Search Results (1,251)

Background/Objectives: Hypercapnic respiratory failure (HRF) is a serious complication of chronic obstructive pulmonary disease (COPD) and is associated with increased morbidity, mortality, and healthcare utilisation. National HRF trends among patients with COPD remain poorly characterised in Lithuania, and the knowledge of prehospital emergency-care professionals regarding oxygen therapy and hypercapnia has not been evaluated. Methods: This study comprised two components. First, a cross-sectional online survey assessed knowledge of COPD, hypercapnia, and oxygen therapy among prehospital emergency-care professionals (EMS physicians, emergency nurses, EMS paramedics, and paramedics); three questionnaire items whose designated correct answers could not be unambiguously supported were excluded from the knowledge score, and the original 10-item score was retained as a sensitivity analysis. Second, nationwide electronic health record data from the Lithuanian national health record system (ESPBI IS, 2020–2023) were analysed retrospectively: patients with COPD and concomitant chronic HRF were identified using ICD-10-AM diagnostic codes, and the number of patients with a recorded J96.11 diagnosis irrespective of underlying disease was obtained as a national denominator. Proportions are reported with 95% confidence intervals and temporal trends as absolute changes in percentage points; multivariable logistic regression was used to estimate odds ratios adjusted for age group and sex. Between-year differences were tested using the χ² test with Holm-adjusted pairwise comparisons, and the association between sex and chronic HRF was expressed as an odds ratio. All tests were two-sided, and p < 0.05 was considered significant. Results: Among the 65 prehospital emergency-care professionals surveyed, knowledge of hypercapnia was relatively high: 78.5% (95% CI 67.0–86.7) correctly defined it and 72.3% (95% CI 60.4–81.7) identified its symptoms, whereas 58.5% (95% CI 46.3–69.6) identified the recommended SpO₂ target range of 88–92%. Respondents answered a median of 5 of the 7 scored knowledge items correctly (IQR 4–6). Total knowledge scores differed by professional role (p = 0.034) but not by years of experience, sex, or frequency of COPD contact; the sensitivity analysis using the original 10-item score gave the same pattern (p = 0.006). In the national electronic health record data, the COPD population increased from 27,239 to 32,446 (+19.1%) between 2020 and 2023, while the number of COPD patients with a recorded chronic HRF diagnosis rose from 160 to 291 (+81.9%). The proportion rose from 0.59% (95% CI 0.50–0.69) to 0.90% (95% CI 0.80–1.01), an absolute increase of 0.31 percentage points (95% CI 0.17–0.45; risk ratio 1.53, 95% CI 1.26–1.85). Men had higher odds than women after adjustment for age (adjusted OR 1.55, 95% CI 1.28–1.88), and adjusted odds were lowest in patients aged 80 years or older. Across the four annual cross-sections, COPD accounted for 41.5% of patient-year observations with a recorded J96.11 diagnosis nationally. Conclusions: Knowledge of COPD, hypercapnia, and oxygen therapy varied among the prehospital emergency-care professionals surveyed, with one of the lowest proportions of correct responses observed for the recommended target oxygen saturation range. National electronic health record data showed an increase in the proportion of patients with COPD who had a recorded diagnosis of chronic HRF between 2020 and 2023. These components were analysed independently, and no relationship between professional knowledge and temporal trends in recorded diagnoses was assessed. The electronic health record findings support continued monitoring and recognition of chronic HRF in COPD, whereas the survey findings support further evaluation of targeted education on oxygen therapy in the prehospital setting. Full article

Background: Borderline ovarian tumors (BOTs) represent a distinct group of rare epithelial ovarian neoplasms with excellent prognosis, but persistent uncertainty in patient understanding and clinical management. This study evaluated disease awareness, perceptions, and treatment patterns among affected women in Germany. Methods: The national multicenter Expression VIII survey was conducted across 34 centers by the North-Eastern German Society of Gynecologic Oncology (NOGGO). Using a standardized 46-item questionnaire, 286 patients with BOTs provided data on symptoms, treatment, fertility, follow-up, and illness perception. Descriptive analyses were performed. Results: Most participants (mean age 51 years) underwent surgery (94%), while systemic therapy was infrequent (chemotherapy 9%, bevacizumab 4%). Fertility-sparing surgery was performed in 14% overall, corresponding to 71% of those desiring future childbearing. Although 81% identified their physician as their main information source and rated information quality highly (mean 8.6/10), 29% believed they had ovarian cancer and 64% were unaware of their tumor stage. Nearly all patients (97%) received regular follow-up, though 18% were uncertain about the procedures performed. Disease severity was rated moderately high (mean 5.4/10), and recurrence risk and mortality were often overestimated. Conclusions: Despite good overall physician communication, substantial misconceptions persist among patients with BOTs, including the mistaken belief that they have been diagnosed with cancer, suggesting a need for clearer, structured education about its favorable prognosis and management of the disease. Improved guideline adherence and treatment centralization in specialized centers may reduce overtreatment and optimize fertility-preserving approaches. Full article

Background/Objectives: Age-related macular degeneration (AMD) is a leading cause of irreversible visual impairment, and AREDS2-based nutritional supplementation is recommended for clinically eligible patients to reduce the risk of disease progression. However, successful implementation depends on regular supplement use and sustained adherence. This study investigated demographic, socioeconomic, clinical, and physician-related factors associated with regular AREDS2 supplement use and evaluated medication adherence, physician counseling, and patient-reported barriers among clinically eligible patients with AMD. Methods: In this single-center cross-sectional study, 389 patients with intermediate AMD or advanced AMD in one eye who fulfilled the indications for AREDS2 supplementation were enrolled. Participants reporting occasional supplement use were excluded. A structured interviewer-administered questionnaire was used to collect demographic, socioeconomic, and clinical data, together with information on physician recommendation, medication adherence, patient knowledge, and perceived barriers to supplementation. Factors associated with regular AREDS2 supplement use were evaluated using univariable and multivariable logistic regression analyses, whereas adherence patterns and patient-reported barriers were analyzed descriptively. Results: Of the 389 participants, 273 (70.2%) reported regular AREDS2 supplement use, whereas 116 (29.8%) were non-users. Multivariable analysis showed that younger age, educational attainment, and physician recommendation were independently associated with regular supplement use (adjusted OR for physician recommendation, 5.38; 95% CI, 2.68–10.81; p < 0.001). Among regular users, 53.5% met the study-defined criteria for good medication adherence. The most frequently reported barriers among non-users were financial burden, limited supplement availability, polypharmacy, and insufficient knowledge regarding AREDS2 supplementation. Conclusions: Regular AREDS2 supplement use among clinically eligible patients with AMD was associated with demographic, educational, and physician-related factors, whereas long-term adherence remained suboptimal despite substantial uptake. These findings emphasize the importance of effective physician counseling, structured patient education, and interventions addressing socioeconomic barriers to improve the real-world implementation of evidence-based nutritional supplementation in AMD. Full article

Background: Cancer pain remains highly prevalent and undertreated despite established guidelines. In Italy, Law 38/2010 mandates systematic pain assessment, yet only 26% of clinicians routinely evaluate pain at each clinical visit, and fewer than one-quarter have received formal training in pain medicine or palliative care. A national multidisciplinary roundtable, convened in Rome in March 2025, formally identified four systemic gaps—insufficient education, fragmented care pathways, unclear professional roles, and challenges in implementing shared diagnostic and therapeutic pathways—and planned the development of a structured Delphi consensus. Methods: A Delphi consensus process was undertaken in accordance with CREDES guidelines. The Steering Committee, comprising representatives of six Italian scientific societies (AIRO, AIOM, AISD, Federdolore-SICD, SICP, ACD-SIAARTI) and a patient advocacy group (Fondazione Nora e Alberto Gentili), developed 15 clinical statements addressing pain assessment, management, referral criteria, monitoring, and documentation over five online meetings held between March and September 2025. Sixty-six Italian clinicians from various specialties were invited to participate; the survey was open from 1 October to 31 December 2025, with reminders every 10 days. Consensus was defined as ≥75% agreement (scoring 4 or 5 on a 5-point Likert scale). Results: Fifty-six clinicians completed the survey (response rate: 84.8%), representing medical oncology, radiation oncology, pain therapy, and palliative care specialties; individual statements were rated by 53–54 panelists, as skipping single items was permitted. All statements reached consensus in the first round (77.8–100%), precluding the need for a second voting round. Panelists’ qualitative comments informed minor wording refinements; substantial content was unchanged. Conclusions: The Delphi process produced a validated, multidisciplinary clinical pathway for cancer pain management in the Italian National Health System (NHS). The pathway establishes structured roles for the clinical reference physician and specialist consultants, objective decision thresholds for analgesic titration and referral, and minimum requirements for standardized pain documentation. These consensus-based statements provide actionable clinical guidance that may help address analgesic undertreatment and support the implementation of Law 38/2010 across Italian oncology centers. Full article

Background/Objectives: Mentoring may support professional development in medicine, but experiences and perceived programme availability may differ across career stages. We aimed to describe previous mentoring participation, perceived availability, satisfaction, preferred topics and formats, and responses to a generic digital facilitation item among medical students and physicians responding to an open survey in Switzerland. Methods: An open cross-sectional Research Electronic Data Capture (REDCap) survey was conducted from November 2024 to March 2025. Of 672 submitted records, 548 (81.5%) were complete and used for principal analyses. Analyses were descriptive and exploratory using valid item-level denominators. Results: Respondents were predominantly German-speaking (473/546, 86.6%), and 263/375 physicians (70.1%) worked in Bern. Previous mentoring participation was reported by 177/545 respondents (32.5%); 91/163 (55.8%) rated prior mentoring positively. Programme availability was perceived as insufficient by 475/530 (89.6%), while 515/545 (94.5%) anticipated professional benefit. Career advice was the most frequently selected topic. Previous participation increased from 21.3% among medical students to 44.6% among senior physicians, whereas perceived insufficiency remained high across career stages (85.5–97.4%). Conclusions: Within this self-selected, predominantly German-speaking and Bern-based respondent sample, previous participation in medical mentoring programmes was relatively uncommon, while perceived insufficiency of programme availability was consistently high across professional stages. Career advice emerged as a shared priority across career groups. These findings describe respondent-level perceptions and should not be interpreted as estimates of mentoring availability or unmet need across Switzerland. Full article

Background: Statins are among the most frequently prescribed medications worldwide, with proven benefits in reducing all-cause and cardiovascular mortality, preventing major adverse cardiovascular events (MACEs), and lowering healthcare costs. Despite their well-established safety and effectiveness, discontinuation of statin therapy remains a common problem in both primary and secondary prevention. Methods: A systematic literature review was conducted in accordance with PRISMA guidelines and registered in the PROSPERO database (CRD420261295172). Original studies published since 1 January 2014 were identified through searches of PubMed (MEDLINE) and Google Scholar using predefined keywords. Methodological quality and risk of bias of the included observational studies were evaluated using the Newcastle-–Ottawa Scale (NOS) and Joanna Briggs Institute (JBI) Critical Appraisal Tools. Results: Synthesized data from 29 included studies indicate that up to half of patients discontinue statin therapy within the first year (discontinuation rates ranging from 27.1% to 47.0% in primary prevention and 18.5% to 32.4% in secondary prevention), with rates increasing over time. Major factors contributing to non-adherence include fear of side effects, particularly statin-associated muscle symptoms (SAMSs), misinformation, limited patient–physician communication, socioeconomic barriers, and polypharmacy. Discontinuation is associated with significantly higher all-cause and cardiovascular mortality (Hazard Ratios ranging from 1.30 to 4.65), higher rates of cardiovascular and cerebrovascular events, worsening metabolic outcomes, reduced quality of life, and greater healthcare expenditures. Conclusions: Improving adherence requires better patient education, addressing misconceptions, strengthening patient–physician relationships, and optimising treatment regimens. A multidisciplinary approach is needed to prevent unjustified discontinuation and improve long-term clinical outcomes. Full article

Background and Objectives: Rising malpractice litigation and the strengthening of patient-rights legislation have changed the way hospital staff approach informed consent and legal risk. This study aimed to (i) assess the distribution of informed-consent knowledge, malpractice anxiety, and defensive practice across professional and departmental groups; (ii) identify independent predictors of high defensive practice; and (iii) evaluate experience-related moderation of the legal-literacy–anxiety association and predictor consistency across defensive-practice severity. Methods: We conducted a cross-sectional survey of 146 healthcare workers (physicians, nurses, midwives, and allied health professionals) from four departments of a tertiary academic hospital network, using a 46-item pilot-tested instrument measuring informed-consent knowledge (0–20), malpractice anxiety (0–100), and defensive-practice behaviors. Results: Physicians showed higher informed-consent knowledge than nurses (14.1 vs. 12.0 points, p < 0.001) but also higher malpractice anxiety (63.4 vs. 57.6, p = 0.015). High defensive practice was associated with a prior malpractice claim (adjusted odds ratio 3.24), surgical specialty (2.47), low consent literacy (2.21), physician role (2.10), and knowing a sued colleague (1.88). Anxiety was highest in emergency medicine; predictors also operated across ordered defensive-practice severity, and the legal-literacy–anxiety association was stronger at lower experience (interaction p = 0.023). Conclusions: Knowledge, anxiety, and defensive practice were unevenly distributed; defensive practice reflected professional context and direct or vicarious litigation exposure, while the legal-literacy–anxiety association varied with experience. Medico-legal education may therefore be best paired with structured consent procedures and experience-sensitive support; larger multi-center studies are needed. Full article

Background: The number of vaccines recommended for adults and older people has increased in recent years, and same-visit coadministration represents a potential strategy to improve vaccination coverage and timeliness. However, its implementation in primary care may depend on general practitioners’ (GPs) attitudes, vaccination experience, and organisational factors. This study investigated knowledge, attitudes, and practices (KAP) regarding vaccine coadministration among GPs in Apulia, Southern Italy. Methods: We conducted an anonymous cross-sectional online survey between January and June 2026 among practicing GPs and general practice trainees working in outpatient primary care settings in Apulia. The questionnaire assessed vaccination activity, intended coadministration practices, perceived effects on vaccine effectiveness and coverage, safety in very old adults or patients with multimorbidity, and perceived barriers to vaccination. Descriptive and bivariate analyses were performed, followed by multivariable logistic regression to identify factors independently associated with a positive perception of coadministration safety in very old or multimorbid patients. An additional sensitivity analysis excluded respondents reporting insufficient information to assess safety. Results: A total of 256 physicians completed the survey; 71.1% were aged ≥50 years. Most respondents had administered adult vaccines during the previous year, and 68.0% were classified as high vaccinators, having administered three or more different vaccine types. Although 68.0% believed that coadministration could increase vaccination coverage, only 13.3% reported willingness to administer three or more vaccines during a single visit. Overall, 50.0% considered coadministration very or fairly safe in very old or multimorbid patients, 24.2% considered it slightly or not at all safe, and 25.8% reported insufficient information to assess its safety. In the fully adjusted model, high vaccination activity was associated with higher odds of a positive safety perception (adjusted odds ratio [aOR] 1.93, 95% confidence interval [CI] 1.01–3.70), whereas difficulties using vaccination IT platforms were associated with lower odds (aOR 0.48, 95% CI 0.26–0.86). Age ≥ 50 years was not independently associated with the outcome after adjustment (aOR 0.66, 95% CI 0.35–1.26). Conclusions: GPs in Apulia showed generally favorable attitudes toward vaccine coadministration, although substantial uncertainty remained regarding its use in very old and multimorbid patients. Confidence in coadministration was primarily associated with greater vaccination activity and fewer difficulties with vaccination IT platforms, whereas age-related differences observed in bivariate analyses were attenuated after multivariable adjustment. Educational, organisational, and digital-support interventions may facilitate broader implementation of same-visit adult vaccination in primary care. Full article

Rapid innovation-driven transitions have, across successive eras, been associated with increased psychological distress, substance use, and suicide when social and economic change outpaces the adaptive capacity of individuals, communities, institutions, and governments. The early artificial intelligence (AI) economy is emerging at an unprecedented pace, reshaping education, employment, and social organization in ways that may intensify these risks, particularly among young people. This perspective argues that school-based mental health nursing, working collaboratively with school psychologists, counsellors, physicians, and other interdisciplinary professionals, represents a practical upstream response to AI-era disruption. Drawing on historical evidence from the Industrial Revolution, population mental health research, and the contemporary mental health nursing literature, the paper examines the mechanisms through which rapid socio-economic change may contribute to psychological distress and substance-use problems. It further distinguishes AI as both a source of socio-economic disruption and a clinical tool that can support—but not replace—relationship-based nursing practice. Strengthening school-based mental health nursing within interdisciplinary systems offers a practical, prevention-oriented strategy to promote resilience, facilitate early intervention, and mitigate downstream mental health and substance-use harms during the AI transition. Full article

Background: Delirium management remains inconsistently implemented in intensive care units (ICUs), and existing studies provide limited insight into how assessment capability, organisational opportunity, and emotional motivation interact in Chinese tertiary care settings. Aim: To explore ICU nurses’ perceived barriers and facilitators to delirium assessment and management using the Capability, Opportunity and Motivation model of Behaviour (COM-B). Methods: A qualitative descriptive exploratory study was conducted with 14 registered ICU nurses from two tertiary hospitals in Chongqing, China, between December 2025 and February 2026. Purposive sampling captured variation in clinical experience, educational background, and ICU type. The first author conducted face-to-face interviews in Mandarin Chinese and completed the initial coding. COM-B informed both the interview guide and the deductive organisation of the analysis, while six themes and 33 lowest-level factors were developed within the three domains. During revision, the fixed analytic structure was audited against all 14 Mandarin transcripts, and the second author independently applied the fixed codebook to five complete transcripts selected for maximum variation; disagreements were resolved by returning to the original Mandarin context and predefined coding boundaries. Results: Eighteen barriers and fifteen facilitators were identified across six themes within the COM-B domains. Capability was strengthened by clinical experience, senior nurses’ intuitive pattern recognition, and conversational assessment, but constrained by difficulty recognising hypoactive delirium, uncertainty when assessing older adults, inconsistent use of CAM-ICU, and insufficient targeted training. Opportunity was enhanced by staffing, environmental control, peer support, family engagement, and physician collaboration, but restricted by fragmented visibility, sensory overstimulation, workload, restrictive visiting, and delayed medical responses. Motivation reflected the tension between professional duty and accountability for safety on one hand and emotional burden, verbal abuse, and violence on the other. Cross-domain accounts showed that opportunity constraints could amplify anxiety and safety-first motivation, narrowing feasible behaviour toward containment, whereas social support could sustain relational care. Conclusions: Delirium management was shaped by interacting behavioural, organisational, and emotional conditions. Strengthening assessment capability alone is unlikely to produce consistent practice without staffing, workflow, environmental, and interprofessional support. Mapping the findings to Behaviour Change Wheel intervention functions highlighted training, environmental restructuring, enablement, and modelling as priority candidate functions for prospective evaluation; education alone was unlikely to be sufficient. Reporting Method: This study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist. Patient or Public Contribution: No patient or public contribution was involved in the design, conduct or reporting of this study. Participants were registered intensive care unit nurses. Full article

Background/Objectives: Dietary supplements (DSs) and over-the-counter (OTC) medications for mood improvement and stress relief are widely used, but little is known about how their use relates to coping preferences, trust in physicians, and communication with doctors. This exploratory cross-sectional study compared users and non-users of such products in Poland. Methods: Data were collected between October 2024 and May 2025 and included 798 adults recruited through a mixed-mode convenience sampling strategy (636 online and 162 in person). Participants were classified as current users (CUs; n = 184), past users (PUs; n = 297), or never-users (NUs; n = 317). The outcomes included hypothetical future coping strategies (under an assumption of unlimited resources), trust in physicians using an author-translated adaptation of the Trust in Doctors in General (T-DiG) scale and three-category communication-related attitudes. Multivariable models were adjusted for age, gender, education, medical or health science background, and recruitment mode. Results: Overall, 60.3% of respondents reported current or past use. Compared with NUs, both CUs and PUs had higher adjusted odds of selecting future DS/OTC use (CUs: aOR = 5.60, 95% CI 3.44–9.14, p < 0.001; PUs: aOR = 2.44, 95% CI 1.52–3.93, p < 0.001). PUs also had higher adjusted odds of selecting psychotherapy (aOR = 1.50, 95% CI 1.04–2.17, p = 0.031; overall p = 0.018). Product-use status was associated with selected items of T-DiG: communication competency (overall p = 0.031) and global trust (overall p < 0.001). Compared with NUs, CUs had lower adjusted scores on both subscales (aMD = −0.19, 95% CI −0.33 to −0.04, p = 0.010 and aMD = −0.40, 95% CI −0.59 to −0.21, p < 0.001, respectively). Overall product-group effects were also observed for the first two communication items: CUs had lower relative risk ratios than NUs for discussing product-related doubts first with their physician (RRR = 0.52, 95% CI 0.35–0.78, p = 0.001) and for feeling free to raise such doubts (RRR = 0.57, 95% CI 0.36–0.92, p = 0.022). Conclusions: Product-use status showed selective associations with hypothetical coping preferences, physician trust, and communication-related attitudes rather than a uniform pattern of reluctance to seek professional support. Current use was most strongly associated with lower trust and less favorable product-related communication attitudes. Given the cross-sectional design and hypothetical nature of the coping outcomes, these findings do not establish causality, temporal ordering, or actual healthcare-seeking behavior. Full article

Background/Objectives: Nutrition is an important component of disease prevention and clinical care, yet nutrition training in medical education is often limited and may not adequately prepare future physicians for dietary counselling. Valid assessment tools are therefore needed to identify specific educational gaps and guide curriculum improvement. Unlike general nutrition knowledge instruments, the present questionnaire was specifically developed for medical students and integrates factual nutrition knowledge, applied food composition knowledge, and dietary habits within a multidimensional assessment framework. This study aimed to develop and preliminarily validate a multidimensional questionnaire assessing nutrition knowledge, food composition knowledge, and dietary habits in medical students. Methods: A cross-sectional psychometric validation study with a mixed-methods approach was conducted at the University of Santiago de Compostela, Spain. The instrument was developed by the research team using the revised General Nutrition Knowledge Questionnaire by Kliemann et al. as a conceptual reference and was subsequently adapted to the educational context and expected baseline knowledge of medical students. Face validity was examined through student focus groups, and content validity was established by an expert panel. The initial questionnaire included 61 analyzable items across three domains. Internal consistency was evaluated using Cronbach’s alpha, construct validity by exploratory factor analysis with Promax rotation, and sensitivity analysis was performed to refine the scale. Results: A total of 150 medical students from all six academic years participated (mean age 21.26 years). The initial instrument showed high overall internal consistency with a Cronbach’s alpha = 0.824. After excluding 15 low-performing items, the final 46-item version demonstrated improved reliability (alpha = 0.849). Domain-specific reliability was moderate for general nutrition knowledge (alpha = 0.632) and acceptable for food composition knowledge (alpha = 0.751) and dietary habits (alpha = 0.776). The revised structure produced interpretable components with potential utility for educational diagnosis. Conclusions: The refined questionnaire showed preliminary psychometric validity as a multidimensional assessment tool for medical students. Its potential value lies in providing a framework for future assessment of nutrition-related educational needs rather than in directly producing curricular or behavioral change. Independent multicenter and cross-cultural validation is required before broader use can be recommended. Full article

Background and Objectives: Digitalization studies often emphasize perceived benefits while overlooking professionals who cannot determine whether digital tools are useful. This study quantified digital hesitancy among anesthesia and intensive-care professionals, examined its relationship with professional role and experience, and compared it with reported barriers and technology use. Methods: A single-centre cross-sectional survey included 161 professionals (80.1% of 201 eligible departmental staff): 55 nurses and 106 physicians. A four-item Uncertainty Index measured inability to appraise digital benefits in patient safety, clinical decisions, management, and education. Barrier Burden and Resource-Efficiency indices were also calculated. Group differences were assessed using nonparametric tests, and predictors of high uncertainty were examined by multivariable logistic regression. Results: Nurses had substantially higher uncertainty than physicians (mean Uncertainty Index 1.60 vs. 0.49, difference 1.11, 95% CI 0.80 to 1.42; p < 0.001), particularly regarding educational and clinical benefits. Reported barriers were similar across professional groups, with technical problems being the most common. Any reported prior use of training simulators, irrespective of frequency or recency, was markedly lower among nurses than physicians (1.8% vs. 47.2%; absolute gap 45.4 percentage points, 95% CI 35.2 to 55.5; p < 0.001). After adjustment, physician status remained strongly associated with lower odds of high uncertainty, whereas overall seniority was not significant. In an exploratory within-nurse analysis, uncertainty was higher among more experienced nurses, reaching its highest level among those with more than 20 years of practice (Spearman ρ = 0.49, 95% CI 0.24 to 0.68; p < 0.001); the seniority bands were small (n = 7 to 18), so this gradient is hypothesis-generating. Conclusions: Digital hesitancy was concentrated among nurses and was distinct from shared technical barriers; within nurses it was higher at greater seniority. Because patient-safety outcomes and intervention effects were not measured, targeted simulator-based training and role-specific feedback should be regarded as hypotheses for prospective evaluation alongside, rather than established alternatives to, generic infrastructure improvements. Full article

Background/Objectives: Patient-centered antimicrobial stewardship depends not only on restricting non-prescription antibiotic access, but also on how people interpret professional advice when an antibiotic request is declined. This study explored how adults in Jordan interpreted antibiotic refusal and distinguished personally reported experiences from anticipated vignette responses and perceptions of other people’s behavior. Methods: Semi-structured interviews were conducted between November 2025 and March 2026 with 32 adults purposively recruited for variation in age, gender, region, education, caregiving status, healthcare access, and antibiotic-use experience. Thirteen participants reported a previous refusal encounter—seven involving a pharmacist and six involving a physician—whereas 19 discussed refusal primarily through vignettes. Data were analyzed using an experiential, contextualist form of reflexive thematic analysis. Results: Three themes were developed: (1) antibiotics as active and responsible care under uncertainty; (2) refusal as a negotiation of credibility and care; and (3) continued antibiotic seeking after refusal as a set of reported, anticipated, or socially attributed possibilities. Antibiotics could symbolize strength, rapid recovery, and responsible caregiving. Refusal was more readily interpreted as care when participants described or anticipated acknowledgement, a reasoned explanation, symptom-relief options, and safety-netting. Responses after refusal included acceptance and monitoring, uncertainty or clinical reassessment, and continued antibiotic seeking, but these were not equivalent forms of evidence. Conclusions: Antibiotic refusal is a trust-sensitive and context-dependent patient–provider interaction rather than a uniform behavioral pathway. The findings identify communication and access conditions that merit prospective evaluation; they do not establish that communication causes acceptance or that vignette intentions predict behavior. Full article

Background and Objectives: Digital tools are now embedded in anesthesia and intensive care, but access to them, and in particular to digital educational resources, is distributed unevenly across professional groups. This study describes how nurses, residents, and specialist physicians in one department appraise the contribution of digital technologies to continuing education, patient safety, and clinical and managerial decision-making, and how they report using the digital educational resources available to them. The study is descriptive and exploratory. It does not evaluate an educational intervention and does not measure learning. Methods: We conducted an anonymous, paper-based cross-sectional survey of all 198 clinical staff of a tertiary anesthesia and intensive care department between 2 June and 31 July 2025; 161 questionnaires were analyzable (81.3%). The instrument was investigator-developed and has not been validated, and it is therefore treated as a set of individual items rather than as a scale. Four trichotomous items (Yes/No/Cannot appraise) covering continuing education, patient safety, clinical decision-making, and managerial decision-making were designated primary outcomes and are reported as proportions with Wilson 95% confidence intervals, together with between-group differences and their confidence intervals; overall comparisons used the chi-square or Fisher exact test with Cramér’s V as the effect size. Reporting follows STROBE and the CROSS checklist for survey research. Composite indices, regression models, and correlation analyses were devised after data inspection, are labelled exploratory, and are not reported in this manuscript. Results: Daily use of at least one digital tool was reported by 98.1% of respondents. An educational contribution was affirmed by 56.4% of nurses (95% CI 43.3–68.6), 91.9% of residents (82.5–96.5), and 93.2% of specialists (81.8–97.7); the difference was 35.5 percentage points between residents and nurses (95% CI 20.1–49.4) and 36.8 points between specialists and nurses (20.1–50.7). Response distributions differed by professional category on all four items (p < 0.001 for education, patient safety, and clinical decisions; p = 0.005 for managerial decisions; Cramér’s V 0.22–0.31). Explicit disagreement was very rare (1 to 4 respondents per item), so the differences consist almost entirely of the “Cannot appraise” category, which is reported descriptively because the reason for that response was not measured. Reported use of digital educational resources followed the same ordering: e-learning 50.9% of nurses, 98.4% of residents, 93.2% of specialists; simulators 18.2%, 72.6%, 50.0%; webinars 65.5%, 67.7%, 86.4%. These proportions correspond to documented differences in institutional access, since simulation rotations were mandatory for residents only and the e-learning platform was opened to physicians in 2021 but to nursing staff only in October 2023. Conclusions: In this single department, response distributions on all four appraisal items differed by professional category, and reported use of digital educational resources was lowest in the group with the latest and most restricted institutional access. Because the groups used different technologies under different access conditions, these differences cannot be attributed to professional role itself, and because no learning outcome was measured they are not evidence of educational benefit. The findings are exploratory and support the hypothesis that equalizing access to digital educational resources deserves prospective evaluation. Full article