Survey strategies to increase participant response rates in primary care research studies

Association Between COVID-19 and Planned and Postponed Cancer Screenings Among American Indian Adults Residing in California and Oklahoma, March-December 2020

OBJECTIVE

Little is known about how the COVID-19 pandemic affected cancer screenings among American Indian people residing in California and Oklahoma, 2 states with the largest American Indian populations. We assessed rates and factors associated with cancer screenings among American Indian adults during the pandemic.

METHODS

From October 2020 through January 2021, we surveyed 767 American Indian adults residing in California and Oklahoma. We asked participants whether they had planned to obtain screenings for breast cancer, cervical cancer, and colorectal cancer (CRC) from March through December 2020 and whether screening was postponed because of COVID-19. We calculated adjusted odds ratios (AORs) for factors associated with reasons for planned and postponed cancer screening.

RESULTS

Among 395 participants eligible for breast cancer screening, 234 (59.2%) planned to obtain the screening, 127 (54.3%) of whom postponed it. Among 517 participants eligible for cervical cancer screening, 357 (69.1%) planned to obtain the screening, 115 (32.2%) of whom postponed it. Among 454 participants eligible for CRC screening, 282 (62.1%) planned to obtain CRC screening, 80 of whom (28.4%) postponed it. In multivariate analyses, women who lived with a child (vs did not) had lower odds of planning to obtain a breast cancer screening (AOR = 0.6; 95% CI, 0.3-1.0). Adherence to social distancing recommendations was associated with planning to have and postponement of cervical cancer screening (AOR = 7.3; 95% CI, 0.9-58.9). Participants who received (vs did not receive) social or financial support had higher odds of planning to have CRC screening (AOR = 2.0; 95% CI, 1.1-3.9).

CONCLUSION

The COVID-19 pandemic impeded completion of cancer screenings among American Indian adults. Interventions are needed to increase the intent to receive evidence-based cancer screenings among eligible American Indian adults.

Enabling Health Information Recommendation Using Crowdsourced Refinement in Web-Based Health Information Applications: User-Centered Design Approach and EndoZone Informatics Case Study

BACKGROUND

In the digital age, search engines and social media platforms are primary sources for health information, yet their commercial interests-focused algorithms often prioritize irrelevant content. Web-based health applications by reputable sources offer a solution to circumvent these biased algorithms. Despite this advantage, there remains a significant gap in research on the effective integration of content-ranking algorithms within these specialized health applications to ensure the delivery of personalized and relevant health information.

OBJECTIVE

This study introduces a generic methodology designed to facilitate the development and implementation of health information recommendation features within web-based health applications.

METHODS

We detail our proposed methodology, covering conceptual foundation and practical considerations through the stages of design, development, operation, review, and optimization in the software development life cycle. Using a case study, we demonstrate the practical application of the proposed methodology through the implementation of recommendation functionalities in the EndoZone platform, a platform dedicated to providing targeted health information on endometriosis.

RESULTS

Application of the proposed methodology in the EndoZone platform led to the creation of a tailored health information recommendation system known as EndoZone Informatics. Feedback from EndoZone stakeholders as well as insights from the implementation process validate the methodology's utility in enabling advanced recommendation features in health information applications. Preliminary assessments indicate that the system successfully delivers personalized content, adeptly incorporates user feedback, and exhibits considerable flexibility in adjusting its recommendation logic. While certain project-specific design flaws were not caught in the initial stages, these issues were subsequently identified and rectified in the review and optimization stages.

CONCLUSIONS

We propose a generic methodology to guide the design and implementation of health information recommendation functionality within web-based health information applications. By harnessing user characteristics and feedback for content ranking, this methodology enables the creation of personalized recommendations that align with individual user needs within trusted health applications. The successful application of our methodology in the development of EndoZone Informatics marks a significant progress toward personalized health information delivery at scale, tailored to the specific needs of users.

Exploring the working life of people with multiple sclerosis during the COVID-19 pandemic in Sweden

BACKGROUND

The COVID-19 pandemic led to vast changes in working life and conditions in which we work. These changes may affect people with multiple sclerosis (PwMS) differently. We aimed to describe the working situation of PwMS during the COVID-19 pandemic and the pandemic's impact on their working lives.

METHODS

All individuals aged 20-50 listed in the Swedish Multiple Sclerosis Registry were invited to participate in an online survey in 2021. Closed and open-ended responses linked to individual-level register data were used in this exploratory mixed-methods study. Differences in the proportions reporting specific impacts were assessed with chi-square tests by sex, MS severity, education, and profession. The open-ended answers were analysed through content analysis.

RESULTS

Over 8500 PwMS were invited (52% response rate). We included the 3887 respondents who answered questions about the impact of the pandemic on working life. Most (93.7%) reported being in paid work. An impact of the ongoing pandemic to one's daily occupation was reported by 26.2%, with different characteristics observed across the impacts. Four categories of type of answers were identified from the open-ended answers: Direct impact on one's occupation, Disclosing or concealing MS in the workplace, Worry and uncertainty, and Broader impact to life situation.

CONCLUSIONS

PwMS navigated the pandemic by interrupting as well as continuing their working lives. Many PwMS reported that the pandemic did not affect their work situation. However, the reported impacts differed among the participants and a sense of uncertainty and worry was often underlying their statements. Lessons from the pandemic may support future work participation.

Survey of Resources in Behavioral Sleep Medicine Across the Department of Defense, Defense Health Agency

INTRODUCTION

Insomnia affects approximately 40% of active duty service members and adversely affects health, readiness, and safety. The VA/DoD Clinical Practice Guideline for the management of insomnia recommends cognitive-behavioral treatment of insomnia (CBTI) or its abbreviated version (brief behavioral treatment of insomnia [BBTI]) as the first-line insomnia treatment. The goal of this study was to assess CBTI/BBTI resources at MTFs, perceived facilitators and barriers for CBTI/BBTI, and gaps in these treatments across the Defense Health Agency.

MATERIALS AND METHODS

Between July and October 2022, we conducted an electronic survey of CBTI/BBTI resources across Contiguous United States and the District of Columbia (CONUS) and Outside Continental United States (OCONUS) MTFs. The survey was distributed to 154 military sleep health care providers from 32 MTFs, and a link to the survey was posted on two online military sleep medicine discussion forums. Fifteen providers from 12 MTFs volunteered to complete a 30-minute qualitative interview to explore their perception of barriers and facilitators of CBTI/BBTI at their facility.

RESULTS

Fifty-two of 154 providers (33.8%) at 20 MTFs completed the survey. A majority of providers indicated that hypnotics remain the most common treatment for insomnia at their facility. Sixty-eight percent reported that CBTI/BBTI was available at their facility and estimated that less than 50% of the patients diagnosed with insomnia receive CBTI/BBTI. The main facilitators were dedicated, trained CBTI/BBTI providers and leadership support. Referrals to the off-post civilian network and self-help apps were not perceived as significant facilitators for augmenting insomnia care capabilities. The primary barriers to offering CBTI/BBTI were under-resourced clinics to meet the high volume of patients presenting with insomnia and scheduling and workflow limitations that impede repeated treatment appointments over the period prescribed by CBTI/BBTI protocols. Four primary themes emerged from qualitative interviews: (1) CBTI/BBTI groups can scale access to insomnia care, but patient engagement and clinical outcomes are perceived as inferior to individual treatment; (2) embedding trained providers in primary or behavioral health care could accelerate access, before escalation and referral to a sleep clinic; (3) few providers have the time to adhere to traditional CBTI protocols, and appointment scheduling often does not support weekly or bi-weekly treatment visits; and (4) the absence of quality and/or continuity of care measures dampens providers' enthusiasm for using external referral resources or self-help apps.

CONCLUSIONS

Although there is a wide recognition that CBTI/BBTI is the first-line recommended insomnia treatment, the limited scalability of treatment protocols, clinical workflow limitations, and scarcity of trained CBTI/BBTI providers limit the implementation of the VA/DoD clinical guideline. Educating and engaging health care providers and leadership about CBTI, augmenting CBTI-dedicated resources, and adapting clinical workflows were identified as specific strategies needed to meet the current insomnia care needs of service members. Developing protocols for scaling the availability of CBTI expertise at diverse points of care, upstream from the sleep clinics, could accelerate access to care. Establishing standardized quality measures and processes across points of care, including for external providers and self-help apps, would enhance providers' confidence in the quality of insomnia care offered to service members.

A Comparison of Uniformed Services University and Health Professions Scholarship Program Graduates' First Deployment Readiness

INTRODUCTION

Military physicians must be prepared to lead health care teams across complex landscapes of war during future small- and large-scale combat operations. This preparation optimally begins in medical school so that early career physicians are fully ready for their first deployment. Past qualitative research has suggested that military physicians who attended civilian medical school are not as well prepared for the operational environment as physicians who attended the Uniformed Services University (USU), our nation's military medical school. However, there is a lack of larger-scale quantitative research comparing the readiness differences between the two medical school pathways. The purpose of this study, therefore, was to quantify any differences in first deployment preparation between students attending USU and civilian medical schools through the Health Professions Scholarship Program (HPSP).

MATERIALS AND METHODS

We compared USU and HPSP graduates' first deployment experiences by distributing a 14-item Likert survey to active duty military physicians in the U.S. Army, U.S. Navy, and U.S. Air Force who graduated within the past 10 years from medical school (USU or civilian).

RESULTS

The USU graduates rated themselves significantly higher than the HPSP graduates on their readiness for deployment (3.83 vs. 3.24; P < .001); ability to navigate the operational environment (3.59 vs. 2.99; P < .001); confidence in communicating with their commanding officer (3.59 vs. 2.99; P = .002); navigating the combined role as physician and officer (3.33 vs. 2.84; P = .004); leading a health care team (3.94 vs. 3.43; P = .001); preparation by a medical school (3.78 vs. 2.52; P < .001); and overall readiness compared to peers (4.20 vs. 3.49; P < .001). There was no significant difference between the two pathways regarding their stress level at the beginning of deployment (2.74 vs. 2.68; P = .683); clinical preparation (3.94 vs. 3.76; P = .202); and success of first deployment (3.87 vs. 3.91; P = .792). The largest effect size of the difference between the two pathways was noted on the question "How well did medical school prepare you for your first deployment" (Cohen's d = 1.02).

CONCLUSIONS

While both groups believed that they were prepared for their first deployment, USU graduates consistently reported being more prepared by medical school for their first deployment than HPSP graduates. To close this readiness gap, supplemental military unique curricula may help to optimize HPSP students' readiness.

Mentally healthy living after pandemic social distancing: a study of older Canadians reveals helpful anxiety reduction strategies

BACKGROUND

Throughout the COVID-19 pandemic, older Canadians were the most at risk of severe physical harm, including death, and their return to post-COVID life was expected to be especially anxiety-provoking. A study was conducted to obtain nationally representative evidence of older Canadians' self-perceived anxiety levels and their strategies to manage or mitigate it as public health restrictions were lifting.

MATERIALS AND METHODS

This study had a cross-sectional descriptive design. An e-survey was used to collect data from 1327 Canadians aged 60+ stratified by age, sex, and education to resemble the larger general population. Participants completed the Geriatric Anxiety Scale (GAS-10) and indicated which of the 16 Centre for Addictions and Mental Health's (2022) Coping with Stress and Anxiety strategies they were using to manage or mitigate their anxiety when social distancing was lifting. Descriptive statistics, Pearson correlation, and multiple regression analysis were used to explore the data.

RESULTS

While, on average, older Canadians were mildly anxious, nearly one-quarter of responders rated their anxiety as severe. Age, sex, perceived health, were statistically significant correlates of anxiety. Six coping strategies were associated with significantly lower anxiety scores. Moreover, accepting some fear and anxiety as normal, challenging worries and anxious thoughts, and practising relaxation/meditation appeared to increase anxiety.

CONCLUSION

Older Canadians used multiple strategies to manage or mitigate their anxiety, and seemingly, with more successful than detrimental tries. Practitioners have much to learn and understand about older people's mental health promotion efforts after social distancing, now and for future pandemics.

Feasibility of In-Home Virtual Reality for Chronic Pain in Sickle Cell Disease

PURPOSE

This study assessed the feasibility of an in-home virtual reality intervention for chronic pain in adults with sickle cell disease.

DESIGN

Two-group, parallel, randomized, multiple methods design with surveys, and interviews.

METHODS

Participants were randomized to virtual reality or audio control, with 2-16-minute daily modules for 8 weeks, a daily pain diary survey, and a post study interview. Chronic pain and pain correlates were evaluated at baseline and every 4 weeks for 3 months. Feasibility outcomes were participant enrollment (set at > 50%), questionnaire response (> 50%), intervention use, and cybersickness (< 20%).

RESULTS

Of the individuals approached, 67.8% (n = 19) were enrolled. Questionnaire response rates were 100% at baseline, 57.8% at week 4, and < 50% at weeks 8 and 12. The intervention was used for a median of 781 minutes and 210 minutes in the virtual reality and audio groups, respectively. Participants reported slight symptoms of cybersickness with no reports of severe symptoms, and the intervention was acceptable.

CONCLUSIONS

Home-based virtual reality can be used in future sickle cell disease research. To further strengthen evaluations of virtual reality in adults with sickle cell who experience chronic pain, future trials should address sample size limitations and incorporate recommended strategies to address cybersickness and questionnaire response.

CLINICAL IMPLICATIONS

The first known application of in-home virtual reality for chronic pain in adults with sickle cell disease was successful. Findings can inform future in-home investigations of virtual reality in this underserved population.

Fostering collaborative practice through interprofessional simulation for occupational therapy, physiotherapy, dietetics, and nursing students

Literature regarding simulation for learning interprofessional collaborative practice (IPCP) indicates a need to include a range of health professions and to focus on students' development of team communication and conflict resolution skills in day-to-day healthcare delivery. This study evaluated the impact of interprofessional simulation for occupational therapy, physiotherapy, dietetics, and nursing students on interprofessional collaboration competencies, specifically collaborative communication and conflict resolution during day-to-day interactions, and their intention for IPCP during placement. A series of simulations featuring the potential for interprofessional conflict and involving explicit coaching on communication and conflict resolution were conducted. A single cohort pre-test post-test design included the Students' Perceptions of Interprofessional Clinical Education Revised (SPICE-R), the Interprofessional Collaborative Competencies Attainment Survey (ICCAS), and an open response survey question on future intended practice. A total of 237 students participated in the simulation experience. Overall scores and scores on all IPCP competencies in the ICASS (n = 193) and SPICE-R (n = 226) improved for all professions post-simulation. The mean score of the ICCAS increased for 98% of the respondents and similarly the mean score of the SPICE-R increased for 71% of the respondents. Open-ended responses indicated students' intentions to pursue self-leadership in IPCP. Students who participated in an interprofessional simulation reported perceived improvements in IPCP competencies and were encouraged to initiate IPCP when on placement in the practice setting.

Staff perceptions of barriers to self-harm care in the emergency department: A cross-sectional survey study

BACKGROUND

Emergency departments (EDs) are often the first point of contact for people with self-harm; however, they do not always receive optimal care. The study objective was to examine the perspectives of ED staff who respond to self-harm presentations, perceived barriers to providing optimal, guideline-concordant care, and staff's familiarity with existing guidelines.

METHODS

An online cross-sectional survey comprising purpose-designed questions concerning self-harm in the ED was completed by 131 staff (83.2% nurses) from two hospitals in Victoria, Australia. Survey results were analysed using Stata version 16 and frequencies and percentages were calculated.

RESULTS

Respondents reported knowledge of how to appropriately manage a person presenting with self-harm. However, lack of space (62.3%) and time (78.7%) to conduct the appropriate assessments, lack of self-harm training (71.8%), and limited awareness of or access to guidelines and recommendations for self-harm management within the ED (63.6%), were identified as primary barriers to their ability to appropriately manage these presenters.

CONCLUSIONS

Improvements to the ED environment and processes, as well as the provision of regular self-harm specific education and training for all ED staff are needed. Implementation of best-practice standards should prioritise guideline-concordant care, with a particular focus on the education needs of nursing staff.

Physical work environment and burnout among primary care physicians in Israel: a cross-sectional study

BACKGROUND

Physician burnout remains a prevalent issue globally, negatively affecting work satisfaction and patient care. However, exploration of the physical work environments of physicians, a potential influencing factor for burnout, remains scarce. The physical work environment is everything that surrounds the physician, including the doctor's office, the clinic, the clinic's building, the waiting, and staff rooms. The aims of this study were to describe aspects of the physical work environment of primary care physicians (PCPs) and to explore the association between the physical work environment and burnout.

METHODS

In this cross-sectional study, we emailed questionnaires to an online community of PCPs in Israel in October 2021. We asked physicians about their satisfaction with their physical work environment, evaluated elements of the work environment, and assessed burnout status (with the Shirom-Melamed Burnout Measure, SMBM). We used the Chi-square and Mann-Witney tests to compare categorical and continuous variables and used logistic regression for the final model.

RESULTS

Two hundred twenty-one PCPs answered the questionnaire (27.6% response rate). Over a third (35.7%) of respondents reported high burnout. PCPs who were satisfied with their general physical environment had lower burnout rates than those who were unsatisfied (28.1% vs. 47.8%, p-value < 0.001). We found positive correlations between general satisfaction with the physical work environment and the scores achieved for the doctor's office, the clinic, the clinic's building, and the waiting room. In the multivariate analysis, high satisfaction with the general physical work environment was associated with decreased odds for burnout (OR-0.50, 95% CI 0.25-0.99, p-value-0.048).

CONCLUSION

The doctor's office, the clinic, the clinic's building, and the waiting room affected general satisfaction from the physical work environment. High satisfaction with the physical work environment reduced burnout rates. Future studies are needed to determine whether PCPs and managers should invest in the physical work environment to decrease burnout and increase satisfaction.

Directional electrodes in deep brain stimulation: Results of a survey by the European Association of Neurosurgical Societies (EANS)

Introduction

Directional Leads (dLeads) represent a new technical tool in Deep Brain Stimulation (DBS), and a rapidly growing population of patients receive dLeads.

Research question

The European Association of Neurosurgical Societies(EANS) functional neurosurgery Task Force on dLeads conducted a survey of DBS specialists in Europe to evaluate their use, applications, advantages, and disadvantages.

Material and methods

EANS functional neurosurgery and European Society for Stereotactic and Functional Neurosurgery (ESSFN) members were asked to complete an online survey with 50 multiple-choice and open questions on their use of dLeads in clinical practice.

Results

Forty-nine respondents from 16 countries participated in the survey (n = 38 neurosurgeons, n = 8 neurologists, n = 3 DBS nurses). Five had not used dLeads. All users reported that dLeads provided an advantage (n = 23 minor, n = 21 major). Most surgeons (n = 35) stated that trajectory planning does not differ when implanting dLeads or conventional leads. Most respondents selected dLeads for the ability to optimize stimulation parameters (n = 41). However, the majority (n = 24), regarded time-consuming programming as the main disadvantage of this technology. Innovations that were highly valued by most participants included full 3T MRI compatibility, remote programming, and closed loop technology.

Discussion and conclusion

Directional leads are widely used by European DBS specialists. Despite challenges with programming time, users report that dLeads have had a positive impact and maintain an optimistic view of future technological advances.

The influence of "bad news" and "neutral/good news" on patients' perception of physician empathy during oncology consultations

OBJECTIVES

Being met with empathy increases information sharing, treatment coherence, and helps patients to recover faster. However, we do not know how the content of the conversation about disease progression, new treatments, or other issues concerning serious illness affects patients' perceptions of the physician's empathy, and thus, the quality of the conversation. This study aimed to test the hypothesis that patients will rate their physician lower following a "bad news" consultation using the consultation and relational empathy (CARE) measure.

METHODS

A total of 186 outpatients from the Department of Oncology were recruited for this study. After meeting with a patient, the physician filled out a form, placing the patient in either the "bad news" group, or the "neutral/good news" group along with information about the patient and the consultation. The patient was given the CARE measure after the visit.

RESULTS

The patients who had received bad news rated their physicians a significantly lower score on the CARE measure, even though the effect size was small, than those who had neutral/good news. On average, bad news consultations were 11 min longer.

CONCLUSIONS

Physicians need to be aware of the patients' need to be known and understood, in addition to having skills to attend to emotional cues and concerns, since the current study's finding could be a sign either of the content being projected onto the physician or that the physician is focused on the message rather than on the patient.

Cognitive Screening for Mild Cognitive Impairment: Clinician Perspectives on Current Practices and Future Directions

 This study surveyed 51 specialist clinicians for their views on existing cognitive screening tests for mild cognitive impairment and their opinions about a hypothetical remote screener driven by artificial intelligence (AI). Responses revealed significant concerns regarding the sensitivity, specificity, and time taken to administer current tests, along with a general willingness to consider adopting telephone-based screening driven by AI. Findings highlight the need to design screeners that address the challenges of recognizing the earliest stages of cognitive decline and that prioritize not only accuracy but also stakeholder input.

Experiences of Residents and Fellows at Mayo Clinic After the Rapid Implementation of Telemedicine During the COVID-19 Pandemic

OBJECTIVE

The COVID-19 pandemic led to many changes across medical organizations and graduate medical education programs nationwide including the rapid implementation of telemedicine as a modality for delivering health care. The purpose of this study was to investigate the telemedicine experiences of residents and fellows with their self-reported level of preparedness, impact on their education including precepting, skill development, and patient-physician relationships, and perceptions of telehealth platforms and curricula in the future.

METHODS

A total of 365 Mayo Clinic residents and fellows across three sites (Florida, Arizona, and Minnesota) were identified as trainees who conducted at least one telemedicine encounter from January 1, 2020 to June 30, 2020 and were sent an electronic survey by e-mail.

RESULTS

There was a total of 103 completed surveys across various specialties with 58.3% female respondents, 63.1% residents, 35.0% fellows and 77.7% of respondents who attended medical school in the United States. Most trainees reported having very little to no exposure to telemedicine in their medical careers before the pandemic. The majority were satisfied with their first telemedicine encounter and found precepting comparable to in-person visits. The trainees in this study had a favorable view with 98.1% believing telemedicine will play a more prevalent role in the future and most agreed this should be included in medical school and residency training.

CONCLUSION

Our survey found that after the implementation of telemedicine during the COVID-19 pandemic, the experiences of trainees at a multi-site academic center were overall positive. More research is needed on the perceptions of skill development (physical exam and history taking) during a telemedicine encounter and outlining an optimal telemedicine curriculum that can improve confidence in trainees.

Delirium education for family caregivers of patients in the intensive care unit: A pilot study

Objectives

Delirium, an acute change in mental state, seen in hospitalized older adults is a growing public health concern with implications for both patients and caregivers; however, there is minimal research on educating caregivers about delirium. Utilizing family caregivers to assist with delirium management in acute care settings demonstrates improved health outcomes supporting the need for patient and family centered care. The primary aims of the study were to determine feasibility of implementing a delirium education video for caregivers of patients in an adult oncology intensive care unit and compare delirium knowledge to caregivers in a control group.

Methods

A quasi-experimental design comprised of 31 family caregivers of adult patients in an oncology intensive care unit to determine feasibility of implementing a delirium education video.

Results

The results demonstrate feasibility of implementing a caregiver education video in-person and virtually. While total delirium knowledge scores were not statistically significant, knowledge gained within the delirium presentation subgroup was significant (p = .05).

Conclusion

This study demonstrates feasibility of implementing a caregiver education video and findings support further research in this area.

Innovation

Collaborating with caregivers to develop virtual video education for delirium allows for a versatile approach to connect with caregivers to support their caregiving role.

Patient perspective on task shifting from general practitioners to medical practice assistants - a quantitative survey in Germany

INTRODUCTION

Various developments result in increasing workloads in general practices. New models of care and a restructuring of the division of tasks could provide relief. One approach is to extend the delegation of medical tasks from general practitioners (GPs) to medical practice assistants (MPAs). So far, there has been a lack of information about specific situations in which patients are willing to be treated exclusively by MPAs.

METHODS

In three German federal states, patients who visited a general practice were surveyed exploratively and cross-sectionally with a self-designed, paper-based questionnaire. The data were analysed descriptively and multivariate. A mixed binary logistic regression model was calculated to account for cluster effects at practice level (random intercept model). The dependent variable was patients' acceptance of task delegation.

RESULTS

A total of 1861 questionnaires from 61 general practices were included in the analysis. Regarding the current problem/request, a total of 30% of respondents could imagine being treated only by MPAs. Regarding theoretical reasons for consultation, more than half of the patients agreed to be treated by MPAs. According to the regression model, MPAs were preferred when patients were younger (10-year OR = 0.84, 95%-CI [0.75, 0.93]) or had a less complicated issue (OR = 0.44, 95%-CI [0.26, 0.8]). For four current problems/requests ("acute complaints" OR = 0.27, 95%-CI [0.17, 0.45], "routine health check" OR = 0.48, 95%-CI [0.3, 0.79], "new problem" OR = 0.13, 95%-CI [0.06, 0.28], "known problem" OR = 0.16, 95%-CI [0.1, 0.27]) patients prefer to be treated by GPs instead of MPAs.

DISCUSSION

For the first time, statements could be made on patients' acceptance of task delegation in relation to current and theoretical reasons for treatment in general practices in Germany. The discrepancy in response behaviour on a theoretical and individual level could be explained by different contexts of questions and differences at practice level. Overall, patients seem to be open to increased delegation of medical tasks, depending on the reason for treatment. Selection and response biases should be considered in the interpretation.

CONCLUSION

The results are not completely opposed to an extension of task delegation. Further interventional studies could provide information on the possible effects of expansion of delegable tasks.

Introducing the Dysphagiameter: a novel patient-reported outcome measure for evaluating dysphagia in oculopharyngeal muscular dystrophy - from conceptual framework to initial development

Oculopharyngeal muscular dystrophy (OPMD) is a rare late-onset muscle disease associated with progressive dysphagia. As there was no patient-reported outcome measure specific for the assessment of dysphagia in OPMD, the Dysphagiameter was developed. The Food and Drug Administration guidance was followed. In Phase 1, a systematic literature review and an expert consultation were conducted to identify the concepts of interest. It was decided that the instrument should assess difficulty swallowing using pictures of foods of various textures (part A) and impact of dysphagia on activities and participation (part B), as defined by the International Classification of Functioning, Disability and Health. In Phase 2, focus groups (n = 3) and online surveys (n = 55) were conducted to generate the items. Then, the food items for part A were selected and grouped into 17 textures by a panel of registered dietitians. Cognitive interviews were conducted (n = 23) to refine the instrument and assess its clarity and comprehensiveness. The final draft included 82 food items assessing the capacity to swallow foods and drinks (part A) and 10 items assessing the impact of dysphagia on activities and participation (part B). Item reduction and assessment of psychometrics properties, using Rasch analysis, are ongoing as part of Phase 3.

The Primary Healthcare Physician's Awareness and Engagement in Community-Based Medical Education: A Mixed Qualitative and Quantitative Study

BACKGROUND

Community-based medical education (CBME) is an essential component of medical education, where primary healthcare physicians (PCPs) play a crucial role. This study explores PCPs' awareness and engagement in CBME and investigates the factors influencing their participation.

METHODS

This mixed study was conducted in two phases. In the first phase, a qualitative study was conducted using semi-structured interviews with PCPs as well as thematic analysis related to their awareness and engagement in CBME. In the second phase, a quantitative survey was conducted on 72 PCPs' pre- and post-training programs.

RESULTS

Primary healthcare physicians had a positive attitude toward community-based medical education. The participants had an acceptable level of awareness and engagement, which increased substantially by (p-value = 0.03) and (p-value = 0.003), respectively. Logistical analysis indicated that non-Saudi physicians were more likely to participate in the CBME (p-value = 0.001). Professions and academic experiences influenced their willingness to engage and participate in CBME (OR = 7.5, p-value = 0.001) and (OR = 0.21, p-value = 0.001), respectively.

CONCLUSION

The study findings highlighted the importance of increased awareness and the factors that enhance PCPs' engagement in CBME. This positive perspective of the PCPs will help build effective partnerships and facilitate the extension of the curriculum to apply CBME.

Consistent hearing aid use is associated with lower fall prevalence and risk in older adults with hearing loss

BACKGROUND

Falls and their sequelae cost more than $50 billion every year. Older adults with hearing loss are at 2.4 times greater risk of falls than their normal hearing peers. Current research is inconclusive about whether hearing aids can offset this increased fall risk, and no previous studies considered if outcomes differed based on the consistency of hearing aid use.

METHODS

Individuals 60 years and older with bilateral hearing loss completed a survey consisting of the Fall Risk Questionnaire (FRQ) and questions about hearing loss history, hearing aid use, and other common fall risk factors. In this cross-sectional study, fall prevalence, as well as fall risk (based on FRQ score), was compared between hearing aid users and non-users. A separate group of consistent hearing-aid users (at least 4 h daily use for more than 1 year) was also compared with inconsistent/non-users.

RESULTS

Responses from 299 surveys were analyzed. Bivariate analysis found 50% reduced odds of experiencing a fall for hearing aid users compared with non-users (OR = 0.50 [95% CI: 0.29-0.85], p = 0.01). After adjusting for age, sex, hearing loss severity, and medication usage, those who reported any hearing aid use still had lower odds of falls (OR = 0.48 [95% CI: 0.26-0.90], p = 0.02) and lower odds of being at risk for falls (OR = 0.36 [95% CI: 0.19-0.66] p < 0.001) than non-users. Results for consistent hearing aid users demonstrate an even stronger association of lowered odds of falling (OR = 0.35 [95% CI: 0.19-0.67], p < 0.001) and lower odds of being at risk for falls (OR = 0.32 [95% CI: 0.12-0.59], p < 0.001), suggesting a potential dose-response relationship.

CONCLUSIONS

These findings suggest that use of hearing aids-especially consistent hearing aid use-is associated with lower odds of experiencing a fall or being classified as at risk for falls in older individuals with hearing loss.

Quantitative Analysis of Brain Swelling Resolution With Regard to Cranioplasty After Decompressive Craniectomy

OBJECTIVE

Adequate brain swelling resolution prior to cranioplasty (CP) is an important yet loosely defined issue. Despite efforts to balance timely CP and patient safety, heterogeneous study methodologies have led to conflicting results. This study aims to standardize this issue through quantifying degree of brain swelling resolution using a proposed Visual CP Scale.

METHODS

The proposed Visual CP Scale is validated through a 2-pronged approach. The first prong involves a national survey in Taiwan, where neurosurgeons were surveyed to determine what constitutes a patient's readiness for CP. The second prong involves a large retrospective cohort, where the correlations between timing, degree of brain swelling resolution, and post-CP complication rates, are evaluated.

RESULTS

In the national Taiwan CP Survey, 124 out of 772 neurosurgeons (17.2%) completed the survey. Respondents who chose higher grades on the Visual CP Scale preferred later CP timings. In the retrospective data, 378 out of 770 (49.1%) patients had pre-CP brain images, allowing for the utilization of the Visual CP Scale. A Visual CP Scale score of greater than or equal to 4 was associated with fewer complications after CP.

CONCLUSIONS

The timing of CP should be determined by the degree of brain swelling resolution, not vice versa. The proposed Visual CP Scale offers an objective method for assessing brain swelling resolution, making it an adjuvant tool for clinical decision-making and future research related to CP.

A Spiritual Self-Care Mobile App (Skylight) for Mental Health, Sleep, and Spiritual Well-Being Among Generation Z and Young Millennials: Cross-Sectional Survey

BACKGROUND

Generation Z (Gen Z) and young millennials (GenZennials) (ages 18-35 years) are unique in that they either have no memory of or were born shortly after the internet "explosion." They are constantly on the internet, face significant challenges with their mental health and sleep, and are frequent users of digital wellness apps. GenZennials also uniquely identify with and practice spirituality, which has been linked to better mental health and sleep in adult populations. Research has not examined digital approaches to spiritual self-care and its relationship to mental health and sleep in GenZennials.

OBJECTIVE

The purpose of this study was to describe a sample of adult GenZennials who use a spiritual self-care app (ie, Skylight), describe how users engage with and perceive the app, and assess the relationship between frequency of using the app with mental health, sleep, and spiritual well-being.

METHODS

Participants were 475 adult Gen Z (ages 18-28 years) and young millennial (ages 29-35 years) Skylight app users who responded to an anonymous survey on the web. The survey asked about demographics, spiritual self-care and practice, and user engagement and perceptions of the app. Outcome measures included 4 validated surveys for mental health (ie, depression, anxiety, and stress) and sleep disturbance, and one validated survey on spiritual well-being. Mean scores were calculated for all measures, and linear regressions were conducted to examine the relationship between the frequency of app use and mental health, sleep, and spiritual well-being outcomes.

RESULTS

Participants were predominantly White (324/475, 68.2%) and female (255/475, 53.7%), and approximately half Gen Z (260/475, 54.5%) and half young millennials (215/475, 45.3%). Most users engaged in spiritual self-care (399/475, 84%) and said it was important or very important to them (437/475, 92%). Users downloaded the app for spiritual well-being (130/475, 30%) and overall health (125/475, 26.3%). Users had normal, average depressive symptoms (6.9/21), borderline abnormal anxiety levels (7.7/21), slightly elevated stress (6.7/16), and nonclinically significant sleep disturbance (5.3/28). Frequency of app use was significantly associated with lower anxiety (Moderate use: β=-2.01; P=.02; high use: β=-2.58; P<.001). There were no significant relationships between the frequency of app use and mental health, sleep, and spiritual well-being outcomes except for the personal domain of spiritual well-being.

CONCLUSIONS

This is the first study to describe a sample of adult GenZennials who use a spiritual self-care app and examine how the frequency of app use is related to their mental health, sleep, and spiritual well-being. Spiritual self-care apps like Skylight may be useful in addressing anxiety among GenZennials and be a resource to spiritually connect to their personal spiritual well-being. Future research is needed to determine how a spiritual self-care app may benefit mental health, sleep, and spiritual well-being in adult GenZennials.

A pharmacist-led community-based survey study: Determining the impact of the Covid-19 pandemic on actionable factors associated with worse cancer outcomes and cancer health disparities

Purpose

The goals of this cross-sectional community-based survey study were to assess the impact of the Covid-19 pandemic on actionable factors which are known to contribute to worse cancer outcomes, and to determine whether race and ethnicity-based differences exist.

Methods

A survey study which captured demographic information and changes in cancer outcomes-related factors since the start of the Covid-19 pandemic, was conducted at a public Covid-19 vaccination clinic over a period of 10 days during March 2021. Surveys were administered in multiple languages. Chi-square tests and ANOVA followed by post-hoc Dunnett testing assessed for race and ethnicity-based differences.

Results

A total of 949 people participated (61.6% participation rate). Ninety-three surveys were removed based on inclusion criteria giving a final participant number of 856. Many participants reported postponing cancer screenings (17.8%) and cancellation of medical appointments (22.8% and 25.8% reported cancelled appointments by providers or themselves, respectively) due to the pandemic. Participants also reported decreased physical activity (44.7%) and increased tobacco and/or marijuana usage (7.0%). Conversely, participants reported consuming more fruits and vegetables (21.4%) and decreasing alcohol consumption (21.4%). Several race-related differences but no ethnicity-related differences were observed.

Conclusion

Our data can be used to help guide pharmacist-led targeted outreach in our community which will help mitigate Covid-19 pandemic-driven changes in behaviors associated with worse cancer outcomes and exacerbation of cancer health disparities. To our knowledge, this is the first cancer outcomes-related study to be conducted at a public Covid-19 vaccination site and is the first pharmacist-led study in this area.

Prevalence and Characteristics of Long COVID 7-12 Months After Hospitalization Among Patients From an Urban Safety-Net Hospital: A Pilot Study

Introduction

Little is known about the burden of long COVID among Black and Hispanic patients in the U.S. We surveyed adult patients hospitalized for COVID-19 at John H. Roger, Jr. Hospital of Cook County, a safety-net hospital predominantly serving Black and Hispanic patients in Chicago, for persistent symptoms after hospitalization to assess prevalence and identify risk factors.

Methods

Cross-sectional data were obtained over 6 months after discharge from patients hospitalized at John H. Roger, Jr. Hospital of Cook County who tested positive for SARS-CoV-2 between October 1, 2020 and January 12, 2021. Multivariable logistic regression was used to analyze the associations between patient characteristics and symptom persistence.

Results

Of 145 patients surveyed at a median follow-up period of 255 days (IQR=238-302), 80% were Black or Hispanic, and 50 (34%) reported at least 1 symptom. In multivariable logistic regression, the risk of long COVID was associated with the severity of acute COVID-19 illness, consistent with findings from population-based cohort studies.

Conclusions

Long COVID prevalence remains high 7 months to a year after an initial illness in a majority Black and Hispanic hospitalized cohort. There is a long-term and ongoing need to assess and address the burden of long COVID, especially among minority communities disproportionately affected by acute COVID-19.

Assessing Confidence Levels in Endodontic Procedures Among Senior Undergraduate Dental Students at Qassim University, Saudi Arabia: A Cross-Sectional Observational Study

Background This study aimed to determine the confidence of senior dental students in Qassim University's undergraduate dentistry program in Saudi Arabia regarding their capacity to perform endodontic procedures. The study's objective was to pinpoint areas of weakness and offer suggestions for potential improvement of endodontic and clinical training for dental students. Methodology Using anonymous survey forms, 120 senior dental students were surveyed. Students' self-reported levels of confidence in performing various endodontic procedures, such as periapical radiographs, rubber dam placement, endodontically treated tooth restoration, anesthesia, broken instrument removal, and endodontic retreatment, were studied in this survey. A Likert-style rating scale of 1 to 5 was used in the survey, with 1 denoting high confidence and 5 denoting low confidence. Results The majority of senior dental students at Qassim University reported high levels of confidence in taking periapical radiographs, with 64.04% indicating a high level of confidence. The second most assured field was rubber dam installation, with 47.6% of students expressing high levels of assurance. Confidence levels were noticeably lower during more difficult procedures such as endodontic retreatment and the removal of broken instruments. While 12% of students expressed high confidence in endodontic retreatment, only 3.46% of students expressed high confidence in removing broken instruments. According to Pearson's correlation (r = 0.352, p = 0.001), there was a significant and favorable correlation between competency level and confidence in performing various endodontic procedure-related steps. Conclusions The study's findings suggest that senior dentistry students at Qassim University might benefit from additional training and assistance in some endodontic treatment areas. The lack of confidence displayed during more challenging procedures, such as the removal of broken instruments and endodontic retreatment, demonstrates the need for additional training and supervision in such cases. The results of this study may be useful for educators in other dental colleges who wish to consider developing new teaching techniques, utilizing simulators and digital learning tools, and increasing opportunities for hands-on training and supervision to improve dental students' self-confidence and skills.

Resting Blood Pressure in Master Athletes: Immune from Hypertension?

Ageing is associated with decreased physical activity, obesity and increased risk of hypertension (HTN). Master athletes (MA) have either pursued a physically active lifestyle throughout their life or initiated exercise or sport later in life. We assessed resting blood pressure (BP) in male and female World Masters Games (WMG) athletes. This was a cross-sectional, observational study which utilized an online survey to assess the blood pressure (BP) and other physiological parameters. Results: a total of 2793 participants were involved in this study. Key findings included differences between genders with males reporting higher resting SBP (+9.4%, p < 0.001), resting DBP (+5.9%, p < 0.001) and mean arterial pressure (+6.2%, p < 0.001). Significant differences (p < 0.001) were also identified when comparing WMG athletes' resting BP results (genders combined) to the general Australian population with WMG athletes having a lower SBP (p < 0.001, -8.4%) and DBP (p < 0.001, -3.6%). Additionally, 19.9% of males and 49.7% of female WMG participants were normotensive whereas 35.7% of the general Australian population were normotensive. Only 8.1% of the WMG athletes (genders combined) were found to be HTN compared to 17.2% in the general Australian population. These findings reflect a low prevalence of HTN in WMG participants and support our hypothesis of a low prevalence of HTN in an active, but aged cohort of MA.

Should suicide risk assessment be embedded in undergraduate dental curricula?

Aims and objectives The aim of this Plan-Do-Study-Act cycle was to establish if undergraduate students believe they have a role to play in suicide risk assessment, and to discuss the implementation of suicide risk prevention into the undergraduate dental curriculum. Data gathered informed development of a subsequent suicide risk assessment educational workshop.Methodology An online questionnaire was disseminated to undergraduate students as part of a quality improvement service evaluation within a UK dental hospital and school. This sought to gain information on attitudes to suicide prevention, previous suicide awareness training, and the appetite and potential barriers to future training.Results A response rate of 23% (n = 30) was achieved. In total, 87% of undergraduate students responding reported having no experience or training in the identification of suicidal patients, 97% of respondents expressed a desire for training, and 80% stated not knowing what to do if a patient disclosed suicidal thoughts during an appointment.Conclusion The dental team have a role to play in suicide risk assessment and the signposting of at-risk patients to appropriate services. To embed this within daily practice, awareness and training must be introduced to undergraduate curricula.

Patient Perspectives on Artificial Intelligence in Healthcare Decision Making: A Multi-Center Comparative Study

Objective

Investigate the patient opinion on the use of Artificial Intelligence (AI) in Orthopaedics.

Methods

397 orthopaedic patients from a large urban academic center and a rural health system completed a 37-component survey querying patient demographics and perspectives on clinical scenarios involving AI. An average comfort score was calculated from thirteen Likert-scale questions (1, not comfortable; 10, very comfortable). Secondary outcomes requested a binary opinion on whether it is acceptable for patient healthcare data to be used to create AI (yes/no) and the impact of AI on: orthopaedic care (positive/negative); healthcare cost (increase/decrease); and their decision to refuse healthcare if cost increased (yes/no). Bivariate and multivariable analyses were employed to identify characteristics that impacted patient perspectives.

Results

The average comfort score across the population was 6.4, with significant bivariate differences between age (p = 0.0086), gender (p = 0.0001), education (p = 0.0029), experience with AI/ML (p < 0.0001), survey format (p < 0.0001), and four binary outcomes (p < 0.05). When controlling for age and education, multivariable regression identified significant relationships between comfort score and experience with AI/ML (p = 0.0018) and each of the four binary outcomes (p < 0.05). In the final multivariable model gender, survey format, perceived impact of AI on orthopaedic care, and the decision to refuse care if it were to increase cost remained significantly associated with the average AI comfort score (p < 0.05). Additionally, patients were not comfortable undergoing surgery entirely by a robot with distant physician supervision compared to close supervision.

Conclusion

The orthopaedic patient appears comfortable with AI joining the care team.

Multicentre study on rates and reasons for treatment discontinuation in patients with remaining cryopreserved embryos

RESEARCH QUESTION

What is the discontinuation rate among patients with remaining cryopreserved embryos in Belgium and what are the reasons for discontinuation?

DESIGN

Multicentre, cross-sectional study across 11 Belgian fertility clinics. Patients were eligible (n = 1917) if they had previously undergone an unsuccessful fresh embryo transfer (fresh group) or frozen embryo transfer (FET) (in-between group) and did not start a subsequent FET cycle within 1 year despite having remaining cryopreserved embryos. The denominator was all patients with embryos cryopreserved during the same period (2012-2017) (n = 21,329). Data were collected through an online anonymous questionnaire.

RESULTS

The discontinuation rate for patients with remaining cryopreserved embryos was 9% (1917/21329). For the final analysis, 304 completed questionnaires were included. The most important reasons for discontinuing FET cycles were psychological (50%) and physical (43%) burden, effect on work (29%), woman's age (25%) and effect on the relationship (25%). In 69% of cases, the patient themselves made the decision to delay FET treatment. In 16% of respondents, the decision to delay FET was determined by external factors: treating physician (9%), social environment (4%), close family (3%) and society (3%). Suggested improvements were psychological support before (41%), during (51%) and after (51%) treatment, as well as lifestyle counselling (44%) and receiving digital information (43%).

CONCLUSIONS

The discontinuation rate is remarkably high in patients with remaining cryopreserved embryos who have a good prognosis. Respondents stressed the need to improve the integration of psychological and patient-tailored care into daily assisted reproductive technology practice.

Association of service use with subjective oral health indicators in a freedom of choice pilot

OBJECTIVES

A freedom of choice pilot provided access to private oral health care services without queuing and with fixed public service-fees for participants in Tampere region, Finland in 2018-2019. The aim of this study was to investigate how use of oral health care services differed by demographics, socioeconomic status, dental fear, and self-reported oral health in this pilot.

MATERIAL AND METHODS

SMS-messages including a link to online questionnaire were sent to participants who had booked an appointment, and to those who had not booked an appointment despite registering to pilot. We categorized participants to (1) those who had booked their first appointment before receiving SMS (visitors), (2) those who booked an appointment after receiving the SMS-message (late-visitors), and (3) those who had not booked an appointment during pilot (nonvisitors). We used regression analysis to estimate the association of age, gender, dental fear, economic situation, Oral Health Impact Profile-14-severity (oral health-related quality of life [OHRQoL]), self-reported oral health and need for oral health care (exposures) with oral health care service use during the pilot (outcome).

RESULTS

Out of 2300 participants, 636 (28%) responded. Late-visitors were more likely older and reported more likely need for oral health care, poorer oral health and OHRQoL than visitors or nonvisitors. Nonvisitors were younger and had better OHRQoL than the others. The differences in the service use by gender, economic situation, and dental fear were small.

CONCLUSIONS

Service use during the pilot depended on the subjective oral health. Our findings highlight the potential of reminders in increasing care use among those with perceived need for services.

Factors Affecting Achieving Learning Outcomes in Basic Years in Medical School at King Abdul Aziz University, Jeddah, Saudi Arabia

OBJECTIVE

This study was conducted as part of a curricular reform process in Faculty of Medicine (FOM), King Abdul Aziz University Jeddah Saudi Arabia. It explored the perspective of FOM stakeholders on the challenges and factors in the teaching and learning domains that are affecting achieving learning outcomes.

METHODS

Faculty teaching in the second and third year, students in third and fourth year, and administrative personnel were included. An electronic survey was created. Chi-Squared test for independence was used to test the association between the correspondent group and different statements. Kruskal-Wallis ANOVA was used to examine the differences in medians among the questions utilizing ranks to evaluate different questions, followed by post hoc pairwise comparison with Bonferroni-corrected alpha.

RESULTS

A strong association was seen between the correspondent level and perspective on time allocated for modules and vertical integration of the curriculum. Among the most highly ranked challenges for using various teaching strategies were the loaded curricula content and the limitation of time, with an overall median rank of 8. Student readiness and motivation were also significant factors, however, students considered motivation less of a challenge.

CONCLUSION

Continuous assessment of factors affecting teaching and learning will bridge gaps in curriculum.

What percentage of patients with cancer develop hiccups with oxaliplatin- or cisplatin-based chemotherapy? a compilation of patient-reported outcomes

BACKGROUND

Chemotherapy-induced hiccups are understudied but can cause sleep deprivation, fatigue, pain in the chest and abdomen, poor oral intake, aspiration, and even death. As a critical next step toward investigating better palliative methods, this study reported patient-reported incidence of hiccups after oxaliplatin- or cisplatin-based chemotherapy.

METHODS

The current study relied on 2 previous studies that sought to acquire consecutive direct patient report of hiccups among patients who had recently received chemotherapy with cisplatin or oxaliplatin. These patient-reported data in conjunction with information from the medical record are the focus of this report.

RESULTS

Of 541 patients, 337 were successful contacted by phone; and 95 (28%; 95% CI: 23%, 33%) of these contacted patients reported hiccups. In univariable analyses, male gender (odds ratio (OR): 2.17 (95% confidence ratio (95% CI): 1.30, 3.62); p = 0.002), increased height (OR: 1.03 (95% CI: 1.00, 1.06); p = 0.02), and concomitant aprepitant/fosaprepitant (OR: 2.23 (95% CI: 1.31, 3.78); p = 0.002) were associated with hiccups. In multivariable analyses, these statistically significant associations persisted except for height.

CONCLUSIONS

These patient-reported data demonstrate that oxaliplatin- or cisplatin-induced hiccups occur in a notable proportion of patients with cancer. Male gender and concomitant aprepitant/fosaprepitant appear to increase risk.

An exploratory study investigating the barriers to reporting child dental neglect concerns among general medical practitioners in Greater Manchester

Introduction Dental neglect presents a global concern and is a shared public challenge for all healthcare professionals, including general medical practitioners (GPs). Previous literature highlights a lack of training among GPs and suggests that barriers are present to reporting concerns of dental neglect.Aims To investigate the current awareness of child dental neglect among GPs in Greater Manchester and to investigate barriers to the reporting of concerns.Methods An anonymous, electronic questionnaire was distributed to GPs in Greater Manchester. Respondents reported their experience and training in child dental neglect and their management of suspected cases. Results were assessed using descriptive analysis.Results In total, 25 GPs completed the questionnaire. It was found 60% received undergraduate child protection training and 96% completed postgraduate training. Only 20% felt adequately trained in the referral of suspected child dental neglect and the majority acknowledged that more training is required. Furthermore, 42% had been suspicious of child dental neglect; however, only 80% recorded their observations. Plus, 32% had suspected child dental neglect and not completed a referral. Common barriers to reporting included lack of knowledge of referral procedures and lack of certainty of diagnosis.Conclusion Barriers to referral of suspected cases of neglect were reported and there is a demand for further training among GPs.

Patient-reported outcomes among patients with systemic mastocytosis in routine clinical practice: Results of the TouchStone SM Patient Survey

BACKGROUND

Systemic mastocytosis (SM) is a rare clonal neoplasm driven by KIT D816V and other mutations. Data were collected from the patient perspective on disease burden and included an SM-specific symptom assessment tool.

METHODS

US adults aged 18 years and older with a self-reported SM diagnosis completed an online TouchStone SM Patient Survey of 100 items, including the 12-item Short-Form Health Survey, the Indolent Systemic Mastocytosis Symptom Assessment Form, and the Work Productivity and Activity Impairment Questionnaire, as well as questions about SM diagnosis, the impact of SM on daily activities, work impairment, and health care use. The results were analyzed using descriptive statistics.

RESULTS

Fifty-six individuals completed the survey (89% women; median age, 48 years; mean time since diagnosis, 6.7 years), reporting indolent SM (66%), aggressive SM (9%), smoldering SM (5%), and unknown SM subtype (18%). Over a 1-year recall, respondents reported seeking emergency care for anaphylaxis (30%) and taking three or more prescription medications (52%) for SM. Over one half of patients (54%) reduced their work hours because of SM, and 64% avoided leaving home because of symptoms. A majority of respondents (93%) had experienced ≥10 SM-related symptoms, noting that the most bothersome were anaphylactic episodes (18%), abdominal/stomach pain (16%), diarrhea/loose stools (13%), and fatigue (11%). Whereas an Indolent Systemic Mastocytosis Symptom Assessment Form-derived total symptom score of 28 is used to indicate moderate-to-severe symptoms, the mean total symptom score was 52.7. Mental and physical component summary scores from the 12-item Short-Form Health Survey were below population norms.

CONCLUSIONS

Patients who were surveyed reported substantial symptom burden and unmet needs because of SM, as evidenced by seeking emergency care and reporting bothersome symptoms, poor quality of life, and reduced work hours and productivity.

LAY SUMMARY

The objective of this research was to understand the burden and unmet needs in the rare disease of systemic mastocytosis (SM) to guide future care. Fifty-six patients completed an online survey containing questions about their diagnosis, medications, health care use, quality of life, and SM symptoms. The results demonstrated that SM is associated with severe and burdensome symptoms, anaphylactic events, emergency department visits, use of multiple medications, reduced ability to work, and poor physical and psychological quality of life. These findings suggest the need for future advances to address unmet needs in patients affected by SM.

Translating and validating a Japanese version of the instrument for patient assessment of medical professionalism (J-IPAMP): a cross-sectional survey

BACKGROUND

Although there are many tools to assess medical professionalism, they rarely address patients' perspectives. The instrument for patient assessment of medical professionalism (IPAMP) comprises 11 items and has been established and validated as a valuable tool for assessing trainees' professionalism from the patient's perspective. However, there is no instrument to assess professionalism from the patient's perspective in Japan. The purpose of the present study was to develop a Japanese version of the IPAMP (J-IPAMP) and test its validity and reliability.

METHODS

We conducted a cross-sectional survey to examine the reliability and validity of the J-IPAMP in two hospitals (one each in an urban and rural area) in Japan. Receptionists or surveyors distributed the anonymous questionnaire to 276 inpatients; all participants were aged above 20 years and assigned to medical trainees. We evaluated its structural and criterion-related validity, as well as internal consistency reliability.

RESULTS

Data of 235 (85.1%) patients were analyzed. Using the split-half validation technique, we performed an exploratory factor analysis (EFA) along with a confirmatory factor analysis (CFA). The EFA showed a one-factor solution. Then, to compare the model fitness between two models (the two-factor model from the original English version vs. unidimensional model suggested by the EFA), the CFA was performed. The CFA showed that almost all of the fit indices met their respective criteria and were approximately the same for the two models. Thus, we adopted a single-factor model. The Pearson correlation coefficients between the total J-IPAMP scores and the global ratings were 0.738, indicating adequate criterion-related validity. The Cronbach's alpha of the 11 items of the instrument was 0.96 (95% confidence interval: 0.96-0.97) and the omega value was 0.96, demonstrating acceptable internal consistency reliability.

CONCLUSIONS

We developed the Japanese version of the IPAMP. Its validity and reliability were verified through analysis. This instrument can be utilized for professionalism education in the postgraduate training setting.

Targeted Primary and Secondary Preventive Strategies for Depression among Malaysian Pharmacy Students

The global depression burden has remained a challenge throughout the pre- and post-pandemic era. The pandemic effect has led to the spiraling of mental disorders among young people who will be the next generation of leaders. This study aims to identify university students’ sociodemographic, psychosocial and academic backgrounds and performance associated with depression symptoms for the development of primary and secondary preventive strategies for mental health. A cross-sectional study was conducted using an online questionnaire distributed to 19 institutions in Malaysia offering a Bachelor of Pharmacy degree program. The self-rated Depression Anxiety Stress Scale (DASS-42) was used to assess depression symptoms. Pearson’s chi-square test and Fisher’s exact test were used to assess the investigated variables with depression symptoms. Independent T-test and one-way ANOVA were used to compare means of depression score across variables. Binary logistic regression was employed to examine the relationship between the investigated variables and depression symptoms. A total of 610 pharmacy students participated, of which 47% (n = 289/610) were having depression symptoms. Students who smoke nicotine and those who have separated parents, family history of mental illness, and poor academic performance were associated with depression symptoms (p < 0.05). Differences in geographical areas, race and religion also showed significant associations with depression symptoms. Parental marital status, poor academic performance, history of mental illness and comorbidities were statistically predicting depression symptoms (p < 0.05). Primary preventive strategies allowing students to harness healthy coping skills for stress, nicotine-free campaigns and a holistic curriculum are warranted. Secondary measures on mindfulness and compassion skills activities to benefit students who experienced early life crises are highly recommended. Enforcing these targeted strategies in collaboration with health and social sectors should be the primary agenda of universities to ensure their uptake.

Interprofessional continuing professional development programs can foster lifelong learning in healthcare professionals: experiences from the Project ECHO model

BACKGROUND

The success of continuing professional development (CPD) programs that foster skills in lifelong learning (LLL) has been well established. However, healthcare professionals often report barriers such as access to CPD and cost which limit uptake. Further research is required to assess how accessible CPD programs, such as those delivered virtually, impact orientation to LLL. Project Extension for Community Healthcare Outcomes (Project ECHO®) is a CPD model that has a growing body of evidence demonstrating improvements in knowledge and skills. Central to this model is the use of a virtual platform, varied teaching approaches, the promotion of multi-directional learning and provider support through a community of practice. This study aimed to explore whether participation in a provincial mental health ECHO program had an effect on interprofessional healthcare providers' orientation to LLL.

METHODS

Using a pre-post design, orientation to LLL was measured using the Jefferson Scale of Lifelong Learning. Eligible participants were healthcare professionals enrolled in a cycle of ECHO Ontario Mental Health from 2017 to 2020. Participants were classified as 'high' or 'low' users using median session attendance as a cut-point.

RESULTS

The results demonstrate an increase in orientation to LLL following program participation (Pre: 44.64 ± 5.57 vs. Post: 45.94 ± 5.70, t (66) = - 3.023, p < .01, Cohen's d = 0.37), with high ECHO users demonstrating greater orientation to LLL post-ECHO.

CONCLUSION

Findings are discussed in the context of self-determination theory and suggest there may be components of CPD programs that more readily support increased motivation for LLL for interprofessional healthcare professionals.

Coordination and Perceived Support for Return to Work: A Cross-Sectional Study among Patients in Swedish Healthcare

Background: Receiving support from a return-to-work (RTW) coordinator (RTWC) may be beneficial for people on long-term sick leave. The aim of this study was to investigate whether the number of contacts with an RTWC and their involvement in designing rehabilitation plans for the patients were associated with perceiving support for RTW, emotional response to the RTWC, and healthcare utilization. Methods: In this cross-sectional study, 274 patients who had recently been in contact with an RTWC in Swedish primary or psychiatric care answered questions regarding their interaction with an RTWC, perceived support for RTW, and emotional response to the RTWC. Results: Having more contact with an RTWC was associated with perceiving more support in the RTW process (adjusted OR 4.14, 95% CI 1.49–11.47). RTWC involvement in designing a rehabilitation plan for the patient was associated with perceiving more support in the RTW process from an RTWC and having a more positive emotional response to the RTWC. Conclusions: From the patient’s perspective, this study indicates that the involvement of an RTWC and receiving a rehabilitation plan that an RTWC has helped to design might be perceived as important in the RTW process.

A Descriptive Evaluation of Health Literacy and Determinants of COVID-19 Vaccine Acceptance among Patients with IgA Nephropathy with High Vaccine Uptake

Aims

Shared decision-making regarding COVID-19 vaccination in IgA nephropathy involves the ability to handle health information regarding potential benefits and risk of flare, but few studies have evaluated health literacy in the context of vaccination. We aimed to evaluate the health literacy and COVID-19 vaccination uptake and acceptance in IgA nephropathy.

Methods

Single-center cross-sectional study of 126 consecutive patients with IgA nephropathy. Health literacy was assessed using the HLS-EU-47 questionnaire. Determinants of vaccine acceptance such as contextual influences, individual and group influences, and vaccine-specific issues were adapted from the World Health Organization framework.

Results

Forty-eight patients (38.1%) with IgAN nephropathy completed the survey between June and August 2021. The participants' median age was 40.5 (31.6, 52.8) years with median disease duration of 2.8 (1.3, 4.3) years. The median general health literacy index was 31.74 (29.88, 35.82) with significantly greater difficulty in the competency of appraising health information and in the domain of disease prevention (p < 0.001). Forty-five patients (93.8%) received at least one dose of COVID-19 vaccine between January and August 2021. Among the 3 unvaccinated patients, 2 intended to receive the vaccination while and 1 did not intend to get vaccinated. There was a high level of trust and belief that their government and healthcare providers had their best interests at heart and that the healthcare providers were honest about the vaccine's risk and benefits, although 31.2% did not understand how the vaccine works and 22.9% believed that there were other ways to prevent infection. Most thought there was adequate safety information, were confident in the system for tracking adverse events and had no issues with access to the vaccine.

Conclusion

Participants with IgA nephropathy had high health literacy scores and low vaccine hesitancy. The determinants for vaccine acceptance can potentially guide efforts to optimize vaccination coverage.

Improving postal survey response using behavioural science: a nested randomised control trial

Background

Systematic reviews have identified effective strategies for increasing postal response rates to questionnaires; however, most studies have isolated single techniques, testing the effect of each one individually. Despite providing insight into explanatory mechanisms, this approach lacks ecological validity, given that multiple techniques are often combined in routine practice.

Methods

We used a two-armed parallel randomised controlled trial (n = 2702), nested within a cross-sectional health survey study, to evaluate whether using a pragmatic combination of behavioural science and evidenced-based techniques (e.g., personalisation, social norms messaging) in a study invitation letter increased response to the survey, when compared with a standard invitation letter. Participants and outcome assessors were blinded to group assignment. We tested this in a sample of women testing positive for human papillomavirus (HPV) at cervical cancer screening in England.

Results

Overall, 646 participants responded to the survey (response rate [RR] = 23.9%). Logistic regression revealed higher odds of response in the intervention arm (n = 357/1353, RR = 26.4%) compared with the control arm (n = 289/1349, RR = 21.4%), while adjusting for age, deprivation, clinical site, and clinical test result (aOR = 1.30, 95% CI: 1.09–1.55).

Conclusion

Applying easy-to-implement behavioural science and evidence-based methods to routine invitation letters improved postal response to a health-related survey, whilst adjusting for demographic characteristics. Our findings provide support for the pragmatic adoption of combined techniques in routine research to increase response to postal surveys.

Trial registration

ISRCTN, ISRCTN15113095. Registered 7 May 2019 – retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-021-01476-7.