Professionals Physicians Research Articles

The Prostate Stromal Transcriptome in Aggressive and Lethal Prostate Cancer.

Prostate cancer has a heterogeneous prognosis. Most previous studies have focused on the identification of prognostic biomarkers in the prostate cancer tumor. However, it is increasingly recognized that the tumor microenvironment contributes to prostate cancer aggressiveness and progression. We therefore examined whole transcriptome expression of the prostate stroma and associations with aggressive and lethal prostate cancer. We performed RNA sequencing (Illumina TruSeq Exome Capture) of 272 tumor-adjacent and 120 benign-adjacent macrodissected prostate stromal samples from 293 men with prostate cancer from the Health Professionals Follow-up Study and Physicians' Health Study. We performed differential expression analysis comparing gene expression and pathways by Gleason score and lethal outcome. We also tested a previously developed stromal gene signature of Gleason score in these datasets. Comparing high- with low-Gleason score cancers, 26 genes (P < 0.001) and 12 pathways (FDR < 0.20) were significantly differentially expressed in tumor-adjacent stroma, including pathways related to stroma composition remodeling and DNA repair, with 73 genes and 65 pathways significant in benign-adjacent stroma. Comparing lethal with nonlethal prostate cancer, 11 genes were differentially expressed in tumor-adjacent and 15 genes in benign-adjacent stroma, and pathways involved in inflammatory response were differentially enriched in both tumor and benign-adjacent stroma. In addition, our previously identified Gleason stromal gene signature was validated to be associated with Gleason score in these data. Implications: Our study uncovers stroma-specific genes and pathways that are differentially enriched with high Gleason score and lethal prostate cancer, demonstrating that the molecular investigation of the tumor microenvironment can provide additional information about prostate cancer prognosis.

Exploring Health Care Professionals’ Perceptions Regarding Shared Clinical Decision-Making in Both Acute and Palliative Cancer Care

Qualitative explorative design, using online focus-group interviews, based on patient-cases, among health care professionals (physicians and nurses) and Framework Analysis. Six online focus-group interviews were performed. Few signs of systematic integration were found, risking fragmented care, and putting the patients in a vulnerable situation. Different aspects of uncertainty related to mandates and goals-of-care impacted clinical decision-making. Organizational factors appeared to hinder mutual clinical decision-making as well as the uncertainty related to responsibilities. These uncertainties seemed to be a barrier to timely end-of-life conversations and clinical decisions on optimal care, for example, the appropriateness of transfer to acute care. Lack of integration between acute and palliative care have negative consequences for patients (fragmented care), health care professionals (ethical stress), and the health care system (inadequate use of resources).

Analyzing Factors Influencing Patient Selection of a Surgeon for Elective Surgery in Saudi Arabia: A Questionnaire-Based Survey.

Nowadays patients are encouraged to partake in healthcare decision making and patient preferences are givenincreasing weight. Patient's choice is important to reduce waiting time and to encourage competition between providers, as most patients look for high-quality care while minimizing costs, according to different studies this may not be as simple as the attributes and factors that patients value when selecting a hospital or surgeon. Overall, Saudi Arabia has minimal research on how patients select surgeons or surgical facilities. Therefore, the goal of the current study was to evaluate the criteria Saudi population patients used to select their surgeons. The objective is to determine the relative importance of the following aspects that patients may consider when selecting a surgeon: (a) physician-related considerations; (b) elements relating to healthcare service and access; (c) the perspectives of patients on various factors. This observational cross-sectional study attempts to investigate the criteria that people in Saudi Arabia considered most important while selecting their surgeons. This study was conducted between August and November 2022. The questionnaire is also given in English along with Arabic. Six hundred nine completed the survey with a response rate of 91.6%. Concerning physician-related factors considered when choosing a surgeon attitudes of the physician were the factor most significantly contributed to physician selection rather than reputation or professional experience and physician social media: (84.7%) mentioned that paying attention to patient's needs and opinions is important; sparing enough time for patients is important as reported by83.9%of the participants; Personal care and hygiene is important for 83.4%of the participants; Communication skills were considered to be important as stated by 82.6% of the participants. Regarding healthcare services/access-related factors considered by patients in physician selection; it was found that patients considered hospital hygiene-cleanliness (91.3 %) as the most significant healthcare service/access-related factor in physician selection and then it comes Ease of obtaining an appointment (89.7%), reasonable scheduling and wait for time (87.7%) and cost of surgery (82.1%). Physician selection was deemed crucial to the success of the therapy by 87.7%of patients, while 88.3%of patients thought it was crucial to research the doctor before contacting her or him for the current admission. Patients consider a wide range of variables when selecting their surgeons and the location of their procedure. Depending on sociodemographic, cultural, and other aspects, the conditions surrounding patients' decisions may vary. Overall, the selection of a surgeon by surgery patients appears to be more influenced by the doctor's attitudes than by his or her reputation, professional experience, or social media presence. In order to elicit preferences across a wider range of surgical subspecialties and patient demographics, more study is necessary.

Implementation of a novel shared decision-making intervention in women with chronic hypertension in pregnancy: multiple-site multiple-method investigation.

Many women with chronic hypertension are conflicted about antihypertensive medication during pregnancy and some are non-adherent to prescribed medication. Codesign, implement and evaluate a novel shared decision-making (SDM) intervention for use with pregnant women with chronic hypertension. Pregnant women with chronic hypertension and their principal healthcare professionals (obstetricians, midwives, and physicians), at three National Health Service hospital trusts with different models of care. The RE-AIM framework guided the evaluation. Primary: Decisional conflict scale, medication intention survey and women's acceptability. Secondary: Healthcare professionals' acceptability and the barriers and facilitators to SDM implementation with pregnant women with chronic hypertension. Fifty women participated. Nearly half (46%; n=23) of women were from Black and Asian backgrounds. The SDM intervention was effective at reducing decisional conflict (mean reduction from baseline 42%, 95% CI 35-49, p≤0.05). In 36 women (72%), the reduction was of clinical importance. 24 women (48%) were uncertain about or planned not to take antihypertensives prior to the SDM intervention, compared to two women (4%) after the intervention. The intervention was acceptable to women and healthcare professionals. 10 of 14 healthcare professionals felt that the in-consultation aid facilitated SDM in current antenatal contexts, a similar proportion (10/14) felt the length of consultations hindered SDM. A novel codesigned SDM intervention reduced decisional conflict and increased women's intention to take antihypertensive agents during pregnancy. This intervention could be adopted into practice for women making pregnancy decisions where there is uncertainty around the medication management option.

The prophylactic efficacy of Anatolian propolis in individuals at high risk of COVID-19.

No prophylactic treatment is available for individuals at high risk of developing COVID-19. This study, which was conducted between December 25, 2020, and January 25, 2021, is one of the first clinical studies to evaluate the efficacy of Anatolian propolis supplement against COVID-19. The aim was to obtain evidence on the prophylactic use of Anatolian propolis in individuals at high risk of developing COVID-19. This volunteer-based study was conducted in two centers. The study involved 209 healthcare professionals (physicians, nurses, medical secretaries) from Emergency Medicine Department of Medical Faculty of Ataturk University and Emergency Medicine Department of Rize Recep Tayyip Erdogan University. 204 participants meeting the study criteria were divided into two groups as experimental group and control group. The experimental group received 20 drops of BEE'O UP (BEE&YOU) 30% Propolis drops twice a day during a follow-up period of 1 month. The control group received no supplement but was followed up. The participants showing symptoms during the study and all the participants at the end the study were subjected to PCR testing. The evaluation of the results of PCR testing at the end of the study has shown that 14 participants from the control group and only 2 participants from the experimental group, who received Anatolian propolis supplement, were reported as positive cases. It has been found that a statistically significant protection was induced against COVID-19 infection in 98% of the experimental group, who received Anatolian propolis, compared to the control group.

ADHERENCE TO TREATMENT AND PSYCHO-EMOTIONAL STATUS IN PATIENTS WITH PSORIATIC ARTHRITIS AND COMORBIDITY

At the current stage of medical science, the effectiveness of treatment depends not only on the professionalism of physicians, but also on the responsibility of the patients themselves. Low adherence has been proven to be a significant cause of the reduced therapy effectiveness and quality of life, increased risk of complications and treatment costs, worsening of disease prognosis, and reduced patient life expectancy. According to WHO reports, more than 250 factors can influence the adherence to the treatment. Until now, no "gold standard" has been developed for the assessment of adherence to treatment. Patients with psoriasis typically face social stigmatization and rejection, with subsequent profound effects on self-confidence, self-esteem, and feeling of psycho-emotional discomfort. Comorbidity of arthritis affects the psycho-emotional status of patients even more seriously. The purpose of the study is to analyze the psycho-emotional state, adherence to treatment, medical support and recommendations for lifestyle modification in patients with erosive form of psoriatic arthritis comorbidity. 60 patients with a reliable diagnosis of psoriatic arthritis and comorbid pathology were included in the study. Patients with psoriatic arthritis and comorbidity had mainly an average level of adherence to medication, medical support, and a low level of adherence to recommendations for lifestyle modifications. Taking oral glucocorticosteroids was associated with high adherence to drug therapy, while low adherence to medical care was associated with psychoemotional disorders such as anxiety and depression.

Health professionals’ sentiments towards implemented information technologies in psychiatric hospitals: a text-mining analysis

BackgroundPsychiatric hospitals are increasingly being digitalised. Digitalisation often requires changes at work for health professionals. A positive attitude from health professionals towards technology is crucial for a successful and sustainable digital transformation at work. Nevertheless, insufficient attention is being paid to the health professionals’ sentiments towards technology.ObjectiveThis study aims to identify the implemented technologies in psychiatric hospitals and to describe the health professionals’ sentiments towards these implemented technologies.MethodsA text-mining analysis of semi-structured interviews with nurses, physicians and psychologists was conducted. The analysis comprised word frequencies and sentiment analyses. For the sentiment analyses, the SentimentWortschatz dataset was used. The sentiments ranged from -1 (strongly negative sentiment) to 1 (strongly positive sentiment).ResultsIn total, 20 health professionals (nurses, physicians and psychologists) participated in the study. When asked about the technologies they used, the participating health professionals mainly referred to the computer, email, phone and electronic health record. Overall, 4% of the words in the transcripts were positive or negative sentiments. Of all words that express a sentiment, 73% were positive. The discussed technologies were associated with positive and negative sentiments. However, of all sentences that described technology at the workplace, 69.4% were negative.ConclusionsThe participating health professionals mentioned a limited number of technologies at work. The sentiments towards technologies were mostly negative. The way in which technologies are implemented and the lack of health professionals’ involvement seem to be reasons for the negative sentiments.

Expectations of social workers for interprofessional practice in healthcare: qualitative insights from practicing physician, nurse, and social work professionals

ABSTRACT Expectations of the social work role within healthcare teams was explored utilizing perceptions of physicians, nurses, and social workers from a variety of healthcare settings and specialties. Thematic categories illuminated intraprofessional and interprofessional perceptions of experiences pertinent to the inclusion of social work services. Responsibilities for social work healthcare practice in specialist settings included providing assessments, counseling to address emotional and social wellbeing, assisting in coordination of systems, and management of systemic family issues. Traits expected of the social worker included expressing confidence, communication aptitude, and basic knowledge of medical terminology.

Multidisciplinary interaction of Russian professional communities in oncology

Background. The effective treatment of oncological diseases requires the proper organization of interdisciplinary communication between specialists. Such an approach should be implemented in educational events organized by professional communities.&#x0D; Aim. To analyze the effectiveness of interaction between professional oncology communities and expert physicians on the platforms of educational events in Russia as a response to the unprecedented growth of scientific knowledge in oncology.&#x0D; Materials and methods. We studied educational events programs organized by oncological communities. The keywords of the report titles in 2012 and 2021 and the features of the networking structure of the speakers at the educational events in 2021 were analyzed.&#x0D; Results. In 2021, there was a significant expansion of the range of topics discussed compared to 2012, while experts began to use the terms "diagnosis", "prevention", "radiotherapy", and others much less frequently. The network structure of professional community interactions and interdisciplinary connections of experts at educational events is heterogeneous; some communities actively cooperate, while others show a closed position. At the level of systematic multidisciplinary expert interaction, there is also an underrepresentation of pathologists, geneticists, and other specialists.&#x0D; Conclusion. The oncology professional community needs to regularly work on multidisciplinary consolidation of competencies and broad discussion of clinical experience at scientific and educational events.

INFORMATION AND COMMUNICATION TECHNOLOGIES: THE PERSPECTIVE OF THE URGENCY AND EMERGENCY MOBILE CARE SERVICE PROFESSIONALS

Objective: to assess the interest, access and knowledge of the Urgency and Emergency Mobile Care Service professionals in relation to Information and Communication Technologies in such service. Method: a descriptive and cross-sectional study conducted with Urgency and Emergency Mobile Care Service professionals (physicians, nurses, nursing technicians and drivers) in September and October 2020 in the Northwest region of the state of Paraná, Brazil. The data were collected through a structured instrument and analyzed by means of descriptive statistics. Results: of the 30 participants, 80% reported access only to a simple cell phone, and 86.7% believed in the viability of a computerized system to assist in care provision and in the improvement of the response time for the event. Conclusion: despite the technological deficit in the service researched and dissatisfaction of its professionals, they wish for technologies to streamline care, thus reducing the response time for the event. Thus, the results can support management of the services and bring about positive contributions to the SAMU team professional practice.

Survey of the Relevance of Quality of Life (QoL) Questionnaires (QoLQs) Currently Used to Evaluate Multiple Myeloma (MM) Patients' Qol in Real-World MM Patients and Healthcare Professionals (HCPs)

Background: Advances in treatment options for Multiple Myeloma (MM), have significantly improved life expectancy. MM related organ dysfunction, treatment toxicity, age and overall health comorbidities have major impact on patients' Quality of Life (QoL). Several QoL Questionnaires (QLQs) are used in clinical and research practice, although these were developed and validated years prior to the plethora of the current novel therapies. The aim of this study was to evaluate the relevance of these QoLQs to the QoL of MM patients in the current era. Methods: MM Patients and MM Healthcare Professionals (HCPs) (physicians, nurses, physiotherapists, dieticians and pharmaceutical representatives) were asked to complete online surveys assessing the relevance of the total of 149 questions from the internationally commonly used QoLQs (EORTC QLQ-C30, EORTC QLQ-MY20, EORTC QLQ-CIPN20, EQ-5D-3L, FACT-G, FACT-MM, FACT-N, FACIT-F) to the MM patients' QoL. HCPs and patient demographics, disease and treatment characteristics were collected for each survey. The relevance of each question of the MM QoLQs was graded using the 5-point Likert scale: not relevant, slightly relevant, relevant, fairly relevant, and very relevant. Separate analysis was performed for HCPs and MM patients' responses. MM patients' results were further stratified based on age, treatment lines, active treatment and time from diagnosis. Analysis was performed initially for (I) the not relevant versus very relevant questions and further analysis was conducted to sense relevance for (II) non relevant + slightly relevant versus the fairly relevant +very relevant and (III) non relevant + slightly relevant and the relevant+ fairly relevant +very relevant. Relevance was defined as agreement ³ 50% between respondents. Results: 224 MM patients of different age, racial origin, time from diagnosis and on different treatment regimens and 39 HCPs completed the surveys. From the MM patients' perspective, only eight questions addressing their social, family and emotional well-being [{FACT-G} GS2, GS4, GS5, GS6 GE2, GF3-4; {FACT-N} N2 ] were graded as very relevant irrespective of their age, disease status and prior therapy lines. Further subgroup analysis identified a trend for significant relevance between the ≤70 years vs >70 years old age groups for the FACTG QoL subscales: Physical (PWB), Functional (FWB), Emotional (EWB) and Social/Family (SWB) Well-Being and the FACT-N N2. Sub-analysis of the responses, revealed 5 further relevant questions in stage II: {FACT-G} GS1, GS2, GS4, GF3, GF4 and 28 in stage III of the analysis: {EORTC QLQ-C30} Q1, 2, 29, 30; {EORTC QLQ-MY20} Q48; {EORTC 5D-3L} Q16; {FACT-G} GS1-5, GE6, GF1-7; {FACT-MM} P2, N3, Leu6; {FACT-N} An5, N2-3; {FACIT-F} An5, 7, 13. These questions explore further aspects of FWB, EWB and SWB of the patients. However, 27/149 of the total QoL questions were considered as non-relevant by the MM patients. Interestingly, the >70 years old age-group did not consider the MM-associated mobility issues as relevant to their QoL that could be partially explained by the co-existing comorbidities. In contrast, HCPs survey response graded the majority of the existing QoL questions at least somewhat relevant. HCPs valued 61 questions referring -in addition to the emotional issues that patients raised- to reduced vitality, limitations in physical ability, effects on the family role, working capacity, neuropathy and pain as very relevant QoL aspects when caring for MM patients. Conclusions: This survey on assessing how MM patients and HCPs graded the relevance of the >15 years old, validated MM QoL questionnaires showed significant differences between the 2 groups' responses. From the MM patients' perspective, the majority of the current QoLQ were not relevant in representing their disease or treatment -related QoL issues. There was a trend for significant difference in QOL issues for age groups that could be incorporated with frailty. This survey results stress the need to develop an updated patient centric QoLQ, which would assist HCPs in therapy decision-making.

Abstract 14507: Perceptions and Attitudes About Advance Care Planning Among Healthcare Professionals of Cardiac Care: A Q Methodology Study

Background: Provision of advance care planning (ACP) in patients with cardiovascular diseases is suboptimal in South Korea, which leads to an increase in the burden of care. Healthcare professionals’ perspectives of ACP are particularly important to facilitate its utilization. However, Korean healthcare professionals’ perspectives on ACP remain unknown. Aim: We explored perspectives and attitudes regarding ACP among healthcare professionals (physicians and nurses) who provide care to patients with cardiovascular diseases, using a Q methodology. Methodology: The Q sample consisted of 40 statements representing perspectives for and attitudes toward ACP derived from a literature review, mass media reports, and an in-depth qualitative interview. P samples consisted of 10 physicians and 14 nurses. The P sample filled each grid with a statement in the Q sorting table. Data were analyzed using the PQ Method program. Results: Seventy-one percent of the variance was explained with four factors represented by 18 Q – sorters, with each variance explained by each factor ranging from 16% to 20%: Factor A (n=5), healthcare professional-led decision about ACP; Factor B (n=5), patient value-based persuasive decision about ACP; Factor C (n=5), prognosis-based passive support for ACP; Factor D (n=3), comprehensive consideration -induced decision for ACP. Six Q-sorters fell into either confounded or non-significant. Shared perspectives for ACP among Korean healthcare professionals emerged in areas including conceptual definition, educational support and training, and ethical and legal concerns, while each factor also presented unique and primary perspectives for ACP. Conclusions: Our research revealed shared and unique perspectives for ACP in Korean healthcare professionals who treat cardiac patients. The findings of this study provide basic data for the provision of ACP in which, as a major stakeholder, healthcare providers’ perspectives should be considered in educational support and training. Keywords: advance care planning; cardiac disease; nurse; physician; perspectives; Q methodology

Barriers and facilitators for implementation of the SWORD evidence-based psychological intervention for fear of cancer recurrence in three different healthcare settings

PurposeFear of cancer recurrence (FCR) interventions are effective, but few are implemented. This study aimed to identify barriers and facilitators for implementing the evidence-based blended SWORD intervention in routine psycho-oncological care.MethodsSemi-structured interviews with 19 cancer survivors and 18 professionals from three healthcare settings assessed barriers and facilitators in six domains as described by the determinant frameworks of Grol and Flottorp: (1) innovation, (2) professionals, (3) patients, (4) social context, (5) organization, and (6) economic and political context.ResultsIn the innovation domain, there were few barriers. Facilitators included high reliability, accessibility, and relevance of SWORD. In the professional domain, physicians and nurses barriers were lack of self-efficacy, knowledge, and skills to address FCR whereas psychologists had sufficient knowledge and skills, but some were critical towards protocolized treatments, cognitive behavioral therapy, or eHealth. Patient domain barriers included lack of FCR awareness, negative expectations of psychotherapy, and unwillingness/inability to actively engage in treatment. A social context domain barrier was poor communication between different healthcare professionals. Organization domain barriers included inadequate referral structures to psychological services, limited capacity, and complex legal procedures. Economic and political context domain barriers included lack of a national implementation structure for evidence-based psycho-oncological interventions and eHealth platform costs.ConclusionsImplementation strategies should be targeted at patient, professional, organizational and economic and political domains. Identified barriers and facilitators are relevant to other researchers in psycho-oncology that aim to bridge the research-practice gap.Implications for cancer survivorsThis study contributes to the implementation of evidence-based psychological interventions for cancer survivors, who can benefit from these services.

Reinforcement Learning Based Diagnosis and Prediction for COVID-19 by Optimizing a Mixed Cost Function From CT Images.

A novel coronavirus disease (COVID-19) is a pandemic disease has caused 4 million deaths and more than 200 million infections worldwide (as of August 4, 2021). Rapid and accurate diagnosis of COVID-19 infection is critical to controlling the spread of the epidemic. In order to quickly and efficiently detect COVID-19 and reduce the threat of COVID-19 to human survival, we have firstly proposed a detection framework based on reinforcement learning for COVID-19 diagnosis, which constructs a mixed loss function that can integrate the advantages of multiple loss functions. This paper uses the accuracy of the validation set as the reward value, and obtains the initial model for the next epoch by searching the model corresponding to the maximum reward value in each epoch. We also have proposed a prediction framework that integrates multiple detection frameworks using parameter sharing to predict the progression of patients' disease without additional training. This paper also constructed a higher-quality version of the CT image dataset containing 247 cases screened by professional physicians, and obtained more excellent results on this dataset. Meanwhile, we used the other two COVID-19 datasets as external verifications, and still achieved a high accuracy rate without additional training. Finally, the experimental results show that our classification accuracy can reach 98.31%, and the precision, sensitivity, specificity, and AUC (Area Under Curve) are 98.82%, 97.99%, 98.67%, and 0.989, respectively. The accuracy of external verification can reach 93.34% and 91.05%. What's more, the accuracy of our prediction framework is 91.54%. A large number of experiments demonstrate that our proposed method is effective and robust for COVID-19 detection and prediction.

Driving quality improvement with nudges: True interventions in cardiology.

Key Points Quality improvement research brings evidence‐based interventions to clinical practice. This single‐center study demonstrated that simple clinical guidelines, computer prompts, and education were able to reduce the duration of triple therapy after percutaneous coronary intervention. Behavioral interventions are an important tool to drive clinical improvement but must be tailored to respect physician autonomy and professionalism.

Failed tracheal intubation in primary health care.

Tracheal intubation in primary health care is a necessary skill and usually one that is necessary for appropriate emergency management of unstable patients. Primary care practitioners may not have an anaesthetist or critical care doctor available to help them in these emergencies and must manage these patients themselves. Often tracheal intubation may fail because of multiple possible factors and a different course of action may be needed to minimise the potential for harm to the patient. The primary care professional or family physician will have to manage this failed intubation. Primary health care facilities providing obstetric services must have guidelines and appropriate equipment for management of airway problems. This article will explore reasons for the failure of tracheal intubation and how this can be managed.

US Military Healthcare Professionals' Practice, Knowledge, and Misconceptions About Concussion.

To determine the US military healthcare professionals' knowledge and training preferences to improve diagnosis and management of concussion sustained in nondeployed settings. US military healthcare professionals (physicians, physician assistants, and nurse practitioners) completed online surveys to investigate practices, knowledge, and attitudes about concussion diagnosis and treatment, as well as preferences on future training. There were 744 responses from active duty US military healthcare providers, all of whom had cared for at least one patient with mild traumatic brain injury (mTBI) in the previous 24 months. The majority of physicians reported they were confident in their ability to evaluate a patient for a new mTBI (82.1%) and order appropriate imaging for mTBI (78.3%). Accuracy of identifying "red flag" symptoms ranged between 28.2% and 92.6%. A Likert scale from 1 ("not at all confident") to 4 ("very confident") was used to assess providers' confidence in their ability to perform services for patients with mTBI. With respect to barriers to optimal patient care, nurse practitioners consistently reported highest levels of barriers (90.8%). Although US military providers regularly care for patients with concussion, many report experiencing barriers to providing care, low confidence in basic skills, and inadequate training to diagnose and manage these patients. Customized provider education based on branch of service and occupation, and broader dissemination and utilization of decision support tools or practice guidelines, and patient information tool kits could help improve concussion care.

Impact of Cooperation Established Between Physicians and Nurses Working at Surgical Clinics on The Tendency of Nurses to Make Medical Errors

The aim of this study is to determine the effect of cooperation between physicians and nurses working in ‎surgical clinics on the tendency of nurses to make medical errors. The research was carried out in a ‎descriptive manner at Yozgat Bozok University Research and Application Center surgical units between April-‎May 2021. 130 surgical nurses and 40 surgeons were included in the study. In the evaluation of the data, ‎independent two-sample t-test, Mann-Whitney U test, one-way analysis of variance, Duncan test, Kruskal ‎Wallis test, Pearson correlation coefficient, and regression analysis were used. When the Jefferson Physician ‎and Nurse Professional Collaboration Scale mean scores of physicians and nurses were examined; the mean ‎score of nurses was 52.2±5.8, and the mean score of physicians was 50.7±4.6. Nurses' Malpractice Tendency ‎Scale mean score was determined as 236.1±16.5. It was determined that when the Jefferson Physician and ‎Nurse Professional Collaboration Scale score of the nurses increased by one unit, the Malpractice Tendency ‎Scale score increased by 1.247. Statistically, it was determined that there was a weak positive relationship ‎‎(p&lt;0.05). The existence of a healthy and effective cooperation system between physicians and nurses in ‎surgical units is important in preventing medical errors. In our study, it was determined that the physician-‎nurse relationship in surgical units had an effect on the medical error tendency of nurses. In line with the data ‎obtained, it is recommended to measure the reflections of the trainings on the cooperation in order to ‎increase the effective trainings in changing the professional communication within the team on doctor-nurse ‎cooperation in a positive way and to strengthen the concrete data.

'What you suggest is not what I expected': How pre-consultation expectations affect shared decision-making in patients with low back pain

ObjectiveExisting studies on shared decision-making (SDM) have hardly taken into consideration that patients could have independently developed expectations prior to their consultation with a healthcare provider, nor have studies explored how such expectations affect SDM. Therefore, we explore how pre-consultation expectations affect SDM in patients with low back pain. MethodsWe performed a qualitative study through telephone interviews with 10 patients and seven care professionals (physicians, nurse, physician assistants) and 63 in-person observations of patient-physician consultations in an outpatient clinic in the Netherlands. Transcripts were analyzed through an open coding process. ResultsA discrepancy existed between what patients expected and what care professionals could offer. Professionals perceived they had to undertake additional efforts to address patients' ‘unrealistic’ expectations while attempting SDM. Patients, in turn, were often dissatisfied with the outcomes of the SDM encounter, as they believed their own expectations were not reflected in the final decision. ConclusionUnaddressed pre-consultation expectations form a barrier to constructive SDM encounters. Practical implicationsPatients’ pre-consultation expectations need to be explored during the SDM encounter. To achieve decisions that are truly shared by care professionals and patients, patients’ pre-consultation expectations should be better incorporated into SDM models and education.

A Comparison Study of Doctor-Patient Internet Interactions in Traditional and Modern Medicine: Empirical Evidence from Online Healthcare Communities

Online healthcare platforms serve not just as a medical knowledge-sharing community but also bring about effective interactions between professional physicians and patients. However, it is unclear whether online technology adoption affects such interactions in the same way between traditional Chinese medicine and modern medical departments. By utilizing a large sample of online doctor-patient interaction information from 168,870 doctor-specific interactive webpages recorded in a famous Chinese online healthcare community, this paper studies the differences between 17,513 traditional medicine doctor homepages and 151,357 others from more than 100 different specialty areas. Our chosen platform is representative since it covers about 800,000 physicians working at over 10,000 hospitals across all major provincial regions in China. We document that online medical service users tend to accept and use online health care services. However, patients seeing Chinese medicine doctors exhibit the following unique characteristics. They still prefer choosing doctors according to third-party information and may be reluctant to pay for the current online service price level. This problem is hard to overcome by the platform in the short run. Patients need a long-term process to adapt to the upgraded medical environment gradually. Therefore, establishing a personalized doctor recommendation system has become the most urgent demand presently.