Hospital Physicians Research Articles

Decision-making and ethical dilemmas experienced by hospital physicians during the COVID-19 pandemic in the Czech Republic

BackgroundDuring the COVID-19 pandemic, global healthcare systems faced unprecedented challenges, with a lack of resources and suboptimal patient care emerging as primary concerns.MethodsOur research, using a comprehensive 24-item electronic questionnaire, “Reflections on the Provision of Healthcare during the COVID-19 Pandemic,” delved into the experiences of 938 physicians across the Czech Republic.ResultsOver fifty per cent observed a “lower standard of care” compared to pre-pandemic levels. A division arose among physicians regarding a decision’s medical, ethical, or legal basis, with a notable gender disparity: male doctors leaned towards medical perspectives, whereas females accented the ethical perspective. Decision-making concerning health care limitations required agreement among the physicians on duty, interdisciplinary teams, or shift supervisors. Physicians reported varying degrees of patient or family participation in health care decisions. Variables such as age, pre-existing health conditions, and life expectancy influenced care decisions. Surprisingly, half of the physicians faced refusals of patients’ transportation to better-equipped facilities due to resource constraints. One-third of physicians never discuss the decision about care limitation and other options with patients or their families. As a result, almost fifty per cent of the physicians rarely or never imparted information about care limitations to patients.ConclusionThe survey shed light on the profound ethical dilemmas hospital physicians face across different types of healthcare facilities during the pandemic. It uncovered the need for open dialogue and scholarly debate on resource allocation and strengthening the role of patients and their families in care decisions in future healthcare crises.

Exploring hospital physician relationships in HRD through POS lens: an integrated literature review

Purpose The purpose of the paper is to examine how perceived organizational support (POS) for physicians is situated within different hospital physician relationship (HPR) employment structures and to explore human resource development (HRD) implications within these relationships. Design/methodology/approach This paper focuses on research in the western context using an integrated literature review methodology, which includes employed (“Employed”), affiliated (“Affiliated”) and Locum tenens physicians [“Locum(s)]” who work in hospitals. Findings POS constructs, under the broader purview of organizational support theory (OST), provided evidence for hospital leadership to find intentional ways to support their hospitals physicians within all HPR models. Our review also revealed the strategies adopted by hospitals to align and influence physician practice behaviors, which were researched using economic and/or noneconomic constructs. The findings indicated stronger or isolated alignment with hospitals where the physicians practiced. Research limitations/implications The paper focuses on Employed, Affiliated and Locums HPRs in western healthcare contexts. When available, distinctions are made with respect to the US or Europe. Limitations to our review include (a) limited research within healthcare contexts on organizational support, and (b) limited literature about Affiliated and Locums hospital physician populations in the US and Europe written in English. Practical implications Though hospital physicians are integral to patient care and economic efficiencies in hospitals, not much is known about how hospital physicians perceive organizational support within different HPRs, and what construct contributions are made to hospital system performance. Accordingly, this study contributes to the HRD literature in the healthcare context starting with confirming HPRs from a POS perspective and extending findings to theories of employee alignment that can contribute to organizational performance. The findings of this study serve HRD theory and practice. Theorists may use this to pursue HPR-related inquiries to explore HRD’s influence in creating hospital policies and culture that make physicians feel supported and satisfies the hospital’s financial and patient care-related goals. Practitioners may use the findings of this article to inform quality improvement and organization development efforts. Social implications Hospital physicians are an integral workforce that provides critical patient care across the world. Understanding how organizations can support physicians has a ripple effect from hospitals to communities at large. Originality/value This review contributes toward the development of a conceptual model of organizational support for HRD that can help physicians and their hospital employees within different HPRs to reach mutual goals of support, understanding, integration (clinical, economic and noneconomic) and physician alignment evidenced by improved patient care and organizational performance.

Acute remote home monitoring of acutely ill patients with COVID-19: how Dutch home monitoring initiatives were organized during the pandemic

BackgroundAcute remote home monitoring of acutely ill patients with COVID-19 holds potential for early detection of deterioration and thus subsequentearly intervention that may prevent or mitigate progression to severe illness and need for respiratory support. Our aim was to describe common features of acute remote home monitoring programs for acutely ill patients with COVID-19 in the Netherlands.MethodsWe performed literature searches (both grey and academic) between 1st March 2020 and 1st March 2023 to identify Dutch acute remote home monitoring initiatives, excluding studies on early hospital discharge. From the available protocols, we extracted relevant information on patient eligibility, organization of acute remote home monitoring and home management.ResultsWe identified and approached ten acute remote home monitoring initiatives for information regarding their used protocols. Seven out of ten protocols were retrieved and assessed. All initiatives focused on adult patients with COVID-19 who where at risk of developing severe COVID-19, and all initiatives provided close follow-up through remote home monitoring using medically certified pulse oximeters. Daily measurements included peripheral oxygen saturation (all initiatives, n = 7), body temperature (n = 6), heart frequency per minute (n = 4) and breathing rate per minute (n = 4). For follow-up and review of measured values, in most initiatives (n = 6) the physician (general practitioner or hospital physician) in charge was supported by a dedicated monitoring center. In 5 out of 7 initiatives, the general practitioner (GP) was responsible for supervising the patients and monitoring staff.ConclusionThe acute remote home monitoring initiatives that emerged in the Netherlands during the first wave of the COVID-19 pandemic were similarly organized. Common building blocks for home monitoring include daily check of peripheral oxygen saturation, monitoring through a dedicated remote monitoring center alongside healthcare personnel and a supervising physician.

Staffing situation and basics requirement calculations in the inpatient and outpatient sector in Germany - a representative survey by the Working Group of Senior Gastroenterology Hospital Physicians (ALGK)

In Germany, there are no uniform hospital standards for the transparent calculation of medical staffing requirements in hospitals. This is particularly true for outpatient services.The ALGK conducted a member survey via the link https://de.surveymonkey.com/r/H7TTJYZ from March 21 to May 1, 2024. 400 members with a valid email address were contacted. The 119 extraordinary members who had ended their professional activity were not included. 17 questions were asked in the survey.The response rate was 24%. 37% represented basic and standard, 47% specialized and 16% maximum care providers. Municipal hospitals were represented by 42%, denominational providers by 34% and private providers by 24%. 7% of the hospitals had fewer than 200 beds, 28% 200 to 400 beds, 37% 400 to 600 beds, 15% 600 to 800 beds and 13% more than 800 beds. Up to 1.500 patients were treated annually in 15%, up to 2.500 patients in 15%, each up to 3.000 or 4.000 patient in 22%s, up to 5,000 patientsin 16% and more than 5.000 patients per year in 12%. The average casemix was 2373 ± 999 and the casemix index 0.70 ± 0.11. On average, 17.6 ± 7.6 doctor's posts were available and one consultant treated 14 ± 2.7 patients per day. A transparent personnel calculation was not available in 56% of the departments or clinics, in 82% there was no internal cost allocation or cost recovery calculation, in 54% there was no internal cost allocation. In 54%, there was no feedback on outpatient services from the administration, in 93% there was no transparent calculation of physician positions based on outpatient services, in 97% the training and further training of young colleagues was not taken into account in the calculation of positions, in 75% there was no communicated and recognizable strategic plan by the hospital operator for the senior gastroenterologists with regard to outpatient services. 49% of those surveyed feared that their hospital operator would not be able to cope with the restructuring in the healthcare sector with outpatient services, centralization, minimum volume compliance and would even jeopardize its existence.Transparent job calculation and communication about inpatient and outpatient gastroenterology services and the strategic objectives of the healthcare structural reform are very patchy in German hospitals. This leads to a high degree of uncertainty and existential fears.

Physician experiences of team-based clinical microsystems: implications for the future of inpatient interprofessional communication

ABSTRACT Healthcare clinical microsystems are small, goal-oriented groups of healthcare professionals that work together on a regular basis to provide care to discrete patient populations. They often include team-based frameworks such as bedside interprofessional rounds, geographic colocation of healthcare team members, interprofessional staff leadership, and unit-level data sharing. In inpatient settings, microsystems improve interprofessional communication and collaboration. In this qualitative study, we examined physician experiences of clinical microsystems and the mechanisms underpinning interprofessional communication in this environment. We interviewed 51 resident and hospitalist physicians. Thematic analysis of physician experiences revealed three key themes: (a) Clinical microsystem effect on workflow, (b) Open forum and work relationships, and (c) Face-to-face vs technology-based communication. Physicians described strong interprofessional relationships based on frequent face-to-face communication. Familiarity with healthcare team members, often resulting from being co-located to the same units, created a comfortable work environment, advanced patient care, and accelerated workflow. Physicians preferred in-person communication with interprofessional colleagues over technology-based communicationand described how in-person interactions enriched subsequent technology-led interactions. As the use of technology-based communication grows in inpatient settings, decreasing face-to-face interactions and facilitating dispersed care, understanding and implementing optimal conditions for effective interprofessional communication is essential.

Facility evaluation of resigned hospital physicians:managerial implications for hospital physician manpower

Facility evaluation of resigned hospital physicians:managerial implications for hospital physician manpower

Emotional resilience and sense of danger among doctors in hospitals during periods of heightened tensions and warfare in Israel

BackgroundThe “Iron Swords” War beginning in October 2023 led to unprecedented levels of shock and trauma across Israel, significantly impacting the Israeli population and medical personnel. This study aimed to evaluate and compare the perceived personal resilience and sense of danger among physicians in hospitals located in different conflict zone proximities in Israel during this period.MethodsA quantitative, cross-sectional study was conducted from March to August 2024, during an active phase of the war, using a structured anonymous questionnaire. Participants were 161 physicians from three hospitals: one in southern Israel near the Gaza Strip, another in northern Israel near the borders with Lebanon, Syria, and Jordan, and a third in central Israel near Tel Aviv. The survey measured personal resilience using the Connor-Davidson Resilience Scale (CD-RISC-10) and sense of danger using the Solomon & Prager scale. Statistical analyses included Kruskal-Wallis H test, multiple linear regression, two-way analysis of variance (ANOVA), and Sobel test for mediation effects.ResultsThe final sample included 161 physicians (54 southern, 56 central, 51 northern). The mean resilience score was 31.14 ± 5.77, and the mean sense of danger score was 8.36 ± 4.15 (scales 0–40 and 0–20, respectively). Physicians in the southern hospital reported significantly higher sense of danger scores (p = 0.005). A trend towards lower resilience scores was noted among southern hospital physicians (p = 0.068) (p = 0.068). Two-way ANOVA revealed significant main effects of hospital location and gender on resilience (p = 0.046 and p = 0.003, respectively) and sense of danger (p = 0.005 and p = 0.062, respectively). Multiple regression analysis identified hospital location (β = -0.178, p = 0.023) and gender (β = 0.229, p = 0.004) as significant predictors of resilience. Mediation analysis indicated that personal resilience partially mediated the relationship between hospital location and sense of danger (indirect effect = 0.2896, p < 0.001).ConclusionsPhysicians working near conflict zones report higher levels of perceived danger, though their resilience is comparable to peers in less threatened regions. Enhancing personal resilience is crucial to mitigate the heightened sense of danger. This could include regular resilience training, psychological support, and specific programs for single and childless physicians to improve safety perceptions. Additionally, fostering a supportive community with clear communication and robust emergency protocols is essential for enhancing staff resilience and safety in hospitals.

Examining mobile medical supplies in supply chain: Exploring the impact of intention to use mobile medical apps

All sectors have an increasing interest in smart phone applications based on their many advantages that support business, especially the medical sector, which is constantly competing to develop the medical services provided, and accordingly in this research study we industrialized a mobile medical supplies and equipment ordering application (mobile medical app) classic and make an effort to authenticate it factually. When clients (hospitals doctors) create consumptions on the application, three dimensions can be identified: platform emotion stage, fear effect, and familiarity with product. This research designed to reinforce and brighten the most important magnitudes that improve a physician’s judgment of mobile medical app and the purpose to usage. Furthermore, this study inspected the availability of the model between hospital physicians in UAE. The classic ideal was observed by means of a model of 340 UAE clinic physicians and their personal assistant who utilize mobiles facilities in overall. The review technique, a calculable method, was applied; the fractional smallest cubes organizational calculation exhibiting systems was owned to inspect the planned agenda. The platform emotion dimension, especially fear and resistance to change, and the familiarity with the products were evaluated, and it was discovered that these factors positively influenced the objective to use the application. And the other side, the first dimension of emotion, fear, manifested as “apparent threat”, had no outcome on the purpose to using. These discoveries recommended that scholars should emphasis more on the facilities, merchandises, and the key task of the mobile medical app to control their inspirations on clients’ ordering purpose. This will progress the purchasing ways associated to acquiring medicinal materials utilizing mobile medical app and/or on other operational stages in unambiguously in UAE and the Central East at great.

Knowledge and awareness of emergency department residents and physicians regarding the management of dentofacial traumatic injuries: a cross-sectional study

BackgroundMajority of patients with Dento-Facial Traumatic Injuries (DFTI) seek initial care at an Emergency Department (ED). The timely management of DFTI is of utmost importance in determining long-term prognosis of the tooth and the patient’s overall quality of life. Thus, knowledge and awareness of ED residents & physicians regarding the management of DFTI is crucial for better patient outcomes. Numerous studies have investigated the knowledge of ED specialists regarding initial management of dental trauma, however, scientific evidence in this domain is scarce in our region.ObjectiveThe aim of this study was to evaluate the knowledge and awareness of ED residents and physicians regarding diagnosis and management of DFTI using a web-based survey on REDCap.MethodsAn observational cross-sectional study was conducted among the ED residents and physicians of private and public hospitals in Karachi, Pakistan. Data was collected through a web-based questionnaire, sent via email to the participants. The survey comprised of questions assessing their knowledge regarding the diagnosis and management of various dental and maxillofacial injuries. Responses from the participants were graded as low, moderate or high knowledge levels according to a pre-determined criteria. Pearson’s chi-square test was applied to determine the association between knowledge scores.ResultsThe total response rate was 47.6%. Out of 116 participants, 49 (42%) responses were received from physicians and 67 (58%) from residents. The overall knowledge level of participants was low (46.6%) and there was no significant difference in the knowledge level between residents and physicians (p = 0.157). Participants who had received formal training in dental trauma (p = 0.038) and those with more years of clinical experience (p = 0.004) had higher knowledge scores, that were statistically significant.ConclusionsThe knowledge and awareness of ED residents and physicians in dental trauma management was generally low. Specialized training courses are required to provide timely and adequate management of traumatic dental injuries in order to improve patient-related outcomes.

Belimumab safety in adult and paediatric Chinese patients with systemic lupus erythematosus: A Phase 4, multicentre, observational study.

Although belimumab has been widely used in patients with systemic lupus erythematosus (SLE) globally, real-world safety data among Chinese patients are limited, particularly for children. This study assessed the safety and tolerability of belimumab in adult and paediatric patients with SLE in China in real-world clinical practice. This Phase 4, multicentre, prospective, observational study enrolled patients prescribed intravenous belimumab by their physicians in tertiary hospitals, independent of a clinical study, during routine clinical visits between May 2021 and May 2022. Patients could have been receiving belimumab prior to enrolment. The primary objective was to describe the incidence of adverse events (AEs), serious AEs (SAEs), adverse drug reactions (ADRs) and AEs of special interest (AESIs) over the 24-week follow-up period. Data were collected at enrolment and approximately 4, 12 and 24weeks post-enrolment, during routine clinical visits. AEs, ADRs and SAEs were collected as independent events. The safety population comprised patients who received ≥1 dose of belimumab and completed ≥1 follow-up visit. Overall, 417 patients were included in the analysis (safety population); 89.2% were female and mean (standard deviation) age was 35.5 (11.9) years. AEs were reported in 158 patients (37.9%) and were mostly mild (79.1%). The most common AEs were upper respiratory tract infections (n = 19, 4.6%) and hypokalaemia (n = 18, 4.3%; all mild). Among 22 patients (5.3%) with SAEs, four patients (1.0%) had drug-related SAEs (pneumonia, respiratory tract infection, gingivitis and decreased white blood cell and neutrophil count). ADRs were experienced by 25 patients (6.0%), most commonly urinary tract infections (n = 5, 1.2%). There were no fatal SAEs. AESIs occurred in 14 patients (3.4%), including infections of interest (n = 5, 1.2% all herpes zoster), serious selected psychiatric events (n = 3, 0.7%) and infusion-related systemic and anaphylactic reactions (n = 7, 1.7%). Of 14 paediatric patients enrolled, six experienced AEs, zero ADRs, two SAEs and one AESI. Belimumab was generally well tolerated in adult and paediatric patients with SLE in this real-world setting in China, with no new safety signals identified. Future assessment of long-term belimumab safety in China beyond 24weeks will extend this current body of evidence.

Relationship between sexual dysfunction and burnout among physicians in primary hospital: a cross-sectional study.

The relationship between sexual dysfunction and burnout among physicians remains unclear. To investigate the frequency of sexual dysfunction among physicians in primary hospital and explore the association between sexual dysfunction and burnout. This study was a cross-sectional survey conducted through a questionnaire. We used the Arizona Sexual Experience Scale and the Chinese version of the Maslach Burnout Inventory-Human Service Survey to assess sexual function and burnout among physicians in primary hospital. Considering the working environment of physicians, we also evaluated the doctor-patient relationship and sleep quality. Over one-third of physicians experience sexual dysfunction. Burnout is a significant factor to sexual dysfunction among medical professionals. A total of 382 doctors participated in this survey, and the prevalence of sexual dysfunction was 33.51%. Sexual arousal and orgasm were the main sexual dysfunctions faced by male and female doctors, respectively. The prevalence of burnout among physicians was 43.72%. The prevalence of sexual dysfunction among physicians experiencing burnout (45.51%) was higher than that observed in physicians without burnout (24.19%). Physicians with burnout exhibited significantly higher total and individual scores on the Arizona Sexual Experience Scale as compared with physicians without burnout (all P values <.05). There was a significant positive correlation between depersonalization and sexual drive (r = 0.508, P < .001), sexual arousal (r = 0.521, P < .001), lubrication (r = 0.432, P < .001), orgasm/erection (r = 0.420, P < .001), and sexual satisfaction (r = 0.434, P < .001). Logistic regression analysis confirmed that-in addition to burnout-older age, dissatisfaction with income, a poor doctor-patient relationship, and poor sleep were significant contributors to sexual dysfunction among physicians in primary hospitals. Sexual health is an integral aspect of well-being. Prioritizing the sexual health of medical professionals can significantly contribute to improving their productivity. First, our sample size was small, and the impact of different specialties on sexual functioning was somewhat overlooked. Second, we lacked laboratory data (eg, testosterone and prolactin levels) that could provide substantial support to sexual identification. Finally, although we used logistic regression to establish causality, the relationship between sexual dysfunction and certain factors may be bidirectional. The issue of sexual dysfunction among doctors needs more attention. We should make targeted efforts to improve the quality of physicians' sexual lives.

Empathy fatigue among physicians and its influencing factors: a cross-sectional survey from Southwest China

BackgroundEmpathy fatigue refers to the excessive empathy required of medical staff in the process of helping patients, which can produce traumatic experiences and emotional exhaustion. Severe empathy fatigue can even lead to medical disputes and errors, exacerbating increasingly tense doctor–patient relationships. Most studies on empathy fatigue focus on nurses, with few studies on physicians.MethodsA cross-sectional questionnaire was used to assess empathy fatigue among physicians in public tertiary general hospitals in southwest China using convenience sampling.ResultsA total of 562 physicians participated in the survey; average empathy satisfaction scores were 32.1 ± 6.85, 28.2 ± 5.30, and 26.2 ± 6.04 for empathy satisfaction disorder, job burnout, and secondary traumatic stress domains, respectively. We identified 291 (51.8%) physicians with severe empathy fatigue. Working two or three night shifts per week was associated with severe empathy fatigue. In total, 424 (75.4%) physicians had thoughts of resigning. Weekly rest time, empathic satisfaction disorder, job burnout, and secondary traumatic stress disorder influenced thoughts of resigning.ConclusionsThe majority of hospital physicians experience empathy fatigue and have considered resigning; this study provides reference data that demonstrate the extent of this issue. Efforts are urgently needed to address empathy fatigue in physicians and, therefore, increase physician retention.

A review of antibiotic misuse and bacterial resistance in Iraq

Background: Antimicrobial resistance poses a serious threat to healthcare globally. Reviewing current practice regarding antibiotic prescription and use is crucial to understanding antimicrobial resistance issues in Iraq and how to tackle them. Aim: To review and analyse studies addressing antimicrobial resistance as well as antibiotic prescription, dispensing and use in Iraq. Methods: In June 2023, we searched Google Scholar for, and reviewed, empirical studies related to antibiotic use and antimicrobial resistance in Iraq. Results: Thirty-seven eligible studies published between 2012 and 2023 were included in the review. Multi-drug-resistant bacteria, such as E. coli and P. aeruginosa, were commonly reported by the studies. Most physicians in public hospitals prescribed antibiotics frequently and empirically without relying on culture and sensitivity tests, and community pharmacists often dispensed antibiotics to patients without prescriptions, indicating self-medication and misuse of antibiotics in Iraq. Antibiotic residuals were found in raw meat and drinking water. Although there were antimicrobial resistance control regulations and plans, they were not fully implemented. Conclusion: This review shows that antimicrobial resistance and antibiotic misuse are serious problems in Iraq. The responsible authorities should work together to implement and enforce compliance to the antimicrobial resistance control plans using the One Health approach.

A review of antibiotic misuse and bacterial resistance in Iraq.

Antimicrobial resistance poses a serious threat to healthcare globally. Reviewing current practice regarding antibiotic prescription and use is crucial to understanding antimicrobial resistance issues in Iraq and how to tackle them. To review and analyse studies addressing antimicrobial resistance as well as antibiotic prescription, dispensing and use in Iraq. In June 2023, we searched Google Scholar for, and reviewed, empirical studies related to antibiotic use and antimicrobial resistance in Iraq. Thirty-seven eligible studies published between 2012 and 2023 were included in the review. Multi-drug-resistant bacteria, such as E. coli and P. aeruginosa, were commonly reported by the studies. Most physicians in public hospitals prescribed antibiotics frequently and empirically without relying on culture and sensitivity tests, and community pharmacists often dispensed antibiotics to patients without prescriptions, indicating self-medication and misuse of antibiotics in Iraq. Antibiotic residuals were found in raw meat and drinking water. Although there were antimicrobial resistance control regulations and plans, they were not fully implemented. This review shows that antimicrobial resistance and antibiotic misuse are serious problems in Iraq. The responsible authorities should work together to implement and enforce compliance to the antimicrobial resistance control plans using the One Health approach.

Perception and preparedness of physicians in public-sector hospitals of LMICs during the COVID-19 pandemic: a phenomenology-based qualitative study

Background: Amid such a global chaotic scenario generated by the COVID-19 pandemic, physicians hold a significant frontline position in the health care system. The current study was designed to explore the perception and preparedness of physicians toward the COVID-19 pandemic and their patient assessment and management aspects. Methods: A total of 11 physicians were purposively interviewed. All the interviews were audio-taped, transcribed verbatim, and subjected to thematic content analysis. Results: Thematic content analysis yielded six major themes: familiarity with COVID-19, perceptions and attitudes toward COVID-19, preparedness for safety against COVID-19, case assessment, barriers to lifestyle, and psychological perspectives. Even in resource-limited settings with the scarcity of sufficient protective equipment and first-line medicines, the physicians provided patient care. They demonstrated intact self-esteem and better understanding and preparedness for COVID-19. Conclusions: The findings demand timely and adequate provision of personal protection equipment, availability of first-line medicines, as well as development and implementation of occupational health surveillance measures that ensure mental health well-being.

Causes of Coronary Angioplasty Denial in Patients Diagnosed with Significant Coronary Artery Disease in East Afghanistan

Coronary Artery Disease (CAD) is a leading cause of mortality worldwide, with coronary angioplasty being a crucial intervention for patients with significant disease. This study aimed to identify and analyze the causes of coronary angioplasty denial in patients with significant coronary artery disease in Afghanistan, focusing on demographic, socioeconomic, and clinical factors. A case-control study was conducted with a sample size of 213 patients diagnosed with significant CAD at tertiary care center in Afghanistan. The case group consisted of 106 patients who were denied angioplasty, and the control group included 107 patients who underwent the procedure. Data were collected on demographic characteristics, comorbidities, education, residence, functional status, income, and the reasons for angioplasty denial. Descriptive statistics and comparative analyses were performed to assess the factors associated with denial. The primary reasons for angioplasty denial were financial constraints (45.3%, p &lt; 0.001), limited hospital facilities (15.1%, p = 0.045), patient refusal (23.6%, p &lt; 0.001), and physician preference for conservative management (12.3%, p = 0.091). Denial rates were higher among patients who were older, had multiple comorbidities, were from rural areas, and had lower education and income levels. Illiteracy and cultural beliefs contributed significantly to patient refusal, while inadequate healthcare infrastructure disproportionately affected rural populations. Financial and infrastructural barriers are the leading causes of coronary angioplasty denial in Afghanistan, exacerbating disparities in healthcare access, particularly among low-income and rural patients. Addressing these issues through policy reforms, improved healthcare infrastructure, and targeted public health education is essential to reducing CAD-related morbidity and mortality in the country.

Decision support systems as supporters of clinical work: perspectives from physicians in Finland

Abstract Background The digitalisation of healthcare has changed physicians’ clinical and administrative work. For example, decision support systems (DSSs) are expected to support physicians’ daily work. The present study examined physicians’ experiences of DSSs’ support for their work analysed by age, gender, employment sector and leadership position. Methods Altogether 4630 physicians (64% women) from Finland responded to the online survey. Logistic regression analyses were conducted to examine the associations of age, gender, employment sector, and leadership position with experiences of DSSs’ support for their work. Results Of the respondents, 21.3 % agreed that DSSs supported their work, whereas 43.5 % were neutral and 35.2 % disagreed with the statement. Age (Wald’s F = 15.5, p = 0.001), employment sector (Wald’s F = 84.6, p &amp;lt; 0.001), and leadership position (Wald’s F = 16.3, p &amp;lt; 0.001) were significantly associated with the assesment, whereas gender was not. Those aged between 45 and 54 (OR 0.65, 95% CI 0.51-0.81) and between 55 and 64 (OR 0.74, 95% CI 0.59-0.93) had lower odds for agreeing compared to those aged 35 or under. Compared to physicians in hospitals, primary care physicians had 2.18 times (95%CI=1.84-2.59) greater odds for agreeing that DSSs support their work. Those who were in leadership positions had 1.50 times (95%CI=1.23-1.82) greater odds for agreeing compared to those not in leadership positions. Conclusions Finnish physicians did not experience DSSs supporting their work. Especially older physicians, hospital physicians and those not in leadership positions gave negative assessments. DSSs should be better integrated to physician workflow, it is also possible that usability problems of DSSs such as alert fatigue affected user experiences. More attention should be paid to developing DSSs in a way that they support physicians work better. Key messages • Finnish physicians did not experience that decision support systems would actually support their work. • Especially older physicians, hospital physicians and those not in leadership positions did not agree that decision support systems would support their work.

BE-SAFE: Intervention to reduce benzodiazepine and sedative hypnotics in elderly with sleep problems

Abstract Introduction Benzodiazepine and sedative hypnotics (BSH) may have significant adverse effects and associated costs, especially in older adults: increased risk of falls, fractures, hospitalisations, impaired functioning, delirium, cognitive impairment and mortality. Addressing BSH overuse is therefore an urgent priority to improve patient safety in Europe. Objectives To present the 5-year research project BE-SAFE, funded by the European Commission (HORIZON Europe) and by the Swiss State Secretariat for Education, Research, and Innovation. BE-SAFE aims to improve patient safety by addressing knowledge and practice gaps related to the reduction of BSH used by older adults for sleep problems. Methods BE-SAFE involves seven inter-related work packages and six European countries (Belgium, Greece, Norway, Poland, Spain and Switzerland) as well as experts from Canada; it proposes an interdisciplinary and inter-sectorial approach with experts in guidelines, implementation, dissemination, case studies, geriatrics and sleep. BE-SAFE will develop an intervention comprising trustworthy clinical guidelines, implementation recommendations and patient-centred material. This intervention will be tested in a cluster randomized controlled trial; 470 patients (65 years old and above) and 62 prescribing physicians in hospital and outpatient settings. Results BE-SAFE is expected to result in reduction of BSH use. Its toolkit, encompassing setting-specific implementation recommendations, will enable healthcare professionals (HCPs) to identify, evaluate and prevent risks of BSH use. The BE-SAFE approach could also be expanded to cover reduction of use of other medications. Conclusions Through BE-SAFE, patient safety is expected to improve; BE-SAFE project will reach a wide-ranging audience, including general population, informal carers, older adults, HCPs, healthcare system leaders and decision makers. Authors acknowledge the significant input of J. Grimshaw and W. Levinson, Canada. Key messages • Deprescription of benzodiazepine and sedative hypnotics, especially in older adults, is a priority due to their side effects, particularly in this age group. • The European project BE-SAFE aspires to create easy-to-use guidelines to this aim, improving thus patient safety and healthcare.

Effect on comprehension of an AI patient-friendly hospital discharge letter: a quasi-RCT

Abstract Background During transition from hospital to home care, discharge letters serve as a bridge of information between hospital physicians, general practitioners, and patients. However, the complexity of these letters often hinders patient comprehension, leading to medication errors and adverse outcomes. We assessed the effect on patients’ comprehension and satisfaction of using AI to transform discharge letters into patient-friendly versions. Methods An online quasi-randomized controlled parallel-group trial was conducted in Italy. A synthetic discharge letter for a chronic obstructive pulmonary disease patient was drafted. GPT-4 rephrased the letter into an easier-to-understand version. Participants were assigned to receive either the original or AI-generated letter and completed comprehension assessments and satisfaction survey. Results Out of 460, 166 participants received the original letter, and 175 the AI version. The AI group showed significantly higher comprehension scores (median 4;IQR 2-4 vs. 2; IQR1-2, p &amp;lt; 0.001) and outperformed the control group in understanding diagnosis, medications, and antibiotic instructions. Perceived satisfaction was higher in the AI group across all measures (p &amp;lt; 0.001). Health literacy was a good predictor of comprehension in both arms (p = 0.013; p = 0.015). Subgroup analysis revealed the AI letter nearly bridged the comprehension gap between non-healthcare individuals and healthcare professionals receiving the original letter. Conclusions AI-optimized discharge letters improved patient understanding, and satisfaction compared to traditional letters. The study underscores the influence of sociodemographic factors like healthcare experience and health literacy on comprehension, advocating for adaptive communication strategies. These findings contribute to discussions about integrating AI in healthcare to develop patient-centered communication approaches. Key messages • AI-generated patient-friendly discharge letters significantly improved comprehension and satisfaction compared to traditional letters. • Integrating AI in healthcare communication can help bridge comprehension gaps and promote patient-centered care.

Long-term follow-up after infective endocarditis: comparison of patients who have undergone cardiac surgery versus a conservative therapy with and without an indication for cardiac surgery

Abstract Background Infective endocarditis (IE) is still a serious disease, with a high mortality despite cardiac surgery and modern conservative therapy. However, data on long-term follow-up are sparse. Methods Retrospective single centre registry on the hospital course and long-term follow-up of patients with IE who have undergone cardiac surgery or a conservative therapy with and without an indication for cardiac surgery. Results Between 1/2013 and 12/2016, 171 IE patients were treated at our hospital. A follow-up with either patient contact, review of hospital charts or physician contact was performed in 2022. Due to lost to follow-up (n=4) or refusal to participate after discharge (n=1), the final evaluation was performed with 166 patients (97.1%). They were followed-up for a median 2385.0 (between 2156 and 2773) days. 139 (81.3%) of the patients were operated (surgery) and 32 (18.7%) were treated conservatively. Amongst the conservatively treated group, 34.4% (11/32) of the patients had an indication for surgery, but it was decided not to perform it (cons-with) and 65.6% (21/32) had no indication for surgery (cons-without). Operated patients were younger compared to cons treated patients (65.1 ± 13.0 vs 72.8 ± 15.7, p = 0.00016). Whereas hospital mortality was not different between both groups (21.6 % vs 21.9 %, p = 0.97112), calculated 5y mortality was higher in der cons treated group (71.0 % vs 49.6 %, p=0.03168). Conclusions These data on long-term follow-up after IE show a high total mortality amongst all patients regardless of type of therapy, but higher mortality rate after 5 years amongst conservative treated patients (71%) compared toa surgical treated (49.6% p= 0.03168). The highest mortality rate after 5 years (100%) was detected in the cons-with compared to 55% in the cons-without group. More than 2/3 of deaths were due to IE. However, operated patients were younger and had less co-morbidities. Furthermore, rehospitalisation rate for recurrent IE was also high.