Clinician Attitudes Research Articles

Associations Between Generalist Knowledge of Borderline Personality Disorder and Clinician Factors and Attitudes.

Borderline personality disorder (BPD) is highly stigmatized. It is associated with negative clinician attitudes, which have been shown to improve with training. This study presents data collected at formal trainings in good psychiatric management (GPM) of BPD at several sites in the United States, Canada, Brazil, and Sweden. Three hundred twenty seven clinical professionals completed a 48-question true/false quiz testing knowledge of GPM, with a small subset (N = 33) that also completed a 13-item assessment of attitudes about BPD. Knowledge of GPM did not differ between course participants of different disciplines (e.g., psychiatry, psychology, and social work) but did differ according to level of GPM training and experience practicing GPM. Clinicians with experience working in specialty treatment programs focused on BPD scored higher than clinicians without this type of experience, but the scores of these more generalist clinicians were lower only by a few points. Using linear regression, we analyzed the association between GPM knowledge and negative clinician attitudes toward care of people with BPD. Greater knowledge of GPM was associated with decreased ratings of dislike of BPD patients, avoidance of treating them, and hopelessness about their prognosis.

Clinician views on acupuncture for acute pain care in a busy urban emergency department.

Clinician views on acupuncture for acute pain care in a busy urban emergency department.

Intensive care clinician attitudes and perceptions towards whānau participation in adult intensive care bedside ward rounds in Aotearoa New Zealand: An online survey.

Clinical practice guidelines endorse family involvement in ward rounds to improve communication and engagement between patients, whānau (family), and healthcare teams, yet the practice has not been universally implemented. Whānau inclusion in adult bedside rounds is often met with hesitation by intensive care unit (ICU) healthcare clinicians, and reasons for this have not been explored in Aotearoa, New Zealand. The aim of this study was to assess attitudes and perceptions of ICU clinicians towards whānau-family inclusion in adult ICU ward rounds in Aotearoa New Zealand. A national, prospective, cross-sectional survey using a self-administered online questionnaire was distributed to three metropolitan ICUs in Aotearoa, New Zealand, and members of the New Zealand College of Critical Care Nurses and the College of Intensive Care Medicine of Australia and New Zealand in the period July-December 2020. In total, 188 ICU physicians, nurses, and allied health professionals responded. Over half of respondents strongly (23.4%) or somewhat agreed (29.3%) that whānau-family members should be given the option to attend bedside rounds, whereas more than half reported having had a positive experience when whānau-family had been present on rounds. Less experienced nurses were more likely to ask whānau-family to leave during rounds than more experienced nurses (46.5% vs 38.2%, respectively, p=0.006). Clinicians voiced concern that whānau-family inclusion would prolong rounds, reduce teaching opportunities, constrain discussion of sensitive information, and compromise patient confidentiality. However, they also said that whānau-family-centred rounds were useful to better inform whānau-family members and to facilitate culturally safe practice. Intensive care clinicians demonstrated positive attitudes and perceptions towards whānau-family-centred ward rounds, but concerns regarding the structure and quality of rounds were raised. Clinicians recognise whānau-family-centred rounds as an opportunity to enhance communication and facilitate culturally safe practice. Education regarding the benefits of whānau-family-centred rounds to facilitate implementation is required.

Clinician Perspectives on Measurement-Based Care to Inform Pre-Implementation Training and Workflow Design on an Adolescent Psychiatric Inpatient Unit

ABSTRACT Background Measurement-based care (MBC) in an inpatient psychiatric setting is uncommon. Objective Our aim was to understand clinician pre-implementation attitudes about MBC to optimize workflow and training for MBC implementation in an adolescent inpatient psychiatric unit. Method We assessed clinician attitudes toward MBC prior to implementing it in a real-world clinical setting using interviews and a survey. Qualitative interviews were analyzed using the Consolidated Framework for Implementation Research (CFIR) and then mapped to potential solutions via the CFIR-to-ERIC (Expert Recommendations for Implementing Change) matching tool. These results, combined with the survey responses, informed MBC training and workflow design. We then re-assessed MBC attitudes with a post-training survey. Results The top CFIR barriers emphasized: 1) measure compatibility with unit context, 2) advantage and priority of the measure, 3) evidence strength and quality of MBC, and 4) existing beliefs about MBC. These barriers were mapped to potential implementation strategies via CFIR-to-ERIC matching tool. Top solutions informed an MBC workflow, clinician training, and a pre- and post-training survey. Identified workflow and training strategies included a need to prepare MBC champions, assess clinician readiness, and conduct training. The pre-training survey showed that clinicians strongly agreed with the rationale for MBC, moderately agreed that MBC would promote patient progress, and less strongly agreed that MBC could be feasibly added to their workloads. Post-training survey findings reflected continued high interest in MBC, an increase in attitudes that MBC could promote patient progress, and an increase in feasibility attitudes, though time constraints remained a concern. Conclusions An MBC training and workflow were tailored to incorporate these findings. Pre-implementation attitudes toward MBC critically informed workflow and training development and should be considered in the implementation phase. Specific challenges when implementing MBC within a diverse safety net adolescent inpatient setting are discussed.

Catchment area characteristics do not account for geographical variation in ADHD diagnoses.

Geographical variation in Attention-Deficit/Hyperactivity Disorder (ADHD) diagnoses remains poorly understood. Previous research has found that the variation in ADHD rates between Child and Adolescent Mental Health Services (CAMHS) is not attributable to ADHD symptom load in the catchment areas of the CAMHS. This study aimed to investigate if geographical variation in rates of ADHD-diagnosis per population and per patient, as well as referral rates to CAMHS, were associated with catchment area characteristics. We used data from the Norwegian Patient Registry, covering everyone aged 5-18 in contact with CAMHS 2009-2011, and catchment area level data from Statistics Norway, including population size, centrality, socioeconomic position, welfare reliance, and general population health. Spearman's Rho was calculated to assess the strength and direction of monotonic correlation. Referral rates to CAMHS per population were lower in catchment areas with higher proportion of non-European population; more urban areas; fewer adults receiving disability benefits; and more economic inequality. Higher rates of ADHD per population were seen in areas characterised by lower socio-economic position. The rate of ADHD diagnosis per patient in CAMHS ranged from 5 to 27% and was not associated with catchment area characteristics. This study found that the proportion of ADHD diagnoses per population was moderately related to catchment area characteristics, following a social gradient in health. However, the proportion of ADHD diagnoses among patients in CAMHS was unrelated to area characteristics. This suggests that other factors, such as variation in clinician attitudes or local practice styles, may contribute to the strong variation in ADHD diagnoses.

Beliefs and Attitudes of Neurology Clinicians on Stiff Person Syndrome: A National Survey on Diagnosis and Management (P2-8.005)

Beliefs and Attitudes of Neurology Clinicians on Stiff Person Syndrome: A National Survey on Diagnosis and Management (P2-8.005)

Educating social workers and other non-prescribing clinicians about medications for opioid use disorder: Brief asynchronous training

ABSTRACT Medications for opioid use disorder decrease mortality and increase quality of life during recovery. Social workers and other non-prescribing clinicians play a crucial role in the implementation of these medications by providing treatment recommendations, referrals, and adjunctive counseling. However, many clinicians lack knowledge about these medications and/or harbor negative attitudes toward their use. Non-prescribing clinicians (N = 155) participated in an online asynchronous continuing education program regarding medications for opioid use disorder. The program was associated with increases in positive attitudes and behavioral intentions related to medications for opioid use disorder. Those with less prior exposure exhibited the greatest change. These findings suggest that even brief, self-paced training can help reduce misconceptions and shift clinician attitudes, underscoring the importance of expanding MOUD-focused education to improve treatment access.

E055 Exploring patient and clinician understanding of bone density (DXA) scan results: qualitative findings from the INDEX study

Abstract Background/Aims Dual-energy X-ray absorptiometry (DXA) scans are routinely performed to assess bone mineral density (BMD), diagnose osteoporosis, refine fracture risk assessment and inform osteoporosis medicine decisions. The INDEX (understandINg bone DEnsity [dXa] scans) study aimed to explore patient and clinician understanding of DXA scans and results to identify opportunities to optimise DXA understanding. Methods Semi-structured think-aloud interviews with patients attending DXA scans across 3 NHS sites and primary and secondary care clinicians who refer to, and receive results from, DXA services. Interviews were transcribed verbatim and analysed using framework analysis, sensitised by the common-sense model of illness self-regulation, to explore how patients and clinicians perceive, interpret, and respond to DXA scan results. Results Interviews were completed with 38 patients (84% female; mean age of 66 years; 89% high health literacy), 12 primary care clinicians (11 General Practitioners, 1 First Contact Practitioner), and 10 secondary care clinicians. Four overarching themes related to (1) the importance of DXA scans; (2) (un)met information needs and (3) the impact of these; and (4) barriers and facilitators to addressing information needs. Perceived importance of DXA scans was influenced by individual and system-level factors. Patient and clinician attitudes towards osteoporosis and DXA scans varied, with some describing it as a low priority condition, particularly if ‘higher priority’ comorbidities were present. The reported opportunistic model of osteoporosis care coupled with the disconnect between primary and secondary care means that some patients may not receive adequate care. Patients had unmet information needs about the (1) purpose of a DXA scan, their DXA scan result, and what it means for their bone health and (2) the need for osteoporosis medicines and future scans. These unmet information needs impacted whether patients felt prepared for their DXA scan and anxiety caused by (mis)interpreting their DXA result. Unmet information needs impacted patient decisions about taking osteoporosis medicines. Clinicians also described unmet information needs regarding (1) who to refer for a DXA scan, (2) interpretation of DXA reports, and (3) drug treatment options and management. Barriers to meeting information needs included in DXA result format and content, including technical information. Patients and clinicians reflected that written results (e.g. texts, clinical reports) were insufficient to meet their information needs, particularly in absence of clinical interpretation. Some clinicians described potential clinical risk associated with misreading DXA reports. Opportunities for clinicians to explain DXA results and for patients to ask questions facilitated patient understanding, however time and resource constraints limited this. Conclusion The INDEX study highlights unmet information needs about DXA among patients and clinicians, revealing opportunities to optimise understanding. Findings will inform the coproduction of recommendations and resources to enhance DXA understanding, with the aim of supporting clinical and shared decision-making, osteoporosis care, and medicine uptake. Disclosure C. Kettle: None. F. Manning: Grants/research support; funded by the NIHR Applied Research Collaboration South West Peninsula. B. Henderson: None. J. Griffin: None. K. Knapp: None. J. Butterworth: Grants/research support; funded by a NIHR Doctoral Fellowship award (2017-10-005). C. Jinks: Grants/research support; part funded by NIHR Applied Research Collaboration (ARC) West Midlands. L. Bullock: None. Z. Paskins: Consultancies; received consultancy fees from UCB Pharma. Grants/research support; funded by the National Institute for Health and Care Research (NIHR) [Clinician Scientist Award (CS-2018-18-ST2-010)/NIHR Academy].

Clinician attitudes, opinions and practice patterns regarding inotrope use for cardiac surgery in the USA: a multicentre mixed methods study protocol

IntroductionCardiac inotrope medications administered to cardiac surgical patients carry steep risk–benefit trade-offs, yet wide inter-institutional variation exists in inotrope practices. Despite known wide variation in use of any inotrope for...

Biological sex-dependent differences in postural orthostatic tachycardia syndrome (POTS).

This prospective, cross-sectional study aimed to identify sex-based differences in diagnostic and symptom experiences in postural orthostatic tachycardia syndrome (POTS). Data from participants ≥16 years with physician-confirmed POTS enrolled in the Australian POTS registry between 1st May 2021 and 30th April 2024 were analysed. Health-related quality of life was assessed using the EuroQol 5 Dimension tool. Composite autonomic symptom score (COMPASS-31) assessed autonomic symptom burden. Self-reported sociodemographic and diagnostic journey data informed diagnostic experiences. In total, 452 females (mean age 31.4 ± 11.4 years) and 48 males (mean age 31.1 ± 14.6 years) were included. Females experienced worse autonomic symptom burden (total COMPASS-31; 50.5 ± 13.7 vs 42.4 ± 16.4 for men; P < 0.001). Both sexes interacted with an equivocal number of doctors (P = 0.763) and emergency departments (P = 0.830) before diagnosis. Females had significantly longer diagnostic delays than men (7.0 ± 8.6 vs 3.8 ± 5.4 years; P = 0.010) and were 1.2.7 times more likely to experience ≥10 years of diagnostic delay (95% CI; 1.1-6.6). Despite the diagnostic latency and worse symptom burden, females reported similar, anxiety, depression and health-related quality of life to men (global health rating where '100' = full health; females, 46.2 ± 20.4 vs males, 43.7 ± 23.6; P = 0.485). Females and males with POTS experience significant differences in autonomic symptom burden and diagnostic delay. These differences do not seem to arise from sex-based variations in health-seeking behaviour or symptom reporting but rather indicate the influence of clinician-dependent factors. Further research is needed to explore how clinician attitudes may impact sex-dependent differences in diagnosis and treatment outcomes for those with POTS. ANZCTR:12621001034820.

From Innovation to Implementation: A Qualitative Study of New Zealand Mental Health Clinicians’ Views on Digital Tools

Abstract The objective was to explore New Zealand mental health clinicians’ and trainees’ knowledge, utilization, and attitudes towards digital mental health tools through semi-structured interviews. Participants were recruited from an online survey about digital mental health tools. At the survey’s conclusion, participants could express interest and provide contact details via a link. One-on-one in-depth Zoom interviews were conducted, lasting an average of 45 min each. Data collection occurred between August 2021 and February 2022. Anonymized transcripts were analyzed using reflexive thematic analysis. Seventeen clinicians took part, and four primary themes emerged: (1) receptiveness to digital innovation, most had used digital mental health tools with clients, observing beneficial outcomes and positive responses; (2) digital technology remains a double-edged sword, offering significant supportive opportunities while also highlighting the digital divide; (3) impediments to clinical implementation, stemming from concerns about maintaining clinical safety and the need to adapt beyond established comfort zones; (4) aspirations for digital technology in clinical practice, encompassing innovative ideas, desire for tools responsive to New Zealand’s diverse communities, and ideas to maximize their potential. This qualitative study gives voice to New Zealand mental health practitioners and their interest in digital innovations to improve client care. However, integrating digital mental health tools into clinical practice effectively depends on overcoming challenges like the digital divide, data privacy, safety concerns, and the lack of tools that reflect New Zealand culture or offer personalization to meet individual needs. It highlights the need for collaboration in developing and deploying digital interventions that are both aligned with clinician requirements and adapted to the specific contexts of their client communities. This research provides a historical (albeit 3-year-old) account of clinician attitudes and knowledge. Given the rapid pace of technological innovation—particularly the rise of generative AI since late 2023—taking snapshots of changing attitudes becomes ever more important as the technological landscape continues to evolve.

Exploring Stakeholder Perspectives on the Barriers and Facilitators of Implementing Digital Technologies for Heart Disease Diagnosis: Qualitative Study.

Digital technologies are increasingly being implemented in health care to improve the quality and efficiency of care for patients. However, the rapid adoption of health technologies over the last 5 years has failed to adequately consider patient and clinician needs, which results in ineffective implementation. There is also a lack of consideration for the differences between patient and clinician needs, resulting in overgeneralized approaches to the implementation and use of digital health technologies. This study aimed to explore barriers and facilitators of the implementation of digital technologies in the diagnosis of heart disease for both patients and clinicians, and to provide recommendations to increase the acceptability of novel health technologies. We recruited 32 participants from across the United Kingdom, including 23 (72%) individuals with lived experience of heart disease and 9 (28%) clinicians involved in diagnosing heart disease. Participants with experience of living with heart disease took part in semistructured focused groups, while clinicians contributed to one-to-one semistructured interviews. Inductive thematic analysis using a phenomenological approach was conducted to analyze the resulting qualitative data and to identify themes. Results were discussed with a cardiovascular patient advisory group to enhance the rigor of our interpretation of the data. Emerging themes were separated into facilitators and barriers and categorized into resource-, technology-, and user-related themes. Resource-related barriers and facilitators related to concerns around increased clinician workload, the high cost of digital technologies, and systemic limitations within health care systems such as outdated equipment and limited support. Technology-related barriers and facilitators included themes related to reliability, accuracy, safety parameters, data security, ease of use, and personalization, all of which can impact engagement and trust with digital technologies. Finally, the most prominent themes were the user-related barriers and facilitators, which encompassed user attitudes, individual-level variation in preferences and capabilities, and impact on quality of health care experiences. This theme captured a wide variety of perspectives among the sample and revealed how patient and clinician attitudes and personal experiences substantially impact engagement with digital health technologies across the cardiovascular care pathway. Our findings highlight the importance of considering both patient and clinician needs and preferences when investigating the barriers and facilitators to effective implementation of digital health technologies. Facilitators to technology adoption include the need for cost-effective, accurate, reliable, and easy-to-use systems as well as adequate setup support and personalization to meet individual needs. Positive user attitudes, perceived improvement in care quality, and increased involvement in the care process also enhance engagement. While both clinicians and patients acknowledge the potential benefits of digital technologies, effective implementation hinges on addressing these barriers and leveraging facilitators to ensure that the technologies are perceived as useful, safe, and supportive of health care outcomes. RR2-10.1136/bmjopen-2023-072952.

Effects of the Davos Alzheimer's Collaborative early detection of cognitive impairment program on clinician attitudes, engagement, and confidence.

The number of people with dementia is expected to grow substantially across the world due to population aging, but cognitive impairment remains undetected and undiagnosed, especially in early stages. Newly available diagnostic tools such as digital cognitive assessments and blood biomarker tests may be well suited to increase the rates of early detection of dementia in primary care. The objective of the Davos Alzheimer's Collaborative Healthcare System Preparedness (DAC-SP) Early Detection Flagship Program was to improve the rate of early detection of cognitive impairment in primary care and non-specialty settings. We aimed to understand the program's impact on clinician attitudes, engagement, and confidence in diagnosing and managing cognitive impairment. Survey of participating healthcare professionals before and after the intervention. The DAC Healthcare System Preparedness Early Detection Flagship Program was implemented in seven sites across six countries: Brazil, Jamaica, Japan, Mexico, Scotland, and the United States (2 sites). 110 healthcare professionals, including, primary care physicians, specialists (neurologists and psychologists), nurses, nurse practitioners, physician assistants, social workers, and healthcare support workers completed the pre-intervention survey. 68 healthcare professionals completed the post-intervention survey. Participating sites implemented a digital cognitive assessment tool and a blood biomarker test for the Alzheimer's pathology and were trained in the administration of the digital cognitive assessment tool. The intervention was adapted to each site for cultural relevance and operational feasibility. Participants completed the General Practitioners Attitude and Confidence Scale for Dementia (GPACS-D), a 15-item scale with three subscales: Attitude to Care (six items), Confidence in Clinical Abilities (six items), and Engagement (three items). In addition to the subscale scores, the total GPACS-D score was reported. Across all sites, there was a significant increase in the Confidence in Clinical Abilities score from 2.98 (SD = 0.77) pre-intervention to 3.27 (SD = 0.72) post-intervention (p = 0.01), and in the total GPACS-D score from 3.48 (SD = 0.48) to 3.65 (SD = 0.39) (p = 0.01). There were non-significant increases in the Attitude to Care and Engagement scores across all sites. The implementation of digital cognitive assessment tools and a blood biomarker test was associated with an increase in healthcare professionals' confidence in diagnosing and managing patients with cognitive impairment in primary care and non-specialty settings. Digital cognitive assessments and blood biomarker tests are promising tools that could be utilized in primary care to increase clinicians' confidence in detecting dementia and lead to timely clinical evaluation, treatment, and referral to supportive resources.

The Role of Clinicians' Self-Efficacy in Exercise Promotion for Adults with Venous Leg Ulcers: A Cross-Sectional Study.

Physical activity is recognised for its functional, physical, and psychological benefits in managing venous leg ulcers. Despite these advantages, individuals with venous leg ulcers often remain inactive, largely due to fear of exacerbating their condition and a lack of comprehensive guidance. Clinicians play a crucial role in promoting physical activity, providing support to patients to engage in safe and beneficial exercises. This study aimed to assess clinicians' knowledge, attitudes, and practices toward physical activity in adults with venous leg ulcers to inform clinical practice and the development of targeted physical activity strategies. An online questionnaire was developed to assess clinicians' familiarity with physical activity guidelines, their confidence in recommending physical activity, and the barriers they encountered in practice. A total of 141 clinicians, predominantly nurses (99%), completed the survey, with 83% reporting awareness of clinical guidelines for venous leg ulcer management. However, only 25% regularly recommended a general increase in physical activity, 27% recommended calf strengthening exercises, and 38% consistently recommended ankle joint mobility exercises. Key barriers; 1) insufficient training to recommend specific exercises, 2) lack of evidence-based information to provide to patients and 3) limited access to exercise specialists for referrals. Statistical modelling showed that self-efficacy significantly influenced recommendations for ankle mobility exercises; clinicians with higher confidence were 7.6 times more likely to make such recommendations (p < .001). Although attitudes toward prescribing ankle exercises to adults with venous leg ulcers in compression were not statistically significantly related to reported practice (p = .087), they demonstrated relevance to clinical decision making and warrant further investigation. While clinicians recognise the importance of physical activity for adults with venous leg ulcers, gaps in knowledge, resources, and training limit their ability to provide specific exercise recommendations. Addressing these gaps through large-scale implementation of structured physical activity strategies is essential.

Shared Decision-Making Tools Implemented in the Electronic Health Record: Scoping Review.

Patient-centered care promotes the involvement of patients in decision-making related to their health care. The adoption and implementation of shared decision-making (SDM) into routine care are constrained by several obstacles, including technical and time constraints, clinician and patient attitudes and perceptions, and processes that exist outside the standardized clinical workflow. We aimed to understand the integration and implementation characteristics of reported SDM interventions integrated into an electronic health record (EHR) system. We conducted a scoping review using the methodological framework by Arksey and O'Malley with guidance from the Joanna Briggs Institute. Eligibility criteria included original research and reviews focusing on SDM situations in a real-world clinical setting and EHR integration of SDM tools and processes. We excluded retrospective studies, conference abstracts, simulation studies, user design studies, opinion pieces, and editorials. To identify eligible studies, we searched the following databases on January 11, 2021: MEDLINE, Embase, CINAHL Complete, Cochrane Library including CENTRAL, PsycINFO, Scopus, and Web of Science Core Collection. We systematically categorized descriptive data and key findings in a tabular format using predetermined data charting forms. Results were summarized using tables and associated narratives related to the review questions. Of the 2153 studies, 18 (0.84%) were included in the final review. There was a high degree of variation across studies, including SDM definitions, standardized measures, technical integration, and implementation strategies. SDM tools that targeted established health care processes promoted their use. Integrating SDM templates and tools into an EHR appeared to improve the targeted outcomes of most (17/18, 94%) studies. Most SDM interventions were designed for clinicians. Patient-specific goals and values were included in 56% (10/18) of studies. The 2 most common study outcome measures were SDM-related measures and SDM tool use. Understanding how to integrate SDM tools directly into a clinician's workflow within the EHR is a logical approach to promoting SDM into routine clinical practice. This review contributes to the literature by illuminating features of SDM tools that have been integrated into an EHR system. Standardization of SDM tools and processes, including the use of patient decision aids, is needed for consistency across SDM studies. The implementation approaches for SDM applications showed varying levels of planning and effort to promote SDM intervention awareness. Targeting accepted and established clinical processes may enhance the adoption and use of SDM tools. Future studies designed as randomized controlled trials are needed to expand the quality of the evidence base. This includes the study of integration methods into EHR systems as well as implementation methods and strategies deployed to operationalize the uptake of the SDM-integrated tools. Emphasizing patients' goals and values is another key area for future studies.

Impact of Brief Patient Exposure on Pre-Clinical U.S. Medical Student Bias Towards Mental Health.

Negative bias towards patients with mental illness contributes to worsened healthcare outcomes. However, few data exist on interventions to decrease bias. In this study, the authors examined the impact of brief patient exposure on first-year medical student perceptions of psychiatry. In 2023, two townhalls were introduced to the psychiatry course for first-year medical students at Indiana University School of Medicine. Participants were surveyed before and after the course using the Mental Illness: Clinician's Attitudes version 2 (MICA-2), with higher scores indicating more negative bias. Pre- and post-course scores were compared with paired t-tests. Level of pre-course bias in years with townhalls (2023 and 2024) was compared to the year without townhalls (2022) with an unpaired t-test. Impact of townhalls was assessed by comparing 2022 data to 2023 and 2024 with repeated measures analysis of variance (ANOVA). Response rates ranged from 22.5 to 32.0%. The combined 2023 and 2024 pre- and post-course MICA-2 means were 36.5 (SE 0.6) and 34.8 (SE 0.6), respectively. The pre-course means were not significantly different from 2022's, indicating a consistent level of baseline bias (t(236) = 0.11, p = 0.92). Repeated measures ANOVA indicated change attributed to the course was significantly less in years with townhalls (2023 and 2024) compared to the year without (2022; F = 4.04, p = 0.045). Contrary to the hypothesis, added patient volunteer exposure resulted in less reduction in bias compared to the year without such exposure. These findings suggest increased complexity in reducing bias; timing and context of patient exposures may be important determinants of effect on bias.

Patient and clinician satisfaction with home parenteral nutrition intestinal failure telemedicine consultations: A survey of clinicians and patients.

Despite the widespread use of telemedicine to assess patients with intestinal failure (IF) receiving home parenteral nutrition (HPN), satisfaction with remote consultation methods has not been comprehensively assessed. Here, we assessed patient and clinician attitudes to telephone and video IF consultations. Telemedicine questionnaires were designed and distributed in paper form to patients with IF receiving HPN under the care of a UK national IF reference center and electronically to IF clinicians in Europe, North America, Australia, and New Zealand. Seventy-eight patients (53 women and 25 men) and 110 clinicians agreed to complete the questionnaires. Sixty seven percent of patients who had telephone consultations and 50% of patients who had video consultations were satisfied with their consultations. Forty nine percent and 83% of patients who had telephone and video consultations, respectively, felt they were of the same standard as their face-to-face consultations. Despite 60% of clinicians feeling telemedicine training would be useful, 55% of clinicians stated they mostly or always met all of the needs of their patients via telephone consultations, whereas 96% of clinicians felt similarly for video consultations (P = 0.002). A total of 33% and 57% of clinicians felt telephone and video consultations, respectively, were of the same standard as face-to-face consultations (P = 0.004). This study comprehensively assesses attitudes to IF telemedicine consultations. Our data show that a large proportion of patients and clinicians are satisfied with IF telephone and video consultations. However, there is an unmet need amongst clinicians for telemedicine training.

Valid and Reliable Attitude Scales for Measuring Clinician's Attitudes Towards Telehealth Assisted Sexual Assault Forensic Exams Using a Pre-Post Survey.

The success of telehealth programs to guide clinicians to perform sexual assault medical forensic examinations relies on clinicians' positive attitudes toward telehealth services, though no validated tools to measure these variables exist. This study aims to report validity and reliability of a novel tool with two scales: Positive Beliefs and Acceptance scales for hospital nurse clinicians at sites initiating the Texas Teleforensic Remote Assistance Center (Tex-TRAC). An analysis of pre-post cross-sectional data of hospital nurse clinicians (N = 121) trained in the use of Tex-TRAC telehealth technology at seven participating hospitals in Texas from July 2022 to May 2023 was performed. The Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and Bartlett's test of Sphericity sample size analysis were performed. Exploratory Factor Analysis (EFA) was applied for validity and internal consistency reliability Cronbach alpha (α) values were described for two scales: Positive Beliefs and Acceptance scales. Positive Beliefs scale has a KMO value of 0.810 and Barlett's test of sphericity (χ2 (6) = 380.47, P < .001). Acceptance scale has a KMO value of 0.832 and Barlett's test of sphericity (χ2 (28) = 432.19, P < .001). After Promax Oblique rotation, the final four-item Positive Beliefs scale had α = .894; the final five-item Acceptance scale had α = .876. Validity and reliability of both scales demonstrated potential usefulness for future telehealth interventions engaging Sexual Assault Nurse Examiners. Continued use of these scales could provide additional information that can be leveraged in training curriculum of similar telehealth programs like Tex-TRAC.

Clinician Diagnostic Ratings and Countertransference Reactions Towards Grandiose and Vulnerable Narcissism.

Narcissistic personality disorder (NPD) is known to comprise two distinct but connected phenotypes related to 'grandiosity' and 'vulnerability', respectively. While evidence suggests differing countertransference responses to narcissism subtype expression, no study has examined this using a qualitative methodology and explored associations with ratings of personality disorder severity. Mental health clinicians (N = 180, 67% female, age = 38.9), completed qualitative clinical reflections and ratings of overall personality disorder severity towards two hypothetical vignettes displaying pathological narcissism ('grandiose' and 'vulnerable' narcissism respectively), as well as a rating of attitudes towards patients in their routine practice who resemble these vignettes. Distinct qualitative themes were identified between narcissistic subtype, with grandiose narcissism evoking anger, lack of empathy and hopelessness, compared to sympathy, sadness and discomfort in vulnerable narcissism. In terms of diagnostic category, the grandiose vignette was predominately identified as 'narcissistic personality disorder' (97%), whereas the vulnerable vignette was a mixture of 'depressive disorder' (29%), 'narcissistic personality disorder' (24%), 'trauma and stressor related disorders' (21%) and 'borderline personality disorder' (21%). Attitude scores differed significantly between subtypes, with more negative attitudes towards narcissistic grandiosity than narcissistic vulnerability. The grandiose vignette was also rated as displaying more overall personality impairment, with an association observed between negative clinician attitude scores and increased ratings of personality disorder severity. Two potential pathways are outlined to interpret these findings. The first is that inordinate stigma towards narcissistic grandiosity negatively biases clinicians when working with these patients due to feelings of anger and frustration. The second is that clinicians are drawn to minimise pathology of vulnerable patients due to their feelings of sadness and empathy. We propose that effective diagnosis and psychotherapy for pathological narcissism rely on clinicians' ability to balance these two dilemmas and resist either extreme.

Factors associated with willingness to perform expedited excisional treatment for patients at high risk for cervical precancer.

Factors associated with willingness to perform expedited excisional treatment for patients at high risk for cervical precancer.