From surgical problem to surgical solution - lessons and reflections.

Introduction: Physician burnout is strongly associated with adverse effects on patient care, physician health, workforce stability, and health costs. Resilience is understood as a protective factor, but its association with burnout within specific cultural and organizational contexts such as those in Saudi Arabia, remains inadequately studied. The main objective of this study was to assess the prevalence of burnout and resilience and examine their relationship among Family Medicine physicians at Prince Sultan Military Medical City (PSMMC). Methods: A cross-sectional study was conducted among Family Medicine physicians at PSMMC, who were selected via stratified sampling. Participants completed a structured questionnaire capturing demographic factors, the Oldenburg Burnout Inventory (16-items), and the Connor-Davidson Resilience Scale (10-items). Data were analyzed using descriptive statistics, Pearson’s correlation coefficient, T-test, and one-way Analysis of Variance (ANOVA). Results: A total of 296 family medicine physicians from PSMMC participated. The majority of the respondents were female (74%) and Saudi nationals (97.3%). Most participants were aged 40 years or younger (81.8%), with nearly half (49.7%) having 6-10 years of clinical work experience. A substantial 40.6% of physicians reported clinically significant burnout (16.6% high, 24% medium), while 25.3% reported low levels of resilience. A significant moderate negative association was found between burnout and resilience (r = -0.304, p <.01). Additionally, the average resilience score was significantly higher among physicians with more clinical experience (p = 0.004) and those working in specialist clinics or urgent care compared to general clinics (p= .006). Conclusion: Physician burnout is a prevalent and systemic issue among Family Medicine physicians at PSMMC, affecting individuals uniformly regardless of their demographic characteristics. Physician resilience scores were negatively associated with burnout. Resilience scores differed significantly by work setting and years of clinical experience. Therefore, public health policy should address the impact of the workplace environment and organizational factors to effectively mitigate the crisis.

Background: Dental hygienists study dental radiology through the dental hygiene department and curriculum, and most of the radiography work in dental clinics is performed by dental hygienists; however, the legal work regulations for dental hygienists place restrictions on the type of radiography performed. This study aimed to identify the actual conditions of the radiographic work performed by dental hygienists and to determine the difference according to the type of hospital. Methods: This study included 195 dental hygienists working at dental medical institutions in the metropolitan area. A survey was conducted on regarding the radiographic work performed and the clinical career of the main performers. The radiography work was divided into periapical radiography, bite-wing radiography, occlusal radiography, panoramic radiography, computed tomography (CT), and cephalometric radiography. Results: The frequency of performing intraoral radiography was as follows: periapical radiography, 94.9%; bite-wing radiography, 93.8%; and occlusal radiography, 77.9%. The frequency of performing extraoral radiography was 94.4% for panoramic radiography, 89.7% for CT, and 73.3% for cephalometric radiography. The frequency of internal and external radiography performance was higher among hygienists in dental clinics than among those in dental hospitals and university hospitals. The analysis of the dental hygienists' clinical experience in the areas of intraoral and extraoral radiography showed that those working at university hospitals, dental hospitals, and dental clinics had over 5 years, 24 years, and 1 year of clinical experience, respectively. The hygienists with less than 1 year of clinical experience showed high performance frequency (p 0.05). Conclusion: For the dental hygienists to perform radiography safely, a discussion regarding the revision of related laws and regulations is warranted.

PurposeAccurate evaluation of the cup-to-disc ratio is crucial for optometrists and may be influenced by their clinical experience. The study’s objective was to compare the thresholds for discriminating vertical cup-to-disc ratio (VCDR) between years 2, 3, and 4 clinical optometry trainees.MethodsOne hundred fundus photos with various VCDR sizes were selected from a clinic database. The median VCDR (0.43) photo was assigned as the standard, while the other 99 were assigned as the test photos. The participant’s task was to discriminate using a 2-alternate-forced-choice paradigm whether the test photos’ VCDR were larger or smaller than the standard VCDR. Data were fit with a Weibull function, and three discrimination thresholds were determined: the point of subjective equality (PSE), the range of VCDR uncertainty, and the ability to judge VCDR that was 0.1 unit larger than the standard photo.ResultsYear 4 trainees had better VCDR discrimination thresholds. However, the difference between the three participant groups was not statistically different for all measurements (PSE: F(2,27) = 0.43, p = 0.657; VCDR uncertainty range: F(2,27) = 0.12, p = 0.887), and thresholds for correctly discriminating VCDR 0.1 larger than the standard photo’s VCDR: F(2,27) = 0.69, p = 0.512).ConclusionAlthough Year 4 optometry trainees performed slightly better at estimating VCDR than their Year 3 and Year 2 peers, the number of years of clinical experiences did not significantly affect their VCDR discrimination thresholds when 2-dimensional fundus photos were used as stimuli.

Evaluation of the vertical accuracy of bracket placement with the Boone gauge.

Candida species cause life-threatening bloodstream infections, particularly in critically ill and immunocompromised patients. Although guideline adherence has been shown to improve outcomes, real-world implementation is often constrained. This cross-sectional, web-based survey evaluated current clinical practices and barriers in candidemia management across German healthcare institutions. A structured questionnaire based on the EQUAL Candida score was disseminated online from 10/2023 to 07/2025. Physicians involved in candidemia management reported institutional characteristics, diagnostic practices, antifungal treatment strategies, central line management, and follow-up practices. Data were analyzed using descriptive statistics and chi-square testing. A total of 217 physicians from 147 institutions participated, with 74.5% of participants affiliated with large care facilities. Caspofungin was the predominant first-line therapy (81.4%), whereas fluconazole was used by 5.3% of participants. First-line choice did not differ by years of clinical experience (P=0.194). Echocardiography was routinely performed by 57% of participants; selective use showed no association with years of clinical experience (P=0.845) or annual number of candidemia cases (P=0.089). Ophthalmoscopy was performed routinely by 37% of participants and showed no association with experience (P=0.907), but was significantly associated with lower annual caseload (P=0.02) and infectious disease speciality (P= 0.003). Central line removal or replacement within 24 h was reported by 82.5%. Follow-up blood cultures were obtained daily by 31.4%, while 54.8% repeated cultures every 48 h. While core candidemia management practices are generally well implemented in German healthcare institutions, certain recommended diagnostic steps remain underutilized. Targeted educational and structural interventions are needed to strengthen guideline adherence and optimize patient outcomes across diverse settings.

Depression, anxiety and stress are prevalent among healthcare providers but limited data is available regarding respiratory therapists (RTs). This study aimed to assess the prevalence of depression, anxiety and stress, and identify the associated sociodemographic factors among RTs in Saudi Arabia. A cross-sectional online survey was distributed to RTs in Saudi Arabia. Data were summarized using frequency and percentages. Stress, anxiety, and depression prevalence rates were expressed as proportions with 95% confidence intervals (CI). The associated factors of stress, anxiety, and depression were subjected to logistic regression. Overall, 988 (91%) RTs, 661 (66.9%) males, completed the online survey. The prevalence (95% CI) of depression, anxiety and stress among RTs was 81.3% (0.787, 0.837), 89.6% (0.875, 0.914), and 45.5% (0.424, 0.487), respectively. RT staff who were ≥41 years old, divorced, widowed or separated, or had > 10 years of clinical experience were more likely to experience stress. RTs who were (divorced, widowed or separated), did not live with their family, were current smokers, or worked the night shift were more likely to experience anxiety. RTs who were (divorced, widowed or separated), were current smokers, had >10 years of clinical experience were more likely to experience depression. Stress, anxiety and depression are prevalent among RTs. Several sociodemographic factors are associated with the incidence of stress, anxiety and depression.

Non-thermal plasma—More than five years of clinical experience

As opioid overdose deaths continue to rise, the emergency department (ED) remains an important point of contact for many at risk for overdose. In this study our purpose was to better understand the attitudes, beliefs, and knowledge of ED nurses in caring for patients with opioid use disorder (OUD). We hypothesized a difference in training received and attitudes toward caring for patients with OUD between nurses with <5years and ≥6years of clinical experience. We conducted a survey among ED nurses in a large academic medical center from May-July 2022. All ED staff nurses were surveyed. Data entry instruments for the nursing surveys were programmed in Qualtrics, and we analyzed results R using a chi-square test or Fisher exact test to compare nurses with <5years and ≥6years of clinical experience. A P-value of < 0.05 was considered statistically significant. We distributed 74 surveys, and 69 were completed (93%). Attitudes toward naloxone distribution from the ED were positive, with 72% of respondents reporting they were "very" or "extremely" supportive of distributing naloxone kits to individuals at risk of overdose. While attitudes were positive, barriers included limited time, lack of system support, and cost. Level of comfort in caring for patients with OUD was high, with 78% of respondents "very" or "extremely" comfortable. More education is needed on overdose education and naloxone distribution (OEND) with respondents 38% and 45% "a little" or "somewhat" comfortable, respectively. Nurses with <5years of experience reported receiving more training on OEND in nursing school compared to those with ≥6years of experience (P = 0.03). There were no significant differences in reported attitudes, knowledge, or comfort in caring for patients with OUD. In this single-center survey, we found ED nurses were supportive of overdose education and naloxone distribution. There are opportunities for targeted education and addressing systemic barriers to OEND. All interventions should be evaluated to gauge impact on knowledge, attitudes, and behaviors.

Background: Stigma has been identified as a complex and problematic issue. It acts as a major barrier to accessing care and can exacerbate the experience of a health condition, particularly for clients with mental illness. Research on the attitudes of health care providers towards people with mental illness has repeatedly shown that they may be stigmatizing. The aim of the study is to identify factors associated with stigmatization of mental illness among Healthcare providers and to determine the nature of stigma present in different professional group. Method: The investigation was a descriptive and cross-sectional study on a stratified and randomly selected sample population of 308 Health workers at the Jos University Teaching Hospital. Questionnaires were used to elicit responses from the respondents, using the Community Attitudes towards the Mentally Ill (CAMI) scale, Results: The present study revealed that male gender, age group (55-64years), professional group (especially laboratory Scientists) and years of clinical experience (especially year 10 and above) were significantly associated with stigmatizing attitude towards mental illness among health care providers at the Jos University Teaching Hospital. Conclusion: Demographic variables such as gender, age, professional group and years of clinical experience can contribute to variations in attitudes towards people with mental illness among health care providers.

ABSTRACTBackground:Dental implants are a widely accepted treatment modality for replacing missing teeth, but their long-term success relies significantly on maintenance protocols. This study aims to evaluate the knowledge, attitudes, and practices (KAP) regarding dental implant maintenance among dental professionals, emphasizing gaps and areas for improvement.Materials and Methods:A cross-sectional questionnaire-based survey was conducted among 200 dental professionals in Maharashtra, India. The self-administered questionnaire consisted of 25 questions divided into three domains: knowledge, attitudes, and practices. Participants were categorized based on their specialization (general dentists, periodontists, prosthodontists, and oral surgeons) and years of clinical experience. Descriptive and inferential statistics were used for data analysis, with a significance level set at P < 0.05.Results:Out of the 200 participants, 80% demonstrated adequate knowledge regarding implant maintenance, with periodontists scoring the highest (90%). Positive attitudes toward the importance of implant maintenance were observed in 70% of the participants. However, only 60% reported routinely incorporating implant maintenance protocols into practice. Common barriers included lack of time (40%) and inadequate patient awareness (35%). A significant association was observed between years of clinical experience and adherence to implant maintenance protocols (P = 0.03).Conclusion:The study highlights a disparity between knowledge and practice regarding dental implant maintenance among dental professionals. While knowledge levels are commendable, practical application requires reinforcement. Focused training and awareness programs can bridge this gap, enhancing patient outcomes.

Use and perceived benefits of mobile devices by physicians in preventing adverse drug events in the nursing home.

As medical technology advances, physicians' responsibilities in clinical practice continue to increase, with medical history documentation becoming an essential component. Artificial Intelligence (AI) technologies, particularly advances in Natural Language Processing (NLP), have introduced new possibilities for medical documentation. This study aims to evaluate the efficiency and quality of medical history documentation by ChatGPT-4o compared to resident physicians and explore the potential applications of AI in clinical documentation. Using a non-inferiority design, this study compared the documentation time and quality scores between 5 resident physicians from the hematology department (with an average of 2.4 years of clinical experience) and ChatGPT-4o based on identical case materials. Medical history quality was evaluated by two attending physicians with over 10 years of clinical experience using ten case content criteria. Data were analyzed using paired t-tests and Wilcoxon signed-rank tests, with Kappa coefficients used to assess scoring consistency. Detailed scoring criteria included completeness (coverage of history elements), accuracy (correctness of information), logic (organization and coherence of content), and professionalism (appropriate use of medical terminology and format), each rated on a 10-point scale. In terms of medical history quality, ChatGPT-4o achieved an average score of 88.9, while resident physicians scored 89.6, with no statistically significant difference between the two (p = 0.25). The Kappa coefficient between the two evaluators was 0.82, indicating good consistency in scoring. Non-inferiority testing showed that ChatGPT-4o's quality scores fell within the preset non-inferiority margin (5 points), indicating that its documentation quality was not inferior to that of resident physicians. ChatGPT-4o's average documentation time was 40.1 s, significantly shorter than the resident physicians' average of 14.9 min (p < 0.001). While maintaining quality comparable to resident physicians, ChatGPT-4o significantly reduced the time required for medical history documentation. Despite these positive results, practical considerations such as data preprocessing, data security, and privacy protection must be addressed in real-world applications. Future research should further explore ChatGPT-4o's capabilities in handling complex cases and its applicability across different clinical settings.

749 Background: Presentation of rectal cancer cases at a multidisciplinary tumor conference (MTC) is a required standard for the newly formed National Accreditation Program for Rectal Cancer. However, its impact on clinical decision-making remains incompletely defined. Our aim was to determine the frequency and manner in which MTC changed the management of patients with rectal cancer at a tertiary academic center. Methods: All rectal cancer cases presented at the weekly Colorectal Cancer MTC between July 2015 and June 2016 at a single institution were prospectively included. Patient demographics and clinical information were recorded. The presenting physician completed a uniform written questionnaire outlining their plan before and after the MTC discussion, and any changes in management as a result of the discussion. Imaging and pathology were reviewed for each case at MTC and consistency with prior interpretation was recorded. Results: 234 unique initial rectal cancer cases were included. Survey responses were obtained for 212 cases (90.6%). The mean patient age was 58.3 years. 37 patients (15.8%) presented with Stage IV disease and 20 (9.4%) had locally recurrent cancer. There was a documented change in plan as a result of the MTC discussion in 70 of 212 (33%) cases surveyed, including 22 cases (10.4%) in which the presenting physician had a “definitive plan” prior to the MTC. Changes in management included a change in therapy or change in therapy sequence in 45 cases (64%), and recommendation of further evaluation in 26 cases (37%). Change in management following MTC did not vary by surgeon experience: it occurred in 31.4%, 37.2% and 29.8% of cases presented by surgeons with &lt; 10, 10-20, and ≥ 20 years of experience respectively (Chi-square p= 0.71). The imaging or pathology review at MTC resulted in a different interpretation than previously reported in 23% and 12% of cases, respectively. Conclusions: MTC changes clinical management for a significant portion of rectal cancer patients at a tertiary care center, independent of the presenting surgeons’ years of clinical experience. Our results highlight the utility of multidisciplinary rectal cancer care and support the MTC standard for the National Accreditation Program for Rectal Cancer.

THU0598 Dissemination and Evaluation of the Eular Recommendations for the Role of the Nurse in the Management of Chronic Inflammatory Arthritis

The development of the 'frameless' intrauterine system (IUS) is a response to the growing need to develop high-performing, long-acting, reversible, and acceptable contraceptives with a high continuation of use. This is a review of 15 years of clinical experience in randomized controlled and non-randomized clinical trials. The IUS has a similar failure rate as the TCu380A Intrauterine device (IUD), considered the 'golden standard' IUD, which is attributed to the optimal target delivery of the copper ions in the upper part of the uterine cavity. Its performance is further optimized by the atraumatic design, which reduces partial and total expulsion and minimizes the side-effects and discomforts experienced with conventional 'framed' IUDs. The mini IUS is likely to further reduce the menstrual blood loss due to the very small size. The safety of the anchoring concept is beyond doubt as was demonstrated in all clinical studies covering 15,000 woman-years experience. Young nulliparous/nulligravid and parous women may significantly benefit from the advantages the 'frameless' IUS, which could be strategically important to help in reducing the increasing number of unintended pregnancies and induced abortions worldwide. Furthermore, the 'frameless' IUS has been shown to be highly effective for emergency contraception and for immediate postabortal insertion. The long lifespan of the IUS could constitute a cost-effective reversible alternative to irreversible female sterilization.