Medical Providers Research Articles

Multidisciplinary Perspectives on Medical Decision-Making for Ostomy Surgery in Pediatric IBD: Themes from Focus Groups.

Pediatric Inflammatory Bowel Disease (IBD) is a chronic illness where patients may undergo ostomy surgery. Medical decision-making (MDM) for ostomy surgery is complex for patients/families and multidisciplinary healthcare professionals (HCPs) alike, with current uncertainty about how multidisciplinary HCPs think about ostomy care to inform future interventions to facilitate equitable multidisciplinary care for patients. This study sought to understand pediatric IBD multidisciplinary HCPs' perceptions regarding ostomy-related MDM and education. Multidisciplinary HCPs (e.g., gastroenterology medical providers, social workers, surgeons, and ostomy nurses) participated in semi-structured focus groups. Focus group data underwent qualitative analysis to identify themes. Three multidisciplinary focus groups were conducted, with n = 12 participants across all groups. Qualitative analysis identified three main themes, including (1) HCP perceptions of ostomies, (2) Patient/family-related factors, and (3) Professional roles and collaboration challenges. Ostomy surgery in pediatric IBD requires complex multidisciplinary MDM and education. Perspectives of multidisciplinary HCPs identified patient, HCP, and systems factors that may impact MDM for ostomy surgery. This work highlights nuances in MDM and education in IBD, and the critical role of ongoing research and improved standardized processes to coordinate multidisciplinary ostomy-related MDM and education in this population.

HIV/AIDS public health resource allocation policy and its optimization in the United States

With 38 million HIV-positive individuals living worldwide, HIV/AIDS is a fatal and rigorous threat to build up a global health society. It is critical to optimize the allocation of public health resources for improving the life quality of HIV/AIDS patients in the U.S. Meanwhile, the inevitable mission of confirming HIV diagnosis receive comprehensive care, reduce HIV disparities among marginalized populations, and implement effective prevention measures. This article analyzes the allocation of public health resources for HIV/AIDS in the United States, including key issues such as funding allocation, medical infrastructure, targeted interventions, and health equity. A thorough assessment of the affordability of HIV-related medical services and their interventions' efficacy is executed. At the same time, this article also focuses on the effectiveness of PrEP. Although PrEP has been proven to be effective, its promotion still faces problems such as insufficient awareness, financial barriers, limited access, and social stigma. To address these challenges, it is necessary to strengthen public education, train medical providers, reduce PrEP costs, expand access, and combat stigma through public awareness campaigns and legal protection. This comprehensive approach is consistent with a broader public health strategy aimed at slowing HIV transmission and achieving sustained viral suppression.

Medication supply and polypharmacy in long-term care : An overview of possible interventions and the question of afunctioning concept

Polypharmacy and the resulting problems lead to considerable consequences for those affected. There are also considerable problems with the medication management. Which interventions and programs for optimizing the supply of medication are available for nursing homes and which implementation problems can be expected? A literature search was carried out for interventional studies in nursing homes in Germany, with a focus on improving medication safety. A total of six programs were identified for which evaluation results are available. Despite amostly multimodal approach with several pillars of intervention (e.g., medication reviews, further education and training, development of aids), the results are largely disappointing. The effects on the number of prescriptions in general, specific medication groups or outcome parameters such as hospital admissions could only be shown in one study, whereby, selection bias could also be at least partly responsible for this. Interdisciplinary collaboration and the implementation of medication recommendations formulated in reviews by the responsible physicians are the main problem areas. At the same time, too little attention is paid to the central role of nurses in the entire process and they are not actively promoted enough. This could be one of the reasons for the difficulties in implementation in practice. There are nearly no significant changes as aresult of the interventions implemented in the studies reviewed. In particular, interprofessional cooperation, especially the skills of nurses and the reluctance on the part of physicians, should probably be given more attention.

Toward Water and Oil Repellent Coating: Synthesis of Fluorinated Methacrylate-Glycidyl Methacrylate Copolymers.

The development of durable and eco-friendly coatings with excellent adhesion and remarkable surface properties remains a critical pursuit in various industries. This study introduces an innovative methodology for the synthesis of glycidyl methacrylate-co-fluorinated methacrylate (P(GMA-co-FMA)) random copolymers with variable fluorine contents derived from GMA and FMA monomers. The copolymerization of these constituents yields coatings with enhanced durability and unique surface characteristics. Particularly, the incorporation of FMA introduces novel surface functionalities, leading to high water and oil repellent properties. The copolymer-coated surfaces exhibited impressive water contact angles ranging from 105° to 125° and decane contact angles ranging from 50° to 85°. The wettability of the P(GMA-co-FMA) coatings demonstrated a strong dependence on the fluorine content in the copolymers, with higher fluorine content resulting in superior water and oil repellency. Through a comprehensive characterization, we demonstrate the exceptional adhesion and self-cleaning capabilities of the fabricated films. Notably, the self-cleaning efficacy of P(GMA-co-FMA)-coated surfaces persists even following a prolonged duration of 6 months. Furthermore, our investigation reveals the influence of copolymer composition on surface wettability and contact angle hysteresis, providing valuable insights for tailoring coating properties. Overall, the novelty of this study lies in the synthesis of P(GMA-co-FMA) copolymer coatings with superior adhesion and self-cleaning properties. These advancements present promising applications in various fields, including electronics, textiles, and medical supplies, where such durable and functional coatings can significantly enhance product performance and longevity.

A home healthcare routing-scheduling optimization model considering time-balancing and outsourcing

Home care services have a significant role in lowering healthcare expenditure. Supply chain management in home healthcare (HHC) ensures efficient delivery of medical supplies and equipment to patients' homes, improving overall quality of care and patient outcomes. This study proposes a routing and scheduling optimization model for HHC by prioritizing patients, developing an effective delivery strategy, and considering home care logistics and services. The model primarily concerns reducing logistics activities’ overall expenses while considering patients’ priorities. A bi-objective optimization model for a multi-period HHC problem is developed by prioritizing patients with urgent critical needs. The best-worst method (BWM) and technique for order of preference by similarity to ideal solution (TOPSIS) are used to prioritize patients using a linear programming metric (Lp-metric). The BWM and TOPSIS have been uniquely used in this study for routing and scheduling in HHC. Eventually, the applicability of the proposed method is demonstrated through a real-life case study with a series of numerical examples and sensitivity analysis. For instance, by analyzing privilege, we see patients are carefully matched with caregivers possessing advanced skills, leading to increased patient satisfaction. Based on assigned routes, caregivers prioritize patients with higher weight and emergency conditions at the start of each path, followed by patients with less urgent conditions. This ensures that patients with more severe conditions are serviced first.

Evaluation of four chatbots in autoimmune liver disease: A comparative analysis

Introduction and ObjectivesAutoimmune liver diseases (AILDs) are rare and require precise evaluation, which is often challenging for medical providers. Chatbots are innovative solutions to assist healthcare professionals in clinical management. In our study, ten liver specialists systematically evaluated four chatbots to determine their utility as clinical decision support tools in the field of AILDs. Materials and MethodsWe constructed a 56-question questionnaire focusing on AILD evaluation, diagnosis, and management of Autoimmune Hepatitis (AIH), Primary Biliary Cholangitis (PBC), and Primary Sclerosing Cholangitis (PSC). Four chatbots -ChatGPT 3.5, Claude, Microsoft Copilot, and Google Bard- were presented with the questions in their free tiers in December 2023. Responses underwent critical evaluation by ten liver specialists using a standardized 1 to 10 Likert scale. The analysis included mean scores, the number of highest-rated replies, and the identification of common shortcomings in chatbots performance. ResultsAmong the assessed chatbots, specialists rated Claude highest with a mean score of 7.37 (SD = 1.91), followed by ChatGPT (7.17, SD = 1.89), Microsoft Copilot (6.63, SD = 2.10), and Google Bard (6.52, SD = 2.27). Claude also excelled with 27 best-rated replies, outperforming ChatGPT (20), while Microsoft Copilot and Google Bard lagged with only 6 and 9, respectively. Common deficiencies included listing details over specific advice, limited dosing options, inaccuracies for pregnant patients, insufficient recent data, over-reliance on CT and MRI imaging, and inadequate discussion regarding off-label use and fibrates in PBC treatment. Notably, internet access for Microsoft Copilot and Google Bard did not enhance precision compared to pre-trained models. ConclusionsChatbots hold promise in AILD support, but our study underscores key areas for improvement. Refinement is needed in providing specific advice, accuracy, and focused up-to-date information. Addressing these shortcomings is essential for enhancing the utility of chatbots in AILD management, guiding future development, and ensuring their effectiveness as clinical decision-support tools.

Mobile Phone Apps for Pelvic Floor Disorders.

Up to 50% of patients report not readily seeking treatment for pelvic floor disorders (PFDs). The increase in phone applications (apps) for health care information is an opportunity to increase access to care. The aim of the study was to systematically evaluate content and function of apps for patients with PFDs. Apps were screened using PFD-related search terms. Included apps were on the Apple store, in English, and targeted patients with PFDs. The primary outcome was app quality based on the APPLICATIONS scoring system (scored 0-16). Secondary outcomes included professional medical involvement, iTunes rating details, the presence of a voiding/bowel diary, tracking of diet, pain/symptoms, exercise, and medication, graphing or social functions, reminders, disease information, and decision support. Data was reported with descriptive statistics (medians (ranges) and n (percentages). Eight hundred forty apps were identified and 83 were analyzed. The top 3 PFD categories represented were defecatory dysfunction (29), overactive bladder (28), and stress incontinence (27). The median APPLICATIONS score was 7 (3-12). Most apps (78%) were developed without professional medical involvement. Most apps were free, while the remainder ranged from $1.99 to $4.99. No app had all features. Twenty-five apps (30%) included a voiding diary, 33 (40%) had a bowel diary, 27 (33%) included exercise tracking, and 44 (53%) had reminder systems. Most apps had reasonable, but not high, functionality. Current apps provide varying degrees of overall utility, with limited disease information and decision support. Further collaboration with medical providers in app development would support better integration of clinician and patient needs.

A cross-sectional evaluation of city firefighters' exposure to potentially traumatic events during opioid overdose responses and mental health

Firefighters often serve as emergency medical services providers and face repeated exposure to potentially traumatic events (PTEs) while participating in opioid overdose responses (OORs), which may impact their mental health. A survey of 173 firefighters who had participated in an OOR in the previous 6 months was used to assess exposure to PTEs during such events, job stress, mental health symptoms, and resources used to address mental health symptoms. Most firefighters (97%) reported experiencing one or more PTEs while responding to an opioid overdose in the past 6 months. Associations between PTEs and mental health are reported. For example, there was a higher prevalence of high job stress (22.7% vs. 5.3%, p = 0.014) and meeting the screening definition of PTSD (15.4% vs. 1.9%, p = 0.047), depression (33.1% vs. 6.1%, p = 0.022), and anxiety (33.1% vs. 6.1%, p = 0.022) among those who experienced a needlestick injury during an OOR than those who did not experience a needlestick injury during an OOR. Seeking social support is recommended following PTEs; mental health care should be sought when symptoms interfere with personal, social, or occupational functioning. This survey identified important firefighter mental health characteristics which will assist fire departments in determining the appropriate mental health training, support, and services.

Manipulation of solid dosage forms for oral administration to paediatric patients for drug-resistant tuberculosis in South Africa: an observation study

BackgroundChildren represent a particularly vulnerable demographic in the context of drug-resistant (DR) tuberculosis (TB) due to their increased likelihood of close contact with adults diagnosed with the disease. Approximately 25 000–30 000 children develop DR-TB annually. While treatment success rates for DR-TB in children surpass those in adults, children and adolescents encounter distinct challenges throughout the diagnosis and treatment of DR-TB (including MDR-TB, Pre-XDR TB, and XDR-TB).AimTo identify current practices in drug administration to children diagnosed with DR-TB where appropriate dosage forms are not available in South Africa.MethodAn observational study was carried out at the study site to determine how medication prescribed was manipulated and administered by nursing staff to paediatric patients in the wards.ResultsThe observational study identified 8 drugs used in DR-TB at the study site, where some manipulation to the formulation was necessary to enable administration to paediatric patients. Linezolid and para-aminosalicylic acid are the only drugs available and registered in the South Africa in a formulation that is suitable for administration to paediatric patients. Activities carried out by nursing staff to enable the administration of DR-TB medication included cutting capsules and tablets and dissolving the tablet or capsule contents in distilled water to obtain the required suitable dose.DiscussionLack of availability of suitable dosage forms for paediatrics patients results in several challenges, such as additional time required for drug preparation, increased time duration of medication administration, and unpalatability of drugs. These challenges may subsequently affect compliance and therapeutic outcomes of the treatment of paediatric patients, especially as outpatients.ConclusionResearch needs to focus on the development of appropriate dosage forms for the paediatric population and focus on identifying cases of DR-TB in children. This will assist in building evidence to advocate for registration of child-friendly dosage forms thereby ensuring a sustainable supply of medication.

How viruses spread across space and time: forecasting pandemic progression by modelling geographico-temporal interactions

The COVID-19 pandemic has revealed severe flaws in the global healthcare systems ability to respond to unexpected health catastrophes. Much of the confusion and mishandling of the situation could be attributed to the failure in accurately predicting the spread of the virus across geographical locations. A global resource shortage in essential medical supplies and equipment, such as personal protective equipment (PPE) and ventilators, led to a compromised global supply chain. As a result, resources could not be allocated as needed to curb the spread of the pathogen in the most efficacious way. Although forecast models and machine learning algorithms have served as invaluable tools in devising effective response strategies, a large majority of these models were limited by their ability to describe the intricate interactions that underlie the spatio-temporal dynamics of viral proliferation. To address this issue, we employed a vector autoregression model to help capture the evolution of the disease across both the spatial and the temporal axes. Unlike traditional autoregression models, the present model is able to account for statistical regularities that exist both within a given region, and between geographical locations. Our results demonstrate that this approach accurately described the relationships across domestic and international localities throughout the evolution of the disease.

HPV vaccine behaviors and intentions among a diverse sample of women aged 27-45 years: implications for shared clinical decision-making

BackgroundThe Advisory Committee on Immunization Practices issued a shared clinical decision-making (SCDM) recommendation for HPV vaccination in persons aged 27–45. Since expanded eligibility for the vaccine was issued, little information has been available about HPV vaccine behaviors and intentions among women in this age group.MethodsWe conducted a cross-sectional online survey among women aged 27–45 years recruited through a Qualtrics™ respondent panel (N = 324) to answer the following questions (1) What is the prevalence of HPV vaccination among a diverse sample of adult women aged 27–45 years? (2) What are the characteristics of those who have or have not previously been vaccinated? and (3) What factors are associated with the intention to obtain the HPV vaccine among those who had never been vaccinated? Multivariable logistic regression analyses estimated adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs).ResultsOnly 31.1% had at least one dose of the HPV vaccine. In multivariable analyses, those more likely to have been vaccinated were younger and were more likely to believe that the vaccine was effective. Of those unvaccinated or unsure, 54.8% indicated they were likely to get vaccinated in the future. Factors associated with future vaccine intention (compared to those not intending) included beliefs about vaccine testing, perceived likelihood of HPV infection, greater comfort in asking one’s provider for vaccination, and prior negative healthcare experiences.ConclusionsOur findings suggest that many women in this age group are interested in HPV vaccination. While the recommendation is for SCDM rather than routine vaccination for all women in this age group, efforts to promote informed decision-making among mid-adult women may include educating women about the rigorous vaccine testing and approval process, their risk factors for HPV infection, and encouraging them to engage in SCDM with their medical providers. Targeted efforts to reach women who have had negative experiences with healthcare may also be needed.

Synergistic state governance of labour standards in global value chains: Forced labour in the Malaysia–Nepal–UK medical gloves supply chain

Drawing on research into medical gloves global value chains (GVCs), this article examines the interacting roles that states differently positioned in GVCs have played in preventing and eliminating forced labour. Our case study, based on a worker survey and semi-structured interviews across GVC actors, focuses on forced labour in the Malaysian medical gloves sector during the COVID-19 pandemic, linking production in Malaysia, end markets in the UK (primarily through procurement for the National Health Service) and migrant-sending countries, especially Nepal. We analyze the intermeshing effects of the different roles of states, operating at either the horizontal or vertical level of GVC governance, in terms of contributing to issues of forced labour. We identify three state roles in the Malaysia–UK medical gloves chain: producer state (Malaysia), migrant-sending state (Nepal) and regulator-buyer state (UK). We also identify some of the most persistent barriers to resolving forced labour in the value chain. Our research illustrates that Malaysia’s complex regulatory, political and institutional dynamics most directly influence forced labour in gloves production, but Nepal’s migration policies and the UK’s healthcare procurement practices also create forced labour risk in Malaysia. Advancing Gereffi and Lee’s (2016: 25) notion of “synergistc governance” and Jessop’s (2016) strategic-relational approach (SRA) to the state, we thus argue that the creation of sustained and positive regulatory synergies among states differently positioned in GVCs is necessary for the prevention and elimination of forced labour.

U.S. Selected Practice Recommendations for Contraceptive Use, 2024.

The 2024 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR) addresses a selected group of common, yet sometimes complex, issues regarding initiation and use of specific contraceptive methods. These recommendations for health care providers were updated by CDC after review of the scientific evidence and a meeting with national experts in Atlanta, Georgia, during January 25-27, 2023. The information in this report replaces the 2016 U.S. SPR (CDC. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR 2016;65[No. RR-4]:1-66). Notable updates include 1) updated recommendations for provision of medications for intrauterine device placement, 2) updated recommendations for bleeding irregularities during implant use, 3) new recommendations for testosterone use and risk for pregnancy, and 4) new recommendations for self-administration of injectable contraception. The recommendations in this report are intended to serve as a source of evidence-based clinical practice guidance for health care providers. The goals of these recommendations are to remove unnecessary medical barriers to accessing and using contraception and to support the provision of person-centered contraceptive counseling and services in a noncoercive manner. Health care providers should always consider the individual clinical circumstances of each person seeking contraceptive services. This report is not intended to be a substitute for professional medical advice for individual patients; when needed, patients should seek advice from their health care providers about contraceptive use.

Hospital Pharmaceutical Inventory Control in In-Vitro Fertilization Services Using Minimum-Maximum Stock Level

Type C "X" Specialized Hospital in Semarang experienced in vitro fertilization (IVF) and embryology laboratory consumable medical supplies (CMS) stockouts in early 2023, delaying medical care. Minimum-maximum stock level (MMSL) is an alternative pharmaceutical inventory procurement method. Compared to the conventional method, this study examined how well the MMSL method controls IVF medications and embryology laboratory CMS at Hospital “X” Department of Pharmacy. This study is a quantitative, secondary data-based, quasi-experimental, non-equivalent study without a control group. The study sampled all IVF medications and embryology laboratory CMS data from October to December 2023 at Hospital “X” with consistent supply. MMSL was implemented prospectively in January – March 2024. Twelve (12) IVF medications and fifty-six (56) embryology laboratory CMS were studied. Efficiency analysis included inventory value, inventory turnover ratio (ITOR), and stockout value; effectiveness analysis included stockout incidences. Statistics were tested using Wilcoxon signed-rank and McNemar tests. MMSL implementation led to increased inventory value of IVF medications (from IDR21,514,537.00 to IDR49,635,116.00, p=0.040, p<0.05), decreased inventory value of embryology laboratory CMS (from IDR117,421,582.00 to IDR105,318,804.00, p=0.005, p<0.05), and increased ITOR of embryology laboratory CMS (from 0.82 to 0.84 times, p=0.040, p<0.05). MMSL significantly improved IVF medications and embryology laboratory CMS inventory management efficiency.

EVALUATING RESOURCE ALLOCATION MANAGEMENT TO HOSPITALS IN BAUCHI STATE: A CASE STUDY OF FEDERAL MEDICAL CENTRE AZARE AND PRIMARY HEALTHCARE CENTRE AZARE

Background: This study evaluates resource allocation management in hospitals in Bauchi State, focusing on Federal Medical Centre (FMC) Azare and Primary Healthcare Centre (PHC) Azare. The research addresses significant disparities in resource allocation that affect healthcare service delivery and patient outcomes. Methods: Using a mixed-method approach, the study combines quantitative data analysis of financial records, resource allocation reports, and healthcare service delivery metrics with qualitative insights from interviews and focus group discussions. Data Envelopment Analysis (DEA) was utilized to measure the relative efficiency of the hospitals in converting inputs such as financial resources, staff, and infrastructure into healthcare services and outputs. Additionally, descriptive analysis was conducted using IBM SPSS version 27 to analyze 100 questionnaire responses and demographic data. Results: The findings reveal significant disparities between FMC Azare and PHC Azare, with FMC Azare benefiting from more adequate financial resources, human resources, medical supplies, and infrastructure. These disparities lead to differences in patient satisfaction, service delivery efficiency, patient outcomes, and waiting times. Conclusions: The study underscores the need for more equitable resource allocation to improve healthcare delivery and patient outcomes at under-resourced centers like PHC Azare. Recommendations for policy interventions include addressing resource allocation inequities, staffing solutions, supply chain improvements, and infrastructure development. These recommendations aim to enhance resource allocation management, thereby improving healthcare services in Bauchi State and providing insights applicable to similar contexts in Nigeria, Africa, and globally. KEYWORDS: Resource Allocation Management, Healthcare Delivery, Data Envelopment Analysis (DEA), Federal Medical Centre, Primary Healthcare Centre.

Patient and Provider Opinions Regarding Chaperones for Sensitive Exams.

Recommendations for chaperone use during sensitive exams have been left mostly to individual institutions, despite a paucity of data providing guidance. The purpose of this study was to survey patients and medical providers on their attitudes toward chaperone use and explore factors that may influence these attitudes. A survey was administered at a single tertiary military medical center to providers and patients across multiple specialties, and further sub-analysis of the data were completed. For patients, sub-analysis was done for gender, age, history of sexual abuse, and clinic seen. For providers, sub-analysis was done for provider gender and training status. Before data collection, this study was deemed exempt from institutional review board approval by the Eisenhower Army Medical Center Human Research and Protections Office. A total of 319 patient surveys and 61 provider surveys were collected. Fifty seven percent of patients have no preference regarding chaperone use, 19% prefer having a chaperone, and 24% prefer to not have a chaperone. Female patients and patients with a history of sexual abuse are more likely to prefer a chaperone. Forty two percent of providers always use a chaperone, 79% are more likely to use a chaperone if a patient is of the opposite gender, and 43% select a chaperone based on the gender of the patient. Male providers and providers still in training are more likely to use a chaperone. The majority of patients do not have a preference regarding chaperone presence during sensitive exams; however, female gender and history of sexual abuse increase the likelihood of a patient preferring to have a chaperone present. These factors should be considered when creating an institutional policy regarding chaperone use. Future research should focus on homosexual and transgender patient preferences as this has yet to be explored.

The Impact of Eliminating Out-of-Pocket Payments on Asthma Medication Use.

High costs of controller therapies may be a barrier to guideline-recommended asthma treatment. We determined whether eliminating out-of-pocket (OOP) payments among low-income patients with asthma impacted controller medication use. We applied a controlled interrupted time series design to administrative claims data in British Columbia, Canada from 2017-2020. Cases were individuals with an annual household income <$13,750 in whom copays were eliminated on January 2019; there was no change in public coverage for the control group with annual income >$45,000. We evaluated trends in asthma medication costs, use, the ratio of inhaled corticosteroid (ICS)-containing medications to all asthma medications, excessive use of short-acting β-agonists (SABA) (>1 canister/month), and the proportion of days (PDC) covered by controller therapies. There were 12,940 cases (62% female, mean age 30.3 years, SD 14.9), and 71,331 controls (55% female, mean age of 31.3 years, SD 16.3). Removal of OOP payments increased monthly mean medication costs by $3.32 (95% CI $0.08 - $6.56, 2020 Canadian dollars), days supply of controller medications by 1.50 days (95% CI 0.61 - 2.40), and the ratio of ICS-containing medications to total medications by 4.20% (95% CI 0.73% - 7.66%) compared to the control group. The policy had no effect on PDC by controller therapies (0.01, 95% CI -0.01 - 0.04), but non-significantly decreased the percentage of patients with excessive SABA use (-6.37%; 95% CI -12.90% - 0.16%). Removal of OOP payments increased the dispensation of controller therapies, suggesting cost-related non-adherence could impair optimal asthma management.

Impact of Patient Education on Establishing Trust as the Medical Student Provider: A Student Run Free Clinic Experience

Background: Effective doctor-patient relationships are crucial for quality healthcare, and trust is central to this dynamic. Trust in healthcare comprises competence, empathy, communication, and shared decision-making. Patient education sessions offer a platform to enhance patient trust, especially amongst novice providers. This study investigates the impact of patient education sessions led by medical students on patient trust within the context of a student-run free clinic. Methods: At our student-run free clinic, we conducted a cross-sectional survey to collect patient data, including background information, trust in healthcare, and opinions on education sessions at a student-run free clinic. Results: Amongst the enrolled 24 participants, the demographics revealed a diverse racial composition, with a significant portion having not completed high school and the majority being either unemployed or on disability. Following attendance at patient education sessions, a high percentage of participants reported positive experiences, including improved rapport with medical student providers and a likelihood of returning for future services and following medication recommendations. Conclusion: This study highlights the significant role of patient education sessions in fostering trust between patients and providers, improving health behaviors, and enhancing the broader healthcare system's credibility. It demonstrates how such sessions empower patients, leading to better medication adherence and timely medical assistance seeking, while also suggesting their potential for implementation across various healthcare settings to improve patient engagement and healthcare services.

Assessing Corpsmen Training Needs: Enhanced Medical Readiness in the Indo-Pacific for Near Peer.

Naval operations rely on Corpsmen to provide combat casualty and primary care services to the fleet, including the Fleet Marine Force. The United States faces new conflict challenges with near-peer adversaries in the modern geo-political climate. Corpsmen will likely require new skills to care for patients in anti-access/area-denial regions and transport patients across expansive maritime environments. To help them adapt to these new challenges, we evaluated the need for Corpsmen curriculum reform at the III Marine Expeditionary Force (MEF). This model begins with a general needs assessment to target gaps between the current and ideal approaches identified by the stakeholders. We identified 4 primary stakeholders within the Fleet Marine Force community: Marine Commanders (Society), Marines receiving treatment (Patients), Corpsmen providing care (Health Care Workers), and medical providers supervising Corpsmen (Medical Educators). We invited all ranks from III MEF to participate. The participants were interviewed in a mixture of focus groups and individual interviews in conversational and open-ended discussions. Transcripts of these discussions were analyzed and inductively coded using principles of grounded theory to identify prevailing themes that connected across interviews. The study was exempted by the Institutional Review Board at Naval Medical Center San Diego and Headquarters Marine Corps. The study involved 47 participants, including all stakeholders in III MEF and ranks from E1 through general officers. Through interviews and focus groups, 4 key themes emerged regarding Corpsmen's education: "Training," "Tasking," "Performance," and "Impact". "Training" discussions covered formal education, including gaps in basic training and the applicability of skills in civilian settings. "Tasking" examined daily responsibilities and equipment needs, such as teaching roles and first-responder care. "Performance" highlighted the quality of care and challenges in maintaining skills amid non-clinical tasks. Lastly, "Impact" assessed Corpsmen's influence on mission success and job satisfaction, revealing positive and negative perceptions among participants regarding their role and career prospects. The discussion emphasizes the importance of contextual factors in developing a Corpsmen-based curriculum, focusing on themes such as Training, Performance, and Impact. Tasking highlights critical areas for curriculum development, especially in educating Corpsmen as Educators, Leaders, and First-responder Caregivers. Gaps in training were identified, particularly in Non-trauma and First-responder Care, impacting Corpsmen's ability to handle diseases and injuries independently. Drawing parallels with Community Health Worker and Physician Extender (PE) education paradigms, we suggest adapting existing models to meet Corpsmen's needs. The discussion also delves into the history of employing PEs and developing training programs within the Naval Service. We propose a combination of Community Health Worker and PE-based education to enhance Corpsmen's competency and job satisfaction while facilitating their transition to civilian health care. Standardized curricula and training programs could improve skill transferability and readiness for Corpsmen in both military and civilian settings.

Machine Learning and Image Processing-Based System for Identifying Mushrooms Species in Malaysia

Malaysia, a country with a tropical climate characterized by consistent warmth and year-long high humidity, houses the perfect conditions for mushroom growth. Recently, there has been a surge in back-to-nature activities in Malaysia. However, many participants lack prior knowledge about the local flora and fungi, leading to a rise in mushroom poisoning cases, some of which have been fatal. Despite thorough research, there is a notable lack of identification studies specifically focused on mushroom species in Malaysia. Identifying these species is crucial for medical providers to effectively counteract the toxins from ingested mushrooms and also serves as an important educational tool. This study aims to determine the most suitable architecture for mushroom identification, focusing specifically on mushroom species found in Malaysia. A dataset of these mushrooms was curated, augmented, and processed through multiple variants of Vision Transformers (ViTs) and ResNet models, with uniform hyperparameters to ensure fairness. The results indicate that the ViT-L/16 model achieved the highest accuracy at 90.47%.