Journal of evaluation in clinical practiceSamuel Atiku, Olufisayo Olakotan
BACKGROUND: The integration of ambient artificial intelligence (AI) scribes into the OpenNotes environment presents a profound governance crisis in healthcare. While patient access to medical records was designed as a transparency reform, the introduction of machine-generated text introduces novel vulnerabilities regarding record integrity, liability, and patients' trust. OBJECTIVE: This study investigates how clinicians discursively negotiate the systemic risks and accountability challenges of patient-facing, AI-assisted documentation. METHODS: Employing a netnographically informed qualitative design, the research conducted a reflexive thematic analysis of 484 relevant comments across 120 threads from eight clinician-oriented subreddits spanning October 2020 to February 2026. RESULTS: The analysis revealed five distinct governance challenges. First, an accountability vacuum exists where the mandatory clinician signature functions merely as a legal shock absorber for institutional AI liability. Second, clinicians frame AI hallucinations as a mathematically inevitable epistemic risk rather than a correctable technical bug. Third, a "dual-audience" problem emerges, as algorithmic optimization compromises both the individual clinical voice needed for peer communication and the empathetic clarity required for patient readers. Fourth, existing privacy frameworks are structurally inadequate to manage commercial data extraction during patient encounters. Finally, institutional productivity demands and AI-driven over-documentation severely threaten the fiscal credibility of the medical record through inadvertent upcoding. CONCLUSIONS: The prevailing regulatory assumption-that a physician's digital signature combined with passive patient visibility guarantees documentation accountability-is a fragile fiction. To protect clinical truth, health systems must transition from models of passive disclosure toward contingent transparency. This requires establishing authoritative, enforceable mechanisms for provenance tracking, error contestation, and vendor accountability.
Journal of evaluation in clinical practiceFilippo Raggini, Alberto Vassallo
BACKGROUND: Informed consent is a cornerstone of modern medicine, yet the extent to which patients truly understand surgical information in the perioperative setting remains uncertain, particularly among older and vulnerable populations. Orthopaedic surgery represents a particularly challenging context, as trauma pathways are often characterized by urgency, pain, and emotional stress, whereas elective procedures allow greater opportunity for structured communication. AIMS: To assess real-time patient comprehension of surgical informed consent immediately before orthopaedic surgery and to compare understanding between elective and trauma pathways. METHODS: We conducted a prospective observational study at a single tertiary referral hospital in Northern Italy between January 2023 and December 2024. Approximately 870 adult orthopaedic surgical patients were screened for eligibility. After exclusion of patients with cognitive impairment, severe psychiatric illness, language barriers, refusal to participate, or incomplete questionnaires, 750 consecutive patients were included in the final analysis (460 elective, 290 trauma). All patients had received standard preoperative explanations and completed institutional informed consent procedures. In routine clinical practice, consent discussions generally involved both an orthopaedic resident and the supervising attending surgeon. Comprehension was assessed immediately before transfer to the operating room using a brief standardized four-item tool evaluating understanding of the planned procedure, risks, benefits, and therapeutic alternatives. Responses were independently categorized as absent, vague/partial, or adequate. RESULTS: Overall, 488 patients (65.1%) demonstrated absent comprehension, 188 (25.1%) vague or partial comprehension, and only 74 (9.9%) adequate comprehension. Trauma patients showed significantly lower overall comprehension than elective patients, with fewer patients demonstrating at least partial comprehension (28.3% vs. 39.1%; p = 0.003). Adequate comprehension remained low in both groups (8.3% vs. 10.9%; p = 0.30). Older age and lower educational attainment were associated with poorer comprehension in exploratory analyses. Mean questionnaire completion time was 3.5 ± 1.2 min. DISCUSSION: Despite repeated explanations and signed consent forms, most patients entered the operating room without meaningful understanding of the planned procedure, risks, benefits, or alternatives. The observed deficit was present in both elective and trauma settings, suggesting a systemic limitation of routine consent processes rather than solely a physician-specific communication issue. CONCLUSIONS: Informed consent in orthopaedic surgery frequently fails to ensure patient comprehension. Consent should be reframed as a dynamic verification process rather than a purely administrative requirement, incorporating structured communication pathways, simplified language, and teach-back-based strategies tailored to both elective and trauma settings.
Journal of evaluation in clinical practiceAkemi Hara, Masanori Ueda, James Larkin, Keita Shimizu, Michioki Endo, Hiroaki Saito, Tetsuya Tanimoto, Akihiko Ozaki
BACKGROUND: Financial ties between healthcare professionals and the medical-device industry raise conflict-of-interest and transparency concerns; despite Japan's 2012 self-regulatory guidelines, device-related payments receive less scrutiny than pharmaceutical payments globally, including in Japan. OBJECTIVE: To provide the first detailed analysis of honoraria from medical device companies to Japanese physicians in 2019, offering a baseline before the COVID-19 pandemic. METHODS: We retrospectively examined 2019 payment data from the Yen for Docs database, compiled from disclosures by 118 companies affiliated with the Japan Medical Devices Network and other major firms. The analysis focused on honoraria-lecture, consulting, and writing fees-because these are the only categories disclosed with individual healthcare professionals names. Payments were standardized, cleaned, and aggregated at company and recipient levels. Descriptive analyses identified overall volume, company distribution, and top-earning specialties. RESULTS: In 2019, 66 companies disclosed 60,161 honorarium payments totaling USD 46.0 million. Most funds (66.7%) were lecture fees, followed by consulting (28.8%) and writing (4.5%). Payments were highly concentrated: the top 10 companies accounted for 63.3% of the total, led by Medtronic, Terumo, and Johnson & Johnson. Among 24,434 recipients, 66.1% received less than USD 1,000, while only seven physicians received more than USD 100,000. Cardiologists (48.0%) and cardiovascular surgeons (24.0%) dominated the top 50 earners. CONCLUSION: Honoraria from Japan's device industry were modest in scale compared with pharmaceutical companies but highly concentrated among a few firms and cardiovascular specialists. These findings highlight the need for more comprehensive and legally enforceable transparency frameworks to safeguard clinical integrity and public trust.
Health expectations : an international journal of public participation in health care and health policyKimberly E Kopecky, Jacquelyn E F Speer, Janet Julson, Alizeh Abbas, Olivia Monton, Fabian M Johnston, J Nicholas Odom
BACKGROUND: Despite the central role of expectations in informed consent and surgical shared decision-making, patient expectations frequently remain unelicited or underexplored and are often assumed rather than explicitly addressed. OBJECTIVE: To explore how patients form expectations about high-risk abdominal surgery for cancer and how preoperative expectations influence the experience of surgical recovery and life after surgery. DESIGN: Qualitative study using semi-structured interviews informed by cognitive task analysis and analysed using an abductive thematic framework. SETTING AND PARTICIPANTS: Adults (n = 34) at two U.S. academic hospitals who were either scheduled to undergo, or had recently undergone, high-risk abdominal surgery for cancer; interviews were conducted preoperatively (52.9%) and postoperatively (47.1%). RESULTS: Analysis of the interviews revealed three overarching themes characterising how patients formed, understood, and experienced expectations around high-risk cancer surgery. Theme 1: Origin of Expectations- Expectation development was dynamic, context-dependent, and shaped by multiple information sources. Theme 2: The Complexity of Expectations- Patients varied widely in how much they wanted to know; expectations were often internally inconsistent and frequently conflated with hopes. Theme 3: Contrasting Anticipated and Actual Recovery After Surgery- Postoperative experiences commonly diverged from preoperative expectations, and many patients expressed uncertainty regarding recovery and prognosis, even in medically uncomplicated recoveries. DISCUSSION: The wide variation and inconsistency in patient expectations reflect both the complexity of how patients prepare for high-risk abdominal cancer surgery and their need to navigate uncertainty in ways that align with their individual preferences, values, and tolerance for information. Mismatches between anticipated and actual postoperative experiences underscore the need for structured, patient-centred communication strategies that support realistic preparation for surgical recovery. CONCLUSION: This study provides insight into how patients with cancer form expectations regarding high-risk abdominal surgery and how these expectations shape preparation for the experience of surgical recovery. Expectations were often incomplete, internally inconsistent, and difficult for patients to articulate, contributing to gaps between anticipated and actual recovery. These findings highlight the need for intentional, patient-centred approaches to elicit, clarify, and better align patient and clinician expectations in surgical oncology. Future work should evaluate intervention strategies to support this goal. PATIENT OR PUBLIC CONTRIBUTION: Patients participated in in-depth interviews that form the basis of this study. Caregiver interviews were conducted in parallel as part of a related study but were not included in the present analysis. Patients and/or caregivers were not formally involved in the design of the study or in the analysis of the qualitative data.
Journal of robotic surgeryRobert A Keenan, Dara O Kavanagh, Sorcha O'Meara, Liam M Chadwick, Barry B McGuire, Fardod O'Kelly
Robotic-assisted surgery (RAS) sees over six million procedures performed annually. Malpractice claims involving RAS increased by more than 250% between the periods 2006-2013 and 2014-2021 [1]. Understanding the legal landscape, risk profile, and evidence-based mitigation strategies is critical for all stakeholders. This scoping review aimed to: (1) map medicolegal cases involving RAS; (2) quantify complication incidence (3) characterise general and procedure-specific risks; and (4) synthesise interventions capable of reducing adverse events and litigation exposure. A structured search of PubMed/MEDLINE, EMBASE, the Westlaw legal database and FDA MAUDE was conducted for English-language sources from January 2000 to May 2026 [2]. Included sources reported medicolegal cases, adverse event rates, or human factors interventions in RAS. Sixty-one US malpractice cases were identified with 169 total liabilities claimed, most commonly negligent surgery, misdiagnosis, delayed treatment, and lack of informed consent [1]. Individual indemnity payments averaged $1,251,274. FDA MAUDE data (2000-2013) recorded 144 deaths, 1,391 injuries, and 8,061 device malfunctions across 1.75 million procedures [3]. Overall adverse event rates were 0.0834% [3]. Key modifiable risk factors include cognitive overload, loss of haptic feedback, team communication breakdown, and suboptimal ergonomics [4-7]. Medicolegal risk in RAS is rising but remains concentrated in a small number of procedure types and surgeon-experience brackets. The majority of claims relate to human error rather than device malfunction [1]. Severable actionable risk-reduction strategies such as structured training, governance, simulation-based competency are discussed [6, 8-10]. Adverse event registries and credentialing standards remain urgent legislative priorities.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in CancerGerard Mawhinney, Helen Higham, Simon Leedham, Olaf Ansorge
PURPOSE: Requests for tissue donation for research are often made at times of heightened vulnerability, particularly around diagnosis and surgery. This study explored patient experiences of tissue donation discussions, perspectives on consent, and the acceptability of digital decision support in primary craniospinal tumour research. METHODS: A UK national online cross-sectional survey was conducted with 50 adults with a primary brain tumour or spinal sarcoma. The survey was developed with patient and public involvement; six patient contributors reviewed the initial questionnaire before launch. Descriptive statistics summarised closed responses, and open-text comments were grouped descriptively to contextualise quantitative findings. Reporting was informed by STROBE guidance. RESULTS: Just over half of participants reported being invited to donate tissue for research (26/50, 52%). Respondents strongly preferred tissue donation to be discussed at or after a clinic appointment, and none selected the day of surgery as the preferred time. Among invited respondents, most reported that information was easy to understand (22/26, 85%), that they had an opportunity to ask questions (23/25, 92%), and that they had sufficient time to consider the decision (23/26, 88%). Sixteen of 26 invited respondents (62%) discussed the decision with family or friends; among invited respondents who had not done so, 7/10 (70%) would have liked the opportunity. Interest in a secure digital adjunct was high (46/49, 94%). CONCLUSION: Overall experience was generally positive, but the data identify specific, practical opportunities to strengthen consent support in rare craniospinal tumour pathways, including appropriate timing, clear and revisitable information, opportunities for question-asking, and resources that support family-inclusive decision-making.
MedicineAmer Al Ani, Yusor Al-Nuaimy, Umaima Adnan Ahmed, Zainab Zyara, Alaa Alhawari, Mena Alkubaisi, Ammar Jairoun
Disclosing a cancer diagnosis, particularly to individuals in family-centric cultures, is a complex process that directly impacts patient-centered care. This study explores the factors that influence attitudes toward truth disclosure of a terminal cancer diagnosis in the diverse population of the United Arab Emirates and compares these findings with practices in other nations and regions. A descriptive cross-sectional study was conducted using an online self-administered questionnaire. The questionnaire comprised 4 sections: 9 questions collected demographic data, 6 questions assessed respondents' perceptions regarding the diagnosis of terminal-stage cancer, 7 questions evaluated their perceptions of its prognosis, and 7 questions focused on their views on truth disclosure in terminal-stage cancer. The questionnaire was developed based on existing literature and expert input. The study targeted healthcare providers, as well as all students (undergraduate or postgraduate), faculty members, and staff at universities in the United Arab Emirates. Multivariate logistic regression models were applied to determine the factors influencing participants' attitudes and perceptions. A total of 495 participants were recruited, with 73.7% being female and 26.3% being male. The majority (45.9%) were aged 18 to 24 years. The average attitude scores were 87.8% for the diagnosis of terminal-stage cancer, 85.8% for its prognosis, and 69.7% for truth disclosure to family. Logistic regression analysis showed that female participants had more positive attitudes toward diagnosis (odds ratio [OR] = 1.85; 95% confidence interval [CI]: 1.1-3.1), while participants from the Middle East and North Africa had less positive attitudes toward both diagnosis (OR = 0.653; 95% CI: 0.48-0.87) and prognosis (OR = 0.652; 95% CI: 0.47-0.86). More positive attitudes toward truth disclosure were observed among participants from South Asia (OR = 1.52; 95% CI: 1.25-1.85) and Southeast Asia/Oceania (OR = 2.1; 95% CI: 1.63-2.70), as well as among nurses (OR = 5.15; 95% CI: 2.64-10.03) and Christian participants (OR = 4; 95% CI: 1.02-15.6), whereas single participants exhibited less positive attitudes (OR = 0.560; 95% CI: 0.38-0.82). These results highlight the complex interaction between cultural and demographic factors in determining perceptions of terminal-stage cancer. They emphasize the value of customized treatments and communication techniques to address different points of view, which will ultimately improve patient support and care in situations involving terminal illness.
INTRODUCTION: HIV status disclosure decision-making is a complex process influenced by stigma, relationship dynamics, and anticipated social consequences. Although decision aids can support individuals in navigating such decisions, no disclosure decision-support interventions have been adapted for use in the Georgian context. This study aimed to identify and prioritize an existing evidence-based intervention for adaptation to support HIV disclosure decision-making among people living with HIV (PLWH) in Georgia. METHODS: We used the Nominal Group Technique (NGT), a structured consensus method, to elicit and prioritize stakeholder perspectives. Two separate NGT sessions were conducted with HIV care providers (n = 12) and PLWH (n = 10), followed by a joint session to reach consensus. Prior to the sessions, nine evidence-based disclosure decision-support interventions from HIV, mental health, and substance use fields were identified through a desk review and grouped into session-based, paper-based, and digital formats. Participants generated ideas, discussed advantages and limitations, and ranked intervention formats and specific interventions. Descriptive content analysis was used to summarize discussion themes. RESULTS: Providers prioritized digital interventions, emphasizing accessibility and scalability, whereas PLWH preferred session-based interventions, highlighting the importance of trust, individualized support, and peer involvement. Within these formats, providers favored a structured digital program, while PLWH selected an individual session-based intervention focused on disclosure to family members. Adaptation priorities included incorporating peer educators, addressing disclosure to different social and healthcare contexts, and including locally relevant content on legal issues, treatment adherence, and available support services. In the joint session, consensus was reached to prioritize the intervention selected by PLWH. CONCLUSIONS: This study identified a priority disclosure decision-support intervention for adaptation to the Georgian context, emphasizing the importance of patient-centered and contextually tailored approaches. Future research will focus on adapting the selected intervention and identifying appropriate implementation strategies to support pilot testing and integration into HIV care services.
Proceedings of the National Academy of Sciences of the United States of AmericaZoe A Purcell, Nils Köbis, Andrew Samuel, Jean-François Bonnefon
Prior work using controlled principal-agent experiments suggests two risks from delegating tasks to AI systems: Human principals are more likely to request profit-maximizing misconduct from AI agents than from human agents, and AI agents are more likely to comply. Here we test whether third-party observers can contain the resulting harm. In an incentivized die-reporting paradigm, principals instructed either a human or an AI agent how strongly to prioritize profit over accuracy, creating potential financial harm to a charity. We first confirm, with human principals (N = 600) and three large language models as AI agents, that delegation to AI produces larger negative externalities than delegation to humans. We then study observers who could pay a personal cost to flag a principal's instruction, canceling the principal's gain in favor of the charity, as a laboratory analogue of whistleblowing. In this observer study (N = 300), the probability of flagging increased with how unethical the principal's request was, but did not depend on whether the request was directed to a human or an AI agent. Because principals made more unethical requests under AI delegation, flagging was more frequent under AI delegation. When combined with agent behavior, this increase in flagging fully neutralized the negative externalities of AI delegation in our experimental setting. These findings support institutional protections for whistleblowers as one potential organizational safeguard against the harms of human-AI delegation.
Hernia : the journal of hernias and abdominal wall surgeryKenney Fehrenkamp Pedersen, Martin Frimand Rønnow, Thue Bisgaard
PURPOSE: Economic claims after surgery may be regarded as an alternative surrogate outcome for long-term deprived quality of life. This study reports economic claims of chronic pain following inguinal hernia repair. METHODS: Consecutive data on economic claims following inguinal hernia repair was collected from the nationwide Danish Patient Compensation Association. Patients' claims were stratified into three groups: 1) isolated chronic pain claims without claims of competing potential reasons for chronic pain (ICP); 2) diverse claims not involving claims of chronic pain (NCP); and 3) claims involving a combination of chronic pain and competing potential claim reasons for chronic pain (CCP). RESULTS: A total of 507 patients were included and 256 (50.5%) filed a claim involving chronic pain. Follow-up was 100% and median time from hernia repair to patient filing a claim in the ICP group was 1.5 years (IQR 0.6-2.6 years). ICP, NCP and CCP comprised 172 patients (33.9%), 251 patients (49.5%) and 84 patients (16.6%) respectively. Chronic pain was by far the most common claim reason (33.6% of all claim reasons). The median sum of granted compensation per patient in the ICP, NCP and CCP groups was €14,440 (IQR 7,233-100,600), €6,289 (4,024-12,094) and €7,777 (5,639-11,781) respectively. CONCLUSION: Long-term chronic pain alone, not involving other complications, was by far the most common reason for seeking economic compensation. Economic compensation of isolated chronic pain (ICP) was rare, but when awarded, was substantially higher than compensation for other claims.
The Behavioral and brain sciencesRaihan Alam, Tage Rai
Western punitive justice systems persist despite weak evidence that they reduce crime. We argue that they function as WEIRD cultural superstitions: punishment intuitively feels effective even when it fails. Drawing on Singh's framework, historical evidence of punishment's dominance origins, and our own experiments, we show how subjective selection sustains maladaptive punitive institutions - ultimately raising the question, intuitively effective to whom?
Journal of epidemiology and global healthSamuel Derso Tezera, Belayneh Zelalem, Atsedemariam Nigus Gedamu, Shewatatek Melaku Asefa, Jean Claude Manirambona, Sefinew Alemu Mekonnen, Inne Nauwelaers, Pe…
OBJECTIVE: To understand the dog owners' willingness to pay (WTP) for rabies vaccines to control rabies and influencing factors in selected zones of Amhara region, Ethiopia. METHODS: Questionnaire data were collected from 403 dog owners selected for this purpose. Contingent valuation method was used to evaluate WTP. The interval regression analysis was used to identify factors associated to owners' WTP for rabies vaccine. RESULTS: The majority of dog owners (65%) were WTP for suggested price bid amounts, but some had shown variability when it comes to specific price bid amounts, namely their WTP decreased when the price of the vaccine increased. The mean WTP for rabies vaccine was 38.61 ETB (0.471USD) per year. Government employees were 18.5 (95% CI: 5.55-26.10, P value <0.003) times more likely WTP for rabies vaccine compared to farmers. Respondents who believe that vaccines prevent diseases were 19.5 times more likely to be WTP for rabies vaccine. CONCLUSION: Although majority of dog owners were WTP for rabies vaccine, increasing awareness of the importance of vaccination in disease control and increasing availability of rabies vaccine by low price would increase the chances of controlling rabies through vaccination.
Antibody-Drug Conjugates (ADCs) represent a rapidly evolving, and increasingly important frontier in targeted therapeutics, demanding specialised approaches to development and manufacturing. With a highly complex supply chain, specialist Contract Development and Manufacturing Organisations (CDMOs) play a critical role in ADC development. Increasingly, positive CDMO partnerships with sponsor companies can build competitive advantage in an increasingly innovative and competitive clinical development environment for ADCs. Carefully considered CDMO engagement strategies can be employed to deliver successful outcomes for ADC development and manufacture across the full spectrum of the development life-cycle. This commentary considers early and late-stage ADC development, focusing on the systematic optimisation, technology transfer, and gap analysis essential for robust scale-up and manufacture. Facility design requirements and process modifications are discussed in the context of scalable, cGMP-compliant manufacturing, highlighting the engineering and environmental controls necessary for the safe and efficient handling of ADCs. The discussion will offers insights into the requirements for successful ADC development and manufacture with CDMO partners, while ensuring, regulatory compliance.
Global public healthG Nduku Wambua, Nondumiso Dlamini, Syethemba Nkosi, Thandeka Smith, Mpilonhle Nzuza, Janet Seeley, Alan Stein, Nothando Ngwenya
We examined how adolescents living with HIV in rural KwaZulu-Natal, South Africa, navigate privacy boundaries in disclosure-related issues. We conducted small group discussions with 31 adolescents (aged 16-19 years) recruited from three HIV clinics. Reflexive thematic data analysis was conducted through the lens of communication privacy management theory. Three major themes emerged: (1) ownership and control of private information, in which adolescents demonstrated varying levels of autonomy over their HIV status information, often developing strategies to manage medication discreetly; (2) managing disclosure and privacy boundaries, in which participants developed nuanced privacy rules influenced by stigma, context, and family dynamics; and (3) emotional and social support in disclosure management, highlighting the significant role of support systems in the disclosure process. Overall, participants actively managed privacy boundaries through careful information control, selective disclosure, and strategic coordination with family members and healthcare providers. Our findings show that adolescents in a rural setting actively manage privacy boundaries around their HIV status through well-developed information management strategies. There is a complex interplay between personal agency, family dynamics, and cultural context in shaping disclosure decisions. These insights can provide more effective support interventions for adolescents living with HIV in resource-limited settings.
International journal of medical informaticsAndrea Basualdo Allende, Sarah Sadat Ehsani, Pascal Eber, Aminah Ikram Ullah, Esra Kosan, Nora Saif, Mohadeseh Alimohammadi, Onyeloili Maureen, Filwende Dan Ki…
BACKGROUND: Informed consent (IC) is central to patient autonomy, yet its role in artificial intelligence (AI) for clinical deployment, model development, and secondary data use remains unclear in medicine and dentistry. OBJECTIVES: This review characterised how IC is justified and operationalised for AI; synthesised ethical, legal, governance, and practical requirements; identified gaps in consent models, stakeholders, and AI functionality; and developed author-derived communication thresholds for notification, routine clinical consent with explicit AI disclosure, or AI-specific IC. METHODS: We conducted a PRISMA-ScR-guided scoping review with an OSF-registered protocol. MEDLINE, Scopus, IEEE Xplore, arXiv, Google Scholar, Web of Science, and HeinOnline were searched for English-language sources published 2015 to 25 May 2026. From 6,242 records, 116 reports were assessed; 69 were included, plus one manual source, yielding 70. Data were charted across 24 domains, synthesised, and appraised with JBI tools. RESULTS: Publications peaked in 2024 (22/70, 31.4%). The evidence base was non-empirical: conceptual analyses (37/70, 52.9%) and narrative reviews/book chapters (17/70, 24.3%). Medicine-only sources predominated (60/70, 85.7%); dentistry-only sources accounted for 8/70 (11.4%). Traditional IC appeared alone in 46/70 sources (65.7%) and overall in 52/70 (74.3%); dynamic consent was uncommon (6/70, 8.6%). IC was endorsed in 67/70 (95.7%) and qualified in 40/70 (57.1%). Explainability/transparency was addressed in 65/70 (92.9%), and proposed solutions in 57/70 (81.4%), but formal protocols remained uncommon (6/70, 8.6%). Thresholds consolidated rules by AI application, automation, risk, data use, and patient decision relevance. CONCLUSIONS: AI-related IC is widely endorsed but remains fragmented and largely conceptual. Findings support a risk-adaptive approach to AI-informed consent, calibrated to AI function, automation, risk, data use, explainability, and clinical decision impact. The author-derived thresholds offer a synthesis-informed basis for future governance guidance or framework development, pending empirical and stakeholder validation.
The European journal of general practiceOrlane Pivert, Clémence Loubrieu, Julie Magret, Nicolas Naiditch, Stéphanie Mignot
BACKGROUND: Identifying victims of interpersonal violence remains a challenge for general practitioners, who must rely on subtle clinical cues and foster an environment conducive to disclosure. OBJECTIVES: To describe the symptoms, behaviours, and communication strategies that facilitate the recognition of interpersonal violence in primary care consultations. METHODS: For this qualitative study, general practice consultations by three physicians in the Poitou-Charentes department, France, were audio-recorded from June to September 2019. Adult patients (≥18 years, fluent in French) were included unless they rejected audio recording. Only the audio-recording of consultations during which interpersonal violence was disclosed were analysed following an inductive approach to identify categories and themes until saturation was reached. RESULTS: In total 25/326 patients disclosed experiences of violence. Detection combined verbal cues (vague somatic complaints, ambiguous trauma references) by the patient and open-ended or direct questions by the general practitioners. Techniques included linking symptoms to violence, broad funnel questions, and most effectively, direct queries, such as 'Did someone hurt you?. The three physicians adapted their approach, balancing respect for the patient readiness and clinical conviction, often revisiting the topic from different perspectives. Empathy and a trusted doctor-patient relationship proved crucial for violence disclosure. CONCLUSION: Our findings highlight the value of the physicians' tenacity and empathic attitude for identifying hidden situations of violence, and suggest that integrating these strategies in routine general practice can enhance detection. The findings underscore the need of training physicians in patient-centred communication and suggest future research avenues for refining detection protocols in primary care.
Scandinavian journal of primary health careEmil Johansson, Hálfdán Pétursson, Jörgen Månsson, Lina Maria Ellegård, Gustav Kjellsson
BACKGROUND: Continuity of care is key for high-quality primary care, associated with improved health outcomes, reduced mortality and more efficient use of resources. Achieving relational continuity is challenging in systems with high provider choice and fragmented care-seeking. Sweden exemplifies this tension, combining broad access to primary care and low GP continuity. AIM: To examine how individual characteristics (age, morbidity, socioeconomic status and migration background) and primary care center (PCC) features (ownership, size, physician turnover, patient mix and location) are associated with relational continuity and to contrast within-PCC continuity with total continuity systemwide. DESIGN AND SETTING: Retrospective cohort study using linked administrative register data covering all in-person physician contacts in primary care for 1.4 million residents in Region Skåne, Sweden. METHOD: Continuity of Care Index (CoCI) was measured using all primary care physician visits over 36-months. Linear regression models estimated associations between individual and PCC characteristics and continuity, adjusting for individual- and PCC-level covariates. RESULTS: The characteristics most strongly associated with higher continuity were low physician turnover, older age, chronic conditions, smaller PCC size and private ownership. Individuals with higher education, higher income and foreign background had lower total continuity. Differences in continuity were more strongly associated with PCC characteristics than with patient characteristics. CONCLUSION: Relational continuity in Swedish primary care is associated primarily with organizational factors, particularly physician turnover and practice size. Fragmented care-seeking among specific groups, especially individuals born outside the Nordic countries, contributes to lower total continuity but does not reflect weaker patient-provider relationships within PCCs.
BACKGROUND: Reporting suspected child sexual abuse (CSA) to law enforcement (LE) is a complex process for professionals working with children. Existing research indicates that both individual (e.g., self-efficacy) and institutional factors (e.g., trust in and collaboration with authorities) influence reporting behaviour, but their specific roles in this context remain underexplored. OBJECTIVE: This study investigates how CSA-specific self-efficacy and trust in LE predict German professionals' attitudes toward reporting suspected CSA, how these concepts interdepend and whether these relationships vary across key professional groups. PARTICIPANTS AND SETTING: An online survey was completed by 608 professionals in Germany, including school personnel, child protection professionals and LE. METHODS: Participants completed validated scales measuring CSA-specific self-efficacy and trust in LE in cases of CSA. Logistic and linear regression analyses examined differences in reporting attitudes between professional groups and tested the predictive role of self-efficacy and trust on willingness to report suspected CSA to LE. RESULTS: Teachers showed significantly higher odds of endorsing mandatory reporting than child protection professionals. Trust in LE was strongly associated with higher odds of reporting (OR ∼ 4.0), whereas CSA-specific self-efficacy did not independently predict reporting when controlling for trust and professional group membership. Self-efficacy did not mediate the trust-reporting relationship. CONCLUSIONS: Institutional trust appears to be a critical determinant of CSA reporting attitudes among professionals, exceeding the influence of self-efficacy. Efforts to enhance collaboration and perceptions of fairness and competence within law enforcement may strengthen reporting behaviour and improve systemic responses to CSA.
Patient education and counselingMunita Kaur, Chin Hai Teo, Muhammad Alieff Isqandar Jefnee, Sharon Kaur, Mark Kiak Min Tan, Thangaraj Munusamy, Tan Fong Ang, Dharmendra Ganesan
OBJECTIVES: While innovations such as smartphones and dedicated applications enable patients to record their clinical consultations, concerns about legal implications and privacy continue to influence healthcare providers' willingness to adopt these practices. This systematic review examines healthcare providers' perspectives on the digital recording of clinical consultations, amid ongoing concerns about the legal, privacy, organisational, and workflow implications of such recordings. METHODS: We followed the PRISMA guidelines and included qualitative, quantitative, and mixed-methods studies. Eligible studies were identified through database searches (PubMed, EBSCO, Web of Science, Scopus), backwards reference mining, and expert consultations. Qualitative data were synthesised using the best-fit framework, and quantitative data were compiled and reported descriptively without meta-analysis due to study heterogeneity. RESULTS: Of 6633 records retrieved, 4307 were screened, and 22 studies met the inclusion criteria. The thematic synthesis revealed five key themes: (1) provider attitudes toward consultation recording, (2) impact on patient care, (3) workflow and resource concerns, (4) legal and policy considerations, and (5) implementation strategies. Acceptance levels for consultation recordings among providers ranged from 18.7% to 95.4% (n = 8). Higher acceptance was associated with confidence in the perceived benefits of recordings for communication and patient care, whereas legal, organisational, and workflow concerns often drove resistance. CONCLUSIONS: Healthcare providers are divided and hold mixed attitudes regarding the acceptance of consultation recordings. Acceptance appears to be influenced by contextual, professional, and organisational considerations, whereas scepticism is frequently associated with legal uncertainty and workflow concerns. Consideration of these factors is important when evaluating the integration of digital consultation recording into routine clinical practice. Further research is needed to explore provider perspectives in diverse healthcare settings. PRACTICE IMPLICATIONS: These findings may inform institutional policy development and guide organisational and policy efforts to integrate consultation recording into clinical practice, taking into account providers' concerns and organisational readiness.
Clinical oncology (Royal College of Radiologists (Great Britain))K Yip, H Johnson, J Wang, A Ghose, N Thavanesan, A Khattak, P Yoong, J Conibear, C Harrison, M Thillai, S K Aggarwal, C Johnson, T Underwood, T Sharpe, T Roque…
There has been mounting pressure on cancer multidisciplinary team (MDT) meetings due to increasing case volumes. Efforts to streamline MDT workflows over the past decade have not resulted in substantial change. Artificial intelligence (AI)-driven technologies are being increasingly deployed across the healthcare sector. Their application in MDT decision-making, especially in reducing preparation time, triaging cases, and enhancing the consistency and evidence-based nature of clinical recommendations, remains an area of active research. However, important considerations such as medicolegal liability, as well as patient acceptance and informed consent, must be addressed before widespread adoption into routine clinical practice is realised.