Patient Acceptance Research Articles

Artificial intelligence, medications, pharmacogenomics, and ethics.

Artificial Intelligence (AI) and Machine Learning (ML) are revolutionizing various scientific and clinical disciplines including pharmacogenomics (PGx) by enabling the analysis of complex datasets and the development of predictive models. The integration of AI and ML with PGx has the potential to provide more precise, data-driven insights into new drug targets, drug efficacy, drug selection, and risk of adverse events. While significant effort to develop and validate these tools remain, ongoing advancements in AI technologies, coupled with improvements in data quality and depth is anticipated to drive the transition of these tools into clinical practice and delivery of individualized treatments and improved patient outcomes. The successful development and integration of AI-assisted PGx tools will require careful consideration of ethical, legal, and social issues (ELSI) in research and clinical practice. This paper explores the intersection of PGx with AI, highlighting current research and potential clinical applications, and ELSI including privacy, oversight, patient and provider knowledge and acceptance, and the impact on patient-provider relationship and new roles.

Will a patient information brochure increase acceptance of Omani women with varicose veins to be examined by a male surgeon ?- A prospective randomized single blinded study.

Varicose veins are not uncommon among Omani women. As currently there are no female vascular surgeons, it has been noticed in our outpatient clinic that a number of them are reluctant to be examined by a male vascular surgeon, have a duplex ultrasound done and therefore a management plan cannot be made in this subset. This study is a first of its kind in Oman, looking at the impact of a patient information booklet about varicose veins etiology, symptoms, signs, assessment and management, on the attitude of a female patient's acceptance towards examination by a male surgeon in the presence of a chaperone.

Patient awareness, knowledge, and acceptability of antenatal perineal massage: A single-center cross-sectional study from Saudi Arabia.

This study assessed the knowledge, awareness, and acceptability of antenatal perineal massage (APM) among pregnant women in Saudi Arabia. This cross-sectional study included 240 pregnant women who met the predefined inclusion criteria and attended the Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia, from 1 October to 31 December 2023. Participants answered seven knowledge questions, classified as having good knowledge if they answered ≥4 correctly and poor knowledge if <4 were correct. Most women (46.25%) reported it was their first encounter with APM. Common sources of information included the internet (39.58%), physicians/midwives (7.92%), and friends/family (3.75%). Nearly half (47.5%) had heard of APM, but only 8.75% had practiced it, and 3.75% attended related classes. Only 17.5% knew that APM could be performed by the woman or her partner, while 25.83% knew it should start at 34 weeks, and 17.92% recognized the recommended duration of 5 to 10 minutes daily. Additionally, 22.5%, 15.83%, and 35.42% acknowledged APM's benefits for labor duration, anal sphincter dysfunction, and perineal injuries, respectively. The average knowledge score was 1.39±1.84, with 84.17% classified as having poor knowledge. No significant differences were found between knowledge levels (p>0.05). Low acceptability was noted, with only 58% of patients and 37% of their partners willing to engage in APM. No significant differences in acceptability were found between poor and good knowledge groups (p>0.05). The study revealed low awareness, poor knowledge, and weak acceptability of APM among pregnant patients. Targeted education for patients and healthcare providers could enhance knowledge and improve maternal-fetal health outcomes.

Short-Term Efficacy of LCBDE+LC Versus ERCP/EST+LC in the Treatment of Cholelithiasis Combined with Common Bile Duct Stones: A Retrospective Cohort Study.

Background: Minimally invasive treatments for cholelithiasis have gained popularity. The complexity of diagnosing and treating choledocholithiasis offers multiple surgical options, including laparoscopic common bile duct exploration plus laparoscopic cholecystectomy (LCBDE+LC) and endoscopic retrograde cholangiopancreatography and/or endoscopic sphincterotomy plus laparoscopic cholecystectomy (ERCP/EST+LC). Objective: To compare outcomes in patients with typical signs, symptoms, laboratory, and imaging features of cholelithiasis combined with common bile duct stones, we retrospectively analyzed the short-term outcomes of LCBDE+LC and ERCP/EST+LC. Methods: We analyzed 318 patients with gallbladder stones treated between January 2022 and May 2024. Of these, 152 underwent LCBDE+LC, and 166 underwent ERCP/EST+LC. We compared patients' baseline characteristics, perioperative outcomes, and short-term complications between the two groups. The primary outcome was the effectiveness of choledochal stone removal, while secondary outcomes included length of stay, hospitalization costs, and patient satisfaction. Results: Patients' baseline characteristics were similar between the LCBDE+LC and ERCP/EST+LC groups. Stone clearance rates were comparable (97.37% versus 95.18%, P = .306), with a slight advantage in the LCBDE+LC group. The length of hospitalization was significantly shorter in the LCBDE+LC group (6.49 ± 1.18 days versus 6.77 ± 1.11 days, P < .05). The LCBDE+LC group also had lower total hospitalization costs ($5188.78 ± 861.26 versus $6498.76 ± 1190.58 P < .01). Additionally, the incidence of pancreatitis was lower in the LCBDE+LC group (0.66% versus 6.02%, P < .01). There were no significant differences between the groups in other short-term complications such as abdominal infection, cholangitis, biliary bleeding, or bile leakage. Postoperative follow-up indicated higher patient satisfaction and acceptance in the LCBDE+LC group (SSQ-8, 85.84 ± 4.31 points versus 81.20 ± 4.54 points, P < .01). Conclusion: Our findings suggest that the LCBDE+LC holds promise as a safe and efficacious approach for the management of cholelithiasis combined with common bile duct stones. However, further prospective clinical trials are essential to corroborate these results and confirm their broader applicability.

A stepped wedge randomised controlled trial assessing the efficacy and patient acceptability of virtual clinical pharmacy in rural and remote Australian hospitals.

Despite medication being the most common healthcare intervention and medication-related incidents being common in hospitals, many rural and remote hospitals in Australia lack onsite pharmacy services due to resource constraints. A Virtual Clinical Pharmacy Service (VCPS) staffed by two senior, rural generalist hospital pharmacists assigned to four hospitals each was implemented in rural and remote facilities to determine whether the VCPS increased adherence to National Safety and Quality Health Service Standards (NSQHS). A stepped-wedge randomised controlled trial was employed to sequentially implement a telehealth pharmacy service at one-month intervals in eight hospitals. The primary outcomes were patient-level medication reconciliation completion rates on admission and discharge. Secondary measures evaluated compliance with other NSQHS standards (including Best Possible Medication History, Medication Reconciliation and venous thromboembolism risk assessment), patient outcomes (including representation within 48h, readmission within 28 days and length of stay), and detection of potential medication-related harms (including pharmacist identified medication related problems, reported medication errors and falls). Patients were invited to complete a patient-reported experience questionnaire. Data were collected from electronic medical records and analysed using mixed logistic regression models to estimate the effectiveness of the VCPS. Antimicrobial usage, falls, and medication errors were analysed at the facility level, while other data were analysed at the patient level. Compared to control (n = 535), patients in the intervention period (n = 527) were more likely to have an admission medication reconciliation completed (Odds Ratio (OR) 11.16, 95% confidence interval (CI) 5.59-22.30, p < 0.001) in models adjusted for the study period. A similar improvement was observed for discharge medication reconciliation completion (OR 4.07, CI 2.38-6.95, p < 0.001), whereas a 33-fold improvement was seen in Best Possible Medication History completion (OR 33.27, CI 17.53-63.14, p < 0.001). The VCPS documented 879 medication related problems, with 61% of patients having at least one medication-related problem documented by a pharmacist. There was no change in length of stay, falls, readmission rates or reported medication error rates; however, the study was not powered to detect these changes. Patient feedback was positive and comparable to in-person care, with 95% (179/189) reporting their overall experience as 'good' or 'very good.' No unintended harms were reported. The VCPS improved compliance with national standards for medication safety, had high patient acceptability and resulted in the detection of clinically relevant medication-related issues in rural and remote settings. The applicability of virtual pharmacy should be explored in further rural and remote locations in addition to other settings such as metropolitan locations with no onsite clinical pharmacists. GWHREC 2019/ETH13355. ANZCTR registration number ACTRN12619001757101. Registered on 11/12/2019. Published trial protocol: A stepped wedge trial of efficacy and scalability of a virtual clinical pharmacy service (VCPS) in rural and remote NSW health facilities.

Effectiveness of Acceptance and Commitment Therapy (ACT) on disease acceptance for breast cancer patients: Study protocol of a randomized controlled trial.

Breast cancer patients face significant psychological challenges, including difficulties in accepting the diagnosis, treatment, and long-term impact of the disease. Acceptance and Commitment Therapy (ACT) has shown promise in enhancing acceptance and psychological flexibility in various populations. This study aims to investigate the effectiveness of ACT in promoting disease acceptance among breast cancer patients through a randomized controlled trial. This study will recruit 90 breast cancer patients and randomly allocate them to an ACT intervention or control group. The ACT intervention, focusing on acceptance, mindfulness, value clarification, and committed action, will be delivered over 4 weeks. Meanwhile, the control group will receive standard care with non-therapeutic intervention. The study's primary outcome is disease acceptance, while secondary outcomes include depression, anxiety, social support, quality of life (QoL), and psychological inflexibility. Data will be collected at three points: baseline, post-intervention, and three-month follow-up. Statistical analysis will compare outcomes between groups to evaluate the effectiveness and mechanism of this intervention using covariance and mediation analysis. This study evaluates the effectiveness of ACT in promoting disease acceptance among breast cancer patients. It hypothesizes that the ACT group will show higher disease acceptance and improvements in social support, QoL, and psychological flexibility compared to the control group. The findings will contribute to research on psychological interventions and demonstrate ACT's effectiveness in enhancing disease acceptance. The research project is registered in the ClinicalTrials (NCT05327153).

Patient-Reported Goals of Care in the Preoperative Clinic: Barriers to and Facilitators of Patient Values Elicitation and Documentation.

Infrequent preoperative goals of care (GOC) documentation leads to challenges in medical decision-making when patients experience postoperative complications. We evaluated the feasibility of enhancing GOC documentation through a patient portal-based values questionnaire. A patient values questionnaire (PVQ) was distributed to patients before their Gynecologic Surgical Oncology clinic appointments via an electronic health record (EHR)-based portal from June to October 2023. Surgeons and advanced practice providers were encouraged to address PVQ responses during clinic appointments. Patient acceptability surveys were sent to PVQ respondents and clinicians were interviewed to assess feasibility and acceptability. PVQ response rate was 225/383 (59%); 29% of all patients had an established cancer diagnosis. Clinicians deemed preoperative GOC documentation important and the PVQ valuable to prepare for unexpected postoperative complications. Accessing questionnaire responses through the EHR was a technical barrier. Clinicians agreed that GOC should be addressed after diagnosis and treatment discussions, but before surgery. Ninety percent of patients felt comfortable discussing GOC at their first clinic appointment. Patient portals facilitate preoperative GOC documentation, however, clarifying and integrating values into care require ongoing discussions between clinicians and patients. Optimal timing of GOC elicitation is posttreatment planning and before surgery when the patient is most informed.

Advancements in p53-Based Anti-Tumor Gene Therapy Research

The p53 gene is one of the genes most closely associated with human tumors and has become a popular target for tumor drug design. Currently, p53-based gene therapy techniques have been developed, but these therapies face challenges such as immaturity, high safety hazards, limited efficacy, and low patient acceptance. However, researchers are no less enthusiastic about the treatment because of its theoretical potential to treat cancer. In this paper, the advances in p53-based gene therapy and related nucleic acid delivery technologies were reviewed and prospected in order to support further development in this field.

Optical Diagnosis in the Era or Artificial Intelligence.

The development of new image enhancement modalities and improved endoscopic imaging quality have not led to increased adoption of resect-and-discard in routine practice. Studies have shown that endoscopists have the capacity to achieve quality thresholds to perform optical diagnosis, however, this has not led to acceptance of optical diagnosis as a replacement for pathology for diminutive (1-5mm) polyps. In recent years, Artificial Intelligence (AI)-based Computer Assisted Characterisation (CADx) of diminutive polyps has recently emerged as a strategy that could potentially represent a breakthrough technology to enable widespread adoption of resect-and-discard. Recent evidence suggests that pathology-based diagnosis is suboptimal, as polyp non-retrieval, fragmentation, sectioning errors, incorrect diagnosis as 'normal mucosa', and inter-pathologist variability limit the efficacy of pathology for the diagnosis of 1-5mm polyps. New paradigms in performing polyp diagnosis with or without AI have emerged to compete with pathology in terms of efficacy. Strategies, such as Autonomous AI, AI-assisted human diagnosis, AI-unassisted human diagnosis, and combined strategies have been proposed as potential paradigms for resect-and-discard, although further research is still required to determine the optimal strategy. Implementation studies with high patient acceptance, where polyps are truly being discarded without histologic diagnosis are paving the way towards normalizing resect-and-discard in routine clinical practice. Ultimately the largest challenges for CADx remain liability perceptions from endoscopists. The potential benefits of AI-based resect-and-discard are many, with very little potential harm. Real world implementation studies are therefore required to pave the way for the acceptability of such strategies in routine practice.

Management of COVID-19 in the community using virtual care: An Australian perspective.

Virtual care and remote monitoring were widely used during the COVID-19 pandemic. However, early evaluations of effectiveness were often inconclusive due to low rates of enrolment and limited data. The aim of this study was to evaluate the effectiveness of virtual care in managing individuals in community-based self-isolation and quarantine in Australia during this pandemic. A retrospective cross-sectional study was conducted of individuals admitted to a virtual hospital in Sydney who either tested positive for COVID-19 and required self-isolation, or tested negative but still needed to self-isolate, amidst the Delta wave of the COVID-19 pandemic. Outcome measures included health service utilisation, in-hospital mortality, patient-reported experience measures (PREM), and cost savings resulting from avoided emergency department (ED) presentations. Out of 9571 individuals admitted, 8544 (89.3%) had COVID-19. Clinical deterioration or acute illness occurred in 2477 (25.9%) individuals, of whom 890 (9.3%) were referred to ED for further assessment or investigation, and 614 (6.4%) were admitted for inpatient treatment. Overall mortality was 0.2%. Out of 1020 individuals who completed the PREM survey, 846 (82.9%) rated the overall virtual care experience as 'good' or 'very good'. Avoided ED presentations possibly resulted in cost savings estimated between AU$691,214 and AU$2,994,540. Virtual care was successfully used to manage a large number of individuals in community-based self-isolation and quarantine during the COVID-19 pandemic. Scalable pathways for triage, monitoring and clinical escalation via telehealth ensured patient safety and acceptability, and alleviated strain on the broader health system.

Patient acceptance of medical service robots in the medical intelligence era: an empirical study based on an extended AI device use acceptance model

In the era of medical intelligence, there are still few studies focusing on medical service robots from a user experience perspective. Guided by the model of artificial intelligence (AI) device use acceptance (AIDUA), this article develops a theoretical model to explain patients’ intention to use medical service robots at hospitals. The proposed model specifically distinguished the dimensions of anthropomorphic attributes of service robots and further introduces two variables, perceived empathy and interaction experience, as a way to construct a three-stage psychological mechanism for patient acceptance of robots. 400 questionnaires from Chinese patients were collected offline and analyzed using structural equation modeling (SEM). The results revealed that the four attributes of anthropomorphism play a differential influence in performance expectations and effort expectations, but all positively contribute to empathy, which in turn positively affects interaction quality. Interaction quality, performance expectations, and effort expectations all influence patients’ emotions, thus having an impact on patients’ intentions to accept service robots. The findings from this study will assist the healthcare sector in upgrading medical service robots, which will improve patient acceptance of these robots.

An Assessment of the Feasibility, Patient Acceptance, and Performance of Point-of-Care Transient Elastography for Metabolic-Dysfunction-Associated Steatotic Liver Disease (MASLD): A Systematic Review and Meta-Analysis

Background: Vibration-Controlled Transient Elastography (VCTE) with FibroScan is a non-invasive, reliable diagnostic tool for Metabolic-Dysfunction-Associated Steatotic Liver Disease (MASLD), enabling early detection and management to prevent severe liver diseases. VCTE’s ease and portability suit primary care, streamlining referrals, promoting lifestyle changes, reducing costs, and benefiting underserved communities. Methods: Studies on point-of-care VCTE were systematically reviewed, followed by meta-analysis using a random-effects model. Pooled proportions with 95% confidence intervals were reported, and heterogeneity was assessed using I2%. Results: A total of twenty studies from 14 countries, including 6159 patients, were analyzed, with three studies from France, two from the U.S., and four from China. The population had a slight male preponderance, with a mean age range of 35–73 years and a BMI range of 24.4–41.1%. The diagnostic accuracy for detecting any fibrosis (≥F1) was reported in four studies (n = 210) with an AUC of 0.74, sensitivity of 69.5%, and specificity of 70.6%. For significant fibrosis (≥F2), eight studies (n = 650) reported an AUC of 0.69, sensitivity of 81.7%, and specificity of 64.6%. Advanced fibrosis (≥F3) was evaluated in 10 studies (n = 619), with an AUC of 0.84, sensitivity of 88.1%, and specificity of 63.8%. Cirrhosis (F4) was assessed in nine studies (n = 533), with an AUC of 0.65, sensitivity of 87.5%, and specificity of 62.6%. Steatosis diagnoses across stages S1 to S3 showed increasing diagnostic accuracies, with AUCs of 0.85, 0.76, and 0.80, respectively. Probe type and BMI were significant covariates influencing diagnostic performance for both fibrosis and steatosis, while the percentage of male participants also showed significant associations. Conclusions: VCTE shows high diagnostic accuracy for fibrosis and steatosis in MASLD patients at the point of care. Future research should assess its implementation in fibroscan settings.

A Qualitative Study of Type 2 Diabetes Mellitus Outpatients' Perspectives on Readiness, Acceptance and Barriers of Mobile Apps for Medication Adherence

ObjectivesThis qualitative phenomenological study explored the perspectives of type 2 diabetes mellitus (T2DM) outpatients in adopting mobile apps for medication adherence management. MethodsThrough 25 semi-structured in-depth interviews, themes were identified using thematic analysis, guided by the Technology Readiness and Acceptance Model (TRAM). ResultsAnticipated convenience and benefits, openness to new technologies acted as drivers, while limited digital literacy and concerns about data privacy and security served as inhibitors of readiness to adopt health apps. Acceptance was influenced by elements related to medication, patient, healthcare professional, family and app aspects. The identified barriers were related to patient, smartphone and monetary factors. Patients perceived the need to adopt digital apps were for those with poor adherence, complex medication regimen and forgetfulness issues. However, concerns about effectively implementing this approach were noted as T2DM patients were predominantly late middle-aged adults who faced technical challenges, leading to combination approach between digital technology and conventional patient education and counselling. ConclusionThe findings highlighted the factors influencing patient's readiness, acceptance, and barriers on effective utilisation of digital health solutions in managing adherence issues. Practical implicationsThe elements of TRAM provide guidance for strategic actions to enhance digital health technology adoption among T2DM patients.

Early medical abortion provision via telehealth in Victoria: A qualitative descriptive study.

Little is known about the views of service providers currently working in telehealth early medical abortion (EMA) provision in Victoria, Australia. This study aims to contextualise the enablers and barriers to telehealth EMA provision, providing insight for healthcare policy and practice to improve the accessibility of this service. This was a qualitative descriptive study involving semi-structured interviews with 14 Victorian stakeholders with expertise and knowledge on telehealth EMA provision. Data were analysed using conventional content analysis. This study presents perceived enablers and barriers across four different contexts of the Victorian abortion system: (1)perceived patient context; (2) perceived provider context; (3) health organisation-system context; and (4)sociopolitical context. The COVID-19 pandemic's disruption of healthcare services led to greater patient and provider acceptance of telehealth EMA. However, barriers within the patient context included the inability to ensure safety and confidentiality, digital access and literacy issues, language barriers, and theimportance of trusting provider-patient relationships. Providers encountered challenges in delivering holistic care via telehealth, including time and workload issues and working with interpreters. Shortcomings within the organisational context encompassed structural barriers for culturally and linguistically diverse population groups, the absence of standard telehealth guidelines and varying interpretations of telehealth. Although temporary Medicare item number changes improved access, they presented financial challenges for mixed and private billing practices. The application of these findings by relevant health services and policymakers has the potential to improve the quality of, and increase accessibility to, telehealth EMA, better meeting the needs of individuals seeking this service.

Scoping review of enablers and challenges of implementing pharmacogenomics testing in the primary care settings.

Pharmacogenomic testing (PGx) plays a crucial role in improving patient medication safety, yet ethical concerns and limitations impede its clinical implementation in the primary care settings. To systematically review the current state of PGx in the primary care settings and determine the enablers and challenges of its implementation. A scoping review was carried out by adhering to Arksey and O'Malley's 6-stage methodological framework and the 2020 Joanna Briggs Institute and Levac et al. DATA SOURCES: Cochrane Library, EMBASE, Global Health, MEDLINE and PubMed were searched up to 17 July 2023. All peer-reviewed studies in English, reporting the enablers and the challenges of implementing PGx in the primary care settings were included. Two independent reviewers extracted the data. Information was synthesised based on the reported enablers and the challenges of implementing PGx testing in the primary care settings. Information was then presented to stakeholders for their inputs. 78 studies discussing the implementation of PGx testing are included, of which 57% were published between 2019 and 2023. 68% of the studies discussed PGx testing in the primary care setting as a disease-specific themes. Healthcare professionals were the major stakeholders, with primary care physicians (55%) being the most represented. Enablers encompassed various advantages such as diagnostic and therapeutic benefits, cost reduction and the empowerment of healthcare professionals. Challenges included the absence of sufficient scientific evidence, insufficient training for healthcare professionals, ethical and legal aspects of PGx data, low patient awareness and acceptance and the high costs linked to PGx testing. PGx testing integration in primary care requires increased consumer awareness, comprehensive healthcare provider training on legal and ethical aspects and global feasibility studies to better understand its implementation challenges. Managing high costs entails streamlining processes, advocating for reimbursement policies and investing in research on innovation and affordability research to improve life expectancy.

Ultrahypofractionated Adjuvant Breast Radiotherapy (+/- Boost) and Virtual Consultations: Patient Perspectives at One Year

Purpose/Objectives: In March 2020, a 1 week ultrahypofractionated adjuvant breast radiotherapy schedule, 26 Gy in 5 fractions and telehealth were adopted to reduce the risk of COVID-19 for staff and patients. This study describes real world 1 year late toxicity for ultrahypofractionation (including a sequential boost) and patient perspectives on this new schedule and telehealth workflows. Materials and Methods: Consecutive patients were enrolled Mar-Aug 2020. Patient reported outcome measures including the presence of breast pain, swelling, firmness, and others were recorded using the EORTC QLQ BR45 at baseline, 3 months, 6 months and 1 year. Virtual teleconferencing without video was utilised. Patients were invited to use video at 1 year for a physician based assessment including breast inspection. Patient reported experience measures were also collected at 1 year to capture how a shortened schedule and telehealth influenced patient experience. ResultsIn total, 121/135 patients completed at least two assessments of which 33 (25%) received a sequential boost. The majority of patients reported no toxicity or a mild toxicity at all three time points, 76% at 3 months, 76% at 6 months, and 82% at 1 year. When comparing 26Gy in 5 fractions alone versus 26 Gy in 5 fractions followed by a sequential boost, there was no difference in toxicity reported at one year.94% felt supported by the medical team throughout their treatment course using telehealth only consultations. Only 27% actually agreed to video consultation for the purpose of breast inspection when offered. ConclusionsUltrahypofractionated breast radiotherapy leads to acceptable late toxicity at 1 year even when followed by a hypofractionated tumour bed boost. Patient satisfaction with ultrahypofractionated treatment and virtual consultations without video was high. Further investigation concerning the patient acceptance of video consultations for a physician-based assessment including breast inspection is warranted.

Sacrocolpopexy: Alternatives to Mesh Grafts.

The ongoing pelvic mesh controversy, coupled with a regulatory pause in using pelvic mesh in some countries, has created a need for mesh-free alternatives for sacrocolpopexy (SCP). This article provides an overview of mesh-free alternatives for SCP. MEDLINE and PubMed searches were conducted to identify studies reporting on autologous and non-autologous biologic grafts for SCP. Identified studies were reviewed by two of the authors (CY and MR). Emerging evidence on autologous fascia lata (AFL) and rectus sheath (ARS) for SCP is promising, with low donor site morbidity. Non-autologous biologic grafts for SCP are mostly reported to be inferior to mesh. Emerging evidence suggests that AFL and ARS might be safe and effective alternative options to mesh SCP. The main advantages of AFL for SCP over ARS are laparoscopy or robot-assisted laparoscopy approaches, and that a larger graft can be safely harvested. The benefits of utilising allografts and xenografts are limited by their reduced durability compared with mesh and patient acceptability.

Machine learning perioperative applications in visceral surgery: a narrative review.

Artificial intelligence in surgery has seen an expansive rise in research and clinical implementation in recent years, with many of the models being driven by machine learning. In the preoperative setting, machine learning models have been utilized to guide indications for surgery, appropriate timing of operations, calculation of risks and prognostication, along with improving estimations of time and resources required for surgeries. Intraoperative applications that have been demonstrated are visual annotations of the surgical field, automated classification of surgical phases and prediction of intraoperative patient decompensation. Postoperative applications have been studied the most, with most efforts put towards prediction of postoperative complications, recurrence patterns of malignancy, enhanced surgical education and assessment of surgical skill. Challenges to implementation of these models in clinical practice include the need for more quantity and quality of standardized data to improve model performance, sufficient resources and infrastructure to train and use machine learning, along with addressing ethical and patient acceptance considerations.

International case studies: success and failure factors for digital transformation in healthcare

Abstract Background The digitalization of healthcare systems is expected to lead to improvements in the quality and efficiency of healthcare services. Despite Germany’s leading economic and technological position, the implementation and utilization of digital health solutions is lagging far behind internationally. A look at other countries shows that the digital transformation in healthcare can be successful, and that financial resources and available technologies are not the only determining factors. Rather, it is a matter of political processes, the interests of different stakeholders and the acceptance of patients and HCPs. Methods While the impression often arises that the selection of countries in case studies is random, eight international case studies were identified using a scientific method. A systematic and multi-stage process was developed to select the case studies, taking into account various relevant criteria (e.g. degree of digitalization, geography, economy). The implementation and use of various digital health tools will be examined in selected countries and healthcare systems, in which the digitalization of the healthcare system is particularly advanced. Semi-structured interviews will be conducted with experts from the international healthcare systems between fall 2024 and summer 2025. The findings will inform the development of recommendations for actions for policymakers in Germany. Conclusions This study aims to provide new insights into the key success and failure factors for the digital transformation of healthcare systems. Recommendations for action, tailored specifically to the German healthcare system and aimed at policymakers, are intended to support decision-makers in setting the course for a successful further transformation towards digital health. Key messages • International case studies will be used to identify factors that contribute to the success or failure of digital transformation in healthcare systems. • Based on the findings of this research, recommendations for action will be developed for policymakers in Germany to set the course for the successful further digitalization of healthcare.

Assessment of ventricular mechanics by means of myocardial work in patients undergoing physiologic versus right ventricular apical stimulation:a prospective study

Abstract Introduction Left bundle branch area (LBBA) pacing has recently gained widespread acceptance in patients that need pacemaker (PM) stimulation. This type of physiologic pacing may improve ventricular mechanical contraction and reduce the risk of PM-induced left ventricular (LV) dysfunction. Myocardial work (MW), a new tool, based on the analysis of pressure-strain loops, combines the information from speckle tracking strain imaging and non-invasive estimate of LV pressure. It provides a better characterization of LV performance and detection of LV myocardial dysfunction. The aim of this study was to compare MW after PM implantation in LBBA pacing patients (group 1) vs right ventricular apical (RVA, group 2) pacing patients. A control group (group 3) was also enrolled for establishing MW normal values. Methods We studied 30 patients (56% females, age 80 y, IQR 75-84) who underwent PM implantation and had a high probability of a high % of stimulation and 21 controls (57% females, age 79 y, IQR 73-85, p=0.46 and p=0.73 respectively) Patients were prospectively included at two large university hospitals from March 23 until February 24. The mode of stimulation was chosen at their physician’s discretion. Exclusion criteria included LVEF &amp;lt;50% or significant structural or valvular disease. We compared MW parameters between group 1 and group 2 before PM implantation, and 24 hours and 3 months post PM implantation by Kruskal Wallis test. Additionally, we compared MW parameters between group 3 and PM patients after 24 hours using U Mann-Whitney test. Results The % of stimulation was 93%±12. There were no differences in baseline characteristics between group 1 (n=21, 71%) and group 2. At baseline, global work index (GWI), global constructive work (GCW), global wasted work (GWW) or global work efficiency (GWE) did not differ significantly between Group 1 and 2. At 24 hours, all the components of MW significantly improved in Group 1 and 2 and were maintained at 3 months, but the improvement was notably greater in Group 1 (see Table 1). Group 3 and PM patients were similar at baseline (HTN, 86% vs 80%, p=0.7197; DM, 29% vs 30%, p=0.91; coronary artery disease, 14% vs 10%, p=0.68; sinus rhythm, 76% vs 83%, p=0.68). Comparing group 3 and PM at 24 h, GWI, GCW, GWE was significantly higher in group 3 (p=0.0023, p=0.009, p=&amp;lt;0.0001) and GWW was significantly lower (p=&amp;lt;0.0001). Regarding the type of stimulation, MW parameters values in Group 1 were still lower than in Group 3 but clearly better than Group 2 values (see Figure 1). Discussion Our results showed that MW parameters improved to a greater extent in LBBA compared to RVA pacing immediately and after 3 months of PM implantation. Compared to our control group, LBBA pacing group achieved better performance than RVA pacing patients, yielding a more coordinated LV contraction. Nevertheless, more studies are needed to clarify if LBBA pacing causes less PM induced LV dysfunction compared to RVA pacing.