Senior Doctors Research Articles

Application of artificial intelligence in VSD prenatal diagnosis from fetal heart ultrasound images.

Developing a combined artificial intelligence (AI) and ultrasound imaging to provide an accurate, objective, and efficient adjunctive diagnostic approach for fetal heart ventricular septal defects (VSD). 1,451 fetal heart ultrasound images from 500 pregnant women were comprehensively analyzed between January 2016 and June 2022. The fetal heart region was manually labeled and the presence of VSD was discriminated by experts. The principle of five-fold cross-validation was followed in the training set to develop the AI model to assist in the diagnosis of VSD. The model was evaluated in the test set using metrics such as mAP@0.5, precision, recall, and F1 score. The diagnostic accuracy and inference time were also compared with junior doctors, intermediate doctors, and senior doctors. The mAP@0.5, precision, recall, and F1 scores for the AI model diagnosis of VSD were 0.926, 0.879, 0.873, and 0.88, respectively. The accuracy of junior doctors and intermediate doctors improved by 6.7% and 2.8%, respectively, with the assistance of this system. This study reports an AI-assisted diagnostic method for VSD that has a high agreement with manual recognition. It also has a low number of parameters and computational complexity, which can also improve the diagnostic accuracy and speed of some physicians for VSD.

Exploring Collaboration and Social Dynamics in the Paediatric Morbidity and Mortality Meeting, A Qualitative Case Study.

To explore collaboration and social dynamics within paediatric Morbidity and Mortality meetings. Qualitative Exploratory Case Study Methodology incorporating semi-structured interviews and qualitative observations. Data were collected in a large quaternary paediatric hospital in Melbourne, Australia. Semi-structured interviews with meeting attendees were conducted after observing and documenting meeting conduct. Reflexive thematic analysis was used to interpret data and generate a thematic map of findings. Forty-four interviews and 32 meeting observations were conducted between July 2019 and January 2020. Participants valued collaboration between attendees in Morbidity and Mortality meetings, however there were barriers to this. They included differing views about roles and negative impacts of hierarchies and authority. Senior doctors dominated discussion, and participants described this occasionally signalling reverence and respect, but sometimes signified intimidation and feeling unsure about how to contribute. Because of this complexity, successfully achieving positive social dynamics in a meeting required active promotion and management. Morbidity and Mortality meetings mirror the complexity and richness of the clinical environment. Descriptions of how meeting conduct can shape positive workplace culture and address hierarchical obstructions to safe clinical care highlight their far-reaching potential. Effective collaboration is an intrinsic part of realising this value. This paper addresses a paucity in the literature in understanding how social dynamics and collaboration in Morbidity and Mortality meetings are interpreted and experienced. These findings illuminate challenges and obstacles to achieving a productive and equitable social dynamic in meetings. They also illustrate positive discrimination strategies that may improve participation and widespread engagement of nurses, junior doctors, and allied health professionals. Importantly, fostering constructive social dynamics in the Morbidity and Mortality meeting could positively impact patient safety culture and therefore patient care. No patient or public contribution.

Identification of middle cerebral artery stenosis in transcranial Doppler using a modified VGG-16.

The diagnosis of intracranial atherosclerotic stenosis (ICAS) is of great significance for the prevention of stroke. Deep learning (DL)-based artificial intelligence techniques may aid in the diagnosis. The study aimed to identify ICAS in the middle cerebral artery (MCA) based on a modified DL model. This retrospective study included two datasets. Dataset1 consisted of 3,068 transcranial Doppler (TCD) images of the MCA from 1,729 patients, which were assessed as normal or stenosis by three physicians with varying levels of experience, in conjunction with other medical imaging data. The data were used to improve and train the VGG16 models. Dataset2 consisted of TCD images of 90 people who underwent physical examination, which were used to verify the robustness of the model and compare the consistency between the model and human physicians. The accuracy, precision, specificity, sensitivity, and area under curve (AUC) of the best model VGG16 + Squeeze-and-Excitation (SE) + skip connection (SC) on dataset1 reached 85.67 ± 0.43(%),87.23 ± 1.17(%),87.73 ± 1.47(%),83.60 ± 1.60(%), and 0.857 ± 0.004, while those of dataset2 were 93.70 ± 2.80(%),62.65 ± 11.27(%),93.00 ± 3.11(%),100.00 ± 0.00(%), and 0.965 ± 0.016. The kappa coefficient showed that it reached the recognition level of senior doctors. The improved DL model has a good diagnostic effect for MCV stenosis in TCD images and is expected to help in ICAS screening.

Evaluation of unplanned reattendances to the pediatric emergency department – a five-year study

BackgroundUnplanned reattendances (UR) are an important quality indicator in the emergency department (ED). Understanding the risk factors associated with UR can aid clinicians in optimizing the allocation of time and resources, as well as targeted counselling for this specific group of patients. In this study, we aimed to compare patient characteristics between children who attended a pediatric emergency department (ED) with unplanned reattendances (UR) and those without UR. We also aimed to study the association between healthcare delivery factors such as timing of the attendance, patient load, changeover months for rotating junior doctors, presence of supervision, and rate of UR.Study designWe performed a retrospective, single-center cohort study of patients < 18 years old who visited the ED between January 2018 and March 2023. UR was defined as a revisit within 72 h of the index ED visit. We collected data on demographics, attendance data and clinical characteristics. Logistic regression was performed for factors independently associated with UR, after adjusting for age, patient acuity, timing of attendance, presence of senior doctor supervision, rotation months for junior doctors, and diagnostic category.ResultsOut of the 544,699 eligible children, 24,733 (4.5%) reattended the ED within 72 h, of which 10,915 (44.1%) of them were hospitalized on their reattendance visit. The independent factors associated with UR were young age (age < 3 years old: aOR 1.585 95%CI 1.481–1.698, p < 0.001), high acuity P2+ (aOR 1.398 95%CI 1.354–1.444, p < 0.001), attendance in the evening (aOR 1.086 95%CI 1.055–1.117, p < 0.001) and night (aOR 1.365 95%CI 1.314–1.417, p < 0.001), gastrointestinal diagnosis (aOR 1.528, CI 1.469–1.588; p < 0.001) and respiratory diagnosis (aOR 1.155, CI 1.121–1.189, p < 0.001).ConclusionsWe identified independent risk factors for UR that could guide resource allocation. Future studies should investigate if targeted interventions may reduce UR in these at-risk populations.

Preventable Hospital Admission-associated VTE: Thoughts on Thromboprophylaxis as Asians

AbstractPrevious studies surveying senior and junior doctors have shown that thromboprophylaxis was not commonly practiced in hospitalized medical patients in three public hospitals in Singapore. We, therefore, conducted an audit of our hospital's venous thromboembolism (VTE) clinic cases to study the proportion of preventable hospital admission-associated VTE (HAAVTE). All newly diagnosed VTE cases referred to our VTE clinic from March 2023 to December 2023 were reviewed, to identify those potentially associated with recent hospital admissions. We then reviewed the medical records of those cases to see if thromboprophylaxis was prescribed if indicated. HAAVTEs that had high VTE risk and did not receive appropriate thromboprophylaxis (pharmacological or mechanical) were considered preventable HAAVTE. Thirteen cases of HAAVTEs were identified, out of which only one was given the appropriate thromboprophylaxis. The proportion of preventable HAAVTE was 92.3%. Thromboprophylaxis is not widely practiced in our hospital. More effort is required to improve local thromboprophylaxis practice for hospitalized patients to reduce the burden of preventable HAAVTE.

Secondary analysis of hand-offs in internal medicine using the I-PASS mnemonic

BackgroundMiscommunications account for up to 80% of preventable medical errors. Mnemonics like I-PASS (Illness severity, Patient summary, Actions list, Situation awareness, Synthesis) have demonstrated a positive impact on reducing error rates. Currently, physicians at our hospital do not follow a specific structure during hand-offs. We aimed to compare current hand-offs without prior training to a gold standard and the I-PASS tool in terms of content and sequence.MethodsThis study is a secondary analysis of data collected during a simulation study of a Friday evening hand-off to the night resident at University Hospitals of Geneva. Thirty physicians received a hand-off of four patients and managed two other patients through nursing pages at the start of the night shift, generating six sign-outs each, totaling 177 sign-outs. A focus group of three senior doctors defined the gold standard (GS) by consensus on the essential content of each sign-out. The analysis focused on the rates of relevance (ratio of information considered relevant by the GS) and completeness (proportion of transmitted elements out of all expected elements of the GS), and the distribution and sequence of the first four I-PASS categories.ResultsRelevance and completeness rates were 37.2% ± 0.07 and 51.9% ± 0.1, respectively, with no significant difference between residents and supervisors. There was a positive correlation between total hand-off time and relevance (residents: R2 = 0.62; supervisors: R2 = 0.67) and completeness (residents: R2 = 0.32; supervisors: R2 = 0.56). The distribution of I-PASS categories was highly skewed in both the GS (I = 2%, P = 72%, A = 17%, S = 9%) and participants (I = 6%, P = 73%, A = 14%, S = 7%), with significant differences in categories A (p = 0.046) and I (p ≤ 0.001). Sequences of I-PASS categories generally followed a P-A-S-I pattern. The first S category was frequently absent, and only one participant began by announcing the case severity as suggested by I-PASS.ConclusionWe identified gaps between current medical sign-outs in our institution's general internal medicine division and the I-PASS structure. We recommend implementing the I-PASS mnemonic, emphasizing the "I" category at the start and the "S" category to anticipate and prevent complications. Future studies should assess the impact of this recommendation, adapt the mnemonic elements to the context, and introduce specific hand-off training for senior medical students.

ThP6.17 - ‘If it’s not documented, it didn’t happen’: an audit into surgical ward documentation and clinicians expectations in a district general hospital

Abstract Introduction &amp; Aims There are guidelines published by the Royal College of Surgeons (RCS) on adult surgical ward round documentation. Locally, documentation is done on pre populated sheets containing blood results, antibiotics and VTE prophylaxis. We aimed to assess documentation in our unit against the RCS guidelines. Methodology We audited documentation for surgical inpatients over 1 week, looking at daily ward rounds (DWR), and initial consultant post take ward round (PTWR). Through an online survey, we established the minimum standards of documentation expected by doctors of varying seniority on a ward round within our unit. Results 21 DWR and 21 PTWR entries were reviewed; 90% (n=19) contained the date and 95% (n=20) the name of the reviewing consultant. Time of review was documented in 29% (n=6) and 35% (n=7) respectively. 33% (n=4) DWR entries documented examination findings, compared to 8 40% (n=8) PTWR entries. 45% (n=10) PTWR contained the presenting complaint. 26 doctors completed the online survey; 100% thought date, time and examination findings were important. More senior doctors highlighted that drain status was a key part of ward round documentation. Conclusions Within our unit, there is poor adherence with the RCS ward round documentation guidelines. Juniors suggested this is because ward rounds are too fast paced, often on complex and comorbid patients. We plan to address our findings with an improved surgical admission proforma and an electronic handover to ensure all team members are up to date with patients’ admission details.

Practices of Informed Written Consent for Elective Urological Procedures at a Tertiary Care Hospital in Sudan.

Objective This study aimed to assess informed consent practices in elective urological surgeries at a tertiary care facility. Materials and methods A retrospective cross-sectional survey was carried out between March 1, 2023and April 1, 2023, at the Department of Urology, Omdurman Military Hospital, Sudan. We included all patients who had undergone elective urological procedures under local, spinal, or general anesthesia. The medical records were accessed to analyze the consent forms' standards. A total of 42 consent forms were included and analyzed. We use the General Medical Council's (GMC) Guidance on Professional Standards and Ethics for Doctors: Decision Making and Consent, and the Royal College of Surgeons (RCS) of England's Consent: Supported Decision-Makingas the standard for our study. The GMC and the RCS of England have provided comprehensive and standardized guidelines for obtaining informed written consent, including indications, benefits, risks involved, and alternatives in addition to demographics, patient details, responsible consultant, diagnosis, and title of the surgery, intended benefits, probable risks, type of anesthesia, consenting doctor's name, designation, and signature, and the patient's signature and name. Results A total of 42 consent forms were included. The diagnosis and the intended surgical procedure were mentioned in all consents. The potential benefits and risks were discussed in 36 (85.7%) and 18 (42.9%) cases, respectively. The type of anesthesia was discussed in 39 (92.9%) of cases. The likely result of not having the procedure and the alternative treatment: Recorded completion rates of 10 (23.8%) and 12 (28.6%), respectively. Patient demographics were completely documented in 41 (97.6%) forms. Senior doctors were only involved in 14 (33.3%) of the consents. Details of the consenting doctor, including name, title, and signature, were present in 30 cases (71.4%), and the date of signing the consent was documented in 38 cases (90.5%). The completeness of the consent form correlated with the level of the doctor obtaining it, with consultants achieving the highest completion rates (100%), followed by registrars (66.7%) and medical officers (35.7%). Conclusion The current practices of informed consent were found to be substandard. Handwritten consent forms do not adhere to the recommended guidelines for informed consent in elective urological procedures. It is preferable to utilize a pre-designed consent form, allowing for personalized additions based on the patient's specifics. Our recommendation is to organize an educational session for junior doctors to emphasize proper consent procedures, and deepen their knowledge of common urological elective procedures, and associated risks. This approach promotes adherence to best clinical practices and minimizes the risk of legal challenges.

Awareness about Neonatal Lactose Intolerance among Chinese Neonatologists in Outpatient Settings: A Multi-Center Survey.

This study aimed to identify the specific areas of knowledge gaps regarding lactose intolerance among neonatologists in Chinese outpatient settings as well as to assess the availability of lactose intolerance testing in hospitals. A total of 278 neonatologists in outpatient settings from 144 hospitals were surveyed. To explore the awareness level, diagnosis, and treatment of neonatal lactose intolerance among neonatologists in outpatient settings, a multicenter cross-sectional survey was designed. Descriptive analysis based on frequency and percent distribution was performed for all variables. Most respondents were senior doctors (256, 92.09%) from general hospitals and maternity/maternal and child health hospitals, had over 10 years of experience, and were dominantly associate chief physicians and chief physicians (211, 75.90%). A significant proportion of the participants (236, 84.89%) believed that neonatal lactose intolerance tends to be overlooked during clinical practice. When the most common symptoms of neonatal lactose intolerance were surveyed, diarrhea was selected by 142 (51.08%) respondents, followed by bloating and milk regurgitation or emesis (71, 25.54%). Other symptoms included unexplained crying (36, 12.85%), stool with milk flap or foam (15, 5.40%), and increased venting (14, 5.04%). Furthermore, the survey results indicated that the most common method for diagnosing neonatal lactose intolerance in the respondents' hospitals was qualitative test for urinary galactose (78, 28.06%). Of the respondents, 137 (49.28%) stated that their hospital could not test for lactose intolerance. For treating lactose intolerance, the neonatologists primarily opted for exogenous lactase rather than lactose-free formula milk. This study sheds light on Chinese neonatologists' awareness of neonatal lactose intolerance, revealing some knowledge gaps. The expeditious popularization and conduct of lactose intolerance-related examinations in hospitals will have a positive stimulative effect on the management of lactose intolerance in newborns.

2254 Improving the quality and breadth of advance care planning discussions on gerontology wards in an acute London trust

Abstract Introduction Advance care planning (ACP) offers people the opportunity to plan their future care whilst they have capacity to do so and is supported by national guidance. Decisions regarding future care are more likely to be individualised and holistic when patients and their significant others are involved. This QI project aimed to address this by increasing the frequency of ACP discussions being offered and recorded on gerontology wards in an acute London Trust. Method A multi-professional steering group was established to improve ACP using PDSA methodology. A new ACP toolkit, training programme and electronic flowsheet (within the hospital’s patient record system) were implemented. ACP documentation quality was audited on gerontology wards pre and post implementation (over one to four months respectively). Data was compared using Pearson’s Chi-squared test. Results ACP flowsheets were completed by junior and senior doctors, and clinical nurse specialists in frailty and palliative medicine. The initial audit found disparity between documented topics of ACP conversations, with cardiopulmonary resuscitation recommendations being most discussed. Post implementation, 24 ACP flowsheets were reviewed, showing that more ACP topics were documented where these conversations were had; preferred place of death increased from 24% to 60% (p 0.011); treatment escalation plan increased from 41% to 75% (p 0.014); preferred place of care increased from 59% to 71% (p 0.066). Topics not showing significant improvement in documentation (despite inclusion in the flowsheet) were spiritual needs, information needs and prognostic discussion, broader social needs and what was most important to the patient. Conclusion The implementation of an electronic ACP flowsheet improved documented ACP conversations in some topics, guiding healthcare professionals to deliver care that aligns with peoples’ wishes and preferences. Documented conversations became easier to access, review and audit. Work is still needed to promote ACP conversations being centralised around what matters most to patients.

2271 Older trauma in the emergency department

Abstract Aim Improve the care of patients aged 65+ presenting with trauma to the emergency department by ensuring earlier senior reviews (ST4+) and consideration of trauma calls and appropriate imaging. Method Staff survey to assess awareness of older trauma and its management. Data analysis and collection followed by use of PDSA cycles to implement change. Teaching session on primary survey assessment and management of older trauma. Development of older trauma standard operating procedure. Results Improvement was seen in both primary outcomes over a period of 8 months. Documentation of primary survey improved from 30% from the initial 5 weeks to 52% over the final 5 weeks on average. Senior doctor review or discussion improved from 30% average in the first 5 weeks to 80% averaged across the final 5 weeks. There was no evidence of effect on waiting times in the emergency department for these patients. Conclusion This quality improvement initiative has positively impacted the early assessment of older trauma patients, aiming to mitigate the likelihood of missed injuries and adverse outcomes. While we haven’t formally assessed more complex outcome data, a notable achievement is the initiation of a cultural shift among our frontline medical and nursing staff. This shift involves approaching older trauma patients with a heightened index of suspicion. Among the interventions, the most straightforward and reproducible was the implementation of regular educational emails. We anticipate continued progress and hope that this poster serves as inspiration for other departments. Encouraging a review of how they assess and treat this expanding cohort of vulnerable, complex, and potentially critically ill patients. Unfortunately, it is not uncommon that for our growing elderly population, a trip and fall can lead to fatal consequences. We aspire for this work to contribute towards broader efforts in changing that narrative.

Ovarian-adnexal reporting and data system ultrasound evaluation and pathological characteristics of ovarian collision tumor.

Collision tumor are neoplasms, including two histologically distinct tumors that coexist in the same mass without histological admixture. The incidence of collision tumor is low and is rare clinically. To investigate ultrasound images and application of ovarian-adnexal reporting and data system (O-RADS) to evaluate the risk and pathological characteristics of ovarian collision tumor. This study retrospectively analyzed 17 cases of ovarian collision tumor diagnosed pathologically from January 2020 to December 2023. All clinical features, ultrasound images and histopathological features were collected and analyzed. The O-RADS score was used for classification. The O-RADS score was determined by two senior doctors in the gynecological ultrasound group. Lesions with O-RADS score of 1-3 were classified as benign tumors, and lesions with O-RADS score of 4 or 5 were classified as malignant tumors. There were 17 collision tumors detected in 16 of 6274 patients who underwent gynecological surgery. The average age of 17 women with ovarian collision tumor was 36.7 years (range 20-68 years), in whom, one occurred bilaterally and the rest occurred unilaterally. The average tumor diameter was 10 cm, of which three were 2-5 cm, 11 were 5-10 cm, and three were > 10 cm. Five (29.4%) tumors with O-RADS score 3 were endometriotic cysts with fibroma/serous cystadenoma, and unilocular or multilocular cysts contained a small number of parenchymal components. Eleven (64.7%) tumors had an O-RADS score of 4, including two in category 4A, six in category 4B, and three in category 4C; all of which were multilocular cystic tumors with solid components or multiple papillary components. One (5.9%) tumor had an O-RADS score of 5. This case was a solid mass, and a small amount of pelvic effusion was detected under ultrasound. The pathology was high-grade serous cystic cancer combined with cystic mature teratoma. There were nine (52.9%) tumors with elevated serum carbohydrate antigen (CA)125 and two (11.8%) with elevated serum CA19-9. Histological and pathological results showed that epithelial-cell-derived tumors combined with other tumors were the most common, which was different from previous results. The ultrasound images of ovarian collision tumor have certain specificity, but diagnosis by preoperative ultrasound is difficult. The combination of epithelial and mesenchymal cell tumors is one of the most common types of ovarian collision tumor. The O-RADS score of ovarian collision tumor is mostly ≥ 4, which can sensitively detect malignant tumors.

Upper blepharoplasty in Asian population: A novel technique based on functional zoning and dynamic reconstruction with anatomical structure.

Double eyelid blepharoplasty is the most popular cosmetic operation in Asian population. Various surgical techniques have been developed in order to create dynamic eyelid folds with natural-looking in recent years, but postoperative complications like so-called sausage-like appearance have not been resolved completely. To create natural-looking dynamic folds, we propose a new method imitating the original anatomical structure of congenital double-eyelid. Eighty-six patients who underwent the double-eyelid surgery from June 1st, 2018 to October 31st, 2020 were included in this retrospective study, including 10 males and 76 females, aged 18-39 years (mean 27.4 ± 5.6 years). All the included patients received double eyelid surgery performed by the same senior doctor, using the pretarsal orbicularis oculi muscle-releasing technique. Patient Reported Outcome Measures questionnaires were administrated to assess the severity of scarring, pain, and asymmetry, as well as functional and appearance issues. Surgical outcome was assessed through objective and subjective evaluation forms (PROM and patient satisfaction rate). Among the 86 patients, 5 were lost during the follow-up period. The absolute number of enrolled patients is 81. 91.36% of the enrolled patients reported minimal or non-visible scarring at the double eyelid incision. As to functional and appearance issues, the main problem were asymmetry (12.35%) and the narrowing of the supratarsal crease width (8.64%). No supratarsal depression and "sausage-like" appearance occurred in this study. 95.1% of patients reported either good or excellent outcome (mean score: 108 of 120) based on analysis of PROM results, and 96.3% of patients reported either high or very high satisfaction (mean score: 96 of 120) for the patient satisfaction assessment. This new surgical method of double-eyelid blepharoplasty provides comparatively safe and effective results.

Validation of Artificial Intelligence in the Classification of Adolescent Idiopathic Scoliosis and the Compairment to Clinical Manual Handling.

The accurate measurement of Cobb angles is crucial for the effective clinical management of patients with adolescent idiopathic scoliosis (AIS). The Lenke classification system plays a pivotal role in determining the appropriate fusion levels for treatment planning. However, the presence of interobserver variability and time-intensive procedures presents challenges for clinicians. The purpose of this study is to compare the measurement accuracy of our developed artificial intelligence measurement system for Cobb angles and Lenke classification in AIS patients with manual measurements to validate its feasibility. An artificial intelligence (AI) system measured the Cobb angle of AIS patients using convolutional neural networks, which identified the vertebral boundaries and sequences, recognized the upper and lower end vertebras, and estimated the Cobb angles of the proximal thoracic, main thoracic, and thoracolumbar/lumbar curves sequentially. Accordingly, the Lenke classifications of scoliosis were divided by oscillogram and defined by the AI system. Furthermore, a man-machine comparison (n = 300) was conducted for senior spine surgeons (n = 2), junior spine surgeons (n = 2), and the AI system for the image measurements of proximal thoracic (PT), main thoracic (MT), thoracolumbar/lumbar (TL/L), thoracic sagittal profile T5-T12, bending views PT, bending views MT, bending views TL/L, the Lenke classification system, the lumbar modifier, and sagittal thoracic alignment. In the AI system, the calculation time for each patient's data was 0.2 s, while the measurement time for each surgeon was 23.6 min. The AI system showed high accuracy in the recognition of the Lenke classification and had high reliability compared to senior doctors(ICC 0.962). The AI system has high reliability for the Lenke classification and is a potential auxiliary tool for spinal surgeons.

Clinical application potential of large language model: a study based on thyroid nodules.

Limited data indicated the performance of large language model (LLM) taking on the role of doctors. We aimed to investigate the potential for ChatGPT-3.5 and New Bing Chat acting as doctors using thyroid nodules as an example. A total of 145 patients with thyroid nodules were included for generating questions. Each question was entered into chatbot of ChatGPT-3.5 and New Bing Chat five times and five responses were acquired respectively. These responses were compared with answers given by five junior doctors. Responses from five senior doctors were regarded as gold standard. Accuracy and reproducibility of responses from ChatGPT-3.5 and New Bing Chat were evaluated. The accuracy of ChatGPT-3.5 and New Bing Chat in answering Q2, Q3, Q5 were lower than that of junior doctors (all P < 0.05), while both LLMs were comparable to junior doctors when answering Q4 and Q6. In terms of "high reproducibility and accuracy", ChatGPT-3.5 outperformed New Bing Chat in Q1 and Q5 (P < 0.001 and P = 0.008, respectively), but showed no significant difference in Q2, Q3, Q4, and Q6 (P > 0.05 for all). New Bing Chat generated higher accuracy than ChatGPT-3.5 (72.41% vs 58.62%) (P = 0.003) in decision making of thyroid nodules, and both were less accurate than junior doctors (89.66%, P < 0.001 for both). The exploration of ChatGPT-3.5 and New Bing Chat in the diagnosis and management of thyroid nodules illustrates that LLMs currently demonstrate the potential for medical applications, but do not yet reach the clinical decision-making capacity of doctors.

Healthcare Resilience in Trinidad and Tobago: A short report on the Healthy Hospital Initiative at the Sangre Grande Hospital

Objective: To describe the establishment of the Healthy Hospital Initiative (HHI), its activities and accomplishments, challenges and future steps. Methods: The initiative was implemented at the Sangre Grande Hospital in the Eastern Regional Health Authority (ERHA), one of five Regional Health Authorities in Trinidad and Tobago. A review of personal records maintained by members of the Healthy Hospital Initiative was undertaken. These records included descriptions of the activities, accomplishments and obstacles that the team experienced. Results: The Healthy Hospital Initiative was launched in November 2019 with the aim of creating an environmentally sustainable health system and improving the physical and mental health of staff and patients. A senior doctor led the initiative and team members included a range of staff, including both clinical and non-clinical professionals who were all volunteers. This allowed for a multi-directional, inclusive approach and created a sense of ownership amongst the staff. In 2022, several activities were implemented: green spaces, recycling bins, a kitchen garden and staff exercise sessions. In addition, team members participated in training on Pan-American Health Organization (PAHO) Smart hospitals and collaborated with a local non-governmental organisation as well as the University of the West Indies, St. Augustine campus engineering department to develop further projects. Conclusion: Next steps include promoting similar projects in community health facilities, developing a hydroponics system and, assessing the disaster resilience and carbon footprint of the hospital.

Appropriate Hand Drying - The Missed Step of Hand Hygiene: A Qualitative Evaluation of Hand Drying Practices among Indian Health Care Workers.

Hand hygiene remains one of the most effective methods of preventing healthcare-associated infections. Hand drying is the end point of hand hygiene. Hand drying after hand hygiene is less explored, and the practice varies in different facilities. This explorative study was done to know the various hand-drying methods and practices of healthcare workers in Indian settings. This was a descriptive cross-sectional questionnaire-based observational study initiated from a tertiary care setup in Uttarakhand. Healthcare workers over 18 years of age directly involved in patient care were enrolled. A semi-structured questionnaire with both open-ended and close-ended questions was used with snowballing sampling technique. Statistical analysis was done using Statistical Package for Social Sciences (SPSS). Out of the eligible 395 respondents, 62.8% were female. The mean age of the respondents was 31.34 ± 8.44 years and average working hours were 8.87 ± 2.97 (range 4-24) hours. Only 72.7% did hand hygiene always before touching a patient. Nurses were more compliant about hand hygiene than doctors (P < 0.0001). A total of 82.8% were aware of appropriate hand-drying methods. Staff in the Intensive care unit Intensive care unit (ICU) setup were more aware of hand drying practices (P = 0.033). A total of 21.8% wiped their hands on their clothing to dry their hands. This was more in staff from paraclinical departments (P = 0.001). A total of 35.7% used handkerchiefs to dry hands. Resident doctors used handkerchiefs more than senior doctors or nursing staff (P = 0.01). A total of 49.9% of respondents spent less than 10 seconds in hand drying. Hand-hygiene knowledge is high among healthcare workers in India, but the knowledge of appropriate hand-drying practices is lacking. There is wide variation in the practice of hand drying. Better hand drying guidelines and incorporating hand drying as the essential endpoint of the hand hygiene ritual are warranted.

Implementing high-value, cost-conscious care: experiences of Irish doctors and the role of education in facilitating this approach

BackgroundAdopting high-value, cost-conscious care (HVCCC) principles into medical education is growing in importance due to soaring global healthcare costs and the recognition that efficient care can enhance patient outcomes and control costs. Understanding the current opportunities and challenges doctors face concerning HVCCC in healthcare systems is crucial to tailor education to doctors’ needs. Hence, this study aimed to explore medical students, junior doctors, and senior doctors’ experiences with HVCCC, and to seek senior doctors’ viewpoints on how education can foster HVCCC in clinical environments.MethodsUsing a mixed-methods design, our study involved a cross-sectional survey using the Maastricht HVCCC-Attitude Questionnaire (MHAQ), with a subset of consultants engaging in semi-structured interviews. Descriptive analysis provided insights into both categorical and non-categorical variables, with differences examined across roles (students, interns, junior doctors, senior doctors) via Kruskal-Wallis tests, supplemented by two-group analyses using Mann-Whitney U testing. We correlated experience with MHAQ scores using Spearman’s rho, tested MHAQ’s internal consistency with Cronbach’s alpha, and employed thematic analysis for the qualitative data.ResultsWe received 416 responses to the survey, and 12 senior doctors participated in the semi-structured interviews. Overall, all groups demonstrated moderately positive attitudes towards HVCCC, with more experienced doctors exhibiting more favourable views, especially about integrating costs into daily practice. In the interviews, participants agreed on the importance of instilling HVCCC values during undergraduate teaching and supplementing it with a formal curriculum in postgraduate training. This, coupled with practical knowledge gained on-the-job, was seen as a beneficial strategy for training doctors.ConclusionsThis sample of medical students and hospital-based doctors display generally positive attitudes towards HVCCC, high-value care provision, and the integration of healthcare costs, suggesting receptiveness to future HVCCC training among students and doctors. Experience is a key factor in HVCCC, so early exposure to these concepts can potentially enhance practice within existing healthcare budgets.

Knowledge, Attidue and Practice of Advanced Trauma Life Suppoort (ATLS) Protocol among House-Officers in Khartoum State Hospitals, Sudan, 2023

BackgroundAdvanced Trauma Life Support was originated mainly to train doctors who don’t manage trauma on a regular basis, including junior doctors as it prepares them more efficiently and effectively for treating and managing trauma patients. This study was conducted to study knowledge, attitude and practice of advanced trauma life support protocol among house-officers in Khartoum state hospitals, Sudan 2023.MethodsThis is a cross-sectional descriptive health facility based study conducted in Bahri Teaching Hospital, Omdurman Teaching Hospital and Ibrahim Malik teaching hospital, Khartoum state, Sudan. Data of 151 House-officers of all nationality working in Khartoum state hospitals was collected using a simple random technique, filling questionnaire that was designed especially for this study. Comparison between different variables by Chi-square test and statistical significance difference at P value < 0.05 was done.ResultA total of 151 house officers were included in the study. 49% aged between 20 and 25 years, females were the majority 56.3%. About 41.1% have took ATLS course before. 55.21% of the study participants didn’t take the course because it was not available, while 35.42% because it was expensive and 29.17% referred it to their busy lifestyle. 91% of the study population think that ATLS course should be compulsory and 85% think that the ATLS protocol should be recommended to both junior and senior doctors. 77% of the study participants stated that their seniors teaching skills affect how they apply ATLS.ConclusionOverall junior doctors at Khartoum state hospitals demonstrated a positive attitude towards ATLS, but they showed poor knowledge regarding the topic. It’s advised that an earlier training program is introduced by incorporating ATLS course to be part of all final year medical school’s curriculum.

A national survey of clinicians’ opinions of rotational vaginal births

IntroductionMalposition of the fetal head, defined as occiput transverse or posterior positions, occurs in approximately 5% of births. At full cervical dilatation, fetal malposition is associated with an increased risk of rotational vaginal birth. There are three different rotational methods: manual rotation, rotational ventouse or rotational (Kielland’s) forceps. In the absence of robust evidence, it is not currently known which of the three methods is most efficacious, and safest for parents and babies. ObjectiveTo gain greater insights into opinions and preferences of rotational birth to explore the acceptability and feasibility of performing a randomised trial comparing different rotational methods. Material and methodsA survey was sent via email to obstetricians from the British Maternal Fetal Medicine Society, as well as expert obstetricians and active academics in ongoing research in the UK. The questions focussed on perceived competence, preferred rotational method, location (theatre or labour room), willingness to recruit to an RCT, and its outcome measures. Closed questions were followed by the option of free text to allow further comments. The free text answers underwent thematic analysis. Results252 consultant obstetricians responded. The majority stated they were competent in performing manual rotation (88.1%). Half felt proficient using Kielland’s rotational forceps (54.4%). Most obstetricians felt skilled in rotational ventouse (76.2%). Manual rotation was the preferred first rotational method of choice in cases of both occiput transverse and posterior positions. The decision for which rotational method to attempt first was considered case-dependent by many. Two thirds of obstetricians would usually conduct rotational births in theatre (67.9%). Over half (52%) do not routinely use intrapartum ultrasound. Most (62.7%) would be willing to recruit to a randomised controlled trial comparing manual versus instrumental rotation. Over half (57.2%) would be willing to recruit to the same RCT if they were the most senior doctor competent in rotational vaginal birth supervising a junior. ConclusionThere is a wide range of practice in conducting rotational vaginal births in the UK. An RCT to investigate the impact of different rotational methods on outcome would be both feasible and desirable, especially in research-active hospitals.