Physician Responses Research Articles

Application of Medical Professional Ethics in a Legal Context: Comparative Analysis of Ethical Cases and Legal Aspects

This research explores the relationship between ethical values in medical practice and the governing legal framework, especially in the context of medical cases involving patient privacy and treatment decisions. Through an in-depth analysis of the differences and harmony between the principles of medical ethics and legal requirements, this research discusses the implications of these discrepancies for clinical decisions, physician responsibilities, and the protection of patient rights. These findings highlight the complexity of achieving appropriate alignment between the ethical values underlying medical practice and the legal framework governing medical practice

Do all prostate cancer patients want, and experience shared decision making prior to curative treatment?

In comparable men with non-metastatic prostate cancer, radical prostatectomy (RP), radiotherapy (RAD) and active surveillance (AS) are treatment options with similar survival rates, but different side-effects. Healthcare professionals consider pretreatment shared decision making (SDM) to be an essential part of medical care, though the patients' view about SDM is less known. In this article, we explore prostate cancer (PCa) patients' SDM wish (SDMwish), and experiences (SDMexp). Material and methods: This is a registry-based survey performed by the Cancer Registry of Norway (2017-2019). One year after diagnosis, 5,063 curatively treated PCa patients responded to questions about their pre-treatment wish and experience regarding SDM. Multivariable analyses identified factors associated with SDM. Statistical significance level: p < 0.05. Results: Overall, 78% of the patients wished to be involved in SDM and 83% of these had experienced SDM. SDMwish and SDMexp was significantly associated with decreasing age, increasing education, and living with a partner. Compared with the RP group, the probability of SDMwish and SDMexp was reduced by about 40% in the RAD and the AS groups. Conclusion: Three of four curatively treated PCa wanted to participate in SDM, and this wish was met in four of five men. Younger PCa patients with higher education in a relationship, and opting for RP, wanted an active role in SDM, and experienced being involved. Effective SDM requires the responsible physicians' attention to the individual patients' characteristics and needs.

Kids Lung Registry and Child-EU Project - Progress in Rare and Interstitial Lung Diseases in Childhood Through Collaboration

Progress in rare and interstitial lung disease in childhood can most usefully be achieved through systematic, registry-based collection. What are the practicalities and benefits of participating in the pediatric lung registry/chILD-EU project? We report our clinical experiences. Pediatricians and pediatric pulmonologists identify children with rare lung diseases. These are reported to the Kid's Lung Register after parental consent. Clinical data, imaging, and blood are sent to the registry. Genetic analysis can be arranged if desired. With completeness of the data, a peer-review process by pediatric radiology, possibly lung pathology, clinical and possibly genetic experts takes place in an interdisciplinary conference. A working diagnosis is established and communicated to the responsible physician via the registry and, if necessary, further discussed in case-related discussions. Assistance in entering the data is provided by the registry. Follow-ups are performed annually, and all registered physicians are invited to regular, web-based case discussions. Significant questions are answered in scientific projects and jointly published (>110 publications to date). Due to voluntary additional work of all participants beyond clinical routine, more than 1000 children with rare lung diseases have been included in the registry with biobank to date. A deeper understanding of the clinical courses of large cohorts of rare diseases and the initial description of new entities contributes to better care for these children.

Physicians’ self-perceived preparedness for clinical supervision of medical students at university and non-university hospitals -results from a Swedish survey

BackgroundThe need for clinical placements outside traditional teaching hospitals for medical students is growing, both due to a decrease in hospital beds and the expansion of medical students. In this survey, distributed to supervisors at university and non-university hospitals, we investigated supervisors’ self-perceived preparedness for the training assignment and searched for factors associated with self-perceived pedagogical knowledge and familiarity with the students’ learning objectives.MethodsA pilot survey was developed using results from qualitative studies regarding clinical supervision of medical students and included questions on the supervisors’ education and preparation, if they were familiar with the students’ learning objectives, self-perceived pedagogical knowledge, and characteristics of the learning environment. The pilot survey was tested on a smaller group of supervisors. The results from the pilot survey were used to develop an e-survey that was distributed to all hospital employed physicians in Region Västra Götaland.ResultsThe survey was completed by 1732 physicians (response rate 43%). Among 517 respondents at the university hospital who reported activity as supervisor, 240 (46%) had attended preparatory supervisor training, 423 (82%) perceived enough pedagogical knowledge for the teaching assignment, and 391 (76%) reported familiarity with the learning objectives. The corresponding proportions at non-university hospitals were 159/485 (33%), 363/485 (75%), and 298/485 (61%), respectively (p ≤ .007 all through, compared to the university hospital). Perceiving that goal description and written information from the course management was sufficient for being able to complete the training assignment showed strong association with both self-perceived pedagogical knowledge and familiarity with the students’ learning objectives.ConclusionsWe found consistent differences between university and non-university hospitals with respect to the supervisors’ self-perceived preparedness for the training assignment. Efforts to convey the learning objectives and support to clinical supervisors are crucial for supervision of students at non-university hospitals.

Need for Improvement in Death Pronouncements in Palliative Care Units.

Death pronouncement is an important moment that can impact a family's bereavement process; however, necessary improvements in physicians' behavior during death pronouncement remain unclear. To explore whether the lack of certain behaviors by the physician was associated with a perceived need for improving death pronouncement for advanced cancer patients in palliative care units (PCUs). This study was a secondary analysis of a nationwide multicenter questionnaire survey conducted in 2018 that targeted bereaved family members of cancer patients who died in PCUs. We performed univariate analysis to investigate the need to improve behavior toward death pronouncement. We performed bivariate analysis to investigate the relationship among the need for improvement in behavior toward death pronouncement, physician attribution (primary responsible physician, a member of the same team, and another physician), and nine specific behaviors. Four hundred twenty-two questionnaires (64.2%) were returned. We analyzed 356 responses and found that 32.5% perceived the need to improve death pronouncement. Lack of certain behaviors at death pronouncement, especially not explicitly explaining the cause of death to family members (odds ratio: 11.89, p < 0.001), were positively associated with the need for improvement. There were significant differences among the types of physician attribution regarding the need for improvement (primary responsible physician vs. a member of the same team vs. another physician [15.1% vs. 42.6% vs. 45.7%, p < 0.001]). There was a significant positive association between the lack of certain behaviors toward death pronouncement and the need for improvement. The major lack of behavior toward death pronouncement was not explicitly explaining the cause of death to family members and not calling out to the patient before beginning the patient's examination.

Using coercion in mental disorders or risking the patient’s death? An analysis of the protocols of a clinical ethics committee and a derived decision algorithm

While principle-based ethics is well known and widely accepted in psychiatry, much less is known about how decisions are made in clinical practice, which case scenarios exist, and which challenges...

Investigation of Views and Experiences of Medical Interns on the Facilitating and Inhibiting Factors Affecting the Quality of Education in the Clinical Education System

Introduction: Clinical education is the most important part of medical education that provides a golden opportunity for medical students to combine their theoretical mix with the clinical environment, and this is important in the countries of the style of the arena of medicine Special attention is paid. Therefore, this study was conducted to examine the views and experiences of medical students as facilitators and inhibitors of clinical education quality.&#x0D; Methods: This is qualitative research and a phenomenological approach was used. The study population consisted of medical students of Kerman University of Medical Sciences. Target-based sampling was performed on 40 medical students. The method for collecting information was a deep interview with the participants. The data were analyzed by the Colaizzi method.&#x0D; Results: Two initial codes were extracted in the form of two main themes (facilitating and inhibiting factors) and 10 sub-themes including providing motivational patterns and creating interest in interns, the high scientific and educational level of attending professors, use of technology, authorizing more responsibility, inappropriate treatment, inappropriate educational planning, inappropriate evaluation method, low-quality mornings, lack of facilities, and overwhelming of some wards were classified.&#x0D; Conclusion: Considering these factors, it is possible to raise the quality of clinical education to the highest possible level and educate responsible and responsible physicians for generations.

Artificial Intelligence Versus Expert Plastic Surgeon: Comparative Study Shows ChatGPT "Wins" Rhinoplasty Consultations: Should We Be Worried?

Introduction: Large language models, such as ChatGPT, hold tremendous promise to bridge gaps in patient education and enhance the decision-making resources available online for patients seeking nasal surgery. Objective: To compare the performance of ChatGPT in answering preoperative and postoperative patient questions related to septorhinoplasty. Methods: Two sets of responses were collected for the questions: one from an expert rhinoplasty surgeon with over two decades of experience, and the other from ChatGPT-3.5. Seven expert rhinoplasty surgeons, blinded to the source of responses, independently assessed the responses using a 5-point Likert scale in four performance areas: empathy, accuracy, completeness, and overall quality. Results: ChatGPT outperformed physician responses in three of the four performance areas, earning significantly higher ratings in accuracy, completeness, and overall quality (p < 0.001). In addition, ChatGPT was overwhelmingly preferred over physician responses (p < 0.001), with evaluators favoring ChatGPT in 80.95% of instances. Conclusions: ChatGPT has demonstrated its remarkable ability to deliver accurate, complete, and high-quality responses to preoperative and postoperative patient questions. Although certain improvements are warranted, this artificial intelligence tool has shown its potential to effectively counsel and educate prospective septorhinoplasty patients at a level comparable with or exceeding that of an expert surgeon.

Evaluation of Oropharyngeal Cancer Information from Revolutionary Artificial Intelligence Chatbot.

With burgeoning popularity of artificial intelligence-based chatbots, oropharyngeal cancer patients now have access to a novel source of medical information. Because chatbot information is not reviewed by experts, we sought to evaluate an artificial intelligence-based chatbot's oropharyngeal cancer-related information for accuracy. Fifteen oropharyngeal cancer-related questions were developed and input into ChatGPT version 3.5. Four physician-graders independently assessed accuracy, comprehensiveness, and similarity to a physician response using 5-point Likert scales. Responses graded lower than three were then critiqued by physician-graders. Critiques were analyzed using inductive thematic analysis. Readability of responses was assessed using Flesch Reading Ease (FRE) and Flesch-Kincaid Reading Grade Level (FKRGL) scales. Average accuracy, comprehensiveness, and similarity to a physician response scores were 3.88 (SD = 0.99), 3.80 (SD = 1.14), and 3.67 (SD = 1.08), respectively. Posttreatment-related questions were most accurate, comprehensive, and similar to a physician response, followed by treatment-related, then diagnosis-related questions. Posttreatment-related questions scored significantly higher than diagnosis-related questions in all three domains (p < 0.01). Two themes of the physician critiques were identified: suboptimal education value and potential to misinform patients. The mean FRE and FKRGL scores both indicated greater than an 11th grade readability level-higher than the 6th grade level recommended for patients. ChatGPT responses may not educate patients to an appropriate degree, could outright misinform them, and read at a more difficult grade level than is recommended for patient material. As oropharyngeal cancer patients represent a vulnerable population facing complex, life-altering diagnoses, and treatments, they should be cautious when consuming chatbot-generated medical information. NA Laryngoscope, 134:2252-2257, 2024.

Prognosis of diastolic dysfunction in patients with preserved LVEF. Value of left atrial strain

Abstract Introduction The assessment of diastolic function is of paramount importance in a context of an epidemic of HFpEF. (1) Left atrial reservoir Strain (LARS) &amp;lt;18% identif patients with elevated filling pressures when one of the three standard criteria is not available. (2) However, LARS has better accuracy in patients with reduced than preserved EF. (2,3) The aim of our study was to assess the prognosis of patients with preserved LVEF according to the different grades of diastolic function and to determine whether LARS can improve the prognostic assessment of these patients. Methods Observational, prospective, single-center study. We included 364 patients referred for transthoracic echocardiography at the indication of their responsible physician. Inclusion criteria were: LVEF&amp;gt;50% and sinus rhythm. Diastolic function was assessed according to current ASE/EACVI guidelines. LARS was measured in 4 and 2 chambers, obtaining a mean value. Clinical and echocardiographic parameters were evaluated. The primary endpoint was a combined event of heart failure (HF), atrial fibrillation (AF) or stroke, whichever occurred first. Events were recorded from the electronic medical record. Results 364 patients were included (53% women), age 68 years (±14), LVEF Simpson 64.4% (± 6.9), BMI 28.31 (±5.65). Patients were grouped into 4 groups: normal diastolic function (NDF) 88 patients, grade 1 diastolic dysfunction (DD1) 88 patients, grade 2-3 diastolic dysfunction (DD2-DD3) 114 patients and indeterminate diastolic function or diastolic dysfunction of undetermined grade (IDF-DDI) 76 patients. After a mean follow-up of 2.44 (±1.03) years, 55 events were recorded (15% of the sample). Compared to patients with NDF (1 event/88 patients), those with DD1 had no increased risk, HR 0.73 (0.05- 11.87), p=0.82, while those with FDI-DDI and DD2-DD3 had increased risk of events, HR 9.21 (1.16-73.35), p= 0.04 and HR 16.88 (2.09- 136.31), p=0.008, respectively. Figure 1. On the other hand, compared to patients with LARS &amp;gt;24%, those with a LARS 18-24% and with a LARS ≤18% presented higher risk of events, HR 2.99 (1.37- 6.53), p=0.006 and HR 5.25 (2.14- 12.88), p=0.0003, respectively. Figure 2A. Analyzing only patients with IDF-DDI, again those with LARS ≤18% and LARS 18-24% were at higher risk than those with LARS &amp;gt;24%. Figure 2B. Conclusions In our population of patients with preserved LVEF and sinus rhythm, those with DD2-DD3 and with IDF-DDI are at increased risk of presenting combined HF/ AF/stroke events, not so those with DD1. A LARS value ≤24% identifies patients at increased risk of events, also in those with IDF-DDI. Therefore, from a prognostic point of view, in our study a LARS value ≤24% better identifies patients at increased risk of events than a LARS value ≤18%. This could have implications in AF screening and risk factors management. More studies will be needed to confirm these results.Figure 1.Kaplan-Meier curves of combineFigure 2.Kaplan-Meier curves for the pr

Abstract 18734: Comparison of Hypertension Prevention Education Among Community Health Students, Online Chat-Based Artificial Intelligence Model, and Physician

Introduction: Health literacy and preventive education remain the core of hypertension management. Emerging language processing, artificial intelligence (AI) tools have the potential to provide effective preventive information. We sought to compare the quality of responses to commonly asked questions about hypertension by community health students, a physician, and an AI tool. Methods: Through a structured, student service-learning program, 270 trained undergraduate students conducted 56 health fairs across 19 locations in NJ from Jan 2022 - March 2023. We identified the 10 most commonly asked questions related to blood pressure and asked a physician, a trained student, and ChatGPT to answer them in paragraph format within 200 words. Four independent, blinded expert reviewers graded each response from 1 to 3 (3=best, 1=worst response relative to others). We assessed the reliability across responses using the Fleiss' Kappa statistic. We used ANOVA with post-hoc pairwise comparisons to determine differences in average response score. Results: Among 30 responses, there was a significant difference in score by response type (physician, 2.0 [SD, 0.6]; student, 1.8 [0.5]; ChatGPT, 2.2 [0.6], p=0.001). Post-hoc, pairwise comparisons revealed student scores were significantly lower than ChatGPT scores (p=0.0038), but there was no difference between physician and ChatGPT responses (p=0.81). Scores were moderately reliable across expert reviewers (kappa = 0.56). Qualitatively, student and physician scores were rated to be more empathetic and personalized, but less comprehensive and actionable. Conclusions: A language-processing, AI-based tool performed as well, if not better, than a physician and trained community health students to provide preventive education related to blood pressure. Further quality improvement initiatives need to be done to better understand the utility of AI tools to augment preventive education and to more effectively train students/physicians to provide comprehensive and actionable strategies.

Inadequate Completion of Computed Tomography Request Forms of Patients Visiting the Department of Radiology and Imaging in a Tertiary Care Centre.

From both medical and legal points of view, it is vital that computed tomography request forms should be adequately filled up. It is the responsibility of physicians to collect adequate clinical information that justifies the computed tomography examination and the ethical responsibility of radiological technologists and radiologists is to perform only the justified radiological examinations. Thus, a properly filled request form is crucial for understanding the clinical problem, using the proper protocol for avoiding unnecessary radiation exposure and providing concise radiological reports. The aim of this study was to find out the prevalence of inadequate completion of computed tomography request forms of patients visiting the Department of Radiology of a tertiary care centre. This descriptive study was performed in the Department of Radiology from 22 April 2021 to 21 April 2022 after receiving ethical approval from the Institutional Review Committee. Computed tomography request forms from emergency, ward and outpatient Departments were used in the study whereas that from other hospitals and clinics were excluded. A convience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Out of 470 computed tomography examination forms, the prevalence of inadequate computed tomography request forms was 195 (41.49%) (37.03-45.94, 95% Confidence Interval). The prevalence of the inadequacy of completion of computed tomography examination forms was higher than other similar studies done in similar settings. audit; computed tomography; form.

Motheŕs own milk (MOM) feeding in preterm infants in Germany – A status quo of personal attitudes

Abstract Background The best nutrition for all new-borns and especially vulnerable groups like preterm infants is motheŕs own milk (MOM). Nevertheless, recent research showed that many preterm infants receive formula in neonatal intensive care units (NICU) in Germany. In order to achieve MOM feeding in preterm infants, a MOM-friendly clinical environment is crucial. In Germany, no data is yet available on the attitudes towards MOM of physicians and nurses in NICUs and mothers. Methods Written surveys were conducted to assess attitudes and the current status of MOM-feeding from different perspectives (medical and nursing staff and mothers of preterm infants). Questions included personal attitudes towards MOM and perceived lactation support in NICUs. Descriptive statistics and bivariate tests (Spearman's rho, Pearson chi2) were examined. Results Data of 158 leading physicians (response rate: 76%), 143 nurses (response rate: 68%) and 533 mothers (response rate: 32%) was included. The personal importance of MOM feeding is slightly higher in both physicians and nurses than their attitude towards the effects of feeding with MOM on the medical outcome of preterm infants (M: 9.5/9.5 vs. 8.3/8.9; [1-10]). Mothers predominantly perceived the NICU staff as MOM promotive (M:4.7,4.9; [1-6]) and reported an overall positive attitude towards feeding preterm infants with MOM (M:5.6; [1-6]). Their attitude showed no significant differences between educational levels (p = 0.635), age (p = 0.079) or ethnicity (p = 0.184), whereas the MOM promotive NICU staff was significantly correlated to the motherś attitude (p = 0.001, p = 0.001). Conclusions The status quo of attitudes towards MOM in Germany is rather positive in both health care professionals and mothers, independently of sociodemographic characteristics. Presumably, the challenge in achieving MOM feeding seems to occur in transferring positive attitudes to actual interventions. Key messages • To enhance MOM feeding in preterm infants, future interventions should focus on the transmission of positive attitudes to actual strategies. • NICU staff that is MOM promotive is eminent for the maternal attitudes towards MOM.

Physician responses to Medicare reimbursement rates

This paper investigates how office-based physicians respond to Medicare reimbursement changes. Using variation from an Affordable Care Act policy that increased reimbursements for office-based care in four states, we use a triple difference analysis, comparing physicians with higher and lower reimbursement changes in treated states to similar physicians in untreated states. We find two mechanisms through which physicians respond. First, the reimbursement change affected integration—physicians with larger increases in office-based reimbursement were less likely to vertically integrate with hospitals and more likely to continue providing office-based care than physicians with smaller reimbursement increases. Second, we find some evidence that physicians who continued practicing in an office setting increased the volume of services provided.

Impact of clinical decision support on controlled substance prescribing

BackgroundPrescription drug overdose and misuse has reached alarming numbers. A persistent problem in clinical care is lack of easy, immediate access to all relevant information at the actionable time. Prescribers must digest an overwhelming amount of information from each patient’s record as well as remain up-to-date with current evidence to provide optimal care. This study aimed to describe prescriber response to a prospective clinical decision support intervention designed to identify patients at risk of adverse events associated with misuse of prescription opioids/benzodiazepines and promote adherence to clinical practice guidelines.MethodsThis study was conducted at a large multi-center healthcare system, using data from the electronic health record. A prospective observational study was performed as clinical decision support (CDS) interventions were sequentially launched (January 2016–July 2019). All data were captured from the medical record prospectively via the CDS tools implemented. A consecutive series of all patient encounters including an opioid/benzodiazepine prescription were included in this study (n = 61,124,172 encounters; n = 674,785 patients). Physician response to the CDS interventions was the primary outcome, and it was assessed over time using control charts.ResultsAn alert was triggered in 23.5% of encounters with a prescription (n = 555,626). The prescriber decision was influenced in 18.1% of these encounters (n = 100,301). As the number of risk factors increased, the rate of decision being influenced also increased (p = 0.0001). The effect of the alert differed by drug, risk factor, specialty, and facility.ConclusionThe delivery of evidence-based, patient-specific information had an influence on the final prescription in nearly 1 in 5 encounters. Our intervention was sustained with minimal prescriber fatigue over many years in a large and diverse health system.

Implementing Electronic Discharge Communication Tools in Pediatric Emergency Departments: Multicountry, Cross-Sectional Readiness Survey of Nurses and Physicians.

Pediatric emergency departments (ED) in many countries are implementing electronic tools such as kiosks, mobile apps, and electronic patient portals, to improve the effectiveness of discharge communication. This study aimed to survey nurse and physician readiness to adopt these tools. An electronic, cross-sectional survey was distributed to a convenience sample of currently practicing ED nurses and physicians affiliated with national pediatric research organizations in Canada, Australia, and New Zealand. Survey development was informed by the nonadoption, abandonment, scale-up, spread, sustainability framework. Measures of central tendency, and parametric and nonparametric tests were used to describe and compare nurse and physician responses. Out of the 270 participants, the majority were physicians (61%, 164/270), female (65%, 176/270), and had 5 or more years of ED experience (76%, 205/270). There were high levels of consensus related to the value proposition of electronic discharge communication tools (EDCTs) with 82% (221/270) of them agreeing that they help parents and patients with comprehension and recall. Lower levels of consensus were observed for organizational factors with only 37% (100/270) agreeing that their staff is equipped to handle challenges with communication technologies. Nurses and physicians showed significant differences on 3 out of 21 readiness factors. Compared to physicians, nurses were significantly more likely to report that EDs have a responsibility to integrate EDCTs as part of a modern system (P<.001) and that policies are in place to guide safe and secure electronic communication (P=.02). Physicians were more likely to agree that using an EDCT would change their routine tasks (P=.04). One third (33%, 89/270) of participants indicated that they use or have used EDCT. Despite low levels of uptake, both nurses and physicians in multiple countries view EDCTs as a valuable support to families visiting pediatric ED. Leadership for technology change, unclear impact on workflow, and disparities in digital literacy skills require focused research effort.

Poor Oral Health Care Practices by Diabetic Patients

Background: Sustained poor hyperglycemic control is devastating to oral mucosa that needs top-notch care of oral health. The study aimed to assess the strength of knowledge, attitude, and practices of oral health in diabetic patients, and its associated demographic factors. Methods: This study was carried out on diabetic patients who came into the Endocrine OPD of Patel Hospital in Karachi. The study was conducted on 363 patients for more than a year. Genders with age greater than 18 years and had at least one natural tooth, were included. The study was analyzed by SPSS software version 21, applying the Mann-Whitney U Test and the Kruskal-Wallis test for categorical variables and mean scores for knowledge, attitude, and practices. Results: In our study, 64.2% were females with a median age of 56 years. The education level was 20.7%, 23.7%, 19.8%, and 37.5% tertiary, secondary, primary, and formal, respectively. The socioeconomic status was 21%, 57%, and 22%, were belonging to low, middle, and upper, respectively. The age of participants was found weak but positively correlated with knowledge (r= −0.108, p =0.040*) and negatively correlated with attitude (r= -0.004, p= 0.946. Employment status and anti-diabetic therapy had an insignificant association with knowledge, attitude, and practices regarding oral health in diabetic patients (p &gt; 0.05). Conclusion: The diabetic patients had adequate knowledge regarding oral health but poor attitudes and practices. They are at risk of developing oral health complications; however, it is the responsibility of physicians and dental health professionals to counsel them.

Poor Oral Health Care Practices by Diabetic Patients

Background: Sustained poor hyperglycemic control is devastating to oral mucosa that needs top-notch care of oral health. The study aimed to assess the strength of knowledge, attitude, and practices of oral health in diabetic patients, and its associated demographic factors. Methods: This study was carried out on diabetic patients who came into the Endocrine OPD of Patel Hospital in Karachi. The study was conducted on 363 patients for more than a year. Genders with age greater than 18 years and had at least one natural tooth, were included. The study was analyzed by SPSS software version 21, applying the Mann-Whitney U Test and the Kruskal-Wallis test for categorical variables and mean scores for knowledge, attitude, and practices. Results: In our study, 64.2% were females with a median age of 56 years. The education level was 20.7%, 23.7%, 19.8%, and 37.5% tertiary, secondary, primary, and formal, respectively. The socioeconomic status was 21%, 57%, and 22%, were belonging to low, middle, and upper, respectively. The age of participants was found weak but positively correlated with knowledge (r= −0.108, p =0.040*) and negatively correlated with attitude (r= -0.004, p= 0.946. Employment status and anti-diabetic therapy had an insignificant association with knowledge, attitude, and practices regarding oral health in diabetic patients (p &gt; 0.05). Conclusion: The diabetic patients had adequate knowledge regarding oral health but poor attitudes and practices. They are at risk of developing oral health complications; however, it is the responsibility of physicians and dental health professionals to counsel them.

Poor Oral Health Care Practices by Diabetic Patients

Background: Sustained poor hyperglycemic control is devastating to oral mucosa that needs top-notch care of oral health. The study aimed to assess the strength of knowledge, attitude, and practices of oral health in diabetic patients, and its associated demographic factors. Methods: This study was carried out on diabetic patients who came into the Endocrine OPD of Patel Hospital in Karachi. The study was conducted on 363 patients for more than a year. Genders with age greater than 18 years and had at least one natural tooth, were included. The study was analyzed by SPSS software version 21, applying the Mann-Whitney U Test and the Kruskal-Wallis test for categorical variables and mean scores for knowledge, attitude, and practices. Results: In our study, 64.2% were females with a median age of 56 years. The education level was 20.7%, 23.7%, 19.8%, and 37.5% tertiary, secondary, primary, and formal, respectively. The socioeconomic status was 21%, 57%, and 22%, were belonging to low, middle, and upper, respectively. The age of participants was found weak but positively correlated with knowledge (r= −0.108, p =0.040*) and negatively correlated with attitude (r= -0.004, p= 0.946. Employment status and anti-diabetic therapy had an insignificant association with knowledge, attitude, and practices regarding oral health in diabetic patients (p &gt; 0.05). Conclusion: The diabetic patients had adequate knowledge regarding oral health but poor attitudes and practices. They are at risk of developing oral health complications; however, it is the responsibility of physicians and dental health professionals to counsel them.

Empowering the Role of Nurse Triage in Radiation Oncology - A Single Center Analysis.

Hours spent on the increasing volume of electronic medical record (EMR) messages and phone calls is a significant contributor to clinician burnout1. Within radiation oncology, nurses often serve a critical team role in patient education and EMR and phone call response. With the goal of maintaining high quality care and rapid EMR and phone response, our clinic utilizes a rotating triage nurse position; patterns of practice and team member perspectives are investigated. A retrospective chart review was conducted analyzing EMR messages and phone calls to the RO department between Sept-Dec 2021. Messages were identified for theme, author of message recorded (patient, family, provider), number of message iterations, and message pathway. Separately, an online survey was administered via REDCap to physicians (50% response rate), nurses (57% response rate), and radiation therapist (60% response rate) to assess nurse triage efficacy and efficiency. Four of the most common message themes were scheduling (26%), medications (21%), side effects/symptoms (15%), and treatment decision making (13%). Only 12% of messages were resolved by the RO triage nurse without further message forwarding. The average number of message iterations by healthcare personnel was 2.93 with mode of 2 (i.e., RN -> patient -> MD is a 2 message iteration). Across all themes physicians concluded 67% of the routed messages and nursing concluded 29%. By theme, physicians concluded 95% of treatment questions, 77% of medication questions, 69% of side effect/symptom questions, and 57% of scheduling questions. Survey results indicated average satisfaction with 'effectiveness of triage' was 3 (max 5), perceived triage nurse preparedness to resolve encounters was 3 (max 5), and perception of the overall EMR triage program by physicians was 2.2 (max 5). Staff survey established clear opportunity to improve effectiveness of RN triage through better alignment of nurse and physician expectations and improving nurse preparedness. Two-thirds of patient messages were ultimately concluded by physician response whereas 12% were resolved by nurse triage alone. Preparing nursing staff about common patient messages should increase autonomy to resolve patient queries and may improve work satisfaction for all providers through enhanced multidisciplinary collaboration and empowering individuals to practice at top of his/her license.