Clinical Health Care Research Articles

Wide-field imaging and recognition through cascaded complex scattering media

Considering the obvious application value in the field of minimally invasive and non-destructive clinical healthcare, we explore the challenge of wide-field imaging and recognition through cascaded complex scattering media, a topic that has been less researched, by realizing wide-field imaging and pathological screening through multimode fibers (MMF) and turbid media. To address the challenge of extracting features from chaotic and globally correlated speckles formed by transmitting images through cascaded complex scattering media, we establish a deep learning approach based on SMixerNet. By efficiently using the parameter-free matrix transposition, SMixerNet achieves a broad receptive field with less inductive bias through concise multi-layer perceptron (MLP). This approach circumvents the parameter's intensive requirements of previous implementations relying on self-attention mechanisms for global receptive fields. Imaging and pathological screening results based on extensive datasets demonstrate that our approach achieves better performance with fewer learning parameters, which helps deploy deep learning models on desktop-level edge computing devices for clinical healthcare. Our research shows that, deep learning facilitates imaging and recognition through cascaded complex scattering media. This research extends the scenarios of medical and industrial imaging, offering additional possibilities in minimally invasive and non-destructive clinical healthcare and industrial monitoring in harsh and complex scenarios.

Perceptions and attitudes of health science students relating to artificial intelligence (AI): A scoping review.

The recent integration of artificial intelligence (AI) across education, research, and clinical healthcare has led to a growing interest in AI training for healthcare students. This scoping review seeks to delve into existing literature, aiming to evaluate the perceptions and attitudes, of health science students toward the implementation of AI in their field. This review followed the methodological guidance offered by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). A systematic search was conducted in the databases Medline, Emcare, and Scopus. Studies using both quantitative and qualitative methodologies were eligible if they explored the perceptions or attitudes of health science students in relation to AI. Relevant data from eligible articles was extracted and analyzed using narrative synthesis. Ten studies were included. Articles reported on the primary outcomes of perceptions (i.e., thoughts, ideas, satisfaction, etc.) and attitudes (i.e., beliefs, tendencies, etc.). Disciplines included nursing, diagnostic radiography, pharmacy, midwifery, occupational therapy, physiotherapy, and speech pathology were featured. Overall, students felt positively about the potential benefits AI would have on their future work. Students' interest and willingness to learn about AI was also favorable. Studies evaluating attitudes found positive correlations between attitudes toward AI, AI utilization, and intention to use AI. Negative perceptions related to threats of job security, and a lack of realism associated with AI software. Overall, evidence from this review indicates that health science students' worldwide hold positive perceptions toward AI. Educators should focus on instilling positive attitudes toward AI, given correlations between AI exposure and intention to adopt AI.

Limited health literacy does not adversely affect compliance with postoperative restrictions, 90-day emergency department return, or opioid use following shoulder arthroscopy

BackgroundLimited health literacy can negatively impact how patients process medical information, make medical decisions, and navigate the healthcare system. The literature with regards to health literacy and its impact on both postoperative compliance and healthcare utilization remains scant. MethodsWe retrospectively analyzed the records for patients who underwent elective shoulder arthroscopy with a minimum 90-day follow-up at a single academic institution. Demographic data including age, gender, prior ipsilateral shoulder arthroscopy, body mass index (BMI) and age-adjusted Charlson Comorbidity Index (ACCI) were collected. A validated 9-item Literacy in Musculoskeletal Problems (LiMP) questionnaire to assess musculoskeletal health literacy (MHL) was administered preoperatively. Postoperative compliance with therapy and surgeon-directed immobilization restrictions, 90-day return to ED, and the number of opioid prescriptions filled within 3 months postoperatively was recorded. ResultsThere were 252 cases included in this study. Seventy-seven (31%) patients demonstrated adequate MHL (AMHL). On multivariable analysis, limited MHL (LMHL) was not significantly associated with 90-day postoperative ED return, compliance with postoperative surgeon instructions regarding shoulder motion or therapy restrictions, or obtaining ≥ 2 postoperative opioid prescriptions. ConclusionsLMHL is highly prevalent amongst patients undergoing elective shoulder arthroscopy. The lack of association between LMHL and postoperative compliance, 90-day ED return, or filling ≥ 2 postoperative opioid prescriptions suggests that further research is needed to identify more relevant modifiable risk factors that could reduce these negative clinical outcomes and healthcare utilization patterns.

Accuracy of death risk prediction models for acute coronary syndrome patients: a systematic review and meta-analysis.

This study systematically evaluates the accuracy of several death risk prediction models for patients with acute coronary syndrome (ACS) through evidence-based methods. We identify the most accurate and effective ACS death risk prediction model and provide an evidence-based basis for clinical healthcare personnel to evaluate their choice of death risk prediction model for ACS patients. An evidence-based approach was used to study the current death risk prediction model for ACS. First, a literature search was carried out using computer-based and manual searching. The literature databases searched include Cochrane Library, MEDLINE, EMBASE, PubMed, Web of Science, WanFang Data, CNKI, VPCS, and SinoMed. The search period was limited to 2009 to 2022. Screening, quality evaluation and data extraction were carried out for the included articles. The PROBAST was used to conduct a migration risk assessment. RevMan 5.3 and Meta-DiSc 1.4 were used in combination to determine the model effect sizes. A descriptive analysis was conducted for the data that could not be meta-analyzed. A total of 8277 articles were initially included in this study. After screening, 25 articles were finally included, involving 11 different risk prediction models. A total of 306,390 patients with ACS were included of which 158,080 (51.6%) were male and 147,793 (48.4%) were female. The patients stemmed from 11 different countries (e.g., China, the USA, Spain, the UK, etc.). The total number of deaths was 23,601. The sensitivity of the GRACE risk prediction model was 0.78, with a specificity of 0.76 and an AUC value of 0.86. The sensitivity of the CAMI risk prediction model was 0.78, with a specificity of 0.70 and an AUC value of 0.85. The sensitivity of the TIMI risk prediction model was 0.51, with a specificity of 0.81, and an AUC value of 0.64. The sensitivity of the REMS risk prediction model was 0.78, with a specificity of 0.46 and an AUC value of 0.41. Eight different risk prediction models (EPICOR, CRUSADE, SAMI, GWTG, LNS, SYNTAX II, APACHE II) that could not be combined with the effect size were also included, with sensitivities ranging from 0.77-0.95, specificities ranging from 0.22-0.99, and AUC values ranging from 0.71-0.92. The GRACE and CAMI risk prediction models demonstrate good accuracy for evaluating the death risk of ACS patients. The accuracy of the TIMI risk prediction model is similar to that of the REMS risk prediction model. The APACHE II, SYNTAX II, EPICOR, and CAMI risk prediction models also show good accuracy for estimating the risk of death in ACS patients, although further validation is needed due to limited evidence. For improved predictive accuracy and to help advance medical interventions, the author recommends that clinical medical staff use the GRACE model to predict the death risk of ACS patients.

Impact of COVID-19 on Healthcare Professionals at a Midwestern Quaternary Academic Urban Health Center.

Prior pandemic research has focused on physicians and nurses who provide direct patient care. Literature on the experiences of nonnurse/physician clinicians and nonclinical health care professionals is sparse. An observational, cross-sectional study was conducted over threetime points to examine the impact of COVID-19 on clinical and nonclinical healthcare professionals (n = 464). There were no significant differences in distress across survey waves, except for anger (p = .046). No significant differences in distress scores were found between job types. Multiple linear regression results varied. Both the threat and interrupted plans scores were significant predictors of distress. Resources available to healthcare providers (HCPs) were underutilized in all three waves. Healthcare professionals' distress increases with exposure. Integrating self-care resources for staff may mitigate the impact and maintain a healthy work environment. Occupational health providers should incorporate these findings when developing opportunities to address the needs of health care professionals in the workplace.

The dynamics of intercultural clinical encounters in times of pandemic crisis. Swedish healthcare providers’ reflections on social norms in relation to sexual and reproductive healthcare

BackgroundExperiences from the COVID-19 pandemic may help to better understand resilience, competences and skills for healthcare providers and the healthcare system. Within sexual and reproductive health inequalities for migrants exist and it is an area where promoting both cultural competency and healthcare equity in the clinical encounter is expected of healthcare providers yet can create tension. The aim is to explore healthcare providers experiences of encounters with migrants in the context of the pandemic and the subsequent changes in routines and norms. MethodsA qualitative study based on semi-structured interviews with 31 healthcare providers working in sexual and reproductive healthcare in southern Sweden. Interviews were conducted during the COVID-19 pandemic influencing how healthcare providers reflected on their experiences. Analysis was done using reflexive thematic data analysis. FindingsHealthcare providers reflected on how changes in routines increased the understanding of challenges and enablers in the intercultural encounter including the impact on communication and role of relatives and male partners. They emphasized the dynamics of culture in the clinical encounter and healthcare system through highlighting the importance of structural awareness, self-reflection and the flexibility of conducts and norms, often given a cultural connotation. ConclusionThe COVID-19 pandemic resulted in changes of previously established routines directly affecting clinical encounters, which provided a unique opportunity for healthcare providers to reflect, with communication and self-reflection being discussed as central in complex encounters. It highlighted the dynamics of presumed deeply rooted cultural norms and the interplay with social factors affecting healthcare providers and patients alike.

Machine Learning-Based Prediction of Readmission Risk in Cardiovascular and Cerebrovascular Conditions Using Patient EMR Data.

The primary objective of this study was to develop a risk-based readmission prediction model using the EMR data available at discharge. This model was then validated with the LACE plus score. The study cohort consisted of about 310,000 hospital admissions of patients with cardiovascular and cerebrovascular conditions. The EMR data of the patients consisted of lab results, vitals, medications, comorbidities, and admit/discharge settings. These data served as the input to an XGBoost model v1.7.6, which was then used to predict the number of days until the next readmission. Our model achieved remarkable results, with a precision score of 0.74 (±0.03), a recall score of 0.75 (±0.02), and an overall accuracy of approximately 82% (±5%). Notably, the model demonstrated a high accuracy rate of 78.39% in identifying the patients readmitted within 30 days and 80.81% accuracy for those with readmissions exceeding six months. The model was able to outperform the LACE plus score; of the people who were readmitted within 30 days, only 47.70 percent had a LACE plus score greater than 70, and, for people with greater than 6 months, only 10.09 percent had a LACE plus score less than 30. Furthermore, our analysis revealed that the patients with a higher comorbidity burden and lower-than-normal hemoglobin levels were associated with increased readmission rates. This study opens new doors to the world of differential patient care, helping both clinical decision makers and healthcare providers make more informed and effective decisions. This model is comparatively more robust and can potentially substitute the LACE plus score in cardiovascular and cerebrovascular settings for predicting the readmission risk.

Timely integration of palliative care. the reality check. a retrospective analysis

PurposeA large volume of literature suggests that timely integration of palliative care (PC) enhances the well-being, quality of life and satisfaction of patients and their families. It may also positively impact clinical outcomes and healthcare costs throughout the disease trajectory. Therefore, reviewing clinical practice to reflect real-life situations regarding timely PC integration is essential.MethodsThis study, conducted at the Vienna General Hospital between March 2016 and August 2022, retrospectively examined PC consultation (PCC) requests. It aimed to assess the timeliness of PC integration by analysing the duration between diagnosis and the first PCC request, as well as the interval between the first PCC request and death.ResultsThis study included 895 PCCs. The median time from diagnosis to the first PCC was 16.6 (interquartile range (IQR): 3.9–48.4) months, while the median time from the first PCC to death was 17.2 (IQR: 6.1–50.7) days. The median time from diagnosis to first PCC was 10.4 months in females (confidence interval (CI): 6.0–14.8) compared to 10.6 months in males (CI: 8.1–13.1; p = 0.675). There were no gender disparities in the time from first PCC to death, with a median of 23.3 days (CI: 15.6–31.0) for females and 22.3 days (CI: 16.2–28.4) for males (p = 0.93). Fifty percent of patients died between 5 and 47 days after the first PCC.ConclusionThese findings highlight the discrepancy between the clinical perception of PC as end-of-life care and the existing literature, thereby emphasising the importance of timely PC integration.

Barriers and facilitators of improved nutritional support for patients newly diagnosed with cancer: a pre-implementation study

BackgroundDisease-related malnutrition affects a significant number of patients with cancer and poses a major social problem worldwide. Despite both global and national guidelines to prevent and treat malnutrition, the prevalence is high, ranging from 20 to 70% in all patients with cancer. This study aimed to explore the current practice of nutritional support for patients with cancer at a large university hospital in Norway and to explore potential barriers and facilitators of the intervention in the Green Approach to Improved Nutritional support for patients with cancer (GAIN), prior to implementation in a clinical setting.MethodsThe study used individual interviews and a focus group discussion to collect data. Study participants included different healthcare professionals and patients with cancer treated at a nutrition outpatient clinic. The Consolidated Framework for Implementation Research (CFIR) was used to guide the thematic data analysis.ResultsBarriers connected to the current nutritional support were limited resources and undefined roles concerning responsibility for providing nutritional support among healthcare professionals. Facilitators included a desire for change regarding the current nutritional practice. The GAIN intervention was perceived as feasible for patients and healthcare professionals. Potential barriers included limited knowledge of technology, lack of motivation among patients, and a potential added burden experienced by the participating patients.ConclusionsThe identification of the potential barriers and facilitators of the current nutritional support to patients with cancer will be used to plan the implementation of improved nutritional support in a randomized controlled trial for patients with cancer prior to clinical implementation. The current findings may be of value to others trying to implement either or both nutritional support and digital application tools in a clinical healthcare setting.Trial registrationThe study was registered in the National Institutes of Health Clinical trials 08/09/22. The identification code is NCT05544318.

Difficult Airway Assessment Based on Multi-View Metric Learning.

The preoperative assessment of difficult airways is of great significance in the practice of anesthesia intubation. In recent years, although a large number of difficult airway recognition algorithms have been investigated, defects such as low recognition accuracy and poor recognition reliability still exist. In this paper, we propose a Dual-Path Multi-View Fusion Network (DMF-Net) based on multi-view metric learning, which aims to predict difficult airways through multi-view facial images of patients. DMF-Net adopts a dual-path structure to extract features by grouping the frontal and lateral images of the patients. Meanwhile, a Multi-Scale Feature Fusion Module and a Hybrid Co-Attention Module are designed to improve the feature representation ability of the model. Consistency loss and complementarity loss are utilized fully for the complementarity and consistency of information between multi-view data. Combined with Focal Loss, information bias is effectively avoided. Experimental validation illustrates the effectiveness of the proposed method, with the accuracy, specificity, sensitivity, and F1 score reaching 77.92%, 75.62%, 82.50%, and 71.35%, respectively. Compared with methods such as clinical bedside screening tests and existing artificial intelligence-based methods, our method is more accurate and reliable and can provide a reliable auxiliary tool for clinical healthcare personnel to effectively improve the accuracy and reliability of preoperative difficult airway assessments. The proposed network can help to identify and assess the risk of difficult airways in patients before surgery and reduce the incidence of postoperative complications.

Seasonal increase in syphilis screening reactivity rates in whole blood donors, United States, 2011-2023.

In December 2021, the U.S. Food and Drug Administration published a letter to clinical laboratory staff and healthcare providers detailing a risk of false Rapid Plasma Reagin (RPR) when using the Bio-Rad Laboratories BioPlex 2200 Syphilis Total & RPR kit in people who had received COVID-19 vaccination; Treponema pallidum particle agglutination assays did not appear to be impacted by this issue. We evaluated reactivity rates of syphilis screening with negative confirmatory testing at our institution by year and seasonality. We performed a retrospective study of routine syphilis testing of whole blood (WB) collections at an academic hospital-based donor center in the eastern United States. All WB donations from 2011 to 2023 which demonstrated reactive syphilis screening (Beckman Coulter PK TP Microhemagglutination) with negative confirmatory testing (CAPTIA Syphilis (T. pallidum)-G) were evaluated. Reactivity rates by year and season of donation were compared using unpaired t-tests. A total of 109 WB donations from 86 unique donors who donated from 2011 to 2023 screened reactive for syphilis with negative confirmatory testing. The unconfirmed syphilis reactivity rate increased from 2018 to 2023 (mean: 0.360%) compared to 2011-2017 (mean: 0.071%, p < .05). An autumnal peak in unconfirmed reactives was observed. The unconfirmed syphilis reactivity rate among WB donors at our institution increased markedly since 2017 compared to the 7 years prior and doubled from 2020 to 2021. No testing assay changes explain these results. The autumnal peak in unconfirmed reactives suggests a possible environmental trigger such as viral infection or vaccination.

Association between high-density mapping of atypical atrial flutter, clinical outcomes and healthcare utilization.

Success of atypical atrial flutter (AAFL) ablation has historically been limited by difficulty mapping the complex re-entrant circuits involved. While high-density (HD) mapping has become commonplace in clinical practice, there are limited data on outcomes of HD versus non-HD mapping for AAFL ablation. To compare clinical outcomes and healthcare utilization using HD mapping versus non-HD mapping for AAFL ablation. Retrospective analysis of all AAFL procedures between 2005 and 2022 at an academic medical center was conducted. Procedures utilizing a 16-electrode HD Grid catheter and Precision mapping system were compared to procedures using prior generation 10-20 electrode spiral catheters and the Velocity system (Abbott, IL). Cox regression models and Poisson regression models were utilized to examine procedural and healthcare utilization outcomes. Models were adjusted for left ventricular ejection fraction, CHA2DS2-VASc, and history of prior ablation. There were 108 patients (62% HD mapping) included in the analysis. Baseline clinical characteristics were similar between groups. Use of HD mapping was associated with a higher rate of AAFL circuit delineation (92.5% vs. 76%; p = .014) and a greater adjusted procedure success rate, defined as non-inducibility at procedure end, (aRR (95% CI) 1.26 (1.02-1.55) p = .035) than non-HD mapping. HD mapping was also associated with a lower rate of ED visits (aIRR (95% CI) 0.32 (0.14-0.71); p = .007) and hospitalizations (aIRR (95% CI) 0.32 (0.14-0.68); p = .004) for AF/AFL/HF through 1 year. While there was a lower rate of recurrent AFL through 1 year among HD mapping cases (aHR (95% CI) 0.60 (0.31-1.16) p = .13), statistical significance was not met likely due to the low sample size and higher rate of ambulatory rhythm monitoring in the HD group (61% vs. 39%, p = .025). Compared to non-HD mapping, AAFL ablation with HD mapping is associated with improvements in the ability to define the AAFL circuit, greater procedural success, and a reduction in the number of ED visits and hospitalization for AF/AFL/HF.

Stimulating leisure-time activities and the risk of dementia: a multi-cohort study.

Stimulating activities are associated with a decreased risk of dementia. However, the extent to which this reflects a protective effect of activity or non-participation resulting from dementia is debated. We investigated the association of stimulating leisure-time activity in late adulthood with the risk of dementia across up to two decades' follow-up. We used data from five prospective cohort studies from Finland and Sweden. Mental, social, outdoor, consumptive and physical leisure-time activities were self-reported. Incident dementia was ascertained from clinical diagnoses or healthcare and death registers. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Of the 33 263 dementia-free individuals aged ≥50years at baseline, 1408 had dementia during a mean follow-up of 7.0years. Active participation in mental (HR: 0.52, 95% CI: 0.41 to 0.65), social (HR: 0.56 95% CI: 0.46 to 0.72), outdoor (HR: 0.70, 95% CI: 0.58 to 0.85), consumptive (HR: 0.67, 95% CI: 0.53 to 0.94) and physical (HR: 0.62, 95% CI: 0.51 to 0.75) activity, as well as variety (HR: 0.54, 95% CI: 0.43 to 0.68) and the overall frequency of activity (HR: 0.41, 95% CI: 0.34 to 0.49) were associated with a reduced risk of dementia in <10years' follow-up. In ≥10years' follow-up all associations attenuated toward the null. Stimulating leisure-time activities are associated with a reduced risk of dementia in short-term but not long-term follow-up. These findings may reflect a reduction in leisure-time activity following preclinical dementia or dilution of the association over time.

Impact of race and socioeconomic deprivation on clinical outcomes and healthcare utilization in pediatric multiple sclerosis.

Health disparities in adult-onset multiple sclerosis have been identified in the Black/African American (AA) population. A higher relapse rate has been suggested in Black/AA patients with pediatric-onset MS (POMS), but little work explores healthcare utilization and social determinants of health (SDOH). To evaluate racial, ethnic, and socioeconomic disparities in POMS outcomes. Retrospective chart review identified 31 eligible patients diagnosed with POMS at Children's of Alabama between 2013 and 2023. Demographics, outcomes, and healthcare utilization over 2 years from diagnosis were collected. Patient addresses were connected to SDOH measures from the US Census. Bivariate analysis was performed using Fisher's Exact Test, Wilcoxin Test, and 2-sided t-test. Black/AA children had a higher Expanded Disability Status Scale (EDSS) at first presentation (p = 0.0276) and were more likely to initiate fingolimod vs. glatiramer acetate (p = 0.0464). Living further from Children's of Alabama was associated with a higher most recent EDSS (p = 0.0301) and fewer neurology appointments (p = 0.0167). Families living in more socioeconomically deprived census tracts had significantly more hospital admissions. Black/AA POMS patients had a more severe initial presentation and were started on higher efficacy medication. We identified disparities in EDSS and healthcare utilization based on SDOH data linked to a child's home address.

†Assessment of Unmet Clinical Needs and Healthcare Resource Use among Statin-Treated Patients with or at Risk of Developing ASCVD

†Assessment of Unmet Clinical Needs and Healthcare Resource Use among Statin-Treated Patients with or at Risk of Developing ASCVD

Proactive patient safety: enhancing hospital readiness through simulation-based clinical systems testing and healthcare failure mode and effect analysis

BackgroundRecognizing and identifying latent safety threats (LSTs) before patient care commences is crucial, aiding leaders in ensuring hospital readiness and extending its impact beyond patient safety alone. This study evaluated the effectiveness of a combination of Simulation-based Clinical Systems Testing (SbCST) with Healthcare Failure Mode and Effect Analysis (HFMEA) with regard to mitigating LSTs within a newly constructed hospital.MethodsThree phases of the combined SbCST and HFMEA approach were implemented across all hospital settings. The scenarios tested system functionalities, team responses, and resource availability. The threats thus identified were categorized into system-related issues, human issues, and resource issues, after which they were prioritized and addressed using mitigation strategies. Reassessment confirmed the effectiveness of these strategies before hospital commissioning.ResultsMore than 76% of the LSTs were mitigated through the combined approach. System-related issues, such as nonfunctional communication devices and faulty elevators, were addressed by leadership. Human issues such as miscommunication and nonadherence to hospital policy led to improvements in interprofessional communication and teamwork. Resource issues, including missing equipment and risks of oxygen explosion, were addressed through procurement, maintenance, and staff training for equipment preparation.ConclusionThe SbCST and HFMEA were highly effective with regard to proactively identifying and mitigating LSTs across all aspects of hospital preparedness. This systematic and comprehensive approach offers a valuable tool for enhancing patient safety in new healthcare facilities, thereby potentially setting a new standard for proactive hazard identification and risk management in the context of healthcare construction and commissioning.

Genipin crosslinked quaternary ammonium chitosan hydrogels for wound dressings

Bacterial infection can lead to various complications, such as inflammations on surrounding tissues, which can prolong wound healing and thus represent a significant clinical and public healthcare problem. Herein, a report on the fabrication of a novel genipin/quaternized chitosan (CS) hydrogel for wound dressing is presented. The hydrogel was prepared by mixing quaternized CS and genipin under 35 °C bath. The hydrogels showed porous structure (250–500 μm) and mechanical properties (3000–6000 Pa). In addition, the hydrogels displayed self-healing ability and adhesion performance on different substrates. Genipin crosslinked quaternized CS hydrogels showed antibacterial activities against E. coli and S. aureus. The CCK-8 and fluorescent images confirmed the cytocompatibility of hydrogels by seeding with NIH-3T3 cells. The present study showed that the prepared hydrogel has the potential to be used as wound dressing.

Maximizing Satisfaction in Orthopedic Outpatient Clinics: Evidence From Ireland.

Background Patient satisfaction is a critical metric in healthcare, reflecting the quality of care provided and influencing clinical outcomes and healthcare utilization. In orthopedic outpatient clinics, patient satisfaction affects patient adherence to treatment plans and overall health outcomes. This study aims to identify and analyze key factors influencing patient satisfaction in orthopedic outpatient clinics. Methodology This cross-sectional study was conducted from April to May 2024 across 10 orthopedic outpatient clinics. In this study, family members were included as respondents to the Patient Satisfaction Questionnaire (PSQ) when patients were unable to complete the survey due to age, cognitive impairment, or physical disabilities. This approach was adopted to ensure that the experiences of all patients, particularly minors, elderly individuals, and those with disabilities, were accurately captured. The PSQ assessed various aspects of patient satisfaction, including communication, treatment plans, addressing concerns, clinic environment, and overall satisfaction. Quantitative data were analyzed using SPSS version 27.0 (IBM Corp., Armonk, NY, USA). Results The study included 172 respondents. High levels of overall satisfaction were reported, with 142 (82.6%) respondents very satisfied and 28 (16.2%) somewhat satisfied. Significant associations were found between overall satisfaction and several factors, namely, effective communication, thorough explanation of treatment plans, addressing patient concerns, and a clean, comfortable clinic environment. Shorter waiting times were also associated with higher satisfaction. Regression analysis revealed that staff rating and the thoroughness of treatment plans were significant predictors of overall satisfaction. Conclusions Effective communication, thorough treatment explanations, addressing patient concerns, and maintaining a clean clinic environment are key determinants of patient satisfaction in orthopedic outpatient clinics. Reducing waiting times and investing in staff training on communication and empathetic care can further enhance patient satisfaction. These findings provide valuable insights for healthcare providers and administrators aiming to improve patient experiences in orthopedic outpatient settings. Further research is recommended to explore these relationships in diverse settings and develop targeted interventions.

Do inexperienced nurses in the lactation period experience workplace violence? A qualitative study.

Among clinical healthcare personnel, nurses face the highest proportion of workplace violence, which has a significant impact on their physical and mental well-being as well as their personal and professional lives. However, little is known about the effects of workplace violence on inexperienced breastfeeding nurses and their experiences during and after breastfeeding when they return to work. This study aimed to explore the experiences of inexperienced breastfeeding nurses who encountered workplace violence and its resulting impacts. This study employed a descriptive qualitative design. Semi-structured in-depth interviews were conducted with 20 nurses working in various positions and departments at three tertiary hospitals. Purposive and maximum variation sampling techniques were employed. The interview data were analyzed using Colaizzi's method, and the research findings were reported according to Consolidated Criteria for Reporting Qualitative Studies (COREQ)standards. Inferences regarding workplace violence and risks for inexperienced breastfeeding nurses included physical labor (such as lifting heavy objects and performing cardiopulmonary resuscitation), conflicts, inadequate job skills, role confusion, occupational exposure risks, patient violence, and pressure from older adults. An inductive thematic investigation revealed the "Challenges faced during breastfeeding," "Conflicting professional and family roles," "Out of balance," and "Coping strategies." Inexperienced breastfeeding nurses experience several negative consequences due to workplace violence. Therefore, it is essential to plan and implement preventive strategies and management programs that specifically target workplace violence among inexperienced breastfeeding nurses.

What Types of Continuing Professional Development Training Courses Do Healthcare Assistants Employed in Community Care Settings Think Should Be Conducted Face-To-Face or Online?

Aim: This study was undertaken to explore what types of continuing professional development (CPD) clinical training courses Healthcare Assistants think should be conducted by face-to-face or online methods. Methodology: A purpose-built piloted questionnaire was utilised to collect data. A total of 71 completed questionnaires were included in the data analysis. The participants were all consenting adults aged between 20 - 61 years. Results: The face-to-face learning method was thought of as the preferred method by 45/71 (63%) of the participants while 9/71 (14%) of the participants thought of online learning as their preferred method. Interestingly, 17/71 (23%) thought of blended learning as their preferred method. Among 20 popular CPD courses, participants preferred 16/20 (80%) for the face-to-face training method and 3/20 (15%) of the courses for online training methods. There was an equal preference for 1/20 (5%) course. Conclusion: The face-to-face training/learning method remains the dominant preference for HCAs, but online training/learning is gaining popularity, especially among younger computer-literate learners. A blend of the two methods may satisfy proponents of traditional teacher-centric training/learning styles on one hand and those supporting digitally aided student-centric training/learning on the other.