Health Care Providers Research Articles

Abstract 4136952: The Clinical Importance of Arrhythmia Notifications During Use of Wearable Cardioverter Defibrillator

Introduction: Wearable cardioverter defibrillators (WCDs) record continuous ECG data for the purpose of delivering treatment for lethal arrhythmias, but occasionally capture non-treatable arrhythmias that may be of clinical value. The purpose of this study was to evaluate the usefulness to health care providers (HCPs) of evaluating and reporting these other recorded ECGs and the impact on additional arrhythmia detection and clinical management decisions. Research Questions: Do clinicians find arrhythmias identified during routine WCD useful? What arrhythmias are observed? Can the identification of these arrhythmias, validation through ZOLL’s Independent Diagnostic Testing Facility (IDTF) and notification to the provider lead to changes in clinical management? Methods: A multi-center, observational study of 52 US HCPs enrolled 474 patients with commercial LifeVest prescriptions and followed them for up to 3 months. All routinely transmitted LifeVest ECG strips (corresponding to Baseline, Patient Initiated, or other automatic event recordings) during this period were analyzed by ECG technicians at the IDTF within ZOLL. These arrhythmias were reported to the HCP who completed a questionnaire assessing the utility (scored 1 to 5) and clinical impact (medication changes, tests, and procedures ordered) of these events. Results: At the conclusion of the study, 22% of patients (105/474) monitored had 112 reportable, unique arrhythmia events that were sent to 34 providers who completed questionnaires regarding report utility and clinical management decisions. A significant proportion of reports led to medication changes (40%), additional testing (32%) and procedural interventions (23%). The average usefulness of the reports was 3.63/5 with atrial fibrillation representing the most common arrhythmia, but many variations of ventricular ectopy were also captured which tended to be more clinically useful and impactful. Conclusions: WCD patients experience a high burden of actionable arrhythmias. Monitoring and reporting these arrhythmias over the course of normal wear provides additional clinical value to providers. Those arrhythmias that lead to changes to clinical management are the most useful.

Moral hazard in physician prescribing behavior: evidence from China’s Zero-Markup Policy

ABSTRACT In this study, we investigate the moral hazard associated with physician prescription patterns in the context of China’s Zero-Markup Policy (ZMP), which annuls markups on Western medications while exempting Traditional Chinese Medicine (TCM). Using a distinctive dataset of administrative records, we investigate the influence of patient insurance status on the consumption of drugs, with a discerning focus on the disparate utilization of Western drugs and TCM. Our empirical results reveal a pattern in which insured patients exhibit increased expenditure on TCM and decreased outlay on Western drugs relative to their uninsured counterparts, suggesting that physicians are incentivized to prescribe profit-generating TCM rather than Western drugs with zero markup. A heterogeneity analysis confirms the consistency of these findings across varied health insurance schemes and a pronounced tendency among patients aged over 30. Our findings illuminate the dynamics of provider-induced demand in the pharmaceutical sector under China’s ZMP, contributing to the discourse on policy-induced perverse incentives in healthcare provisioning.

The Discourse Surrounding Polycystic Ovary Syndrome on TikTok: A Social Media Analysis

Background/Objectives: Individuals are turning increasingly towards online resources, such as TikTok, to educate themselves on their medical conditions. Polycystic ovary syndrome (PCOS) is a prominent example, as women report dissatisfaction with the diagnosis process and treatment options. This study aims to provide a content analysis of the quality of PCOS health information on TikTok. Methods: A total of 325 TikTok videos were screened. Pertinent data, including likes, comments, shares, and views, along with video content concerning symptoms, interventions, and provider interactions were analyzed. Two reviewers independently used a modified DISCERN criteria to assess the quality of information for each video. A logistic regression was also utilized to model the probability of healthcare professionals creating educational videos. Results: A total of 238 videos met the eligibility criteria for analysis. Videos had a median of 468,400 views (Q1 = 146,400, Q3 = 1,100,000) and 18,000 likes (Q1 = 5631, Q3 = 65,100). The mean modified DISCERN scores were 3.6 ± 0.9 for physicians (n = 23), 2.0 ± 1.1 for non-physician healthcare providers (n = 52), and 1.0 ± 0.2 for non-healthcare professionals (n = 141) (p < 0.001). Healthcare professionals were 10.9 times more likely to create educational videos in comparison to non-healthcare professionals (p < 0.001). Conclusions: TikTok videos related to PCOS attract considerable engagement but provide low-quality information. Most videos were made by non-healthcare professionals, who discussed treatment options with limited or no research. Healthcare providers should be aware of the impacts on patients’ preconceived notions and help to improve patient education.

Uncovering Linguistic Strategies in Kuwaiti Doctor’s Patient-Directed Communication

The current study explores linguistic strategies used by Kuwaiti Doctors in their interactions with patients. By examining the language used in standard doctor-patient interactions, it provides preliminary insights into the communication practices of Kuwaiti healthcare professionals. Due to practical and ethical considerations, twenty-six family doctors participated in a Discourse Completion Task featuring six different scenarios to identify preferred linguistic strategies. The findings reveal a tendency towards indirect requests and questions indicating obligation or possibility when advising patients. Doctors frequently offered help using inclusive first-person plural 'we' inflections, especially with apprehensive patients. In supportive contexts, multiple communicative functions were often utilized simultaneously. These insights are valuable for linguists and healthcare providers, contributing to cross-cultural and inter-language communication research. The findings also inform subsequent investigations into patient preferences, enriching the understanding of effective communication in healthcare settings in Kuwait.

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.

Patients' and clinicians' knowledge in cancer-related cognitive impairment and its implications: current perspective.

Health literacy is essential in cancer care. Low health literacy compromises the capacity to maintain one's health through self-management and collaboration with healthcare providers, especially when facing cognitive side effects related to cancer and its treatments. Cancer-related cognitive impairment (CRCI) is a common phenomenon among cancer patients and might determine a significant impact on their quality of life, yet it is still under identified by both clinicians and patients. This perspective aims to discuss the implications of patients' and healthcare professionals' lack of awareness on the matter and argues about the importance of improving the level of information on CRCI to mitigate difficulties in identifying and managing such manifestations on various levels.

Development of a Hybrid Medical Softbot for Enhanced Decision Making using AI-tools

Health is wealth. The maintenance of health is of paramount importance. Due to increasing environmental decay, human health is threatened and therefore requires maintenance. Healthcare providers are few in number and therefore may not be able to cater for everyone. They tend to get fatigued because of the volume of work required on daily basis. This terribly affects their decision making and may lead to death as a result of wrong diagnosis or recommendations. This is the motivation behind this work; design and implementation of a hybrid medical softbot for enhanced decision making. This work was designed with the aid of machine learning algorithms for image analysis and classification and a rule based system that accepts input in the form of symptoms from user to make expert diagnosis and recommendation. Object oriented analysis and design methodology was employed in the analysis and design phase. The result is a hybrid softbot capable of analyzing and classifying X-ray images and giving expert diagnosis for patients.

Abstract 4137177: A pharmacovigilance investigation from the FAERS database on patients using pembrolizumab and its association with cardiac arrhythmias

Background: Arrhythmia is always a concern in oncological treatments. The advent of immune checkpoint inhibitors (ICIs) has revolutionized cancer treatment, enhancing the immune system's ability to combat malignancies. They are being more frequently used, revealing a range of immune-related adverse events (irAEs). This study aims to investigate the incidence of cardiac arrhythmias in patients receiving Pembrolizumab. Methods: We conducted a retrospective analysis of the FDA Adverse Event Reporting System (FAERS) database, focusing on reports submitted between 2006 to 2024. Cases involving patients treated with ICs were identified, and information related to cardiac arrhythmias was extracted using the Medical Dictionary for Regulatory Activities (MedDRA). Patients ≥ 18 years of age treated with ICIs were included in this study. A disproportionality analysis was conducted to identify arrhythmia events associated with pembrolizumab by comparing it with other immune checkpoint inhibitors (nivolumab, ipilimumab, and atezolizumab) and the entire FAERS database using the reporting odds ratio (ROR) and information component (IC). Results: A comprehensive analysis of 61,236 reported cases of pembrolizumab use revealed a total of 3,901 cases with cardiac complications. Among these, 672 cases (17.22 %) of arrhythmias were reported, with 452 individuals (67.26%) requiring hospitalization and 172 cases (25.59%) resulting in fatalities. Atrial fibrillation emerged as the most prevalent arrhythmia (49.7%). The occurrence of ventricular tachycardia with an ROR of 1.67 (1.18–2.35) and an IC of 0.44 (0.01–1.46) and complete atrio-ventricular block with an ROR of 1.57 (1.19–2.08) and an IC of 0.40 (0.04–1.24) were statistically significant. The reported arrhythmias associated with pembrolizumab are tabulated in Table 1 . The majority of events were reported in males, as shown in Figure 1 . Conclusion: This research offers significant insights into the connection between ICIs and cardiac arrhythmias, utilizing real-world data from the FAERS database. Healthcare providers should monitor cardiac events in patients receiving ICIs and aim to achieve a balance between anticancer effectiveness and cardiovascular safety. Further investigation is necessary to better understand the underlying mechanisms of arrhythmia and enhance risk stratification strategies for this specific patient group.

Based -evidence, an intervention study to improve sleep quality in awake adult ICU patients: a prospective, single-blind, clustered controlled trial.

Evidence-based guidelines advocate promoting sleep in intensive care unit (ICU) patients, yet many patients experience poor sleep quality. We sought to develop a collaborative evidence-based intervention with healthcare providers and assess whether evidence-based sleep interventions could improve sleep quality in awake adult ICU patients. We conducted a prospective, nonrandomized cluster control trial in two intensive care units (ICUs) at a tertiary general teaching hospital in China. Patients aged 18years or older who stayed in the ICU for one night or more and were conscious were eligible for enrollment. We only blinded the patients, not the outcome assessors. On the basis of evidence-based practice and clinical reality, we developed intervention measures for the intervention group, which mainly included four aspects: reducing environmental noise in the ICU, adjusting nursing actions, modifying nighttime lighting, and other measures. The assessment tools used were wearable actigraphy sleep monitoring devices and the Richards-Campbell Sleep Questionnaire (RCSQ). The primary outcomes were patient sleep quality, including total sleep time, deep sleep time, light sleep time, rapid eye movement (REM) time, number of awakenings, overall sleep score, and patients' self-assessment of their sleep quality that night. The data collected were analyzed via SPSS and Mplus statistical software for between-group analysis, pre-post comparison, profile analysis, and calculation of the intervention effect size. From September 1, 2023, to January 31, 2024, 713 patients underwent eligibility assessment, and ultimately 246 patients were included in the analysis, with 125 in the intervention group and 121 in the control group. Comparative analysis revealed no statistically significant differences in sleep quality between the two groups when the duration in the ICU = 1 night (P > 0.05), with a small intervention effect size. However, the intervention group had higher sleep quality scores (sleep monitoring wristband: 57.74 ± 22.55 > 57.72 ± 19.39; RCSQ questionnaire: 60.58 ± 22.14 > 57.61 ± 24.4) and total sleep time (440.42 ± 262.11 > 420.31 ± 236.89), a lower awakening frequency (3.98 ± 2.69 < 6.09 ± 4.66) and a lower awakening frequency (3.976 ± 2.693 < 6.09 ± 4.664) than did the control group. The sleep quality of patients who stayed in the ICU for > 1 night significantly improved in all the parameters except rapid eye movement time (min) according to the pre-post-test analyses (P < 0.05), with a medium to large intervention effect size and favorable intervention effects. Evidence-based interventions significantly improve sleep quality in ICU patients hospitalized for more than one day. However, our results do not support the improvement of sleep quality in patients admitted to the ICU for one day. ChiCTR2300075763, Registered 14 September 2023-Retrospectively registered, https://www.chictr.org.cn/bin/userProject.

Unveiling three accessory spleens in one patient: a rare case report and literature review.

During embryogenesis, the spleen undergoes intricate developmental processes, originating from mesenchymal cells in the dorsal mesentery. An accessory spleen, a common anomaly found in autopsies and abdominal CT scans, can often be mistaken for different types of tumors. To the best of our knowledge, this is the first case in Syria documenting the occurrence of 3 accessory spleens in a patient who had previously undergone splenectomy. A 33-year-old male presented with right hypochondrium pain, sharp and radiating to the right flank, exacerbated by movement and large meals. Past medical history included mild Irritable Bowel Syndrome (IBS) and splenectomy due to a traumatic accident in childhood. On admission, vital signs were stable, with abdominal tenderness in the right upper quadrant. Laboratory investigations showed normal values. Ultrasound revealed a lobulated mass at the right adrenal gland (4.5 × 5cm) with an isoechoic to hypoechoic texture. Multi-slice computed tomography (MSCT) Scan showed multiple nodules in the right adrenal gland, regular in shape, exerting a compressive mass effect, and significant lymphadenopathy around the abdominal aorta. Elevated metanephrine levels raised suspicion of an extra-adrenal pheochromocytoma. Laparoscopic surgery was performed, revealing accessory spleens and normal adrenal tissue with no malignancy. Healthcare providers should consider accessory spleens as a differential diagnosis for masses near the adrenal glands. Multiple accessory spleens in the adrenal region can complicate cases. Accessory spleens in uncommon locations like the adrenal glands can be challenging to diagnose and manage.

Abstract Su703: Racial/Ethnic Disparities in Bystander Cardiopulmonary Resuscitation after Witnessed Out-of-Hospital Cardiac Arrest: A NEMSIS Database Study

Introduction: Out of hospital cardiac arrest (OHCA) is a leading cause of death in the United States, with upwards of 360,000 OHCAs annually. Receiving bystander cardiopulmonary resuscitation (CPR) almost doubles an individual’s odds of survival compared to those who don’t receive bystander CPR. Unfortunately, in the US, bystander application of CPR only occurs in 40% of OHCA. Improving the rate of bystander CPR and AED use will improve survival rates for OHCA. Minoritized populations experience worse outcomes from OHCA. Compared to non-Hispanic whites, they are less likely to survive to hospital discharge. A cross-sectional study of witnessed OHCA patients found that Black and Hispanic patients had lower rates of bystander CPR. Less is known about disparities in care for Asian American persons who experience OHCA. Studies using the Resuscitation Outcomes Consortium Epidemiologic Registry (ROC) and the Cardiac Arrest Registry to Enhance Survival (CARES) have concluded discrepant results, with ROC finding that Asian Americans were less likely to receive bystander CPR and CARES finding that they were just as likely to receive bystander CPR compared to non-Hispanic Whites. To that end, we sought to evaluate the association between bystander CPR and Asian race after witnessed OHCA. Objective: To evaluate the association between race/ethnicity and the odds of receiving bystander cardiopulmonary resuscitation (bCPR) after witnessed out-of-hospital cardiac arrest (OHCA). Methods: Data were obtained from the National Emergency Medical Services Information System (NEMSIS) database for adults (≥18 years) with a witnessed non-traumatic OHCA in the year 2022. Patients were separated into two groups: Non-Hispanic White and Asians. The primary outcome was the odds of receiving bCPR. Exclusions included traumatic etiology, do-not-resuscitate orders, and arrests witnessed by healthcare providers. Pearson’s chi-square test was used to test significance. Results: A total of 73,215 witnessed OHCA activations were included in this study. Overall, bystander CPR rates were lower for the Asian group (59.8%) compared to the Non-Hispanic White group (65.0%). Pearson’s chi-square test showed a statistically significant difference between the bCPR rates of the Asian group and Non-Hispanic White group, with a p-value of less than 0.001. Conclusion: Racial/ethnic disparities exist for Asian individuals in the odds of receiving bCPR after a witnessed non-traumatic OHCA.

Identifying legitimate websites selling medicines in South Africa

Background: The online sale of medicines has skyrocketed globally, where medicines are purchased in the comfort and privacy of one’s own home. However, there are an increasing number of illegal websites selling counterfeit and falsified medicines.Aim: The aim of this study was to review the information and medicines sold online through pharmacy websites in South Africa (SA) and their compliance with local legislation.Setting: The study setting comprised online pharmacy websites in SA.Methods: This quantitative descriptive study used a purposeful questionnaire based on the South African Pharmacy Council inspection questionnaire for pharmacies operating websites. Websites claiming to be an online pharmacy in SA were included.Results: There were 25 websites reviewed, which claimed to be online pharmacies. Majority (n = 22) were found to be legal websites, operated by a registered community pharmacy and required a prescription for the purchase of prescription only medicines. Few websites complied with legislation such as displaying the Y number (n = 5) and name of the responsible pharmacist (n = 10). The remaining three websites were not linked to physical pharmacies, none complied with legislation and supplied medicines without a prescription.Conclusion: Although the online sale of medicines is regulated in SA, not all websites complied with legislation. The study highlighted the importance of monitoring websites claiming to be online pharmacies and their compliance with legislation.Contribution: Four stakeholders, consumers; pharmacy websites; regulators and healthcare providers, were identified and their role outlined in promoting the safe online purchasing of medicines.

A case study on COVID-19 infected patient&amp;rsquo;s experience - challenging journey at Colombo East Base Hospital- Mulleriyawa

This study investigates the patient experience within the COVID-19 treatment centre at Colombo East Base Hospital, Mulleriyawa, amidst the global pandemic. A cross-sectional descriptive study was conducted over one month, involving 30 participants recruited through convenience sampling. Participants completed self-administered questionnaires assessing various aspects of care, including staff interaction, cleanliness, health education, counselling, and attention to health-related matters. Results indicate high levels of satisfaction among participants across multiple care domains, with the majority expressing satisfaction with staff interaction, cleanliness, health education, counselling, and attention to health-related matters. These findings underscore the healthcare delivery system's effectiveness in meeting patients' diverse needs and expectations during the pandemic. The study highlights the importance of patient-centred care in promoting positive patient experiences and outcomes, particularly in the context of public health emergencies. Recommendations include sustaining and enhancing best practices in healthcare delivery, prioritizing infection prevention and control measures, and promoting effective communication and patient education. By prioritizing patient-centred care and continuous quality improvement initiatives, healthcare providers can ensure the safety, satisfaction, and well-being of patients amidst crises such as the COVID-19 pandemic.

Abstract 4136023: Eligibility and Barriers of Mavacamten Therapy in Patients with Hypertrophic Cardiomyopathy: A Retrospective Analysis

Background: Hypertrophic Cardiomyopathy (HCM) is a common genetic heart disorder characterized by the thickening of the myocardium. Mavacamten has emerged as a novel medication for targeted therapy in HCM patients, but its adoption faces multiple hurdles. This study aims to evaluate the eligibility of HCM patients for Mavacamten treatment based on certain clinical criteria and to promote consideration of potential barriers patients face in obtaining this medication. Methods: We conducted a retrospective analysis of 115 HCM patients at Truman Medical Center that included demographic data, clinical characteristics, and treatment histories. Patient eligibility for Mavacamten was determined based on ejection fraction (EF) &gt; 55%, symptomatic obstructive HCM, and intolerance to first-line therapy (beta-blockers, calcium channel blockers). Statistical analysis was performed using standard deviation and mean comparisons to estimate the proportion of eligible patients. Results: Out of 115 patients, 96 patients have an EF&gt;55%. 76 patients (66.1%) have a clinical heart failure diagnosis. 94 patients (81.7%) are taking beta-blockers. 49 patients (42.6%) have uncontrolled hypertension indicated by blood pressure &gt;140. Considering these factors, 49 (42.6%) met the clinical criteria for Mavacamten treatment. Of these patients eligible to receive Mavacamten treatment, only one patient was actively taking Mavacamten. The most common obstacles to receiving the drug included lack of insurance coverage, high medication cost, and limited awareness among healthcare providers regarding new treatment options. Conclusion: While a considerable proportion of HCM patients qualify for Mavacamten based on clinical criteria, external factors significantly impede access to this potentially life-altering treatment. Efforts should address this treatment gap through raising awareness to healthcare professionals and improving insurance coverage. This will enhance patient access to Mavacamten, ultimately improving outcomes in HCM management. This study summarizes the eligibility and obstacles to Mavacamten in a sample of HCM patients, emphasizing the need for systemic changes to facilitate access to advanced therapies.

COVID-19 Concerns and Depression Among Older Adults: Does Race/Ethnic Status Moderate the Association?

Background and Objectives: This study examined the association between COVID-19 concerns and depression among adults in later life. We also examined whether race/ethnic status moderated this relationship. Research Design and Methods: This study used data from the 2020 Health and Retirement Study. Using the 8-item CES-D scale, we defined probable depression as having three or more depressive symptoms. COVID-19 concerns included items such as concerns about respondents' own health, the health of family members, respondents' ability to get help from others, and concerns about the future. The associations between COVID-19 concerns and older adults' depression were estimated with logistic regression models. Results: Compared to respondents with lower scores on the COVID-19 concern measures, those with higher scores were more likely to be depressed. The moderation model showed the relationship between concerns about what will happen in the future and depression was not as strong among non-Hispanic Black older adults compared to non-Hispanic White older adults. Concerns about own health, family members' health, the older adult's financial situation, and the ability to get help did not show moderation effects. Discussion and Implications: The results suggested that healthcare providers should focus on older persons to reduce disparities in the risk of depression during public health emergencies.

Healthcare provider-related perceptions toward deprescribing inappropriate medications among older adult outpatients.

To examine healthcare provider-related perceptions toward deprescribing inappropriate medications among older adults. A cross-sectional, correlational study used a convenience sample of outpatient older adults to measure their perception toward deprescribing using a Patient's Perceptions of Deprescribing (PPoD), which include 57 multiple-choice questions related to patients' sociodemographic data, health, medicines, healthcare providers, and experience of care provided by the clinic. Data were collected by a graduate nursing student from one pharmacy in a public hospital, five days per week, via in-person interviews. Data were analyzed for 200 participants. The level of patient collaboration with their primary care providers (PCPs) is linked to their trust in PCPs, beliefs about medication use, PCP knowledge, and medication concerns (p < .0001). Patient involvement in medication deprescribing decision-making is also associated with trust in PCPs and willingness to stop a medication (p < .0001). Additionally, trust in PCPs is related to patient involvement in decision-making, PCP knowledge, general health, collaboration with PCPs, and receiving conflicting information about a medicine (p = .010). Lastly, PCP medication knowledge is associated with trust in PCPs, views on the importance of medicines, medication concerns, seeking help with medicines, interactions with clinical pharmacists, and being advised by a clinical pharmacist to discontinue medication (p < .0001). The study found that older adults' trust in their PCP, collaboration with their PCP, involvement in the decision-making of deprescribing, and knowledge about medication are associated with clinical and medicine-related factors. Therefore, PCPs should discuss the benefits of deprescribing inappropriate medications to prevent long-term side effects. Future studies should focus on the effectiveness of evidence-based deprescribing protocols for older adults.

Assessment of Transcription Errors and their Effects on Medical Approach, Hospitalization Duration, and Financial Costs of Traumatic Patients: How Can We Prevent Them?

Background and aims: Transcription errors pose significant risks to patient well-being, potentially leading to morbidity, mortality, and financial burdens on healthcare systems and society. This study assessed the prevalence of transcription errors and their impacts on medical treatment approaches, hospitalization duration, and associated costs. Methods: Direct observation was used to evaluate and compare all patients’ medical records, identifying errors, costs, and hospitalization duration. Physician orders and patient applications were checked, with intervention and control groups categorized based on the presence or absence of errors, respectively. Data were analyzed using descriptive and quantitative methods such as the chi-square, student’s t-test, Mann-Whitney test, and ANCOVA, to assess statistical significance. Results: No significant differences were observed in gender (P=0.73) and age (P=0.89) between patients. Omission errors and incorrect dosage forms were the most common. Errors were more frequent in patients with underlying diseases (P&lt;0.001), with nurses frequently involved (P&lt;0.001). Errors were more prevalent in intensive care units (ICUs) (P=0.002) and during morning and night shifts (P&lt;0.001). A significant association was found between trauma severity and medication error occurrence (P&lt;0.001). Moreover, patients with transcription errors had higher medical expenses and extended hospital stays (P&lt;0.001). Conclusion: Effective preventive measures are crucial to avoid transcription errors and their adverse consequences. Recommendations include minimizing abbreviations, ensuring complete and explicit orders, rigorous training, double-checking, using technology such as Electronic Prescription and Physician Orders, maintaining a distraction-free, ergonomic work environment, and fostering open communication among healthcare providers and patients to enhance medication safety.

Forensic and legal medicine in Chile: Cinderella without a prince.

Forensic medicine is of enormous importance in the functioning of contemporary justice systems worldwide. Therefore, in order to characterize the current state of medicolegal and forensic activity in Chile, a non-systematic review of the biomedical and legal literature on the subject was carried out. An analysis of open sources of information was also incorporated, including the National Registry of Individual Health Care Providers, the latest public accounts of the Forensic Medical Service, relevant background information available on the active transparency portal of that institution, exempt resolutions included in the "Chile Law" database (of the Department of Legislative and Documentary Services of the Library of the National Congress) and the lists of judicial experts appointed by the Courts of Appeals of the country for the biennium 2024 to 2025. We note that Chile maintains an unacceptable historical debt in terms of academic development and training of qualified professionals in forensic matters. Likewise, national scientific productivity in this field is practically null. Currently, forensic medicine is the medical specialty with the deepest shortage of professionals nationwide. Consequently, as in the early part of the last century, medical expert opinions are frequently performed by professionals untrained in forensic medicine. This scenario, taking into account the attitudes of certain lawyers and judges (detailed in the article), increases the risk of a miscarriage of justice. National public policies must take urgent action to address the deficits and provide solutions.

The Effectiveness of the Moyamoya Healthy Youth Application for the Salutogenesis of Adolescents With Moyamoya Disease: A Randomized Controlled Trial.

Adolescents with moyamoya disease can experience unexpected transient ischemic attacks, significantly impacting their daily lives. This study aimed to examine the effectiveness of the Moyamoya Healthy Youth application for adolescents with moyamoya disease. The research employed a parallel, two-group randomized controlled trial with a repeated measures design. A total of 64 adolescents with moyamoya disease were participated. The intervention group applied the application, whereas the wait-list group received their usual care from an outpatient clinic. The outcome variables were assessed three times during the study, from July 2021 to March 2022. Repeated measures ANOVA and Friedman test were used to analyze results. The intervention group exhibited significant improvements in stress and health behavior. No statistically significant improvement was observed in moyamoya disease knowledge, social support, sense of coherence, depression, cortisol, and symptoms. This mobile-based strategy empowered adolescents to monitor their health behaviors and cope with stress. This intervention is a promising strategy for health care providers to enhance self-management skills and achieve better quality of life in such adolescents. Trial Registration: Korea Clinical Trial Registry KCT0006451. https://cris.nih.go.kr/cris/search/detailSearch.do/21925.

Digital Education for Health Care Providers: An Advanced Cardiac Life Support Resource

Advanced cardiovascular life support (ACLS) refers to a set of urgent treatment guidelines for cardiac emergencies to improve patient outcomes. Strong evidence supports online interactive content in facilitating student learning and engagement. This project introduces an innovative approach to ACLS education, namely a digital ACLS simulation to promote medical resident learning of relevant protocols. No similar resource was found in existing literature, supporting the potential merit of creating this tool for medical education. A scoping review was conducted on current ACLS guidelines to inform interactive content creation with MEDLINE [PubMED] and Web of Science. From this review, a decision tree based on validated care guidelines was derived, guiding digital application development. An online prototype was constructed in HTML, JavaScript, and CSS frameworks. The creation allows users to input cardiovascular emergency patient information and output relevant care instructions based on American Heart Association guidelines. Evidence-based descriptions were provided for each decision, referencing credible external resources for further learning. This interactive application may enhance ACLS protocol learning. Next steps include simulation testing with medical residents to establish whether statistically significant benefits are observed. Long term, this project may inform the development and revision of similar digital resources to enhance medical education delivery.