Incidental pulmonary nodule management in Canada: exploring current state through a narrative literature review and expert interviews

Background and Objective

Incidental pulmonary nodules (IPNs) are common and increasingly detected with the overall rise of radiologic imaging. Effective IPN management is necessary to ensure lung cancer is not missed. This study aims to describe the current landscape of IPN management in Canada, understand barriers to optimal IPN management, and identify opportunities for improvement.

Methods

We performed a narrative literature review by searching biomedical electronic databases for relevant articles published between January 1, 2010, and November 22, 2023. To validate and complement the identified literature, we conducted structured interviews with multidisciplinary experts involved in the pathway of patients with IPNs across Canada. Interviews between December 2021 and May 2022 were audiovisual recorded, transcribed, and thematically analyzed.

Key Content and Findings

A total of 1,299 records were identified, of which 37 studies were included for analysis. Most studies were conducted in Canada and the United States and highlighted variability in radiology reporting of IPNs and patient management, and limited adherence to recommended follow-up imaging. Twenty experts were interviewed, including radiologists, respirologists, thoracic surgeons, primary care physicians, medical oncologists, and an epidemiologist. Three themes emerged from the interviews, supported by the literature, including: variability in radiology reporting of IPNs, suboptimal communication, and variability in guideline adherence and patient management.

Conclusions

Despite general awareness of guidelines, there is inconsistency and lack of standardization in the management of patients with IPNs in Canada. Multidisciplinary expert consensus is recommended to help overcome the communication and operational barriers to a safe and cost-effective approach to this common clinical issue.

[Interprofessional collaboration of general practitioners and nurses in primary care: A qualitative study]

Interprofessional collaboration of general practitioners and nurses in primary care: A qualitative study Abstract. Background: There is a need to strengthen interprofessional collaboration of general practitioners and home care nurses in the primary care of people with chronic diseases and long-term care needs. Aim: This study investigated a) how general practitioners and nurses in Germany perceive their collaboration in primary care and b) which development perspectives of collaboration exist from their point of view. Methods: Expert interviews were conducted with seven general practitioners and eight home care nurses. The data were analysed using thematic-structured qualitative content analysis. Results: The interviewees from both professional groups report that their collaboration is hindered by poor mutual accessibility. At the same time, they emphasise their appreciation of the professional exchange with the other professional group. Nevertheless, the perceptions of the professional competence of home care nurses differ. To improve their cooperation, the interviewees recommend the establishment of interprofessional meetings and cooperation in spatial proximity for regular professional exchange. They expect this to lead to a joint development of trust and competence and to an expansion of the area of responsibility of home care nurses in primary care. Conclusions: Binding communication structures, cooperation in spatial proximity and an expansion of the area of responsibility of home care nurses offer high potential for strengthening primary care in Germany.

Determining design criteria for indoor positioning system projects in hospitals: A design science approach

Objectives

Indoor navigation systems (indoor positioning systems) can improve orientation for patients in hospitals and help employees to track assets. Many hospitals would like to implement indoor positioning systems but do not know how. To support them in doing this, and to gain knowledge about the requirements for indoor positioning system implementation, our research identifies the design criteria relevant to indoor positioning system implementation projects.

Methods

A design science research process is built to design and evaluate an artifact. For this, five indoor positioning system developers and five hospital IT management representatives from various hospitals and companies in Germany are interviewed. Further, controlled experiments are conducted in Germany, using an ultrasound-based indoor positioning system.

Results

We determined and tested indoor positioning system functions, evaluated indoor positioning system performance criteria, and identified the operating conditions in hospitals. Our results show that indoor positioning system functions should provide a benefit to a hospital's daily operations, that some performance criteria are more important than others, and that operating conditions are important, e.g., radiation.

Conclusion

As a theoretical contribution, we show how design science research can be applied to the context of indoor positioning systems in hospitals. In addition, we make a practical contribution in that our propositions can be used for future indoor positioning system developments.

Who With Whom: Matching Therapist and Client in Correctional Institutions

The current study investigated variables that are being considered when assigning psychotherapists to individuals convicted of sexual and violent offences. Its main aim is to inform practitioners and researchers alike of potentially beneficial combinations between therapist and client and infer hypotheses for future studies. A mixed-methods approach, combining interviews and a follow-up questionnaire, was employed. Nineteen interviews with forensic practitioners working in socio-therapeutic facilities in Germany were conducted. Relevant matching criteria were extracted from all interviews. 1.) Capacities of therapist, 2.) therapist's professional background, 3.) (severity of) clinical disorder, 4.) personal fit, and 5.) fit of client into existing groups emerged as top five matching criteria. Directive therapists were viewed as a good match for antisocial or psychopathic offenders. Opinions diverged regarding personality similarity or complementarity in client-therapist dyads. A flexible matching approach may offer unique strengths to enhance treatment outcome. Implications and ideas for future research are discussed.

Influencing health behaviour using smart building interventions for people with dementia and mild cognitive impairment: expert interviews and a systematic literature review

PURPOSE

Behaviour can have an influence on (coping with) chronic conditions such as dementia. Assistive technology can stimulate the daily behaviour of people with dementia, but the mechanisms through which this happens are unclear. Therefore, this paper focuses on potential behaviour change mechanisms, that can be employed in smart building interventions for people with dementia or MCI.

METHODS

This research uses expert interviews with medical experts (n = 9) and a systematic literature review of smart building interventions stimulating health behaviour (n = 12).

RESULTS

Results show how facilitation, incentive motivation (i.e., feedback), observational learning and self-efficacy are most promising according to medical experts; if they are appropriately personalised towards needs, preferences as well as abilities. The literature review shows how most of the examined research uses facilitation and incentive motivation to stimulate behaviour. Although positive results are reported in all studies, methodological quality could be improved.

CONCLUSION

For the design of smart building interventions for people with MCI or dementia, facilitation and incentive motivation seem to be promising behaviour change mechanisms. Outcome expectation, observational learning and self-efficacy could reinforcing the aforementioned mechanisms. Future research should focus on how different (environmental, digital) cues can be personalized and can adapt over time, as dementia progresses.IMPLICATIONS FOR REHABILITATIONAssistive technology for people with dementia can have an effect on (health) behaviour, which may in turn influence coping strategies or quality of life.Behaviour change mechanisms can inform the design of assistive technology such as smart building interventions.Facilitation, Incentive Motivation, Observational Learning and Self-efficacy seem promising behaviour change mechanisms for people with dementia or MCI.In any intervention for people with dementia, personalized and adaptable cues are of vital importance.

Artificial Intelligence Teaching as Part of Medical Education: Qualitative Analysis of Expert Interviews

BACKGROUND

The use of artificial intelligence (AI) in medicine is expected to increase significantly in the upcoming years. Advancements in AI technology have the potential to revolutionize health care, from aiding in the diagnosis of certain diseases to helping with treatment decisions. Current literature suggests the integration of the subject of AI in medicine as part of the medical curriculum to prepare medical students for the opportunities and challenges related to the use of the technology within the clinical context.

OBJECTIVE

We aimed to explore the relevant knowledge and understanding of the subject of AI in medicine and specify curricula teaching content within medical education.

METHODS

For this research, we conducted 12 guideline-based expert interviews. Experts were defined as individuals who have been engaged in full-time academic research, development, or teaching in the field of AI in medicine for at least 5 years. As part of the data analysis, we recorded, transcribed, and analyzed the interviews using qualitative content analysis. We used the software QCAmap and inductive category formation to analyze the data.

RESULTS

The qualitative content analysis led to the formation of three main categories ("Knowledge," "Interpretation," and "Application") with a total of 9 associated subcategories. The experts interviewed cited knowledge and an understanding of the fundamentals of AI, statistics, ethics, and privacy and regulation as necessary basic knowledge that should be part of medical education. The analysis also showed that medical students need to be able to interpret as well as critically reflect on the results provided by AI, taking into account the associated risks and data basis. To enable the application of AI in medicine, medical education should promote the acquisition of practical skills, including the need for basic technological skills, as well as the development of confidence in the technology and one's related competencies.

CONCLUSIONS

The analyzed expert interviews' results suggest that medical curricula should include the topic of AI in medicine to develop the knowledge, understanding, and confidence needed to use AI in the clinical context. The results further imply an imminent need for standardization of the definition of AI as the foundation to identify, define, and teach respective content on AI within medical curricula.

Demographic Policy in Modern Russia: Population View and Expert Assessment

When formulating demographic policy measures, it is important to rely not only on the analysis of quantitative parameters but also on weighted expert assessments that characterize the effectiveness of the measures taken. Based on the data of a mass survey of the population and expert interviews, this article discusses the features of the implementation of the national project "Demography" and analyzes successful regional practices. Gaps in the sociodemographic policy are revealed, and the regional specificity of demographic development is characterized. It is shown that an important aspect of increasing the effectiveness of the implementation of demographic policy is interdepartmental interaction, which helps to overcome bureaucratic obstacles and barriers. According to the authors, a significant role in improving the demographic situation in the country and regions will be played by updating the regulatory framework, expanding regional and local measures to optimize the movement of the population, and activating socially oriented nonprofit organizations and businesses in the demographic sphere.

Organic Juice Processing Quality from the Processors' Perspective: A Qualitative Study

Organic food quality is based on processing. While the EU organic production regulation focuses on agricultural production, private standards provide more detailed information about further processing. For the development of organic processing, practitioner perspectives can provide valuable input. To get insight into practitioner perspectives, we conducted semi-structured expert interviews with nine employees of seven partly organic juice processing companies from Germany and Austria. Interview topics were (i) quality of organic juice processing in general, (ii) assessment of specific processing techniques, (iii) product quality of organic juice and (iv) flow of information between producer and consumer. We conducted a thematic analysis. We found that the experts' understanding of process quality mostly includes more aspects than the EU organic production regulation. It covers the whole food chain plus aspects of social and environmental sustainability. The experts prefer directly bottled juice of local raw materials but chiefly accept juice made from concentrate of exotic raw materials because of environmental concerns. Organic juice is preferred when it is cloudy and natural fluctuations are interpreted as an indicator of natural quality. The experts report that consumer information is challenging because of low food literacy. Raising this might help reduce the number of processed juices on the market.

Selling displaced people? A multi-method study of the public communication strategies of international refugee organisations

The world has seen a major increase in forced displacement since 2011. As a growing number of states implement restrictive refugee policies, public communication has become essential for refugee organisations. This study analysed, therefore, three international refugee organisations' discursive strategies towards the recent Syrian crisis, as well as their production and the social context. A critical discourse analysis of international press releases (N=122) and six semi-structured interviews with press and regional officers revealed that the observed actors largely dehumanise displaced people and subordinate them to the 'Western self' and state interests; displaced people hardly ever acquire their own voice. The study found that the medium characteristics of press releases and the importance of media attention result in a depersonalising humanitarian discourse. In addition, there were indications of a post-humanitarian discourse that reproduced the humanitarian sector's 'marketisation'. Finally, the examined organisations use the political realist cross-issue persuasion strategy, displaying displaced people as resettlement objects.

Improving Rehabilitative Care of Methamphetamine Users in Germany: The Expert's Perspective

Methamphetamine is one of the most frequently used drugs worldwide. In Germany, methamphetamine use has greatly increased in recent years, presenting the rehabilitative treatment system with new challenges. In this study, we identified deficits and possibilities for optimization in the field of medical rehabilitation. A total of 39 interviews and two focus groups with experts along the treatment course of methamphetamine users were conducted. Our analyses indicate that methamphetamine users are more difficult to treat compared with patients who consume other drugs. They are more likely to be associated with problematic characteristics and behaviors than other rehabilitants. Several health care deficits were revealed: too short rehabilitation treatment, no specific or differentiated therapy concepts, lack of capacity for education and vocational training, lack of outpatient options, and insufficient facilities for parents and children. Findings indicate that inadequate rehabilitation is being provided for methamphetamine users in Germany, indicating a need to adapt treatment for this group.

Nursing management of sensory overload in psychiatry – Theoretical densification and modification of the framework model

Background: Within the scope of the research project on the subjects of sensory overload and stimulus regulation, a theoretical framework model of the nursing care of patients with sensory overload in psychiatry was developed. In a second step, this theoretical model should now be theoretically compressed and, if necessary, modified. Aim: Empirical verification as well as modification, enhancement and theoretical densification of the framework model of nursing care of patients with sensory overload in psychiatry. Method: Analysis of 8 expert interviews by summarizing and structuring content analysis methods based on Meuser and Nagel (2009) as well as Mayring (2010). Results: The developed framework model (Scheydt et al., 2016b) could be empirically verified, theoretically densificated and extended by one category (perception modulation). Thus, four categories of nursing care of patients with sensory overload can be described in inpatient psychiatry: removal from stimuli, modulation of environmental factors, perceptual modulation as well as help somebody to help him- or herself / coping support. Conclusions: Based on the methodological approach, a relatively well-saturated, credible conceptualization of a theoretical model for the description of the nursing care of patients with sensory overload in stationary psychiatry could be worked out. In further steps, these measures have to be further developed, implemented and evaluated regarding to their efficacy.

Identification of Delivery Models for the Provision of Predictive Genetic Testing in Europe: Protocol for a Multicentre Qualitative Study and a Systematic Review of the Literature

INTRODUCTION

The appropriate application of genomic technologies in healthcare is surrounded by many concerns. In particular, there is a lack of evidence on what constitutes an optimal genetic service delivery model, which depends on the type of genetic test and healthcare context considered. The present project aims to identify, classify, and evaluate delivery models for the provision of predictive genetic testing in Europe and in selected Anglophone extra-European countries (the USA, Canada, Australia, and New Zealand). It also sets out to survey the European public health community's readiness to incorporate public health genomics into their practice.

MATERIALS AND EQUIPMENT

The project consists of (i) a systematic review of published literature and selected country websites, (ii) structured interviews with health experts on the genetic service delivery models in their respective countries, and (iii) a survey of European Public Health Association (EUPHA) members' knowledge and attitudes toward genomics applications in clinical practice. The inclusion criteria for the systematic review are that articles be published in the period 2000-2015; be in English or Italian; and be from European countries or from Canada, the USA, Australia, or New Zealand. Additional policy documents will be retrieved from represented countries' government-affiliated websites. The results of the research will be disseminated through the EUPHA network, the Italian Network for Genomics in Public Health (GENISAP), and seminars and workshops.

EXPECTED IMPACT OF THE STUDY ON PUBLIC HEALTH

The transfer of genomic technologies from research to clinical application is influenced not only by several factors inherent to research goals and delivery of healthcare but also by external and commercial interests that may cause the premature introduction of genetic tests in the public and private sectors. Furthermore, current genetic services are delivered without a standardized set of process and outcome measures, which makes the evaluation of healthcare services difficult. The present study will identify and classify delivery models and, subsequently, establish which are appropriate for the provision of predictive genetic testing in Europe by comparing sets of process and outcome measures. In this way, the study will provide a basis for future recommendations to decision makers involved in the financing, delivery, and consumption of genetic services.

Using Web 2.0 for health promotion and social marketing efforts: lessons learned from Web 2.0 experts

Web 2.0 experts working in social marketing participated in qualitative in-depth interviews. The research aimed to document the current state of Web 2.0 practice. Perceived strengths (such as the viral nature of Web 2.0) and weaknesses (such as the time consuming effort it took to learn new Web 2.0 platforms) existed when using Web 2.0 platforms for campaigns. Lessons learned were identified--namely, suggestions for engaging in specific types of content creation strategies (such as plain language and transparent communication practices). Findings present originality and value to practitioners working in social marketing who want to effectively use Web 2.0.