Multiple Specialties Research Articles

Performance of Chat Generative Pre-Trained Transformer on Personal Review of Learning in Obstetrics and Gynecology.

Chat Generative Pre-Trained Transformer (ChatGPT) is a popular natural-language processor that is able to analyze and respond to a variety of prompts, providing eloquent answers based on a collection of Internet data. ChatGPT has been considered an avenue for the education of resident physicians in the form of board preparation in the contemporary literature, where it has been applied against board study material across multiple medical specialties. The purpose of our study was to evaluate the performance of ChatGPT on the Personal Review of Learning in Obstetrics and Gynecology (PROLOG) assessments and gauge its specialty specific knowledge for educational applications. PROLOG assessments were administered to ChatGPT version 3.5, and the percentage of correct responses was recorded. Questions were categorized by question stem order and used to measure ChatGPT performance. Performance was compared using descriptive statistics. There were 848 questions without visual components; ChatGPT answered 57.8% correct (N = 490). ChatGPT performed worse on higher-order questions compared with first-order questions, 56.8% vs 60.5%, respectively. There were 65 questions containing visual data, and ChatGPT answered 16.9% correctly. The passing score for the PROLOG assessments is 80%; therefore ChatGPT 3.5 did not perform satisfactorily. Given this, it is unlikely that the tested version of ChatGPT has sufficient specialty-specific knowledge or logical capability to serve as a reliable tool for trainee education.

P-917. Management of pediatric focal intracranial infections: opportunities to reduce low-value care

Abstract Background Focal intracranial infections are rare but life-threatening complications of sinusitis, otitis media and mastoiditis in children. Management requires collaboration between multiple specialists and prolonged antimicrobial treatment. Methods We retrospectively identified patients hospitalized at our tertiary care children’s hospital with focal intracranial infections from Jan 2022 - April 2024 followed in infectious disease clinic. Patient charts were reviewed to inventory imaging, surgical interventions and antibiotic treatment received. We further identified complications in each case requiring intervention, including surgery, hospitalizations and emergency room visits. MRI imaging was defined as low-value if ordered over 2 weeks prior to the study in a patient without new symptoms, or ordered for a hospitalized patient who was afebrile without neurologic symptoms or parental concerns after 30 days of antibiotic therapy. Results Thirty-four patients were followed in pediatric infectious disease clinic for outpatient management of: subdural empyema (13, 38%), epidural empyema (11, 33%) and brain abscess (10, 29%). Patients were most likely male (68%) and Black or African American (74%), with a median age of 12 (range: 2-18). Nearly all (94%) had at least one MRI; 19 (56%) had a repeat MRI during hospitalization, 22 (65%) had a repeat MRI after discharge. About one-third of MRIs (31%) after discharge required sedation. In our cohort 18 patients had a low-value MRI (53%) and 5 of these (28%) had more than one low-value MRI. No low-value MRI led to a finding requiring surgical intervention. The mean duration of antibiotic treatment was 42 days (SD 10.8 days). Four patients (12%) returned to the ED while on antibiotic therapy for PICC line issues, with one patient returning 3 times for PICC concerns. Conclusion Some management strategies for pediatric focal intracranial infections may be unnecessary or have unrecognized consequences. Repeat MRI for half our cohort was of low-value, exposed many to risks of sedation, and consumed significant family and system resources. Children on prolonged IV antibiotic therapy were at risk for line complications. Routine management of these infections merits reconsideration to decrease unwarranted costs and risks to patient. Disclosures All Authors: No reported disclosures

Challenges of Contemporary Practice: Internists Maintaining Competency in Multiple Specialties.

Despite increasing physician specialization, high-quality continuing professional development is needed for continual mastery learning, especially focused on multiple specialties. Board certification is considered a surrogate for competency, and some stakeholders consider it suboptimally aligned with its primary purpose. We set to explore the motivation for continued education and competence in physicians who are board certified in multiple specialties. We performed a qualitative study using thematic analysis. Semistructured interviews were performed virtually. Landscapes of practice, an extension of communities of practice within sociocultural learning theory, was used as a theoretical framework. Fifteen internists and their related subspecialties performing continual board certification completed the study. We identified six themes describing the underlying motivation for why physicians maintain competency in multiple medical specialties: Social responsibility, Promise of expertise, Enhanced job opportunities, Widened expertise, Professional requirements, and Personal fulfillment. The landscape of medicine continues to evolve in how it is practiced. How a physician navigates this process, maintaining their competency, is a continuous lifelong learning process, and there are multiple ways. A portion of internal medicine physicians are motivated to practice in multiple specialties, recognizing the opportunities and challenges involved. The practical application of this study would include organizational-based education focused on hybrid learning (education explicitly focusing on overlapping or cross-discipline fields). Despite a plethora of educational opportunities, there is very little with the focus on cross-discipline education and training.

P0391 The impact of point of care ultrasound on time to initiating advanced therapy in IBD (GUIDE-IBD): A randomised controlled trial

Abstract Background Intestinal ultrasound is an accurate tool for assessing inflammatory bowel disease activity1. Previous studies showed point-of-care ultrasound (POCUS) can impact treatment decisions in 48% of appointments2. Early diagnosis and treatment improves outcomes in Crohn’s disease (CD). We aimed to investigate if POCUS in the IBD clinic led to earlier initiation of advanced therapies using a randomised controlled trial. Methods Patients attending an IBD clinic at a UK tertiary referral centre with known or suspected IBD (with a high likelihood) were eligible. During the primary clinic appointment clinicians’ investigation and treatment decisions were recorded. Immediately following this they were randomised 1:1 to POCUS or standard of care (SOC). The POCUS group then had further review with an option to alter treatment decisions. The primary end-point was time to initiating definitive therapy (in days) (new/changed immunomodulator, advanced therapy or surgery only). Secondary end-points included clinical score (HBI, SCCAI), calprotectin and patient tolerability. Patients were followed for 12 months. Results 122 patients were enrolled between 1st June and 1st November 2023. Median age was 25 years (16-79) and 50% male with a final diagnosis of 87 CD, 23 UC, 4 IBD-U and 8 non IBD (new referrals). 63 had POCUS and 59 SOC. POCUS was performed by one of two sonographers (one gastroenterologist and one radiologist). 65 (53%) were on advanced therapy or immunomodulators at baseline. 99 (81%) had advanced therapy, immunomodulators or surgery during the study period. Mean time to definitive treatment decision was 43 days with POCUS compared to 92 days in SOC (p<0.01). 65 (53%) patients had a change of, or started a new therapy and mean time to treatment initiation was also significantly shorter in the POCUS group, 75 days, compared to SOC, 131 days (p=0.033). In a sub-group of 20 new referrals, 12 were diagnosed with IBD. Mean time to treatment initiation was shorter with POCUS (82 vs 151 days). Steroid prescriptions at the baseline appointment were significantly higher in the POCUS group, 11/63 vs 2/59 (p = 0.012). Any change to treatment in the POCUS group occurred in 29/63 (46%) patients. Scans took an average of 7.5 minutes with 100% patient acceptability. Conclusion POCUS leads to earlier IBD-related decision making which translates into earlier initiation of effective therapy. This should, in turn, lead to improved care with shorter time to remission and reduced complications. Pathways to incorporate POCUS into routine clinical practice to optimise its effectiveness need further evaluation. This will require collaborative training and working across multiple specialties to effectively deliver this service. References (1)Taylor SA, Mallett S, Bhatnagar G, et al. Diagnostic accuracy of magnetic resonance enterography and small bowel ultrasound for the extent and activity of newly diagnosed and relapsed Crohn’s disease (METRIC): a multicentre trial. Lancet Gastroenterol Hepatol. 2018;3(8):548-558. doi:10.1016/S2468-1253(18)30161-4 (2)Bots S, De Voogd F, De Jong M, et al. Point-of-care Intestinal Ultrasound in IBD Patients: Disease Management and Diagnostic Yield in a Real-world Cohort and Proposal of a Point-of-care Algorithm. J Crohns Colitis. 2022;16(4):606-615. doi:10.1093/ecco-jcc/jjab175

Scaling BERT for Healthcare: An End-to-End Framework for Medical Document Automation

This article proposes a comprehensive framework for implementing BERT-based language models at scale for automated medical document processing in healthcare environments. Recent studies have demonstrated BERT models achieving accuracy rates of up to 89.7% in medical entity recognition tasks [2], suggesting significant potential for healthcare applications. The proposed architecture introduces a novel hierarchical attention mechanism specifically engineered to capture the nested complexity of medical documentation while maintaining computational efficiency in production systems. Drawing inspiration from successful implementations in pharmacy settings [15, 16], this framework features a distributed training pipeline designed to process annotated medical documents across multiple specialties, coupled with a dynamic medical vocabulary injection system that aims to preserve BERT's contextual understanding while potentially reducing false positives in entity recognition. By leveraging distributed computing infrastructure and optimized model architecture, the framework could theoretically achieve substantial improvements over traditional approaches in both accuracy and processing efficiency, particularly in handling complex medical terminology and context-sensitive information extraction. The proposed system architecture anticipates addressing current challenges in healthcare documentation, where systems process an average of 6.2 million clinical documents annually [1]. This theoretical framework contributes to the field by proposing a scalable methodology for implementing advanced language models in healthcare settings while addressing the unique challenges of medical domain specificity and production deployment requirements.

Gender differences in self-reported participation in ultrasound-guided procedures: a retrospective analysis.

Across multiple procedural specialties, female trainees tend to perform fewer procedures and receive less autonomy than their male counterparts. However, there is currently no data on procedure contribution levels for radiology trainees. To evaluate whether there was a difference in the degree of reported participation in ultrasound-guided procedures between male and female trainees at our institution. This retrospective study assessed for differences in the reported level of participation between male and female trainees in ultrasound (US) guided paracentesis and thoracentesis. We performed a radiology information system (RIS) search of US guided procedures performed on adult patients from 7/1/2018 to 2/29/2024. Trainee participation levels in the procedures were determined per available reports and classified into independently performed, assisted, or observed. We evaluated the differential reporting of procedure contributions for male and female trainees based on observed vs. expected frequencies, as well as the effect of the trainees' and supervising physicians' gender and experience level on these contributions. A total of 189 trainees (52 female, 137 male) and 58 supervising physicians (18 female and 40 male) were included. The study evaluated 4156 reports, which showed no difference in the percentage of independently completed procedures (females 80.9% vs. 81.9%, X2 (1, N = 4156) = 0.494, p = 0.48) except when supervised by junior physicians less than 2 years out of training (females 81.0% vs. 86.5%, X2 (1, N = 1908) = 8.19, p = 0.0042). However, female trainees were more likely than male trainees to report observing procedures (females 9.2% vs. 5.2%, X2 (1, N = 4156) = 21.1, p < 0.00001) rather than actively participating in procedures despite a similar training level; this difference was not observed when supervising physicians were females. Female radiology trainees report a similar percentage of independently performed procedures but a lower rate of active participation than male trainees.

Diabetes and Untoward Outcomes after ACL Reconstruction

Background Diabetes affects approximately 536.6 million adults worldwide and 32.2 million in the United States. Prior studies across multiple specialties have reported the presence of diabetes is associated with adverse outcomes following surgical operations. While several studies have identified diabetes as a risk factor for adverse outcomes following ACL reconstruction (ACLR), literature evaluating the relationship between diabetes status and outcomes after ACLR is lacking. Purpose We aimed to study surgical outcomes following primary ACLR among patients with diabetes compared to those without diabetes. Study Design Retrospective Cohort Study Methods We conducted a cohort study using data from an integrated healthcare system’s ACLR registry. Patients aged ≥12 receiving a primary unilateral ACLR were included (2005–2020). Preoperative diabetes status was the exposure of interest. The two primary outcomes were revision surgery and ipsilateral reoperation following primary ACLR, modeled using multivariable Cox proportional hazards regression that followed patients until an adverse event or loss to follow up. We also examined hospital readmission within 90 days post-surgery, modeled using logistic regression. All models compared patients with diabetes to those without diabetes, adjusting for age, gender, race, smoking status, body mass index, American Society of Anesthesiologist’s score, comorbid conditions, education level, income level, exercise, and graft type. Results There were 18,797 primary ACLR in the study sample with 383 (2.0%) occurring in patients with diabetes. The diabetes group exercised about 90 minutes less per week than the non-diabetes group. In unadjusted bivariate descriptive analyses, patients with diabetes had a lower rate of revision surgery (1.6% vs. 3.6%, p = 0.037) but a higher rate of ipsilateral reoperation (10.7% vs. 8.0%, p = 0.051). The 90-day readmission rate was higher among patients with diabetes compared to those without diabetes (1.8% vs. 0.7%, p = 0.016). However, after adjusting for covariates, these associations were no longer statistically significant. Conclusion After controlling for patient characteristics and other risk factors, the presence of diabetes was not associated with a higher risk of adverse events following primary ACLR.

A Longitudinal Graduate Medical Education Curriculum in Clinical Informatics: Function, Structure, and Evaluation.

There is a need to integrate informatics education into medical training programs given the rise in demand for health informaticians and the call on the Accreditation Council for Graduate Medical Education and the body of undergraduate medical education for implementation of informatics curricula. This report outlines a 2-year longitudinal informatics curriculum now currently in its seventh year of implementation. This report is intended to inform U.S. Graduate Medical Education (GME) program leaders of the necessary requirements for implementation of a similar program at their institution. The curriculum aligns with the core content for the subspecialty of clinical informatics (CI) and is led by a multidisciplinary team with both informatics and clinical expertise. This educational pathway has a low direct cost and is a practical example of the academic learning health system (aLHS) in action. The pathway is housed within an internal medicine department at a large tertiary academic medical center. The curriculum has yielded 13 graduates from both internal medicine (11, 85%) and pediatrics (2, 15%) whose projects have spanned acute and ambulatory care and multiple specialties. Projects have included clinical decision support tools, of which some will be leveraged as substrate in applications seeking extramural funding. Graduates have gone on to CI board certification and fellowship, as well as several other specialties, creating a distributed network of clinicians with specialized experience in applied CI. An informatics curriculum at the GME level may increase matriculation to CI fellowship and more broadly increase development of the CI workforce through building a cadre of physicians with health information technology expertise across specialties without formal CI board certification. We offer an example of a longitudinal pathway, which is rooted in aLHS principles. The pathway requires a dedicated multidisciplinary team and departmental and information technology leadership support.

Professionals in the care of the end of life: plurality of postures.

Deciding what type of health professional to be: the postural profile that is assumed in the care relationship is born from this challenge. These postures have a profound impact on the way in which care for the patient and end-of-life decisions will be developed. Broadly speaking, we can distinguish five macro postural profiles: the scientistic posture (the natural sciences are the only guide for the professional); the vitalist posture (the goal of saving the patient's life at all costs); the specialist posture (fragmentation of care managed by multiple specialists); the philanthropic posture (in which empathetic closeness to the patient prevails); the conversational posture (care "with" the patient, not "on" him). In light of this, it is essential to become aware of how you want to treat yourself and how you want to be treated, choosing, as far as possible, the appropriate travel companions.

Examiner workload comparison: three structured oral examination formats for the European diploma in anaesthesiology and intensive care

ABSTRACT The COVID-19 pandemic triggered transformations in academic medicine, rapidly adopting remote teaching and online assessments. Whilst virtual environments show promise in evaluating medical knowledge, their impact on examiner workload is unclear. This study explores examiner’s workload during different European Diploma in Anaesthesiology and Intensive Care Part 2 Structured Oral Examinations formats. We hypothesise that online exams result in lower examiner’s workload than traditional face-to-face methods. We also investigate workload structure and its correlation with examiner characteristics and marking performance. In 2023, examiner’s workload for three examination formats (face-to-face, hybrid, online) using the NASA TLX instrument was prospectively evaluated. The impact of examiner demographics, candidate scoring agreement, and examination scores on workload was analysed. The overall NASA TLX score from 215 workload measurements in 142 examiners was high at 59.61 ± 14.13. The online examination had a statistically higher workload (61.65 ± 12.84) than hybrid but not face-to-face. Primary contributors to workload were mental and temporal demands, and effort. Online exams were associated with elevated frustration. Male examiners and those spending more time on exam preparation experienced a higher workload. Multiple diploma specialties and familiarity with European Diploma in Anaesthesiology and Intensive Care exams were protective against high workload. Perceived workload did not impact marking agreement or examination scores across all formats. Examiners experience high workload. Online exams are not systematically associated with decreased workload, likely due to frustration. Despite workload differences, no impact on examiner’s performance or examination scores was found. The hybrid examination mode, combining face-to-face and online, was associated with a minor but statistically significant workload reduction. This hybrid approach may offer a more balanced and efficient examination process while maintaining integrity, cost savings, and increased accessibility for candidates.

A Podcast on Patient and Physician Perspectives in the Holistic Care of Heart-Related Challenges of Type 2 Diabetes.

Type 2 diabetes (T2D) frequently coexists with cardiorenal complications. Therefore, a holistic approach to patient management is required, with specialists such as primary care physicians, cardiologists, endocrinologists, and nephrologists working together to provide patient care. Although glycemic control is important in the management of T2D, patients with T2D and acceptable glycemic control are still at risk from cardiovascular (CV) events such as stroke, heart attack, and heart failure (HF). Therefore, management of other risk factors, such as high blood pressure, high cholesterol, smoking cessation, and excess bodyweight, are imperative for reducing the risk of CV disease and HF in patients with T2D. In addition to pharmacological interventions, patient self-care, including beneficial dietary changes, regular exercise, and smoking cessation are critical for improving heart health and reducing the risk of CV events and progression of HF. In this podcast, a patient with lived experience of the heart-related challenges of T2D and a cardiologist discuss the link between T2D and heart-related complications, the pharmacological interventions and lifestyle modifications that can be used to reduce the risk of CV events and prevent HF, and the complexities of engaging with the healthcare system when managing multiple comorbidities. The discussion highlights the importance of patient education and empowerment for the management of heart-related challenges of T2D, and the central role of collaborative care between physicians of multiple specialties to reduce CV risk for patients with T2D.

Exploring the Core Elements of Interdisciplinary Teamwork During Surgical Procedures: A Systematic Review

Objective: This systematic review aims to identify and analyze the core elements that underpin effective interdisciplinary teamwork in surgical environments and their influence on patient outcomes and procedural efficiency. Methods: We conducted a comprehensive search of electronic databases including PubMed, Scopus, and Web of Science for studies published between January 2000 and December 2024. The review focused on empirical research and reviews that examined teamwork dynamics in surgical settings. Inclusion criteria were studies on interdisciplinary teams involving multiple healthcare specialties in surgical procedures. Data extraction focused on teamwork components, communication patterns, and collaboration outcomes. Results: A total of 45 studies met the inclusion criteria. Analysis revealed that effective teamwork is characterized by clear communication, mutual respect, role clarity, and leadership. These elements were consistently associated with improved patient safety, reduced surgical errors, and enhanced procedural efficiency. The quality of evidence was predominantly high, indicating robust support for the critical role of interdisciplinary teamwork in surgical success. Conclusion: The core elements of interdisciplinary teamwork essential for surgical success include structured communication, well-defined roles, mutual respect among team members, and adaptive leadership. Implementing training programs that focus on these key teamwork components could significantly enhance the quality of surgical care. Future research should explore intervention studies that measure the impact of teamwork enhancement programs on surgical outcomes.

False alarms and the burden of shunt failure in pediatric patients with hydrocephalus: a longitudinal study.

This study aimed to investigate the burden of CSF shunt failure and false alarms on pediatric patients with hydrocephalus, their caregivers, and the healthcare system. This retrospective longitudinal study examined pediatric patients who underwent CSF shunt procedures at Auckland City Hospital from January 2014 to December 2019. The study included patients aged 18 years or younger living within the hospital's catchment area. Clinical encounters were recorded from the date of their first shunt insertion until November 1, 2023. Data collected included patient demographics, hospital admissions, acute and elective shunt-related imaging, clinic visits, surgery times, and symptom characteristics. Shunt-related admissions were categorized as either shunt failures or false alarms. The cohort comprised 73 patients with follow-up periods ranging from 4 to 18 years. By the 1st year, 71% had been rehospitalized for shunt-related concerns, with 59% experiencing at least 1 false alarm and 38% experiencing at least 1 shunt failure. By the 4th year, 88% of patients had been rehospitalized for shunt-related concerns, 42% had experienced at least 3 false alarms, 60% had at least 1 shunt failure, and 25% had at least 3 shunt failures. The average accumulated hospital stay was 1 month for shunt failures and 2 weeks for false alarms, compared with 22 days for all other admissions. Frequent clinic interactions from multiple specialties highlighted the complex care needs of these patients. The timing of shunt failure or false alarm, but not symptom duration, significantly predicted their overall frequency. This study details the chronic burden and complex care requirements for pediatric patients with CSF shunts. Shunt-related concerns significantly and disproportionately contribute to the patients' total hospital interactions. The findings highlight the immediate clinical need for novel technologies to enable long-term and accurate detection of shunt failure to optimize patient care. Future efforts should focus on improving shunt systems to lower failure rates.

SURGICAL INTERVENTION IN SEVERE POSTPARTUM HAEMORRHAGE

Postpartum haemorrhage (PPH) is one of the major causes of maternal mortality and morbidity, defined as haemorrhage occurring within 24 h of childbirth. Postpartum haemorrhage can be categorized into primary, which takes place within the first one day after childbirth, and secondary, which happens anytime from 24 hours after birth up to six weeks after delivery. Among the cases of PPH, some are severe and fatal and hence need to be treated effectively and on time. Conservative methods are to some extent useful in controlling PPH but surgical management involves the use of special operations to address the problem. Objective: This proposed study aims to finally summarize the evidence about surgical interventions in the management of postpartum haemorrhage, including the effectiveness and side effect profile of various surgical techniques. Methods: This study type used a retrospective cohort design and the sample consisted of patients with severe PPH that needed surgical management. This paper used quantitative data and the data was gathered from the records of hospitals for five years. Some of the surgical management activities considered in the study were uterine artery ligation, B-Lynch suture, and hysterectomy. The variables measured were success rates, early clinical outcomes, late clinical recovery and early complications. Quantitative methods of data analysis used in this study include survival analysis tests and chi-square tests. Results: The study enrolled 150 patients with severe manifested PPH; 60% of the patients underwent uterine artery ligation; 25% of the patients required a B-Lynch suture performed; and 15% of the patients required a hysterectomy. Short-term effects revealed that both techniques provided effective control of bleeding, in 85% of cases did not require additional surgery in the form of a B-Lynch suture. It was also shown that 70% of the cases with uterine artery ligation were associated with long-term preservation of fertility. Hysterectomy had the highest complication rates; infection, organ damage, and higher maternal mortality of 5%. Conclusion: Uterine artery ligation as well as B-Lynch suture should be used in cases of severe PPH because during this procedure no tubal sterilization occurs and fertility can be preserved when selecting the right cases. Although hysterectomy remains the surgical option of choice, the procedure is fraught with some significant risks. The study confirms the necessity for early surgical management and the collaboration of multiple specialists to optimise maternal results in grave cases of PPH. More clinical research is required to optimize surgical approaches and to define the role of non-operative interventions to improve the patient’s prognosis.

Pre-hospital management of penetrating neck injuries: derivation of an algorithm through a National Modified Delphi

BackgroundTimely and effective pre-hospital management of penetrating neck injuries (PNI) is critical to improve patient outcomes. Pre-hospital interventions in patients with PNI can be especially challenging due to the anatomical injury site coupled with a resource-limited environment. Nationally, in the United Kingdom, no consensus statement or expert agreed guidance exists on how to best manage PNI in the pre-hospital setting.MethodWe conducted a national modified e-Delphi study with subject matter experts (SMEs) from multiple professional specialities with experience in the management of PNI. Pre-identified SMEs were contacted and consented prior to participation allowing for a remotely conducted Delphi using REDCap and Microsoft Teams. In Round 1, statements drawn from the literature base were distributed to all SMEs. Round 2 comprised a facilitated and structured discussion of the statements and then an online survey provided final ratification in Round 3. Of the participating SMEs consensus was set a priori at 70%.ResultsOf the 67 pre-identified SMEs, 28 participated, resulting in a response rate of 42%. From the first two rounds, 19 statements were derived with every statement achieving consensus in Round 3. Subsequently, an algorithm for the pre-hospital management of PNI was developed and agreed with SME consensus.ConclusionCuration of national consensus statements from SMEs aims to provide principles and guidance for PNI management in a complicated patient group where pre-hospital evidence is lacking. Multi-professional national consensus on the best approach to manage these injuries alongside a novel PNI management algorithm aims to optimise time critical care and by extension improve patient outcomes.

Literature search for healthcare management decision-making on how to increase productivity by performing more surgical cases in the same staffed time.

This report shows an example of using literature search for healthcare management decision making, specifically, how anesthesiologists can enhance operating room (OR) productivity. A search was conducted using Scopus to gather relevant research on increasing surgical case numbers. References and citations were then examined. The search identified strategies to reduce non-operative times, facilitate overlapping surgeries, and optimize OR scheduling. Key findings indicate that reducing anesthesia-controlled times alone is insufficient to reliably add extra surgical cases within an eight-hour workday. Instead, significant productivity gains are realized by managing OR turnover times, using induction rooms, and revising workflows to maximize efficiency. Studies show that overlapping surgeries and strategic use of adjacent spaces can significantly increase the number of daily surgical cases performed. Most surgical growth is driven by accommodating low caseload surgeons across multiple specialties. Facilitating OR time access for these surgeons through flexible scheduling and re-sequencing of cases is crucial. Additionally, anesthesiologists should be engaged in daily OR scheduling and case sequencing, particularly within two days of surgery. The dual goals are to increase OR utilization and reduce patient wait times. These results from the management case report underscores the importance of evidence-based OR management practices and proactive involvement of anesthesiologists in scheduling decisions to enhance surgical productivity effectively.

ED care and Amyloid‐Related Imaging Abnormalities ‐ Impact and Future research

AbstractWith the approval of disease modifying treatments for Alzheimer’s Disease, the practice of dementia care and treatment has changed. Amyloid related imaging changes, are the most common adverse effects of these types of drugs. There is limited guidance across multiple specialties on how to recognize and manage these changes in a dementia patient population. The use of these types of drugs for treatment, impacts multiple stakeholders regarding how they manage and treat dementia patients. ns. Thus the use of these types of drugs, involve multiple stakeholders with different perspectives on how they perceive their role in care and overall treatment plans. In order to optimize collaborative care in the ED setting, recognizing how ARIA may present in a patient who seeks care in the ED, and what types of treatment options are available are needed.

Sexual Harassment in the Medical Workplace: The Experience of Medical Students and Doctors

&lt;p&gt;本文回顧醫師職場的性騷擾議題，包含臺灣醫師勞動條件改革小組與臺北市醫師職業工會等團體於2018發布的「醫師職場性別友善問卷調查報告書」，分析其結果與後續回應，並綜論臺灣與國際文獻，從各國、各專科的研究數據、騷擾行為描述、帶來的負面影響與相應行動，可見#MeToo運動與#MeTooMedicine運動是遍地開花。自詡為亞洲性別平等領航者的臺灣，在當今的全球浪潮中，2023年5月台灣#MeToo運動從政治、學術、演藝界開始延燒，在社群媒體與報導中也陸續看到幾起醫療圈的騷擾事件。對於此議題的關注，臺灣醫界不應缺席，也應檢視醫學教育、醫療職場上的雇主責任、申訴管道與案件分析，並留意2024新版性平三法上路後的相關影響。此外，鑑於經歷疫情、#MeToo運動，帶來生活型態變化和法律變革，但國內對醫療勞動中性別議題的學術研究仍相當有限，今年臺北市醫師職業工會也已重啟「2024醫療職場性別友善調查」。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;This study examines sexual harassment in the medical workplace through analyses of relevant literature, with a focus on the &amp;ldquo;Medical Workplace Gender-Friendliness Survey Report&amp;rdquo; published in 2018 jointly by the Taiwan Physician Labor Conditions Reform Group and Taipei Doctors Union. Results and subsequent responses of the report were analyzed, along with related Taiwanese and international literature spanning multiple countries and specialties, including research data, descriptions of harassment, as well as negative impacts of and reactions to harassment. The widespread global influence of the #MeToo movement and #MeTooMedicine movement is evident with Taiwan, generally recognized as a leader in Asian gender equality, experiencing its own #MeToo movement spreading from politics, academia, and the entertainment industry in May 2023. Concurrent with the movement, several harassment incidents in the medical field have been reported in social and news media. and in the news. Instead of remaining neutral or even absent, the Taiwanese medical community must address the issues through comprehensive review of medical education, employer responsibilities in the medical workplace, reporting mechanisms, and case analyses, while also paying attention to the impacts of the 2023 amendments to the three gender equality laws. To date, domestic academic research on gender issues in medical labor remains limited. In response to changes precipitated by the COVID-19 pandemic and the #MeToo movement, the Taipei Doctors Union has initiated a follow-up study, the &amp;ldquo;2024 Gender-Friendly Workplace Survey for Medical Professionals.&amp;rdquo;&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

The Carbon Footprint of Hospital Services and Care Pathways: A State-of-the-Science Review.

Climate change is the 21st century's biggest global health threat, endangering health care systems worldwide. Health care systems, and hospital care in particular, are also major contributors to greenhouse gas emissions. This study used a systematic search and screening process to review the carbon footprint of hospital services and care pathways, exploring key contributing factors and outlining the rationale for chosen services and care pathways in the studies. This state-of-the-science review searched the MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), GreenFILE (EBSCOhost), Web of Science, Scopus, and the HealthcareLCA databases for literature published between 1 January 2000 and 1 January 2024. Gray literature was considered up to 1 January 2024. Inclusion criteria comprised original research reporting on the carbon footprint of hospital services or care pathways. Quality of evidence was assessed according to the guidelines for critical review of product life cycle assessment (LCA). PROSPERO registration number: CRD42023398527. Of 5,415 records, 76 studies were included, encompassing 151 hospital services and care pathways across multiple medical specialties. Reported carbon footprints varied widely, from carbon dioxide () equivalents () for an hour of intravenously administered anesthesia to 10,200 for a year of hemodialysis treatment. Travel, facilities, and consumables were key contributors to carbon footprints, whereas waste disposal had a smaller contribution. Relative importance of carbon hotspots differed per service, pathway, medical specialty, and setting. Studies employed diverse methodologies, including different LCA techniques, functional units, and system boundaries. A quarter of the studies lacked sufficient quality. Hospital services and care pathways have a large climate impact. Quantifying the carbon footprint and identifying hotspots enables targeted and prioritized mitigation efforts. Even for similar services, the carbon footprint varies considerably between settings, underscoring the necessity of localized studies. The emerging field of health care sustainability research faces substantial methodological heterogeneity, compromising the validity and reproducibility of study results. This review informs future carbon footprint studies by highlighting understudied areas in hospital care and providing guidance for selecting specific services and pathways. https://doi.org/10.1289/EHP14754.

A pilot study to examine the opioid prescribing practices of medical residents.

The present opioid crisis has raised concern regarding the prescribing practices of physicians. However, the training of resident physicians has not been sufficiently evaluated. The proposed objective of this study was to evaluate how residents across different specialties perceived the adequacy of their training in the prescribing of opioid-based anal-gesics. Medical residents were surveyed regarding their opioid prescribing training in medical school and residency, their confidence and frequency of prescribing opioids, the indications for which they prescribed opioids, whether they utilize opioids as first-line treatment in pain management, and their perception of the effectiveness of opioids in managing a pa-tient's pain. Medical residents across multiple years and specialties at two institutions within the same state were surveyed. The resident response rate was 26 percent (75), and of those residents, 56 percent (42) indicated that their medi-cal school training was insufficient and 37 percent (28) reported that their residency training was insufficient, which was independent of both year and specialty. These findings suggest that residents perceive a lack of adequate training on the prescribing of opioids during medical school and to a lesser degree during residency. A larger study will be required to validate these findings as well as to determine which specific aspects of a resident's medical education on opioid prescribing are lacking. More importantly, the authors hope that these findings will initiate an interest in standardizing opioid prescribing education for medical students and residents with the goal of reducing the abuse and deaths related to these medications.