Predicting Health Care Providers' Acceptance of a Personal Health Record Secure Messaging Feature.

BACKGROUND: Personal health records (PHRs) can facilitate patient-centered communication through the secure messaging feature. As health care organizations in the Kingdom of Saudi Arabia implement PHRs and begin to implement the secure messaging feature, studies are needed to evaluate health care providers' acceptance. OBJECTIVE: The aim of this study was to identify predictors of health care providers' behavioral intention to support the addition of a secure messaging feature in PHRs using an adapted model of the Unified Theory of Acceptance and Use of Technology as the theoretical framework. METHODS: Using a cross-sectional survey design, data on acceptance of secure messaging features in PHRs were collected from health care providers working at the Ministry of National Guard Health Affairs between April and May 2021. The proposed model was tested using partial least squares structural equation modeling in SmartPLS. RESULTS: There were 224 participants: female (66.5%), 40 to 49 years of age (39.9%), nurses (45.1%), and those working more than 10 years in the organization (68.8%). Behavioral intention to support the addition of a secure messaging feature was significantly influenced by performance expectancy (ß = 0.21, p = 0.01) and attitude (ß = 0.50, p < 0.01), while other predicting factors, such as effort expectancy, social influence, and facilitating condition, did not significantly affect the intention. Furthermore, age, years of experience, and professional role did not moderate the relationships. CONCLUSION: Health care professionals will support introducing a secure messaging feature in the PHRs if they serve the intended purpose. Considering attitude also plays a significant role in acceptance, it is necessary to arrange for training and support, so that caregivers, health care providers, and the patients become familiar with the benefits and expected outcomes of using the feature.

Acute Kidney Injury in Pediatric Treated with Vancomycin and Piperacillin-Tazobactam in Tertiary Care Hospital.

BACKGROUND: Vancomycin and piperacillin-tazobactam (PTZ) are commonly used as empirical therapy for patients with health care associated infections. Vancomycin has been recognized as a nephrotoxic agent and in a few cases in the literature PTZ has been associated with interstitial nephritis nevertheless; the combination of these agents has routinely been used for many years. However, there have been some observational studies that showed high rates of acute kidney injury (AKI) in patients receiving vancomycin and PTZ concomitant treatment compared to patients receiving vancomycin alone. The incidence of AKI in adult patients receiving vancomycin and PTZ concomitant treatment was reported in these studies to be relatively high. Similar studies in pediatric patients are lacking. METHOD: We conducted a single center retrospective chart review of 248 pediatric patients receiving one of the following treatments: vancomycin alone 36 patients, vancomycin/PTZ 62 patients, vancomycin/ceftazidime 99 patients, and vancomycin/ceftriaxone 51 patients. RESULT: Our results showed a low incidence of AKI in patients on vancomycin/PTZ concomitant treatment where overall incidence was only (4.8%) three cases and only one of them (2.0%) in a patient receiving the vancomycin/ceftriaxone concomitant treatment. No cases of AKI present in patients receiving vancomycin with ceftazidime or vancomycin alone. There were no statistically significant differences between the four treatment groups in terms of AKI incidence, vancomycin trough, and use of nephrotoxins. CONCLUSION: Overall, the incidence of AKI was low in our study sample with no statistically significant increased risk when PTZ was used in combination with vancomycin in a pediatric population. However, further investigation with an equal larger sample size is needed to confirm our findings.