Provider views on rapid diagnostic tests and antibiotic prescribing for respiratory tract infections: A mixed methods study

Background Respiratory tract infections (RTIs) are often inappropriately treated with antibiotics. Rapid diagnostic tests (RDTs) have been developed with the aim of improving antibiotic prescribing but uptake remains low. The aim of this study was to examine provider knowledge, attitudes and behaviors regarding RDT use and their relationship to antibiotic prescribing decisions across multiple clinical departments in an urban safety-net hospital. Methods We conducted a mixed methods sequential explanatory study. Providers with prescribing authority (attending physicians, nurse practitioners and physician assistants) who had at least 20 RTI encounters from January 1, 2016 to December 31, 2018. Eighty-five providers completed surveys and 16 participated in interviews. We conducted electronic surveys via RedCap from April to July 2019, followed by semi-structured individual interviews from October to December 2019, to ascertain knowledge, attitudes and behaviors related to RDT use and antibiotic prescribing. Results Survey findings indicated that providers felt knowledgeable about antibiotic prescribing guidelines. They reported high familiarity with the rapid streptococcus and rapid influenza tests. Familiarity with comprehensive respiratory panel PCR (RPP-respiratory panel PCR) and procalcitonin differed by clinical department. Qualitative interviews identified four main themes: providers trust their clinical judgment more than rapid test results; patient-provider relationships play an important role in prescribing decisions; there is patient demand for antibiotics and providers employ different strategies to address the demand and providers do not believe RDTs are implemented with sufficient education or evidence for clinical practice. Conclusion Prescribers are knowledgeable about prescribing guidelines but often rely on clinical judgement to make final decisions. The utility of RDTs is specific to the type of RDT and the clinical department. Given the low familiarity and clinical utility of RPP and procalcitonin, providers may require additional education and these tests may need to be implemented differently based on clinical department.

Message of the Department Chair

Fifty years ago, the Department of Orthopaedics was founded and became the newest clinical department of the College of Medicine and Philippine General Hospital, University of the Philippines. This year 2021, we celebrate its Golden Anniversary. Even in its infancy, the department has given due emphasis on research as much as its commitment to training and service. It was one of the first if not the first clinical department to hold an Annual Research Forum and even a research unit was organized by its first Chair, Dr. Jose Silao. Much later, a small biomechanical testing unit was put up. Time and again, its staff and trainees have contributed to the continuing studies in Orthopaedics. These include a better understanding of essential surgical anatomy, validation of surgical procedures, new approaches to the treatment of many Orthopaedic pathologies, and innovations in implants and devices. The generation of new knowledge is a mandate for all university colleges and units and the Department of Orthopaedics takes this seriously. It takes pride in being recognized as a university-based training program. It hammers into the consciousness of its staff and trainees the importance of research. It uses research training for its residents as an important tool in inculcating in them the art of critical thinking, a must in our present-day evidence-based medical practice. This Orthopaedic issue of the Acta Medica Philippina is a fitting way of honoring the department’s long research tradition. The ease with which we gathered publishable researches for this issue just shows the vibrancy of research in the department and how much it has grown from its beginning in 1971. The founding fathers of the department will be proud to see that the department takes seriously the challenge to excel in Training, Service, and Research. I heartily congratulate and profusely thank the authors and editorial staff for coming out with this special Orthopaedic Issue of the Acta Medica Philippina. Juanito S. Javier, MD, MChOrth Chair Department of Orthopedics Philippine General HospitalUniversity of the Philippines Manila

STUDY OF A, B, O (H) ISOANTIGENS IN PARAFFIN SECTIONS OF MALIGNENT TUMORS

The present study entitled, Study of A,B,O (H0 Isoantigens in paraffin sections of malignant tumors was conducted among the patients at Amaltas Institute of Medical Sciences, Dewas. Patients coming to any clinical department with tumors during the period ware randomly selected for the study . After complete history and thorough clinical examination, surgery of tumors was done and tissues were sent for histopathology examination.

Consensual qualitative research on the internship experience and development of career identity of Korean doctors

Background Career identity is defined as the ability to substantialise career goals and results from the social learning process achieved through interactions with others. This study aimed to understand how the internship experience in Korea affects career identity, which provides a foundation for developing professional values while promoting personal goals and aspirations. Methods We conducted eleven semi-structured interviews with interns at a university hospital in Korea who had completed internships and chosen a speciality. The interview transcripts underwent inductive thematic analysis using consensual qualitative research approaches. Themes identified were categorised from three domains for the year-long internship experience: personal cognitive, social interaction, and system domains. Results Researchers derived seven categories and 20 subcategories from the transcripts: (1) self-reflection throughout internship training, (2) practical awareness of the internship programme’s operation, (3) perception of individual competence, (4) recognition of mentor importance, (5) situational awareness in the clinical department, (6) relationship experience, and (7) experience of institutional limitations. The internship experience, during which the individual is in charge and core values drive career decisions, is important for the formation of career identity and career orientation. The internship programme provides information about the clinical department to applicants seeking residency and serves a mediating role, providing information about applicants to the clinical departments. Internship is an important period during which career identity is formed. Conclusion The internship programme provides information about clinical departments to applicants seeking residency; it is an important period during which career identity is formed. This study helps provide an in-depth understanding of interns and a base for developing institutional and policy support for students during an uncertain time when specialties should be selected.

Impact of COVID-19 on a Tertiary Otolaryngology Practice in Singapore

The COVID-19 pandemic has had a major impact in healthcare systems across the world, with many hospitals having to come up with protocols and measures to contain the spread of the virus. This affects various specialties’ clinical practices in many ways. Since early 2020 in Singapore, the Department of Otorhinolaryngology at Tan Tock Seng Hospital had to rapidly adapt to this pandemic as we provided services to the main healthcare facility combating the virus in our country. We had to design new workflows and also remain flexible in view of the ever-changing situation. There are 6 important domains for an otolaryngology department or any clinical department in general to consider when making adjustments to their practices in an outbreak: (1) clinical work, (2) education, (3) research, (4) safety of patients and staff, (5) morale of medical staff and (6) pandemic frontline work. We hope that the sharing of our experiences and the lessons learnt will be useful for both our local and international colleagues. Keywords: ENT, pandemic, SARS-CoV-2

Infection, screening, and psychological stress of health care workers with COVID-19 in a non-frontline clinical department

ABSTRACT Objective: To investigate risk factors and psychological stress of health care workers (HCWs) with COVID-19 in a non-frontline clinical department. Methods: Data of 2 source patients and all HCWs with infection risk were obtained in a department in Wuhan from January to February 2020. A questionnaire was designed to evaluate psychological stress of COVID-19 on HCWs. Results: The overall infection rate was 4.8% in HCWs. 10 of 25 HCWs who contacted with 2 source patients were diagnosed with confirmed COVID-19 (8/10) and suspected COVID-19 (2/10). Other 2 HCWs were transmitted by other patients or colleagues. Close care behaviours included physical examination (6/12), life nursing (4/12), ward rounds (4/12), endoscopic examination (2/12). Contacts fluctuated from 1 to 24 times and each contact was short (8.1 min ± 5.6 min). HCWs wore surgical masks (11/12), gloves (7/12), and isolation clothing (3/12) when providing medical care. Most HCWs experienced a mild course with 2 asymptomatic infections, taking 9.8 days and 20.9 days to obtain viral shedding and clinical cure, respectively. Psychological stress included worry (58.3%), anxiety (83.3%), depression (58.3%), and insomnia (58.3%). Conclusions: Close contact with COVID-19 patients and insufficient protection were key risk factors. Precaution measures and psychological support on COVID-19 is urgently required for HCWs.

Assessment of the level of motivation to learning and communicative competence of students at the clinical department of a medical university

The study examined some aspects that affect the motivation of medical students to study and the formation of a part of professional competencies aimed at assessing the ability to work with patients in practice. The aim of the work was to assess the views of KSMU students about the importance of the educational process, motives that affect the success in obtaining education, professional prospects, career growth. The study was carried out by the method of questioning 68 4th year students and 85 6th year students of the medical and preventive medicine faculty. To study the motivational sphere of the personality, we used the methodology "Motivation for studying at a university". To study the formation of a part of professional competencies (communicative and educational), a questionnaire developed by us was used, aimed at assessing the ability to work with patients in practice. The results of the study showed that students adequately chose their profession and are satisfied with the process of studying at the university. However, senior students have higher rates. Moreover, they have different motivation for learning. The dominance of mastering the profession under the influence of the psychological aspect is becoming stronger among sixth-year students. When analyzing the questionnaire on the degree of professional competence, it was revealed that the outpatient service and district doctors remain in secondary roles, forced to concede laurels and money to high-tech hospitals and narrow-profile specialists, and university students are a product of time. Thus, the teacher of the clinical department has a great responsibility in the formation of professional competencies and strengthening the student's motivation for learning.