Search Results (36)

Background/Objectives: Surgical ward rounds are central to trainee education but are often associated with stress, cognitive overload, and inconsistent learning. Advances in artificial intelligence (AI), particularly large language models (LLMs), offer new ways to support trainees by simulating ward-round questioning, enhancing preparedness, and reducing anxiety. This study explores the role of generative AI in surgical ward-round education. Methods: Hypothetical plastic and reconstructive surgery ward-round scenarios were developed, including flexor tenosynovitis, DIEP flap monitoring, acute burns, and abscess management. Using de-identified vignettes, AI platforms (ChatGPT-4.5 and Gemini 2.0) generated consultant-level questions and structured responses. Outputs were assessed qualitatively for relevance, educational value, and alignment with surgical competencies. Results: ChatGPT-4.5 showed a strong ability to anticipate consultant-style questions and deliver concise, accurate answers across multiple surgical domains. ChatGPT-4.5 consistently outperformed Gemini 2.0 across all domains, with higher expert Likert ratings for accuracy, clarity, and educational value. It was particularly effective in pre-ward round preparation, enabling simulated questioning that mirrored consultant expectations. AI also aided post-round consolidation by providing tailored summaries and revision materials. Limitations included occasional inaccuracies, risk of over-reliance, and privacy considerations. Conclusions: Generative AI, particularly ChatGPT-4.5, shows promise as a supplementary tool in surgical ward-round education. While both models demonstrated utility, ChatGPT-4.5 was superior in replicating consultant-level questioning and providing structured responses. Pilot programs with ethical oversight are needed to evaluate their impact on trainee confidence, performance, and outcomes. Although plastic surgery cases were used for proof of concept, the findings are relevant to surgical education across subspecialties. Full article

Background: The project ‘Multicenter Renal Pharmacist Group—Implementation of Pharmaceutical Care for Patients with Renal Impairment at four Non-University Hospitals in Germany’ started in the beginning of 2020 with the goal to establish high-quality pharmaceutical care to improve patient safety for hospitalized patients with renal impairment at German non-university hospitals. Pharmaceutical service quality should be optimized by intense and effective intraprofessional collaboration within the network. Methods: Over a period of two years (2020–2022), we implemented renal pharmacists (RPs) for patients with renal impairment (RI) at four non-university hospitals in Germany (Starnberg Hospital, Rudolf Virchow Hospital Glauchau, Catholic Hospital in the Märkisch District (KKiMK), and Hospital Sindelfingen-Boeblingen). The RPs conducted medication analyses identifying renal-drug-related problems (rDRPs) two to five days a week. The rDRPs, including recommendations to solve them, were forwarded to the attending physicians via written consultations or personally during ward rounds. The RPs were mentored by a renal pharmacist expert from LMU Munich and formed a multicentered team with close collaboration. Data about the RP service were collected and were retrospectively evaluated. Results: During the two-year project period, a total of 3924 patients from various disciplines were visited across all four locations. In total, 1425 patients (36.3%; with a range from 22.7 to 56.4% between hospitals) received one or more interventions by RPs concerning 2454 rDRPs (a median of one to three rDRPs per patient). In cooperation with the physicians, 77.6 to 88.2% of the rDRPs were solved. The most common causes were ‘dosage too high’ and ‘contraindication’. Conclusion: The implementation of pharmaceutical care for patients with renal impairment at four non-university hospitals in Germany increased appropriate prescribing by physicians. The multicenter team proved to be an excellent support for the newly established services. Full article

Registered dietitians (RDs) in palliative care help maintain patients’ quality of life by providing personalized nutritional support that alleviates eating-related distress. This study aimed to clarify the role of RDs in palliative care by examining their responsibilities and challenges in caring for cancer patients. A nationwide mailed survey was conducted in 2022, focusing on RDs involved in cancer palliative care. One RD per facility was included from all 501 hospitals accredited by Japan’s Ministry of Health, Labour and Welfare. Multivariate analysis identified factors related to collaboration with palliative care teams and challenges in cancer care. Responses from 325 RDs (63.9%) across 325 hospitals (63.9%) were analyzed. Among RDs who consistently collaborated with the palliative care team (PCT), significant associations (p < 0.05) were found with exclusive engagement in cancer/palliative care, providing nutritional counseling to inpatients, the frequency of ward rounds, and individualized meal provision. Challenges included the following: “I struggled with determining appropriate food choices for patients unable to eat”, and “Metabolic complications like cachexia hindered my ability to provide adequate support”. RDs play a crucial role in providing individualized meals for cancer patients through PCT collaboration and ward rounds. To ensure effective support in challenging situations, RDs must be exclusively engaged in palliative care and receive specialized education. Full article

Background: Schistosomiasis (SCH) and soil transmitted helminthiasis (STH) have been targeted for elimination as a public health problem (EPHP) within the World Health Organization (WHO)’s Roadmap for Neglected Tropical Diseases (NTDs) 2021–2030. One of the global strategies for the control and elimination of these diseases is the mass administration of praziquantel and albendazole/mebendazole without prior individual diagnosis. To measure the progress towards the 2030 target, we conducted an assessment to determine the impact of the 3–5 rounds of annual mass drug administration among school age children in Ekiti State. Such scientific insights into the impact of these treatments will facilitate improved planning and targeting of resources towards reaching the last mile. Methodology: This assessment was conducted in 16 local government areas (LGAs) of Ekiti State between October and November 2023. Samples were collected from pupils in 166 primary and junior secondary schools across 166 wards of the State. Urine and stool samples were collected from 7670 pupils of ages 5 to 14 years, following standard laboratory procedures. Urine membrane filtration techniques were used for urine preparation while the Kato–Katz technique was used for stool preparation. A novel AiDx digital microscope was used to examine the presence of any ova in the prepared specimen. Parasite ova in urine were reported as the number of ova/10 mL of urine, and were categorized as light infection (˂50 ova/10 mL of urine) or heavy infection (>50 ova/10 mL of urine) while ova of parasites in stool samples were reported as eggs per gram of stool (EPG) and categorized into light, moderate and heavy infection. Results: Overall, 0.76% (0.56–0.95) at 95% CI of the 7670 respondents were infected with Schistosomia haematobium. No Schistosoma mansoni infection was recorded in the study. Similarly, 3.9% (3.43–4.29) at 95% CI were infected with STHs. The overall prevalence of schistosomiasis had significantly reduced from 8.2% in 2008 to 0.8%, while the overall prevalence of STHs significantly reduced from 30.9% to 3.9% with Ascaris lumbricoides being the dominant species of STH. In the 16 LGAs assessed, Ekiti West had the highest S. haematobium prevalence of 4.26%. Ise/Orun and Oye ranked second and third with a prevalence of 3.48% and 2.40% respectively, while all other LGAs had <1% prevalence. The prevalence of STHs was highest in Ekiti-West with a prevalence of 10.45% while Emure and Ikole Local Governments had the lowest prevalence of 0.31% and 0.38%, respectively. There was no significant difference in the prevalence of schistosomiasis between male (0.76%) and female (0.75%) as p ≥ 0.05. Similarly, the difference in prevalence for STH among males (3.95%) was not significantly different from their female counterparts (3.77%), p ≥ 0.05. Conclusions: Based on the WHO guidelines, this study demonstrated that only three LGAs require continued MDA every 2/3 years, seven require only surveillance while six are now non-endemic for schistosomiasis. Similarly, two of the LGAs require one round of MDA yearly, eight LGAs need one round of MDA every two to three years and six LGAs are now below the treatment threshold and no longer require treatment for STH. Full article

Background: A 2014 survey showed nutritional management could be improved in Belgian pediatric departments. This follow-up survey aimed to: (1) list allied health resources/staffing in Belgian pediatric departments, (2) survey nutritional screening and follow-up, and (3) identify barriers. Methods: A nationwide survey (February–April 2021) via national and regional pediatric associations. Results: 61/90 (67.8%) of Belgian pediatric departments responded (80.1% of all Belgian pediatric hospital beds); 60.7% of the respondents were from larger centers (LCs, ≥20 beds). A dietitian was present in 80.3% of all responding units (LCs vs. smaller centers (SCs): p = 0.133), compared to 46.5% in the 2014 survey. Most dietitians seldom or never participate in ward rounds (86.9%) and participate only ad hoc to case discussions (72.1%). Systematic nutritional screening is implemented in 32.8% of pediatric departments. The screening tool STRONGkids is used in 30% of responding centers, compared to 21% in 2014. The most common barriers to conducting nutritional screening were lack of time (59.0%), a lack of knowledge (47.5%), and a lack of staff (42.6%). In French-speaking centers (FrCs), a positive screening result most often led to referral to a dietitian (86.7%), whereas in Dutch-speaking centers (DuCs), it more frequently resulted in a discussion with the pediatrician about nutritional management (54.3%) than referral to a dietitian (34.8%). Nutritional follow-up after discharge is most often conducted by a physician, with or without the involvement of a dietitian (95.1%), rather than a dietitian alone (3.3%). Malnutrition management barriers included “no barriers” (50.8%), a lack of knowledge (34.4%), a lack of reimbursement (24.6%), and a lack of time (24.6%). The barriers remain largely unchanged compared to 2014. Conclusions: The increasing availability of dietitians and the use of a screening tool in pediatric departments suggest an encouraging but limited improvement in nutritional care in Belgium. Persistent barriers that have remained unchanged since 2014 continue to hinder substantial advancements in nutritional care. Full article

Background: This study investigates the impact of transitioning from paper and pencil (P&P) methods to electronic patient records (EPR) on workflow and usability in surgical ward rounds. Methods: Surgical ward rounds were audited by two independent observers to evaluate the effects of transitioning from P&P to EPR. Key observations included the number of medical personnel and five critical workflow aspects before and after EPR implementation. Additionally, usability was assessed using the System Usability Scale (SUS) and the Post-Study System Usability Questionnaire (PSSUQ). Results: A total of 192 P&P and 160 EPR observations were analyzed. Physicians experienced increased administrative workload with EPR, while nurses adapted more easily. Ward teams typically consisted of two physicians and three or four nurses. Usability scores rated the system as “Not Acceptable” across all professional groups. Conclusions: The EPR system introduced usability challenges, particularly for physicians, despite potential benefits like improved data access. Usability flaws hindered system acceptance, highlighting the need for better workflow integration. Addressing these issues could improve efficiency and reduce administrative strain. As artificial intelligence becomes more integrated into clinical practice, healthcare professionals must critically assess AI-driven tools to ensure safe and effective patient care. Full article

Context: Modern medicine aims to ensure a world in which all people experience a good end of life as an integral part of their life journey. A good end-of-life experience means dying with dignity and receiving the best healthcare based on scientific evidence. Objective: This study aims to reach a consensus about the contents of a comprehensive instrument based on the 10/40 Model of the International Collaborative for the Best Care for the Dying Person for evaluating inpatients facing imminent death in Portuguese internal medicine wards and a proposal for anticipatory medication for symptom control in inpatient and home care settings. Methods: We employed the Delphi method and conducted various rounds of questionnaire administration to 23 Portuguese internists competent in palliative medicine. Data were obtained in July and September of 2022. Results: Consensus was reached among the expert panel on the diagnostic, initial assessment, monitoring, and after-death care items of the tool, with minor adjustments to wording or content. However, it was not possible to reach a consensus on most of the proposals presented for anticipatory medication for symptomatic control. Conclusion: We present the consensus about the contents of a comprehensive instrument for evaluating inpatients facing imminent death in Portuguese internal medicine wards. Best practices in this setting were defined from the point of view of internists with expertise in palliative care. However, the best pharmacological practices still require further reviews of the literature and consensus. Full article

Delirium is often the first symptom of incipient acute illness or complications and must therefore be detected promptly. Nevertheless, routine screening for delirium in acute care hospital wards is often inadequate. We recently implemented a simple, user-friendly delirium screening test (RMA) that can be administered during ward rounds and routine nursing care. The test was found to be non-inferior to 4AT in terms of sensitivity and specificity. However, the dominant factors to take into account when assessing the performance of a test added to the routine work of busy acute care hospital wards are ease of administration, real-life amenability and the ability of the staff to adhere to testing requirements. In this study, we evaluated the prevalence of daily RMA tests that were not administered as scheduled and the impact of these omissions on the overall real-world performance of RMA. Using point-in-time assessments of 4AT by an external rater, we found that complete RMA was administered in 88.8% of the days. Physicians omitted significantly more tests than nurses, but their results were more specific for delirium. Omissions reduced the sensitivity and specificity of RMA for delirium (compared to 4AT) from 90.7% to 81.7%, and from 99.2% to 87.8%, respectively. Ideally, the number of omitted RMA tests should be minimized. However, if over 85% of the daily quota of complete tests are administered, the sensitivity and specificity of RMA for diagnosing delirium as soon as it appears remain at acceptable levels. Full article

Iron deficiency is the number one nutritional problem worldwide. Iron uptake is regulated at the intestine and is highly influenced by the gut microbiome. Blood from the intestines drains directly into the liver, informing iron status and gut microbiota status. Changes in either iron or the microbiome are tightly correlated with the development of metabolic dysfunction-associated steatotic liver disease (MASLD). To investigate the underlying mechanisms of the development of MASLD that connect altered iron metabolism and gut microbiota, we compared specific pathogen free (SPF) or germ-free (GF) mice, fed a normal or low-iron diet. SPF mice on a low-iron diet showed reduced serum triglycerides and MASLD. In contrast, GF low-iron diet-fed mice showed increased serum triglycerides and did not develop hepatic steatosis. SPF mice showed significant changes in liver lipid metabolism and increased insulin resistance that was dependent upon the presence of the gut microbiota. We report that total body loss of mitochondrial iron importer Mitoferrin2 (Mfrn2⁻/⁻) exacerbated the development of MASLD on a low-iron diet with significant lipid metabolism alterations. Our study demonstrates a clear contribution of the gut microbiome, dietary iron, and Mfrn2 in the development of MASLD and metabolic syndrome. Full article

Introduction: Hip fractures globally are associated with high levels of morbidity, mortality, and significant financial burden. This audit aimed to assess the impact of orthogeriatric liaison care on post-operative outcomes following surgical management of neck or femur fractures. Methods: Here, 258 patients who underwent hip fracture surgery over 1-year were included. Data were collected as an audit following the transition to an orthogeriatric liaison care model, involving regular orthogeriatric review (thrice weekly ward rounds, daily board rounds), superseding orthogeriatric review as requested. The audit is meant to assess the development of post-operative non-surgical site infection (NSSI) and mortality and duration of inpatient stay. Outcomes were compared to previous data from our hospital site in 2015/2016. Results: Patients with severe cognitive impairment and systemic disease (Abbreviated Mental Test Score (AMTS) < 7 and American Society of Anesthesiologists (ASA) grade ≥ 3) showed significantly elevated NSSI risk, consistent across the study periods. Both periods demonstrated an increased risk of NSSI associated with admission from nursing homes. Despite the 2021/2022 cohort being notably older, NSSI risk decreased from 40.6% to 37.2% after implementing the orthogeriatric care model. NSSI risk was notably reduced for severe cognitive impairment (51.6% vs. 71%), and the p-value was 0.025. Average hospital stay decreased post-intervention (2.4 days shorter), with a notable reduction for NSSI patients (3.4 days shorter). Overall mortality rates were similar, although mortality due to infection was significantly reduced in 2021/2022 (44.4% vs. 93.3%), and the p-value was 0.003. Conclusion: The orthogeriatric liaison care model significantly decreased NSSI only in individuals with severe cognitive impairment and infection-associated mortality. This highlights the integral role of orthogeriatricians in the care of elderly hip fracture patients. Full article

(1) Background: Final-year medical students often feel under prepared for their transition into clinical practice. Clinical ward rounds and shadowing approach this issue by building transferable skills; however, they are highly variable, with teaching clinicians experiencing a large number of work-related interruptions. Simulated ward rounds have garnered significant interest by translating clinical encounters into standardised educational opportunities for students. This review evaluates the impact of simulated ward rounds in promoting the clinical competencies required for work in final-year medical students and assesses the impact of simulated ward rounds on the experience of clinical learning for medical students. (2) Methods: A computer-assisted search was performed in the Medline, Embase, and CINAHL databases. Studies that evaluated simulated ward rounds in final-year medical student cohorts were included. (3) Results: In total, 107 articles were identified by the search and 26 articles were eligible for full-text analysis. The analysis of these studies showed that simulated ward rounds were effective in improving confidence, as well as the technical and non-technical skills of final-year medical students; however this is on the basis of highly heterogeneous and lower-quality evidence. (4) Conclusion: Our systematic review highlights that simulated ward rounds provide final-year medical students with increased confidence and preparedness for clinical work and identifies the need to pursue more methodologically rigorous research to inform the best practice delivery of simulated ward rounds. Full article

Parents are often appointed a passive role in the care for their hospitalised child. In the family-integrated care (FICare) model, parental involvement in neonatal care is emulated. Parental participation in medical rounds, or family-centred rounds (FCR), forms a key element. A paucity remains of randomised trials assessing the outcomes of FCR (embedded in FICare) in families and neonates, and outcomes on an organisational level are relatively unexplored. Likewise, biological mechanisms through which a potential effect may be exerted are lacking robust evidence. Ten level two Dutch neonatal wards are involved in this stepped-wedge cluster-randomised trial FCR (embedded in FICare) by one common implementation strategy. Parents of infants hospitalised for at least 7 days are eligible for inclusion. The primary outcome is parental stress (PSS:NICU) at discharge. Secondary outcomes include parental, neonatal, healthcare professional and organisational outcomes. Biomarkers of stress will be analysed in parent–infant dyads. With a practical approach and broad outcome set, this study aims to obtain evidence on the possible (mechanistic) effect of FCR (as part of FICare) on parents, infants, healthcare professionals and organisations. The practical approach provides (experiences of) FICare material adjusted to the Dutch setting, available for other hospitals after the study. Full article

Tanzania experiences a burden of maternal mortality and morbidity. Despite the efforts to institute accountability mechanisms, little is known about quality improvement in the delivery of maternal health services. This study aimed at exploring barriers and facilitators to enforcing performance accountability mechanisms for quality improvement in maternal health services. A case study design was used to conduct semi-structured interviews with thirteen key informants. Data were analyzed using thematic analyses. The findings were linked to two main performance accountability mechanisms: maternal and perinatal death reviews (MPDRs) and monitoring and evaluation (M&E). Prioritization of the maternal health agenda by the government and the presence of maternal death review committees were the main facilitators for MPDRs, while negligence, inadequate follow-up, poor record-keeping, and delays were the main barriers facing MPDRs. M&E was facilitated by the availability of health management information systems, day-to-day ward rounds, online ordering of medicines, and the use of biometrics. Non-use of data for decision-making, supervision being performed on an ad hoc basis, and inadequate health workforce were the main barriers to M&E. The findings underscore that barriers to the performance accountability mechanisms are systemic and account for limited effectiveness in the improvement of quality of care. Full article

As an important public facility, the number, area, and scale of hospital buildings are growing rapidly. The efficiency of nurses’ rounds to beds is an important indicator of the efficiency of nursing units in ward buildings. Ward buildings occupy a very important position in the overall energy consumption of hospital building complexes. The type and scale of nursing unit floorplans are some of the key factors affecting the energy consumption of ward buildings. In this paper, three typical floorplan layout types of hospital ward buildings in cold regions of China are selected. The relationships between rounding efficiency, building energy consumption, floorplan layout, and building size were quantified using Origin based on linear regression and non-linear regression. The study showed that at 60 beds, the efficiency of nurse rounds was 35.68% higher in the double-corridor layout compared to the single-corridor. At 44 beds, the difference in average bed energy consumption between the double-corridor type and the single-corridor type is the greatest, with a 9.02% saving in energy consumption. This result confirms that the layout and scale of the ward building has a significant impact on the efficiency of nursing unit rounds and building energy efficiency. Full article

Background: Our research hypothesis was that most French indicators of quality of care have been validated by experts who are not clinicians and might not always be meaningful for clinicians. Our objective was to define a core set of measurable indicators of care quality during delivery and the immediate postpartum period relevant to clinical practice. Methods: A steering committee comprising nine specialists in obstetrics and/or public health conducted a literature review to develop potential indicators. A panel of obstetrician-gynecologists and midwives working in a delivery unit rated each indicator for appropriateness in a two-round Rand-modified Delphi procedure and a physical meeting. The consensus among the panelists was assessed. Results: In the first round, 145 panelists (110 obstetrician-gynecologists and 35 midwives) assessed 77 indicators and 3 definitions: 6 related to labor onset, 20 to delivery, 3 to pain management, 23 to neonatal morbidity/mortality, and 28 to maternal morbidity. In the second round, 132 panelists (98 obstetrician-gynecologists and 34 midwives) assessed 42 indicators and 1 definition. The final set comprised 50 indicators and 2 definitions. Conclusions: This Delphi procedure selected 50 indicators that reflect the quality of perinatal care. These indicators should be recorded in each French maternity ward’s birth register for each delivery. Full article