A Consensus-Based Checklist for Reporting of Survey Studies (CROSS)

Post-stroke lateropulsion in Australia and New Zealand: a survey investigating current knowledge, priorities and practice

BACKGROUND

Post-stroke lateropulsion is prevalent and associated with poor rehabilitation outcomes, but evidence to guide rehabilitation of affected stroke survivors is limited. Current post-stroke lateropulsion rehabilitation practice across Australia and New Zealand has not been previously described.

OBJECTIVES

This study aimed to describe lateropulsion rehabilitation practice in Australia and New Zealand, determine clinicians,' educators' and researchers' opinions about the need for educational resources to guide best-practice, and to identify current barriers to, and enablers of, optimal rehabilitation delivery.

METHODS

This cross-sectional survey was distributed to stroke rehabilitation clinicians, educators and researchers across Australia and New Zealand using Qualtrics. Data were described using frequency distributions and Chi-squared tests. Responses to open-ended questions were summarized for reporting.

RESULTS

The final analyses included 127 surveys. Most participants (93%) were physiotherapists. The importance of identifying and assessing post-stroke lateropulsion was noted by 97.6% of participants; however routine lateropulsion assessment was reported by only 60.6% of respondents. About 93.6% of participants indicated that lateropulsion should be targeted as a rehabilitation priority. Limitations in knowledge and skill among clinicians and insufficient evidence to guide rehabilitation were noted as barriers to best-practice rehabilitation delivery. Most respondents (95.2%) indicated that lateropulsion management should be included in stroke rehabilitation guidelines.

CONCLUSIONS

A sample of clinicians, educators, and researchers involved in stroke rehabilitation across Australia and New Zealand have indicated that lateropulsion should be targeted as a rehabilitation priority. Knowledge and skill were identified as barriers to best-practice rehabilitation implementation, which could be improved by addressing lateropulsion in clinical practice guidelines.

Ethics and trustworthiness of artificial intelligence in Hepato-Pancreato-Biliary surgery: a snapshot of insights from the European-African Hepato-Pancreato-Biliary Association (E-AHPBA) survey

BACKGROUND

Hepato-Pancreato-Biliary (HPB) surgery is a complex specialty and Artificial Intelligence (AI) applications have the potential to improve pre- intra- and postoperative outcomes of HPB surgery. While ethics guidelines have been developed for the use of AI in clinical surgery, the ethical implications and reliability of AI in HPB surgery remain specifically unexplored.

METHODS

An online survey was developed by the Innovation Committee of the E-AHPBA to investigate the current perspectives on the ethical principles and trustworthiness of AI in HPB Surgery among E-AHPBA membership. The survey consisted of 22 questions, based on guidelines outlined by the Artificial Intelligence Surgery Journal Task Force on AI Ethics in clinical surgery and was disseminated via email to all E-AHPBA members.

RESULTS

A total of 84 members of the E-AHPBA participated in the survey. Seventeen out of 22 questions achieved more than 80 % agreement, with nine of those exceeding 90 %. Five questions had agreement levels between 70 % and 80 %.

CONCLUSION

While HPB surgeons are aware of the need to regulate the use of AI devices, robots, and to protect patient data, consensus appears to be heterogeneous regarding AI's role in mitigating gender-related and minority biases, as well as ensuring fairness and equity.

Structure and process of Parkinson's disease rehabilitation in the southern sector of Ghana: A cross-sectional survey

RATIONALE

The structure, process and outcome (SPO) framework has been used to establish that improved structures of care influences an enhanced process of stroke care resulting in improved outcome. Although, both stroke and Parkinson's disease (PD) are neurological conditions that require prolonged period of care and rehabilitation, the SPO framework has not yet been used to describe the existing structures and processes of PD care and rehabilitation in Ghana.

AIMS AND OBJECTIVE

To describe the current structures and processes of PD rehabilitation across the three healthcare levels (primary, secondary and tertiary) in the southern sector of Ghana.

METHOD

An online cross-sectional descriptive survey design was used via REDCap. Fifty-two therapists, including department heads, physiotherapists, occupational therapists and speech and language therapists from seven healthcare facilities were purposefully sampled and invited to complete the survey on structures and processes of PD rehabilitation. Descriptive statistical analysis was performed with SPSS v29.0. Comparative analysis was performed using Pearson's chi-square and Kruskal-Wallis test (H-test) as appropriate. Statistical significance was set at p < 0.05.

RESULTS

Forty-nine (94.2%) responses were received and four incomplete responses were excluded from analysis. Structure of rehabilitation: Most of the participants were physiotherapists (n = 36/45; 80.0%) and tertiary level professionals (n = 31/45; 68.9%). Only physiotherapy service was available across all the healthcare levels. Persons with PD were mostly referred for rehabilitation at Hoehn and Yahr stage III as reported by 55.6% (n = 20/36) of the therapists. Process of rehabilitation: Most therapists treated persons with PD two times weekly (n = 19/33; 57.6%) and on individual basis (n = 29/33; 87.9%). Only 9 (27.2%) and 7 (21.2%) therapists often used clinical guidelines or outcome measures respectively in managing PD and 93.9% of the therapists had no local protocols.

CONCLUSION

The structures and processes needed for PD rehabilitation exist but differ across the healthcare levels and among therapists. Physiotherapy was the most common rehabilitation service available at all levels of healthcare.

Risk-Prediction Models for Clinical Decision-Making in Sarcoma Care: An International Survey Among Soft-Tissue Sarcoma Clinicians

INTRODUCTION

Risk prediction models (RPMs) are statistical tools that predict outcomes on the basis of clinical characteristics and can thereby support (shared) decision-making. With the shift toward personalized medicine, the number of RPMs has increased exponentially, including in multimodal sarcoma care. However, their integration into routine soft-tissue sarcoma (STS) care remains largely unknown. Therefore, we inventoried RPM use in sarcoma care during tumor board discussions and patient consultations as well as the attitudes toward the use of RPMs to support (shared) decision-making among STS clinicians.

MATERIALS AND METHODS

A 29-item survey was disseminated online to members of international sarcoma societies.

RESULTS

This study enrolled 278 respondents. Respectively, 68% and 65% of the clinicians reported using RPMs during tumor board discussions and/or patient consultations. During tumor board discussions, RPMs were used primarily to assess the potential benefits of (neo)adjuvant chemotherapy. During patient consultations, RPMs were used to predict patient prognosis upon request and to assist in decision-making regarding (neo)adjuvant therapies. The reliability of patient risk predicted by RPMs and the absence of guidelines regarding the use of RPMs were identified as barriers. Additionally, some clinicians questioned the applicability of estimates from RPMs to individual patients and expressed concerns about causing unnecessary anxiety when discussing prognostic outcomes.

CONCLUSIONS

Responding STS clinicians frequently use RPMs to support decision-making about (neo)adjuvant therapies. However, they expressed concerns about the applicability of RPM estimates to individual patients and reported challenges in communicating prognostic outcomes with patients. These findings highlight the difficulties clinicians face when integrating RPMs into patient consultations.

Status of Sepsis Care in European Hospitals: Results from an International Cross-Sectional Survey

Rationale: Early detection, standardized therapy, adequate infrastructure, and strategies for quality improvement should constitute essential components of every hospital's sepsis plan. Objectives: To investigate the extent to which recommendations from the sepsis guidelines are implemented and the availability of infrastructure for the care of patients with sepsis in acute-care hospitals. Methods: A multidisciplinary cross-sectional questionnaire was used to investigate sepsis care in hospitals. This included the use of sepsis definitions, the implementation of sepsis guideline recommendations, diagnostic and therapeutic infrastructure, antibiotic stewardship, and quality improvement initiatives (QIIs) in hospitals. Measurements and Main Results: A total of 1,023 hospitals in 69 countries were included. Most of them, 835 (81.6%), were in Europe. Sepsis screening was used in 54.2% of emergency departments (EDs), 47.9% of wards, and 61.7% of ICUs. Sepsis management was standardized in 57.3% of EDs, 45.2% of wards, and 70.7% of ICUs. The implementation of comprehensive QIIs was associated with increased screening (EDs, +33.3%; wards, +44.4%; ICUs, +23.8% absolute difference) and increased standardized sepsis management (EDs, +33.6%; wards, +40.0%; ICUs, +17.7% absolute difference) compared with hospitals without QIIs. A total of 9.8% of hospitals had implemented ongoing QIIs, and 4.6% had invested in sepsis programs. Conclusions: The findings indicate that there is considerable room for improvement in a large number of mainly European hospitals, particularly with regard to early identification and standardized management of sepsis, the availability of guidelines, diagnostic and therapeutic infrastructure, and the implementation of QIIs. Further efforts are required to implement a more comprehensive and appropriate quality of care.

Assessing Breastfeeding Attitudes and Self-Efficacy Among Health care Personnel and Women With Multiple Sclerosis: Two Cross-Sectional Surveys

INTRODUCTION

This study aimed to describe breastfeeding attitudes among health care personnel, as well as breastfeeding attitudes and self-efficacy in women with multiple sclerosis (MS), who are currently or have previously breastfed.

METHODS

Two cross-sectional surveys were sent electronically to health care personnel at a single center to capture attitudes toward breastfeeding in women with MS using the Iowa Infant Feeding Attitudes Scale (IIFAS), and women with MS who were currently or had previously breastfed to measure breastfeeding attitudes and self-efficacy using the IIFAS and Breastfeeding Self-Efficacy Survey-Short Form (BSES-SF). Descriptive statistics and one-way analysis of variance were used to assess differences among categories of participant demographics.

RESULTS

In the health care personnel survey, among health care specialties, neonatology exhibited the highest mean scores on the IIFAS (69.8 ± 8.89), reflecting positive attitudes, while neurology and students had the lowest mean IIFAS scores (62.4 ± 10.3 and 58.2 ± 3.94, respectively) with neutral attitudes. Health care personnel with 16 or more years of service demonstrated positive attitudes toward breastfeeding (70.9 ± 9.30), as assessed by IIFAS. In the survey of women with MS, women identifying as Middle Eastern/North African had the highest mean IIFAS score (78.0 ± 5.66), indicating positive breastfeeding attitudes, while women identifying as Black had the lowest (62.7 ± 6.07), reflecting a neutral attitude. Positive attitudes were revealed by participants who exclusively breastfed for 6 months (70.1 ± 7.17) and who had three or more children (70.1 ± 6.17). Participants who exclusively breastfed for 6 months and who had breastfed three or more children demonstrated the highest breastfeeding self-efficacy as assessed by BSES-SF scores (52.2 ± 4.93 and 51.7 ± 5.26, respectively).

DISCUSSION

Attitudes towards breastfeeding in women with MS differed by health care specialty and years of service in health care personnel. Among women with MS, infant feeding attitudes and breastfeeding self-efficacy varied based on ethnicity, age, number of children, number of children breastfed, and breastfeeding exclusivity.

Patient and Public Perceptions of Simulation Training in Neurosurgery: A Two-Stage Cross-Sectional Survey

BACKGROUND

The use of simulation in neurosurgery is a widespread and popular means of training worldwide. However, little is known about patient and public acceptability of simulation in neurosurgical training and the potential consequences of this for future simulation development.

METHODS

A two-stage questionnaire strategy was utilized, the first gathering insights from neurosurgical inpatients, and the second from the general public. These questionnaires assessed general understanding of the concept of simulation in neurosurgery, the relative importance of factors affecting simulation training, and acceptability of different simulation modalities and means of providing feedback to trainees.

RESULTS

Seventeen inpatients responded to the first-stage survey, and 192 members of the public responded to the second-stage survey. Familiarity with the concept of simulation training in neurosurgery was generally lacking. Fidelity was established as the most important element of simulation training by the public, with cadavers and physical models the most acceptable form of simulation training. Augmented reality solutions were least popular among the public. There was enthusiasm for both artificial intelligence and telementoring as training feedback solutions.

CONCLUSIONS

Patients and the public are accepting of the use of simulation training in neurosurgery. Future development should focus on improving access to high-fidelity simulation and exploring the use of artificial intelligence and telementoring in providing trainee feedback.

Collaborative Outcomes Study on Health and Functioning During Infection Times (COH-FIT): Global and Risk-Group Stratified Course of Well-Being and Mental Health During the COVID-19 Pandemic in Adolescents

OBJECTIVE

To identify the COVID-19 pandemic impact on well-being/mental health, coping strategies, and risk factors in adolescents worldwide.

METHOD

This study was based on an anonymous online multi-national/multi-language survey in the general population (representative/weighted non-representative samples, 14-17 years of age), measuring change in well-being (World Health Organization-Five Well-Being Index [WHO-5]/range = 0-100) and psychopathology (validated composite P-score/range = 0-100), WHO-5 <50 and <29, pre- vs during COVID-19 pandemic (April 26, 2020-June 26, 2022). Coping strategies and 9 a priori- defined individual/cumulative risk factors were measured. A χ2, penalized cubic splines, linear regression, and correlation analyses were conducted.

RESULTS

Analyzing 8,115 of 8,762 initiated surveys (representative = 75.1%), the pre-pandemic WHO-5 and P-score remained stable during the study (excluding relevant recall bias/drift), but worsened during the pandemic by 5.55 ± 17.13 (SD) and 6.74 ± 16.06 points, respectively (effect size d = 0.27 and d = 0.28). The proportion of adolescents with WHO-5 scores suggesting depression screening (<50) and major depression (<29) increased from 9% to 17% and 2% to 6%. WHO-5 worsened (descending magnitude, with cumulative effect) in adolescents with a mental or physical disorder, female gender, and with school closure. Results were similar for the P-score, with the exception of school closure (not significant) and living in a low-income country, as well as not living in a large city (significant). Changes were significantly but minimally related to COVID-19 deaths/restrictions, returning to near-pre-pandemic values after >2 years. The 3 most subjectively effective coping strategies were Internet use, exercise/walking, and social contacts.

CONCLUSION

Overall, well-being/mental health worsened (small effect sizes) during the early stages of the COVID-19 pandemic, especially in vulnerable subpopulations. Identified at-risk groups, association with pandemic-related measures, and coping strategies can inform individual behaviors and global public health strategies.

PLAIN LANGUAGE SUMMARY

The impact of COVID-19 and related restrictions on the mental health of children and adolescents remains unclear. This study conducted an anonymous online survey with over 8,100 adolescents aged 14 to 17 years worldwide. Results showed a significant decline in wellbeing, with depression rates increasing from 9% to 17% returning to near- pre-pandemic values after about 2 years. Adolescents with preexisting mental health conditions, female youth, and those affected by school closures were particularly vulnerable. Effective coping strategies included internet use, exercise, and social contacts, highlighting areas for public health focus to support youth during pandemics.

STUDY PREREGISTRATION INFORMATION

Physical and mental health impact of COVID-19 on children, adolescents, and their families: The Collaborative Outcomes study on Health and Functioning during Infection Times - Children and Adolescents (COH-FIT-C&A); https://doi.org/10.1016/j.jad.2021.09.090 DIVERSITY & INCLUSION STATEMENT: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. We actively worked to promote sex and gender balance in our author group. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science.

Diagnosing and treating upper back pain: insights from New Zealand's manipulative physiotherapists and osteopaths

BACKGROUND

Manual therapy is routinely used in the management of upper back pain (UBP), a disabling condition. However, the approach to diagnosis and treatment techniques used by manipulative physiotherapists and osteopaths is largely unknown.

OBJECTIVES

To explore knowledge about UBP, including diagnosis and treatment, by New Zealand (NZ) osteopaths and manipulative physiotherapists and to investigate differences (if any) in the self-reported approaches to diagnosis and management of UBP between the professions.

DESIGN

A cross-sectional survey administered through an online platform (Qualtrics) between September 2023 and January 2024.

PARTICIPANTS

One hundred and ten NZ osteopaths and manipulative physiotherapists completed the survey.

RESULTS

Forty-eight percent (n = 53) of respondents identified their profession as physiotherapists and 52% (n = 57) as osteopaths. Over three-quarters of respondents (77%) 'strongly agreed' that a multimodal approach is essential for effective UBP management. Osteopaths were significantly more likely to often proffer 'wear and tear/degeneration' (p < 0.01) and 'visceral referred pain' (p = 0.02) as the cause of a patient's UBP. In terms of management, osteopaths were significantly more likely to use soft tissue techniques (p < 0.01), spinal manipulations (p < 0.01), rib manipulations (p < 0.01), rib mobilizations (p < 0.01), and visceral techniques (p < 0.01), compared to physiotherapists.

CONCLUSIONS

The survey highlights a strong consensus among respondents that a multimodal approach is essential for effective UBP management. The survey also identified profession-specific approaches to the diagnosis and management of UBP. Future research using qualitative methods is required to further explore these profession-specific differences and explore outcomes of care.

A study of professional practices, attitudes and barriers to blended tube feeding in Australia and New Zealand

AIMS

This study investigates the utilisation of blended tube feeding by health professionals in Australia and New Zealand, assessing factors influencing its implementation following the Australasian Society of Parenteral and Enteral Nutrition blended tube feeding consensus statement.

METHODS

A cross-sectional survey was conducted targeting health professionals across Australia and New Zealand. The survey comprised 35-questions including multiple choice, Likert scales and open-ended responses, to gain insights into blended tube feeding practices and perspectives. The effect of the health professional factors on outcomes was explored in pairs with a series of Chi-squared tests. Odds ratios (ORs) were calculated using standard univariate logistic regression. An exploratory content analysis was used to code the open-ended text responses to the survey questions which were then categorised and further synthesised into overarching themes.

RESULTS

Out of 89 health professionals who completed the survey, the majority were dietitians, 63% reported managing fewer than five patients using blended tube feeding within their services. Parental request was the leading reason for adoption. Notable barriers included clinician time constraints, resource limitations and a lack of formal guidelines. Some health professionals considered the primary risk associated with blended tube feeding to be poor growth and/or weight loss. Professional development was pivotal in increasing confidence and advocating for blended tube feeding, with significant correlations observed between blended tube feeding training and clinical practice.

CONCLUSIONS

This study emphasises the essential role of education, resource availability and institutional policy in promoting blended tube feeding practices for health professionals. Findings suggest that focusing on professional development and standardised resources could significantly enhance knowledge, confidence and competence of health professionals in blended tube feeding application. The outcomes point towards the need for a coordinated approach to support evidence-based blended tube feeding practices, aligning with the Australasian Society of Parenteral and Enteral Nutrition blended tube feeding resources and recommendations.

The obese population's views on the symptoms and risks of chronic venous insufficiency - 2 (OBVIOUS-2) cross-sectional survey

IntroductionIndividuals with high body mass index (BMI) are more likely to have symptomatic LLVD than age matched populations with normal BMI. National priorities in venous disease set by the James Lind Alliance focus on improving access to healthcare and patient education. The aims of this study are to determine patient knowledge and potential burden of LLVD in a population of patients attending a UK, regional weight management service.MethodsA postal questionnaire containing 12 questions relating to LLVD and obesity was distributed to the active list of patients under the weight management medical service at Dudley Group of Hospitals between May 2022-23. Respondents were provided with a stamped, addressed envelope to return the questionnaire. Ethical approval was granted by the Hampshire Research & Ethics Committee.ResultsSome 367 questionnaires were distributed to patients currently enrolled in specialist weight management services. 103 complete responses were received (28%), Most patients were between 50 and 70 years of age. 25% of patients already had a formal diagnosis of LLVD, with a further 84 (82%) reported signs or symptoms which may be related to LLVD. Almost half (49/103, 48%) had concerns over their skin quality with a similar proportion (25/103, 51%) having sought medical help. The majority (71/103, 69%) were unaware of the association between obesity and LLVD. Twelve participants had education regarding simple adjuncts designed to improve symptoms and/or prevent ulceration (emollients, dressings, stockings, or leg elevation). Four participants had previously undergone treatment for varicose veins.ConclusionIn a population of patients accessing weight management services, we have demonstrated that a quarter of patients have already received a diagnosis of LLVD, however there is for a greater undiagnosed burden of LLVD in part due to lack of patient and possibly clinician awareness.

Identifying and comparing types of social comparisons on social networking sites among mothers with infants: Differences in maternal loneliness by types

PURPOSE

Loneliness among mothers of infants is a serious problem that leads to increased stress and depression. Social networking sites (SNS) are platforms commonly used by mothers to gain information and socialize; however, the sites can also lead to social comparison. This study aimed to identify and compare the types of parental social comparisons on SNS among mothers with infants and examine their differences regarding maternal loneliness.

METHODS

A random sampling cross-sectional survey of 233 Japanese mothers with infants aged 6-11 months old was conducted. The questionnaire considered the frequency of parental social comparisons on SNS and the associated positive/negative emotions, loneliness, perceived social support, SNS use, and participant characteristics. Hierarchical cluster analysis and analysis of covariance were used to examine differences in loneliness by social comparison type.

RESULTS

Identified types of parental social comparisons on SNS included: "Negative-leaning comparisons (n = 40)," "Ambivalent comparisons (n = 53)," "Heavy comparisons (n = 39)," and "Positive-leaning comparisons (n = 67)." The "non-comparative group (n = 34)" made no comparisons. The loneliness scores of the "Negative-leaning comparisons" group were significantly higher than those of the "Ambivalent comparisons," "Positive-leaning comparisons," and "Non-comparative" groups (p = 0.019, p = 0.017, and p < 0.001, respectively). Additionally, the loneliness scores of the "Heavy comparisons" group were higher than those of the "Non-comparative" group (p = 0.005).

CONCLUSION

Interventions aimed at enhancing digital literacy among mothers and providing tailored support based on their social comparison types are crucial for mitigating the negative effects of parental social comparisons on SNS.

Students' perceptions of assessment feedback in an undergraduate nursing and midwifery subject: a mixed-methods study

BACKGROUND

In an undergraduate Bachelor of Nursing course, students enrol in an evidence-based Practice (EBP) subject. Three scaffolded tasks assess students' ability to find, summarise and synthesise professional literature. For each assessment task, students are provided feedback that informs subsequent assessments. It is unclear how students use the feedback, and what elements of feedback are perceived as being most useful.

AIM

This study aimed to examine nursing students' perspectives of receiving feedback from scaffolded assessments and how feedback received influenced the development of the final assessment task.

DESIGN

A mixed-methods approach was used with a cross-sectional survey and online qualitative interviews.

SETTING

This research was conducted at Deakin University, School of Nursing and Midwifery in Melbourne, Australia.

PARTICIPANTS

One hundred forty-eight students (17.4%, n = 851) participated in the cross-sectional survey. Seven students participated in the online qualitative interviews.

METHODS

Students enrolled in the EBP subject in Trimester, 2023 were invited to participate in a survey where they rated their experience of assessment feedback using a Likert scale. Students were also invited to participate in an online qualitative interview that further explored their perceptions.

RESULTS

Assessment exemplars were highly beneficial to understanding the assessment task (87.8% agree/strongly agree, n = 107). Responding to feedback was challenging (38.5%, n = 47). Qualitative themes identified were engagement with assessments, appropriateness of feedback, and use of scaffolded feedback.

CONCLUSIONS

This study highlights that scaffolded feedback is valuable for student learning. Feedback in each rubric criterion helps with the alignment of learning outcomes. Resources that support students in how to respond to feedback are important.

Factors Influencing Medication Adherence in Heart Failure Patients-A Survey Among Cardiac Healthcare Providers

Adhering to medication regimens is key behavior to alleviate symptoms and slow disease progression in heart failure (HF). This study explores cardiac healthcare providers' perceptions and experiences of factors influencing medication adherence (MA) in HF patients, with findings contributing to developing a HF-specific MA assessment scale. Using a cross-sectional, mixed methods design, we conducted an online survey with both closed and open-ended questions distributed to cardiac healthcare providers, working at the National University Hospital in Iceland. The survey consisted of 103 questions divided into 18 themes. Analysis included descriptive statistics of the participants' responses to closed responses with simplified scoring. Free-text responses were grouped into thematic categories and then into subthemes. Of 104 healthcare providers invited, 73 (70%) participated. Key factors identified as most beneficial for supporting MA included supportive patient-provider relationships (97%), selecting suitable drug formulation (96%), healthcare support at home (95%), and multi-dose dispensing from pharmacies (93%). The youngest and oldest HF patients were believed to be at the highest risk of medication non-adherence, particularly among males. Other patients estimated at increased risk included those with alcohol and/or substance abuse (89%), those with limited knowledge of medication effects (89%), those perceiving medication as useless (88%), and those with cognitive impairment (86%). Most participants (73%) agreed that healthcare providers should assess and document MA in clinical care. These findings provide a comprehensive overview of factors that cardiac healthcare providers believe influence non-adherence in HF patients, contributing to the development of a HF-specific MA scale.

Quality of outpatient palliative care assessed by direct service providers, regional palliative care organisations and healthcare authorities - A nationwide survey from Switzerland

PURPOSE

A prior study used 13 indicators to assess overall palliative care quality: Switzerland scored 88 points (top quartile: 82-93). This study assessed the quality of outpatient palliative care in Switzerland, and identified criteria associated with higher quality.

METHOD

Cross-sectional study surveying direct service providers, 14 palliative care organisations, 26 healthcare authorities. The 13 indicators assessed outpatient palliative care quality. Multivariable regression analysed associations between established criteria and higher scores.

RESULTS

The survey was completed by 141 participants (≥4 per canton) including 96 (68%) direct service providers, all palliative care organisations and cantonal authorities. Nurses accounted for 52% (n = 73, including 61 providers). Participants agreed with 'treated kindly' (98% agreed), 'controlled pain and discomfort' (98%), 'appropriate levels of life extending treatments' (95%) but disagreed with 'costs are no barrier' (44% disagreed), 'good coordination' (19%), 'cared for/die at place of choice' (14%). All 13 indicator questions were answered by 100 participants (71%), resulting in a median score of 82. Of participants seeing patients, 85% (82/97) answered all 13 questions, only 41% (18/44) of those without patient contact (p < 0.001). 'Recording desired place of death' (odds ratio [OR] 6.7, 95% confidence interval [95%CI] 2.7-21.3), 'preventing critical incidents' (OR 5.8, 95%CI 2.8-13.0), 'recording critical incidents' (OR 2.1, 95%CI 1.3-3.7) were independently associated with higher scores.

CONCLUSIONS

A score of 82 indicates high quality. Recording desired place of death, preventing critical incidents, costs, and coordination require attention. Only those with patient contact are best suited to assess the quality of outpatient palliative care.

Mapping of Children's Palliative Care Development Globally in 2023

Background: The demand for children's palliative care is increasingly urgent, with over 21 million children worldwide needing access, yet only 5-10% currently receiving it. Mapping the development of children's palliative care is important in tracking progress and focusing priorities for future work. Methods: In 2023, a cross-sectional survey was conducted to assess the status of children's palliative care globally, focusing on eight key indicators. Children's palliative care experts and stakeholders were asked to evaluate the perceived levels of development in their countries across five defined levels, ranging from no known provision to broad integration into health care services. Efforts were made to engage non-responding countries. Regional palliative care associations were consulted to validate the results. Results: The survey was distributed to experts in 167/197 countries (85%), achieving data collection for 131 countries (78% of surveys sent). A total of 42% of countries (83) were at the lowest level of development (Level 1), while only 6% (11) of countries reached the highest level (Level 5), showing significant regional variation. An overall increase in children's palliative care globally was seen, including significant movement between levels. Variations were seen between regions and across country income categories, providing insight to inform ongoing efforts in service development, advocacy, education, research and access to essential medicines. Conclusions: There has been global progress in children's palliative care, although substantial gaps remain in access, particularly between high-income countries and low- and middle-income countries (LMICs). The study highlights the importance of a comprehensive approach to children's palliative care, with advocacy and education and training programmes being crucial for sustainable development.

What laparoscopic skills are necessary for the certificate of completion of training? A prospective nationwide cross-sectional survey of obstetrics and gynaecology and general surgery trainees and consultants in the UK

OBJECTIVES

To explore the views of obstetrics and gynaecology (O&G) and general surgery (GS) trainees and consultants on the laparoscopic skills considered necessary to achieve the certificate of completion of training (CCT) and identify any mismatch between consultants and trainees in their expectations of these skills.

DESIGN

A prospective nationwide cross-sectional study in the UK.

SETTING

A national survey distributed through Health Education, England and national training bodies such as the Royal College of Obstetricians & Gynaecologists, British Society for Gynaecological Endoscopy and the Association of Surgeons of Great Britain and Ireland.

PARTICIPANTS

O&G and GS consultants and specialty trainees in O&G and GS. Specialty trainees below ST3 level and consultants performing open surgery or minor laparoscopic surgery only were excluded.

INTERVENTIONS

Trainees completed a 27-item questionnaire on their training characteristics, rated their confidence and perceived importance of 10 laparoscopic skills required for CCT using a 5-point Likert scale. Consultants answered a 36-item questionnaire on their demographic details, their views on the importance of the same 10 laparoscopic skills, their confidence and the standard of laparoscopic skills they observed among trainees approaching CCT.

RESULTS

345 participants responded to the questionnaire: 117 O&G trainees, 95 O&G consultants, 57 GS trainees and 76 GS consultants. O&G trainees and consultants expected similar laparoscopic skills required for CCT for all 10 skills (p>0.050), while GS consultants had higher expectations of GS trainees for use of endovascular devices (p<0.05), suturing (p<0.01) and staplers (p<0.05). Consultants in both specialties observed that trainees were performing significantly below the expected standards; p<0.010 (O&G) and p<0.001 (GS) for all 10 listed skills. O&G trainees reported lower confidence than GS trainees for all 10 laparoscopic skills, p<0.001.

CONCLUSIONS

This nationwide study showed that UK O&G trainees and consultants both agree on the skills required for CCT, but GS consultants had higher expectations than their trainees. Trainees in GS were more confident in their surgical skills than those in O&G. However, consultants in both specialities believed that trainees were not achieving the requisite laparoscopic skills required for CCT.

TRIAL REGISTRATION NUMBER

NCT05116332.

Prescribing preoperative weight loss prior to major non-bariatric surgery for patients with elevated weight: a national provider survey (PREPARE provider survey)

Background

The surgical patient with obesity presents several challenges in intraoperative and postoperative care. We designed this cross-sectional survey to assess surgeon willingness to prescribe preoperative very low energy diets (VLEDs) and practice patterns in prescribing preoperative weight loss interventions for patients with obesity undergoing non-bariatric abdominal surgery.

Methods and findings

We conducted a cross-sectional survey of practicing surgeons in Canada who perform major non-bariatric abdominal surgery, reported in accordance with the Consensus-Based Checklist for Reporting of Survey Studies and utilizing non-probability convenience sampling. The primary outcome was willingness to prescribe preoperative VLED to obese patients undergoing major non-bariatric abdominal surgery for both benign and malignant indications. We created a multivariable proportional odds model to identify factors associated with willingness to prescribe VLEDs. A total of 78 participants completed and returned the survey (response rate 10.9%; mean age 43.54 ± 8.13 years; 48.72% female). Most surgeons (79.5%) felt that obesity significantly impacted the technical difficulty of their operations. We identified a disconnect between those surgeons who were willing prescribe VLEDs vs. those who actually prescribed them (78.2% vs. 30.8%, respectively). Approximately half of the surgeons reported being unfamiliar with VLEDs. Regression analysis identified practicing in academic institutions was associated with increased willingness to prescribe [odds ratio (OR) 3.71, 95% confidence intervals (CI) 1.01-13.7, p < 0.01].

Conclusion

Although the majority of surgeons feel that obesity adversely impacts perioperative care, only one-third routinely discuss preoperative VLEDs with their patients. Opportunities to increase awareness and evaluate the impact of VLEDs on patient outcomes remain high.

Peruvian university students' mental health in crisis: assessing anxiety, depression, fear, and stress during the Russia-Ukraine conflict

Background

The conflict between Russia and Ukraine, exacerbated by the COVID-19 pandemic, has created global fears over the possibility of another third world war. Populations both close to and far from the conflict can be affected by it and the mental health outcomes can be devastating. We aimed to assess levels of anxiety, depression, fear, and stress among Peruvian university students facing potential war-related consequences.

Methods

This web-based observational study conducted in 2022 included 494 randomly selected students. Participants were over 18 years of age, with a balanced representation of gender and geography. Anxiety, depression, stress, and fear of war were evaluated using validated instruments, including the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9).

Results

Of the participants, 58.3% were women, with an average age of 26.4 ± 8.1 years. Symptoms of stress, fear, anxiety, and depression affected 49.2, 49, 47.8, and 47.8%, respectively. Women were more affected, with 54.2% reporting high stress and 53.5% reporting high fear (p &lt; 0.001). The most vulnerable group for anxiety and depression were younger students aged 18–20, with 44.3% presenting mild anxiety and 44.3% mild depression (p &lt; 0.001).

Conclusion

These findings highlight the urgent need for mental health interventions for university students, particularly women and younger students, who face heightened vulnerability to global crises such as wars and pandemics. Further studies should explore additional influencing factors, including pre-existing health conditions, academic challenges, and regional disparities, to address these mental health issues better.

A Greener Vascular Surgery: A Survey of Current Green Practices

BACKGROUND

Climate change is an environmental emergency. With health care systems contributing to 5% of carbon emissions globally, environmental sustainability is an important consideration when delivering surgical services. This survey aimed to understand current green practices across vascular centers.

METHODS

A survey on routine sustainable practices and the feasibility of implementing greener practices was developed between the Vascular and Endovascular Research Network and the Vascular Society of Great Britain and Ireland. The survey was delivered using the Qualtrics online survey tool and distributed through mailing lists and social media. The survey was open to completion by all vascular health care professionals internationally. Responses were collected between June 2, 2023, and September 15, 2023.

RESULTS

A total of 115 vascular health care professionals across 14 different countries responded. Disposable theater materials were used in 85% (98/115) of respondents' centers. Most centers used electronic patient records (investigation requests [76%, 85/112], observation charts [81%; 91/112], prescriptions [74%; 83/112]). Paper recycling policies were available in 52% (58/112) of respondents' centers. All the respondents agreed that vascular surgery can be greener. 80% (92/115) of respondents reported environmental sustainability was never discussed in departmental meetings and 24% (28/115) reported their department engaged with management to implement more sustainable practices. Barriers to change included finance (77%, 89/115), competing priorities (84%, 97/115), and lack of engagement (82%, 94/115).

CONCLUSION

This survey identified areas where vascular services could be more environmentally friendly, including reducing the use of disposable materials and improving recycling. Vascular health professionals are largely supportive of implementing changes to reduce the carbon footprint.

Patient Acceptability and Technical Reliability of Wearable Devices Used for Monitoring People With Parkinson Disease: Survey Study

Background

Parkinson disease is a progressive neurodegenerative disorder with complex motor and nonmotor symptoms. To assess these, clinical assessments are completed, providing a snapshot of a person's experience. Monitoring Parkinson disease using wearable devices can provide continuous and objective data and capture information on movement patterns in daily life.

Objective

The aim of the study is to assess patient acceptability and technical reliability of 2 wearable devices used in clinical trials (ActivInsights and Axivity AX3).

Methods

Participants in a feasibility study testing a self-management toolkit (PD-Care) optionally wore a wearable device for 1 week, providing feedback through an open- and closed-question survey conducted over the telephone about the acceptability of wearing the device. The closed questions used a Likert scale from 1 to 5 (with 1=strongly agree and 5=strongly disagree) asking whether (1) the device was comfortable to wear, (2) the device was easy to put on, (3) the device was easy to wear, (4) the device was embarrassing to wear, and (5) if they were happy to wear the device for longer than 7 days. Differences in acceptability between devices were analyzed using Mann-Whitney U tests and Wilcoxon matched pairs signed rank tests. These were followed by open-ended questions asking (1) How did you find wearing the device? (2) How did you find putting the device on? (3) Did you take it off and why? (4) What was your overall impression? (5) Did you prefer the wrist- or trunk-worn device and why (Axivity AX3 only)?

Results

A total of 22 of 32 (69%) participants offered the device agreed to wear it. There were no significant differences in the demographic characteristics between those monitored and those who chose not to be. Acceptance with both devices was generally good. The ActivInsights device was more acceptable than the wrist- and trunk-worn Axivity AX3 devices, as more participants found it to be comfortable (n=15, 100% vs n=5, 71%; P=.02 and n=4, 57%; P=.004, respectively), easy to wear (n=15, 100% vs n=6, 86%; P=.048 and n=3, 43%; P=.004, respectively) and would wear for more than 7 days (n=13, 87% vs n=4, 57%; P=.02 and n=1, 14%; P<.001, respectively). The trunk-worn Axivity AX3 device had the lowest acceptance rates, but there were no statistical differences in acceptability between the wrist- and trunk-worn Axivity AX3 devices (all P>.05). There were issues with battery life and recording errors in 3 of 14 (21%) Axivity AX3 devices and upload failures in 3 of 15 (20%) ActivInsights devices.

Conclusions

Acceptability of wearables for monitoring Parkinson was satisfactory, especially when wrist-worn, although a few participants experienced difficulties in correct use, and there were some errors with the data upload.

Factors influencing person-centred care: Speech-language pathologists and audiologists perspective

Background

Person-centred care (PCC) is a fundamental aspect of healthcare, and its implementation is primarily based on clinicians' initiation and sustained efforts and the availability of resources. Recent PCC literature has primarily focused on high-income settings, raising concerns about the feasibility of PCC implementation in low- and middle-income countries.

Objectives

This study examined speech-language pathologists' (SLPs) and audiologists' (AUDs) perceptions of barriers and facilitators towards implementing PCC in the diverse South African context, particularly how their demographic factors influence these perceptions.

Method

A national cross-sectional e-survey pooled 103 clinicians who were providing speech-language pathology and audiological services in South Africa. The e-survey included questions on participants' demographics, working environment and a seven-point Likert scale rating 10 components that influence PCC.

Results

Clinicians scored personal factors (64.7%), followed by their relationships with different professionals (54.9%) as the most facilitating factors for achieving PCC. The most significant perceived barrier was resources, including time and finances (59.8%), followed by the client perspectives (53.9%). Significant associations were found between the components influencing PCC and clinicians' qualifications, work sectors and populations served.

Conclusion

The collective findings of this study highlighted the multifaceted nature of PCC implementation within a diverse healthcare context. Client perspectives need to be considered while leveraging clinician attributes and fostering supportive workplace environments for the successful adoption of PCC.

Contribution

This study contributes to literature of PCC implementation and has captured how the perceptions of speech-language therapists (SLPs) and AUDs call for tailored approaches in diverse healthcare contexts.

Protective ileostomy creation after anterior resection of the rectum (PICARR): a decision-making exploring international survey

In our previous survey of experts, surgeon's decision-making process (DMP) about protective ileostomy (PI) creation after anterior resection was investigated. Based on our previous data, a multiple choice questionnaire has been developed. The aim is to perform a quantitative analysis of the results obtained from an international survey and to describe the clinical practice worldwide. Ten questions were related to participants' demographics and, 20 questions (of which 17 Likert scale questions) investigated the DMP regarding PI creation. To evaluate the tendency of the answers in the Likert-type questions, the mean of the answers obtained was compared with the mean point of the Likert scale. The survey was completed by 1019 physicians. Neoadjuvant chemoradiotherapy and distance of the anastomosis from the anal verge ≤ 10 cm were each considered alone sufficient to justify creation of a PI, with statistically significant differences in comparison to the mean point of the scales in (p =  < 0.0001 in both cases). Total Mesorectal Excision alone was not considered a factor sufficient to create a PI (p = 0.416). Most of the participants agree to define their approach to create a PI "tailored" to patients' risk factors (p =  < 0.0001) and "influenced by my experience" in case of patients with low/moderate risk of anastomotic leakage (p =  < 0.0001). This study provides useful insights on the worldwide clinical practice regarding creation of PI following anterior resection. Given the lack of standardization and evidence-based guidelines, this analysis may be helpful to assist surgeons' practice.

Use of the biopsychosocial model of functioning in physiotherapeutic evaluation of patients with obstructive sleep apnea: a survey-based study

PURPOSE

Our study aimed to analyze the use of the biopsychosocial model of functioning in the physiotherapeutic evaluation of patients with obstructive sleep apnea in Brazil.

METHODS

Physiotherapists working with sleep-related breathing disorders were included. They completed an electronic questionnaire with items related to physiotherapeutic evaluations and sociodemographic characteristics. Data were reported in descriptive statistics, and the Wilcoxon test compared the codes of the International Classification of Functioning, Disability, and Health (ICF) included in the evaluation and therapeutic objectives.

RESULTS

The sample (n = 72) had a mean age of 41.4 ± 8.3 years, and most (n = 40) worked in the Southeast region. About 43.1% of the physiotherapists held sleep therapy certifications, 87.5% worked in clinical care, and most (62.5%) only with sleep disorders. Regarding the evaluation of sleep functions, 98.6% of the physiotherapists evaluated excessive sleepiness, and sleep quality was investigated using subjective questioning (80.3%). The components considered very relevant for evaluation were activity (73.6%), followed by body functions (72.2%), environmental factors (70.8%), body structure (65.3%), and participation (63.9%). Some components were evaluated but were not often included among the therapeutic objectives, such as recreational activity (p = 0.016) and intimate relationships (p = 0.035).

CONCLUSIONS

Physiotherapists reported collecting information on all functioning components; most were activity and body function components. However, standardized evaluation tools for investigating functioning are not often applied.

Development, dissemination and survey evaluation of layered education for healthcare professionals to support implementation of firearm injury and mortality prevention strategies in emergency care settings, New York, USA

BACKGROUND

There is consensus on the need and ability to address firearm injury risk in healthcare settings; however, the lack of education for healthcare professionals hinders the implementation of evidence-based firearm injury and mortality prevention strategies. The objectives of this study are to develop, disseminate and evaluate education for team members to facilitate implementation in emergency departments METHOD: Two-tiered education was developed in partnership with stakeholders and disseminated to the healthcare team, covering evidence-based screening and interventions for firearm access and violence risk. The implementation, development and dissemination strategies followed the framework used for systemwide Screening, Brief Intervention and Referral to Treatment implementation for substance use. Team members who screened patients for firearm injury risk received screening education and team members meeting with patients who screened positive received intervention education. Participants completed surveys to evaluate the education and learning objectives.

RESULTS

Across three emergency departments from March 2021 to May 2022, 267 team members completed screening education. Key takeaways reported by 173 participants were how to screen (24.9%), the 5L's of Firearm Safety (19.7%) and the prevalence of firearm injury (11.0%). Participants still had questions about workflow, resources and safety. 34 of 67 (50.7%) intervention education participants completed the postsurvey. 100% were confident they could screen, 79% were confident they could provide brief interventions and 88% were confident their site could implement firearm injury prevention strategies.

CONCLUSION

Tiered education for firearm injury prevention screening and intervention achieved learning objectives and facilitated programme implementation. Education increased knowledge and confidence regarding firearm injury risk screening and its importance in healthcare settings.

Current Care and Barriers to Optimal Care of People With Hip Fracture: A Survey of Hospitals in New South Wales, Australia

Background

Fragility hip fractures are a common and often devastating event, and a shared care approach between orthopaedics and geriatrics can improve patient, health service and quality of care outcomes. The aim of this cross-sectional survey, administered to all hospitals caring for patients with acute hip fracture, in New South Wales (NSW), Australia, was to establish current models of care (e.g. shared care or other), and barriers and facilitators of best care.

Methods

A combination of quantitative and free-text data was collected. In total, 30/36 (83%) hospitals responded, with representation from all 15 state local health districts.

Results

Overall, 21/30 had a formal orthopedic surgery/geriatric medicine shared care model; orthopaedic surgery admission with routine (ortho)geriatrician input was commonest (13/21). Multiple barriers to optimal hip fracture care were identified along the various stages of the national guideline-recommended care pathway. Common barriers reported included staffing deficits (for pain assessment, fascia iliaca block administration) and gaps in service structure (lack of specialist services for refracture prevention). Multidisciplinary meetings were in place to enable best care and to promote team communication, but were impeded by absence of relevant team members (8/16). Free-text themes of enablers of good practice included clear escalation and hand-over processes, multidisciplinary communication strategies, and guideline-aligned clinical pathways.

Conclusion

Moving forward, addressing common barriers such as staffing and knowledge deficits, and harnessing enablers of good practice such as multidisciplinary communication and support, combined with effective implementation strategies, are likely to optimize care for patients with hip fracture.

How are fast tracks organized in adult and pediatric emergency departments in Switzerland? A cross-sectional survey

BACKGROUND

In response to the challenges faced by emergency departments (ED), including overcrowding and high patient volumes, Fast Track (FT) systems are designed to optimize patient flow, yet their implementation and impact in Switzerland remain understudied. Our study provides a comprehensive description of Fast Track (FT) processes across both pediatric and adult settings in Switzerland and compares challenges.

METHODS

We conducted a cross-sectional online survey of ED leadership in Switzerland from May to September 2023, using the WHO SARA framework to explore FT processes. The survey included 28 pediatric EDs and their corresponding adult EDs, with questions addressing FT availability, staffing, infrastructure, and operational challenges. Results were analyzed descriptively, providing insights into FT organization and highlighting barriers to implementation and expansion.

RESULTS

The survey achieved a response rate of 93% (52/56 EDs). Overall, 68% of surveyed hospitals have implemented a FT system, with a higher prevalence in adult EDs (88%) than in pediatric EDs (59%). The absence of FTs in certain pediatric departments was primarily due to structural and personnel constraints. Most FTs are managed internally by hospitals, employing emergency team members, and occasionally general practitioners, reflecting a tailored approach to staffing based on departmental needs. Despite the strategic organization of FTs, operational challenges persist; 45% of respondents identified staff shortages as a major challenge, particularly in pediatric FTs (63%) compared to adult FTs (32%). Financial barriers, including disparities in external physician compensation, remain significant obstacles to FT expansion. Satisfaction levels among EDs with their FT systems were generally high, with improvements in personnel resource allocation and patient flow frequently reported.

CONCLUSION

While FT systems in Swiss EDs have enhanced patient care and operational efficiency, their expansion and effectiveness are hampered by staffing and financial limitations. Addressing these barriers requires a collaborative effort to reform health system policies and financial frameworks, ensuring the sustainable implementation of FTs to meet the growing demands of emergency care.

Variable use of modern abdominal wall closure techniques at emergency laparotomy - an international, cross-sectional survey of surgical practice

PURPOSE

Incisional hernias (IH) occur after 20-30% of laparotomies. Modern closure techniques including small bite closure and prophylactic mesh augmentation (PMA) demonstrate significant reduction in IH rates. European and American Hernia Society guidelines suggest use of small bite closure and consideration of PMA at elective laparotomy closure but do not make a recommendation for emergency surgery. International surveys demonstrate poor uptake of small bite closure and PMA. This survey aims to assess the uptake of these techniques specifically in emergency abdominal surgery.

METHODS

An online, cross-sectional survey was circulated through emergency general surgery (EGS) and abdominal closure networks between June and August 2024. This interrogated surgeons' technical approach to all elements of emergency laparotomy closure including use of wound bundles, small bite, suture-to-wound ratio, suture choice, and PMA.

RESULTS

The survey was completed by 234 general surgeons from 32 countries. Wound bundle components varied between surgeons. Small bite closure was used by 85.8% during midline laparotomy closure but only 42.2% of surgeons used 5 mm wide tissue bites placed every 5 mm. Suture-to-wound ratio was rarely measured (7.7%). A looped PDS (size 0 or 1) was used preferentially (42.7%). Self-locking (15.8%) and antiseptic coated sutures (20.2%) were used infrequently. One in ten surgeons used PMA and most often placed the mesh in the retrorectus space (39.6%).

CONCLUSION

Uptake of new techniques in emergency laparotomy has been variable and with limited penetrance amongst emergency general surgeons. Many surgeons are using adapted versions of the original descriptions of these approaches.

"I feel like my job is to give patients hope" - perspectives of Community Health Workers and employers in Iowa: a mixed methods study

INTRODUCTION

Community Health Workers (CHWs) play a crucial role in extending health services, particularly for people who are medically underserved. Despite efforts to expand CHW programs nationally and in Iowa, challenges persist in defining their roles and responsibilities. Few studies have considered the perspectives of both CHWs and CHW employers simultaneously.

METHODS

We conducted an exploratory sequential mixed-methods study, first involving key informant interviews with CHWs and employers, which then informed the development of surveys distributed to both populations. We performed thematic analysis of qualitative data and calculated descriptive statistics of quantitative data.

RESULTS

Key informant interviews were conducted with five CHWs and five employers. An additional 123 CHWs and 81 employers responded to the survey. From the interviews, we report six themes, including roles and responsibilities, interaction with the broader health care team, and support needed. Survey respondents reported 69 unique job titles, a wide range of populations served, and diverse training needs. Despite 93.6% (n = 102) of CHWs receiving on-the-job training, 48% (n = 52) indicated they would still benefit from more training to be effective in their roles. 46% (n = 21) of employers reported unstable funding as a major barrier to program implementation.

DISCUSSION

CHWs in Iowa felt supported and valued as members of the care team, yet challenges to growing the CHW workforce remain. Our findings highlight the need for continued role definition of the CHW workforce, as well as the need to establish more sustainable sources of funding to ensure the continuity and expansion of this health equity-enhancing workforce.

Scoping review of single-item global rating scales utilized in epilepsy research: Patterns of use, challenges, and recommendations

SIGRs (single-item global ratings) are gaining popularity among clinicians and health researchers as efficient tools to assess patient-reported outcomes. There has been no systematic assessment of domains explored, methodological aspects, and validation efforts of SIGRs in epilepsy. We aimed to critically appraise and provide recommendations on the use and reporting of SIGRs in epilepsy research. We performed a systematic scoping review using the Joanna Briggs Institute's recommendations. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) method was used to search five electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane Register of Controlled Trials) from 1980 to present day. We included English-language studies utilizing SIGRs that assessed health aspects (concept) in people with epilepsy of all ages (participants), in all settings (context), containing ≥30 patients, and using SIGRs with continuous or categorical responses in any study design. Abstract and full-text review was conducted independently by two reviewers; disagreements were resolved through consensus. Standardized data abstraction was used. Of 16 417 citations, we included 289 studies, involving 114 584 patients who underwent 747 unique measurements using SIGRs. Use increased over time; 30% were published in the last 4 years, and 51% used 1 SIGR (range 1-23 SIGRs). Commonly assessed domains were overall health (24.2%) and seizure-related aspects (23.5%), whereas 37% measured perceived change. Most studies used SIGRs descriptively (80.1%). Numerous SIGR formats were used (most commonly Likert-like, 73.3%). Ad hoc SIGRs without validation occurred frequently (45.6%). Stem questions were absent in 9.5% of measures, and only 6.5% reported SIGR measurement properties. SIGRs are widely used and increasingly prevalent in epilepsy research to assess diverse domains across various formats. However, many SIGRs suffer from poor reporting and methodological limitations. We provide a comprehensive catalog of SIGRs and offer recommendations to improve their use in research and clinical practice.

A cross-sectional survey analysis of patient and family knowledge, confidence, and perceived barriers to reporting patient deterioration

BACKGROUND

The knowledge, confidence, and skills of healthcare consumers to identify acute clinical deterioration and appropriately escalate concerns remain largely undetermined. This gap is despite the widespread international introduction of consumer escalation systems intended to provide patients and family an avenue to escalate their concerns if worried about deterioration in their own or relative's condition during a hospital stay.

AIM

To explore patient and family knowledge of acute clinical deterioration, and their confidence and perceived barriers to escalating their concerns.

DESIGN

Cross-sectional, in-person, consumer surveys across an Australian acute adult hospital. The study specific survey tool was developed through a multistage process with healthcare consumer input during creation and testing.

METHODS

Questions explored healthcare consumer knowledge, confidence, and perceived barriers in association with acute clinical deterioration, recognising deterioration, and escalating concerns. Descriptive and inferential analysis was completed, and knowledge, confidence, and barrier scores established. Association between scores and consumer type, gender, age, education level, prior experience with clinical deterioration or rapid response team review, and hospitalisation history in the last 12 months were assessed using multivariable linear regression.

RESULTS

133 surveys were completed. Knowledge scores varied across respondents. Awareness of the local consumer escalation system was low. A positive association was identified between knowledge and confidence that diminished with increasing barrier scores. A strong negative correlation was present between barriers and confidence. No significant difference existed in knowledge, confidence, or barrier scores based on consumer type, gender, education level, previous experience with deterioration or rapid response team review, or hospitalisation history.

CONCLUSIONS

Limitations in patient and family knowledge may impede consumer escalation system success. Increasing knowledge may enhance patient and family confidence to identify deterioration and escalate concerns. However, barriers to consumer escalation decrease this potential. Interventions to increase consumer knowledge should therefore be accompanied by strategies to minimise barriers.

The use of nasopharyngeal and oropharyngeal suctioning in physiotherapy practice in the United Kingdom: a preliminary survey of current practice

INTRODUCTION

Nasopharyngeal (NP) and oropharyngeal (OP) suctioning are airway clearance techniques (ACTs) used to maintain airway patency and enhance gas exchange by removing secretions in an acutely unwell self-ventilating patient. Data on the current use of NP and OP suctioning by physiotherapists are scarce.

AIM AND OBJECTIVES

To investigate the use of NP and OP suctioning by physiotherapists in the UK.

METHODS

An anonymous online questionnaire was developed in Microsoft Forms. UK-registered physiotherapists working in respiratory practice were invited to complete the survey via professional organisations and social media between May and June 2021. Data were analysed descriptively.

RESULTS

Respondents (N=134) mainly worked in the National Health Service (99%) in England (89%) across various clinical speciality levels. The median (IQR) frequency of treatment involving either NP or OP suctioning was 3 (1,5) in the preceding month. Suctioning was usually reported as being successful (92%) and most commonly administered following manual airway clearance techniques (78%), mechanical in/exsufflation (61%), and/or positioning and postural drainage (52%). The majority of respondents reported they performed suctioning with a lubricant (98%) and a nasal pharyngeal airway in situ (95%). Respondents reported experience of a number of adverse effects in relation to NP or OP suction, most notably bleeding (80%), hypoxaemia (63%), and tachycardia (58%).

CONCLUSIONS

Although NP/OP suctioning is an important ACT in UK physiotherapy practice, it is highly invasive and carries the risk of adverse effects and negative patient experience. Further research and development of adaptations and less invasive alternatives to the technique are warranted. CONTRIBUTION OF THE PAPER.

[Challenges and good practices of regional hospice and palliative care networks in Germany: Results of an online survey]

Regional hospice and palliative care networks (RHPCN) can help improve collaboration between health care providers in order to provide comprehensive care for seriously ill patients and their families in the last stages of life. In Germany, RHPCNs are eligible for funding by statutory health insurers from 2022 under Section 39 d SGB V. What are the challenges RHCPNs face and what good practices have emerged in their work?As part of the project HOPAN (German Innovation Fund of the Federal Joint Committee [G-BA], grant N° 01VSF22042), an online survey was conducted among RHPCNs in Germany between December 2023 and February 2024. The survey explored challenges and good practices in six areas of network work. Quantitative data was analysed using a frequency analysis with the statistical software SPSS (closed questions). Free text answers were openly coded using MAXQDA 2022.A total response rate of n=408 data sets was achieved, of which n=64 data sets were included in the analysis after plausibility checks and data cleaning. The most significant challenges facing RHPCNs were the lack of awareness of the network among the general public (n=39; 60.9%) and care providers (n=27; 42.2%), varying qualifications and quality standards of network partners (n=31; 48.2%), and acquisition of new network partners (n=27; 42.2%). The most frequently mentioned good practices were appreciative, transparent, and regular communication (n=41; 50.6%), a personal approach to new network partners (n=38; 28.3%), and attractive network activities (n=33; 25.2%).Many RHPCNs are currently encountering challenges in establishing and expanding their network infrastructure. The implementation of effective network moderation and delivery of high-quality network activities can enhance the reach of RHPCNs. Joint training and further education, in addition to the development of regional care practices and standards, require a high level of commitment from the network partners, which is not yet the case in many instances.

Researcher Perceptions of Inclusion of Study Participants Who Use Languages Other Than English

Importance

Despite constituting 8% of the US population, people who speak languages other than English (LOE) are consistently underrepresented in health-focused research. To make research more inclusive and generalizable, it is crucial to better understand researcher perspectives on barriers to inclusion of participants using LOE and solutions to promote language justice.

Objective

To assess researcher perspectives on barriers to and best practices for inclusion of participants using LOE and to generate strategies to make research more inclusive.

Design, Setting, and Participants

This exploratory cross-sectional survey study used an anonymous digital Qualtrics survey distributed between March 1 and June 30, 2023. The study was conducted among principal investigators (PIs) and research coordinators at the University of Pittsburgh, Pennsylvania. Any PIs or research coordinators who conducted human participant research in the past 5 years were eligible to participate. A convenience sample, using department emails, research electronic mailing lists, a recruitment repository, and word of mouth, was recruited.

Main Outcomes and Measures

Survey questions, drafted with input from community partners, assessed researcher demographics, experience working with participants using LOE, barriers to inclusion, and recommendations to increase research inclusivity. All variables were analyzed using descriptive statistics to calculate means, SDs, and frequencies.

Results

There were 339 respondents who completed the survey (260 cisgender females or women [76.7%]). Of these respondents, 127 (37.5%) were PIs and 212 (62.5%) were research coordinators. In terms of race and ethnicity, 8.8% were Asian; 3.8% were Black, African, or African American; 2.4% were Hispanic, Latino, Latina, Latine, or Latinx; 0.9% were Middle Eastern or North African; 70.5% were White; 6.5% were of other race or ethnicity or were multiracial; 2.7% preferred not to say; and 4.4% had missing data. Most respondents primarily conducted clinical research (239 [70.5%]), and 170 (50.1%) worked with participants using LOE in the prior 5 years. In 188 reported cases in which inclusion occurred, 78 respondents (41.5%) did not proactively include participants using LOE but instead reactively included interested participants after studies had begun. Respondents listed lack of training, time and scheduling challenges around interpreter services, and budget constraints as barriers to inclusion. Recommendations to improve inclusion were made by 272 respondents (80.2%), 265 (78.2%) of whom suggested access to low-cost interpreters and translators, 249 (73.5%) of whom suggested training, and 272 (80.2%) of whom suggested availability of validated measures in different languages.

Conclusions and Relevance

In this survey study of health PIs and research coordinators affiliated with 1 academic institution, respondents faced multiple barriers to including participants who use LOE in their studies. Because a lack of language representation may compromise the quality and applicability of research, purposeful individual and institutional investments are needed to overcome these barriers.

Partnered health research in Canada: a cross-sectional survey of perceptions among researchers and knowledge users involved in funded projects between 2011 and 2019

BACKGROUND

Engaging knowledge users in health research is accelerating in Canada. Our objective was to examine perceptions of partnered health research among individuals involved in funded Canadian partnered health research projects between 2011 and 2019.

METHODS

We invited 2155 recipients of 1153 funded projects to answer a questionnaire probing project characteristics and perceptions of partnered health research. We described and compared perceived effects of involving knowledge users in the project, team cohesion, capability, opportunity and motivation for working in partnership between two categories of respondents: project role [nominated principal investigators (NPIs), other researchers and knowledge users] and gender.

FINDINGS

We analysed data from 589 respondents (42% NPIs, 40% other researchers and 18% knowledge users; 56% women). Among the perceived effects variables, the proportion of ratings of significant influence of involving knowledge users in the project ranged between 12% and 63%. Cohesion, capability, opportunity and motivation variables ranged between 58% and 97% agreement. There were no significant differences between respondent groups for most variables. NPIs and women rated the overall influence of involving knowledge users as significant more than other respondent groups (p < 0.001). NPIs also reported higher agreement with feeling sufficiently included in team activities, pressure to engage and partnerships enabling personal goals (all p < 0.001).

CONCLUSIONS

Most respondents held positive perceptions of working in partnership, although ratings of perceived effects indicated limited effects of involving knowledge users in specific research components and on project outcomes. Continued analysis of project outcomes may identify specific contexts and partnership characteristics associated with greater impact.

Clinical assessment and treatment of patients presenting with longstanding hip and groin pain in primary care: a survey study among physical therapists and general practitioners in Sweden

BACKGROUND

Methods of assessment, treatment and referral rates of patients presenting with longstanding hip and groin pain (LHGP) are not well documented. The aim of this study was to investigate assessment and treatment of patients with LHGP among general practitioners (GPs) and physical therapists (PTs) in primary care.

METHODS

An anonymous web-based survey was developed specifically for this study and distributed to GPs and PTs at primary care centers in the southern part of Sweden. The survey covered the use of different methods of assessment and treatment for LHGP, the perceived importance these methods, and referral rates to orthopedic care. Responses from clinicians were reported in frequencies and percentages, and differences in assessment methodology between professions were examined with chi-square tests.

RESULTS

PTs (n = 104) and GPs (n = 62) referred less than 25% of patients with LHGP to orthopedic care. Both professions used clinical assessments as range of motion tests, but PTs were more likely to use specific clinical tests (PTs 76% vs. GPs 19%, p = < 0.001), GPs used more imaging (GPs 98% vs. PTs 58%, p = < 0.001) and neither profession used validated patient-reported outcome measures (GPs 2% vs. PTs 11%, p = 0.134). GPs and PTs ranked patient history and range of motion as the most important factors for diagnosis. GPs and PTs both reported providing patient education and advice on physical activity as part of the treatment. GPs commonly prescribed pain medication, including NSAIDs (97%), paracetamol (100%), and opioids (69%). 77% of PTs reported treatment duration less than 3 months, with treatment consisting of combinations of exercise therapy and manual therapy.

CONCLUSIONS

GPs and PTs in primary care referred 25% or less of patients with LHGP to orthopedic care. Both professions generally used assessment for LHGP in line with clinical recommendations. However, some assessment methods differed between GPs and PTs, and neither used validated patient-reported outcome measures. Treatment strategies mainly included pain medication (GPs), exercise and manual therapy (PTs), and education (both professions). Inconsistent with clinical recommendations, GPs commonly prescribed opioids as part of pain management, and PTs report treatment duration of less than 3 months.

CLINICAL TRIAL NUMBER

NA.

ESTRO guidelines for developing questionnaires in survey-based radiation oncology research

Survey-based research is increasingly used in radiation oncology, yet survey-based research methodology is often unfamiliar in the field. This guideline offers comprehensive instructions for conducting survey-based research in radiation oncology, covering critical aspects such as survey design, validation, dissemination, analysis, and reporting. Tailored to professionals, it emphasizes the importance of methodological rigour to ensure reliable and actionable data collection. Dissemination strategies are highlighted to maximize response rates and enhance data completeness across diverse clinical, research and industrial settings. Rigorous analysis techniques are discussed to uncover insights that optimize operational efficiencies and inform evidence-based practices. Transparent reporting is underscored as crucial for enhancing the credibility and applicability of findings. This guideline aims to be a practical resource for enhancing research standards in survey-based research for researchers and practitioners in radiation oncology.

Using the Theoretical Domains Framework to identify barriers and facilitators to peripheral nerve block use in older adult patients with a hip fracture: a national survey

PURPOSE

Peripheral nerve blocks (PNBs) in older adult patients with a hip fracture improve morbidity and mortality, reduce health care costs, and improve quality of care. Despite the benefits, PNB use rates remain low. We aimed to use the Theoretical Domains Framework to investigate the barriers and facilitators to PNB use in patients with a hip fracture from the perspective of Canadian anesthesiologists.

METHODS

We created an online survey that collected both quantitative and qualitative responses. After research ethics board approval, the survey was distributed among all Canadian Anesthesiologists' Society (CAS) members. We present five-point Likert responses as medians and interquartile ranges [IQRs], conducted thematic analysis on the narrative feedback, and performed cluster analysis to explore patterns associated with survey responses.

RESULTS

We obtained responses from 256/2,498 (10.2%) CAS members. Of these respondents, 215 (84%) performed PNBs for patients with a hip fracture. The median [IQR] five-point Likert responses showed that participants felt confident placing a PNB (4 [4-5]) and agreed they possessed adequate knowledge and skills for PNB placement (4 [4-5]). Participants' responses showed lower ratings with greater variability for availability of adequate time (3 [3-4]), collaboration with the perioperative team (4 [2-4]), and adequate resources (4 [3-5]). Barriers to PNB use identified through thematic analysis included time pressure as well as inadequate human resources, training opportunities, and multidisciplinary collaboration with other health care professionals. Facilitators included more education, dedicated resources, and clinical care pathways.

CONCLUSION

Our results identified several barriers and facilitators related to physical resources, operational support, and educational factors that may inform future interventions to increase PNB use in older patients with a hip fracture. The results of this study may not be generalizable to all Canadian practice settings because of a low response rate and high proportion of respondents who performed PNBs at their local institution.

A clinician survey of skin substitute use in burns care in the UK and Ireland: The CASSIUS study

BACKGROUND

Skin substitutes are routinely used in burn surgery. Increasing numbers of marketed products, regional variation in use, and lack of high-quality research may be contributing to non-standardised care across units. Previous research has also shown that many healthcare professionals in burns care cannot correctly identify the constituents of skin substitute products, with medicolegal implications related to consent.

METHODS

A cross-sectional survey of healthcare professionals across all burn units/centres in the UK and Ireland was conducted between 24/04/2022-15/08/2022. The survey was developed and distributed by the Reconstructive Surgery Trials Network using REDCap©. We evaluated current skin substitute use, clinicians' awareness of their constituents, factors influencing product selection, and feasibility of performing future randomised trials in this area.

RESULTS

From all burn units and centres in the UK, 306 healthcare professionals responded. Knowledge of product constituents was significantly greater among senior burn surgeons, but <50% respondents correctly identified the constituents of most products. Skin substitutes were used by most units/centres for acute superficial partial burns (16/21, 76%), deep partial/full-thickness burns (18/21, 86%) and secondary reconstruction (20/21, 95%) but not for donor sites (6/21, 29%). Biobrane was the most used for superficial partial burns and Novosorb-BTM for acute deep partial/full-thickness burns and secondary burn reconstruction. Most respondents reported willingness to consider randomising patients to future trials involving skin substitutes.

CONCLUSIONS

Skin substitute use is reportedly widespread, but there is significant intra- and inter-unit variability. Better evidence to guide use is required, ideally with randomised controlled trials comparing products. Knowledge of product constituents, particularly by non-senior burn surgeons, requires improvement.

Patient self-reported perception and knowledge of periodontal disease: An observational, university-representative, survey-based analysis in an academic setting

BACKGROUND

Limited information is available about patient knowledge and perceptions of periodontal diseases. In this observational, survey-based study, the authors investigated patients' understanding of periodontal diseases and their experience after periodontal therapy using self-reported oral health-related quality of life.

METHODS

Patients receiving oral health care at the College of Dentistry, University of Oklahoma, were recruited and surveyed about topics related to general knowledge, etiopathogenesis, treatment outcomes, level of treatment satisfaction, and oral health-related quality of life in the context of periodontal diseases. The collected data were analyzed using descriptive and bivariate statistical methods.

RESULTS

A total of 190 surveys were collected. The results showed that 19.6% of patients did not know whether they had received a diagnosis of periodontitis and 13.7% were unaware whether they had undergone any treatment for it. Patients who reported having periodontitis had a better understanding of what a periodontal pocket was than healthy patients (79% vs 48%) and agreed smoking tobacco products could worsen the condition (92% vs 69%). Patients who had received a diagnosis of periodontal disease were more concerned about their teeth (eg, esthetics, tooth loss, function, and discomfort) than healthy patients (84.3% vs 58.9%). Lastly, a strong association was found between patients' total knowledge scores and positive attitude toward their dental health and periodontal therapy.

CONCLUSIONS

Patients generally have a limited understanding of their periodontitis diagnosis and treatment. However, those requiring advanced treatment had a better understanding of their condition compared with patients not treated for periodontitis.

PRACTICAL IMPLICATIONS

Clinicians will dedicate more time to patient education about periodontal diseases.

Results of a multinational survey on the diagnostic and management practices of catheter-related arterial thrombosis in children and neonates: communication from the ISTH SSC Subcommittee on Pediatric and Neonatal Thrombosis and Hemostasis

BACKGROUND

Arterial thrombosis is increasingly recognized in children and is most commonly related to the presence of an arterial catheter. Diagnosis and treatment of arterial thrombosis in children varies widely and consists of commonly available anticoagulants and antiplatelet drugs. No evidence-based guidelines exist for management strategies for catheter-related arterial thrombosis (CAT).

OBJECTIVES

To understand pediatric hematologists' current practices and opinions in the management of CAT in children and neonates.

METHODS

A multinational survey on diagnostic and management practices from experts and practitioners in the field was conducted by means of a questionnaire with general questions and specific clinical CAT scenarios in regard to umbilical arterial catheters, extremity indwelling arterial catheters, and cardiac catheterization.

RESULTS

Of 54 complete survey responses, there was agreement that Doppler ultrasound is the preferred diagnostic modality to identify CAT and unfractionated heparin and low-molecular-weight heparin are the preferred antithrombotic treatments, while thrombolysis/thrombectomy is used in life-/limb-threatening CAT, long-term follow-up is necessary to detect adverse outcomes, and generally no thrombophilia testing is indicated. There was considerable heterogeneity in treatment indications on when to start antithrombotic treatment, treatment duration, timepoint of catheter removal, and length of follow-up.

CONCLUSION

These results highlight some congruency, but also considerable heterogeneity, in the management practices of CAT. Based on these findings, an international guidance document is necessary to harmonize management practices and further clinical investigations of CAT.

Survey of Continuous EEG Monitoring Practices in the United States

OBJECTIVE

Continuous EEG (cEEG) practice has markedly changed over the last decade given its utility in improving critical care outcomes. However, there are limited data describing the current cEEG infrastructure in US hospitals.

METHODS

A web-based cEEG practice survey was sent to neurophysiologists at 123 ACGME-accredited epilepsy or clinical neurophysiology programs.

RESULTS

Neurophysiologists from 100 (81.3%) institutions completed the survey. Most institutions had 3 to 10 EEG faculty (80.0%), 1 to 5 fellows (74.8%), ≥6 technologists (84.9%), and provided coverage to neurology ICUs with >10 patients (71.0%) at a time. Round-the-clock EEG technologist coverage was available at most (90.0%) institutions with technologists mostly being in-house (68.0%). Most institutions without after-hours coverage (8 of 10) attributed this to insufficient technologists. The typical monitoring duration was 24 to 48 hours (23.0 and 40.0%), most commonly for subclinical seizures (68.4%) and spell characterization (11.2%). Larger neurology ICUs had more EEG technologists ( p = 0.02), fellows ( p = 0.001), and quantitative EEG use ( p = 0.001).

CONCLUSIONS

This survey explores current cEEG practice patterns in the United States. Larger centers had more technologists and fellows. Overall technologist numbers are stable over time, but with a move toward more in-hospital compared with home-based coverage. Reduced availability of EEG technologists was a major factor limiting cEEG availability at some centers.

Maintenance of prehospital anaesthesia in trauma patients: inconsistencies and variability in practice

Background

Literature on prehospital anaesthesia predominantly focuses on preparation and induction, while there is limited guidance on anaesthesia maintenance. The hypothesis of this study was that for prehospital trauma patients, protocols and practice for anaesthesia maintenance may vary considerably between services. Hence, we sought to describe the practice of prehospital anaesthesia maintenance for trauma patients in Australia, New Zealand, and the UK.

Methods

An online practice survey of prehospital and retrieval services in Australia, New Zealand, and the UK was conducted from May to September 2022. Branching logic of between five and 140 questions covered services' background information, protocols relating to anaesthesia maintenance, and perceived effectiveness and governance.

Results

Forty-two services were approached with an 81% response rate. While most services (88%) had some form of maintenance protocol, only 14% had one specific for trauma patients. Most services (61%) used a combination of intermittent boluses and continuous infusions. Ketamine and midazolam were the favoured hypnotics, and fentanyl the favoured opioid. However, there was considerable variation in drug selection and dosing, and in the detail contained within protocols. There was high self-reported confidence in effectiveness and governance of anaesthesia maintenance practices.

Conclusions

Protocols for anaesthesia maintenance in prehospital trauma patients show considerable variation in content and detail across the surveyed services. Further consideration of pharmacokinetics and the specific aims of anaesthesia maintenance is warranted. More research is needed to establish the optimal choice of drugs, dosing, delivery, and adjustment criteria for anaesthesia maintenance in prehospital trauma patients.

Intraoperative opioid administrations, rescue doses in the post-anaesthesia care unit and clinician-perceived factors for dose adjustments in adults: A Danish nationwide survey

BACKGROUND

The impact of demographic- and surgical factors on individual perioperative opioid requirements is not fully understood. Anaesthesia personnel adjust opioid administrations based on their own clinical experience, expert opinions and local guidelines. This survey aimed to assess the current practice of anaesthesia personnel regarding intraoperative opioid treatment for postoperative analgesia and rescue opioid dosing strategies in the post-anaesthesia care unit in Denmark.

METHODS

We conducted a cross-sectional online survey with 37 questions addressing pain management and opioid-dosing strategies. Local site investigators from 46 of 47 public Danish anaesthesia departments distributed the survey. Data collection took place from 5 February to 30 April 2024.

RESULTS

Of the 4187 survey participants, 2025 (48%) answered. Intra- and postoperative opioid doses were adjusted based on chronic pain, age, preoperative opioid use, body weight and type of surgery. Between 84% and 89% of respondents adhered to and had perioperative pain management guidelines available. Respondents preferred intraoperative fentanyl (44%) and morphine (36%) to prevent postoperative pain. Median intraoperative intravenous morphine equivalents ranged from 0.12 to 0.38 mg/kg in clinical scenarios. In these cases, the following variables were assembled in different combinations to assess their impact on dosing: age (30 vs. 65 years), sex (female vs. male), ASA score (1 vs. 3) and type of surgery (anterior cruciate ligament vs. laparoscopic cholecystectomy surgery). Respondents preferred intravenous morphine and fentanyl for moderate and severe postoperative pain, respectively. Median postoperative rescue doses were 0.06-0.12 mg/kg in clinical scenarios based on shifting combinations of the variables: age (30 vs. 65 years), ASA score (1 vs. 3) and degree of expected pain (moderate vs. severe).

CONCLUSION

Respondents preferred fentanyl and morphine for postoperative pain control with considerable variation in choice of opioid and morphine equivalent dose. Respondents expressed that guidelines were highly available and strongly adhered to. Opioid dosing was predominantly guided by chronic pain, age, preoperative opioid use, body weight and type of surgery.

Mean arterial pressure targets in intensive care unit patients receiving noradrenaline: An international survey

Objective

This study aimed to evaluate intensive care doctors' views about a large-scale pragmatic minimum mean arterial pressure (MAP) targets trial and their attitudes and beliefs about minimum MAP targets in different clinical scenarios.

Design

An online survey was conducted.

Setting and participants

An online survey was distributed to intensive care doctors in sites participating in a large-scale international randomised clinical trial evaluating oxygen therapy targets in 15 countries and to additional intensive care clinicians from Canada.

Main outcome measures

Outcomes included the expressed level of support for a large pragmatic trial to evaluate minimum MAP targets in critically ill adults and stated current practice and acceptability of minimum MAP for specific scenarios.

Results

The response rate to our survey for respondents who work in sites participating in the mega randomised registry trial research program was 265 out of 701 (37.8%), with an additional 56 out of 256 (21.8%) responses obtained from a direct email containing a link to the survey sent to intensive care clinicians in Canada. A total of 309 of 321 respondents (96.3%) were supportive, in principle, of conducting a very large pragmatic trial to evaluate MAP targets in intensive care unit patients receiving noradrenaline. The commonest response in all scenarios was to agree that the optimal minimum MAP target was uncertain. In all scenarios, except for active bleeding, the most common reported minimum MAP target was 65 mmHg; for patients who were actively bleeding, the most common reported target was 60 mmHg.

Conclusions

Our data suggest that intensive care clinicians are broadly supportive of a large-scale pragmatic minimum MAP targets in intensive care unit patients receiving noradrenaline.

User perceptions of aspects related to the use of the activity chair: A descriptive cross-sectional study

Introduction

Little is known about the use and aspects impacting the use of the activity chair, which is a device supporting seated activities in everyday life. The aim was to understand (a) purpose of provision, (b) frequency and magnitude of use, (c) barriers impacting use, (d) instruction provided and (e) overall satisfaction with the activity chair.

Method

This is a cross-sectional study involving 141 adult activity chair users. Data were collected through telephone interviews using a study-specific questionnaire with 21 items. Descriptive statistics were used to summarise the quantitative results, and data-driven text analysis was conducted to analyse open-ended question responses.

Results

Most respondents (87%) were provided the activity chair for kitchen work, 87% used the device on a daily basis, 75% used the device for additional activities beyond the provision purpose, 65% experienced barriers impacting use, instructions varied, with 28% receiving none and 16% had received activity-based training, 85% were satisfied with the activity chair.

Conclusion

The activity chair appears to be regularly utilised and appreciated by respondents. However, improved device provision, particularly concerning activity-based training in relevant context and systematic follow up, may be required to reduce barriers impacting use. Findings emphasise the importance of learning from users.

Barriers and enablers to nurse-initiated care in emergency departments: An embedded mixed methods survey study

BACKGROUND

Increased demand, wait times and length of stay have seen many emergency departments implement nurse-initiated protocols In New South Wales, Australia, 74 nurse-initiated protocols have been developed for implementation. The aim of this paper is to identify the barriers and enablers to nurses' use of these protocols to inform and maximise future implementation.

METHODS

Data were collected via surveys informed by the theoretical domains' framework and the Practice Environment Scale of the Nursing Work Index (PES-NWI). Descriptive statistics summarised quantitative data and content analysis was performed on qualitative data. Results were integrated and classified as barriers or enablers to nurses' use of protocols.

RESULTS

The nurses' response rate was 82 % (n = 76) and doctors 72 % (n = 34) Six categories were generated; one barrier (lack of resources), three enablers (patient and organisational benefits, nurses' motivation, nurses' desire to develop their practice) and two were both a barrier and enabler ( nurse confidence and the work environment).

CONCLUSION

Emergency nurses are highly motivated to use nurse-initiated protocols to positively impact patient outcomes. However, a lack of resources, time, access to education and confidence are barriers to use that need to be addressed when designing implementation.

Instruments used by physiotherapists to assess functional capacity in hospitalized patients with COVID-19: An online survey

BACKGROUND

Assessing functional capacity in hospitalized patients with COVID-19 may have been neglected due to a great demand for resources at the height of pandemic and the lack of specific assessment instruments for this population.

OBJECTIVES

To identify the instruments used to evaluate functional capacity in COVID-19 patients hospitalized in COVID-19 wards and ICUs and the associations between use of assessment instruments and physiotherapist characteristics METHODS: The survey was conducted using REDCap web-based application, following the Consensus-Based Checklist for Reporting of Survey Studies guidelines. A non-probability recruitment approach aimed at physiotherapists who had treated hospitalized patients with COVID-19 in Brazil. The instruments were classified into four domains: muscle strength, mobility, activities of daily living, and physical performance, as for the International Classification of Functioning, Disability, and Health RESULTS: Overall, 485 physiotherapists responded to the survey, 81.9% of whom used one or more instruments to assess functional capacity. The Medical Research Council (59.6%) and the Six-Minute Walk Test (21.7%) were the most commonly used instruments in COVID-19 wards; the MRC (63.9%) and the Intensive Care Mobility Scale (33.1%), in ICUs. In COVID-19 wards, higher probability of using assessment instruments was associated with being male, having training on COVID-19 management, and working > 50 h/week. In ICUs, having training on COVID-19 management and working in university hospitals were associated with higher probability of using these instruments CONCLUSIONS: Most physiotherapists used one or more instruments to assess functional capacity, assessed more than one physical domain, and used the obtained results to plan interventions.

International practice patterns and perspectives on endovascular therapy for the treatment of cerebral venous thrombosis

BACKGROUND

Cerebral venous thrombosis (CVT) accounts for 0.5-1% of all strokes. The role of endovascular therapy (EVT) in the management of CVT remains controversial and variations in practice patterns are not well known.

AIMS

Here, we present a comprehensive, international characterization of practice patterns and perspectives on the use of EVT for CVT.

METHODS

A comprehensive 42-question survey was distributed to stroke clinicians globally from May to October 2023, asking about practice patterns and perspectives on the use of EVT for CVT.

RESULTS

The overall response rate was 31% (863 respondents of 2744 invited) across 61 countries. The majority of respondents (74%) supported the use of EVT for CVT in certain clinical situations. Key considerations for decision-making in using EVT favored clinical over radiographic/procedural factors and included worsening level of consciousness (86%) and worsening neurological deficits (76%). In the past 3 years, 56% of respondents used EVT for the treatment of CVT, with most (49.5%) involved in two to five cases. Among interventionalists, significant variability existed in the techniques used for EVT (p < 0.001), with aspiration thrombectomy (56%) and stent retriever (51%) being the most used overall. Regionally, interventionalists from China predominantly used intra-sinus heparin (56%), while this technique was most commonly ranked as "never indicated" throughout the rest of the world (23%). Post-procedure, low molecular weight heparin was the most used anticoagulant (83%), although North American respondents favored unfractionated heparin (37%), while imaging was primarily split between magnetic resonance (71.8%) and computed tomography (65.9%) arteriography or venography.

CONCLUSION

Our survey reveals significant heterogeneity in approaches to EVT for CVT, and provides a comprehensive characterization of indications, techniques, and long-term management used by clinicians internationally. This resource will aid in optimizing patient selection and endovascular treatments for future trials.