Source Of Clinical Information Research Articles

Joint-individual fusion structure with fusion attention module for multi-modal skin cancer classification

Many convolutional neural network (CNN) based approaches for skin cancer classification primarily rely on dermatological images, yielding commendable results in classification accuracy. However, leveraging patient metadata, a crucial source of clinical information for dermatologists, can further enhance accuracy. Current methodologies predominantly employ basic joint fusion structures (FS) and fusion modules (FMs) for multi-modal classification, leaving room for advancement in enhancing accuracy through exploration of more sophisticated FS and FM architectures. Thus, this paper introduces a novel fusion method that integrates dermatological images (dermoscopy images or clinical images) with patient metadata for skin cancer classification, focusing on enhancing FS and FM components. Initially, we propose a joint-individual fusion (JIF) structure that simultaneously learns shared features across multi-modality data while preserving specific characteristics. Subsequently, we introduce a multi-modal fusion attention (MMFA) module designed to amplify the most relevant image and metadata features through a combination of self and mutual attention mechanisms, thereby bolstering the decision-making pipeline. Our study compares the efficacy of the proposed JIF-MMFA method with other state-of-the-art fusion techniques across three distinct public datasets. Results demonstrate that the JIF-MMFA method consistently enhances classification outcomes across various CNN backbones, outperforming alternative fusion methodologies on all three datasets. These findings underscore the effectiveness and robustness of our proposed approach in skin cancer classification.

Clinical study types and guidance for their correct post-pandemic interpretation.

Randomized clinical trials (RCTs) are key to the advancement of medicine and microbiology, but they are not the only option. Observational studies provide information on long-term efficacy and safety, are less expensive, allow the study of rare events, and obtain information more quickly than RCTs. On the other hand, they are more vulnerable to confounding factors. Prospective exploratory pilot studies share many aspects with RCTs but are not subject to supervision by external commissions or mandatory registration. Multitesting can pervert the balance of publications in favor of the desired effect. Bonferroni's reasoning shows that if 10 studies are performed with an ineffective antibiotic, the probability that at least one will show P <0.05 might be 40%. Scenarios in which there is intensive pressure to perform research, such as the recent pandemic, might result in many research teams trying to study the effect of an antimicrobial. Even if the drug has no efficacy, if 100 research teams conduct a study to assess its usefulness, it might be virtually certain that at least one will get a P value <0.05. If the other studies (with P >0.05) are not published, the scientific commu nity would consider that there is strong evidence in favor of its usefulness. In conclusion, RCTs are a very good source of clinical information, but are not the only one. The systematic registration of all research can and should be applied to all types of clinical studies.

Designing a Digital Health Solution: A Platform for Automated Surveillance of Fungal Infection.

Surveillance of invasive fungal infection (IFI) requires laborious review of multiple sources of clinical information, while applying complex criteria to effectively identify relevant infections. These processes can be automated using artificial intelligence (AI) methodologies, including applying natural language processing (NLP) to clinical reports. However, developing a practically useful automated IFI surveillance tool requires consideration of the implementation context. We employed the Design Thinking Framework (DTF) to focus on the needs of end users of the tool to ensure sustained user engagement and enable its prospective validation. DTF allowed iterative generation of ideas and refinement of the final digital health solution. We believe this approach is key to increasing the likelihood that the solution will be implemented in clinical practice.

Getting More Out of Clinical Documentation: Can Clinical Dashboards Yield Clinically Useful Information?

This study investigated coded data retrieved from clinical dashboards, which are decision-support tools that include a graphical display of clinical progress and clinical activities. Data were extracted from clinical dashboards representing 256 youth (M age = 11.9) from 128 practitioners who were trained in the Managing and Adapting Practice (MAP) system (Chorpita & Daleiden in BF Chorpita EL Daleiden 2014 Structuring the collaboration of science and service in pursuit of a shared vision. 43(2):323 338. 2014, Chorpita & Daleiden in BF Chorpita EL Daleiden 2018 Coordinated strategic action: Aspiring to wisdom in mental health service systems. 25(4):e12264. 2018) in 55 agencies across 5 regional mental health systems. Practitioners labeled up to 35 fields (i.e., descriptions of clinical activities), with the options of drawing from a controlled vocabulary or writing in a client-specific activity. Practitioners then noted when certain activities occurred during the episode of care. Fields from the extracted data were coded and reliability was assessed for Field Type, Practice Element Type, Target Area, and Audience (e.g., Caregiver Psychoeducation: Anxiety would be coded as Field Type = Practice Element; Practice Element Type = Psychoeducation; Target Area = Anxiety; Audience = Caregiver). Coders demonstrated moderate to almost perfect interrater reliability. On average, practitioners recorded two activities per session, and clients had 10 unique activities across all their sessions. Results from multilevel models showed that clinical activity characteristics and sessions accounted for the most variance in the occurrence, recurrence, and co-occurrence of clinical activities, with relatively less variance accounted for by practitioners, clients, and regional systems. Findings are consistent with patterns of practice reported in other studies and suggest that clinical dashboards may be a useful source of clinical information. More generally, the use of a controlled vocabulary for clinical activities appears to increase the retrievability and actionability of healthcare information and thus sets the stage for advancing the utility of clinical documentation.

Utilizing Artificial Intelligence and Chat Generative Pretrained Transformer to Answer Questions About Clinical Scenarios in Neuroanesthesiology.

We tested the ability of chat generative pretrained transformer (ChatGPT), an artificial intelligence chatbot, to answer questions relevant to scenarios covered in 3 clinical guidelines, published by the Society for Neuroscience in Anesthesiology and Critical Care (SNACC), which has published management guidelines: endovascular treatment of stroke, perioperative stroke (Stroke), and care of patients undergoing complex spine surgery (Spine). Four neuroanesthesiologists independently assessed whether ChatGPT could apply 52 high-quality recommendations (HQRs) included in the 3 SNACC guidelines. HQRs were deemed present in the ChatGPT responses if noted by at least 3 of the 4 reviewers. Reviewers also identified incorrect references, potentially harmful recommendations, and whether ChatGPT cited the SNACC guidelines. The overall reviewer agreement for the presence of HQRs in the ChatGPT answers ranged from 0% to 100%. Only 4 of 52 (8%) HQRs were deemed present by at least 3 of the 4 reviewers after 5 generic questions, and 23 (44%) HQRs were deemed present after at least 1 additional targeted question. Potentially harmful recommendations were identified for each of the 3 clinical scenarios and ChatGPT failed to cite the SNACC guidelines. The ChatGPT answers were open to human interpretation regarding whether the responses included the HQRs. Though targeted questions resulted in the inclusion of more HQRs than generic questions, fewer than 50% of HQRs were noted even after targeted questions. This suggests that ChatGPT should not currently be considered a reliable source of information for clinical decision-making. Future iterations of ChatGPT may refine algorithms to improve its reliability as a source of clinical information.

Exploring the Information Sources Consulted by Doctors at the Point of Care in Four Selected South African Referral Hospitals.

To provide an understanding of the clinical information sources consulted by teaching or referral hospital-based doctors in four South African provinces. A quantitative cross-sectional survey design was used. To identify provinces, hospitals, and participants, simple random sampling was adopted. This study targeted a total of 276 doctors from all the four hospitals working across different departments within the hospitals. This study was conducted in four selected South African public referral/teaching hospitals in four different provinces, namely Nelson Mandela Academic Hospital in the Eastern Cape province; Witbank Hospital in Mpumalanga province; Robert Mangaliso Sobukwe Hospital in Northern Cape province and lastly, Pietersburg Hospital in Limpopo province. Overall, 221 doctors were surveyed. Doctors relied more on colleagues as formal and informal sources of information. They seldomly relied on newspapers, reference, and library books, or used hospital computers to access the internet. They seldomly attended training workshops organised by the district or provincial office. Protocols and clinical guidelines which are kept in the hospitals and easily accessible were often (27.9%) or always (51.1%) used. Teaching hospitals need to strengthen information resources to ensure that even when colleagues are used as an information source, they are an accessible means to validate the correctness of the information provided.

Digital Health Literacy: Evaluating the Readability and Reliability of Cochlear Implant Patient Information on the Web.

Hearing aids and implants are used to treat hearing loss, with cochlear implants being the most successful option for severe sensorineural hearing loss. Patients frequently use the internet as a trusted source of clinical information before committing to any therapeutic procedure, including receiving a cochlear implant. A health resource's readability and dependability influence its value to patients. Readability refers to how easily language can be understood, whereas reliability refers to the correctness and consistency of the information presented. JAMA standards and the DISCERN tool were used to assess the reliability of the websites listed. For readability analysis, the FRE, FKG and GFI were chosen. The acceptable readability level was set to < 7 for the FKG, GF score over 17 as the equivalent of college-level education and ≥ 80.0 for the FRE. The readability scores vary across the sources, suggesting a range of comprehension levels required for understanding the cochlear implant patient information found on Google. There was a statistical difference detected in Discern score between the groups (p = 0.008). The mean discern score was significantly higher in hospital generated sources when compared to industry (3.13±0.69 vs. 2.11±0.78, p = 0.03).

Documentation practice and associated factors among nurses working in public hospitals in Wolaita Zone, Southern Ethiopia

BackgroundNursing documentation documents the everyday activities of nursing care that are planned and implemented on individual patients by nurses of different educational statuses. Documentation of nursing activities is the key source of clinical information to meet professional and legal requirements. Although nursing documentation is an important part of nursing practice, it is commonly undone by nurses working with patients for different reasons.ObjectiveTo assess the documentation practice and their associated factors among nurses working in public hospitals in the Wolaita Zone, Southern Ethiopia.MethodsAn institutional-based cross-sectional study was conducted among 402 nurses and a simple random sampling technique was used to select participants. Data were collected using a pretested structured self-administered questionnaire adapted from previous studies. Statistical Package for the Social Science version 26 was used for data entry and analysis. Independent variables with p-value < 0.25 from bivariable logistic regression were entered into the multivariable logistic regression method and significant associations were obtained at an adjusted odds ratio with a 95% confidence interval and p-value < 0.05.ResultsIn this study, the good documentation practice among nurses was 42% [95% confidence interval (CI), 37.2–46.8]. There was a statistically significant relationship between documentation practice and age [adjusted odds ratio (AOR): 2.590 (95% CI: 1.4–4.79)], educational status [AOR: 2.248 (95% CI: 1.13–4.48)], hospital level [AOR: 4.185 (95% CI: 2.63–6.72)], work experience (2–5 years and > 5 years) [AOR: 4.066 (95% CI: 1.55–10.64)] and [AOR: 5.395 (95% CI: 1.97–14.81)] respectively and in-service training [AOR: 0.582 (95% CI: 0.366–0.923)].Conclusion and recommendationsThis study demonstrated that the good practice of documentation among nurses was found to be low. Age, educational status, working in comprehensive specialized hospitals, work experience, and having in-service training had significant associations with documentation practice. It is very important to plan and intervene with different strategies, such as providing training for young nurses, nurses with low educational status, nurses working in primary hospitals, and nurses with less than two years of work experience on documentation standards, to create positive attitudes and enhance their knowledge.

Utility of empathy informant report in FTD differential diagnosis.

Loss of empathy is a hallmark feature of behavioral variant frontotemporal dementia (bvFTD). Change in socioemotional functioning identified by others is often the primary initial presenting concern in this disorder, in contrast to more subtle early cognitive changes and limited patient insight. The present study examined the predictive utility of an empathy informant-report measure for discriminating clinician-diagnosed bvFTD from other dementia syndromes. Data from the National Alzheimer's Coordinating Center (NACC) database were used to study individuals with bvFTD (n = 406) and other dementia syndromes (n = 385). Participants were administered neuropsychological measures and collateral informants completed an informant-report of empathy. Informants reported that patients with bvFTD demonstrated significantly lower levels of empathic concern [F(1, 789) = 120.91, p < .001, η2 = 0.13] and perspective taking [F(1, 789) = 153.08, p < .001, η2 = 0.16] than patients with other dementia syndromes. These differences were not attributable to the level of global cognitive impairment. Empathy scores were not significantly associated with any neurocognitive measure when controlling for age. ROC curve analyses showed fair to good clinical utility of the informant-report empathy measure for distinguishing bvFTD from non-bvFTD, whereas a traditional measure of executive functioning failed to differentiate the groups. These findings indicate that informant ratings of empathy offer a unique source of clinical information that may be useful in detecting neurobehavioral changes specific to bvFTD before a clear neurocognitive pattern emerges on testing.

A case of neglect

In 1875 William Andrew Johnson, who had been formerly enslaved by Andrew Johnson and who subsequently served as his valet after being emancipated, was present when the former president suffered his fatal stroke. William's description of his deficits, as told decades later to journalist Ernie Pyle, appears to represent one of the earliest known cases of asomatognosia. The limited description of the symptoms provides a backdrop for a discussion of the evolution of knowledge regarding disorders of body awareness. This case also highlights the importance of caregivers as sources of clinical information and serves as a cautionary tale regarding the risk of marginalizing them due to cultural bias.

UNDERSTANDING EPIDEMIOLOGY AND HEALTH BURDEN FROM COVID-19 PANDEMIC: A REVIEW OF GLOBAL CASE REPORTS IN THE EARLY PANDEMIC PERIOD

&#x0D; &#x0D; &#x0D; The coronavirus disease 2019 (COVID-19) pandemic has affected people globally. In many countries, the situation is getting worse with the rapid transmission of COVID-19. The daily incidence is drastically increasing. In this review, we aim to summarise epidemiological information and adverse health outcomes of severe acute respiratory syndrome coronavirus 2 infections. The major outcomes are described based on information from the literature and hospital reports. COVID-19 has affected individuals both physiologically and psychologically. The physiological effect on human health includes respiratory distress, pneumonia, cardiac injury, kidney failure, nervous system symptoms, and gastrointestinal symptoms. The psychological effect was observed in patients, health care workers, and the general population in the community. This review could be a source of clinical information on COVID-19 for physicians, researchers, and the general population for further studies to deal with this pandemic.&#x0D; &#x0D; &#x0D;

Nonsuicidal self-injury and family environment among college students in Kolkata, West Bengal: Mixed method explanatory sequential design

Background: Nonsuicidal self-injury (NSSI) refers to intentional, deliberate, and socially unexpected harming acts to oneself without any intention to die. It is a growing concern among recent mental health professionals. NSSI behaviors have an impact primarily on the individual, family, and ultimately on society. This problem is prevalent among the clinical population, but it has also become a threat to the general population, specifically adolescents and the young population. Aim: In this present study, we have explored the relationship between family environment and NSSI and investigated the predictable family factor for NSSI. Materials and Methods: Mixed method sequential research design was used for this research work. First, we did quantitative data collection; a total of 535 college students aged 18–26 years were selected and assessed using the Family Environment Scale and Functional Assessment of Self-Mutilation Scale. Second, thematic analysis was performed, followed by interviews with six participants. Results: There is a significant relationship between family conflict and NSSI χ2 = 33.47 (P < 0.001). Family conflict can be most reliable to predict NSSI, χ2 (16, n = 499) = 57.78, P < 0.001. In addition, the Thematic Analysis highlighted family interpersonal relationship, lack of expressiveness, and lack of sense of belongingness in the role of NSSI. Conclusion: Family conflict can be a crucial factor in detecting NSSI. This study can be a good source of information for clinicians and social scientists, but more studies should be conducted to control and prevent NSSI.

Conducting Dermatological Operations in Patients Who Have Previously Undergone Cardiac Surgery

Thoracic surgical procedures and the use of cardiac devices such as pacemakers are becoming increasingly common in the population. Therefore, dermatologists may be more likely to encounter previously implanted or discarded surgical material during a dermatological operation on the chest wall. A basic understanding of the types of wires and tunneling paths used in such procedures is essential to accurately predict the presence of these wires and effectively manage any chance encounters.&#x0D; Dermatologists should be aware that temporary epicardial pacemaker electrodes and pacemaker electrodes often remain in the chest wall of many patients. All patients with a history of cardiac surgery should be asked about the possible presence of temporary epicardial electrodes in their body, and if such materials are found during the operation, it is necessary to immediately stop the procedure and do not undertake further manipulations with them until the material from which it is made is determined.&#x0D; Specialists in cardiology and cardiothoracic surgery need to document any abandoned wire in the patient's list of problems and inform the patient about the abandoned wire so that he or she can be an important source of clinical information.&#x0D; Trying to pull out the remaining pacemaker electrodes is a serious risk, so dermatologist surgeons should not attempt it under any circumstances. When detecting wire material, it is necessary to determine the type and location of the material before any manipulation or pulling attempts. Once it is established that this is a non-functional, abandoned wire, it is necessary to apply the correct technique for removing it, which consists in gently pulling and securing the wire at the exit point. Accurate identification of the material is required in order not to interfere with the operation of the active device and not to abandon the operation unnecessarily.&#x0D; The aim of the work is to consider the implementation of dermatological operations in patients who have previously undergone cardiac surgery.

The Relationship Between Individual Coping and the Need to Have and Seek Health Information Among Older Adults: Exploratory Mixed Methods Study.

BackgroundThe need to have and seek information shapes the context of computing systems. When it comes to health, individual coping influences human behavior. Therefore, the relationship between individual coping and the need to have and seek health information plays a crucial role in the development of digital health systems.ObjectiveThis study aims to examine the relationship between individual coping and the need to have and seek health information among older adults.MethodsQuestionnaires and semistructured interviews investigated the health information need (HIN) and health information–seeking behavior (HISB) in relation to the individual coping strategies of 26 older Germans.ResultsThe mean age of the interviewed group was 71 years (SD 7). Quantitatively, a trend was found for a negative correlation between the avoidance-oriented coping and HIN (rs=−0.37895; bias-corrected and accelerated bootstrap 95% BCa CI −0.730 to 0.092; P=.05). The qualitative results supported this finding. For some participants, information and exchange was part of dealing with their health situation, whereas others wanted to learn as little as possible to avoid a decline in their health status. The older adults acquired, collected, and exchanged paper-based health data to augment clinical information sources and support information exchange with professionals.ConclusionsIndividual coping strategies are relevant for the design of digital health systems. They can support older adults in coping with their health situation, although it remains unclear how systems must be designed for people with an avoidance coping strategy to achieve the same acceptance.

An analysis of research quality underlying IDSA clinical practice guidelines: a cross-sectional study.

As a result of new developments in medicine, the need for evidence-based clinical practice guidelines (CPG) is of utmost importance. However, studies have shown that many medical societies are using low quality research to develop CPGs. To evaluate the quality of research underlying the CPGs issued by the Infectious Diseases Society of America (IDSA). We examined 29 CPGs issued between January 1, 2012 and December 31, 2019 and classified each by research quality according to levels reported by the CPG authors and previously specified by the IDSA: Levels I through III, corresponding to high, moderate, and low quality of evidence, respectively. Each ranking was cross-checked with a second researcher to improve inter-rater reliability. To analyze evolution of research quality over time, three updated CPGs were randomly selected and compared to their original versions. Chi-square analysis was then performed to determine statistical significance. We evaluated the quality of research for 2,920 recommendations within the 29 CPGs that met our criteria and found that 418 (14%) were developed using high-quality (Level I) research from randomized, controlled trials. Of the remaining recommendations, 928 (32%) were based on moderate quality research (observational studies) and 1574 (54%) on low quality research (expert opinion). A Pearson chi-squared analysis indicated no-statistically significant difference between original guidelines or their subsequent updates for Clostridium difficile (χ2=0.323; n=85; degrees of freedom [df]=2; p=0.851), candidiasis (χ2=4.133; n=195; df=2; p=0.127), or coccidiomycosis (χ2=0.531; n=95; df=1; p=0.466). The proportion of high-quality research underlying guideline recommendations is remarkably low, indicating that moderate and low quality evidence is still influencing infectious disease guidelines despite IDSA standards. Moreover, the quality of research has not significantly changed over time. IDSA CPGs are a formidable source of information for clinicians, but an increased number of quality studies should be utilized to further guide CPG development.

Quality of evidence-based guidelines for platelet transfusion and use: A systematic review.

Guidelines for platelet (PLT) transfusion are an important source of information for clinicians. Although guidelines intend to increase consistency and quality of care, variation in methodology and recommendations may exist that could impact the value of a guideline. We aimed to determine the quality of existing PLT transfusion guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument and to describe the inconsistencies in recommendations. A systematic search was undertaken for evidence-based guidelines from January 1, 2013, to January 25, 2019. Citations were reviewed in duplicate for inclusion and descriptive data extracted. Four physicians appraised the guideline using the AGREE II instrument and the scaled score for each item evaluated was calculated. The protocol was registered in PROSPERO. Of 6744 citations, 6740 records were screened. Seven of 28 full-text studies met the inclusion criteria. The median scaled score (and the interquartile range of the scaled score) for the following items were as follows: scope and purpose, 94% (8%); stakeholder involvement, 63% (18%); rigor of development, 83% (14%); clarity of presentation, 94% (6%); applicability, 58% (20%); and editorial independence, 77% (4%). Overall quality ranged from 4 to 7 (7 is the maximum score). Inconsistent recommendations were on prophylactic PLT transfusion in hypoproliferative thrombocytopenia in the presence of risk factors and dose recommendations. Inconsistencies between guidelines and variable quality highlight areas for future guideline writers to address. Areas of specific attention include issues of stakeholder involvement and applicability.

A narrative review of pregnancy after malignancies in young women that don't originate in the female genital organs or in the breast.

While cancer during pregnancy and its treatment has grown to be a popular topic in recent years, little is known on how to advise patients looking to conceive or conceiving after cancer treatment. The aim of this paper is to review the available literature on the impact of pregnancy on survivors of the most common childhood cancers, brain cancer, haematological malignancies, thyroid cancer, melanomas and sarcomas. Its main objective is to be a source of information for clinicians looking to counsel patients in these delicate moments exploiting all the available literature, albeit scarce. Given the available literature, we conclude that the presence of a multidisciplinary team is of great importance in supporting the patient and her loved ones when facing pregnancy with a previous cancer diagnosis.

Providing Information to Support COVID-19 Pandemic Response: Academic Medical Librarians’ Roles in Creating an Intelligence Report

In March 2020, the Dean of the George Washington (GW) University School of Medicine and Health Sciences (SMHS) and the GW COVID-19 Incident Management Team asked the Senior Associate Dean for Clinical Public Health to initiate a daily report that surveyed COVID-19 literature/resources. This COVID-19 Intelligence Report would serve as a concise, authoritative source of COVID-19 information for clinicians, the Incident Management Team, and operational leaders. The Senior Associate Dean established an Intelligence Gathering Team comprised of clinicians and librarians. Himmelfarb librarians facilitated the collection, distribution, and archiving of COVID-19 resources and Intelligence Reports.

Artificial Intelligence, Speech, and Language Processing Approaches to Monitoring Alzheimer's Disease: A Systematic Review.

Background:Language is a valuable source of clinical information in Alzheimer’s disease, as it declines concurrently with neurodegeneration. Consequently, speech and language data have been extensively studied in connection with its diagnosis.Objective:Firstly, to summarize the existing findings on the use of artificial intelligence, speech, and language processing to predict cognitive decline in the context of Alzheimer’s disease. Secondly, to detail current research procedures, highlight their limitations, and suggest strategies to address them.Methods:Systematic review of original research between 2000 and 2019, registered in PROSPERO (reference CRD42018116606). An interdisciplinary search covered six databases on engineering (ACM and IEEE), psychology (PsycINFO), medicine (PubMed and Embase), and Web of Science. Bibliographies of relevant papers were screened until December 2019.Results:From 3,654 search results, 51 articles were selected against the eligibility criteria. Four tables summarize their findings: study details (aim, population, interventions, comparisons, methods, and outcomes), data details (size, type, modalities, annotation, balance, availability, and language of study), methodology (pre-processing, feature generation, machine learning, evaluation, and results), and clinical applicability (research implications, clinical potential, risk of bias, and strengths/limitations).Conclusion:Promising results are reported across nearly all 51 studies, but very few have been implemented in clinical research or practice. The main limitations of the field are poor standardization, limited comparability of results, and a degree of disconnect between study aims and clinical applications. Active attempts to close these gaps will support translation of future research into clinical practice.

Why do general practitioners disregard direct to healthcare professional communication? A user-oriented evaluation to improve drug safety communication.

Post-approval drug risks are a significant public health problem. A central instrument to mitigate them in the European Union is direct to healthcare professional communications (DHPC), typically a letter sent from the manufacturer to prescribers. However, evaluations show that DHPCs have limited impact on prescribing behavior. Which factors influence prescribers' lack of adoption of DHPCs remains unknown. This article presents a think-aloud reading study of 17 Danish general practitioners' reading aloud a 2013 DHPC about new oral anticoagulants, interjecting their immediate reactions and associations to daily clinical routines concurrently. We found that interviewees inferred more from the DHPC than risk information. It was perceived to be commercially biased, which generally discouraged reading despite learning new safety information. DHPCs were also disregarded because they are isolated from routinely used clinical information sources. Furthermore, DHPCs were perceived as pre-emptive acts of legal defence aiming to relocate responsibility from the manufacturer onto prescribers. In conclusion, the study indicates that certain DHPCs may be disregarded because of the perceived motivations that prescribers attribute to the DHPC senders. While the specific letter itself was deemed unsatisfactory, its legitimacy among prescribers remains the central challenge. Further integration with trusted and established information structures is also needed.