Search Results (72)

Generative artificial intelligence (genAI) shows promising results in clinical practice. This study compared a GPT-4-turbo virtual assistant with physicians from Italy, France, Spain, and Portugal on medical knowledge derived from national exams while analysing knowledge retention over time and domain-specific performance. Via a digital platform, 17,144 physicians provided 221,574 answers to 600 exam questions between December 2022 and February 2024. Physicians were stratified by years since graduation and specialty, and the assistant answered the same questions in each native language. Differences in proportions of correct answers were tested with binomial logistic regression (odds ratios, 95% CI) or Fisher’s exact test (α = 0.05). The assistant outperformed physicians in all countries (72–96% vs. 46–62%; logistic regression, p < 0.001). Physicians also trailed the assistant across most knowledge domains (p < 0.001), except paediatrics (45% vs. 52%; Fisher, p = 0.60). Accuracy declined with seniority, falling 4–10% between the youngest and oldest cohorts (logistic regression, p < 0.001). Overall, genAI exceeds practising doctors on broad medical knowledge and may help counter knowledge attrition, though paediatrics remains a domain requiring targeted refinement. Full article

Background/Objectives: Education on antibiotic use has the potential to positively shape the practices and perspectives of future professionals. Assessing awareness levels of antibiotic resistance among university students is, therefore, critical, as they represent a vital demographic capable of influencing public health outcomes, especially in low- and middle-income countries. Methods: This cross-sectional study employed the World Health Organization’s Antibiotic Resistance: Multi-Country Public Awareness Survey, which examines demographics, antibiotic use, knowledge, perspectives, and sources of information. A total of 922 surveys were collected from students across various disciplines at two universities in Greater Guayaquil. Results: Most participants reported obtaining antibiotics through healthcare professionals, adhering to proper usage instructions, and purchasing them primarily from pharmacies. However, only 56% of the responses were correct, with many students incorrectly associating antibiotic use with conditions where they are typically ineffective. Despite these gaps, the students expressed positive attitudes toward proposed measures to address antibiotic resistance. While the participants demonstrated familiarity with terms related to antibiotic resistance and identified doctors and educators as their main sources of information, educational campaigns were not widely recognized as important. Conclusions: These findings evidence knowledge gaps among an essential group, suggesting the need for targeted health programs, preventive strategies, and educational initiatives to combat misinformation regarding antimicrobial resistance. Full article

Background/Objectives: The COVID-19 pandemic overwhelmed many health care facilities with patients, leading to an increased risk of potential transmission. Though the disease process was identical, the triaging system was unique at different sites, without a unified system for emergency department triaging globally. Proper implementation of pre-screening and triaging is of paramount importance in tertiary care settings to prevent nosocomial spread of infection. Methods: Each country has its own triage guidelines and Infection, Prevention, and Control policies developed by its health ministry and may face significant challenges in implementing them. Triage guidelines followed by two tertiary care hospitals in Detroit, United States of America and Manipal, India are compared during the early phases of the COVID-19 pandemic. Results: This paper offers a unique perspective of the challenges experienced with the hospital triage practices and provides solutions to address them. The future trajectory of COVID-19 epidemiology in both countries will be determined by the adherence to best practices in Infection Prevention and Control and triage protocols. The healthcare facility triage algorithm is constantly evolving in both settings as new evidence is being added to hospital epidemiology and infection prevention practices. Conclusions: Training healthcare workers on new triage protocols is required. It is critical for infectious disease doctors, clinical microbiologists, hospital epidemiologists, and Infection Prevention and Control (IPC) staff to collaborate with clinicians, nurses, and other ancillary staff in order to successfully implement the triage protocols. Developing and modifying guidelines for cleaning hospital triage areas and providing high throughput for patient care are also important lessons learned. Usage of face shields and the quality of Personal Protective Equipment (PPE) should be ensured for all healthcare workers (HCWs). Resilient staff and resilient hospital infrastructure are crucial for a sustainable response to future pandemics. Full article

Background/Objectives: Vaccination against influenza and pertussis in pregnant women protects the mother and child through the transfer of protective antibodies across the placenta. However, pregnant women’s vaccine hesitancy is a major barrier to achieve satisfactory vaccination coverage in many developed countries. Methods: Greek pregnant women’s vaccination knowledge, attitudes, and practices were recorded. Structured questionnaires were administered to mothers of infants under the age of 12 months through their pediatricians. Sampling across the country’s districts was applied to achieve geographic representativeness. Results: Questionnaires from 474 mothers were collected. Their mean age was 34 (±5) years. Vaccination uptake was 16.8% and 45.7%, for pertussis and influenza, respectively. During their recent pregnancy, 68.9% and 27.1% of the responders had been informed by their gynecologists regarding influenza and pertussis maternal immunization, respectively, indicating that gynecologists miss out on informing a significant rate of pregnant women. According to multiple logistic regression, women who gave birth during spring (OR: 2.29 vs. winter delivery, p = 0.042) and those with an MSc or PhD (OR: 2.93 vs. school graduates, p = 0.015) were more likely to receive influenza vaccination. Factors favoring influenza vaccination included doctor’s recommendation (OR: 18.86, p < 0.001), being not/somewhat afraid of potential vaccine side effects during pregnancy (OR: 2.09, p = 0.012), considering the flu as relatively/very dangerous during pregnancy (OR: 8.05, p < 0.001), and considering the flu vaccine as relatively/completely safe (OR: 4.37, p < 0.001). Doctor’s recommendation (OR: 29.55, p < 0.001) and considering pertussis a relatively/very serious risk to the mother’s health during pregnancy (OR: 6.00, p = 0.002) were factors associated with pertussis vaccination during pregnancy. Conclusions: The education of both expectant mothers and obstetricians is urgently needed in order to increase immunization coverage during pregnancy. The low influenza vaccination coverage among women delivering during winter and low pertussis immunization rates, in combination with low recommendation rates for both vaccines, strongly indicate that Greek obstetricians focus on maternal health alone. Their perspectives play an instrumental role in vaccine acceptance during pregnancy, shaping the immunization inclusion maps. Full article

Background: It is well established by research that large-scale and indiscriminate prescribing, dispensing, and use of antimicrobials drive antimicrobial resistance (AMR) endangering the health and well-being of people, animals, and the environment. In the context of low- and middle-income countries (LMICs), the prescribing of antimicrobials is often not based on biomedical rationality but involves alternative logic driven by social, cultural, and institutional factors. This paper seeks to develop a “biosocial” perspective, reflecting a unified perspective that treats the biomedical and social conditions as two sides of the same coin. Methods: This analysis is based on an empirical investigation of prescription slips that patients carry to buy drugs from the pharmacy following an outpatient department encounter with the clinician. Data collection involves mixed methods, including the quantitative analysis of the antimicrobials prescribed and a qualitative analysis of the underlying reasons for these prescriptions, as described by doctors, pharmacists, and patients. Data analysis involved triangulating quantitative and qualitative data, to develop a “biosocial” perspective, which can provide implications for the development of antimicrobial stewardship policies, particularly relevant for health institutions in low- and middle-income countries. Results: Our analysis of 1175 prescription slips showed that 98% contained antimicrobials, with 74% being broad-spectrum antimicrobials. Only 9% of cases were advised antimicrobial sensitivity testing (AST) before initiating treatment. Qualitative findings indicated that patients had poor awareness of antimicrobials and pharmacists played a crucial role in counseling. Conclusions: This study highlights that antimicrobial prescriptions in public health settings are influenced by both biomedical and social factors, supporting a biosocial perspective. Although AMS interventions are predominantly biomedical, adhering to clinical standards and best practices, this study underscores the necessity of integrating a biosocial viewpoint by incorporating the experiences of pharmacists and patient groups. Strengthening diagnostic support, patient education, and interprofessional collaboration could improve rational antimicrobial uses in low-resource settings. Full article

Primary healthcare has an important role in a patient’s long-term health. While patients in most countries are free to change their family physician, fragmented care leads to higher healthcare costs, more preventable hospitalizations, and an increased likelihood of deviation from clinical best practice. This review aims to identify the main reasons patients change family doctors, summarize the factors influencing these decisions, and highlight areas in healthcare that can be improved to increase patient satisfaction and design better services. An electronic search of the literature was conducted in March 2023 in PubMed and Embase databases for articles in English, French, Portuguese, or Spanish published from 1980 to March 2023. A thematic synthesis approach was applied to the included studies, involving systematic analysis of their findings to identify and categorize analytical themes. Nineteen relevant studies were identified. The following themes were identified as reasons to change family physicians: doctor–patient relationship; consultation schedule and convenience; referrals and positive references; medication and treatment issues; practice management and cost; personal preferences and physician characteristics; and accessibility and distance. The identified themes can serve as valuable targets for developing interventions aimed at enhancing the quality of care provided to patients. Full article

The anxiety of doctoral students in school has consistently been a major concern in society and the medical community, stemming from pressures, such as the pursuit of identity within highly professional and fiercely competitive academic communities, the urgent drive for high-level original scientific research output, and the need to break through the limits of personal ability to complete in-depth academic training. Current research has focused on the prevalence of, causes of, and intervention strategies for anxiety among doctoral students, but it still exhibits deficiencies, such as overly generalized analytical methods, neglect of the diversity within the doctoral student population, and the incomplete theoretical framework for the mechanisms of influence. Therefore, our study aims to examine the anxiety status of different categories of doctoral students and to explore their anxiety intervention mechanisms. Specifically, we employ a mixed research method combining quantitative and qualitative approaches to address issues, such as the influencing factors of anxiety in different types of doctoral students, the mechanisms of action of each factor, and the formation of an influence mechanism framework. The results indicate that anxiety is prevalent among doctoral students, with the key influencing factors being gender, age, love and marriage pressure, and self-perception. Full-time and part-time doctoral students exhibit different anxiety states and causes on account of varying pressures related to graduation, employment, and family factors. Our research distinguishes the heterogeneity of anxiety among different types of doctoral students in China, innovatively constructing a set of anxiety intervention mechanisms for doctoral students. It aims to provide policy insights for the adjustment of their anxiety and hopes to offer novel perspectives and exemplary references for the theoretical research and practical exploration of doctoral students’ anxiety in other countries around the world. Full article

Introduction: Self-medication with antibiotics (SMA)—the use of these drugs without a physician’s diagnosis, supervision, or a medical prescription—has emerged as a significant crisis in many societies, being a particular concern in low- and middle-income countries. SMA practices hinder global efforts to reduce antibiotic consumption in the human health sector and to control antimicrobial resistance (AMR). The aims of the study were to explore the motivations, perspectives, and personal experiences of the Malaysian population related to SMA, analyzing their subjective viewpoints, attitudes, and behaviors. Methods: The present qualitative study applied an interpretivism paradigm to explore the complex topic of SMA; the interview questions were developed and confirmed by experts in AMR and pharmacy practice. Qualitative data analysis was carried out through a thematic approach. Results: Out of twenty-seven (n = 27) eligible individuals, eleven (n = 11) agreed to participate in in-depth interviews. Three main themes and seven subthemes were identified. Participants revealed directly purchasing antibiotics from pharmacies, due to doctors prescribing similar medications for comparable illnesses in the past. Trust issues related to physicians prescribing unnecessary additional medications and suspected personal motives were revealed. Budgetary constraints, timesaving, and aspects of self-care were identified as some of the key drivers for SMA. Conclusions: The current study’s findings contribute to the understanding of the complexities surrounding SMA and provides insights into the public perceptions and behaviors regarding unregulated antibiotic use in Malaysia. Understanding these dynamics may inform targeted public health interventions to address SMA to mitigate the development of AMR. Full article

Introduction: District hospitals in KwaZulu-Natal Province, South Africa, do not have onsite specialist dermatology services. Doctors at these hospitals use WhatsApp instant messaging to informally seek advice from dermatologists and colleagues before possible referral. They have expressed the need to formalise WhatsApp teledermatology. Aim: To determine the views and perspectives of clinicians on the feasibility and practicality of formalising the current WhatsApp-based teledermatology activities within the KwaZulu-Natal Department of Health Dermatology Service. Methods: Key informant interviews with 12 purposively selected doctors at district hospitals and all 14 dermatologists in the KwaZulu-Natal dermatology service. Their views and perspectives on formalising the current informal use of WhatsApp for teledermatology were recorded, transcribed, and thematically analysed. Results: Five primary themes (communication, usability, utility, process, and poor understanding of legal, regulatory, and ethical issues) and 22 sub-themes were identified. Clinicians wanted WhatsApp teledermatology to continue, be formalised, and be incorporated within the KwaZulu-Natal Department of Health, facilitated by the provision of practical guidelines addressing legal, regulatory, and ethical issues. Conclusions: These findings will be used to develop a policy brief, providing recommendations and proposed guidelines for formalising the teledermatology service. The findings and methods will be relevant to similar circumstances in other countries. Full article

Background: This viewpoint paper reports the state of the art at a global level on research, practice and assessment, policies, and training in the clinical psychology of aging and, more specifically, in geropsychology. The main sources of information were as follows: (1) the most recent reviews of the literature available in the scientific literature; (2) the resources on the internet referable to professional and academic associations dealing with the topic; and (3) the laws, policy initiatives, and funded programs that are aimed at the diffusion and applications of mental health in aging. Methods: The present study aims to provide an updated and comprehensive memorandum highlighting the importance of prioritizing mental health in older adults. It seeks to promote health in general and disease prevention strategies, ensuring equitable access to mental health services integrated into primary care and designed for aging. This paper also aims to shed light on the slow development process and lack of consolidation in the adaptation of academic training at master’s and doctoral levels in most developed countries, despite the long-declared importance of enhancing resources for the promotion of geropsychology. Results: The results of the present study are patchy. Although the importance of enhancing resources for the promotion of geropsychology has long been declared, the development process seems very slow, and the adaptation of academic training at master’s and doctoral levels in most developed countries—those that, for demographic reasons and attitudes, should be more sensitive to the issue, does not yet seem to have consolidated. Conclusions: Collaboration among diverse professionals is crucial for providing integrated and comprehensive care to older adults that addresses their physical, psychological, and social needs. Full article

In the last two decades, sustainable urban environments have been predominant, meaning that knowledge production has accompanied this growth. The objective of this study is to present multiple projects for sustainable urban management applied in cities, based on the original Strategic Digital City (SDC) concept, model, and project. The research methodology included an SDC systematic literature review, highlighting the sustainability and respective action research of 11 doctoral theses and multiple projects. The obtained results highlight a set of published multiple projects that form a practical analytical cycle of sustainable and interconnected urban processes through the original SDC framework proposition, SDC, which can be applied in different cities in different countries. The innovations present in the SDC multiple projects propose a theoretical–empirical debate in the interdisciplinary areas of urban management, municipal administration, and sustainable public innovation, with a focus on local government and democracy studies, prioritizing sustainable strategies in cities and not just technologies. The conclusion reiterates that the original multiple projects, created and applied in different cities, present an interdisciplinary advance in sustainable urban management areas and public administration, focused on sustainable urban studies. Full article

Glucocorticoid-induced osteoporosis (GIOP) is a side effect of glucocorticoid (GC) treatment; however, despite established prevention guidelines in various countries, a gap persists between these guidelines and clinical practice. To address this gap, we implemented a collaborative intervention between hospitals and community pharmacists, aiming to assess its effectiveness. Pharmacists recommended to the prescribing doctor osteoporosis treatment for patients who did not undergo osteoporosis treatment with a fracture risk score of ≥3 via tracing reports (TRs), between 15 December 2021, and 21 January 2022. Data were extracted from electronic medical records, including prescriptions, concomitant medications, reasons for not pursuing osteoporosis treatment, and TR contents. Of 391 evaluated patients, 45 were eligible for TRs, with 34 (75.6%) being males. Prednisolone was the most common GCs administered, and urology was the predominant treatment department. Among the 45 patients who received TRs, prescription suggestions were accepted for 19 (42.2%). After undertaking the intervention, guideline adherence significantly increased from 87% to 92.5%. This improvement indicates that TRs effectively bridged the evidence–practice gap in GIOP prevention among GC patients, suggesting their potential utility. Expansion of this initiative is warranted to further prevent GIOP. Full article

Background/Objectives: The treatment of patients with mild-to-moderate ulcerative colitis (UC) is challenging. Although there are commonly used guidelines, therapy optimization is not standardized. We conducted a survey to investigate the management and treatment of patients with mild-to-moderate UC. Methods: Physicians with experience in treating inflammatory bowel diseases (IBD) were invited to participate in an anonymous, multiple-choice survey between June and July 2023. The survey addressed various issues of patient care such as patient monitoring, treatment optimization, follow-up, treatment decision making, and therapy de-escalation. Results: The survey included 222 physicians (59.9% men; mean age = 50.4 years) from 66 countries worldwide. Gastroenterologists were the most represented specialists (89.6%), followed by surgeons (3.2%), and internal medicine doctors (2.7%). Two-thirds of the participants (66.7%) had >10 years of experience in the field of IBD. The combination of oral (≥4 g/day) and rectal 5-aminosalicylic acid (5-ASA) was the preferred choice when optimizing therapy. Budesonide MMX (41.8%) and systemic steroids (39.9%) were preferred in patients who failed 5-ASA. Treatment decisions were predominantly based on endoscopic (99.0%) or clinical (59.8%) activity. A significant percentage of clinicians did not optimize therapy in the case of increased fecal calprotectin alone (45.1%) or radiological/ultrasound activity (39.8%) alone. Conclusions: The guidelines for the management of mild-to-moderate UC are well accepted in clinical practice. Endoscopic remission remains the main therapeutic target, followed by clinical remission. Fecal calprotectin and intestinal ultrasound still elicit complaints from physicians. Full article

Introduction: Patient awareness of postoperative lymphedema in the field of gynecologic oncology has been poorly documented in the international literature. We wished to capture and document the awareness among gynecological cancer survivors about postoperative lymphedema, including aspects such as the adequacy of perioperative counseling, management, and quality of life. Methods: A web-based survey comprising 25 multiple-choice questions was distributed to gynecological cancer advocacy groups within the European Network of Gynecological Cancer Advocacy Groups (ENGAGe) group. The survey was validated in a pilot group of gynecological patients prior to distribution. Results: Overall, 386 women from 20 countries completed the questionnaire. Only half of the patients (n = 211) knew what lymphedema is, whereas 52% of the respondents stated that they were never informed at their pre-operative assessment about the potential risk of developing lymphedema. Fifty-three percent of those women who were informed about the risk and management of lymphedema received information through self-initiative, connecting mainly with patient groups or online. Approximately 84% of patients with lymphedema reported that they informed their doctor about their symptoms. Ninety-four patients (55.3%, which is not 55% of the 386) were treated for lymphedema. Forty-five women out of 136 reported that lymphedema significantly affected their everyday lives. Discussion: We report a large lack of awareness and a significant gap of knowledge about the risks and treatment options related to postoperative lymphedema among gynecological cancer survivors. Institutional practice routines and awareness among professionals need to be urgently recalled and adapted to adequately inform and support gynecological cancer patients. Full article

Since ancient times, the shells of marine molluscs have been used as a therapeutic and/or prophylactic resource. In Spain, they were part of practical guides for doctors or pharmacists until the 19th century. In general, seashells were prepared by dissolving in vinegar and were part of plasters or powders used as toothpaste, or to treat dyspepsia, heartburn and leprosy. Thus, the nacre or mother-of-pearl of various molluscs was regularly used in the Royal Colleges of Surgery and in hospitals during the times of the Cortes of Cadiz, as a medicine in galenic preparations based on powders. In contemporary Spanish ethnomedicine, seashells, with a high symbolic value, have been used as an amulet to prevent cracks in the breasts and promote their development during lactation, to avoid teething pain in young children, to eliminate stains on the face or to cure erysipelas. But, as in other countries, products derived from seashells have also been empirically applied. The two resources used traditionally have been the cuttlebone, the internal shell of cuttlefish and the nacre obtained from the external shells of some species. Cuttlebone, dried and pulverised, has been applied externally to cure corneal leukoma and in dental hygiene. In the case of nacre, a distinction must be made between chemical and physical remedies. Certain seashells, macerated in lemon juice, were used in coastal areas to remove spots on the face during postpartum. However, the most common practice in Spain mainland was to dissolve mother-of-pearl buttons in lemon juice (or vinegar). The substance thus obtained has been used to treat different dermatological conditions of the face (chloasma, acne), as well as to eliminate freckles. For the extraction of foreign bodies in the eyes, a very widespread traditional remedy has been to introduce small mother-of-pearl buttons under the lid. These popular remedies and practices are compared with those collected in classic works of medicine throughout history, and data on the pharmacological activity and pharmaceutical applications of the products used are provided. The use of cuttlebone powders is supported by different works on anti-inflammatory, immune-modulatory and/or wound healing properties. Nacre powder has been used in traditional medicines to treat palpitations, convulsions or epilepsy. As sedation and a tranquilisation agent, nacre is an interesting source for further drug development. Likewise, nacre is a biomaterial for orthopaedic and other tissue bioengineering applications. This article is a historical, cultural and anthropological view that can open new epistemological paths in marine-derived product research. Full article