Decision support systems for antibiotic prescription in hospitals: a survey with hospital managers on factors for implementation.

BACKGROUND: Inappropriate antimicrobial use, such as antibiotic intake in viral infections, incorrect dosing and incorrect dosing cycles, has been shown to be an important determinant of the emergence of antimicrobial resistance. Artificial intelligence-based decision support systems represent a potential solution for improving antimicrobial prescribing and containing antimicrobial resistance by supporting clinical decision-making thus optimizing antibiotic use and improving patient outcomes. OBJECTIVE: The aim of this research was to examine implementation factors of artificial intelligence-based decision support systems for antibiotic prescription in hospitals from the perspective of the hospital managers, who have decision-making authority for the organization. METHODS: An online survey was conducted between December 2022 and May 2023 with managers of German hospitals on factors for decision support system implementation. Survey responses were analyzed from 118 respondents through descriptive statistics. RESULTS: Survey participants reported openness towards the use of artificial intelligence-based decision support systems for antibiotic prescription in hospitals but little self-perceived knowledge in this field. Artificial intelligence-based decision support systems appear to be a promising opportunity to improve quality of care and increase treatment safety. Along with the Human-Organization-Technology-fit model attitudes were presented. In particular, user-friendliness of the system and compatibility with existing technical structures are considered to be important for implementation. The uptake of decision support systems also depends on the ability of an organization to create a facilitating environment that helps to address the lack of user knowledge as well as trust in and skepticism towards these systems. This includes the training of user groups and support of the management level. Besides, it has been assessed to be important that potential users are open towards change and perceive an added value of the use of artificial intelligence-based decision support systems. CONCLUSION: The survey has revealed the perspective of hospital managers on different factors that may help to address implementation challenges for artificial intelligence-based decision support systems in antibiotic prescribing. By combining factors of user perceptions about the systems´ perceived benefits with external factors of system design requirements and contextual conditions, the findings highlight the need for a holistic implementation framework of artificial intelligence-based decision support systems.

[Factors influencing the implementation of AI-based decision support systems for antibiotic prescription in hospitals: a qualitative analysis from the perspective of health professionals]. / Faktoren für die Implementierung von KI-basierten Entscheidungsunterstützungssystemen zur Antibiotikavorhersage im Krankenhaus ­ eine qualitative Analyse aus der Perspektive von ärztlichem Personal.

BACKGROUND: Decision support systems based on artificial intelligence might optimize antibiotic prescribing in hospitals and prevent the development of antimicrobial resistance. The aim of this study was to identify impeding and facilitating factors for successful implementation from the perspective of health professionals. METHODS: Problem-centered individual interviews were conducted with health professionals working in hospitals. Data evaluation was based on the structured qualitative content analysis according Kuckartz. RESULTS: Attitudes of health professionals were presented along the Human-Organization -Technology-fit model. Technological and organizational themes were the most important factors for system implementation. Especially, compatibility with existing systems and user-friendliness were seen to play a major role in successful implementation. Additionally, the training of potential users and the technical equipment of the organization were considered essential. Finally, the importance of promoting technical skills of potential users in the long term and creating trust in the benefits of the system were highlighted. CONCLUSION: The identified factors provide a basis for prioritizing and quantifying needs and attitudes in a next step. It becomes clear that, beside technological factors, attention to context-specific and user-related conditions are of fundamental importance to ensure successful implementation and system trust in the long term.

Factors influencing the implementation of decision support systems for antibiotic prescription in hospitals: a systematic review.

BACKGROUND: Antibiotic resistance is a major health threat. Inappropriate antibiotic use has been shown to be an important determinant of the emergence of antibiotic resistance. Decision support systems for antimicrobial management can support clinicians to optimize antibiotic prescription. OBJECTIVE: The aim of this systematic review is to identify factors influencing the implementation of decision support systems for antibiotic prescription in hospitals. METHODS: A systematic search of factors impeding or facilitating successful implementation of decision support systems for antibiotic prescription was performed in January 2022 in the databases PubMed, Web of Science and The Cochrane Library. Only studies were included which comprised decision support systems in hospitals for prescribing antibiotic therapy, published in English with a qualitative, quantitative or mixed-methods study design and between 2011 and 2021. Factors influencing the implementation were identified through text analysis by two reviewers. RESULTS: A total of 14 publications were identified matching the inclusion criteria. The majority of factors relate to technological and organizational aspects of decision support system implementation. Some factors include the integration of the decision support systems into existing systems, system design, consideration of potential end-users as well as training and support for end-users. In addition, user-related factors, like user attitude towards the system, computer literacy and prior experience with the system seem to be important for successful implementation of decision support systems for antibiotic prescription in hospitals. CONCLUSION: The results indicate a broad spectrum of factors of decision support system implementation for antibiotic prescription and contributes to the literature by identifying important organizational as well as user-related factors. Wider organizational dimensions as well as the interaction between user and technology appear important for supporting implementation.

Sialylations reactions: Expanding the effect of silicon protecting groups at C-4.

As a part of a general research goal into evaluating the effect of O-protecting groups in sialylation reactions, we compared the reactivities of phenylthio α- and ß-sialyl donors protected at C-4 with tert-butyldimethyl silyl (TBDMS) and tri-isopropylsilyl (TIPS) groups in the coupling with primary and secondary galactosyl acceptors. The effect of the solvent and the donor's anomeric configuration were investigated and compared to previously published data. It is demonstrated that silicon groups at C-4 have a significant influence on sialylation reactions, and in general their overall performance is optimized with the use of acetonitrile.

Digital Health Interventions in Depression Care-A Survey on Acceptance from the Perspective of Patients, Their Relatives and Health Professionals.

Digital health interventions may contribute to closing the treatment gap for depression by reaching large populations at relatively low costs. This article presents the results of a broad, multisided German survey in 2020 on the acceptance and use of digital health interventions in depression care from the perspective of patients, their relatives, and health professionals. A total of 97 patients and relatives and 229 health professionals participated. Survey participants reported openness towards the use of digital health interventions in depression care but little knowledge and experience in the field. Digital health interventions appear to be a promising opportunity for reducing depressive symptoms and shortening waiting time for depression treatment, especially in rural areas. Providing information and technical competencies may increase awareness and knowledge about digital health interventions and the benefits of depression care.

[Acceptance of Digital Health Interventions in Light to Moderate Depressive Disorders - A Qualitative Analysis from the Perspective of Affected Persons, Relatives and Health Professionals]. / Akzeptanz von digitalen Gesundheitstechnologien bei leichter bis mittelgradiger Depression ­ Eine qualitative Analyse aus der Perspektive von Betroffenen, Angehörigen und Leistungserbringern.

OBJECTIVE: User acceptance of digital health interventions in light to moderate depressive disorders has been rudimentarily researched and is examined in this study. METHODS: Problem-centered individual interviews were conducted with 3 affected persons, 3 relatives and 13 health care professionals. The data evaluation was based on the structured qualitative content analysis. RESULTS: Along the Unified Theory of Acceptance and Use of Technology attitudes of affected persons, relatives and health care professionals were presented. Expectations of performance and the supportive framework conditions were the most significant influencing predictors for the positive intention to use. CONCLUSION: The results provide a basis for prioritizing needs and attitudes in next step. In terms of ethical, sustainable and economical use further research on user acceptance is required.

Digital Health Interventions in Prevention, Relapse, and Therapy of Mild and Moderate Depression: Scoping Review.

BACKGROUND: Depression is a major cause for disability worldwide, and digital health interventions are expected to be an augmentative and effective treatment. According to the fast-growing field of information and communication technologies and its dissemination, there is a need for mapping the technological landscape and its benefits for users. OBJECTIVE: The purpose of this scoping review was to give an overview of the digital health interventions used for depression. The main goal of this review was to provide a comprehensive review of the system landscape and its technological state and functions, as well as its evidence and benefits for users. METHODS: A scoping review was conducted to provide a comprehensive overview of the field of digital health interventions for the treatment of depression. PubMed, PSYNDEX, and the Cochrane Library were searched by two independent researchers in October 2020 to identify relevant publications of the last 10 years, which were examined using the inclusion and exclusion criteria. To conduct the review, we used Rayyan, a freely available web tool. RESULTS: In total, 65 studies were included in the qualitative synthesis. After categorizing the studies into the areas of prevention, early detection, therapy, and relapse prevention, we found dominant numbers of studies in the area of therapy (n=52). There was only one study for prevention, 5 studies for early detection, and 7 studies for relapse prevention. The most dominant therapy approaches were cognitive behavioral therapy, acceptance and commitment therapy, and problem-solving therapy. Most of the studies revealed significant effects of digital health interventions when cognitive behavioral therapy was applied. Cognitive behavioral therapy as the most dominant form was often provided through web-based systems. Combined interventions consisting of web-based and smartphone-based approaches are increasingly found. CONCLUSIONS: Digital health interventions for treating depression are quite comprehensive. There are different interventions focusing on different fields of care. While most interventions can be beneficial to achieve a better depression treatment, it can be difficult to determine which approaches are suitable. Cognitive behavioral therapy through digital health interventions has shown good effects in the treatment of depression, but treatment for depression still stays very individualistic.

Large check size pattern reversal visual evoked potentials - Full and sectorial field stimulation in multiple sclerosis and controls.

Pattern reversal visual evoked potentials have been used to study optic neuritis. Although smaller check size in the central fields are more sensitive, larger check sizes can be advantageous for patient fixation and in poor vision. We compared sectorial central and peripheral hemisurround stimulus with commonly used full- and half- field stimulus using large check sizes (65') in the context of optic neuritis and multiple sclerosis. Of 19 female and 16 male control subjects studied, females had shorter P100 latencies and larger amplitudes than males. In 9 of the 18 patients with VEP abnormalities, the central field abnormalities were greater than those recorded with the full field response. The results confirm for the first time that central field stimulation using large checks can show a greater extent of abnormality than can be appreciated with large check full field stimulation alone, and could be commonly employed to improve yield in the investigation of optic neuritis. The data suggest that it is necessary to collect separate gender-specific laboratory normal values using this check size.

Refugee students' perspectives on inclusive and exclusive school experiences in Austria.

This paper examines refugee students' experiences in the Austrian mainstream school system. It highlights four areas: school connectedness, social exclusion, support systems and friendships. In the study, 55 refugee students between 8 and 21 years old enrolled in primary and secondary education participated in a semi-structured interview. Data were analysed with directed qualitative content analysis, whereby codes were created deductively and inductively. Students stressed the importance of schooling in order to prosper in the future, particularly through language acquisition. Peers and bilingual teachers played an important role in their efforts to learn German and develop feelings of belonging in the school system. While language acquisition was important for the students, they indicated that other support measures (i.e., remedial education) were largely absent. Further, half of the students reported bullying experiences (verbal, social and physical) associated with their refugee status, language proficiency and religious affiliation. This study has implications for school professionals. The scope of support refugee students receive at school must be broadened, forced migration should be addressed in school in order to counteract negative effects of bullying students receive due to their refugee status and school connectedness can be promoted by hiring staff from diverse cultural backgrounds.

Thermal quantitative sensory testing: a study of 101 control subjects.

Quantitative sensory testing is useful for the diagnosis, confirmation and monitoring of small fibre neuropathies. Normative data have been reported but differences in methodology, lack of age-specific values and graphical presentation of data make much of these data difficult to apply in a clinical setting. We have collected normative age-specific thermal threshold data for use in a clinical setting and clarified other factors influencing reference values, including the individual machine or operator. Thermal threshold studies were performed on 101 healthy volunteers (21-70 years old) using one of two Medoc Thermal Sensory Analyser II machines (Medoc, Ramat Yishai, Israel) with a number of operators. A further study was performed on 10 healthy volunteers using both machines and one operator at least 3 weeks apart. Thermal threshold detection increases with age and is different for different body regions. There is no significant difference seen in results between machines of the same make and model; however, different operators may influence results. Normative data for thermal thresholds should be applied using only age- and region-specific values and all operators should be trained and strictly adhere to standard protocols. To our knowledge, this is the largest published collection of normal controls for thermal threshold testing presented with regression data which can easily be used in the clinical setting.

Axonal excitability in primary amyloidotic neuropathy.

INTRODUCTION: Acquired and hereditary amyloidosis can cause peripheral neuropathy, but the mechanisms by which this occurs have not been established. Threshold tracking techniques allow in vivo assessment of the properties of the axonal membrane and may shed light on pathogenetic mechanisms underlying neuropathic disorders. METHODS: We studied 10 subjects with primary amyloidosis using conventional nerve conduction studies and quantitative sensory, autonomic, and axonal excitability testing of median motor and sensory fibers. RESULTS: As expected, subjects with amyloidosis had evidence of small- and large-fiber neuropathy on conventional testing. There was no significant difference in axonal excitability between subjects and controls apart from the stimulus required to activate sensory fibers. CONCLUSIONS: Amyloid-related neuropathy does not produce a change in membrane potential as either a primary or secondary event. This suggests that ischemia and axonal compression are unlikely mechanisms for the neuropathy.

Impact of New Regulations On Assessing Driving Status (INROADS): a South Australian seizure clinic cohort.

The ability to drive is important to patients and driving restriction often leads to restriction of employment and social opportunities. In March 2012, Austroads released revised Assessing Fitness to Drive Guidelines (AFTDG) with significant changes for drivers with seizures and epilepsy. Our study aimed to assess the impact of the 2012 AFTDG on a Seizure Clinic cohort compared to the previous 2003 AFTDG and an individual's current driving status. We also aimed to quantify the difference in AFTDG interpretation between expert and non-expert doctors. We performed a retrospective observational audit of case notes for all patients managed in a public hospital outpatient Seizure Clinic between 1 March 2010 and 1 March 2012. A total of 142 patients were included in the analysis. Comparison between the 2003 and 2012 AFTDG resulted in reduced eligibility to drive a private vehicle by 2.1% (52.5% versus 50.4%) and commercial vehicle by 2.2% (4.5% versus 2.3%). The proportion of those currently driving against guideline recommendations increased (private 8.8% versus 19%; commercial 50% versus 100%) and the non-expert assessor was more likely to agree with the experts with the 2012 AFTDG. In summary, the 2012 AFTDG has had a measurable impact on driving eligibility in individuals with seizure although it is easier to interpret for non-expert doctors. Greater awareness of the 2012 AFTDG is required to reduce the proportion of patients driving against current recommendations.