+2 to a 3+1 schedule on patient access to care, perceived quality of care, and resident/faculty satisfaction. Methods Our residency program switched from a 6+2 to a 3+1 scheduling model in July 2018. We measured access to care before and after the change using the "third next available" (TNA) metric. In June 2019, we administered a voluntary, anonymous, 20-item survey to residents, staff, and faculty who worked in resident clinic in both the 6+2 and 3+1 years. Results Patient access to appointments with their resident physician, as measured by TNA, improved significantly after the schedule change (mean 34.1 days in 6+2, mean 26.5 days in 3+1, P<.0001). Fifteen of 17 (88%) eligible residents and 13 of 24 (54%) faculty/staff filled out the voluntary anonymous survey. Surveyed residents and faculty/staff had concordant perception that the schedule change led to improvement in patient continuity, quality of care, and ability of residents to follow up on diagnostic tests and have regular interaction with clinic attendings. However, residents did not report a change in satisfaction with continuity clinic. Conclusions Changing from a 6+2 to a 3+1 schedule was associated with improvement in patient access to care. Residents and faculty/staff perceived that this schedule change improved several aspects of patient care.

Utilizing Point of Care Ultrasound for Ventilation Liberation: A State-of-the-Art Narrative Review

Mechanical ventilation (MV) is an essential aspect of critical care for patients with acute respiratory failure, but prolonged MV can lead to various complications. Ultrasound (US) is becoming widely available and simple to use, and more people are getting trained to use it. It offers real-time radiation-free assessment of lung aeration, diaphragmatic, and cardiac function. This review explores the role of point-of-care ultrasound (POCUS) in enhancing decision-making and patient care during the weaning and liberation process from MV. Lung US aids in diagnosing lung and pleural pathologies, thereby optimizing ventilator settings and lung recruitment, while diaphragmatic ultrasound provides valuable insights into diaphragmatic atrophy and readiness for extubation. Cardiac function evaluation helps in optimizing hemodynamics that may affect weaning. Despite its advantages, it is crucial to realize that POCUS has limitations, and standardized protocols are still lacking. In conclusion, POCUS holds promise in improving the weaning process and patient care in the context of MV liberation, complementing existing weaning protocols.

Early outcomes of fenestrated and/or branched endovascular repair of complex aortic aneurysms (F/B-EVAR); A single-center experience

Background: Open surgical repair of juxta-, para- and thoracoabdominal aortic aneurysms (TAAA) has been the gold-standard for patients fit for surgery. However, endovascular repair of complex aortic aneurysms using devices implementing directional branches or fenestrations for incorporation of reno-visceral target vessels (TV) has gained widespread attention, due to its lower mortality and complication rate and its more attractive profile for high-risk patients. Nonetheless, complex endovascular technologies require meticulous abidance to protocols for successful application. Methods: A retrospective analysis of prospectively collected data from a single, tertiary center was undertaken, including all patients undergoing complex aortic endovascular repair with fenestrated (F-EVAR) of branched devices (B-EVAR) from a 5-year time period (2018-2023). Primary outcomes included 30-day mortality, while secondary outcomes included primary TV patency, acute kidney injury (AKI), spinal cord ischemia (SCI), myocardial infarction (MI) and stroke rates. Results: Of 74 patients (mean age: 69 ± 5.6 years-old, 98% males), 31 (42.6) and 43 (57.6%) were treated by F-EVAR and B-EVAR, respectively. Mean aneurysm diameter was 68 ± 1.8cm, with 15 (20.5%) juxtarenal AAA, 27 (35.6%) pararenal AAA, 16 (21.9%) type IV TAAA, 6 (8.2%) type III TAAA, and 10 (13.7%) type II TAAA treated. Sixteen (21.6%) patients were treated due to failed-EVAR. In total, 272 TV were successfully revascularized. Thirty-day mortality was 8.1%. Primary TV patency rate was 99.2% (270/272). Endoleak rate was 8.1% (6/74). No cases of AKI or MI were observed. One (1.3%) case of hemorrhagic stroke was observed. Three cases (4%) of SCI were observed, including one temporary paraparesis and two permanent paraplegia cases. Reintervention rate was 5.4%, including two cases of renal artery stent thrombosis revascularization procedures. Conclusions: Endovascular repair of complex aortic aneurysms is feasible, with good perioperative outcomes. Adherence to precise protocols covering every technical aspect of patient care is warranted for satisfactory outcomes.

Characteristics of constipation screening and assessment tools: a scoping review protocol

IntroductionConstipation is a common and significant burden on individuals and healthcare systems. Accurate assessment of constipation severity and symptom improvement are vital aspects of caring for patients with constipation. Therefore,...

Behavioural determinants shaping infection prevention and control behaviour among healthcare workers in Dutch general practices: a qualitative study reflecting on pre-, during and post-COVID-19 pandemic

BackgroundSince the Coronavirus Disease 2019 (COVID-19) pandemic, awareness of infection prevention and control (IPC) has increased in primary care settings. This study aimed to examine behavioural determinants shaping IPC behaviour pre-, during, and post-pandemic among healthcare workers (HCWs) in general practices, to inform optimised IPC in primary care.MethodsFor this qualitative study, semi-structured in-depth interviews were conducted during two study periods: (1) pre-COVID-19 pandemic: July 2019-February 2020, with 14 general practitioners (GPs) and medical assistants, and (2) during the COVID-19 pandemic: July 2022-February 2023, with 22 GPs and medical assistants. The design was informed by behaviour change theories. Data were analysed using thematic analysis.ResultsMain themes were: (1) risk perception and IPC awareness, (2) attitudes towards IPC and professional responsibility, (3) decision-making process and risk considerations for IPC adherence, (4) social norm and social influence in GP practice team, and (5) environmental context and resource availability in GP practice. During the pandemic, risk perception and awareness of the importance of IPC increased compared to the pre-pandemic period. A consistent belief emerged that IPC is part of professional responsibility, while needing to be balanced with other aspects of patient care. Decision-making is dependent on the individual GP and mainly influenced by risk assessments and sustainability considerations. The social context in the practice team can reinforce IPC behaviours. GP practice building and layout, and limited IPC resource and material availability were reported as main barriers.ConclusionsThe theory-informed insights of this study can be used for targeted interventions to optimise IPC behaviour in general practices. Adopting multifaceted strategies to target the various determinants is recommended to sustain IPC, by implementing continuous education using tailored communication, integrating IPC in work routines and organisational workflows, refining existing IPC protocols by incorporating decision-making tools for HCWs, fostering a culture of IPC through knowledge-sharing and teamwork, and addressing GP practice physical environment and IPC resource barriers.

Case Report on a Multidisciplinary Approach to Address Malnutrition and Improve a Patient’s Fitness for Treatment

Approximately 5,700 people are diagnosed with myeloma each year in the UK. The standard of care is to receive an autologous stem cell transplant after completion of induction therapy. There are no specific dietary recommendations for people with myeloma, however they are at risk of malnutrition due to symptoms and side effects of treatments. This report describes the journey of a 73-year-old male diagnosed with immunoglobulin A (IgA) lambda myeloma in April 2021. The patient lost 23% of his body weight during 6 months of systemic anti-cancer treatment (SACT), resulting in postponing his transplant twice due to reduced fitness. This report describes an effective, although late, multidisciplinary intervention which was successful for the patient who managed to reestablish a healthy weight and good quality of life. The patient received his transplant in January 2023. This case highlights two important aspects of patient care that should not be underestimated in dietetic clinical practice: early screening and multidisciplinary collaboration. Monitoring the nutritional status of patients and providing early nutrition support can prevent hospital admissions, treatment delays and reduce the associated costs. Multidisciplinary teamwork can improve patient care and clinical outcomes, and it is fundamental to strengthen communication and collaboration among clinical disciplines.

Characteristics and outcomes of patients with do-not-resuscitate and physician orders for life-sustaining treatment in a medical intensive care unit: a retrospective cohort study

BackgroundIn the intensive care unit (ICU), we may encounter patients who have completed a Do-Not-Resuscitate (DNR) or a Physician Orders to Stop Life-Sustaining Treatment (POLST) document. However, the characteristics of ICU patients who choose DNR/POLST are not well understood.MethodsWe retrospectively analyzed the electronic medical records of 577 patients admitted to a medical ICU from October 2019 to November 2020, focusing on the characteristics of patients according to whether they completed DNR/POLST documents. Patients were categorized into DNR/POLST group and no DNR/POLST group according to whether they completed DNR/POLST documents, and logistic regression analysis was used to evaluate factors influencing DNR/POLST document completion.ResultsA total of 577 patients were admitted to the ICU. Of these, 211 patients (36.6%) had DNR or POLST records. DNR and/or POLST were completed prior to ICU admission in 48 (22.7%) patients. The DNR/POLST group was older (72.9 ± 13.5 vs. 67.6 ± 13.8 years, p < 0.001) and had higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (26.1 ± 9.2 vs. 20.3 ± 7.7, p < 0.001) and clinical frailty scale (5.1 ± 1.4 vs. 4.4 ± 1.4, p < 0.001) than the other groups. Solid tumors, hematologic malignancies, and chronic lung disease were the most common comorbidities in the DNR/POLST groups. The DNR/POLST group had higher ICU and in-hospital mortality and more invasive treatments (arterial line, central line, renal replacement therapy, invasive mechanical ventilation) than the other groups. Body mass index, APAHCE II score, hematologic malignancy, DNR/POLST were factors associated with in-hospital mortality.ConclusionsAmong ICU patients, 36.6% had DNR or POLST orders and received more invasive treatments. This is contrary to the common belief that DNR/POLST patients would receive less invasive treatment and underscores the need to better understand and include end-of-life care as an important ongoing aspect of patient care, along with communication with patients and families.

Enhancing Patient-Centric Approaches and Regulatory Measures in Valproate Use

Valproate is an effective treatment for bipolar disorder, migraine, and seizures. It is a flexible medication for neurological illnesses. In addition to its immediate benefits, the neuroprotective capabilities of this substance, which may be attributed to its antioxidant and anti-inflammatory properties, contribute to its complexity. Nevertheless, the presence of significant negative consequences such as pancreatitis, liver failure, teratogenicity, and an elevated risk of suicide present considerable difficulties. Significantly, its capacity to block histone deacetylase motivates investigation into possible epigenetic impacts for the treatment of AIDS and cancer. The article discusses the issue surrounding the use of valproate in neurology. It agrees with the guidelines set by the MHRA (Medicines and Healthcare products Regulatory Agency), but also emphasises the need for further considerations in patient care and regulatory enhancements. The statement emphasises the need of providing clear guidance to patients and carers, while highlighting the need for comprehensive education of neurologists worldwide, with the backing of government. The paper advocates for allocating funding to support in-depth understanding through preclinical and clinical investigations, emphasising the importance of a well-rounded approach that prioritises the needs of patients. The aim is to create a flexible framework that can respond to changing medical knowledge by incorporating risk assessment, patient education, and thorough monitoring after regulatory changes. The objective of this strategy is to achieve a balance between ensuring reproductive safety and promoting the well-being of those who are reliant on valproate. This involves taking into account both the practical and emotional aspects of patient care.

Assessing Medical Ethics Knowledge and Practice Among Healthcare Professionals in Al Majma'ah, Saudi Arabia.

Background The healthcare system is increasingly confronted with ethical challenges, necessitating a thorough exploration of healthcare providers' ethical knowledge and attitudes. This study aims to evaluate the ethical awareness and attitudes of healthcare providers in the Al Majma'ah region of the Kingdom of Saudi Arabia (KSA). Aim This research focuses on assessing the level of knowledge and practice regarding medical ethics among healthcare providers in a community hospital in Majmaah, KSA. Methods A comprehensive cross-sectional study was undertaken in the Majmaah governorate of Saudi Arabia. Data collection involved distributing a meticulously designed questionnaire to healthcare providers and faculty members affiliated with the College of Medicine. Subsequently, the acquired dataset underwent analysis utilizing SPSS software. Results A total of 183 participants were included in the study. The findings revealed that only 77 respondents (42.1%) considered ethical issues in their profession as extremely important. Moreover, 104 participants (56.8%) were aware of the existence of an ethics committee in their institution. A total of 113 respondents (61.7%) disagreed with the notion that ethical conduct is primarily important to avoid legal consequences, and 120 participants (65.6%) believed in the significance of in-service training on medical ethics for doctors. The study also highlighted that 100 participants (54.6%) believed that healthcare providers' opinions supersede patient preferences. However, a majority, 163 participants (89.1%), agreed that patients should be informed of any wrongdoing, contrasting with only 20 (10.9%) who disagreed. When asked about adhering to patients' wishes despite doctors' opinions, 112 (61.2%) responded affirmatively, while 71 (38.3%) disagreed. There was also a disparity in opinions regarding the necessity of obtaining consent, with 81 (44.3%) agreeing that consent is required not only for surgical procedures but also for medications or investigations. Furthermore, 137 participants (74.9%) recognized the importance of discussing ethical, social, and legal issues during clinical rounds alongside clinical aspects of patient care, while 46 (25.1%) disagreed. Conclusion Although medical ethics were introduced into the Saudi healthcare system more than a decade ago, this study underscores the ethical necessity of obtaining comprehensive informed consent prior to invasive and other medical procedures. It also highlights the significance of engaging patients in the decision-making process regarding their treatment. Well-informed patients typically exhibit higher satisfaction levels and are less inclined to pursue legal action.

1990 Acute Sedation Prescribing in the Older Person

Abstract Introduction Anti-psychotics and benzodiazepines are commonly prescribed for older people. They are usually indicated in the short term for delirium and agitation. There are known risks associated with these drugs in the older population including functional decline, increased falls risk and overall mortality. Moreover, chemical sedation is a form of restraint and deprives patients of their liberty. Sedative prescribing should be protocol driven and preceded by non-pharmacological intervention. However, these prescriptions are often initiated prematurely and evade review, continuing in the long-term. Method Our QI team aimed to reduce prescribing of new sedating drugs by 60% in patients using an MDT approach. Our strategies focused on increasing awareness and utilisation of existing protocols, to improve non-pharmacological management of delirium. This was achieved through the strategic delivery of teaching sessions for nursing, pharmacy and medical staff. Further, we utilised force function techniques and management charts to encourage review of these prescriptions. We gathered our data on a weekly basis over a five-month period by reviewing all prescribed medicines for patients on an older people’s ward. Results We exceeded our initial aim achieving a reduction of 82% in the prescribing of new lorazepam and haloperidol. We also attained a significant and sustained uptake of over 95% in the use of the delirium protocol. Where a review sticker was used, 80% led to discontinuation of the target prescription. Although these improvements were focused on one ward, the wider changes and improvements were observed throughout the hospital. Conclusion The significant reduction in sedative prescribing demonstrates the need and potential for improving the quality and safety of this aspect of patient care. The wider success of this project highlights the importance of addressing human factors to drive and sustain change. Improving the understanding of MDT members is integral to changing behaviours and improving patient safety.

Role of artificial intelligence in early detection of congenital heart diseases in neonates.

In the domain of healthcare, most importantly pediatric healthcare, the role of artificial intelligence (AI) has significantly impacted the medical field. Congenital heart diseases represent a group of heart diseases that are known to be some of the most critical cardiac conditions present at birth. These heart diseases need a swift diagnosis as well as an intervention to ensure the wellbeing of newborns. Fortunately, with the help of AI, including the highly advanced algorithms, analytics and imaging involved, it provides us with a promising era for neonatal care. This article reviewed published data in PubMed, Science Direct, UpToDate, and Google Scholar between the years 2015-2023. To conclude The use of artificial intelligence in detecting congenital heart diseases has shown great promise in improving the accuracy and efficiency of diagnosis. Several studies have demonstrated the efficacy of AI-based approaches for diagnosing congenital heart diseases, with results indicating that the systems can achieve high levels of sensitivity and specificity. In addition, AI can help reduce the workload of healthcare professionals allowing them to focus on other critical aspects of patient care. Despite the potential benefits of using AI, in addition to detecting congenital heart disease, there are still some challenges to overcome, such as the need for large amounts of high-quality data and the requirement for careful validation of the algorithms. Nevertheless, with ongoing research and development, AI is likely to become an increasingly valuable tool for improving the diagnosis and treatment of congenital heart diseases.