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

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.

Acceptability of physiotherapists as primary care practitioners for the care of people with musculoskeletal disorders: a French population-based cross-sectional survey

OBJECTIVES

In France, early access to physiotherapy for people with musculoskeletal disorders (MSKDs) depends on prescription and referral by the family physician in the physician-led model of care. The readiness of French people for direct access to physiotherapy is not known. This survey aims to identify the perceptions of French adults regarding physiotherapists' competence to diagnose and manage MSKDs if they were primary care practitioners, confidence in their ability to provide quality care, and satisfaction with the last episode of care for those concerned; and to identify factors associated with these three variables.

DESIGN

French population-based cross-sectional survey.

PARTICIPANTS

A representative sample of the French adult population was surveyed between June 2020 and September 2021.

OUTCOME MEASURES

Collected variables included previous physiotherapy experience, perception of competence to diagnose and manage MSKDs as primary care practitioners, confidence about quality of care, and self-referral preferences. Multivariate logistic regression analyses were performed to identify the factors associated with these three variables.

RESULTS

A total of 1000 participants completed the survey; 854 (85%) believed that physiotherapists would be competent primary care practitioners, and 920 (92%) were confident about the quality of care. Most had previously consulted a physiotherapist (n = 823, 82%); of these, 762 (91%) were satisfied with care received.

CONCLUSION

This large sample of French adults considered physiotherapists as competent to diagnose and treat some MSKDs as primary care practitioners, and that they provided quality care. Further studies should investigate the scope of care, safety, and efficacy of a direct access physiotherapy model. CONTRIBUTION OF PAPER.

Health technology assessment capacity to support Zambia's health benefits package reform policy

BACKGROUND

The need for more local technical capacity in Health Technology Assessment (HTA) is a leading challenge to its use in low- and middle-income countries. Zambia has been considering using HTA to support its universal health coverage initiative, which includes health benefits package design and implementation. This study assesses the local HTA capacity for the steering committee tasked with supporting the design and implementation of the national health benefits package in Zambia.

METHODS

The study applied a cross-sectional web-based survey design and the consensus-based Checklist for Reporting of Survey Studies. Data were collected from the steering committee of the benefits package working group, tasked with leading the design process of the health benefits package using the Instrument for the Assessment of Skills to Conduct a Health Technology Assessment tool.

RESULTS

The majority of respondents had not served on a selection and reimbursement committee. Clinical effectiveness skills in structuring a search strategy, handling missing data, conducting qualitative evidence synthesis, and grading the certainty of evidence were low. Skills for leadership, networking, conflict management, and project coordination, public and patient involvement were mid-level to low. Most of the respondents were aware of ethical issues with health technologies. Health economics skills in economic evaluations and decision analytic modeling, equity and health system efficiency measurement, budget impact analysis, and quality of life were identified for capacity strengthening.

CONCLUSION

Available technical capacities to revise and implement the national benefits package were lower in health economics, synthesis for clinical effectiveness evidence, ethics, patient and public involvement, and soft skills, in that order.

Vaccine microarray patch self-administration: A preliminary study in adults 50 years of age and over

INTRODUCTION

We assessed the safety, performance, acceptability, and usability of the High-Density Microarray Patch (HD-MAP) for vaccination in adults aged 50 and over.

METHODS

This study was a single-centre, open-label, single-arm intervention in healthy adults aged 50+. HD-MAPs (vaccine-free) were applied by a trained user and self-administered. Participants received one excipient-coated HD-MAP to the volar forearm (FA) and the upper arm (UA) administered by a trained user. Participants then self-administered a HD-MAP to the FA and UA. Application sites were compared for skin response. Participants completed an online survey and participated in a semi-structured interview on acceptability and usability. Analyses were undertaken using descriptive statistics. Interviews were coded in NVivo 12 and subject to thematic analysis. The study occurred from 8 September 2021 to 15 February 2022 in Brisbane, Australia.

RESULTS

Of 44 participants, 43 % (n = 19) were male, and 57 % (n = 25) female. The HD-MAP was well-tolerated, with no treatment-related serious adverse events. The increase in transepidermal water loss following self-administration was similar to that observed for trained user administration (UA: 7.5 fold vs 6-fold, FA: 6.1-fold vs 6.6 fold). Fluorescent dermatoscopy confirmed that HD-MAPs engaged with the skin surface and that self and trained user administrations were similar. All participants found the HD-MAP applicator easy to use. 82 % of participants preferred "vaccination" by HD-MAP should its efficacy be proven equivalent to intramuscular injection (IM). Participants reported high acceptance of the resulting transient marks on the skin (82 %). 98 % of participants agreed that self-administration of the HD-MAP at home, without supervision, was highly preferable for its convenience.

CONCLUSION

HD-MAPs were safe in adults 50+ years, and performance was effective, regardless of administrator. Participants preferred the HD-MAP for its ease of use and convenience in self-administration. This vaccine delivery method shows promise for future implementation for this population.

Singaporean attitudes to cognitive enhancement: a cross-sectional survey

Recent developments in genetic technologies have provided prospective parents with increasing opportunities to influence their future child's phenotype. This study aimed to understand public attitudes towards gene-based technologies and services, with a particular focus on improving educational outcomes. We conducted a cross-sectional survey among a Singaporean population (n=1438), adapting a survey instrument previously used in the US context. Our results suggested that Singaporeans had a greater moral acceptance of, and willingness to use, genetic technologies and services compared with the US population. Among the technologies examined, the use of polygenic embryo screening was considered more acceptable than gene editing. While these public attitudes show some support for the use of these technologies, further research and consultation among multiple stakeholder groups is necessary to determine whether such technology should be used and how it should be regulated.

Knowledge, attitude, and practice in communication assessment of speech-language pathologists working with adolescents with mental health concerns

PURPOSE

The recovery model underlying mental health services emphasises the importance of the voice of the adolescent client in identifying needs, goals, and negotiating intervention. This study aimed to characterise speech-language pathologists' (SLPs) knowledge, attitude, and practice in relation to communication assessment of adolescents, focusing on adolescents with mental health concerns and the use of discourse sampling and analysis.

METHOD

An online survey using a Knowledge, Attitude, Practice framework gathered data from 43 English-speaking SLPs. SLPs responded, using a five-point Likert scale, to closed statements regarding perceived knowledge, attitude, and practice in approaches to communication assessment. Survey items relating to discourse sampling and analysis were aggregated into subscales and six statements related to assessment of adolescents with mental health concerns. A final, open-ended question invited comments on changing clinical practice.

RESULT

A strong positive correlation was found between knowledge and practice; with a weak, positive correlation between knowledge and attitude.

CONCLUSION

SLPs are aware of the benefits of a comprehensive communication assessment. However, greater knowledge and experience is needed to incorporate more formalised approaches into clinical practice, especially as it relates to social and emotional outcomes. Participants' comments suggest that professional learning communities may be helpful in delivering this outcome.

Digital clinical decision support to improve care and to save costs: a pilot survey of the views of frontline healthcare professionals

Introduction

There has been much discourse about the features and impact of clinical decision support. However, until recently, there has been less evidence on how healthcare professionals use decision support to provide evidence-based care or on the potential cost savings that could emerge from its use. This study attempted to fill this gap by asking healthcare professionals to what extent they value digital clinical decision support as a means to apply evidence-based care and to save costs.

Methods

Frontline resident doctors were invited to complete an online semistructured questionnaire on if, and how, they used a clinical decision support resource to obtain and apply information to provide evidence-based care and/or to save costs.

Results

Among the respondents, 93% agreed or strongly agreed that the clinical decision support helped them obtain information to provide evidence-based care, and 93% agreed or strongly agreed that they could apply the information obtained from the resource to provide evidence-based care. Half of the respondents agreed or strongly agreed that using the resource helped them save healthcare costs.

Discussion

The results strongly support the idea that the doctors used the resource to provide evidence-based care; the results related to cost savings were not as strong.

Association of impostor phenomenon and burnout among Swiss residents and junior anaesthesiologists: results of a cross-sectional survey

BACKGROUND

Imposter phenomenon (IP) can impact professional performance and has been described as a risk factor for burnout within healthcare workers. We hypothesize that IP and burnout are prevalent among Swiss anaesthesiology residents and junior anaesthesiologists, and that specific risk factors are significantly associated with these conditions.

METHODS

We conducted a cross-sectional web-based survey of anaesthesiologists working in regions of Switzerland. The survey included demographic questions, the Clance Impostor Phenomenon Scale (CIPS), and the Maslach Burnout Inventory for Medical Personnel (MBI-HSS-MP). Descriptive statistics and logistic regression were used to identify demographic variables predictive of IP and burnout and to examine the association between IP and burnout.

RESULTS

A total of 318 people were eligible to participate. Of those, 136 (42.8%) participants completed the CIPS, and 127 (39.9%) completed the MBI-HSS-MP. Among CIPS respondents, 55% (75/136) identified as women, and 59% (80/136) were Swiss nationals. The prevalence of IP was 56% (76/136) and burnout was 10.2% (13/127). Women were more at risk of IP and burnout (p = 0.037). Independent covariates associated with IP were woman gender (p = 0.015) and Swiss nationality (p = 0.023). Additionally, the presence of IP was correlated with an increased likelihood of burnout (p = 0.04).

CONCLUSIONS

IP was correlated with the presence of burnout in anaesthesiologists in training. Additionally, IP affected more than half of the participants. Two risk factors were identified for IP: being a woman and a Swiss national. The rates of IP and its concerning association with burnout among resident and junior anaesthesiologists needs to be addressed.

TRIAL REGISTRATION

NCT06097325, https://www.

CLINICALTRIALS

gov/study/NCT06097325.

Challenges in early career for HPB surgeons: an international practice survey

BACKGROUND

Understanding the needs of early-career surgeons is essential for developing strategies for support. This study examined perceived needs of early-career HPB surgeons worldwide.

METHODS

A self-administered web-based survey of early career HPB surgeons (aged ≤45 years old or practicing for ≤5 years) was conducted. A questionnaire was developed through items generation and reduction, followed by pilot testing. Quantitative data were reported with descriptive statistics and qualitative responses analysed using open coding.

RESULTS

There were 282 respondents. Six main areas of challenges were identified: mentorship opportunities, continued skills acquisition and training, research and collaboration, leadership and career development, clinical knowledge exchange, and accessibility including financial barriers. Specifically, highest rated challenges were ebalancing work and personal life (mean 6.98, SD 2.92), research (mean 6.79, SD 2.50), career development/mentorship (mean 6.70, SD 2.30), networking/collaboration (mean 6.16, SD 2.71), leadership and (mean 6.09, SD 2.53). Rating of research as a challenge was higher in Africa and Central/South America (p = 0.01), and that of leadership was higher in Asia, Oceania, and the Middle East (p = 0.02).

CONCLUSIONS

This survey highlights the multiple challenges faced by early-career HPB surgeons worldwide. These results provide insights into how to better support early-career HPB surgeons to fully develop their specialty.

Mapping tobacco use cessation counselling awareness in dental offices: a cross-country survey

BACKGROUND

Tobacco is a global public health issue. Brief interventions can motivate tobacco use cessation. However, Tobacco Use Cessation Counselling (TUCC) is underutilized in dental settings despite being ideal for such interventions. This survey aimed to assess the awareness, associated factors towards TUCC among dental care professionals in Sri Lanka, Brazil, and Queensland (QLD), Australia.

METHODS

This descriptive cross-sectional online survey used a self-administered questionnaire via Qualtrics, conducted from February to August 2023 among dental care professionals. Eligibility criteria included any practicing dental care professionals in the respective countries to account for potential non-response in online surveys. Awareness was assessed using three questions: "Have you ever heard of TUCC?"; "Have you ever heard of the 5A method of counselling?"; and "Have you ever heard of the 5R method of counselling?" Each answer was rated on a 3-point Likert scale: no (score 0), maybe (score 1), and yes (score 2). Participants were categorized into two groups, high and low awareness, based on their total awareness scores ranging from 0 (fully unaware) to 6 (fully aware), with the median score used as the threshold.

RESULTS

A total of 480 dental care professionals participated in this online survey across 3 countries. Only 15.6% were fully aware of TUCC, the 5As method, and the 5Rs method of counselling and 10.8% were fully unaware of TUCC. The awareness levels of dental care professionals were comparable and generally higher in Sri Lanka (56.3%) and Queensland, Australia (52.6%), than in Brazil (21.8%). Binary logistic regression analysis revealed that awareness levels differed significantly among the 3 countries (P < 0.01) and the awareness was significantly higher among the dental care professionals who recently joined the service having less than 10 years of service experience in the field of dentistry (P < 0.01).

CONCLUSION

The awareness of TUCC among dental care professionals was low in the survey sample. The results could contribute valuable insights for refining policies, educational strategies, and interventions aiming to improve TUCC awareness and training among dental care professionals and in turn, TUCC in dental settings could significantly contribute to tobacco control and reduce harm among populations.

A Survey on Current Practices, Needs, Responsibilities and Preferences for Knowledge Dissemination in the Field of Injury and Illness Prevention Among Competitive Snow Sports Stakeholders

BACKGROUND

Injury and illness prevention practices in competitive snow sports must be better understood among stakeholders. In particular, there is a need for a greater understanding of what context-specific stakeholders require for prevention. Therefore, this study surveyed stakeholders' current practices, needs, responsibilities and knowledge dissemination preferences related to injury and illness prevention in competitive snow sports and described the main commonalities and differences between stakeholder groups.

METHODS

We conducted a cross-sectional study that used an online survey developed using Kipling's principle (the "5W1H" method) and targeted athletes, coaches, team staff, ski racing suppliers, and representatives from all competition levels and all competitive snow sports governed by the International Ski and Snowboard Federation. The data were analysed following both quantitative and qualitative descriptive analyses.

RESULTS

Most of the 436 respondents believed in and reported needing more information on injury and illness prevention. The participants stated that the main goal of prevention was to avoid injuries and minimise their time away from being on snow, and they stressed their different underlying motivations. Despite the differences across subgroups, participants highlighted knee and head injuries and concussions as their primary injury prevention targets and priorities for additional information. Respiratory and cardiovascular illnesses were reported as their main targets of illness prevention, but more information on all illnesses was reported. Current practices and priorities for additional information fell under athlete-, equipment-, snow/environment-, and course-related prevention areas. Moreover, stakeholders highlighted their need for more information on mental health and training. Shared responsibilities were identified across the development, dissemination, and implementation of prevention, along with stakeholders' preferred communication channels.

CONCLUSIONS

Our study provides meaningful insights across athlete, equipment-, snow/environment-, and course-related prevention areas related to snow sports, roles, and competition levels. These insights may inform the development, dissemination and further implementation of any tailored and context-driven preventive measure by better addressing end-users' needs. These findings may support successful future preventive interventions by providing key elements and a clear path to improve athletes' health and safety.

Future liver remnant volumetry: an E-AHPBA international survey of current practice among liver surgeons

BACKGROUND

Accurate assessment of the future liver remnant (FLR) is crucial for predicting the risk of post-hepatectomy liver failure (PHLF). This survey aims to evaluate the current practices of liver surgeons regarding FLR volumetry and its clinical use.

METHODS

A cross-sectional survey was conducted among 212 liver surgeons to assess their use of FLR volumetry and associated methodologies. The survey consisted of 40 questions distributed in five sections covering multiple aspects of FLR volumetry.

RESULTS

Ninety percent of respondents utilize preoperative FLR volumetry. However, there is significant variability in the methods used for FLR calculation and the thresholds for safe liver resection, which deviate from the proposed 20/30/40 % rule. Before right hepatectomy, 21 % of respondents indicated that they rarely or never utilise volumetry. Extended resections are the surgical procedures in which volumetry is most frequently employed. Furthermore, the kinetic growth rate is not widely adopted in clinical decision making.

CONCLUSION

This survey highlights the widespread use of FLR volumetry, but also reveals substantial variation in its application. This demonstrates a lack of evidence or guidelines regarding the appropriate use of FLR volumetry.

Broad consent in the emergency department: a cross sectional study

BACKGROUND

The Medical Informatics Initiative (MII) introduced a broad consent form (MII-BC) encompassing clinical, insurance, and biomaterial data, along with re-contacting options. In the emergency department (ED), outpatient and inpatient patients of all illnesses and severity could be reached early in their treatment course. The BC-ED (Broad Consent in the Emergency Department) project uniquely investigated the implementation of MII-BC in EDs, exploring feasibility, selection bias and patients' perceptions of voluntariness, information recall, motivation, and satisfaction.

METHODS

The BC-ED project involving four university hospital EDs in Germany, is part of CODEX+ (Collaborative Data Exchange and Usage), an initiative within the Network University Medicine (NUM). To minimize selection bias, a systematic sampling approach (every 5th/30th patient) was applied, with patient recruitment and consent processes adapted to local conditions and therefore varying among sites. Data collection included patient questionnaires, surveys completed by study nurses, and routine clinical data. Analysis was conducted descriptively using SPSS.

RESULTS

Of 1,138 patients approached, 553 (48.6%) were capable of giving consent. Of 353 patients who could not consent, primary reasons included language barriers (35.4%) and inability to grasp study details (21.5%). Of all eligible patients, 3.3% could not be contacted. Of 535 (47.0%) patients able to consent and contacted, 313 consented to the MII-BC. Resulting in a consent rate of 27.5% corresponding to the baseline population and 58.5% of those contacted. Motivations for consenting were general support for research (85.3%) and the desire to help future patients (78.2%). Patients generally reported a high level of understanding and satisfaction with the consent process, reporting comprehensive understanding of scientific data use (89.8%) and associated risks (82.2%). However, discrepancies were noted between consented options and patient recall.

CONCLUSIONS

This study is the first to investigate the implementation of the MII-BC in the challenging ED environment. With a consent rate of 27.5% total baseline population and 58.5% of those contacted, it demonstrates that patients were able and willing to participate in research. Reasons for non-consent were barriers like language and medical conditions. Strategies to address these barriers are crucial for inclusivity. Although patients generally understood the consent process, discrepancies in recall highlight the need for improved comprehension strategies.

TRIAL REGISTRATION

German Clinical Trials Register on 25 October 2022 (DRKS0003054).

Thoracic Cancer Exercise Services in Australia: A Point-Prevalence Survey

BACKGROUND

Cancer guidelines recommend pre- and rehabilitation; however, current research shows these services are not well integrated into clinical practice. To date, there has been no prospective audit of Australian lung cancer exercise services or the people accessing these services. The aim of this study was to describe the exercise pre- and rehabilitation services available to people with thoracic cancer and the characteristics of people with thoracic cancer attending these services in Australia.

METHODS

Prospective, observational, multicenter, 5-day, point-prevalence study. Australian healthcare services likely to provide exercise services to people with thoracic cancer were contacted to participate. Conduct and reporting followed the CROSS guidelines.

RESULTS

A total of 397 services were contacted, and 203 responded (51%). Overall, 67% (n = 137) accepted thoracic cancer referrals, and 107 (78%) completed the survey. Most exercise services were targeted at respiratory disease (58%, n = 60) compared with 31% cancer-specific (n = 33) and 5% lung cancer-specific (n = 5). A total of 73 patients with thoracic cancer attended programs across 41 sites (38%). Mean (SD) age was 68.5 (9.7) years. Overall, 4% of patients (n = 3) were culturally and linguistically diverse, and none identified as Aboriginal or Torres Strait Islander. A total of 19 outcomes were used in 51 combinations to assess participants (n = 70), and 12 exercise interventions were delivered in 45 combinations (n = 67).

CONCLUSIONS

One-third of responding exercise programs did not offer exercise services to people with thoracic cancer. Almost two-thirds of services that accept referrals did not have a thoracic cancer patient attend their service. High heterogeneity in outcome measures and exercise interventions was observed.

Radiographic classification of mandibular osteoradionecrosis: A blinded prospective multi-disciplinary interobserver diagnostic performance study

Background

Osteoradionecrosis of the jaw (ORNJ) is a debilitating complication that affects up to 15% of head and neck cancer patients who undergo radiotherapy. The ASCO/ISOO/MASCC-endorsed ClinRad severity classification system was recently proposed (and recommended in the latest ASCO guidelines) to incorporate radiographic findings for determining ORNJ severity based on the vertical extent of bone necrosis. However, variability in imaging modalities and specialty-specific knowledge may contribute to disparities in diagnosing and classifying ORNJ. This study aims to evaluate and benchmark multi-specialty physician performance in diagnosing and severity classification of ORNJ using different radiographic imaging.

Methods

A single institution retrospective diagnostic validation study was conducted at The University of Texas MD Anderson Cancer Center involving 20 healthcare providers across varying specialties including oral oncology, radiation oncology, surgery, and neuroradiology. Participants reviewed 85 de-identified imaging sets including computed tomography (CT) and orthopantomogram (OPG) images from 30 patients with confirmed ORN, with blinded replicates (n=10) for assessment of intra-observer variability and asked to diagnose and stage ORNJ using the ClinRad system. Diagnostic performance was assessed using ROC curves; intra- and inter-observer agreement were measured with Cohen's and Fleiss kappa, respectively. Sub-analyses considered physician specialty, years of clinical experience and level of confidence.

Results

Paired CT-OPG imaging improved ORNJ diagnostic performance across all specialties, with AUC values ranging from 0.79 (residents) to 0.98 (surgeons). Inter- and intra-rater agreements for ORNJ detection were limited, with median (IQR) Fleiss and Cohen's kappa values of 0.38 (0.22) and 0.08 (0.17), respectively. Slight to fair inter-rater agreement in severity classification ORNJ was observed with median (IQR) Fleiss kappa values of 0.22, 0.13, and 0.05 for stages 0/1, 2, and 3, respectively. The most commonly reported radiographic features for confirmed ORNJ cases staged as ClinRad grade 1 or 2 were "bone necrosis confined to alveolar bone" (22.7%), "bone necrosis involving the basilar bone or maxillary sinus" (14.8%), and "bone lysis/sclerosis" (20.0%).

Conclusion

This study establishes an essential benchmark for physician detection of radiographic ORNJ. The significant variability in diagnostic and severity classification observed across specialties emphasizes the need for standardized imaging protocols and specialist training as well as highlights the value of multimodality imaging.

Prevalence and contributory factors to burnout in the New Zealand surgical specialist and registrar population

Burnout is a growing phenomenon among medical professionals due to aging patient populations and an increasing burden of chronic disease, in a resource constrained environment. We aim to quantify the prevalence of burnout in surgical specialists and registrars at a tertiary center in New Zealand and identify contributory factors, using a New Zealand based tool, the McEwan Burnout Questionnaire. Of the 110 people surveyed, 55% respondents had concern or high risk of burnout. Contributory factors were frustration with management, lack of resources and long working hours, with predominance toward fatigue and service provision over career progression among the registrar group. Bullying and harassment were reported more in the sub-specialty groups. More time in private practice appeared to be associated with less concern for burnout. These high rates of burnout require targeted interventions toward contributory factors to protect our workers and to maintain a sustainable workforce.

Improving research transparency with individualized report cards: A feasibility study in clinical trials at a large university medical center

BACKGROUND

Research transparency is crucial for ensuring the relevance, integrity, and reliability of scientific findings. However, previous work indicates room for improvement across transparency practices. The primary objective of this study was to develop an extensible tool to provide individualized feedback and guidance for improved transparency across phases of a study. Our secondary objective was to assess the feasibility of implementing this tool to improve transparency in clinical trials.

METHODS

We developed study-level "report cards" that combine tailored feedback and guidance to investigators across several transparency practices, including prospective registration, availability of summary results, and open access publication. The report cards were generated through an automated pipeline for scalability. We also developed an infosheet to summarize relevant laws, guidelines, and resources relating to transparency. To assess the feasibility of using these tools to improve transparency, we conducted a single-arm intervention study at Berlin's university medical center, the Charité - Universitätsmedizin Berlin. Investigators (n = 92) of 155 clinical trials were sent individualized report cards and the infosheet, and surveyed to assess their perceived usefulness. We also evaluated included trials for improvements in transparency following the intervention.

RESULTS

Survey responses indicated general appreciation for the report cards and infosheet, with a majority of participants finding them helpful to build awareness of the transparency of their trial and transparency requirements. However, improvement on transparency practices was minimal and largely limited to linking publications in registries. Investigators also commented on various challenges associated with implementing transparency, including a lack of clarity around best practices and institutional hurdles.

CONCLUSIONS

This study demonstrates the potential of developing and using tools, such as report cards, to provide individualized feedback at scale to investigators on the transparency of their study. While these tools were positively received by investigators, the limited improvement in transparency practices suggests that awareness alone is likely not sufficient to drive improvement. Future research and implementation efforts may adapt the tools to further practices or research areas, and explore integrated approaches that combine the report cards with incentives and institutional support to effectively strengthen transparency in research.

Central venous access device management for children undergoing treatment for blood disorders and cancer: a descriptive international cross-sectional survey

PURPOSE

This study aimed to explore current central vascular access device (CVAD) management practices in pediatric cancer care globally and compare practices across high-income and middle-income (i.e., upper middle-income and lower middle-income) countries.

METHODS

A descriptive cross-sectional international survey was conducted between May 2022 and December 2023. Clinicians involved in CVAD insertion/management for pediatric cancer patients were invited to participate through established clinical networks globally. The survey covered CVAD management practices, including dressings, securements, routine care, and maintenance procedures.

RESULTS

A total of 220 responses from 42 countries were received. Polyurethane dressings were most commonly used across all CVAD types (55-65/34.2-40.4). Bordered dressings were the primary securement method for all CVAD types (69-96/161, 42.9-59.6%). Routine practices varied, with 31/102 (30.4%) assessing CVADs hourly during infusion in high-income countries and 22 (37.3%) assessing every shift in middle-income countries. Heparin and normal saline were the commonly used solutions for flushing and locking. Chlorhexidine 2% in 70% alcohol was the predominant decontamination solution in high-income countries (64/102, 62.8%), while alcohol was more common in middle-income countries (22/59, 37.3%). Differences were observed between high-income and middle-income countries in the types of dressings, securements, and maintenance practices used.

CONCLUSION

This study revealed significant variability in CVAD management practices for pediatric cancer care globally, particularly between high-income and middle-income countries. These findings highlight the need for standardized, evidence-based guidelines considering resource availability and contextual factors to improve CVAD management in pediatric oncology across diverse healthcare settings.

Patient Perceptions of Artificial Intelligence in Hand Surgery: A Survey of 511 Patients Presenting to a Hand Surgery Clinic

PURPOSE

This study aimed to evaluate patient awareness and perceptions of artificial intelligence (AI) chatbots in a hand surgery clinic setting.

METHODS

A 16-question, multiple-choice, paper survey was administered to adult patients at five urban and suburban hand clinic locations from February to March 2024. The anonymous survey assessed patient characteristics and patient familiarity, usage, and trust toward chatbots in hand surgery. Descriptive statistics summarized the survey results, whereas multivariable logistic regression analyses determined the factors associated with positive perceptions of AI.

RESULTS

Of the 564 surveys administered, 511 (91%) were completed in their entirety and were included in the study. Most patients (81%) reported having at least basic familiarity with computers and smartphones, whereas 45% had never heard of specific AI chatbots (eg, ChatGPT). Only 3.9% of patients frequently use chatbots in daily life, whereas 70% have never used a chatbot. Only 14.1% of patients stated that they were likely to use chatbots to answer questions about their upper-extremity condition. Similarly, low proportions were likely to trust chatbots to accurately answer questions (14.7%), make a diagnosis (9.0%), make appropriate treatment recommendations (11.9%), and help manage complications (10.8%). A greater proportion thought chatbots would play an important role in their future upper- extremity care (18.6%). Positive perceptions of chatbots were associated with uninsured payment status and those with a college degree, whereas patients who were older or who had greater familiarity with technology were less likely to have positive perceptions of chatbots.

CONCLUSIONS

As AI is increasingly integrated into medical practice, many hand clinic patients remain unaware of or uncertain about its role in their care.

CLINICAL RELEVANCE

Although certain populations had positive attitudes toward chatbots, enhancing patient education about the role and benefits of AI, as well as ensuring transparency, may facilitate its integration into patient care.

Perceptions of community pharmacists regarding pregabalin abuse: a survey from Sudan

OBJECTIVES

Pregabalin abuse is increasing in prevalence and is associated with significant harm. This study aimed to assess community pharmacists' perceptions of pregabalin abuse and their recommendations to address this issue.

METHODS

This was a descriptive cross-sectional study conducted in the Omdurman locality, Khartoum in 2022. Community pharmacies were selected randomly and surveyed using a pre-tested and self-administered questionnaire held on a smartphone. Chi-squared and Fisher's exact tests were run using the Statistical Package for Social Sciences version 26.

KEY FINDINGS

A total of 172 community pharmacists completed the questionnaire (77.8% aged 22-30 years, 65.1% females, 79.1% holding bachelor's degrees, and 57.6% having ≤ 5 years of work experience). Most participants (81.4%) perceived that they had observed pregabalin abuse in the last 6 months. Participants indicated that they were aware of the abuse potential of pregabalin (97.7%) and that they routinely dispensed pregabalin only by prescription (92.4%). Most participants reported that people they suspected of abusing pregabalin were mainly men (98.8%), aged 21-30 years (90.7%), and did not regularly visit the pharmacy (72.7%). Actions taken for such customers included stating the product was not available (64.0%) and refusing to dispense (56.4%). The most recommended solutions were raising community awareness about the risks and consequences of pregabalin abuse (35.8%) and maximizing pharmacists' adherence to dispensing regulations (36.5%).

CONCLUSIONS

Most pharmacists believed that they had observed pregabalin abuse and that it was increasing. They managed the situation primarily by reporting the drug was unavailable and refusing to dispense it. Effective community pharmacy-based interventions are strongly needed to tackle the issue of pregabalin abuse.

Communication and information exchange between practices and hospitals: a survey among primary care practitioners in central Switzerland

BACKGROUND

Digital tools are widely utilised to improve communication and information exchange among healthcare professionals. The cantonal hospital in Lucerne was the first to implement the Epic clinical information system in a German-speaking country, including information access for primary care physicians via an electronic health record portal.

OBJECTIVES

This study assessed how primary care physicians perceive the communication with hospitals in the canton of Lucerne, including their preferences for discharge summary contents and experiences and utilisation of a regionally implemented electronic health record portal.

METHODS

We performed an online survey among primary care physicians and contacted all 323 primary care physicians enlisted as members of the cantonal medical society in Lucerne, Switzerland.

RESULTS

A total of 109 primary care physicians completed the online survey (34% response rate). Half of the primary care physicians were satisfied with hospital communication. Three-quarters (n = 83) wanted to be informed of patients' emergency hospital admission within 48 hours, but only 30% (n = 33) reported being notified. In discharge summaries, primary care physicians expect information on the diagnosis, medication, therapies, and recommendations for follow-up care. A large portion of primary care physicians deemed the electronic health record portal beneficial for patient management. Most primary care physicians utilise the portal to retrieve patient data, but it is rarely used for patient referrals.

CONCLUSION

Half of primary care physicians were satisfied with communication with regional hospitals. Primary care physicians reported a lack of timely notifications or reports about emergency admissions, in-hospital deaths, and discharges of their patients. Primary care physicians value the electronic health record portal as a supporting tool for patient management.

Human research ethics committee processes and practices for approving Aboriginal and Torres Strait Islander health research: a mixed methods study

OBJECTIVES

To describe human research ethics committee (HREC) members' reports of: HREC membership structures; HREC processes for reviewing Aboriginal and Torres Strait Islander health and medical research; and experiences and perceptions of review operations.

STUDY DESIGN

Cross-sectional 36-item survey and qualitative interviews with a subsample of survey participants.

SETTING, PARTICIPANTS

Current and past members (preceding five years) of HRECs who assessed Aboriginal and Torres Strait Islander research.

MAIN OUTCOMES

Survey and interview results related to HREC structures, processes and functioning; challenges in review processes; and what is needed to improve ethical governance.

RESULTS

229 HREC members completed the survey and 13 were interviewed. Half the participants (115 of 221, 52%) reported having an Aboriginal and Torres Strait Islander representative position. Key issues identified related to assessment processes and resourcing, including burden on Aboriginal and Torres Strait Islander members, ability for Aboriginal and Torres Strait Islander HRECs to manage additional applications, lack of clarity around specific assessment criteria for general population studies, lack of cohesion across the application or complaints processes, and lack of resourcing and infrastructure to monitor ethical practice after approval.

CONCLUSION

Aboriginal and Torres Strait Islander people carry an important role and burden in the review of applications and monitoring of health research. However, Aboriginal and Torres Strait Islander people are not presently involved in all aspects of ethical research governance within current HREC structures, including the review and monitoring of approved research. Standardised processes and guidelines that uphold Aboriginal and Torres Strait Islander rights and expert knowledges are required.

Clinical empathy in a medium and high-risk Brazilian unit

BACKGROUND

Clinical empathy is an essential part of healthcare, and patient-centered care models require clinical empathy to be established. Despite this, little is known about its measurement in the neonatal scenario.

RESEARCH AIM

To measure clinical empathy in health professionals who work with medium and high-risk neonates and build a construct of this empathy.

RESEARCH DESIGN

Single-center survey study.

PARTICIPANTS AND RESEARCH CONTEXT

The Jefferson Scale of Empathy for Health Professionals questionnaire was applied to health professionals who work in an intensive care unit and a medium-risk unit, in Brazil. Analysis was done using descriptive statistics and a factor analysis model, to build the construct of empathy. Overall empathy was calculated, and the domains' punctuations were analyzed and compared to the maximum punctuation possible. The study followed the STROBE checklist.

ETHICAL CONSIDERATIONS

This study was approved by the Research Ethics Committee of the institution. All participants signed the informed consent form. Participants' confidentiality and anonymity were protected.

FINDINGS

Median empathy was 117 (IQR 113-124). The domain of Walking in the Patient's Shoes had lower scores and represented 77.6% of the maximum punctuation possible. The factor analysis included three factors named Understanding, Experiences, and Treatment, and Emotional Relationships, explaining 64.3% of the overall variance. The domain Walking in the Patient's Shoes was not included in the model.

CONCLUSIONS

In this scenario, clinical empathy should improve. There is a need to improve the domain of Walking in the Patient's Shoes, in this case, the neonate, and provide more empathic care to them.

Current Status of Hospitalist Practice and Factors Influencing Job Satisfaction in Korea

BACKGROUND

Although the roles and responsibilities of hospitalists have grown considerably in recent years, research on the current job status and satisfaction levels of Korean hospitalists is lacking.

OBJECTIVE

We investigate the present state of Korean hospitalists and the factors influencing their job satisfaction 6 years after the pilot program's launch.

DESIGN

This cross-sectional analysis was based on an online survey conducted from January 30 to February 18, 2023.

PARTICIPANTS

Korean hospitalists (N = 303) MAIN MEASURES: The survey encompassed participant demographics, hospital information, education, clinical practice, research involvement, and job satisfaction. We employed multiple logistic regression analyses to identify determinants of satisfaction as a hospitalist.

KEY RESULTS

The analysis was based on 79 hospitalists' responses (response rate 26%). Respondents had a median age of 39 years; approximately half were male internal medicine specialists, possessing over 3 years of hospitalist experience. Most respondents were interested in clinical work (94.4%), with only 21.5% interested in research and evidence-based medicine. Over two-thirds indicated that non-clinical duties occupied less than 20% of their time. Overall, job satisfaction among hospitalists averaged 51.9%. Notably, the availability of a research mentor was significantly associated with job satisfaction (P = .011). While hospitalists with more than 3 years of experience, more hospitalists per facility, and autonomy were associated with increased job satisfaction, these associations were not statistically significant. Furthermore, there was no association between night shift work, work type, or work hours and job satisfaction.

CONCLUSIONS

Although Korean hospitalists primarily focus on clinical practice, our study underscores the positive impact of mentorship from research mentors on job satisfaction, supported by comprehensive univariate and multivariate analyses. These findings signal a progressive transformation in the role of Korean hospitalists, as they increasingly engage in research alongside patient care.

Problems accessing pain care, and the adverse outcomes among adults with chronic pain: a cross-sectional survey study

AIMS

Prescribing restrictions have significantly impacted patients with chronic pain, leading to opioid medication tapering and reduced access. This study examines the consequences of these restrictions and their impact on patient health and pain management strategies.

PATIENTS & METHODS/MATERIALS & METHODS

This research explores barriers to pain care, especially opioid therapy, adverse health outcomes resulting from reduced access to pain medications, and alternative pain management strategies. The study analyzes data from a cross-sectional survey conducted by the American Chronic Pain Association (ACPA) between November 2014 and January 2015. The survey gathered quantitative data on demographics, healthcare access, pain management strategies, and challenges in obtaining prescribed medications, alongside qualitative responses. Descriptive statistics summarized quantitative findings; chi-square and t-tests compared those with and without medication access difficulties. Thematic analysis revealed recurring themes in qualitative responses.

RESULTS

The study reveals that over half of the respondents faced difficulties obtaining prescribed pain medications, leading to significant adverse health consequences, including unmanaged pain, psychological distress, and suicidal ideation.

CONCLUSION

These findings highlight the urgent need to address systemic and personal barriers to pain medication access, and the need for patient-centered care that incorporates evidence-based, holistic pain management strategies and shared decision-making between clinicians and patients.

What to Measure in Aneurysmal Subarachnoid Haemorrhage Research-An International Delphi Survey

Aneurysmal subarachnoid haemorrhage (aSAH) is a devastating condition with high mortality and morbidity. The outcome measures used in aSAH clinical research vary making it challenging to compare and combine different studies. Additionally, there may be a mismatch between the outcomes prioritized by patients, caregivers, and health care providers and those selected by researchers. We conducted an international, online, multiple round Delphi study to develop consensus on domains (where a domain is a health concept or aspect) prioritized by key stakeholders including those with lived experience of aSAH, health care providers, and researchers, funders, or industry professionals. One hundred seventy-five people participated in the survey, 59% of whom had lived experience of aSAH. Over three rounds, 32 domains reached the consensus threshold pre-defined as 70% of participants rating the domain as being critically important. During the fourth round, participants ranked the importance of each of these 32 domains. The top ten domains ranked highest to lowest were (1) Cognition and executive function, (2) Aneurysm obliteration, (3) Cerebral infarction, (4) Functional outcomes including ability to walk, (5) Delayed cerebral ischemia, (6) The overall quality of life as reported by the SAH survivor, (7) Changes to emotions or mood (including depression), (8) The basic activities of daily living, (9) Vasospasm, and (10) ICU complications. Our findings confirm that there is a mismatch between domains prioritized by stakeholders and outcomes used in clinical research. Our future work aims to address this mismatch through the development of a core outcome set in aSAH research.

Suicide Prevention and Telehealth in Children's Hospital Emergency Departments

OBJECTIVES

Suicide is a leading cause of death among adolescents. Emergency department (ED) visits for mental health concerns are rising, and telehealth is increasingly used to provide emergency mental health care. We conducted a national survey to describe suicide prevention practices and tele-mental health care in children's hospital EDs.

METHODS

We conducted a cross-sectional survey of leaders at all 52 US EDs affiliated with dedicated children's hospitals (ie, hospitals that provide care only to children) to describe use of tele-mental health care and suicide prevention practices.

RESULTS

Leaders from 41 EDs completed the survey (79% response rate). Tele-mental health care was used in 23 EDs (56%); there were no differences in ED structural characteristics between institutions with telehealth versus without telehealth. Among responding EDs, 40 (98%) reported they screen for suicide risk, and 29 (71%) reported they use a standardized approach to suicide prevention discharge planning. Risk reduction practices conducted at many but not all EDs included assessment of access to lethal means (n = 31, 86%), counseling on reduction of access to lethal means (n = 30, 73%) and providing patients with a list of professionals or agencies that they can contact in a crisis (n = 35, 85%). There were no differences in use of suicide prevention practices at EDs with versus without telehealth ( P > 0.1 for all).

CONCLUSIONS

Approximately half of children's hospital EDs use tele-mental health care, and hospitals with versus without tele-mental health care report similar rates of suicide prevention practice use. Opportunities exist to increase use of discharge safety practices.

Important features of hospitals, intensive care unit waiting rooms, and patient care rooms: perspectives of intensive care unit visitors

PURPOSE

Family members of critically ill patients spend significant periods of time in the intensive care unit (ICU) and hospital environment. We aimed to identify what services, resources, and conveniences are important to adult ICU visitors.

METHODS

We conducted a cross-sectional study including visitors in four adult ICUs in the province of Ontario, Canada. In the survey, we asked visitors to rate the importance of 58 items relating to the environment of patient rooms, the waiting room, and hospital facilities. For each item, we gave respondents five categorical response options, from "not at all important" to "extremely important." We used descriptive statistics to analyze the survey results.

RESULTS

We analyzed 224 surveys completed by ICU visitors (60% female, ages 14-87 yr). Respondents were predominantly children (41%) or the spouse/partner (23%) of adult ICU patients. Nearly half (51%) lived more than 30 km from the hospital, and 30% spent at least one night in the ICU waiting room, with a median of 2 nights (range, 1-20) spent in hospital. Within the hospital environment, the top four items rated as "extremely important" or "very important" were directional signage (82%), convenient parking (80%), discounted parking (80%), and healthy and affordable food (78%). Regarding ICU waiting rooms, 24/7 visitation (92%), convenient restrooms (87%), a water dispenser (83%), and Wi-Fi (80%) were priorities. Features of ICU patient rooms identified as most important included seating for visitors (92%), access to natural light (78%), and access to fresh air (74%).

CONCLUSIONS

Intensive care unit visitors prioritized pragmatic environmental elements. Many of these modifications are simple and inexpensive but may significantly improve visitors' comfort and experience.

Self-Reported Motor and Non-Motor Symptoms in People With Functional Gait Disorder: A Cross-Sectional Study

BACKGROUND

Functional gait disorder is a common presentation of functional neurological disorder. Altered gait is the defining feature, along with a range of associated motor and nonmotor symptoms. The aim of this study was to explore the prevalence and impact of these symptoms in people with functional gait disorder.

METHODS

A total of 156 people with functional gait disorder completed an online survey that included demographic information, self-reported symptoms, and standardized questionnaires.

RESULTS

Weakness (85.9%) and reduced balance (80.1%) were the most prevalent motor symptoms, while fatigue (85.9%), somatosensory (69.9%), and cognitive (69.9%) symptoms were the most prevalent nonmotor symptoms. Logistic regression indicated that dependent ambulation had the greatest association with fear of falling and functional seizures (X2 (11, n = 128) = 40.68, p < 0.001). Stepwise regression indicated that functional seizures, muscle rigidity, depression, fear of falling, pain, and speech symptoms were associated with reduced participation in work and social function (adjusted R2 = 0.39, F (6, 120) = 14.31, p < 0.001). Stepwise regression revealed that lower physical quality of life was associated with pain, bradykinesia, fatigue, and dystonia (adjusted R2 = 0.32, F (4, 122) = 15.92, p < 0.001) while depression, anxiety, and functional seizures were associated with reduced mental quality of life (adjusted R2 = 0.46, F (3, 123) = 36.89, p < 0.001).

CONCLUSIONS

Motor and nonmotor symptoms are highly prevalent in people with functional gait disorder and are associated with high levels of disability, reduced participation in work and social function, and reduced quality of life.

Survey of vitamin D supplementation practices in extremely preterm infants

BACKGROUND

Most extremely preterm (EP) infants are vitamin D deficient (serum 25-hydroxyvitamin D levels below 20 ng/mL), and optimal supplementation practices for EP infants remain unknown. Our objective is to assess current vitamin D supplementation practices in U.S. neonatal intensive care units (NICU) for EP infants to provide baseline information for the design of future clinical trials.

METHODS

We conducted an online survey to study vitamin D intake and supplementation practices in U.S. NICUs caring for EP infants. Descriptive statistics compared responses by affiliation and level of care.

RESULTS

We analyzed responses from 253 NICUs, representing the majority of academic and level IV centers. Nearly all centers (97%) provided enteral vitamin D supplementation during the NICU stay, with 400 IU/day as the most common dosage (77%). Over half (56%) used feeding volume to initiate supplementation, with 71% of centers starting after achieving at least 120 ml/kg/day. Additionally, 94% of NICUs reported prescribing a vitamin D supplementation at discharge.

CONCLUSIONS

Most NICUs in the U.S. supplement EP infants with 400 IU/day of enteral vitamin D. Clinical trials of vitamin D supplementation comparing the most common regimen to earlier and higher doses are needed to identify adequate regimens for EP infants.

IMPACT

Despite the prevalence of vitamin D deficiency in extremely preterm (EP) infants at birth, optimal levels and supplementation strategies remain debated. Recent studies have suggested benefits of early high-dose vitamin D supplementation (800 IU/day) for reducing complications like bronchopulmonary dysplasia, infections, and disability. There is US center variation in timing and dose of vitamin D supplementation, being the most common regimen 400 IU/d started after established feedings (≥120 ml/kg/day). These findings inform and highlight the need for clinical trials of usual vs. early, higher-dose vitamin D supplementation to advance clinical outcomes and define desirable blood levels of EP infants.

[How to: correctly read scientific articles : Research design and methodology]

Criteria for assessment of the significance of scientific articles are presented. The focus is on research design and methodology, illustrated by the classical study on prehospital volume treatment of severely injured individuals with penetrating torso injuries by Bickell et al. (1994). A well-thought out research design is crucial for the success of a scientific study and is documented in a study protocol beforehand. A hypothesis is a provisional explanation or prediction and must be testable, falsifiable, precise, and relevant. There are various types of randomization methods, with the randomized controlled trial being the gold standard for clinical interventional studies. When reading a scientific article it is important to verify whether the research design and setting align with the research question and whether potential sources of error have been considered and controlled. Critical scrutiny should also be applied to references, the funding and expertise of the researchers.

Common practices of dental implant maintenance among dental hygienists working in the Netherlands - A survey

BACKGROUND

Dental implant maintenance is crucial to obtain and maintain a healthy peri-implant situation. Although it is part of a dental hygienists (DH) scope of practice, the knowledge and common practices among DHs in the Netherlands are unclear.

MATERIALS AND METHODS

A web-based survey was distributed by the Dutch Association of DHs, by spreading survey QR codes and snowballing. The role of the different DH curricula 2- or 3-year diploma and a 4-year bachelor's degree is evaluated.

RESULTS

In total, 165 (diploma: 73, bachelor: 92) DHs responded. Peri-implant diseases were well known (98%), indices and clinical symptoms were used to assess peri-implant tissues. A periodontal probe (97%) was used and bone loss was evaluated on radiographs (89%). Treatment was performed supra- and subgingivally (69%), mostly by titanium (45%) or plastic hand instruments (42%). Ultrasonic (52%) and air-abrasive (52%) devices were often used. The recall interval for maintenance was based on a risk-adjusted protocol (70%). DHs with a bachelor's received significantly more training compared to DHs with a diploma during primary education (p < 0.001). Diploma DHs mainly obtained their knowledge from continuing education (p = 0.04). In general, there was no significant difference in knowledge or common practices.

CONCLUSIONS

The primary education of DHs with a 2- or 3-year diploma and a 4-year bachelor's varies. Due to the continuing education of diploma DHs, knowledge and common practices generally do not differ. Most DHs in the Netherlands perform implant maintenance. A periodontal probe and radiographs are used for examination. Instrumentation is performed supra- and subgingivally, usually with titanium or plastic hand instruments. The recall interval is based on a patient's risk assessment.

Real-time attending trauma surgeon assessment of direct-to-operating room trauma resuscitations: Results from a prospective observational study

BACKGROUND

Direct-to-operating room (DOR) resuscitation expedites interventions for trauma patients. Perceived benefit from the surgeon's perspective is not well known. This study assesses the integration of a real-time surgeon assessment tool into a DOR protocol.

METHODS

Surgeon assessment tool results from a prospective study of DOR cases were analyzed. Analysis assessed patient factors and surgeon perception for appropriateness and benefit of DOR. Multivariate analysis identified independent factors associated with perceived DOR benefit.

RESULTS

A total of 104 trauma patients underwent DOR resuscitation; 84% were perceived as appropriate triage, and 48% as beneficial. Patients with Injury Severity Score of >15 (50% vs. 28%), systolic blood pressure of <90 mm Hg (24% vs. 9%), and severe abdominal injury (28% vs. 9%) had higher perceived DOR benefits (all p < 0.05). Patients deemed to benefit from DOR underwent more emergent interventions or truncal surgery (44% vs. 92%, p < 0.01). No difference in benefit was seen based on age, sex, Glasgow Coma Scale score of <9, or injury mechanism. Forty-four percent had perceived benefit from DOR resuscitation despite requiring imaging after initial evaluation. Patients with perceived benefit had a higher rate of unplanned return to the operating room (16% vs. 2%, p < 0.05), but no differences in complication rates, Glasgow Outcome Score, or mortality. Injury Severity Score of >15 was the only independently associated variable with a perceived benefit on surgeon assessment tool (odds ratio, 3.5; p < 0.05).

CONCLUSION

The majority of DOR resuscitations were deemed as appropriately triaged, and approximately half had a perceived benefit. Benefit was associated with higher injury severity and the need for urgent interventions but was not predicted by injury mechanism or other triage variables.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.

Variation in the surgical management of complicated diverticulitis: a cross-sectional study of European surgeons

INTRODUCTION

There are many options for the surgical management of complicated diverticulitis, and standards vary widely despite international practice recommendations. We conducted a survey to capture the variation in practice across Europe.

METHODS

An online questionnaire was distributed to fellow and surgeon members of the European Association of Endoscopic Surgery (EAES) via email using the Opinio survey platform. Participants shared their demographic details. We asked members to rank the most likely intervention for patients with both stable and unstable Hinchey Class III, as well as Hinchey Class IV diverticulitis based on practice standards in their country. We used descriptive statistics, including counts and percentages, to characterize survey results. We created a heatmap to visualize the percentage of votes received for each intervention.

RESULTS

We received 233 responses from surgeons and fellows across Europe from various countries, including Italy (35.6%), Greece (11.2%), and the United Kingdom (9.9%). Most members (79.4%) self-reported having expertise in colorectal surgery. For patients with stable Hinchey III diverticulitis, surgeons offered Hartmann's resection (HR) (41.6%), primary resection and anastomosis (PRA) (18.5%), laparoscopic peritonea lavage (LPL) prior to HR (16.9%), or LPL prior to PRA (15.5%), or LPL only (8.6%). In total, 31.4% of respondents offered LPL prior to sigmoid resection (HR + PRA). For patients with unstable Hinchey III diverticulitis, respondents offered HR (73.9%), PRA (3.85%), LPL only (6.84%), or LPL followed by sigmoid resection (15.4%). For patients with stable Hinchey IV diverticulitis, surgeons offered HR (71.7%), PRA (4.7%), LPL only (1.3%), or LPL then sigmoid resection (22.3%). Finally, for patients with unstable Hinchey IV diverticulitis, surgeons offered HR (83.1%), PRA (1.3%), LPL only (3.5%), or LPL followed by sigmoid resection (12.1%).

CONCLUSION

Significant variation exists in the surgical management of complicated diverticulitis across Europe. Efforts must be made to increase the awareness and uptake of surgical guideline recommendations in clinical practice.

Clinician assessment of kidney function from plasma creatinine values during critical illness: A scenario-based international multi-professional survey

PURPOSE

During critical illness interpretation of serum creatinine is affected by non-steady state conditions, reduced creatinine generation, and altered distribution. We evaluated healthcare professionals' ability to adjudicate underlying kidney function, based on simulated creatinine values.

METHODS

We developed an online survey, incorporating 12 scenarios with simulated trajectories of creatinine based on profiles of muscle mass, GFR and fluid balance using bespoke kinetic modelling. Participants predicted true underlying GFR (<5, 5-14, 15-29, 30-44, 45-59, 60-90, >90 ml.min-1.1.73 m-2) and AKI stage (stages 1-3, defined as 33 %, 50 %, 66 % decrease in GFR from baseline) during the first 7-days and at ICU discharge.

RESULTS

100 of 103 respondents from 16 countries, 94 completed 1 or more scenarios. 43(43 %) were senior physicians, 74(74 %) critical care and 31(31 %) nephrology physicians. Over the first 7-days, true GFR was correctly estimated 43 % of the time and underlying AKI stage in 57 % of patient days. At ICU discharge GFR was predicted 35 % of the time. At all timepoints, over and under-estimation of GFR was observed.

CONCLUSION

Participants displayed marked variation in estimation of kidney function, suggesting difficulty in accounting for multiple confounders. There is need for alternative, unbiased measures of kidney function in critical illness to avoid misclassifying kidney disease.

Cross-referencing French hematology teams' knowledge and perception of end-of-life situations: a national mixed-methods survey

INTRODUCTION

Haematology is a speciality frequently confronted with end-of-life situations, and teams will be concerned by the question of medical assistance in dying. The Ethics Commission of the French Society of Haematology has conducted a survey on the knowledge and perceptions of healthcare professionals regarding complex end-of-life situations.

METHODS

A cross-sectionalonline survey of hematology professionals in France. The comprehensive online questionnaire addressed respondents' experience of complex end-of-life situations in hematology, based on 7 clinical vignettes. The survey contained 55 questions, 6 of which were open-ended. They were asked to give their opinion on whether it should be legalized. Justifications were then requested and analyzed by theme.

RESULTS

The survey was distributed to associations of hematology healthcare professionals (approximately 1,300 members). Overall, 182 healthcare professionals replied, including a third nurses and a third physicians. The average score for identifying complex situations was 7.1 out of 10 (IQR 5.7,8.6), with lesser knowledge of situations involving double effect, euthanasia and sedation for distress than of situations involving limiting or stopping treatment. Training in palliative care was the main driver of knowledge (p = 0.004), as well as being a physician (p < 0.001). We found that the opinions of healthcare professionals regarding the legalization of medical assistance in dying in France were diverse and well-founded.

CONCLUSION

Hematology healthcare professionals had lesser knowledge of situations involving double effect, euthanasia and sedation for distress. Knowledge of specific situations impacts professionals' opinion on legalization of medical assistance in dying.

The Management of Chronic Insomnia in Young Children: A Survey of UK General Practice

OBJECTIVES

Chronic insomnia (CI), the most common sleep disorder in young children, is associated with negative outcomes for the child and family. This study explores the beliefs, current practice, and understanding of UK primary health care professionals (PCPs) regarding CI in children under 5 years.

METHOD

An online survey of UK PCPs (e.g. general practitioners (GPs), practice nurses) recruited through Clinical Research Networks. The survey consisted of Likert-style and closed- questions regarding beliefs, current practice, and training/knowledge. Data were analyzed descriptively.

RESULTS

Two hundred and ninety-five PCPs took part (mostly GPs, n = 244). Respondents believe that CI has a large impact on children and family. 80% agreed that CI should be managed in health care and 66.3% in primary care. However, consultations with families regarding CI were reported as infrequent. 91.6% agreed that CI should be managed with behavioral approaches, and more than  85% of respondents recommend positive bedtime routines. Respondents had varied confidence and knowledge about management. They had received little to no professional education about CI.

CONCLUSIONS

PCPs recognize the importance of CI and understand some principles of management, though they lack training and confidence. Improved training and awareness of evidence-based resources for support would improve management in primary care.

'We don't know nearly enough': an online survey exploring perspectives of specialists who support children with brain-based visual impairments

Introduction

Children with brain-based visual impairments (some of whom have a diagnosis of Cerebral Visual Impairment, or 'CVI') represent a growing and underserved population within vision services. These children often have more complex needs than those with ocular visual impairments and benefit from specialist support from multiple disciplines. This study aimed to understand the perspectives of these specialists in terms of their goals, views on collaboration, and understanding of the term 'CVI'.

Methods

We invited a range of specialists who work with children with brain-based visual impairments, including educators, rehabilitation staff, clinicians, and family members, to complete an online survey between April 2023 and April 2024.

Results

The analysis included 94 respondents: 51 educators, 30 rehabilitation staff, 7 clinicians, and 6 family members. Respondents shared common goals of connecting with the child (87/94, 93%) and fostering their learning and development (82/94, 93%). However, respondents also noted some specific and divergent goals, which can be at odds with each other. Professional staff frequently identified family members as the most valuable source of information about their child's vision (36/88, 41%), though family members expressed feeling under-valued. Transdisciplinary clinics were highlighted as a helpful model to provide quality child-centered care. Of the 73 professional staff who reported being familiar with the term 'CVI' (73/88, 83%), most (61/73, 84%) thought it was underdiagnosed, but respondents had different perspectives on what a diagnosis meant. Only 73% of professionals familiar with CVI reported receiving formal training about it.

Discussion

The varied goals and different perspectives on CVI create challenges to providing cohesive support for children with brain-based visual impairments. Increasing the availability of complementary formal training across disciplines and adopting transdisciplinary models of care are promising approaches to improve the quality of services.

Pelvic ring fracture and erectile dysfunction (PERFECD) - 3 year follow-up cross sectional study

INTRODUCTION

Pelvic ring fractures are known to be associated with complications associated with adjacent organ injuries, such as the urogenital tract (e.g. erectile dysfunction (ED), which are sometimes diagnosed in a delayed fashion. Therefore, we assessed the quality of life (QoL) and the rate of erectile dysfunction (ED) following pelvic ring fractures at a minimum of 3 years after pelvic ring injury.

METHODS

Between January 1, 2016, and December 31, 2020, adult male patients (≥ 18 years) with pelvic ring injuries were included in the study. Fractures were classified according to the Young & Burgess (Y&B) classification system, while pelvic contusions were categorized as the control group. Data were collected using a written questionnaire that assessed Quality of Life (QoL) by Short Form 12 (SF-12) and erectile dysfunction (ED) with the International Index of Erectile Function 5 (IIEF-5). ED was stratified as follows: no ED (21-25 points), mild ED (16-21 points), moderate ED (9-15 points), and severe ED (5-7 points). Comorbidities and risk factors for ED were also assessed, including vasculopathy, peripheral artery disease, hypercholesterolemia, coronary artery disease, diabetes, and smoking.

RESULTS

A total of 182 patients were included, with a mean age at injury of 53.5 years (SD 17.1) and a mean age at the time of the questionnaire of 57.8 years (SD 17.4). The distribution of patients was as follows: APC Group (n = 20, 11.1%), LC Group (n = 94, 52.2%), CMVS Group (n = 6, 3.3%), and Control Group (n = 60, 33.3%). The mean Injury Severity Score (ISS) was 24.6 points (SD 16.4). Regarding erectile dysfunction, 8 patients (17.4%) had no ED, 10 (21.7%) had mild ED, 6 (13.0%) had moderate ED, and 22 (47.8%) had severe ED. Quality of Life (QoL) was significantly reduced in patients with CMVS pelvic fractures, particularly in physical role function, which scored 62.5 points (SD 29.6, p < 0.001). All patients in the APC Group reported at least a mild form of ED. APC injuries were identified as an independent risk factor for lower IIEF-5 scores (OR -4.5, 95% CI -8.3 to -0.7, p = 0.02), comparable to other risk factors such as hypertension (OR -9.2, 95% CI -12.8 to -5.6, p < 0.001), diabetes (OR -5.3, 95% CI -9.4 to -1.2, p = 0.012), and smoking (OR -2.6, 95% CI -5.2 to -0.04, p = 0.05).

CONCLUSION

Vertical shear fractures are associated with significantly lower quality of life compared to APC or LC fractures three years post-injury. The APC type of pelvic ring injury was identified as an independent risk factor for the development of erectile dysfunction (ED). Early screening and appropriate management should be initiated for patients with APC injuries to address and mitigate the risk of ED.

Surveys of Knowledge and Awareness of Plastic Pollution and Risk Reduction Behavior in the General Population: A Systematic Review

Individual attitudes and knowledge can predict pro-environmental behaviors. Public surveys, therefore, can provide precious information, which can guide sensitization interventions. In this systematic review, we searched Medline and Embase, with no language or date restrictions, for surveys designed to measure in the general population the level of knowledge about different types of plastics, the risks associated with plastic pollution, and awareness of actions to reduce them. Survey tools were analyzed following the guide of Burns and Kho, and study methodological quality was assessed via the Appraisal Tool for Cross-Sectional Studies. We included 17 articles published from 2019 to 2024, mostly concerning European populations. The tools comprised a median of 13 items (range 7-50), and very differently formulated questions. Overall, 13/17 (76.5%) study questionnaires received less than 50% (<3.5) of the maximum possible score. The remaining four questionnaires obtained intermediate scores (between 3.5 and 5.3) indicating moderate quality. Most studies did not employ the appropriate cross-sectional survey methodology, only two studies statistically justified sample sizes, only three reported a sampling frame, and only two described a selection process that appears to be representative. In most cases, the instruments were not validated, and the statistical significance of key variables was not provided. The many shortcomings highlighted in this review emphasize the urgent need for methodological rigor when conducting survey studies, which are essential tools for public health.

Burden of incidental cerebral aneurysms on lifestyle and quality of life: a survey of patients in expectant management (the SPICE Study)

BACKGROUND

The increasing availability of neuroimaging tests has led to a rise in the identification of incidental unruptured intracranial aneurysms (UIAs). Their management is under debate, with no consensus on their follow-up strategy, which can cause anxiety in patients. Our aim is to evaluate the impact of diagnosis and imaging follow-up on daily activities and quality of life.

METHODS

A multicenter cross-sectional study was carried out in patients with UIAs undergoing watchful waiting. Exclusion criteria were history of stroke, renal polycystic disease, symptomatic aneurysms, intervention or scheduled for intervention. The patients completed an anonymous 36-question survey about their habits and perceived quality of life after diagnosis through a validated questionnaire (PROMIS).

RESULTS

We obtained 73 responses from 183 patients identified in eight hospitals (40%), 68 of which were included in the study (50 women (74%), median (IQR) age 62 (55-70) years). Forty-nine patients (72%) underwent at least one imaging follow-up per year. Forty-two patients (63%) found follow-up tests reassuring and 12 (18%) experienced concern about the results. Nineteen patients (28%) reported adopting a healthier lifestyle since diagnosis, while 13 (19%) acknowledged a negative impact on their daily activities. Forty-six (68%) admitted avoiding or conditioning at least one activity or situation from a list. PROMIS scores were similar to those of the general reference population. Overall, 77% rated their quality of life as 'good' or better.

CONCLUSIONS

The diagnosis of UIAs seems to influence the activities of the majority of patients. However, follow-up yielded more benefit in the form of healthier lifestyles than harm to daily activities, without detriment to their perceived quality of life.

The experiences of speech-language pathologists when collaborating with spoken language interpreters, multilingual families, and their children with hearing loss

PURPOSE

The parents of children who are deaf or hard-of-hearing may require a spoken language interpreter to access early-intervention services. This research sought to describe speech-language pathologists' perspectives regarding collaboration with interpreters in this space.

METHOD

Twenty-seven speech-language pathologists working in Australia completed a cross-sectional mixed-method online survey. Participants responded to questions about knowledge they thought was important for interpreters to know before collaborating in early-intervention and their best and worst experiences when collaborating with interpreters. Quantitative and qualitative analyses of participants' responses were undertaken.

RESULT

Less than half of the 27 speech-language pathologists reported that a qualified interpreter was always used in appointments. Speech-language pathologists stated that the most important information for interpreters to know before an appointment included key terminology in both languages and the purpose of the appointment for which they were interpreting. Major themes relating to before, during, and after the session were identified. Subthemes relating to briefing, procedural skills and prior knowledge, and environmental factors were identified.

CONCLUSION

Speech-language pathologists identified significant barriers to effective collaboration with interpreters in early-intervention settings. Future research should seek the perspectives of interpreters, educators, caregivers, and deaf or hard-of-hearing children collaborating in the early-intervention space.

European surgical societies rarely have recommendations for the treatment of appendicitis - a survey

PURPOSE

Guidelines for management and treatment of appendicitis recommends the removal of a normal-looking appendix, but the recommendations are deemed as weak because they are based on low quality evidence. We aimed to provide an overview of the recommendations from the European societies or associations of surgeons regarding the treatment of acute appendicitis and especially recommendations for the macroscopically normal-looking appendix.

METHODS

European surgical societies were contacted and sent an electronic questionnaire. Questions concerned if the association had a national guideline or recommended an existing one, and if they recommended a specific approach for the management of the normal-looking appendix, including who decided to remove the appendix.

RESULTS

We contacted surgical societies from 28 European countries, and 17 surgical societies (61%) responded. Two societies had a national guideline for the treatment of appendicitis and one of these addressed how to treat the normal-looking appendix. Most societies (59%) answered that the operating surgeon decided whether to remove the normal-looking appendix. Eleven societies recommended using an existing guideline (65%), four societies (24%) did not recommend a guideline, and two societies did not know.

CONCLUSION

Only two surgical societies had a published national recommendation or guideline on the treatment of suspected appendicitis, only one had a guideline for the management of the normal-looking appendix, and most societies answered that the operating surgeon decided.

Lyme borreliosis awareness and risk perception: a survey in 20 European countries

An estimated 129000 cases of Lyme borreliosis (LB) are reported annually in Europe. In 2022, we conducted a representative web-based survey of 28034 persons aged 18-65 years old in 20 European countries to describe tick and LB risk exposures and perceptions. Nearly all respondents (95.0%) were aware of ticks (range, 90.4% in the UK to 98.8% in Estonia). Among those aware of ticks, most (85.1%) were also aware of LB (range, 70.3% in Switzerland to 97.0% in Lithuania). Overall, 8.3% of respondents reported a past LB diagnosis (range, 3.0% in Romania to 13.8% in Sweden). Respondents spent a weekly median of 7 (interquartile range [IQR] 3-14) hours in green spaces at home and 9 (IQR 4-16) hours away from home during April-November. The most common tick prevention measures always or often used were checking for ticks (44.8%) and wearing protective clothing (40.2%). This large multicountry survey provided needed data that can be used to design targeted LB prevention programmes in Europe.

Fecal carriage of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli in South American camelids and biosecurity practices among farms in northern Italy

South American camelids (SACs), particularly llamas (Lama glama) and alpacas (Vicugna pacos) are gaining popularity in Europe. Initially valued for their fiber and land management capabilities, these animals are now also kept for animal therapy, outdoor activities, and as companion animals. Despite their close interactions with humans and other animals, there is limited research on the transmission of microbes or antimicrobial resistance genes from SACs. This study aimed to survey the fecal carriage of extended-spectrum beta-lactamase ESBL-producing Escherichia coli (ESBL- E. coli) in SACs. A questionnaire was administered on-site to the farmers to survey management and biosecurity measures. Twelve farms from northern Italy (Lombardy, Piedmont, Veneto, and Emilia-Romagna) participated in the study. Fecal samples were analyzed to identify ESBL- E. coli and subjected to bacteriological culture on CHROMagar™ ESBL plates. Isolate identification was accomplished by MALDI-TOF MS, then subjected to the double-disk synergy test (DDST) and examined for 3 ESBL-encoding genes (blaCTX-M, blaTEM, blaSHV) via PCR analysis. A total of 125 SACs (19 llamas and 106 alpacas) were included. Four (3.2%) of these animals were positive for ESBL- E. coli. Two isolates carried the blaCTX-M gene; one had both blaCTX-M and blaTEM, and one was negative for all ESBL-encoding genes. Furthermore, none of the ESBL- E. coli isolates tested positive for the blaSHV gene. Several data from our questionnaire revealed a lack of biosecurity protocols, which aligns with other studies. The prevalence of ESBL-producing bacteria identified in this study was lower than in different other studies. Despite the low biosecurity levels observed on the SAC farms, our findings showed a low occurrence of ESBL- E. coli and a low carriage rate of multidrug-resistant (MDR) ESBL- E. coli.

Co-design of a novel rehabilitation intervention for patients after ankle fracture surgery: establishing healthcare professional consensus

Post-surgical rehabilitation advice after ankle fracture surgery, particularly regarding weight-bearing, varies significantly, leading to patient frustration and inconsistent recovery outcomes. This study aimed to establish a consensus for ankle fracture rehabilitation advice and identify content and implementation options for future interventions through consultation with healthcare professionals (HCPs). This study was part of the weight-bearing in ankle fractures (WAX) trial, a multicentre, randomised controlled trial. Using the behaviour change wheel (BCW) framework, three online workshops with HCPs were conducted between April 25, 2022, to May 4, 2022, to generate consensus on rehabilitation interventions. Participants completed pre-workshop tasks, and data were collected using an adapted nominal group technique (NGT). Workshop data were collated to create a survey with indicative statements about rehabilitation preferences. An online survey was subsequently disseminated to surgeons and physiotherapists between May 5, 2022, and July 13, 2022. Respondents were asked to indicate how strongly they agreed with various statements by ranking statements on a 5-point Likert scale from "strongly disagree" to "strongly agree"; 75% was used as a threshold for consensus agreement. Eight HCPs participated in the workshops, and 79 HCPs responded to the survey, representing 38 different NHS hospital trusts. Consensus was achieved on several key aspects: Patients could rest their foot on the floor while seated during non-weight-bearing periods and gradually increase weight-bearing based on comfort. It was agreed that orthotic boots are for comfort, and patients can discontinue use as early as two weeks post-operatively if weight-bearing is permitted. Guidelines for wound management, including when to get wounds wet and how to handle numbness, were also established. This study established a consensus for ankle fracture rehabilitation, emphasising patient autonomy and clear, standardised advice. The findings support the development of a tailored, patient-centred rehabilitation interventions, potentially delivered through digital platforms, to enhance recovery outcomes.

A Survey of the Congenital Glaucoma Surgery Practice Patterns in the Indian Pediatric Glaucoma Society

PURPOSE

To assess the practice patterns among the Indian Pediatric Glaucoma Society (IPGS) members in the management of children with primary congenital glaucoma (PCG).

METHODS

An anonymous 74-question survey was administered online via Qualtrics (Qualtrics, Provo, Utah, USA) using a link sent by email to the 88 IPGS members. The questionnaire comprised five sections and was designed to gather information regarding respondent demographics and specialty training, clinic composition and volume, surgical practices and preferences, follow-up practices, and additional services. The survey was closed after 10 weeks. Data were analyzed using descriptive statistics and Chi-square tests. Statistical significance was set at p < .05.

RESULTS

The response rate was 82%. Of the 71 respondents, 49 (69%) reported possessing glaucoma fellowship training that included specialist training in pediatric glaucoma. By comparison, 8 respondents (11%) reported possessing pediatric ophthalmology fellowship training that included specialist training in pediatric glaucoma, and this difference was statistically significant (69% vs. 11%; χ2 = 47.37; p < .0001). The majority of the respondents were in ophthalmic institution-based practice (83%) and were located in South India (58%). In cases of hazy cornea, the most common surgery (95%) performed was combined trabeculotomy-trabeculectomy while goniotomy was most preferred (49%) in cases of clear cornea. Approximately, one-half of the respondents (56%) preferred to operate on each eye in separate sessions, whereas 46% preferred to operate on both eyes in the same session. One-half of the respondents (51%) preferred to use mitomycin-C in primary surgery. The most common challenges in providing care were patient-related, including delayed presentation, high travel costs, and low socioeconomic status.

CONCLUSIONS

Although a substantial consensus was found in most areas of management, a few areas, for example, use of MMC in primary surgery, showed diversity. The information gathered will enable glaucomatologists to compare their practices with those of their colleagues. In addition, this survey provides a baseline, allowing future trends in management to be determined.

Maternal healthcare service utilisation and associated factors among mothers in a rural Wolaita, southern Ethiopia: a community-based cross-sectional study

OBJECTIVE

To assess the level of maternal healthcare service utilisation and related factors to its frequency of care among mothers who gave birth in the previous 2 years before the survey in rural Wolaita, southern Ethiopia.

DESIGN

Cross-sectional survey.

SETTING

This study was undertaken in Kindo Didaye, rural Wolaita, southern Ethiopia, from February to March 2016.

PARTICIPANTS

Out of 552 who gave birth, 544 (98.5%) mothers aged between 15 and 49 years, selected using two-stage random sampling, participated in the study.

OUTCOME MEASURES

Maternal healthcare service utilisation frequency and proportion and associated factors.

RESULT

The proportion of maternal healthcare service utilisation was 59.38% (95% CI: 55.11% to 63.53%), with 50.74% (95% CI: 46.45% to 55.01%), 16.18% (95% CI: 13.18% to 19.54%) and 31.80% (95% CI: 27.90% to 35.90%) prevalence of antenatal care (ANC), delivery care and postnatal care (PNC), respectively. The frequency of maternal healthcare service utilisation was positively related to having a favourable attitude towards maternal healthcare service utilisation, knowledge of mothers about maternal healthcare, walking distance to healthcare facilities in 30 and 30-60 min from residence and joint decision by mothers and their husbands on the place of delivery.

CONCLUSION

The proportion of maternal healthcare service utilisation in the study area was low, exacerbated by lower ANC, delivery care and PNC. The frequency of maternal healthcare service utilisation increased with a favourable attitude towards maternal healthcare service utilisation, knowledge of mothers about maternal healthcare, short travel distance to healthcare facilities and joint decisions by mothers and their husbands on the place of delivery. Based on the findings of this study, we suggest promoting strategies by the local health department and other concerned bodies to maintain and improve the attitude and knowledge of mothers towards maternal healthcare service utilisation. We also recommend increasing the accessibility to healthcare facilities and promoting joint decision-making processes by the mothers and their husbands on the place of delivery in the study area and similar settings in the country.

Job satisfaction and animal welfare at slaughter: A survey of Official Veterinarians in the United Kingdom and Republic of Ireland

In the UK and the Republic of Ireland, Official Veterinarians (OVs) are employed by the Food Standards Agency and the Food Safety Authority, respectively, as legal authorities for both animal welfare and food safety. However, little is known about job satisfaction in this profession which has the potential to impact professionals' well-being and performance. Moreover, despite animal welfare issues being a reality that OVs witness, we do not yet understand how OVs perceive these issues at slaughter or whether this impacts job satisfaction. We assessed OVs' perceptions on job satisfaction and views on welfare at slaughter across the UK and ROI, through an online questionnaire with 113 participants, which included socio-demographic information of participants and questions or statements about different aspects of job satisfaction and animal welfare issues at slaughter. While most OVs committed to their work they reported issues that may compromise job satisfaction, such as often experiencing loneliness at work, threatening situations and sleep disorders. Moreover, job satisfaction was often impacted by animal welfare incidents, and conflicts with food business operators were considered one of the greatest barriers to improving welfare at slaughter. There is also the likelihood of professionals' individual ethical values being challenged since OVs are virtually certain to witness religious slaughter yet disagree with this practice to the extent that they consider it should be banned. We reveal significant challenges associated with the role of OV that justify creation of a support network to assist and safeguard this profession, as well as animal welfare at slaughter.

Dispatcher-Assisted CPR in Italy: A Nationwide Survey of Current Practices and Future Challenges in Emergency Medical Communication Centers

Background/Objectives: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is widely recognized as a critical intervention that significantly reduces no-flow time, improving survival rates in out-of-hospital cardiac arrests (OHCAs). This study evaluates current practices and the organization of DA-CPR in Italian emergency medical communication centers (EMCCs) and identifies areas for improvement. Methods: A cross-sectional survey was conducted between April and May 2024 among all Italian EMCCs, achieving a 92.6% response rate (62 out of 67) and covering 95.5% of the population. Data were collected on the availability of DA-CPR, additional medical instructions provided, standardized protocols, integration into dispatch software, availability of video call systems, and follow-up programs. Results: All responding EMCCs provide DA-CPR, with 79.1% (n = 49) initiating these protocols more than five years ago. In adult cardiac arrest, 74.2% (n = 46) provide instructions for chest compressions only. Standardized protocols are used in 69.4% (n = 43) of EMCCs, and 53.2% (n = 33) have these protocols integrated into their dispatch software. Additionally, 93.5% (n = 58) provide dispatcher-assisted instructions for other medical conditions, including pediatric CPR (90.3%, n = 56), neonatal CPR (90.3%, n = 56), foreign body airway obstruction (85.5%, n = 53), labor (56.5%, n = 35), and massive bleeding (41.9%, n = 26). A training path for DA-CPR is available in 48 EMCCs (77.4%), and in most cases, it is included in the basic dispatcher course (56.5%, n = 36), with 50% conducting periodic retraining. Moreover, 33.9% (n = 21) utilize video call systems to support dispatcher-assisted instructions. Data on DA-CPR are collected by 46.8% of EMCCs (n = 29), primarily on relevant cases, but only 25.8% (n = 16) have a follow-up path for patients. Conclusions: This study highlights a widespread implementation of DA-CPR across Italian EMCCs. However, regional disparities, mainly in protocols and technological support, indicate areas requiring urgent attention. Enhancing training programs and standardizing protocols could improve DA-CPR effectiveness and patient outcomes, thus guaranteeing equitable care nationwide. Future initiatives should focus on integrating support tools like video calls, expanding retraining programs, and establishing follow-up and debriefing paths.