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Purpose: To investigate the early compression effects of adjustable pressure auricular clips, made of paper clips, during auricular surgery. Methods: 24 patients who underwent auricular surgery between August 2021 and April 2022 were selected as the study participants. Doctors used ear clips made of paper clips to prevent postoperative complications in these patients. Results: In all 24 patients, the wounds healed by stage I. Except for one case of minor local hematoma, all wounds healed well with no postoperative complications, such as subcutaneous hematoma formation, ulceration, or infected skin necrosis. Moreover, doctors were able to operate in lesser time and more conveniently with the help of the paper-clip devices. Conclusions: This study proposes, for the first time, the use of paper clips to make ear clips with adjustable pressure. This simple device is easy to manufacture, inexpensive to the user, reliable in performance, and remarkable in its clinical effects. As such, the present study provides substantial evidence to suggest that this device should be widely applied in the clinical setting. [ABSTRACT FROM AUTHOR]

We examine whether fees paid by Medicaid for primary care affects the use of health care services among adults with Medicaid coverage who have a high school or less than high school degree. The analysis spans the large changes in Medicaid fees that occurred before and after the ACA-mandated fee increase for primary care services in 2013-2014. We use data from the Behavioral Risk Factors Surveillance System and a difference-in-differences approach to estimate the association between Medicaid fees and whether a person has a personal doctor; a routine check-up or flu shot in the past year; whether a woman had a pap test or a mammogram in the past year; whether a person has ever been diagnosed with asthma, diabetes, cardiovascular diseases, cancer, COPD, arthritis, depression, or kidney diseases; and, whether a person reports good-to-excellent health. Estimates indicate that Medicaid fee increases were associated with small increases in the likelihood of having a personal doctor, or receiving a flu shot, although only having a personal doctor remained significant when accounting for multiple hypothesis testing. We conclude that Medicaid fees did not have a major impact on the use of primary care or on the consequences of that care., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: A 2015 survey of the Japan Osteoporosis Society (JOS) on medication-related osteonecrosis of the jaw (MRONJ) revealed that cooperation between physicians and dentists was poor. Discontinuation of antiresorptive agents before tooth extraction was found to increase adverse events without preventing MRONJ. We compared this 2015 survey with a new survey conducted in 2022 to investigate cooperation between physicians and dentists for MRONJ., Materials and Methods: A web-based structured questionnaire including 13 key queries was sent to 3813 physicians who were members of JOS, and 1227 (32.2%) responses were received., Results: Of the 1227 respondents, 909 (74.1%) had complied with a discontinuation request from a dentist before tooth extraction, although 25.4% of medications were not related to the incidence of MRONJ. Of these, 177 respondents reported 252 adverse events including 10 (1.3%) cases of MRONJ. The prevalence of fractures increased from 4.8% in 2015 to 8.2% in 2022. The rates of respondents who requested oral health care by a dentist before antiresorptive agent therapy and reported cooperation between physicians and dentists were 72.7% and 42.4% in 2022 compared with 32.9% and 24.8% in 2015, respectively. The rates of cooperation among the 47 prefectures in Japan were significantly different, ranging from 10.0 to 83.3% (p = 0.02)., Conclusion: This study confirmed increased cooperation between physicians and dentists for MRONJ in Japan. However, a more equal distribution of cooperation across Japan is necessary to optimally manage MRONJ. Discontinuation of antiresorptive agents is no longer necessary because fractures during discontinuation continue to increase in Japan., (© 2023. The Japanese Society Bone and Mineral Research.)

Introduction: Professional burnout in physicians is perceived as an inevitable occupational hazard inhibiting patient-focused care, the preferred approach of care, which enhances satisfaction of physicians with their work and improves clinical outcomes. Burnout jeopardizes the physical, mental, and emotional health of physicians, inhibiting high-quality care. Most individual-driven interventions and job-level interventions to reduce burnout proved inefficient or reduced burnout for only a short term. The potential of organizational processes to reduce burnout was acknowledged but is yet to be empirically tested. Drawing on social exchange theory, this study investigates the role of an organizational phenomenon, organizational trust among physicians in top management, on burnout., Methods: Data were collected across specialties in 10 out of 20 Israeli public general hospitals. The sample comprised 798 senior expert physicians. Measures were all previously published. Structural equation modeling was performed., Results: Response rates ranged from 17% to 77% across the 10 hospitals. Mean burnout was 4.7 (SD = 0.68), mean patient-focused care was 3.9 (SD = 0.79), and mean organizational trust was 3.7 (SD = 0.84). Mean burnout for women was 5.6 and for physicians from internal medicine was 5.5. The structural equation modeling supported the proposed study model, which explained 45% of burnout. Organizational trust reduced burnout by 14%., Discussion: Efforts to reduce burnout should integrate effective individual-level and job-level interventions with building trust among physicians in top management through implementing the paramount professional value of patient-focused care., Conclusions: Perceiving management, among physicians, as facilitating the value of patient-focused care led to organizational trust in top management, which was negatively associated with burnout., (© 2024 Scandinavian Psychological Associations and John Wiley & Sons Ltd.)

Despite the recent growth of attention to English for research publication purposes, little is known about how researchers view the role of peer review in their success of publication. In light of this gap, the present study investigated Iranian surgeons' attitudes towards peer review and the challenges they face in getting their papers published. To this end, 26 Iranian surgeons were interviewed, and the transcribed data were analyzed through thematic analysis. The results revealed that firstly the surgeons attested to the positive and negative contributions of peer review in terms of changing or unchanging their attitudes, respectively. Secondly, the authors faced a myriad of challenges related to editors, reviewers, and socio-political-linguistic factors in getting their papers published. Moreover, they associated these challenges with positive and negative effects in being connected to their career-stage development and motivating them to conduct and submit more papers. The study concludes with implications for research and practice in how researchers can craft more quality papers to enhance their chance of publication in high-quality journals.

Public health emergencies create challenges for the accommodation of visitors to hospitals and other care facilities. To mitigate the spread of COVID-19 early in the pandemic, health care institutions implemented severe visitor restrictions, many remaining in place more than 2 years, producing serious unintended harms. Visitor restrictions have been associated with social isolation and loneliness, worse physical and mental health outcomes, impaired or delayed decision-making, and dying alone. Patients with disabilities, communication challenges, and cognitive or psychiatric impairments are particularly vulnerable without caregiver presence. This paper critically examines the justifications for, and harms imposed by, visitor restrictions during the COVID-19 pandemic and offers ethical guidance on family caregiving, support, and visitation during public health emergencies. Visitation policies must be guided by ethical principles; incorporate the best available scientific evidence; recognize the invaluable roles of caregivers and loved ones; and involve relevant stakeholders, including physicians, who have an ethical duty to advocate for patients and families during public health crises. Visitor policies should be promptly revised as new evidence emerges regarding benefits and risks in order to prevent avoidable harms. [ABSTRACT FROM AUTHOR]

Electronic patient‐reported outcome (ePRO) programs may offer advantages for patients with cancer, clinicians, health care systems, payors, and society in general; but developing and maintaining an ePRO program will require cancer centers to navigate defining meaningful problems, collecting ePROs, implementing action when those ePROs require intervention without over‐burdening clinicians, and monitoring the successes and failures of their ePRO programs. Physician informaticists from the National Comprehensive Cancer Network Electronic Health Record Advisory Group offer 10 guiding principles to consider when contemplating, building, or refining an ePRO program for patients with cancer. [ABSTRACT FROM AUTHOR]

The landscape of medical specialty choice is dynamic, undergoing significant changes as students' progress through undergraduate and graduate medical training. These shifts are influenced by various factors, with financial considerations becoming increasingly relevant among medical students' preferences. This study conducts a retrospective analysis of specialty match rates and physician compensation, suggesting a potential trend where primary care fields, though fundamental to healthcare, appear less competitive and often associated with less financial reward compared to other specialties. The existence of this disparity is not without consequences. It contributes significantly to the ongoing and anticipated primary care physician shortages. This situation requires a comprehensive approach to tackle the complex factors influencing medical students' career choices. Understanding these dynamics is critical for healthcare policy and planning. This paper investigates how financial considerations sway medical students' specialty choices, emphasizing the economic disparities between primary care and other specialties.

General Purpose: To review six articles published in 2022 that provide important new data or change how clinicians may think about pressure injuries., Target Audience: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care., Learning Objectives/outcomes: After participating in this educational activity, the participant will:1. Identify evidence-based risk factors for the development of pressure injuries (PIs).2. Distinguish the predictors for PI development that prompted intervention.3. Identify inconsistencies in documented stages of PIs.4. Explain the impact of staffing on PI development rates., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Abstract: The utilization of sports ultrasound in the clinical practice of sports medicine physicians is growing rapidly. Simultaneously, ultrasound is being increasingly implemented as a teaching tool in undergraduate medical education. However, a sports ultrasound curriculum for medical students has not been previously described. In this article, we describe methods as well as barriers to implementing a sports ultrasound curriculum at the medical school level. Recommended content for the curriculum also is discussed. While educational goals and resources will vary among institutions, this article may serve as a general roadmap for the creation of a successful curriculum., (Copyright © 2023 by the American College of Sports Medicine.)

Purpose: Skin cancer is one of the ten most common cancer types in the world. Early diagnosis and treatment can effectively reduce the mortality of patients. Therefore, it is of great significance to develop an intelligent diagnosis system for skin cancer. According to the survey, at present, most intelligent diagnosis systems of skin cancer only use skin image data, but the multi-modal cross-fusion analysis using image data and patient clinical data is limited. Therefore, to further explore the complementary relationship between image data and patient clinical data, we propose multimode data fusion diagnosis network (MDFNet), a framework for skin cancer based on data fusion strategy., Methods: MDFNet establishes an effective mapping among heterogeneous data features, effectively fuses clinical skin images and patient clinical data, and effectively solves the problems of feature paucity and insufficient feature richness that only use single-mode data., Results: The experimental results present that our proposed smart skin cancer diagnosis model has an accuracy of 80.42%, which is an improvement of about 9% compared with the model accuracy using only medical images, thus effectively confirming the unique fusion advantages exhibited by MDFNet., Conclusions: This illustrates that MDFNet can not only be applied as an effective auxiliary diagnostic tool for skin cancer diagnosis, help physicians improve clinical decision-making ability and effectively improve the efficiency of clinical medicine diagnosis, but also its proposed data fusion method fully exerts the advantage of information convergence and has a certain reference value for the intelligent diagnosis of numerous clinical diseases., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This paper examines the significance of physician agency in medical providers' prescription choices. Physician agency is considered as medical providers' responses to the price and markup percentage of prescription drugs. Their preferences are allowed to be heterogeneous using a random coefficient logit model. Using a sample of anti-diabetic prescriptions with metformin from a population-based database in Taiwan, empirical results reveal that physician owners, privately-owned medical providers, small medical providers and the medical providers facing less competition are more likely to prescribe drugs with higher profit margins. The aggregate pharmaceutical demand is also found to increase with the markup, which is allowed to be endogenous in the estimation. Price elasticity estimates suggest medical providers are quite responsive to pharmaceutical price changes in Taiwan. Counterfactual analysis reveals the potential impact of physician agency is economically significant. Removing markups and lowering pharmaceutical prices are found to be more welfare enhancing than restricting physicians' dispensing services., (© 2023 John Wiley & Sons Ltd.)

Supplemental Digital Content is Available in the Text. In 2011, the Canadian Academy of Sport and Exercise Medicine released their first position paper on Abuse, Harassment, and Bullying in Sport. Since this time, there have been significant advancements within the global sport landscape, including the emergence of regulatory bodies and initiatives aimed at prioritizing athletes' health and well-being. While the shift to a more proactive approach for safeguarding athletes is evident and promising, athletes continue to be affected by cases of maltreatment. To advance safe sport, it is critical that all supporters of safe and healthy performance are aware of their roles and responsibilities for preventing and addressing maltreatment, including the Canadian sport medicine community. In this updated position statement, recent advancements in research on issues of maltreatment are summarized and specific recommendations are provided on how the medical community can contribute to appropriately identifying, treating, and preventing harm in sport, as well as their role in advocating for the health and well-being of athletes in their care. [ABSTRACT FROM AUTHOR]

In its position paper, the American College of Physicians (ACP) provided recommendations for strengthening U.S. public health infrastructure. The editorialists reflect on the ACP recommendations through the lens of the Centers for Disease Control and Prevention, specifically highlighting budget, workforce, and data issues. [ABSTRACT FROM AUTHOR]

Puerto Rico (PR) is facing an unprecedented healthcare crisis due to accelerating migration of physicians to the mainland United States (US), leaving residents with diminishing healthcare and excessively long provider wait times. While scholars and journalists have identified economic factors driving physician migration, our study analyzes the effects of spatial stigma within the broader context of coloniality as unexamined dimensions of physician loss. Drawing on 50 semi-structured interviews with physicians throughout PR and the US, we identified how stigmatizing meanings are attached to PR, its people, and its biomedical system, often incorporating colonial notions of the island's presumed backwardness, lagging medical technology, and lack of cutting-edge career opportunities. We conclude that in addition to economically motivated policies, efforts to curb physician migration should also address globally circulating ideas about PR, acknowledge their roots in coloniality, and valorize local responses to the crisis that are in danger of being lost to history., (© 2024 American Anthropological Association.)

Background: It is unknown whether physicians treating critically ill patients have realistic perceptions of their patients' prognoses., Methods: We sent a survey by email to Finnish anesthesiologists to investigate their ability to estimate the probability of 1-year survival of intensive care unit (ICU) patients based on data available at the beginning of intensive care. We presented 12 fictional but real-life-based patient cases and asked the respondent to estimate the probability of 1-year survival in each case by choosing one of the alternatives 5%, 10%-90% in 10% intervals and 95%. We compared the physicians' estimates to registry data-based realistic prognoses of comparable patients treated in the ICU. Based on the difference between the estimate and the realistic prognosis, we categorized the estimates into three groups: (1) difference less than 10 percentage points, (2) difference between 10 and 20 percentage points, and (3) difference over 20 percentage points., Results: We received 210 responses (totally 2520 estimates). Of the respondents, 43 (20.5%) were specialists working mainly in the ICU, 81 (38.6%) were specialists working occasionally in the ICU, 47 (22.4%) were specialists not working in the ICU, and 39 (18.6%) were doctors in training. The difference between the estimate and the realistic prognosis was less than 10 percentage points for 1083 (43.0%) estimates, between 10 and 20 percentage points for 645 (25.6%) estimates, and over 20 percentage points for 792 (31.4%) estimates, out of which 612 (24.3% of all estimates) underestimated and 180 (7.1%) overestimated the likelihood of survival. The median error (the median of the differences between the estimate and the realistic prognosis) for all estimates was -8.8 [interquartile range (IQR), -20.0 to -0.2], which means that the most typical response underestimated the likelihood of survival by 9 percentage points. Based on the 12 estimates, we calculated the median error for each respondent. The median (IQR) of these median errors was -8.6 (-12.6 to -5.0) for specialists working mainly in the ICU, -8.1 (-13.0 to -5.2) for specialists working occasionally in the ICU, -9.7 (-17.7 to -6.3) for specialists not working in the ICU, and -9.1 (-14.5 to -5.1) for doctors in training (p = .29)., Conclusion: Finnish anesthesiologists commonly misestimate the long-term prognoses of ICU patients, more often underestimating than overestimating the likelihood of 1-year survival. More education about critically ill patients' prognoses and better prediction tools are needed., (© 2024 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)

Objectives: To examine the scale of private equity investment in Australian health care delivery assets (clinics, hospitals, imaging facilities, other doctor-led health care services)., Study Design, Setting: Extraction of information about private equity acquisitions of hospitals, clinics, imaging centres and in vitro fertilisation facilities in Australia, 2008-2022, from a commercial database (PitchBook), supplemented by information from publicly available online media sources., Main Outcome Measures: Number and value of private equity acquisitions of health care assets, 2008-2022; numbers of clinic parent company and clinic acquisitions, 2017-2022., Results: A total of 75 private equity acquisitions of health care delivery assets in Australia during 2008-2022 were identified; the annual number rose from three acquisitions in 2008 to eighteen in 2022. During 2008-2010, five of seven acquisitions were of in vitro fertilisation providers; during 2020-2022, 22 of 39 acquisitions were of clinics or clinic groups, including eleven of eighteen in 2022. The total value of the 39 acquisitions for which purchase price could be ascertained (52%) was $24.1 billion. During 2017-2022, the clinic specialty with the greatest number of private equity acquisitions was general practice (256 of 446 clinics purchased within acquisitions). Seven companies owning ophthalmology clinics (24 clinics) were acquired by private equity. Four private equity acquisitions during 2017-2022 included 60 oncology clinics, all related to a single clinic group., Conclusions: The number of private equity acquisitions of Australian health care delivery assets increased during 2008-2022. Doctors should be aware of the motivations and dynamics of private equity companies, as they are increasingly likely to interact with these firms and assets owned by these firms., (© 2024 AMPCo Pty Ltd.)

Many healthcare systems prohibit primary care physicians from dispensing the drugs they prescribe due to concerns that this encourages excessive, ineffective or unnecessarily costly prescribing. Using data from the English National Health Service for 2011-2018, we estimate the impact of physician dispensing rights on prescribing behavior at the extensive margin (comparing practices that dispense and those that do not) and the intensive margin (comparing practices with different proportions of patients to whom they dispense). We control for practices selecting into dispensing based on observable (OLS, entropy balancing) and unobservable practice characteristics (2SLS). We find that physician dispensing increases drug costs per patient by 3.1%, due to more, and more expensive, drugs being prescribed. Reimbursement is partly based on a fixed fee per package dispensed and we find that dispensing practices prescribe smaller packages. As the proportion of the practice population for whom they can dispense increases, dispensing practices behave more like non-dispensing practices., (© 2023 The Authors. Health Economics published by John Wiley & Sons Ltd.)

The development of artificial intelligence (AI) in healthcare is accelerating rapidly. Beyond the urge for technological optimization, public perceptions and preferences regarding the application of such technologies remain poorly understood. Risk and benefit perceptions of novel technologies are key drivers for successful implementation. Therefore, it is crucial to understand the factors that condition these perceptions. In this study, we draw on the risk perception and human-AI interaction literature to examine how explicit (i.e., deliberate) and implicit (i.e., automatic) comparative trust associations with AI versus physicians, and knowledge about AI, relate to likelihood perceptions of risks and benefits of AI in healthcare and preferences for the integration of AI in healthcare. We use survey data (N = 378) to specify a path model. Results reveal that the path for implicit comparative trust associations on relative preferences for AI over physicians is only significant through risk, but not through benefit perceptions. This finding is reversed for AI knowledge. Explicit comparative trust associations relate to AI preference through risk and benefit perceptions. These findings indicate that risk perceptions of AI in healthcare might be driven more strongly by affect-laden factors than benefit perceptions, which in turn might depend more on reflective cognition. Implications of our findings and directions for future research are discussed considering the conceptualization of trust as heuristic and dual-process theories of judgment and decision-making. Regarding the design and implementation of AI-based healthcare technologies, our findings suggest that a holistic integration of public viewpoints is warranted., (© 2023 The Authors. Risk Analysis published by Wiley Periodicals LLC on behalf of Society for Risk Analysis.)

Abstract: Twenty years ago, pioneer Doctor of Nursing Practice (DNP) program students completed the first DNP projects. Today, DNP projects remain a requirement for graduation. This article illustrates how the DNP project can be integrated throughout the DNP curriculum to maximize effectiveness and promote the introduction, reinforcement, and evaluation of competencies in the new American Association of Colleges of Nursing Essentials., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

There is a pressing debate in the United States concerning the implied physicians' obligation to do no harm and the status of legalizing physician-assisted suicide (PAS). Key issues that underpin the debate are important to consider. These include: (1) foundational medical beginnings; (2) euthanasia's historical and legal background context; and (3) the key arguments held by those for and against legalization of PAS. This paper reviews the major claims made by proponents for the legalization of PAS and the associated complexities and concerns that help underscore the importance of conscience freedoms. Relief of suffering, respect for patient autonomy, and public policy arguments are discussed in these contexts. We argue here that the emphasis by healthcare providers should be on high quality and compassionate care for those at the end of life's journey who are questioning whether to prematurely end their lives. If medicine loses its chief focus on the quality of caring-even when a cure is not possible-it betrays its objective and purpose. In this backdrop, legalization of PAS harms not only healthcare professionals, but also the medical profession's mission itself. Medicine's foundation is grounded in the concept of never intentionally to inflict harm. Inflicting death by any means is not professional or proper, and is not trustworthy medicine., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: The U.S. health care system has seen an increase in hospital-physician integration, with hospitals acquiring increasing numbers of physician practices. This shift has been linked to higher costs without significant improvements in quality., Purpose: This study sought to identify the characteristics of physicians who transitioned from independent practice to hospital integration., Methodology/approach: We used physician variables, including quality scores, medical school rankings, years of experience, experience treating socially or medically complex patients, practice style, and location, as well as health care market and county-level variables to understand these determinants using a fixed-effects logistic regression model., Results: A total of 101,746 physicians representing 66 clinical specialties satisfied our inclusion criteria, of which 3,656 became hospital-integrated between 2018 and 2020. The integrating physicians were generally less experienced, had lower quality scores, and generated less revenue per Medicare patient. Their patients, on average, had higher comorbidity scores, were more likely to be dually eligible, and resided in counties with higher poverty rates., Conclusion: Our findings indicate that the physicians most likely to become hospital integrated are those facing reimbursement pressures due to a complex case mix and the associated challenges of performing well on the quality metrics. We also found some support for the anticompetitive aspects of hospital-physician integration. Our results suggest that hospitals are integrating with a relatively less experienced physician workforce but one that is perhaps more capable of treating clinically and socioeconomically complex patients., Practice Implications: Hospitals interested in using physician integration strategically to improve care quality should put more emphasis on physician quality. Such an approach has the potential to increase efficiency without sacrificing quality of care., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Building trustworthy and transparent image-based medical artificial intelligence (AI) systems requires the ability to interrogate data and models at all stages of the development pipeline, from training models to post-deployment monitoring. Ideally, the data and associated AI systems could be described using terms already familiar to physicians, but this requires medical datasets densely annotated with semantically meaningful concepts. In the present study, we present a foundation model approach, named MONET (medical concept retriever), which learns how to connect medical images with text and densely scores images on concept presence to enable important tasks in medical AI development and deployment such as data auditing, model auditing and model interpretation. Dermatology provides a demanding use case for the versatility of MONET, due to the heterogeneity in diseases, skin tones and imaging modalities. We trained MONET based on 105,550 dermatological images paired with natural language descriptions from a large collection of medical literature. MONET can accurately annotate concepts across dermatology images as verified by board-certified dermatologists, competitively with supervised models built on previously concept-annotated dermatology datasets of clinical images. We demonstrate how MONET enables AI transparency across the entire AI system development pipeline, from building inherently interpretable models to dataset and model auditing, including a case study dissecting the results of an AI clinical trial., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Objective: The similarities and differences in workforce trends in BRICS (Brazil, Russia, India, China, and South Africa) may offer reciprocal lessons for emerging economies., Methods: We used the Global Health Observatory data to assess the secular trends between 2001 and 2017 in the number of skilled health personnel (SHP: doctors, nurses/midwives) in BRICS compared to the average of Organization for Economic Co-operation and Development (OECD) countries., Results: Substantial efforts have been made in BRICS to increase SHP availability, as demonstrated by an average exponential growth rate (AEGR) > 0.03 in Brazil, China, and India compared to 0.01 in OECD. With an AEGR as high as 0.07 after 2008, China reached the level of SHP availability commensurate with the sustainable development goals (SDGs) in 2017. Other than China, BRICS countries had a mean number of nurses and midwives per doctor between 2001 and 2017 higher than or comparable to the OECD average (2.78). The corresponding number in China was 1.04 in 2017, lower than 2.21 in India in 2001., Conclusions: With China as the exception, BRICS countries maintained a sustainable skills mix of SHPs. China reached the level of SHP availability commensurate with the SDGs, but SHP's skill mix was imbalanced., (© 2023 John Wiley & Sons Ltd.)

Purpose: In intensive care units (ICUs), decisions about the continuation or discontinuation of life-sustaining treatment (LST) are made on a daily basis. Professional guidelines recommend an open exchange of standpoints and underlying arguments between doctors and families to arrive at the most appropriate decision. Yet, it is still largely unknown how doctors and families argue in real-life conversations. This study aimed to (1) identify which arguments doctors and families use in support of standpoints to continue or discontinue LST, (2) investigate how doctors and families structure their arguments, and (3) explore how their argumentative practices unfold during conversations., Method: A qualitative inductive thematic analysis of 101 audio-recorded conversations between doctors and families., Results: Seventy-one doctors and the families of 36 patients from the neonatal, pediatric, and adult ICU (respectively, N-ICU, P-ICU, and A-ICU) of a large university-based hospital participated. In almost all conversations, doctors were the first to argue and families followed, thereby either countering the doctor's line of argumentation or substantiating it. Arguments put forward by doctors and families fell under one of ten main types. The types of arguments presented by families largely overlapped with those presented by doctors. A real exchange of arguments occurred in a minority of conversations and was generally quite brief in the sense that not all possible arguments were presented and then discussed together., Conclusion: This study offers a detailed insight in the argumentation practices of doctors and families, which can help doctors to have a sharper eye for the arguments put forward by doctors and families and to offer room for true deliberation., (© 2023. The Author(s).)

Background: The introduction of electronic health records (EHRs) has contributed considerably to EHR work outside work (WOW) hours for physicians. Prior research has identified the pressures associated with stress resulting from EHR WOW, yet developing a nuanced understanding of how physicians appraise and respond to this stress, and the resulting impacts, remains absent from the literature., Purpose: Grounded in the technostress model, this study takes a qualitative approach to explore both the pressures and opportunities associated with EHR WOW., Methods: Thematic analysis of data from semistructured interviews was utilized to examine the pressures and opportunities associated with EHR WOW among primary care pediatricians (n = 15) affiliated with a large Midwestern pediatric health system., Results: The physicians in this study regularly spent time working in the EHR outside work hours. They felt the EHR contributed to their documentation burden, which ultimately increased their EHR WOW, and reported a sense of burden from ubiquitous EHR availability. Conversely, they appreciated the flexibility the EHR provided in terms of work-life balance. Suggestions for improvement under the direct purview of practice management included enhanced EHR usability, improvements in workflow during work hours to free up time to document, and more training on both EHR documentation strategies and ongoing software upgrades., Conclusion: Physicians perceive that the EHR exerts certain pressures while affording new opportunities and conveniences. This study provides evidence of both the pressures and opportunities of EHR WOW and their effect on physician well-being., Practice Implications: Specific opportunities are identified for health administrators to enable physicians to better manage EHR WOW., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)