Attending Physician Research Articles

Large Language Model Influence on Management Reasoning: A Randomized Controlled Trial.

Large language model (LLM) artificial intelligence (AI) systems have shown promise in diagnostic reasoning, but their utility in management reasoning with no clear right answers is unknown. To determine whether LLM assistance improves physician performance on open-ended management reasoning tasks compared to conventional resources. Prospective, randomized controlled trial conducted from 30 November 2023 to 21 April 2024. Multi-institutional study from Stanford University, Beth Israel Deaconess Medical Center, and the University of Virginia involving physicians from across the United States. 92 practicing attending physicians and residents with training in internal medicine, family medicine, or emergency medicine. Five expert-developed clinical case vignettes were presented with multiple open-ended management questions and scoring rubrics created through a Delphi process. Physicians were randomized to use either GPT-4 via ChatGPT Plus in addition to conventional resources (e.g., UpToDate, Google), or conventional resources alone. The primary outcome was difference in total score between groups on expert-developed scoring rubrics. Secondary outcomes included domain-specific scores and time spent per case. Physicians using the LLM scored higher compared to those using conventional resources (mean difference 6.5 %, 95% CI 2.7-10.2, p<0.001). Significant improvements were seen in management decisions (6.1%, 95% CI 2.5-9.7, p=0.001), diagnostic decisions (12.1%, 95% CI 3.1-21.0, p=0.009), and case-specific (6.2%, 95% CI 2.4-9.9, p=0.002) domains. GPT-4 users spent more time per case (mean difference 119.3 seconds, 95% CI 17.4-221.2, p=0.02). There was no significant difference between GPT-4-augmented physicians and GPT-4 alone (-0.9%, 95% CI -9.0 to 7.2, p=0.8). LLM assistance improved physician management reasoning compared to conventional resources, with particular gains in contextual and patient-specific decision-making. These findings indicate that LLMs can augment management decision-making in complex cases. ClinicalTrials.gov Identifier: NCT06208423; https://classic.clinicaltrials.gov/ct2/show/NCT06208423.

Pediatric Hospital Medicine Fellows' Perspectives on Autonomy Through Time.

Promoting autonomy is at the core of fellowship education. Pediatric hospital medicine (PHM) fellowship programs are relatively new, and many supervising physicians are not trained on how to promote fellow autonomy. Moreover, no studies have explored fellows' perception of autonomy throughout training. To fill this gap, we explored PHM fellows' perceptions of autonomy throughout training. PHM fellows starting fellowship in July 2021 were recruited to participate in a longitudinal qualitative study. Using self-determination theory as a sensitizing framework, the authors conducted semistructured interviews with 14 fellows throughout fellowship. Incoming data were iteratively analyzed, and codes were created from patterns in the data. Coded data were clustered into themes. Four themes developed: (1) at the beginning of fellowship, fellows valued direct observation and close supervision from their attending. (2) Initially, fellows felt pressured to make the identical clinical decision as their attending, but over the course of training, they realized their autonomous decisions could coexist with different decisions from their attending physicians. (3) At first, fellows desired attending presence to support and guide their decision making. Over time, fellows desired a coach who could provide valuable formative feedback. (4) Because of the hierarchical nature of medicine, conversations between fellows and attending physicians about autonomy were challenging to initiate. Fellows' perceptions of autonomy change throughout fellowship, which should be taken into consideration as provisions of autonomy evolve through training. Our findings can inform PHM fellowship curricula and professional development around the promotion of autonomy in fellowship.

Assessment of Patients' Referral Patterns with Complaints of Self-harm and Aggression in the COVID-19 Era

Background: Due to the high transmission rate of COVID-19, the high prevalence of the disease, the high mortality rate, and its effects on mental health, we aimed to assess the current status of psychiatric symptoms. Methods: In this observational study, we have assessed various psychiatric presentations and disorders before and after the COVID-19 pandemic within the same time limit. Data have been obtained from the psychiatric interview performed by an attending physician in psychiatry. Results: The following features have been observed after the pandemic: increased depressed mood, irritability, crime trend, physical violations, personality disorders along with improved family support, and decreased suicidal ideation. No significant difference has been observed in the rate of response to psychotherapy and psychiatric medications before and after the time of the pandemic. Conclusion: Increased physical threat and aggression, substance use, and symptoms of psychosis were more frequently observed in the time of the pandemic. The physical threat was mainly committed by younger patients with psychiatric illnesses.

Mild Traumatic Brain Injury by the Glasgow Coma Scale Score and Early CT-Brain Findings in Acute Alcohol Intoxication Patients: A Prospective Observational Study.

Introduction Traumatic brain injuries (TBI) in recent years have proved to be a significant public health problem, with potentially life-changing consequences for the individual and their family. Alcohol consumption is a regular, well-documented problem among persons sustaining TBIdue to road traffic accidents and accidental falls. The primary objective of this study was to find out the correlation between the Glasgow Coma Scale (GCS) score and CT brain findings among mild TBI patients under acute alcohol intoxication and determine if early CT-brain is indicated in this group. Methods A prospective observational study was conducted involving 111 alcohol-intoxicated patients with mild head injuries admitted to the surgical wards of Thanjavur Medical College Hospitalover a period of three months. The Glasgow Coma Scale was used to assess the patient'sneurological status and determine the severity of the brain injury. A semi-structured CT-brain findings chart and a severity of alcohol intoxication objective-based scoring system were developed and validated by experts. Descriptive statistics tools such as frequency, percentage, and mean were used, along with inferential statistics tools like the Chi-squared test, Fisher exact test, and Pearson's correlation coefficient test. Results The study findings showed that the comparison of GCS with early CT-brain was significant at a p-value of 0.012, and a negative correlation (r=-0.253) was found between GCS and CT-brain findings. A comparison of CT-brain findings with the severity of alcohol intoxication was non-significant at a p-value of 0.433. Conclusions Early CT-brain in intoxicated mild TBI patients may have a positive impact on early diagnosis and management, even in centers with limited resources catering to low-income population groups. The results of our short-term study show that early CT-Brain picks up lesions and helps initiate early management while it is up to the attending physician to keep in mind an adverse cost-benefit ratio in overuse of hospital resources and misdiagnosis leading to undertreatment causing long-term sequelae and morbidity before prescribing early CT-brain in this cohort of patients.

Post hoc analysis of the characteristics and treatment needs of patients with dementia with Lewy bodies (DLB) and their caregivers and their physicians' awareness of those treatment needs according to the duration after diagnosis of DLB.

To investigate the differences in patient/caregiver characteristics, their treatment needs, and the attending physician's understanding of those treatment needs according to the duration after diagnosis of dementia with Lewy bodies (DLB). This was a post hoc analysis of a multicenter, cross-sectional, questionnaire survey study. A total of 263 patient-caregiver pairs were reclassified into two groups according to the median duration after diagnosis of DLB as follows: short (<24months; S-group) and long (≥24months; L-group) post-DLB diagnosis duration. Treatment need was defined as the symptom domain that caused the patient or caregiver the most distress. Concordance rates between patient-physician and caregiver-physician were calculated for physicians' understanding of treatment needs. In this analysis, 126 pairs (32 physicians) and 137 pairs (34 physicians) were classified as the S- and L-groups, respectively. Patient and caregiver characteristics were broadly similar between groups (mean age for patients 78.7±6.6 vs. 79.8±6.7, for caregivers 64.7±12.9 vs. 64.9±12.8; number of male/female for patients 61/65 vs. 67/70, for caregivers 34/92 vs. 38/99), but the prevalence of parkinsonism (82.5% vs. 66.7%) and autonomic dysfunction (49.6% vs. 33.3%), severity of parkinsonism (MDS-UPDRS Part III total scores, 29.2±22.6 vs. 18.0±16.4; Part II total score, 14.6±12.0 vs. 7.6±7.9), and caregiver burden (J-ZBI_8 score, 9.1±6.7 vs. 7.5±5.8) were higher in the L-group than the S-group. Regarding treatment needs, the invalid answer rates for patients were 34.9% and 46.8%, and those for caregivers were 28.6% and 34.9% in the S- and L groups, respectively. Patients' treatment needs did not significantly differ (p=0.056), but S-group patients were more likely to select cognitive impairment (p=0.045) as their treatment need, whereas L-group patients were more likely to select parkinsonism (p=0.003). Caregivers' treatment needs significantly differed (p=0.032) between groups. S-group caregivers were more likely to select cognitive impairment (p=0.001), whereas L-group caregivers were more likely to select other symptom domains such as parkinsonism (S-group vs. L-group: 10.3% vs. 16.7%), psychiatric symptoms (20.6% vs. 24.6%), sleep-related disorder (4.0% vs. 7.1%), and autonomic dysfunction (4.8% vs. 9.5%). Concordance rates between patient-physician and caregiver-physician were low in both groups. There were some differences in characteristics according to the duration after diagnosis of DLB. Cognitive dysfunction may be a particular concern for patients and caregivers soon after diagnosis of DLB. Treatment needs of patients and caregivers for parkinsonism, psychiatric symptoms, sleep-related disorder, or autonomic dysfunction were different according to the duration after diagnosis of DLB. Physicians' perception of patients'/caregivers' treatment needs was poor regardless of the duration after diagnosis of DLB. UMIN Clinical Trials Registry (UMIN000041844).

Medication Optimization Protocol Efficacy for Geriatric Inpatients

There is currently no consensus on clinically effective interventions for polypharmacy among older inpatients. To evaluate the effect of multidisciplinary team-based medication optimization on survival, unscheduled hospital visits, and rehospitalization in older inpatients with polypharmacy. This open-label randomized clinical trial was conducted at 8 internal medicine inpatient wards within a community hospital in Japan. Participants included medical inpatients 65 years or older who were receiving 5 or more regular medications. Enrollment took place between May 21, 2019, and March 14, 2022. Statistical analysis was performed from September 2023 to May 2024. The participants were randomly assigned to receive either an intervention for medication optimization or usual care including medication reconciliation. The intervention consisted of a medication review using the STOPP (Screening Tool of Older Persons' Prescriptions)/START (Screening Tool to Alert to Right Treatment) criteria, followed by a medication optimization proposal for participants and their attending physicians developed by a multidisciplinary team. On discharge, the medication optimization summary was sent to patients' primary care physicians and community pharmacists. The primary outcome was a composite of death, unscheduled hospital visits, and rehospitalization within 12 months. Secondary outcomes included the number of prescribed medications, falls, and adverse events. Between May 21, 2019, and March 14, 2022, 442 participants (mean [SD] age, 81.8 [7.1] years; 223 [50.5%] women) were randomly assigned to the intervention (n = 215) and usual care (n = 227). The intervention group had a significantly lower percentage of patients with 1 or more potentially inappropriate medications than the usual care group at discharge (26.2% vs 33.0%; adjusted odds ratio [OR], 0.56 [95% CI, 0.33-0.94]; P = .03), at 6 months (27.7% vs 37.5%; adjusted OR, 0.50 [95% CI, 0.29-0.86]; P = .01), and at 12 months (26.7% vs 37.4%; adjusted OR, 0.45 [95% CI, 0.25-0.80]; P = .007). The primary composite outcome occurred in 106 participants (49.3%) in the intervention group and 117 (51.5%) in the usual care group (stratified hazard ratio, 0.98 [95% CI, 0.75-1.27]). Adverse events were similar between each group (123 [57.2%] in the intervention group and 135 [59.5%] in the usual care group). In this randomized clinical trial of older inpatients with polypharmacy, the multidisciplinary deprescribing intervention did not reduce death, unscheduled hospital visits, or rehospitalization within 12 months. The intervention was effective in reducing the number of medications with no significant adverse effects on clinical outcomes, even among older inpatients with polypharmacy. UMIN Clinical Trials Registry: UMIN000035265.

A survey-based study: assessing inpatient attending perspectives on teaching learners, feeling valued, and symptoms of burnout

BackgroundPhysician burnout is rising, especially among academic physicians facing pressures to increase their clinical workload, lead administrative tasks and committees, and be active in research. There is a concern this could have downstream effects on learners’ experiences and academic physician’s ability to teach learners on the team.MethodsA 29-question RedCap survey was electronically distributed to 54 attending physicians within an academic learning health system who oversaw the General Medicine inpatient teaching services during the 2022–2023 academic year. The aims were to assess this cohort of attending physicians’ experiences, attitudes, and perceptions on their ability to effectively teach learners on the team, feeling valued, contributors to work-life balance and symptoms of burnout, Fisher’s Exact Tests were used for data analysis.ResultsResponse rate was 56%. Attendings splitting time 50% inpatient / 50% outpatient felt that team size and type of admissions model affected their ability to effectively teach learners (p = 0.022 and p = 0.049). Attendings with protected administrative time felt that non-patient care obligations affected their ability to effectively teach the learners (p = 0.019). Male attendings and attendings with ≤ 5 years of General Medicine inpatient teaching experience felt less valued by residency leadership (p = 0.019 and p = 0.026). 80% of attendings experienced emotional exhaustion, and those with > 10 weeks on a General Medicine inpatient teaching service were more likely to experience emotional exhaustion (p = 0.041). Attendings with > 10 weeks on a General Medicine inpatient teaching service and those who were a primary caregiver were more likely to experience depersonalization (p = 0.012 and p = 0.031). 57% of attendings had reduced personal achievement.ConclusionsInstitutions should seek an individual and organizational approach to professional fulfillment. Special attention to these certain groups is warranted to understand how they can be better supported. Further research, such as with focus groups, is needed to address these challenges.

Usability Testing Via Simulation: Optimizing the NEAR4PEM Preintubation Checklist With a Human Factors Approach.

To inform development of a preintubation checklist for pediatric emergency departments via multicenter usability testing of a prototype checklist. This was a prospective, mixed methods study across 7 sites in the National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM) collaborative. Pediatric emergency medicine attending physicians and senior fellows at each site were first oriented to a checklist prototype, including content previously identified using a modified Delphi approach. Each site used the checklist in 2 simulated cases: an "easy airway" and a "difficult airway" scenario. Facilitators recorded verbalization, completion, and timing of checklist items. After each simulation, participants completed an anonymous usability survey. Structured debriefings were used to gather additional feedback on checklist usability. Comments from the surveys and debriefing were qualitatively analyzed using a framework approach. Responses informed human factors-based optimization of the checklist. Fifty-five pediatric emergency medicine physicians/fellows (4-13 per site) participated. Participants found the prototype checklist to be helpful, easy to use, clear, and of appropriate length. During the simulations, 93% of checklist items were verbalized and more than 80% were completed. Median time to checklist completion was 6.2 minutes (interquartile range, 4.8-7.1) for the first scenario and 4.2 minutes (interquartile range, 2.7-5.8) for the second. Survey and debriefing data identified the following strengths: facilitating a shared mental model, cognitively offloading the team leader, and prompting contingency planning. Suggestions for checklist improvement included clarifying specific items, providing more detailed prompts, and allowing institution-specific customization. Integration of these data with human factors heuristic inspection resulted in a final checklist. Simulation-based, human factors usability testing of the National Emergency Airway Registry for Pediatric Emergency Medicine Preintubation Checklist allowed optimization prior to clinical implementation. Next steps involve integration into real-world settings utilizing rigorous implementation science strategies, with concurrent evaluation of the impact on patient outcomes and safety.

Clinician Perspectives on Continuous Monitor Use in a Children's Hospital: A Qualitative Study.

Variation in continuous cardiopulmonary monitor (cCPM) use across children's hospitals suggests preference-based use. We sought to understand how clinical providers make decisions to use cCPMs. We conducted a qualitative study using semi-structed interviews with clinicians (nurses, respiratory therapists [RTs], and resident and attending physicians) from 2 hospital medicine units at a children's hospital. The interview guide employed patient cases and open-ended prompts to elicit information about workflows and decision-making related to cCPM, and we collected basic demographic information about participants. We used an inductive approach following thematic analysis to code transcripts and create themes. We interviewed 5 nurses, 5 RTs, 7 residents, and 7 attending physicians. We discovered that clinicians perceive a low threshold for starting cCPM, and this often occurred as a default action at admission. Clinicians thought of cCPMs as helping them cope with uncertainty. Despite acknowledging considerable flaws in how cCPMs were used, they were perceived as a low-risk intervention. Although RNs and RTs were most aware of the patient's current condition and number of alarms, physicians decided when to discontinue monitors. No structured process for identifying when to discontinue monitors existed. We concluded that nurses, physicians, and RTs often default to cCPM use and lack a standardized process for identifying when cCPM should be discontinued. Interventions aiming to reduce monitor use will need to account for or target these factors.

Effects of anti-corruption campaigns on cesarean section rate: evidence from China

The excessive utilization of cesarean section (CS) has become a global concern, given the potential short-term and long-term detrimental effects for mothers and infants. Worldwide, the rate of CS continues to rise, but efforts to curtail unnecessary CS procedures have yielded limited success. By combining data from three resources, this study aims to estimate the effects of anti-corruption campaigns under the Xi administration on CS rates. We focus on Shanxi Province, a major coal-producing province in north-central China, with notoriety for the collusion between local politicians and business elites. Using the data from the China Corruption Investigation Dataset and data from publicly listed firms between 2013 and 2016, we found that anti-corruption campaigns significantly changed the social environment as firms’ business entertainment spending experienced substantial reductions. Using discharge records from 137 public hospitals, we adopted an instrumental variable (IV) approach and found that the anti-corruption campaigns led to significant reductions in unnecessary CS rates. The reductions are bigger among patients with second or later deliveries. We also find that the anti-corruption campaigns changed behaviors of attending and resident physicians. Our results provide insights into strategies to reduce corrupt practices within the healthcare sector and implementing interventions to minimize the occurrence of CS among healthy women and newborns.

Unlocking the Potential of the HEART Pathway: Predicting MACE and Facilitating Nurse-Physician Collaboration in Chest Pain Unit.

The HEART pathway serves as a tool for predicting major adverse cardiac events (MACE) among patients presenting with acute chest pain, aiding in early discharge of low-risk patients and reducing unnecessary cardiac investigations. This study aimed to evaluate physician-nurse reliability of the HEART pathway. Moreover investigates the efficacy of HEART pathway to predict 3-month MACE in patients with acute chest pain. We conducted a prospective study on 97 patients experiencing acute chest pain. A team of three professionals - a nurse, a cardiology resident, and a cardiology attending physician - performed risk stratification. We assessed inter-rater reliability among the raters as well as explored 3-month MACE outcomes. Excellent pairwise agreements were found between the raters. Overall agreement among raters was excellent, with an ICC of 0.84 (95% CI: 0.73 - 0.97). The HEART pathway score exhibited strong predictive power (AUC: 0.85) for 3-month MACE. At a cut-off score of 4, sensitivity, specificity, and negative predictive values were 87.5%, 58.9%, and 95.8%, respectively. The HEART pathway score effectively predicts 3-month MACE in patients with acute non-traumatic chest pain. Moreover, the high agreement among the attending physician, the resident physician, and the nurse suggests that nurses could use this tool, potentially reducing the workload on physicians.

Self, Physician, and Specialty: A Qualitative Exploration of Medical Students' Specialty Identity Formation During Undergraduate Medical Training.

A physician's specialty is an integral part of their professional identity formation (PIF), not only determining the role they play in patient care but also shaping group interactions in the workplace. Prior work on PIF in medical students has focused on the development of a physician identity. However, little is known about how medical students might begin to develop divergent specialty-specific identities during medical school. Consequently, the authors aimed to explore how the process of specialty selection shapes PIF during undergraduate medical training and to develop a construct of specialty identity formation (SIF) as an important aspect of PIF. The authors used a constructivist grounded theory approach to explore SIF in senior medical students at the University of Washington between August 2022 and January 2023. The author team consisted of 6 attending physicians. Two investigators conducted hour-long, semistructured interviews, which were audio recorded, transcribed, and deidentified. After analysis, member checking was completed with 2 participants. The authors interviewed 14 students and categorized the data into 3 phases: nascent understanding, experiential grounding, and projecting forward. Participants reflected on considering their personal values, while simultaneously exploring the values and defining features of various specialty groups. Early impressions were formed based on ideas influenced by peers and mentors and later integrated with experiences on clinical rotations. Finally, participants noted engaging in a process projecting forward as they attempted to envision their potential futures as both physicians and members of a specialty group. As students explore their specialty identity, they use self-anchoring and self-stereotyping to integrate components of their evolving specialty identity into their professional identity. However, uncertainty regarding their fit with a specialty persists for many. Many sociocultural aspects of the learning environment affect SIF, including threats to psychological and identity safety.

An in vitro model study of the accuracy and operation time of oral surgery robot-assisted endodontic microsurgery

Objective: To explore the operational accuracy and operative time of oral surgery robot-assisted endodontic microsurgery on a head-simulator for clinical reference. Methods: Three pairs of surgical simulation models were set up on head-simulator. Each model included 10 positions anteriorly and posteriorly, 20 teeth for each technique, for a total of 60 teeth. An attending physician with more than 3 years clinical experience in endodontic microsurgery completed fixed-point osteotomy and apicoectomy in three groups of endodontic microsurgery under freehand (FH), static navigation (SN), and surgery robot (SR). The duration of each operation was recorded. Cone-beam CT was taken before the operation and the surgical path was planned in the software; after surgery, a plug gauge (precision gauge for measuring hole dimensions) was inserted into the surgical path for intraoral scanning. Surgical accuracy (starting point, end point, and angular deviation) was assessed in all 3 groups, and surgery time was compared. Results: The deviation at the starting point and the end point, and angular deviation was (0.37±0.11), (0.37±0.10) mm, and 0.71°±0.17°in the SR group. The deviations in the SR group were significantly lower than those in the SN group [(0.59±0.14), (0.65±0.18) mm, and 2.64°±0.75°] (P<0.05), and both groups were significantly lower than the FH group [(1.37±0.31), (1.10±0.21) mm, and 9.84°±3.15°] (P<0.05). The operative time in the SN group [(1.20±0.03) min] was significantly less than that in the SR group [(2.18±0.03) min] (P<0.05), and both groups were significantly less than that in the FH group [(8.70±3.15) min] (P<0.05). Starting point deviation, end point deviation, and angular deviation [(1.09±0.10), (0.90±0.07) mm, 7.22°±1.13°] in anterior teeth using the FH was significantly lower than the starting deviation, endpoint deviation, and angular deviation [(1.65±0.14), (1.30±0.06) mm, 12.46°±2.10°] in the posterior teeth using FH (P<0.05), and the operative time in the anterior teeth using the FH [(5.75±0.57) min] was significantly less than that in the posterior teeth using [(11.65±1.14) min] (P<0.05). The difference in accuracy and operative time between using SN and SR on anterior and posterior teeth was not statistically significant (P>0.05). Conclusions: Oral surgery robot-assisted endodontic microsurgery helps improving the accuracy of clinicians' operations and shorten the operation time.

Leadership and Followership Dynamics in Interprofessional Health Care Teams: Attending Physician Perspectives.

Effective interprofessional health care team (IHT) members collaborate to reduce medical errors, use resources effectively, and improve patient outcomes, making interprofessional collaboration imperative. Because physicians are often designated as the positional leaders of IHTs, understanding their perspectives on collaboration within IHTs could help to mitigate the disconnects between what is suggested in theory and what is happening in practice. This study aimed to explore leader-follower dynamics within medical teams that are commonly working in clinical care contexts. Using a constructivist approach, the authors conducted 12 individual, semistructured interviews from November 2022 to September 2023 with attending physicians who have led IHTs in perioperative (i.e., preoperative clinic, operating room, postoperative and recovery unit) or emergency department settings. The transcripts were analyzed from December 2022 to December 2023 using inductive thematic analysis. Three themes explained the physician perceptions of IHT leadership-followership dynamics: (1) physicians are comfortable sharing leadership intraprofessionally, (2) the clinical culture and environment constrain interprofessional followership and shared leadership, and (3) hierarchical models hold true even while active followers are appreciated, when appropriate. The data in this study suggest that, in perioperative and emergency department settings, shared leadership largely may not occur interprofessionally but occurs intraprofessionally. Participants suggested that the clinical culture and environment (i.e., legal concerns, hierarchical assumption, patient care ownership responsibilities) constrained interprofessional followership and shared leadership. On the basis of the study's findings and how they align with previous research, future research into interprofessional collaboration and followership roles should focus on what factors enable and constrain active followership and shared leadership. Such collaboration can only be achieved when active followership and shared leadership are allowed and promoted. These findings and others suggest that not all contexts are enabling such types of interprofessional collaboration due to legal concerns, hierarchical traditions, and patient ownership considerations.

Comparing the Anxiety of Patients with Epilepsy Before and After Drug Treatment

Background: Epilepsy is a neurological disease that affects people of all ages. Anxiety in patients with epilepsy is more prevalent than in other patients and can significantly contribute to disability in these individuals. Objectives: This study aimed to compare the anxiety levels of epilepsy patients before and after drug treatment. Methods: In this cross-sectional descriptive study, participants were epilepsy patients who referred to the clinics of public hospitals. Patients who met the inclusion criteria were taking the drugs prescribed by their attending physician. The tools used included a demographic information form, the Health Anxiety Inventory (HAI), and the Beck Anxiety Inventory (BAI). These tools were administered before the patients began taking the drug and at intervals of one, three, and six months after starting the drug, with follow-ups conducted by the patients. The data were analyzed using SPSS version 16 software. Results: The results showed that 59.5% of the patients were male, 33.5% had an education level of high school, and 42% were employed. The mean ± SD age of the patients was 44.72 ± 8.64 years. The mean ± SD HAI score before drug administration was 43.82 ± 7.29, and six months after drug administration, it was 17.52 ± 8.08. For the BAI, the mean ± SD score before drug administration was 48.66 ± 9.84, and six months after drug administration, it was 19.73 ± 10.73. Additionally, the BAI score indicated that drug administration in the first month had no significant effect on reducing the BAI score (P = 0.41). Conclusions: Considering the positive effect of drug administration on reducing the HAI and BAI scores of the patients, it is suggested that drug interventions be implemented to improve the health of these patients.

Rationale and Design of a Multicenter Trial on Exploratory Analysis of the Effects of Advance Care Planning Guided by the Prediction Program of Heart Failure Prognosis on Quality of Life in Patients With Heart Failure - ACQUAINT-Trial.

Background: Preplanning of care is necessary for patients with endstage heart failure (HF), but advance care planning (ACP) before the loss of a patient's comprehensive capacity is not yet routine for the public or the medical community. The challenge in accurately predicting a patient's prognosis is a strong barrier to implementing ACP. To address this problem, several models for risk stratification have been proposed and are available in clinical settings. Methods and Results: We randomized the procedure to provide estimated patient survival information to attending physicians and then assessed whether there was a change in (1) the frequency of ACP initiation occurred (physician-side evaluation), and/or (2) the patients' quality of life, including mental state (patient-side evaluation). Conclusions: This multicenter, open-label, single-blinded randomized clinical trial aims to assess the hypothesis that providing information on the estimated survival of a patient to the attending physicians will improve the frequency of ACP initiation and quality of life in patients with HF.

Diversity engagement is associated with lower burnout among anesthesia providers

Study objectiveThe high prevalence of burnout among anesthesia providers is a well-established, multifactorial problem that deserves systematic attention and action. This study aimed to identify how perceptions of institutional diversity engagement are associated with burnout and perceived stress among anesthesia personnel. DesignSurvey-based prospective cross-sectional study. SettingAnesthesiology department that encompasses community and academic hospitals in a large healthcare system. ParticipantsOne-hundred and sixty anesthesiology department employees over 18 years of age (i.e. attending physicians, trainees, advanced practice providers and others). MeasurementsA web-based survey with 39 questions measured: demographics, diversity engagement, burnout, and perceived stress. The primary objective was to assess the association of burnout and diversity engagement and the mediating effect of perceived stress in this relationship. Our secondary objective was to measure the prevalence of burnout, diversity engagement, and perceived stress. Burnout, diversity engagement, and perceived stress were measured using a validated two-item survey developed from the Maslach Burnout Inventory-Human Services Survey, the 22-item Diversity Engagement Survey (DES), and the Perceived Stress Scale (PSS-4), respectively. Main resultsMean scores were 4.4 (SD 3.2) for burnout, 78.3 (SD 14.3) for DES, and 4.8 (SD 2.6) for perceived stress. Higher DES score predicted lower burnout (β = −0.11 [95% CI −0.14, −0.08], P < 0.001) and lower perceived stress (β = −0.05 [95% CI −0.08, −0.03], P < 0.001). Mediation analysis estimated the total effect of burnout (β = −0.10, P < 0.001), which comprised the direct effect of diversity engagement (β = −0.08, P < 0.001) and indirect effect of perceived stress (β = −0.02, P = 0.0048). ConclusionsThe perception of increased institutional diversity engagement is associated with reduced burnout among anesthesia providers, in part due to a reduction in perceived stress. Implementing interventions at the leadership level that improve diversity engagement may reduce the negative effects of perceived stress and burnout, potentially improving patient care.

Postoperative risk of bleeding after removal of third molars in healthy patients - a prospective observational clinical study

Removal of third molars in healthy patients is considered a procedure with a low risk of bleeding. However, exactly how low the incidence of postoperative bleeding is remains unclear due to the heterogeneity of available studies. To determine the exact postoperative risk of bleeding after the removal of third molars in healthy patients, a prospective observational multicentre study was conducted. A total of 1,035 patients with complete follow-up was included. Of these, 329 patients reported subsequent bleeding, but did not consult their attending physician. A total of 15 patients visited the hospital, 8 of whom required minimally invasive (re)treatment. No hospitalizations were necessary. There was a large difference between the incidence of postoperative bleeding reported by patients and postoperative bleeding requiring clinical examination and/or treatment. To reduce this difference in future, patients should be given detailed information about what degree of postoperative bleeding is considered normal after removal of a third molar.

Preferences for Management of Pediatric Pneumonia: A Clinician Survey of Artificially Generated Patient Cases.

It is unknown which factors are associated with chest radiograph (CXR) and antibiotic use for suspected community-acquired pneumonia (CAP) in children. We evaluated factors associated with CXR and antibiotic preferences among clinicians for children with suspected CAP using case scenarios generated through artificial intelligence (AI). We performed a survey of general pediatric, pediatric emergency medicine, and emergency medicine attending physicians employed by a private physician contractor. Respondents were given 5 unique, AI-generated case scenarios. We used generalized estimating equations to identify factors associated with CXR and antibiotic use. We evaluated the cluster-weighted correlation between clinician suspicion and clinical prediction model risk estimates for CAP using 2 predictive models. A total of 172 respondents provided responses to 839 scenarios. Factors associated with CXR acquisition (OR, [95% CI]) included presence of crackles (4.17 [2.19, 7.95]), prior pneumonia (2.38 [1.32, 4.20]), chest pain (1.90 [1.18, 3.05]) and fever (1.82 [1.32, 2.52]). The decision to use antibiotics before knowledge of CXR results included past hospitalization for pneumonia (4.24 [1.88, 9.57]), focal decreased breath sounds (3.86 [1.98, 7.52]), and crackles (3.45 [2.15, 5.53]). After revealing CXR results to clinicians, these results were the sole predictor associated with antibiotic decision-making. Suspicion for CAP correlated with one of 2 prediction models for CAP (Spearman's rho = 0.25). Factors associated with a greater suspicion of pneumonia included prior pneumonia, duration of illness, worsening course of illness, shortness of breath, vomiting, decreased oral intake or urinary output, respiratory distress, head nodding, focal decreased breath sounds, focal rhonchi, fever, and crackles, and lower pulse oximetry. Ordering preferences for CXRs demonstrated similarities and differences with evidence-based risk models for CAP. Clinicians relied heavily on CXR findings to guide antibiotic ordering. These findings can be used within decision support systems to promote evidence-based management practices for pediatric CAP.

ROSES: The most Complete System for Endovascular Surgery

ROSES, an innovative Robotic System for Endovascular Surgery, features a unique mechanism that continuously measures the resistance encountered by catheters and guide wires as they advance within the body. This feature operates seamlessly without the need for additional specialized components. The system is comprised of a series of robotic actuators (up to three) arranged linearly on slides running along a rail, inclined toward the patient. Another slide, housing a pair of step motors, facilitates the adjustment of relative positions between the actuators, with the proximal actuator affixed to the motor slide by a lateral bar. A force transducer, linked to the motor slide via a wire, is responsive to the gravitational component of any object on the rail. Importantly, this force remains constant even as the actuators move. However, the force dynamically changes if an external obstruction hinders the progress of catheters and guide wires, serving as an alert to the attending physician. The system, uniquely, is also capable of guiding the introduction of the first catheter, even if it is pre-curved. This capability facilitates the complete separation of the doctor from the patient throughout the entire surgical procedure. The system employs compact, purely mechanical disposables designed for a wide range of interventions utilizing commercially available catheters and guide wires, including angioplasty, brain and carotid surgery (for aneurysms or thrombi), TAVI, and various lower and upper limb procedures. Future developments include the incorporation of animated catheters capable of altering their shape configuration under console control. As the system also records the penetration length of each device and transmits this data to a workstation along with X-ray images, it effectively becomes the "black box" of endovascular surgeries. This functionality allows for a complete separation between physicians and patients throughout the entire surgical procedure. The system is safeguarded by multiple pending international patent applications.