Search Results (667)

Background: Vaccine hesitancy is a major threat to public health. As part of efforts to increase vaccine uptake, the focus is on optimizing the quality of communication among healthcare workers. Physician shortages and workloads create time constraints, making communication interventions in primary care challenging. This study aimed to propose strategies to improve communication between general practitioners and vaccine-hesitant individuals. This narrative review addresses the specific needs of general practitioners for effective communication and proposes strategies to combat vaccine hesitancy in culturally and linguistically diverse regions. Methods: Systematic searches of EMBASE and PubMed were performed using terms related to vaccine hesitancy, communication strategies, primary care, and cultural diversity. Additionally, the websites of major health organizations were searched for relevant reports and guidelines. Selection criteria were based on the relevance and quality of the selected studies. Results: The findings highlight the importance of empathy, transparency, and personalized information in communication strategies. The need for communication training and addressing policy and workload barriers for healthcare providers is significant. The proposed strategy includes regular communication skills and cultural competency workshops, language training, the development of multilingual resources, implementation of telemedicine services, and active community engagement. Conclusions: Policy recommendations advocate for increased primary care resources, support from general practitioner unions, and the integration of digital tools. These strategies are essential to improve vaccine uptake and public health outcomes by enhancing the capacity of general practitioners to effectively engage with vaccine-hesitant patients. Full article

Background: Inpatient palliative care consultation services operate with an interdisciplinary team, where effective handoffs are crucial for coordinated patient care. We aimed to replace encrypted email handoffs with a more concise and uniform handoff using I-PASS (illness severity, patient summary, action list, situational awareness, contingency planning, and synthesis by receiver) integrated within the electronic medical record (EMR). Aim and Measures: Within six months of launch, our goal was to achieve 90% I-PASS utilization for hospitalized acutely ill patients with cancer receiving palliative care consultation. Intervention: In January 2021, our quality improvement team, consisting of physicians, advanced practice providers, and trainees, began implementing I-PASS using the plan–do–study–act cycle. After providing training sessions for all palliative care clinicians, I-PASS went live on October 1, 2021. I-PASS utilization was tracked via random and monthly audits of EMRs. Through anonymous surveys, both pre- and post-implementation, we gathered clinician feedback and concerns about the handoff system. Survey responses were compared using the Mann–Whitney test. Outcomes: Within six months of implementation, the I-PASS utilization rate reached > 99%. The survey participation rates were 70% (45/64) and 82% (49/60) for the pre-and post-implementation periods, respectively. Respondents provided answers on one to five scale (mean, standard deviation, SD): lower accuracy with email (3.53, SD = 0.98) vs. I-PASS (4.20, SD = 0.83), p < 0.001; handoff lengthier with email (4.17, SD = 1.05) vs. I-PASS (2.1, SD = 1.15), p < 0.001; the time required was longer with email (3.0, SD = 1.22) vs. I-PASS (1.71, SD = 0.73), p < 0.001. Overall, respondents found I-PASS to be significantly better (4.69, SD = 0.58). Conclusion: I-PASS was fully adopted by the team, with nearly 100% utilization and strong clinician endorsement as an effective communication tool. Future efforts should focus on optimizing usability, particularly by educating clinicians on smartphone EMR access and enabling the timely and streamlined editing of I-PASS. Full article

In this multicenter, nonrandomised comparative study, we evaluated the potential effectiveness of a program to promote the safe use of dipeptidyl peptidase-4 (DPP-4) inhibitors led by community pharmacists. The program facilitated early detection of gastrointestinal adverse events (GIAEs) in patients newly prescribed DPP-4 inhibitors and facilitated timely communication with physicians. Community pharmacists reviewed patient conditions and provided relevant information to physicians as needed. GIAE monitoring based on the program was conducted in 35 patients at 10 pharmacies in Japan (intervention group) between March and August 2024. The proportion of pharmacist interventions was compared with that in 451 patients from March to August 2023, before program implementation (baseline cohort). The primary outcome, pharmacist intervention rate, was significantly higher in the intervention group (5 out of 35 patients, 14.3%) than in the baseline cohort (0 out of 451 patients, 0.0%) (p < 0.001). GIAEs were identified in 13 out of 35 patients (37.1%) in the intervention group; information for five patients (14.3%) was shared with physicians, resulting in discontinuation of the DPP-4 inhibitor in one patient and addition of supportive therapy in others. Most GIAEs occurred within the first 1–2 weeks of therapy, highlighting the need for early intervention. Thus, proactive involvement of community pharmacists may improve the care process in these cases and contribute to healthcare coordination and diabetes care quality. Full article

Background/Objectives: There is growing evidence to support ambient artificial intelligence (AI) scribes in healthcare to improve medical documentation by generating timely and comprehensive notes. Using the Plan–Do–Study–Act (PDSA) methodology, this study evaluated the utility and potential time savings of an ambient AI scribe, Scribeberry, (V2), in a palliative medicine outpatient setting, comparing it to the standard practice of dictation. Methods: This prospective quality improvement study was conducted at an academic medical center by two palliative medicine resident physicians. Residents documented patient visits using a freely available ambient AI scribe software program, Scribeberry, as well as using standard dictation software. Primary outcome measures included the editing time for the AI scribe and the dictating and editing times for a dictated manuscript, as well as subjective assessments of the accuracy, organization, and overall usefulness of the AI-generated clinical letters. Results: A heterogenous response was seen with the implementation of an AI scribe. One resident saw a statistically significant reduction (p < 0.025) in the time spent on clinical documentation, while a second resident saw essentially no improvement. The resident who experienced time savings with the ambient AI scribe also demonstrated a significant improvement in the graded organization and usefulness of the AI outputs over time, while the other resident did not demonstrate significant improvements in any of the metrics assessed over the course of this project. Conclusions: This pilot study describes the use of an ambient AI scribe software program, Scribeberry, in the community palliative medicine context. Our results showed a mixed response with respect to time savings and improvements in the organization, accuracy, and overall clinical usefulness of the AI-generated notes over time. Given the small sample size and short study duration, this study is insufficiently powered to draw conclusions with respect to AI scribe benefits in real-world contexts. Full article

Background: Hospitalized patients’ expectations about their treatment play a key role in therapeutic adherence, satisfaction with care, and clinical outcomes. However, there is a lack of brief, psychometrically validated instruments in Spanish-speaking contexts that adequately assess this construct. Objective: The objective of this study is to culturally adapt and validate the Hospitalized Patients’ Expectations for Treatment Scale-Patient Version (HOPE-P) in a Peruvian population. Methods: A methodological, cross-sectional study was conducted with 277 hospitalized patients aged 18 to 85 years (M = 45.87; SD = 17.09). The adaptation process included translation, back-translation, expert review, and pilot testing. Confirmatory factor analysis (CFA) was performed to assess the factor structure, and reliability and validity indices were calculated. Results: The bifactorial model showed good fit (CFI = 0.97, TLI = 0.94, RMSEA = 0.06). One item with a low factor loading was removed to improve the model. Convergent and discriminant validity were confirmed through acceptable values of Average Variance Extracted (0.60 and 0.55) and inter-factor correlation (φ² = 0.23). Internal consistency was strong for both dimensions (α = 0.76–0.77; ω = 0.76–0.77). Conclusions: The Spanish version of the HOPE-P is a valid, reliable, and culturally appropriate instrument for evaluating treatment expectations in hospitalized Peruvian patients. Its implementation in clinical settings could enhance physician–patient communication, support shared decision-making, and contribute to better therapeutic outcomes, especially in high-demand healthcare environments. Full article

The aim of this study is to provide a systematic account of structural discourse markers operating at a conversational macro-level in German Palliative Care interactions, focusing on their frequency, distribution, co-occurrence, and speaker-group-specific usage. By combining qualitative approaches from conversation analysis and interactional linguistics with quantitative methods from corpus linguistics, discourse markers are analyzed together as a functional category from multiple analytical perspectives to enhance the overall understanding of the use of discourse markers. The analysis reveals a functional distribution across different transition points in conversation: Whereas the German so most frequently appears in openings and transitions to non-verbal activities, gut and okay predominate in topic shifts and conversation closings. However, gut and okay differ in their composition of discursive functions, although discourse structuring emerges as the second most frequent function in both cases, an observation that stands in contrast to the continued neglect of this function in standard dictionary entries. The institutional asymmetries inherent in medical interactions are reflected in the finding that both doctors and caregivers use significantly more structural discourse markers than patients and their relatives. Differences between physicians’ and caregivers’ use of discourse markers can be attributed to their different professional roles and communicative responsibilities. Full article

Objective: This study aimed to improve the understanding of the lives of patients with chronic neuropathic pain planned for invasive motor cortex stimulation (iMCS) and assess their expectations towards this intervention and its impact. Methods: Semi-structured face-to-face interviews were conducted until saturation of data was reached. Patients were recruited from one university medical center in the Netherlands. All interviews were audio-recorded, transcribed verbatim, and subjected to thematic analysis using iterative and inductive coding by two researchers independently. Results: Fifteen patients were included (11 females; mean age 63 ± 9.4 yrs). Analysis of the coded interviews revealed seven themes: (1) the consequences of living with chronic neuropathic pain; (2) loss of autonomy and performing usual activities; (3) balancing energy and mood; (4) intimacy; (5) feeling understood and accepted; (6) meaning of life; and (7) the expectations of iMCS treatment. Conclusions: This is the first qualitative study that describes the suffering of patients with chronic neuropathic pain, and their expectations prior to invasive brain stimulation. Significant themes in the lives of patients with chronic pain have been brought to light. The findings strengthen communication between physicians, caregivers, and patients. Practice Implications: The insights gathered from the interviews create a structured framework for comprehending the values and expectations of patients living with central pain and reveal the impact of symptoms due to the central pain. This knowledge improves the communication between physicians and caregivers on one side and the patient on the other side. Furthermore, the framework enhances the capacity for shared decision-making, particularly in managing expectations related to iMCS. Full article

Osteoarthritis (OA) remains a major contributor to pain and disability; however, the current management is largely reactive, focusing on symptoms rather than preventing irreversible cartilage loss. This review first examines the mechanistic foundations for pharmacological chondroprotection—illustrating how conventional agents, such as glucosamine sulfate and chondroitin sulfate, can potentially restore extracellular matrix (ECM) components, may attenuate catabolic enzyme activity, and might enhance joint lubrication—and explores the delivery challenges posed by avascular cartilage and synovial diffusion barriers. Subsequently, a practical “What–How–When” framework is introduced to guide community pharmacists in risk screening, DMOAD selection, chronotherapeutic dosing, safety monitoring, and lifestyle integration, as exemplified by the CHONDROMOVING infographic brochure designed for diverse health literacy levels. Building on these strategies, the P4–4P Chondroprotection Framework is proposed, integrating predictive risk profiling (physicians), preventive pharmacokinetic and chronotherapy optimization (pharmacists), personalized biomechanical interventions (physiotherapists), and participatory self-management (patients) into a unified, feedback-driven OA care model. To translate this framework into routine practice, I recommend the development of DMOAD-specific clinical guidelines, incorporation of chondroprotective chronotherapy and interprofessional collaboration into health-professional curricula, and establishment of multidisciplinary OA management pathways—supported by appropriate reimbursement structures, to support preventive, team-based management, and prioritization of large-scale randomized trials and real-world evidence studies to validate the long-term structural, functional, and quality of life benefits of synchronized DMOAD and exercise-timed interventions. This comprehensive, precision-driven paradigm aims to shift OA care from reactive palliation to true disease modification, preserving cartilage integrity and improving the quality of life for millions worldwide. Full article

Background/Objectives: Effective teamwork is crucial for minimizing human error in healthcare settings. Medical teams, typically composed of physicians and nurses, supported by auxiliary professionals, achieve better outcomes when they possess strong collaborative competencies. High-quality teamwork is associated with fewer adverse events and complications and lower mortality rates. Based on this background, the objective of this study is to analyze the perception of non-technical skills and immediate learning outcomes in interprofessional simulation settings based on E-CRM items. Methods: A cross-sectional observational study was conducted involving participants from the official postgraduate Medicine and Nursing programs at the Catholic University of Murcia (UCAM) during the 2024–2025 academic year. Four interprofessional E-CRM simulation sessions were planned, involving randomly assigned groups with proportional representation of medical and nursing students. Teams worked consistently throughout the training and participated in clinical scenarios observed via video transmission by their peers. Post-scenario debriefings followed INACSL guidelines and employed the PEARLS method. Results: Findings indicate that 48.3% of participants had no difficulty identifying the team leader, while 51.7% reported minor difficulty. Role assignment posed moderate-to-high difficulty for 24.1% of respondents. Communication, situation awareness, and early help-seeking were generally managed with ease, though mobilizing resources remained a challenge for 27.5% of participants. Conclusions: This study supports the value of interprofessional education in developing essential competencies for handling urgent, emergency, and high-complexity clinical situations. Strengthening interdisciplinary collaboration contributes to safer, more effective patient care. Full article

Background: Despite their high prevalence and potential for significant morbidity, hemorrhoidal symptoms remain underreported and undertreated. Misconceptions and stigma may delay care-seeking behaviors and negatively influence patient outcomes. Methods: We conducted a cross-sectional, questionnaire-based study in Romania to assess public awareness, attitudes, and barriers related to hemorrhoidal disease. The survey included 185 participants and evaluated variables such as symptom severity, understanding of the condition, perceived stigma, and willingness to consult a physician. Results: Only 30.8% of participants had sought medical advice for hemorrhoidal symptoms. Younger age (p < 0.001), male sex (p = 0.013), and lower levels of perceived severity were significantly associated with reluctance to seek medical care. The most frequently reported barriers were embarrassment and fear of invasive diagnostic procedures. Colonoscopy and digital rectal examination were identified as major deterrents by 39.5% and 38.9% of respondents, respectively. Educational level influenced both the perceived understanding of the disease (p = 0.001) and comfort in discussing anal symptoms (p = 0.002). Gender preference for physicians was significantly associated with respondent sex (p = 0.007) but not with education or age. Conclusions: Hemorrhoidal disease remains a stigmatized and underestimated condition. Public health efforts should prioritize educational interventions, destigmatization campaigns, and improved physician–patient communication to facilitate earlier diagnosis and better disease management. Full article

Background and objectives: Life expectancies have increased globally, including in Romania, leading to an aging population and thus increasing the burden of chronic diseases. Over 80% of individuals over 65 have more than three chronic conditions, with many exceeding ten and often requiring multiple medications and supplements. This widespread polypharmacy raises concerns about drug interactions, side effects, and inappropriate prescribing. This review examines the impact of polypharmacy in older adult patients, focusing on the physiological changes affecting drug metabolism and the potential risks associated with excessive medication use. Special attention is given to proton pump inhibitors (PPIs), a commonly prescribed drug class with significant benefits but also risks when misused. The aging process alters drug absorption and metabolism, necessitating careful prescription evaluation. Methods: We conducted literature research on polypharmacy and PPIs usage in the older adult population and the risk associated with this practice, synthesizing 217 articles within this narrative review. Results: The overuse of medications, including PPIs, may lead to adverse effects and increased health risks. Clinical tools such as the Beers criteria, the STOPP/START Criteria, and the FORTA list offer structured guidance for optimizing pharmacological treatments while minimizing harm. Despite PPIs’ well-documented safety and efficacy, inappropriate long-term use has raised concerns in the medical community. Efforts are being made internationally to regulate their consumption and reduce the associated risks. Conclusions: Physicians across all specialties must assess the risk–benefit balance when prescribing medications to older adult patients. A personalized treatment approach, supported by evidence-based prescribing tools, is essential to ensure safe and effective pharmacotherapy. Addressing inappropriate PPI use is a priority to prevent potential health complications. Full article

Background/Objectives: Laboratory tests conducted in community settings are occasionally repeated within hours of presentation to pediatric emergency departments (PEDs). Reducing unnecessary repetitions can ease child discomfort and alleviate the healthcare burden without compromising the diagnostic process or quality of care. The aim of this study was to develop a decision tree (DT) model to guide physicians in minimizing unnecessary repeat blood tests in PEDs. The minimal decision tree (MDT) algorithm was selected for its interpretability and capacity to generate optimally pruned classification trees. Methods: Children aged 3 months to 18 years with community-based complete blood count (CBC), electrolyte (ELE), and C-reactive protein (CRP) measurements obtained between 2016 and 2023 were included. Repeat tests performed in the pediatric emergency department within 12 h were evaluated by comparing paired measurements, with tests considered justified when values transitioned from normal to abnormal ranges or changed by ≥20%. Additionally, sensitivity analyses were conducted for absolute change thresholds of 10% and 30% and for repeat intervals of 6, 18, and 24 h. Results: Among 7813 children visits in this study, 6044, 1941, and 2771 underwent repeated CBC, ELE, and CRP tests, respectively. The mean ages of patients undergoing CRP, ELE, and CBC testing were 6.33 ± 5.38, 7.91 ± 5.71, and 5.08 ± 5.28 years, respectively. The majority were of middle socio-economic class, with 66.61–71.24% living in urban areas. Pain was the predominant presented complaint (83.69–85.99%), and in most cases (83.69–85.99%), the examination was conducted by a pediatrician. The DT model was developed and evaluated on training and validation cohorts, and it demonstrated high accuracy in predicting the need for repeat CBC and ELE tests but not CRP. Performance of the DT model significantly exceeded that of the logistic regression model. Conclusions: The data-driven guide derived from the DT model provides clinicians with a practical, interpretable tool to minimize unnecessary repeat laboratory testing, thereby enhancing patient care and optimizing healthcare resource utilization. Full article

Background: The longitudinal RisCoin study investigated risk factors for COVID-19 vaccination failure among healthcare workers (HCWs) and patients with inflammatory bowel disease (IBD) at a University Hospital in Germany. Since the hospital served as the study sponsor and employer of the HCW, we implemented a custom mobile application. We aimed to evaluate the implementation, adherence, benefits, and limitations of this study’s app. Methods: The app allowed secure data collection through questionnaires, disseminated serological results, and managed bidirectional communication. Access was double-pseudonymized and irreversibly anonymized six months after enrollment. Download frequency, login events, and questionnaire submissions between October 2021 and December 2022 were analyzed. Multivariable logistic regression identified factors associated with app adherence. Results: Of the 3979 participants with app access, 3622 (91%) used the app; out of these, 1016 (28%) were “adherent users” (≥12 submitted questionnaires). App adherence significantly increased with age. Among HCW, adherent users were more likely to be non-smokers (p < 0.001), working as administrators or nursing staff vs. physicians (p < 0.001), vaccinated against influenza (p < 0.001), and had not travelled abroad in the past year (p < 0.001). IBD patients exposed to SARS-CoV-2 (p = 0.0133) and those with adverse events following the second COVID-19 vaccination (p = 0.0171) were more likely adherent app users. Despite technical issues causing dropout or non-adherence, the app served as a secure solution for cohort management and longitudinal data collection. Discussion: App-based cohort management enabled continuous data acquisition and individualized care while providing flexibility and anonymity for the study team and participants. App usability, technical issues, and cohort characteristics need to be thoroughly considered prior to implementation to optimize usage and adherence in clinical research. Full article

Background: The outbreak of the COVID-19 pandemic has highlighted the importance of online health consultations, as they can help reduce the risk of contagion and infection. However, due to limited trust, these services have not yet gained widespread adoption and usage among patients. Objective: This research aims to examine the impact of perceived quality on patients’ adoption and usage of online health consultations from three perspectives: emotional support, responsiveness, and service continuity. Additionally, this research further explores the moderating effects of online service prices on these relationships. Methods: Based on trust theory, this research constructs theoretical models and empirically tests them by using a panel dataset that comprises 1255 physicians and 65,314 physician–patient communication records. Results: The empirical results confirm that emotional support, responsiveness, and service continuity positively influence patients’ adoption and usage behaviors. Additionally, higher online service prices negatively moderate the impact of emotional support and responsiveness on adoption behavior. Moreover, increased online service prices weaken the positive relationship between emotional support and usage behavior while strengthening the positive relationship between service continuity and usage behavior. Conclusions: This research extends the existing literature on online health services and provides practical guidance for platform managers, physicians, and policymakers to improve overall service acceptance. Full article

Background/Objectives: Early diagnosis of stroke is crucial for effective treatment with tissue plasminogen activator (tPA) and endovascular thrombectomy. Emergency medical services (EMSs) screening and the early activation of emergency department (ED) stroke protocols reduce treatment times and improve patient outcomes. This study aims to validate ED stroke protocol activation by EMSs in a large stroke center. Methods: This retrospective cross-sectional study was conducted at Magen David Adom and Shamir Medical Center between 1 January 2019 and 31 December 2019. Data were categorized into patients suspected by EMSs of having a stroke and those not suspected by EMSs but diagnosed as having a stroke in the ED. The primary outcome was the accuracy of EMSs in activating ED stroke protocols. Results: In this study, there were 23,061 patients, of which 11,841 (51.9%) were females. The mean age was 61.4 (SD = 22.72) years old. EMSs suspected 743 (3.22%) patients were having a stroke. In 587 (79%), EMSs activated ED stroke protocols. There were 88 cases where strokes were diagnosed in the ED when EMSs did not suspect a stroke. The overall EMSs negative predictive value (NPV) was 100% while the positive predictive value (PPV) was 20%. Conclusions: While Israeli EMSs over-activate the ED stroke protocol, stroke patients are almost never missed, achieving the goal of prehospital stroke screening. To prevent resource waste, all involved teams should be notified, and the actual activation of the stroke protocol should be carried out by an ED physician upon patient arrival. Communication between all levels regarding stroke protocol should also be increased to decrease the time to treatment. Full article