Hospital-based Physicians Research Articles

Exploring Physician Perspectives on Using Real-world Care Data for the Development of Artificial Intelligence-Based Technologies in Health Care: Qualitative Study.

BackgroundDevelopment of artificial intelligence (AI)–based technologies in health care is proceeding rapidly. The sharing and release of real-world data are key practical issues surrounding the implementation of AI solutions into existing clinical practice. However, data derived from daily patient care are necessary for initial training, and continued data supply is needed for the ongoing training, validation, and improvement of AI-based solutions. Data may need to be shared across multiple institutions and settings for the widespread implementation and high-quality use of these solutions. To date, solutions have not been widely implemented in Germany to meet the challenge of providing a sufficient data volume for the development of AI-based technologies for research and third-party entities. The Protected Artificial Intelligence Innovation Environment for Patient-Oriented Digital Health Solutions (pAItient) project aims to meet this challenge by creating a large data pool that feeds on the donation of data derived from daily patient care. Prior to building this data pool, physician perspectives regarding data donation for AI-based solutions should be studied.ObjectiveThis study explores physician perspectives on providing and using real-world care data for the development of AI-based solutions in health care in Germany.MethodsAs a part of the requirements analysis preceding the pAItient project, this qualitative study explored physician perspectives and expectations regarding the use of data derived from daily patient care in AI-based solutions. Semistructured, guide-based, and problem-centered interviews were audiorecorded, deidentified, transcribed verbatim, and analyzed inductively in a thematically structured approach.ResultsInterviews (N=8) with a mean duration of 24 (SD 7.8) minutes were conducted with 6 general practitioners and 2 hospital-based physicians. The mean participant age was 54 (SD 14.1; range 30-74) years, with an average experience as a physician of 25 (SD 13.9; range 1-45) years. Self-rated affinity toward modern information technology varied from very high to low (5-point Likert scale: mean 3.75, SD 1.1). All participants reported they would support the development of AI-based solutions in research contexts by donating deidentified data derived from daily patient care if subsequent data use was made transparent to them and their patients and the benefits for patient care were clear. Contributing to care optimization and efficiency were cited as motivation for potential data donation. Concerns regarding workflow integration (time and effort), appropriate deidentification, and the involvement of third-party entities with economic interests were discussed. The donation of data in reference to psychosomatic treatment needs was viewed critically.ConclusionsThe interviewed physicians reported they would agree to use real-world care data to support the development of AI-based solutions with a clear benefit for daily patient care. Joint ventures with third-party entities were viewed critically and should focus on care optimization and patient benefits rather than financial interests.

Physicians' experiences of challenges in working conditions related to the provision of care during the initial response to the COVID-19 pandemic in Sweden

PurposeThis aim of this study was to explore how hospital-based physicians in Sweden experienced the challenges in working conditions related to the provision of care during the initial response to the COVID-19 pandemic in 2020 when hospitals transitioned to pandemic care.Design/methodology/approachThe study has a qualitative design. Twenty-five hospital-based physicians were interviewed about their experiences from working in a hospital while healthcare organisations initially responded to COVID-19 pandemic in 2020. A thematic analysis was used to analyse the empirical material.FindingsThe analysis resulted in four themes: involuntary self-management, a self-restrictive bureaucracy, passive occupational safety and health (OSH) management, and information overload. These themes reflect how the physicians perceived their work situation during the pandemic and how they tried to maintain quality care for their patients.Practical implicationsThe study gives valuable insights for formulating preparedness in regard to crisis management plans that can secure the provision of care for future emergencies in the healthcare services.Originality/valueThis paper shows that a crisis management plans in the healthcare services should include decision structures and management, measures of risk assessment and OSH management, and the maintenance of personnel wellbeing. A prepared healthcare management can preserve quality care delivery while under crisis.

Hospitalized Children With Limited English Proficiency: The Strive to Improve Analgesia.

Hospitalized Children With Limited English Proficiency: The Strive to Improve Analgesia.

Barriers and Solutions to Improve Therapeutic Adherence from the Perspective of Primary Care and Hospital-Based Physicians.

PurposeTo identify the barriers affecting treatment adherence in patients with chronic disease and to determine solutions through the physician’s opinion of primary care and hospital settings.MethodsAn observational study using the nominal group technique was performed to reach a consensus from experts. A structured face-to-face group discussion was carried out with physicians with more than 10 years of experience in the subject of treatment adherence/compliance in either the primary care setting or the hospital setting. The experts individually rated a list of questions using the Likert scale and prioritized the top 10 questions to identify barriers and seek solutions afterward. The top 10 questions that obtained the maximum score for both groups of experts were prioritized. During the final discussion group, participating experts analyzed the prioritized items and debated on each problem to reach consensual solutions for improvement.ResultsA total of 17 professionals experts participated in the study, nine of them were from a primary care setting. In the expert group from the primary care setting, the proposed solution for the barrier identified as the highest priority was to simplify treatments, measure adherence and review medication. In the expert group from the hospital setting, the proposed solution for the barrier identified as the highest priority was training on motivational clinical interviews for healthcare workers undergraduate and postgraduate education. Finally, the expert participants proposed implementing an improvement plan with eight key ideas.ConclusionA consensual improvement plan to facilitate the control of therapeutic adherence in patients with chronic disease was developed, taking into account expert physicians’ opinions from primary care and hospital settings about barriers and solutions to address therapeutic adherence in patients with chronic disease.

A Review of Complications Associated with Cricothyrotomy

<h3>Introduction</h3> Airway management is a requisite skill set for emergency medical service (EMS) providers. Cricothyrotomy is a potentially lifesaving skill that is used when other airway maneuvers fail. The authors reviewed all patients (>14 years of age) transported to a Level I trauma/academic medical center that had cricothyrotomy performed to assess the success, complications and technique used. <h3>Methods</h3> This was a retrospective chart review of patient records from an electronic medical record system over a 151-month period. <h3>Results</h3> During the study period, 407,765 patients were transported to an academic medical center emergency department, 32 (.008%) of whom underwent cricothyrotomy. The typical patient was a white (90% 29/32) male (84% 27/32) trauma (78% 25/32) victim with a mean age of 40 (range 14-71) transported by helicopter (96% 31/32) from a referring hospital (53% 17/32). 63% (20/32) of the patient group were alive at 24 hours post procedure. Of the clinicians performing the procedure 68% (22/32) were helicopter EMS team members; 19% (6/32) were hospital-based physicians and 12% (4/32) ground EMS personnel. Of the procedures 78% (25/32) were surgical cricothyrotomies (scalpel and endotracheal tube) inserted thru the cricothyroid membrane; the remaining were done with a percutaneous device. None of the percutaneous procedures were associated with complications. Of the surgical cricothyrotomy group four patients (16%) had bleeding that required surgical hemostasis; 72% (18/25) had mainstem intubation confirmed by chest x-ray. <h3>Conclusion</h3> This study demonstrates that emergent cricothyrotomy is a rarely performed airway skill that has a high success rate. In this retrospective review, the surgical method demonstrated more complications than the percutaneous approach (mainstem intubation and bleeding); however, none were immediately life threatening.

Collaborative Care Model Promotes Justice and Equity

Collaborative Care Model Promotes Justice and Equity

An Empirical Study on the Autonomy and Satisfaction for the Physician Behavior under the National Health Insurance Plan in Taiwan

The current research will focus on the issue of physician autonomy and satisfaction under the NHIP to explore the dimensions of physician behavior and establish a reliable measurement in Taiwan. The research conducted a cross-sectional, mailed survey study on hospital-based physicians in Taiwan. The questionnaires were mailed to physicians during the first two months of 2020. Random selection and stratified sampling procedure was used to select homogeneous samples of subset of physicians. SPSS 23.0 and Smart PLS 3.0 for windows were used for data analysis. The study hypothesized that the physician satisfaction covers: resources, autonomy, professional relationship and hypothesized dimension that included autonomy, management, workload, incomes and physician-patient relationship and so no. A total of 772 mailed out, a total of 641 mails were used for analysis purpose that constituted an adjusted response rate of 83.79 percent. About less than one half of the respondents reported that they were satisfied with their jobs. Physicians in Taiwan are generally more dissatisfied and the situation is getting worse than before. The estimated average annual income of physicians in Taiwan is about five times more than that of the general population. Moreover, they tend to come from overall better family background and enjoy higher than average social status. All of them have passed the toughest and most competitive national examinations to enter medical schools. The implementation of the national health insurance policy in Taiwan changes the landscape of market practice to a certain extent. In current study we found that the general levels of satisfaction among physicians in hospitals under the NHIP and the aspects they were satisfied and dissatisfied. Secondly, physician demographics and hospital characteristics were significantly associated with physician satisfaction. Thirdly, some of the attitudinal and behavioral analysis correlated with physician satisfaction and dissatisfaction

Can an online mental health training programme improve physician supervisors' behaviour towards trainees?

Physician trainees have elevated rates of psychological distress, mental disorders and suicide. Physician supervisors can support the mental health needs of trainees. To test the feasibility and acceptability of a tailored online mental health training programme and to ascertain the potential effectiveness of the programme to alter the confidence and behaviours of physician supervisors. Thirty Australian hospital-based physicians who were supervising physician trainees participated in this quasi-experimental pre-post pilot study. All received the intervention that comprised 12 5-min modules to complete over a 3-week period. Baseline and post-intervention data were collected. The primary outcome evaluated participants' confidence to respond to trainees experiencing mental ill-health and promote a mentally healthy workplace. Secondary outcomes evaluated change in self-reported behaviour, mental health knowledge and stigmatising attitudes. Differences in mean scale scores for each outcome measure from baseline and post-intervention were compared using paired sample t-tests. Thirty physicians completed the baseline assessment and 23 (76.7%) completed all programme modules. Most participants found the programme engaging, interesting and useful. Post-intervention data, available for 25 (83.3%) participants, showed a significant increase in participants' knowledge of their role in supporting trainees under their supervision (P = 0.002), confidence to initiate conversations about mental health with staff (P < 0.001), and application of preventive and responsive supervisory behaviours to support the mental health needs of those they supervise (P < 0.001). This online mental health training programme for physician supervisors was feasible and associated with improved confidence and behaviour to support the mental health needs of trainees they supervised.

Family Physicians Working at Hospitals: A 20-Year Nationwide Trend Analysis in Taiwan

Family physicians play an essential role as gatekeepers in primary health care. However, most studies in the past focused on the geographic maldistribution of family physicians, and few studies focused on the distribution of family physicians between private practices and hospitals. This study aims to analyze the trends in practice locations of family physicians in Taiwan between 1999 and 2018, using the databases of the Taiwan Association of Family Medicine and Taiwan Medical Association. Although the annual number of physicians registered as family physicians had steadily increased from 1876 in 1999 to 3655 in 2018, the ratio of family physicians practicing in hospitals to total family physicians remained stable around 40% in the study period. Even after eliminating the trainees who were entirely registered at hospitals, the proportion of hospital-based family physicians still accounted for about one-third of the total in each year. In conclusion, family physicians had been continuously demanded by hospitals in Taiwan. If the supply of primary care-oriented family physicians is insufficient outside hospitals, health manpower planning would require urgent adjustments.

A Real-World, Observational, Prospective Study to Assess the Molecular Epidemiology of Epidermal Growth Factor Receptor (EGFR) Mutations upon Progression on or after First-Line Therapy with a First- or Second-Generation EGFR Tyrosine Kinase Inhibitor in EGFR Mutation-Positive Locally Advanced or Metastatic Non-Small Cell Lung Cancer: The 'LUNGFUL' Study.

Simple SummaryNon-small cell lung cancer (NSCLC) accounts for approximately 85% of lung cancer cases, with few patients carrying driver mutations in the gene encoding for epidermal growth factor receptor (EGFR). Advances in translational research have established EGFR tyrosine kinase inhibitors (TKIs) as the standard first-line therapy for NSCLC patients with activating EGFR mutations. The aim of our observational study was to assess the frequency of T790M acquired resistance and predictors of its presence, in patients with EGFR-mutated locally advanced or metastatic NSCLC who have progressed in the first-line EGFR-TKI treatment setting with first- or second-generation TKIs and have undergone molecular testing in tissue and/or plasma biopsy. The study highlights the challenges of performing tissue re-biopsy in routine care settings, which can lead to patients considered non-eligible for certain therapies from which they can benefit, and merits further actions from the healthcare community, in order to establish re-biopsy as a standard procedure.Background: Real-world data on the molecular epidemiology of EGFR resistance mutations at or after progression with first- or second-generation EGFR-TKIs in patients with advanced NSCLC are lacking. Methods: This ongoing observational study was carried out by 23 hospital-based physicians in Greece. The decision to perform cobas® EGFR Mutation Test v2 in tissue and/or plasma at disease progression was made before enrollment. For patients with negative/inconclusive T790M plasma-based results, tissue re-biopsy could be performed. Results: Ninety-six (96) eligible patients were consecutively enrolled (median age: 67.8 years) between July-2017 and September-2019. Of the patients, 98% were tested upon progression using plasma and 2% using tissue/cytology biopsy. The T790M mutation was detected in 16.0% of liquid biopsies. Tissue re-biopsy was performed in 22.8% of patients with a T790M-negative plasma result. In total, the T790M positivity rate was 21.9%, not differing between patients on first- or second-generation EGFR-TKI. Higher (≥2) ECOG performance status and longer (≥10 months) time to disease progression following EGFR-TKI treatment initiation were associated with T790M positivity. Conclusions: Results from plasma/tissue-cytology samples in a real-world setting, yielded a T790M positivity rate lower than previous reports. Fewer than one in four patients with negative plasma-based testing underwent tissue re-biopsy, indicating the challenges in routine care settings.

Evaluation of the productivity of hospital-based researchers: comparative study between the h-index and the h(fa)-index

The h-index is often used to evaluate researchers and to measure their respective contributions to the scientific community. However, it does not take into account the relative contribution of each author to the articles. We aimed to assess the added value of the h(fa)-index, an index introducing a weighting factor for the first author. This cross-sectional study was conducted in March 2020 in Switzerland. We selected all hospital-based senior physicians practicing internal medicine or family medicine in the six university hospitals. Using Web of Science, we retrieved the h-index and computed the h(fa)-index of all physicians with a non-zero h-index. We used Spearman coefficients to examine the correlation between the two indices and Cohen’s kappa to determine the inter-rater agreement. 244 physicians were included in the study (men: 63%). They had a median h-index of 3 (IQR 11) and a median h(fa) index of 4.5 (IQR 14). The correlation between the two indices was very high (rho 0.98, p-value < 0.001). However, the inter-rater agreement was only moderate (Kappa 0.59 [95% CI 0.56–0.64]). The h(fa)-index was able to correct the categorization of the researchers in about 1/3 of the cases (agreement 63.4%). Although it is very challenging to evaluate researchers with a unique indicator, these data suggest that the h(fa)-index could be a better evaluation tool of researchers’ productivity.

The Collaboration for Increasing Influenza Vaccination in Children (CIIVIC): a meeting report

The Collaboration for Increasing Influenza Vaccination in Children (CIIVIC): a meeting report

Accuracy of PubMed-based author lists of publications and use of author identifiers to address author name ambiguity: a cross-sectional study

Objective: To assess the accuracy of PubMed-based author lists of publications and use of author identifiers to address author name ambiguity. Methods: In this Swiss study conducted in 2019, 300 hospital-based senior physicians were asked to generate a list of their publications in PubMed and complete a questionnaire (type of query used, number of errors in their list of publications, knowledge and use of ORCID and ResearcherID). Results: 156 physicians (52%) agreed to participate, 145 of whom published at least one article (mean number of publications: 60 (SD 73)). Only 17% used the advanced search option. On average, there were 5 articles in the lists that were not co-authored by participants (advanced search: 1.0 (SD 2.6) vs. 5.9 (SD 13.9), p value 0.02) and 3 articles co-authored by participants that did not appear in the lists (advanced search: 1.5 (SD 2.0) vs. 3.6 (SD 8.4), p-value 0.05). Although 82% were aware of ORCID, only 16% added all their articles (39% and 6% respectively for ResearcherID). Conclusions: When used by senior physicians, the advanced search in PubMed is accurate for retrieving authors’ publications. Author identifiers are only used by a minority of physicians and are therefore not recommended in this context, as they would lead to inaccurate results.

Videogame intervention to increase advance care planning conversations by hospitalists with older adults: study protocol for a stepped-wedge clinical trial

IntroductionFewer than half of all people in the USA have a documented advance care plan (ACP). Hospitalisation offers an opportunity for physicians to initiate ACP conversations. Despite expert recommendations, hospital-based...

Comparing burnout and work-life balance among specialists in internal medicine: the role of inpatient vs. outpatient workplace

BackgroundCompared to the general population, physicians are more likely to experience increased burnout and lowered work-life balance. In our article, we want to analyze whether the workplace of a physician is associated with these outcomes.MethodsIn September 2019, physicians from various specialties answered a comprehensive questionnaire. We analyzed a subsample of 183 internists that were working full time, 51.4% were female.ResultsMultivariate analysis showed that internists working in an outpatient setting exhibit significantly higher WLB and more favorable scores on all three burnout dimensions. In the regression analysis, hospital-based physicians exhibited higher exhaustion, cynicism and total burnout score as well as lower WLB.ConclusionsPhysician working at hospitals exhibit less favorable outcomes compared to their colleagues in outpatient settings. This could be a consequence of workplace-specific factors that could be targeted by interventions to improve physician mental health and subsequent patient care.

Prevention of Venous Thromboembolism in Acutely Ill Medical Patients: A New Era.

Venous thromboembolism (VTE) is the leading preventable cause of death in hospitalized patients and data consistently show that acutely ill medical patients remain at increased risk for VTE-related morbidity and mortality in the post-hospital discharge period. Prescribing extended thromboprophylaxis for up to 45 days following an acute hospitalization in key patient subgroups that include more than one-quarter of hospitalized medically-ill patients represents a paradigm shift in the way hospital-based physicians think about VTE prevention. Advances in the field of primary thromboprophylaxis in acutely-ill medical patients using validated VTE and bleeding risk assessment models have established key patient subgroups at high risk of VTE and low risk of bleeding that may benefit from both in-hospital and extended thromboprophylaxis. The direct oral anticoagulants betrixaban and rivaroxaban are now U.S. Food and Drug Administration-approved for in-hospital and extended thromboprophylaxis in medically ill patients and provide net clinical benefit in these key subgroups. Coronavirus disease-2019 may predispose patients to VTE due to excessive inflammation, platelet activation, endothelial dysfunction, and hemostasis. The optimum preventive strategy for these patients requires further investigation. This article aims to review the latest concepts in predicting and preventing VTE and discuss the new era of extended thromboprophylaxis in hospitalized medically ill patients.

Which Strategies Improve Physicians' Experience with Health Information Technology?

Abstract Objectives While electronic health records (EHRs) have improved billing efficiency and note legibility, they may also disrupt clinical workflows, affect patient interactions, and contribute to physician burnout. This study aimed to identify effective strategies, as reported by physicians, to mitigate these EHR shortcomings. Methods The Rhode Island Department of Health administers a health information technology (HIT) survey biennially to all physicians in active practice statewide. The 2019 survey asked physicians about strategies implemented personally or by their practice to improve their experience working with HIT. Physicians who identified at least one strategy were then asked if each implemented strategy was “actually useful.” Results The 2019 survey was administered to 4,266 physicians, with a response rate of 43%. Both office- and hospital-based physicians most commonly reported that their practices had implemented voice-recognition dictation software (48 and 68%, respectively). Office- and hospital-based physicians identified self-care as the most commonly implemented personal change (48 and 47%, respectively). However, 26% of office-based and 15% of hospital-based physicians reported reducing clinical hours or working part-time to improve their experience working with HIT. The strategies identified as “actually useful” varied by practice setting and were not always the most widely implemented approaches. Conclusion Most physicians reported that both they personally and their practices had implemented strategies to improve their experience with HIT. Physicians found some of these strategies more helpful than others, and the strategies identified as most useful differed between office- and hospital-based physicians. From a workforce and access perspective, prioritizing strategies that physicians find “actually useful” is critical, as many physicians in both settings reported reducing clinical hours to improve their experience.

Trends in practice: attitudes and challenges in the diagnosis, treatment and management of HIV infection in Australia.

As life expectancy for people living with human immunodeficiency virus (HIV) (PLWHIV) increases, management models for HIV infection are changing. To understand approaches to practice within this shifting climate and across different medical settings, in 2017 we conducted a baseline survey among the main medical practitioner groups responsible for HIV-infection care in Australia: hospital-based physicians (HBP), sexual health physicians (SHP) and 'accredited general practitioners' (referred to in 2017 study as 's100 GPs'), who are GPs authorised to prescribe HIV therapies after completing accredited national training. The follow-up survey presented here explores any changes in approaches, attitudes and challenges associated with HIV-infection management among the same practitioner groups: 17 HBP, 15 SHP and 69 accredited GP (referred to throughout as GP; includes those with sexual health diploma). Analysis of survey results showed practices remained largely similar between surveys, with a few notable exceptions. Greater consistency in attitudes, knowledge and approaches was observed between the practitioner specialty groups, with only small differences between modes of practice. A trend towards earlier initiation of HIV treatment was also identified, with a higher proportion of practitioners than baseline reporting they were comfortable beginning therapy on the day of HIV diagnosis. The impact of the introduction of two-drug therapy in Australia was also explored. Although the majority of survey respondents (and SHP in particular) expressed greater preference for three-drug compared with two-drug regimens, interest in two-drug regimens appears to be growing and may influence future prescribing practices. Addressing mental health issues for PLWHIV was again highlighted as a major priority, with practitioners overwhelmingly reporting mental health management as among their most difficult clinical challenges. Reduction in stigma/discrimination and better access to substance dependency programmes were also identified as unmet needs for this patient cohort. Consistent with our baseline survey, it appears targeted interventions and supports appropriate to this population are still required to improve overall wellbeing for PLWHIV.

Health-care organization for the management and surveillance of SARS-CoV-2 infection in children during pandemic in Campania region, Italy

BackgroundIn comparison with adults, severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection in children has a milder course. The management of children with suspected or confirmed coronavirus disease (COVID-19) needs to be appropriately targeted.MethodsWe designed a hub-and-spoke system to provide healthcare indications based on the use of telemedicine and stringent admission criteria, coordinate local stakeholders and disseminate information.ResultBetween March 24th and September 24th 2020, the Hub Centre managed a total of 208 children (52% males, median age, 5.2, IQR 2–9.6 years) with suspected or confirmed COVID-19. Among them, 174 were managed in cooperation with family pediatricians and 34 with hospital-based physicians. One hundred-four (50%) received a final diagnosis of SARS-CoV-2 infection. Application of stringent criteria for hospital admission based on clinical conditions, risk factors and respect of biocontainment measures, allowed to manage the majority of cases (74, 71.1%) through telemedicine. Thirty children (28%) were hospitalized (median length 10 days, IQR 5–19 days), mainly due to the presence of persistent fever, mild respiratory distress or co-infection occurring in infant or children with underlying conditions. However, the reasons for admission slightly changed over time.ConclusionAn hub-and-spoke system is effective in coordinate territorial health-care structures involved in management paediatric COVID-19 cases through telemedicine and the definition of stringent hospital admission criteria.The management of children with COVID-19 should be based on clinical conditions, assessed on a case-by-case critical evaluation, as well as on isolation measures, but may vary according to local epidemiological changes.

Scientific publications in internal medicine and family medicine: a comparative cross-sectional study in Swiss university hospitals.

Family medicine is a relatively new academic medical discipline. We aimed to compare the main bibliometric indices of hospital-based senior physicians practicing internal medicine versus family medicine in Switzerland. We conducted this cross-sectional study in March 2020. We selected all hospital-based senior physicians practicing internal medicine or family medicine in the six Swiss university hospitals. Using Web of Science, after removing from both groups of physicians the 5% with the highest number of publications, we extracted the number of publications, the number of publications per year, the number of citations, the number of citations per year, the number of citations per publication and the h-index. We compared the data between the two groups using negative binomial regressions and the proportion of physicians having at least one publication using chi-square tests. We included 349 physicians in the study (internal medicine: 51%, men: 51%). The median number of publications was three [interquartile range (IQR) = 18], the median number of citations was nine (IQR = 158) and the median h-index was one (IQR = 5). All bibliometric indices were similar in both groups, as was the proportion of physicians having at least one publication (family medicine: 87% versus 82%, P = 0.15). We found no association between the bibliometric indices and the medical specialty. Further studies are needed to explore other important indicators of academic output, such as those more specifically assessing its quality and scientific importance.