Attitude and Understanding of Artificial Intelligence Among Saudi Medical Students: An Online Cross-Sectional Study

Purpose

Artificial Intelligence is drastically used nowadays in healthcare, but little is known about the attitude and perception of medical students towards AI in Saudi Arabia. This study aimed to explore undergraduate medical student's views on AI, assessed their understanding of AI, and the level of confidence of using basic AI tools in the future.

Methods

This cross-sectional study invited 303 medical undergraduate students to complete an anonymous electronic survey, which consists of questions related to attitude, understanding and confidence of using basic AI tools. We examined the statistical association between the categorical variables by using Chi-square test.

Results

The results of the study indicate that eighty-seven percent of participants believed that AI will play significant role in healthcare. Thirty-eight percent respondents reported that they have an understanding of the basic computational principle of AI. 71.29% respondents agreed that teaching in AI would be favorable for their career. More than half of the participants were confident in using basic AI tools in the future, Male students (p = 0.00), 26-30 years old participants (p = 0.03), intern students (p = 0.00), and Imam Abdulrahman Bin Faisal University medical students (p = 0.04) had positive attitude of artificial intelligence. Male participants (p = 0.02), and intern students (p = 0.00) had the highest proportion of confidence in using basic healthcare AI tool. Nearly 14% students received training on AI. Participants who received training on AI reported better understanding of AI (p = 0.03), develops positive attitude towards teaching in AI (p = 0.05), more confidence in using basic healthcare AI tools (p = 0.05).

Conclusion

Saudi medical undergraduate students understand the significance of AI and demonstrated a positive attitude towards AI. Medical students training on AI should be expanded and improved to avoid threats for seeking jobs by adapting artificial intelligence.

Virtual reality-based simulation intervention for enhancing the empathy of informal caregivers of people with dementia: A mixed-methods systematic review

Dementia is a long-term and progressive syndrome that not only influences the person with dementia (PWD) but also the caregiver. However, informal caregivers are not always empathic and understand the symptoms of dementia, leading to destructive caregiving relationships and poor quality of caregiving. VR-based simulation interventions can provide a more realistic and memorable learning experience for caregivers to walk in PWDs' shoes. This review aimed to provide practitioners and researchers with insights on developing and/or adopting an effective VR-based simulation intervention for enhancing the empathy of informal caregivers of PWD. A mixed-methods systematic review was conducted. Quantitative, qualitative, and mixed-methods studies were searched from MEDLINE, PsycINFO, CINAHL, Scopus, Embase, and Cochrane Library updating. Standard JBI critical appraisal instruments were used for the quality appraisal. A convergent segregated approach was used to synthesize and integrate the data. A total of seven studies were included. Inconsistent quantitative results were reported on the effects of VR-based simulation on empathy enhancement. Significant effects were reported on knowledge of dementia and emotion-focused coping strategies. Two themes were generated from the qualitative studies, including "Informal caregivers gained better insight into problems encountered by older people with dementia" and "Thinking from the perspective of older people with dementia, leading to changes in attitudes and behaviours towards dementia". The qualitative synthesized evidence showed that informal caregivers gained better insight into problems encountered by PWD, but the quantitative synthesized results are inconsistent. Yet, informal caregivers experienced a change in attitude by thinking from the perspective of PWD.

Traditional health practitioners' understanding of spirit possession in Gauteng province, South Africa

Background

Traditional health practitioners (THPs) understand spirit possession as a cultural or religious spirit occupying a person, while the mental healthcare providers understand it as a mental illness. The different understanding is based on manifestations that mimic that of mental illness, such as seeing and hearing things that others cannot see or hear. Spirit possession holds different meanings in different cultures and religions that could be either beneficial or detrimental. Furthermore, spirit possession is understood as a channel of communication between the living and the dead or God or a supernatural phenomenon in which a spirit owns a person.

Aim

This study explored and interpreted THPs' understanding of spirit possession in Gauteng province, South Africa.

Method

Hermeneutic phenomenology study explored and interpreted the THPs' understanding of spirit possession in Gauteng province. In-depth individual interviews were conducted with 12 THPs who were selected through snowball sampling techniques. Data analysis followed Heidegger's and Gadamer's philosophies and Van Manen's six steps of the analytic approach.

Results

The findings revealed that THPs understood spirit possession as spiritual illness, ancestral calling and demonic spirit or witchcraft.

Conclusion

Traditional health practitioners' understanding of spirit possession could promote mental health and prevent mental illness by providing support to a spirit-possessed person and referral to mental healthcare services.

Contribution

This study contributed that not all manifestations presented by persons with spirit possession are actual and clear-cut mental illness, but could be unwritten cultural and/ or religious illnesses that needs cultural and religious services also.

Understanding of disease status, prognosis and estimated cost of treatment among cancer patients: experience from a tertiary cancer centre in Nepal

Purpose

Lack of adequate knowledge about the disease is one of the key factors that misguide cancer patients and patients' caregivers in choosing a better management plan. The purpose of the study was to assess the patients' and caregivers' knowledge about the disease status and estimated treatment cost. Understanding of disease may improve adherence to treatment plans and quality of care.

Methods

It was a cross-sectional study where 120 cancer patients were selected based on convenience sampling and the availability of record files and relevant data. The site, stage and prognosis of disease recorded from patients and caregivers were compared with the record of outpatient department and inpatient files with the help of the Fisher's exact test. The patients' knowledge about their financial estimates was also recorded. Three patients were selected for in-depth interviews based on purposive sampling to further support the findings.

Results

Among 120 analysed patients, 60.83% were female. Around two-thirds of male patients (69.2%) and male caregivers (62.2%) knew about the site but only one-third of female patients (30.8%) and female caregivers (37.8%) knew the same. The primary responsibility for managing financial issues was caregivers in 89.16%. Only 7.5% knew the estimated cost. Nepali as the primary language and better education level is correlated with knowledge of disease status, among both patients and caregivers but was statistically significant only in knowing prognosis among native Nepali speaker caregivers (p < 0.001), and better-educated patients (p < 0.001). As per the in-depth interview, all three patients knew the site of their disease, but only the patient with breast cancer was aware of the stage of the disease. None of the patients were aware of their disease prognosis, treatment plan or the estimated cost of their treatment.

Conclusion

The level of understanding is low for most patients and their immediate caregivers, particularly among those who are female, not literate and whose primary language is not Nepali. Appropriate strategy should be adopted to enhance basic understanding among patients and caregivers in our setting.

Do Animal Welfare Education Campaigns Really Work? An Evaluation of the RSPCA's #DogKind Campaign in Raising Awareness of Separation-Related Behaviours in UK Dog Owners

One of the main aims of companion animal welfare charities is to educate the public about the needs of animals. This is frequently performed through campaigns focusing on specific aspects of welfare. The Royal Society for the Prevention of Cruelty to Animals (RSPCA), Britain's biggest animal welfare charity, launched the nationwide #DogKind campaign in March 2019. Targeted mainly at 25-34-year-olds, the campaign aimed to increase awareness of separation-related behaviour (SRB) among dog owners and encourage them to seek help for SRB from reliable sources. This research involved a quasi-experimental, non-equivalent control group design evaluating the campaign's effectiveness. It was conducted through a series of online surveys at three different time points: before the launch of the campaign (n = 2002), six months after (n = 2423), and, again, two months later (n = 269), during which we asked the same questions regarding knowledge of SRB. An experimental trial of 269 participants tested whether accessing a video alongside the campaign web pages increased the effectiveness of the campaign objectives. Overall, the campaign appeared to be effective in reaching its target audience but not at raising awareness of SRB or increasing the number of owners intending to seek help. The inclusion of a video in the campaign made no difference to its effectiveness. This study shows that this campaign had limited success in achieving its targets and highlights the importance of thorough evaluations of education interventions that aim to improve the welfare of companion animals.

What Do We Know about Dog Owners? Exploring Associations between Pre-Purchase Behaviours, Knowledge and Understanding, Ownership Practices, and Dog Welfare

Despite many dogs living in homes in the UK, there is still more to know about the welfare of those individual animals. Past research has shown that owners' thoughts and behaviours have a substantial impact on their dog's welfare. This study aimed to better understand owners' pre-purchase behaviours, knowledge and understanding, and ownership practices, and explore any associations between these factors and their dog's welfare. We conducted further analysis of the data collected by People's Dispensary for Sick Animals (PDSA) for their 2017 PDSA Animal Welfare (PAW) Report (n = 1814). We extracted variables to describe owner demographics (7), pre-purchase behaviours (1), knowledge and understanding (4), welfare indicators, (2) and ownership practices (4), and we tested for an association between these variables. We found more pre-purchase research was carried out by younger respondents and those with a higher education level. Also, more research was associated with feeling more informed about the five welfare needs and knowing to seek help for behaviour from appropriate sources. Overall, the study found several novel and significant results worthy of note and further exploration but did not find any strong connections between the variables.

Informed Consent Under Ignorance

In recent years, an old challenge to informed consent has been rediscovered: the challenge of ignorance. Several authors argue that due to the presence of irreducible ignorance in certain treatments, giving informed consent to these treatments is not possible. The present paper examines in what ways ignorance is believed to prevent informed consent and which treatments are affected by that. At this, it becomes clear that if the challenge of ignorance truly holds, it poses a major problem to informed consent. The paper argues, however, that from both an empirical and a theoretical point of view, it is not convincing that ignorance prevents informed consent. Still, it seems important that the presence of irreducible ignorance is openly discussed during the informed consent process.

What do women undergoing in vitro fertilization (IVF) understand about their chance of IVF success?

STUDY QUESTION

How well informed are Australian women who undergo IVF about their chances of having a baby?

SUMMARY ANSWER

Only one in four women estimated their individual chance of success with IVF accurately, with most women overestimating their chance.

WHAT IS KNOWN ALREADY

Limited knowledge about infertility and infertility treatment in the general population is well-documented. The few studies that have investigated patients' knowledge about the chance of IVF success suggest that while IVF patients are aware of average success rates, they tend to be unrealistic about their own chance of success.

STUDY DESIGN, SIZE, DURATION

We conducted an anonymous online survey of 217 women who had started IVF since 2018 in Australia. The survey was advertised on social media, enabling women from across Australia to participate. Responses were collected in June 2021.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The survey included questions on demographic characteristics and IVF history. It asked what participants thought their chance of having a baby from one IVF treatment cycle was, how they rated their knowledge about chance of success, and about their experience of receiving IVF-related information. Participants' estimations of their chance of success were compared with their chance as calculated by the Society for Assisted Reproductive Technology's (SART) online calculator. Responses to a free-text question about what information women wished they had been given when they started treatment were analysed thematically.

MAIN RESULTS AND THE ROLE OF CHANCE

Only about a quarter (58/217, 27%) of participants accurately estimated their chance of having a baby within 20% relative to their SART calculated chance, with more than half (118/217, 54%) overestimating their chance. Ninety percent of women indicated that their preferred source of treatment information was a consultation with their doctor, despite less than half (44%) reporting that doctors explained the probability of having a baby with IVF well (mean 5.9/10). In free-text responses, many women also reported that they wished they had been given more realistic information about IVF and their chance of success.

LIMITATIONS, REASONS FOR CAUTION

The dissemination method precludes calculation of response rate, and it is not possible to know if participants are representative of all women undergoing IVF. Additionally, we only surveyed women undergoing IVF, while those who decided not to have IVF were not included. Therefore, women who overestimated their chance may have been overrepresented. There is also inherent imprecision in the way understanding of chance of success was estimated. The potential impact of recall bias could neither be quantified nor excluded. It is difficult to determine to what extent women's lack of understanding of what is possible with IVF is due to poor information-provision by clinicians and the clinic, and how much can be explained by optimism bias.

WIDER IMPLICATIONS OF THE FINDINGS

The finding of poor understanding of personal chance of success amongst women undergoing IVF in Australia requires further investigation to determine potential reasons for this. The findings can be used by clinics to develop strategies for improvement in the information-provision process to ensure that women can make informed decisions about their fertility treatment.

STUDY FUNDING/COMPETING INTEREST(S)

This study received no external funding. S.L. is supported by a NHMRC Investigator Grant (APP1195189). R.W. is supported by a NHMRC Investigator Grant (APP2009767). B.W.M. is supported by a NHMRC Investigator Grant (GNT1176437). B.W.M. reports consultancy for Merck and ObsEva and has received research funding and travel funding from Merck. The other authors have no conflicts of interest.

TRIAL REGISTRATION NUMBER

N/A.

Experiences of carers of youth, adult children and spouses with ME/CFS

OBJECTIVES

The debilitating nature of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) means that family members often take on a caring role. This study compared the experiences of people caring for three groups: youth, young adults, spouses.

METHODS

An opportunistic sample of 36 carers completed an online survey of open-ended questions asking about their experiences. Thematic analysis was used to consider the three sets of responses separately and Thematic Comparison was used to identify points of connection and disconnection across the sets.

RESULTS

The themes identified were very similar to those identified in past studies. Two super-ordinate themes were identified: "Lack of knowledge and understanding" and "Holistic Impact". Though most sub-ordinate themes were evident across all three groups, important differences were found. The sub-ordinate themes "Caring Blindly", "Emotional and physical health cost", and "Impact on the whole family" were more evident amongst carers of youth while the theme "Worry for the future" was more evident from carers of young adults and spouses.

DISCUSSION

Differences seemed to be related to both the time since diagnosis and the life stage. A longitudinal study would help to understand how carer experiences change over the life course of caring for someone with ME/CFS.

Parents' and adolescents' perspectives and understanding of information about childhood cancer precision medicine

BACKGROUND

Precision medicine is projected to become integral to childhood cancer care. As such, it is essential to support families to understand what precision medicine entails.

METHODS

A total of 182 parents and 23 adolescent patients participating in Precision Medicine for Children with Cancer (PRISM), an Australian precision medicine clinical trial for high-risk childhood cancer, completed questionnaires after study enrollment (time 0 [T0]). Of the parents, 108 completed a questionnaire and 45 completed an interview following return of precision medicine results (time 1 [T1]). We analyzed the mixed-methods data comprising measures exploring families' perceptions and understanding of PRISM's participant information sheet and consent form (PISCF), and factors associated with understanding.

RESULTS

Most parents were satisfied with the PISCF, rating it as at least "somewhat" clearly presented (n = 160/175; 91%) and informative (n = 158/175; 90%). Many suggested improvements including the use of clearer language and a more visually engaging format. Parents' actual understanding of precision medicine was low on average, but scores improved between T0 and T1 (55.8/100-60.0/100; p = .012). Parents from culturally and/or linguistically diverse backgrounds (n = 42/177; 25%) had lower actual understanding scores than those from a Western/European background whose first language was English (p = .010). There was little correlation between parents' perceived and actual understanding scores (p = .794; Pearson correlation -0.020; 95% CI, -0.169 to 0.116). Most adolescent patients read the PISCF either "briefly" or "not at all" (70%) and had a perceived understanding score of 63.6/100 on average.

CONCLUSIONS

Our study revealed gaps in families' understanding of childhood cancer precision medicine. We highlighted areas for potential intervention such as through targeted information resources.

PLAIN LANGUAGE SUMMARY

Precision medicine is projected to become part of the standard of care for children with cancer. Precision medicine aims to give the right treatment to the right patient and involves several complex techniques, many of which may be challenging to understand. Our study analyzed questionnaire and interview data from parents and adolescent patients enrolled in an Australian precision medicine trial. Findings revealed gaps in families' understanding of childhood cancer precision medicine. Drawing on parents' suggestions and the literature, we make brief recommendations about improving information provision to families, such as through targeted information resources.

Survey of hospital practitioners: common understanding of cardiopulmonary resuscitation definition and outcomes

BACKGROUND

Cardiopulmonary resuscitation (CPR) is internationally defined as chest compressions and rescue breaths, and is a subset of resuscitation. First used for out-of-hospital cardiac arrest, CPR is now frequently used for in-hospital cardiac arrest (IHCA) with different causes and outcomes.

AIMS

This paper aims to describe clinical understanding of the role of in-hospital CPR and perceived outcomes for IHCA.

METHODS

An online survey of a secondary care staff involved in resuscitation was conducted, focussing on definitions of CPR, features of do-not-attempt-CPR conversations with patients and clinical case scenarios. Data were analysed using a simple descriptive approach.

RESULTS

Of 652 responses, 500 were complete and used for analysis. Two hundred eleven respondents were senior medical staff covering acute medical disciplines. Ninety-one percent of respondents agreed or strongly agreed that defibrillation is part of CPR, and 96% believed CPR for IHCA included defibrillation. Responses to clinical scenarios were dissonant, with nearly half of respondents demonstrating a pattern of underestimating survival and subsequently showing a desire to offer CPR in similar scenarios with poor outcomes. This was unaffected by seniority and level of resuscitation training.

CONCLUSIONS

The common use of CPR in hospital reflects the broader definition of resuscitation. Recapturing the CPR definition for clinicians and patients as only chest compressions and rescue breaths may allow clinicians to better discuss individualised resuscitation care to aide meaningful shared decision-making around patient deterioration. This may involve reframing current in-hospital algorithms and uncoupling CPR from wider resuscitative measures.

Dementia Simulation for Family Caregivers of Persons With Dementia: A Scoping Review

BACKGROUND

Alzheimer's disease and related dementias are becoming increasingly prevalent worldwide. Persons with dementia receive substantial assistance from family caregivers over extended periods of time. Family caregivers of persons with dementia are twice as likely to report physical, emotional, and financial challenges related to caregiving compared with other types of family caregivers. Empathy has been demonstrated to improve caregivers' quality of life and their relationships with care recipients.

OBJECTIVE

This scoping review examines the current literature on the effects of dementia simulation on empathy levels in family caregivers of persons with dementia.

METHODS

A librarian-assisted search of 4 databases-PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycINFO, and Scopus-was conducted. Key terms included "dementia," "family caregivers," and "simulation." To broaden reference retrieval, "empathy" was not used as a key term but remained an inclusion criterion during reference screening. Data extraction of relevant references was completed.

RESULTS

The search yielded 212 citations. Seven eligible dementia simulation studies were identified, including 1 randomized controlled trial, 3 quasi-experimental studies, and 3 qualitative research studies. Only 3 of the 7 studies focused specifically on family caregivers of persons with dementia.

CONCLUSIONS

Qualitative data supported increased empathy in family caregivers, but quantitative findings on changes in empathy levels were inconclusive. Further research using quantitative or mixed-methods designs is necessary to support benefits of simulation on empathy for family caregivers of persons with dementia.

Scaffolding the human partner by contrastive guidance in an explanatory human-robot dialogue

Explanation has been identified as an important capability for AI-based systems, but research on systematic strategies for achieving understanding in interaction with such systems is still sparse. Negation is a linguistic strategy that is often used in explanations. It creates a contrast space between the affirmed and the negated item that enriches explaining processes with additional contextual information. While negation in human speech has been shown to lead to higher processing costs and worse task performance in terms of recall or action execution when used in isolation, it can decrease processing costs when used in context. So far, it has not been considered as a guiding strategy for explanations in human-robot interaction. We conducted an empirical study to investigate the use of negation as a guiding strategy in explanatory human-robot dialogue, in which a virtual robot explains tasks and possible actions to a human explainee to solve them in terms of gestures on a touchscreen. Our results show that negation vs. affirmation 1) increases processing costs measured as reaction time and 2) increases several aspects of task performance. While there was no significant effect of negation on the number of initially correctly executed gestures, we found a significantly lower number of attempts-measured as breaks in the finger movement data before the correct gesture was carried out-when being instructed through a negation. We further found that the gestures significantly resembled the presented prototype gesture more following an instruction with a negation as opposed to an affirmation. Also, the participants rated the benefit of contrastive vs. affirmative explanations significantly higher. Repeating the instructions decreased the effects of negation, yielding similar processing costs and task performance measures for negation and affirmation after several iterations. We discuss our results with respect to possible effects of negation on linguistic processing of explanations and limitations of our study.

Awareness and knowledge about HPV and primary HPV screening among women in Great Britain: An online population-based survey

OBJECTIVES

Human papillomavirus (HPV) primary testing for cervical screening is being implemented around the world. We explored HPV awareness, and knowledge about primary screening in Great Britain (England, Scotland and Wales), where it has been in place for several years, ahead of extended screening intervals being implemented in England.

SETTING/METHODS

Women aged 18-70 (n = 1995) were recruited by YouGov from their online panel in August 2022. The weighted sample (n = 1930) was population-representative by age, region, education and social grade. We measured HPV awareness, knowledge (excluding those unaware of HPV) using eight true/false items, and understanding of the role of HPV testing in cervical screening.

RESULTS

Overall, 77.6% (1499/1930) of women were aware of HPV. When asked to identify the statement describing how cervical screening works, only 12.2% (236/1930) correctly selected the statement reflecting HPV primary screening (13.5% (194/1436) in screening-eligible women). Excluding those unaware of HPV, most participants had heard about the virus in the context of cervical screening (981/1596; 61.5%) or HPV vaccination (1079/1596; 67.6%). Mean knowledge score was 3.7 out of 8 (SD = 2.2) in this group. Most knew that an HPV-positive result does not mean a woman will definitely develop cervical cancer (1091/1499; 72.8%) but far fewer were aware of the long timeline for HPV to develop into cervical cancer (280/1499; 18.7%).

CONCLUSIONS

Only three-quarters of women in Britain are aware of HPV, and knowledge of primary screening is very low, even among screening-age women. This points to continued need for awareness-raising campaigns to ensure informed choice about screening and mitigate public concern when screening intervals are extended.

Understanding and Use of Artificial Intelligence Among Doctors in a University Hospital in Morocco

INTRODUCTION

Research and development in artificial intelligence (AI) has increased dramatically over the past decade, with all areas of life being affected and particularly the medical field. It is with this in mind that this study focused on the perceptions of AI by physicians at the University Hospital of Casablanca in Morocco.

METHODS

A cross-sectional study conducted among physicians at the University Hospital of Casablanca in April 2023. A questionnaire was distributed electronically by sending it to the participants' email addresses.

RESULTS

We received 103 responses to our questionnaire from physicians. The median age of the participants was 27 years with a range of 23-44 years. Concerning the seniority in clinical practice; about 59% had an experience ranging from 1 to 5 years,58% agreed that the use of medical artificial intelligence technologies will complete clinical tasks quickly, and 51% of these respondents agreed that these applications increase clinical performance. Prevalence of physicians using AI in daily life was 48% with a CI [38-57]%. The concerns perceived by the responding physicians regarding the use of artificial intelligence in the medical field were in 63% of the cases reported about the reduction of human contact with patients.

CONCLUSION

In our study doctors have good knowledge in terms of artificial intelligence and they are open to develop their medical competences in relation with this artificial intelligence.

Patient understanding: How should it be defined and assessed in clinical practice?

In order for patients to make autonomous decisions in a healthcare setting, they must understand relevant information. There is, however, a lack of consensus on how understanding should be defined or assessed in this context, despite the fact that in practice doctors are regularly required to judge whether a patient has understood medical information. Current accounts of patient decision-making often focus on the information which needs to be disclosed to the patient to support their autonomous decision-making. Far less attention has been afforded to questions about how we might determine whether a patient has understood the information disclosed to them. Theoretical approaches to the concept of understanding in this context, and practically useful frameworks for assessing it, are lacking. In this paper, I use a number of hypothetical clinical situations to explore the conditions that are required for a patient to adequately understand information in medical decision-making. Drawing upon the wider philosophical literature, I propose a number of criteria which are necessary for understanding in a medical context: patients must (1) grasp a body of information which (2) reasonably reflects a responsible body of medical professionals' best estimate of the truth, (3) to a degree which meets a context-specific threshold. These criteria may be helpful in guiding assessments of patient understanding in clinical practice.

Understanding understanding in psychiatry

Originally put forward to defend history from the encroachment of physics, the distinction between understanding and explanation was built into the foundations of Karl Jaspers' 'phenomenological' psychiatry, and it is revised, used and defended by many still working in that tradition. On the face of it, this is rather curious. I examine what this notion of 'understanding' amounts to, why it entered and remains influential in psychiatry, and what insights for contemporary psychiatry are buried in the notion. I argue that it is unhelpfully associated with the view that the mental is epistemologically and methodologically autonomous, but that it nevertheless highlights an important lacuna in many views of psychiatry and the scientific study of humans more generally.

Healthcare Professionals' Attitudes towards and Knowledge and Understanding of Paediatric Palliative Medicine (PPM) and Its Meaning within the Paediatric Intensive Care Unit (PICU): A Summative Content Analysis in a Tertiary Children's Hospital in Scotland-"An In Vitro Study"

Background: Paediatric palliative medicine (PPM) is a holistic approach to care for children and their families. Services are growing and developing worldwide but significant disparity in service provision remains. The Paediatric Supportive and Palliative Care Team (PSPCT) at the Royal Hospital for Children in Glasgow was established in 2019, but there is still no clear integrated role within the paediatric intensive care unit (PICU) at present. Through analysing the attitudes, meaning, knowledge and understanding of PPM in the PICU environment, we hoped to explore the experiences of those providing paediatric palliative care and to identify any barriers to or facilitators of integrated working to gain a better understanding of providing this care. Methods: This qualitative study used a survey composed of five open-ended and five closed questions. Sixteen out of a possible thirty-two responses (50%) were accrued from PICU healthcare professionals, including consultants (n = 19), advanced nurse practitioners (n = 4) and band-seven nurses (n = 9). The data were comprehensively studied and analysed by two coders using summative content analysis with assistance from data management software. Codes were further developed to form categories and subcategories. Results: Two categories were found: (1) the role of palliative care and (2) experiences of providing palliative care. A total of five subcategories were found, demonstrating that the PSPCT can enhance care in PICU through collaborative working. Barriers identified included staffing, funding and stigma around palliative care. Conclusions: This study shows that PICU professionals have a good understanding of the concepts of PPM and view it as an essential part of PICU work. Barriers related to resources and misperceptions of palliative care can be overcome through improved education, funding and staff retention, but this would require buy-in from policymakers. The perspective from our relatively small team increases generalizability to growing teams across the country.

Perception of professionalism in clinical practice among clinical year radiography students in a tertiary institution in Ghana

INTRODUCTION

Professionalism describes the positive attitudes, conduct, aims, values, skills, and behaviours that characterize a profession or a group of professionals. The steady professional growth of radiographers, which begins during undergraduate training, continues to be significantly influenced by education. As professional traits are ingrained in radiography students through official clinical instruction and observations, research on professionalism is necessary to monitor the perception of the subject matter. However, no study on Ghanaian radiography students on professionalism has been conducted. The goal of this study was to determine how clinical radiography students at a higher education facility in Ghana viewed the professionalism of radiography practice.

METHODS

Sixty-four consenting Level 300 (3rd year) and Level 400 (4th year) students in the University of Ghana School of Biomedical and Allied Health Sciences' BSc Diagnostic Radiography and BSc Therapy programmes completed the Pennsylvania State College of Medicine Professionalism Questionnaire (PSCOM-PQ) which was used to determine the impacts and challenges to professionalism. Version 23.0 of the Statistical Package for Social Science program (SPSS 23.0) was used to analyze the collected data.

RESULTS

A good sense of professionalism in clinical practice was held by the majority of clinical radiography students. More than 56% of them observed professional practice among the majority of radiographers, contrary to 40.6% of them who witnessed it among only a few radiographers. The students observed both positive and negative effects on the professionalism of radiography practice. As a result, 77.9% of the students said that it was difficult to exhibit professionalism in radiography during their clinical training.

CONCLUSION

The students agreed that professionalism impacted positively and negatively on radiography practice, and consequently identified to need to address the mitigating challenges to improve the level of professionalism. By this, most of the clinical year students had a better understanding of perceptions of the professionalism of radiography practice.

IMPLICATION FOR PRACTICE

According to the study's findings, clinical students' radiography practice is affected either positively or negatively by their conceptions of professionalism and their adherence to them during the entire training period.

The relationship between the pharmacist's role, patient understanding and satisfaction during the provision of a cost-effective pharmacist-led intervention

RATIONALE, AIMS AND OBJECTIVES

This study aimed to investigate the relationship between the pharmacist's role, patient understanding and satisfaction during the provision of a cost-effective pharmacist-led intervention using structural equation modelling (SEM). SEM is a group of statistical techniques used in different disciplines to model latent variables and evaluate theories.

METHODS

A validated questionnaire was used to gather patient views on a pharmacist-led intervention. A conceptual model was developed to test the statistical significance of the relationship between patient understanding and satisfaction, the pharmacist's role and patient understanding, the pharmacist's role and patient satisfaction. In addition, the study evaluated the model's in-sample and out-of-sample predictive power. The analysis tested fours hypotheses (H): 1) There was no significant relationship between patient understanding and patient satisfaction; 2) There was no significant relationship between the pharmacist's role and patient understanding; 3) There was no significant relationship between the pharmacist's role and patient satisfaction; 4) The in-sample and out-of-sample predictive power of the model. Data were analysed using Smart-PLS software version 3.2.8.

RESULTS

Two hundred and forty-six patients returned the questionnaire. Construct reliability, validity (Cronbach's alpha〉0.70, ⍴A>0.70, ⍴C>0.70), average extracted variance (AVE〉0.50) and discriminant validity (HTMT<0.85) were confirmed. The structural model and hypothesis testing results showed that all hypotheses were supported in this study. Path coefficients and effect sizes suggested that the pharmacist's role played a significant part in patient understanding (H2, β=0.650, f² =0.730, p<0.001), which then influenced patient satisfaction (H1, β=0.474, f² =0.222, p<0.001). The in-sample and out-of-sample predictive powers were moderate.

CONCLUSIONS

Patient satisfaction is becoming an integral component in healthcare provision and evaluation of healthcare quality. The results support using structural equation modelling to assess the link between the pharmacist's role and patient understanding and satisfaction when delivering cost-effective pharmacist-led interventions.

Unveiling the Morphological and Physical Mechanism of Burn-in Loss Alleviation by Ternary Matrix Toward Stable and Efficient All-Polymer Solar Cells

All-polymer solar cells (All-PSCs) are considered the most promising candidate in achieving both efficient and stable organic photovoltaic devices, yet the field has rarely presented an in-depth understanding of corresponding device stability while efficiency is continuously boosted via the innovation of polymer acceptors. Herein, a ternary matrix is built for all-PSCs with optimized morphology, improved film ductility and importantly, boosted efficiency and better operational stability than its parental binary counterparts, as a platform to study the underlying mechanism. The target system PQM-Cl:PTQ10:PY-IT (0.8:0.2:1.2) exhibits an alleviated burn-in loss of morphology and efficiency under light soaking, which supports its promoted device lifetime. The comprehensive characterizations of fresh and light-soaked active layers lead to a clear illustration of opposite morphological and physical degradation direction of PQM-Cl and PTQ10, thus resulting in a delicate balance at the optimal ternary system. Specifically, the enlarging tendency of PQM-Cl and shrinking preference of PTQ10 in terms of phase separation leads to a stable morphology in their mixing phase; the hole transfer kinetics of PQM-Cl:PY-IT host is stabilized by incorporating PTQ10. This work succeeds in reaching a deep insight into all-PSC's stability promotion by a rational ternary design, which booms the prospect of gaining high-performance all-PSCs.

Investigating Students' Perceptions towards Artificial Intelligence in Medical Education

Implementing a reform in medical education requires students' awareness regarding the importance of artificial intelligence (AI) in modern medical practice. The objective of this study was to investigate students' perceptions of AI in medical education. A cross-sectional survey was conducted from June 2021 to November 2021 using an online questionnaire to collect data from medical students in the Faculty of Medicine at Kuwait University, Kuwait. The response rate for the survey was 51%, with a sample size of 352. Most students (349 (99.1%)) agreed that AI would play an important role in healthcare. More than half of the students (213 (60.5%)) understood the basic principles of AI, and (329 (93.4%)) students showed comfort with AI terminology. Many students (329 (83.5%)) believed that learning about AI would benefit their careers, and (289 (82.1%)) believed that medical students should receive AI teaching or training. The study revealed that most students had positive perceptions of AI. Undoubtedly, the role of AI in the future of medicine will be significant, and AI-based medical practice is required. There was a strong consensus that AI will not replace doctors but will drastically transform healthcare practices.

Diagrams, images and conceptual maps in nursing education

The way in which one understands information and concepts, and the way a student works to develop this, is an individual aspect of learning that cannot be universally defined as (at least manifested) the same for everyone. 'Understanding' is a broad term, and the way one achieves understanding is dependent on the way that material is presented. In this article, we argue that the philosophy of science can be important to nursing education-in particular, by showing that the way we imbue understanding might depend on the meaning of 'understanding'. Diagrams and concept maps are meant to guide newly formed knowledge and connections to develop proper thinking (e.g., the order in which nursing students must prioritize data) that a student requires in the field. We argue that whether or not an image/diagram/concept map confers understanding will depend on both what the object is and what we mean by 'understanding'.

The debate over understanding in AI's large language models

We survey a current, heated debate in the artificial intelligence (AI) research community on whether large pretrained language models can be said to understand language-and the physical and social situations language encodes-in any humanlike sense. We describe arguments that have been made for and against such understanding and key questions for the broader sciences of intelligence that have arisen in light of these arguments. We contend that an extended science of intelligence can be developed that will provide insight into distinct modes of understanding, their strengths and limitations, and the challenge of integrating diverse forms of cognition.

Children's developing understanding of economic inequality and their place within it

Income inequality is growing in many parts of the world and, for the poorest children in a society, is associated with multiple, negative, developmental outcomes. This review of the research literature considers how childrens' and adolescents' understanding of economic inequality changes with age. It highlights shifts in conceptual understanding (from 'having and not having', to social structural and moral explanations), moral reasoning and the impact of the agents of socialization from parents to the media and cultural norms and discourses. It also examines how social processes affect judgements and the importance of an emerging sense of self in relation to questions of economic inequality. Finally, the review covers methodological considerations and suggests pathways for future research.

[Improved Patients' Satisfaction Level of Radiation Therapy: The Effect of "Explainer Videos about Radiation Therapy", "Treatment of Breast Cancer Patients by Female Radiation Therapists" and "Treating Male Patients While Wearing Underwear in Pelvic Radiation Therapy"]

PURPOSE

The questionnaire survey investigated whether "Explainer videos about radiation therapy (RT-Video)", "Treatment of breast cancer patients by female radiation therapists (F-RTT)" and "Treating male patients while wearing underwear in pelvic radiation therapy (M-RTT)" can improve patient's satisfaction.

METHODS

The RT-Video survey included questions regarding the impression of radiation therapy, improving its understanding, and anxiety reduction (102 patients received radiation therapy). Fifty-one breast cancer patients were asked whether they preferred an F-RTT treatment. Subsequently, the patients treated with F-RTT (41 patients) and M-RTT (50 patients) were surveyed about their treatment satisfaction on a five-point scale.

RESULTS

RT-Video improved the understanding of radiation therapy for 86 out of 102 patients (84%). In all, 68 out of 102 patients (68%) had a negative impression of radiotherapy; among them, watching the RT-Video reduced anxiety in 63% of patients. A total of 14 out of 51 breast cancer patients (28%) preferred the F-RTT treatment. The percentage of patients who received treatment satisfaction by F-RTT and M-RTT was 95% and 84%, respectively.

CONCLUSION

RT-Video, F-RTT and M-RTT treatments improved patients' satisfaction.

How Did People with Prediabetes Who Attended the Diabetes Prevention Education Program (DiPEP) Experience Making Lifestyle Changes? A Qualitative Study in Nepal

Diabetes can be prevented through lifestyle modification in the prediabetic phase. A group-based lifestyle intervention called 'Diabetes Prevention Education Program' (DiPEP) was tested recently in Nepal. The present study aimed to explore experiences of making lifestyle changes among people with prediabetes participating in the DiPEP. This qualitative study, with semi-structured interviews of 20 participants, was conducted 4-7 months following DiPEP intervention. Data analysis was performed by thematic analysis. The results included four themes, understanding that diabetes could be prevented, lifestyle changes made, hurdles to overcome, and experiencing benefits leading to sustained change. Some participants said they felt relieved to know that they had a chance to prevent diabetes. The participants talked mostly about making changes in diet (reducing carbohydrate intake) and physical activity (starting exercises). Obstacles mentioned included a lack of motivation and a lack of family support to implement changes. Experiencing benefits such as weight loss and reduced blood sugar levels were reported to lead them to maintain the changes they had made. Understanding that diabetes could be prevented was a key motivator for implementing changes. The benefits and hurdles experienced by the participants of the present study can be taken into consideration while designing lifestyle intervention programs in similar settings.

[Case Conferences in Inpatient Child and Adolescent Psychotherapy - Single Case Presentation and General Recommendations]

Case conference in a teamgroup in inpatient psychotherapy with children and adolescents are a tool to focus those aspects of treatment relations that can not (yet) be verbalized but present themselves in actions during the treatment. This paper gives a brief overview on the theory and methodology of case conferences and refers to an ongoing study. The presentation of a case conference leads to giving some general recommendations.

Patient autonomy and withholding information

Disclosure in clinical practice is aimed at promoting patient autonomy, usually culminating in patient choice (e.g., to consent to an operation or not, or between different medications). In medical ethics, there is an implicit background assumption that knowing more about (X) automatically translates to greater, or more genuine, autonomy with respect to one's choices involving (X). I challenge this assumption by arguing that in rare cases, withholding information can promote a patient's autonomy (understood as the capacity for rational choice in alignment with one's values and goals).

Same label, different patients: Health-workers' understanding of the label 'critical illness'

Background

During the course of patients' sickness, some become critically ill, and identifying them is the first important step to be able to manage the illness. During the course of care provision, health workers sometimes use the term 'critical illness' as a label when referring to their patient's condition, and the label is then used as a basis for communication and care provision. Their understanding of this label will therefore have a profound impact on the identification and management of patients. This study aimed to determine how Kenyan and Tanzanian health workers understand the label 'critical illness'.

Methods

A total of 10 hospitals-five in Kenya and five in Tanzania-were visited. In-depth interviews were conducted with 30 nurses and physicians from different departments in the hospitals who had experience in providing care for sick patients. We conducted a thematic analysis of the translated and transcribed interviews, synthesized findings and developed an overarching set of themes which captured healthcare workers' understandings of the label 'critical illness'.

Results

Overall, there does not appear to be a unified understanding of the label 'critical illness' among health workers. Health workers understand the label to refer to patients in four thematic ways: (1) those in a life-threatening state; (2) those with certain diagnoses; (3) those receiving care in certain locations; and (4) those in need of a certain level of care.

Conclusion

There is a lack of a unified understanding about the label 'critical illness' among health workers in Tanzania and Kenya. This potentially hampers communication and the selection of patients for urgent life-saving care. A recently proposed definition, "a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided and the potential for reversibility", could be useful for improving communication and care.

Insights from COVID-19: Reflecting on the Promotion of Long-Term Health Policies in China

China announced the Healthy China Initiative (2019-2030) in 2019, an action program aimed to support the country's current long-term health policy, Healthy China 2030, which focuses on public health promotion and health awareness. Following the implementation of the policy, China had the COVID-19 pandemic, which had an influence on both the public's degree of health awareness and the adoption of the HCI. This research examines whether the COVID-19 epidemic has increased public understanding and acceptance of China's long-term health policy. In addition, it analyzes whether the Chinese public's awareness of health policy has been impacted by China's usage of smart healthcare in its response to the pandemic. To correspond to these study aims, we used a questionnaire based on the research questions and recent relevant research. The results of the study, based on an examination of 2488 data, demonstrate that the Healthy China Initiative is still poorly understood. More than 70% of respondents were unfamiliar with it. However, the results imply that respondents are becoming more aware of smart healthcare and that public acceptance of official health policies can be aided by the sharing of knowledge about this. As a result, we examine the situation and draw the conclusion that the spread of cutting-edge health-related technology can enhance the communication of health policy and provide participants and policymakers with fresh insights. Finally, this study also can provide lessons for other countries in the early stages of policy dissemination, particularly health policy advocacy and promotion during epidemics.

Assessment model blending formative and summative assessments using the SOLO taxonomy

INTRODUCTION

Formative assessment with emphasis on feedback has been linked to developmental purposes of assessment, whilst summative assessment is assumed to focus on judgemental and quality assurance purposes. This dichotomy is questioned but designs to blend formative and summative assessments in constructive ways are rare in health care education.

MATERIALS AND METHODS

We have designed an assessment model blending formative and summative assessments. In the formative assessment at the end of a course, students' responses to real-life scenarios with questions demanding responses at the relational level of understanding were assessed at three levels of understanding (incorrect, descriptive and relational) modified after the SOLO taxonomy. Students were presented with individual feedback for each response. At the summative assessment of a subsequent course, the students' new responses were assessed underpinning a final judgement of students' performance. The assessment model was justified across three student cohorts.

RESULTS

Both formative and summative assessment events of the model provided information about the levels of understanding, unique to each student. A comparison of results from the assessments demonstrated that most responses developed to a higher level of understanding. With the summative assessment, it was possible to make judgements about whether or not individual students passed the pre-set standards.

CONCLUSIONS

We argue that the current assessment model presents real interdependence between formative and summative assessments and can provide information that meets the needs of students as learners, education institutes and health care organisations. The SOLO taxonomy can be used to emphasise the importance of developing and assessing cognitive complexity.

Pregnant women's experiences of well-being in high-risk pregnancy: A qualitative study

BACKGROUND

Physical changes in high-risk pregnancy (HRP) can lead to changes in mood and social relationships and negative effects on women's well-being. Individuals in different sociocultural contexts have different perceptions of well-being. Yet, there is limited information about perceptions of well-being in HRP. This study aimed to explore the Iranian women's experiences of well-being in HRP.

MATERIALS AND METHODS

This qualitative study was conducted in 2019-2020 through directed content analysis based on the conceptual framework of well-being in HRP. Participants were 26 women with HRP purposively recruited from public and private healthcare settings in Mashhad, Iran. Face-to-face semistructured interviews were held for data collection until data saturation. Data were analyzed through directed content analysis proposed by Elo and kyngäs (2008) and were managed using the MAXQDA (v. 10) program.

RESULTS

Well-being in HRP had seven attributes in the five main dimensions of physical, mental-emotional, social, marital, and spiritual well-being. The seven attributes of well-being in HRP were controlled physical conditions, controlled mood, emotions, and affections, perceived threat, self-efficacy, and competence for multiple role performance, maintained social relationships, meaning seeking and relationship with the Creator, and positive marital relationships.

CONCLUSION

The present study provide an in-depth understanding about well-being in the Iranian women with HRP. It is a complex and multidimensional concept with physical, mental-emotional, social, marital, and spiritual dimensions. Comprehensive multicomponent interventions are needed to promote well-being among women with HRP and designed the guidelines to provide woman-centered care.

Knowledge of Self-Isolation Rules in the UK for Those Who Have Symptoms of COVID-19: A Repeated Cross-Sectional Survey Study

OBJECTIVES

To investigate knowledge of self-isolation rules and factors associated with knowledge.

METHODS

Repeated cross-sectional online surveys (n ≈ 2000 UK adults) between 9 November 2020 and 16 February 2022 (78,573 responses from 51,881 participants). We computed a composite measure of knowledge of self-isolation rules and investigated associations between knowledge and survey wave, socio-demographic characteristics (age, gender, UK nation, index of multiple deprivation), trust in government, and participants' belief that they had received enough information about self-isolation.

RESULTS

In total, 87.9% (95% CI 87.7% to 88.1%, n = 67,288/76,562) of participants knew that if they had symptoms of COVID-19 they should 'self-isolate'. However, only 62.8% (n = 48,058/76,562, 95% CI 62.4% to 63.1%) knew the main rules regarding what that meant. Younger people had less knowledge than older people, and men had less knowledge than women. Knowledge was lower in people living in England versus in Scotland, Wales, and Northern Ireland. The pattern of association between knowledge and trust in government was unclear. Knowledge was lower in people living in a more deprived area and those who did not believe they had enough information about self-isolation. Knowledge was lower in December 2020 to January 2021, compared with before and after this period.

CONCLUSIONS

Approximately 63% of UK adults between November 2020 and February 2022 appeared to know the main rules regarding self-isolation if symptomatic with COVID-19. Knowledge was lower in younger than older people, men than women, those living in England compared with Scotland, Wales or Northern Ireland, and those living in more deprived areas.

Awareness, use and understanding of nutrition labels among adults from five countries: Findings from the 2018-2020 International Food Policy Study

Few studies have compared the effects of different front-of-package label (FOPL) systems in the 'real world'. This study assessed adults' awareness, use and understanding of nutrition facts labels (NFLs) and nationally implemented FOPLs such as Health Star Ratings (HSR), Traffic lights, and Guideline Daily Amounts (GDAs) in five countries, including before and after implementation of Mexico's warning FOPLs in 2020. Data were from the International Food Policy Study, an annual repeat cross-sectional study conducted in 2018-2020 among adults (N=64,032) in Australia, Canada, Mexico, the UK and the US. Self-reported awareness, use, and understanding of NFLs (in all five countries) and FOPLs (in Australia, Mexico, and UK) were assessed over time, between countries, and between NFLs and FOPLs. Most respondents in all countries reported seeing their country's NFLs (awareness) 'often' or 'all the time' across all three years, with one third to half of respondents using NFLs 'often' or 'all the time' (Australia: 43-45%; Canada: 47-50%; Mexico: 36-39%; UK: 32-34%; US: 47-49%), and approximately one half to two thirds finding NFLs 'easy' or 'very easy to understand' (56-57%; 67-69%; 51-54%; 48-51%; 70-71%). In 2020, awareness, use and self-reported understanding of the Warning FOPLs in Mexico were highest among all countries with a FOPL (p<0.001), whereas awareness and use were lowest for Australia's HSR (p<0.001). In countries with FOPLs, self-reported understanding was higher for FOPLs than NFLs, except for the GDA FOPL in Mexico. Only modest changes were observed over time. Warning FOPLs were associated with greater levels of self-reported awareness, use and understanding among adults compared to NFLs and GDA-based FOPLs. FOPLs implemented on a voluntary basis, such as Australia's HSR, may be less likely to be seen and used.

What Primary Care Practitioners Need to Know about the New NICE Guideline for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome in Adults

The new NICE guideline for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), published in October 2021, makes significant changes in treatment recommendations. It acknowledges the complexity of this chronic medical condition, which always impacts quality of life and can be profoundly disabling, recognising the prejudice and stigma that people with ME/CFS often experience in the absence of any specific diagnostic test. The guideline outlines steps for accurate diagnosis, recognising post-exertional malaise as a core symptom; importantly, ME/CFS can now be diagnosed after just 3 months in a bid to improve long-term health outcomes. It recommends the need for individual, tailored management by a multi-disciplinary team, ensuring that the wellbeing of the individual is paramount. The guideline makes clear that any programme based on fixed incremental increases in physical activity or exercise, for example, graded exercise therapy (GET), should not be offered as a treatment for ME/CFS and emphasises that cognitive behavioural therapy (CBT) should only be offered as a supportive intervention. Because of the rigorous methodology required by NICE Committee review and the inclusion of the testimony of people with lived experience as committee members, this guideline will influence the future diagnosis and management of ME/CFS in the UK and beyond.

How does the British public understand mental health? A qualitative analysis of open-text responses

BACKGROUND

An individual's understanding of mental health can influence their attitudes towards those experiencing mental health problems, and also impact their response to any mental health problems they experience. However, what the lay public understand about mental health is not well explored in existing research.

AIMS

This study aims to gain a deeper insight into what the general public understand by the term 'mental health problem'.

METHODS

Data were taken from a large-scale representative sample of adults from Great Britain (n = 2,708). A thematic analysis was carried out on an open-text question which asked people what they understood by the term 'mental health problem'.

RESULTS

Six themes were identified in the thematic analysis, which included understanding mental health through thinking about cause and effect, thinking about the location of mental health problems in the body, the universality and variation of mental health problems, reflections on lived experience and identifying a specific mental health problem.

CONCLUSION

The analysis suggests that there are many diverse ways the public conceptualises mental health. The themes identified may be useful for future quantitative analyses, and also may suggest how information about mental health can be best communicated to the public.

Deconstructing (e)health literacy: aspects that promote and inhibit understanding of health information in breast cancer patient pathways

Purpose Deconstructing current definitions of “health literacy (HL)” and “eHealth literacy (eHL)”, into the core notion of “understanding health information (HI)”, this study provides insights into what promotes and inhibits the understanding of HI for breast cancer patients during cancer patient pathways (CCP) in Norway. Methods Seven well-educated women were interviewed. Through a stepwise deductive-inductive analysis of the transcribed interviews, the following topics were identified: 1) explanations accompanied by drawings, 2) individualized knowledge-based information, 3) information processing capacity, and 4) ambiguity in medical information. Results The women's understanding of HI increased when spoken communication was accompanied by visual illustrations, which served as roadmaps throughout the CPP. Even if HI should be targeted to the patients’ individual needs, some HI can be generalized if it refers to established knowledge about the health phenomena. The women described their changing mental and physical status during the CPP and how these changes influenced their understanding of HI. Conclusion The results challenge the idea that HL and eHL are fixed, stable, personal characteristics. On the contrary, HL/eHL, in this case particularly the understanding of HI, depends on the individual (temporary) physical and cognitive capacity of the patient and adaptation in the institutional and private contexts.

Addressing the dauntingness of formulation: The value of considering empathy as "grasping"

AIMS AND OBJECTIVES

To explore the value of using Karl Jaspers' lived experience concept of 'grasping' in remediating the reported dauntingness of formulation.

CONCLUSIONS

Formulation can be construed as both the process and explication of understanding why a patient is presenting in a particular way. In an automatic process of abduction, 'feeling into' the mind of the other, hypotheses are posted to consciousness with little mental effort as meaningful connections are grasped. Subsequent more deliberative reasoning is synthesised continuously and with surprisingly little mental effort into the best explanation(s). Karl Jaspers' introduction to Psychiatry of the concepts involved, empathy and understanding, and his aim of making their use more scientific established the ongoing, often fierce debate about the ontology of Psychiatry; empirical versus interpretive. Trainees must resolve this for themselves in explicating a formulation, risking exposure of their prejudices. Jaspers' emphasis on the lived experience of empathic understanding that psychiatrists bring to their work found him often using the term 'grasp' rather than 'empathise'. 'Grasping' seems to convey more vividly and meaningfully the role that empathy plays in the initial ascertainment of mood and the subsequent hypothesis discovery, testing and synthesis.

Knowledge, Understanding and Satisfaction with the Implementation of the Performance Management System at a District Hospital in the Madibeng Subdistrict, South Africa

The Performance Management and Development System (PMDS) is an essential asset in aligning the strategic objectives of both the National and Provincial departments of health with the individual targets and Key Responsibility Areas (KRAs) of the individual employees working in these departments. The system is not without challenges. The sources of contention can be with the rewards mechanism of the system, bias in the application of the system and the incorrect use of the system for punitive measures. The objective of this study was to determine the perceived knowledge, understanding and satisfaction levels of employees at Brits District Hospital regarding the PMDS. Another objective was to provide an intervention targeting the knowledge and understanding of the key concepts of the system. A quantitative cross-sectional and longitudinal action research method was applied by tracking the responses of 64 healthcare workers three times, firstly in a questionnaire and then in an intervention checklist. The respondents were selected via proportionate stratified sampling. Data were analysed via STATA statistical software package 13.0. The respondents had a poor knowledge and understanding of how to score the PMDS. The respondents where highly dissatisfied with the development of their weaknesses and the recognition of their strengths. Training needs to be prioritized on both the PMDS and the employees' areas of weakness affecting their performance toward their assigned Key Responsibility Areas. Employees need to be recognised for areas in which they show strength.

Quantifying Changes in Vaccine Coverage in Mainstream Media as a Result of the COVID-19 Outbreak: Text Mining Study

Background

Achieving herd immunity through vaccination depends upon the public's acceptance, which in turn relies on their understanding of its risks and benefits. The fundamental objective of public health messaging on vaccines is therefore the clear communication of often complex information and, increasingly, the countering of misinformation. The primary outlet shaping public understanding is mainstream online news media, where coverage of COVID-19 vaccines was widespread.

Objective

We used text-mining analysis on the front pages of mainstream online news to quantify the volume and sentiment polarization of vaccine coverage.

Methods

We analyzed 28 million articles from 172 major news sources across 11 countries between July 2015 and April 2021. We employed keyword-based frequency analysis to estimate the proportion of overall articles devoted to vaccines. We performed topic detection using BERTopic and named entity recognition to identify the leading subjects and actors mentioned in the context of vaccines. We used the Vader Python module to perform sentiment polarization quantification of all collated English-language articles.

Results

The proportion of front-page articles mentioning vaccines increased from 0.1% to 4% with the outbreak of COVID-19. The number of negatively polarized articles increased from 6698 in 2015-2019 to 28,552 in 2020-2021. However, overall vaccine coverage before the COVID-19 pandemic was slightly negatively polarized (57% negative), whereas coverage during the pandemic was positively polarized (38% negative).

Conclusions

Throughout the pandemic, vaccines have risen from a marginal to a widely discussed topic on the front pages of major news outlets. Mainstream online media has been positively polarized toward vaccines, compared with mainly negative prepandemic vaccine news. However, the pandemic was accompanied by an order-of-magnitude increase in vaccine news that, due to low prepandemic frequency, may contribute to a perceived negative sentiment. These results highlight important interactions between the volume of news and overall polarization. To the best of our knowledge, our work is the first systematic text mining study of front-page vaccine news headlines in the context of COVID-19.

Involvement, Perception, and Understanding as Determinants for Patient-Physician Relationship and Their Association with Adherence: A Questionnaire Survey among People Living with HIV and Antiretroviral Therapy in Austria

BACKGROUND

The relationship between patients and healthcare professionals (physicians) is the cornerstone of successful long-term antiretroviral therapy for people living with human immunodeficiency virus (HIV).

PURPOSE

This study aimed to investigate the connection between involvement, perception, and understanding as the basis for the patient-physician relationship and drug adherence, measured as the probability of non-adherence.

METHODS

In an online survey, people with HIV were asked about their relationship with their physicians and the extent to which they felt involved in treatment-related decisions. A statistical analysis was conducted to determine whether a better patient-physician relationship was associated with higher adherence to therapy. This was performed by univariate group comparison (Mann-Whitney-U, Fishers Exact Test) and logistic regression.

RESULTS

A total of 303 persons living with HIV participated in the survey, and 257 patients were included in the analysis. Overall, 27.6% were classified as non-adherent and self-reporting based on whether an antiretroviral therapy (ART) was taken in the past or how often the ART was interrupted. This proportion was significantly higher among patients aged 50-74 years (39.7%) and those with a longer therapy duration (9-15 years: 46.6%; from 15 years on: 55.8%). Therapy-non-adherent patients showed significantly lower scores in the relationship aspects understanding (2.68 vs. 3.03), participation (2.63 vs. 3.07), and perception (3.00 vs. 3.24) compared to adherent patients. Logistic regression analysis confirms that higher scores for understanding, involvement, and perception are strongly associated with a reduction in the risk of becoming non-adherent. This was true for all examined regression models, regardless of whether they were adjusted for the length of therapy and socio-demographic characteristics.

CONCLUSION

The results reinforce the need for awareness among health care professionals (HCP) regarding understanding, involvement, and perception as important aspects to improve the quality of the patient-physician relationship for high adherence levels with maximized non-adherence in ART management by PLWH.

How Do Consumers Understand Food Processing? A Study on the Brazilian Population

Food guides are official documents that guide consumers’ food choices. They inform the qualitative classification of food groups and messages on how to adopt a healthy diet. The classifications and nomenclatures adopted in these documents vary according to cultural, nutritional, and scientific criteria. This study aimed to evaluate the understanding of Brazilian consumers regarding food classification according to the Food Guide for the Brazilian Population (FGBP) concepts. An instrument was constructed to assess consumer understanding. It was named “Understanding of the Level of Processing of Food” (ULPF) and validated according to the concepts of constructs presented by psychometrics such as the Delphi methodology. The instrument was composed of 36 items approved by experts (concordance > 80% and with good internal consistency). A total of 2333 Brazilians from all regions participated in the study. The results suggest that food classification according to the level of processing was difficult for participants to understand. About 85% of them did not understand or did not know the definitions and classification of food and preparations according to food and science technology (FST) and the FGBP. More than 50% of the participants believed that it was easier to classify food according to food groups.

COVID-19 Vaccination Intent and Belief that Vaccination Will End the Pandemic

High vaccination coverage is considered to be key in dealing with the coronavirus disease (COVID-19) pandemic. However, vaccine hesitancy can limit uptake. We examined the specific coronavirus beliefs that persons have regarding COVID-19 and COVID-19 vaccines and to what extent these beliefs explain COVID-19 vaccination intentions. We conducted a survey among 4,033 residents of the Netherlands that examined COVID-19 vaccination intentions and various beliefs. Random forest regression analysis explained 76% of the variance in vaccination intentions. The strongest determinant in the model was the belief the COVID-19 crisis will only end if many persons get vaccinated. Other strong determinants were beliefs about safety of vaccines, specifically in relation to vaccine development and approval process; (social) benefits of vaccination; social norms regarding vaccination behavior; and effectiveness of vaccines. We propose to address these specific beliefs in communications about COVID-19 vaccinations to stimulate vaccine uptake.

Prevalence of signs and symptoms of temporomandibular disorder in the metropolitan region of Rio De Janeiro: A population-based cross-sectional study

OBJECTIVE

Temporomandibular disorder (TMD) is a group of heterogeneous pathological conditions that affect the temporomandibular joint (TMJ), mastication muscles, and some associated structures. The aim of this study was to measure the prevalence of signs and symptoms of dysfunction, including knowledge of TMD in a stratum of the population.

METHODS

A population extract from Rio de Janeiro subdivided by conglomerates was interviewed through an online form.

RESULTS

The results showed that only 19% of the participants had no symptoms related to TMD.

CONCLUSION

The results showed that the symptom prevalence is directly related to knowledge and practices about the disorder and that its presence may be under-reported.

Understanding of Critical Elements of Informed Consent in Genomic Research: A Case of a Paediatric HIV-TB Research Project in Uganda

Several studies have reported inadequate comprehension of informed consent for genomic research. This study aimed to assess research participants' understanding of critical elements of informed consent for genomic research. A cross-sectional survey involving 123 parents/caregivers of children participating in a paediatric genomic TB/HIV study was conducted. Only 47.2% of the participants had adequate understanding of consent information. The mean objective (actual) and subjective (perceived) understanding scores were 78.7% and 91.7% respectively. Participants adequately understood most elements of consent however, some elements were poorly understood including foreseeable risks, protection of confidentiality and compensation for research related injury. Overall there was inadequate comprehension of critical elements of informed consent and there was dissonance between actual and perceived comprehension of informed consent.

Putting the Puzzle Back Together-A Narrative Case Study of an Athlete Who Survived Child Sexual Abuse in Sport

Denunciations of child sexual abuse (CSA) in the sport context have been increasing in the last decades. Studies estimate that between 14 and 29% of athletes have been victim of at least one form of sexual violence in sport before the age of 18. However, studies suggest that many do not disclose their experience of CSA during childhood. This finding is alarming since studies have shown that the healing process usually starts with disclosure. Moreover, little is known about the healing process of CSA experienced in the sport context. The aim of the study is to present a single case study of a CSA in sport to better understand the global experience over time from the perspective of the athlete. A narrative inquiry approach was adopted. Three non-structured interviews were conducted with the participant. Three pathways in the survivor journey have been identified through inductive thematic analysis: (a) pathway to understanding, (b) pathway to disclosure, and (c) pathway to healing. These pathways represent distinct processes but are intertwined as they are dynamic and iterative. Indeed, the survivor explained how she had been, and is still, going back and forth between them. Results are consistent with those found in the literature on CSA in the general population. It suggests that theoretical models of CSA in the general population could be applied to CSA in sport. Practical implications include a need for education and clearer boundaries in the coach-athlete relationship. Sport stakeholders also need to be better equipped to recognize the signs of sexual violence in sport. Our results indicate that qualitative research could be a potential avenue to help victims heal from CSA. It gives them the chance to talk about and make sense of their abuse in a safe space. Finally, our results demonstrate the importance of reviewing the current justice system for victims. It should be based on a trauma-informed approach that places the victim at the center of the judicial process.

Show Me, Tell Me: An Investigation Into Learning Processes Within Skateboarding as an Informal Coaching Environment

Coach education is a learner-centred process, which often fails to consider the preferences of the consumer. Historically, research into performers’ experiences of coaching have been influenced by the social constructivism of learning: in short, an expressed preference for what the performer has experienced as determined by their coach, rather than their own personal preferences. Therefore, this research used skateboarding as a natural laboratory in order to explore the current practices and preferences of performers in a coach-free environment. Ninety-one skateboarders from parks in the United Kingdom and New Zealand offered information relating to their current learning practices, how they learnt about learning, and how the top-level performers in their environment were differentiated. Findings suggest that a number of learning tools are used by performers, which are closely aligned with a more traditional, cognitive view of coaching (e.g., demonstration, drills, and error usage). Results also suggest that performers deployed a number of cognitive skills (e.g., imagery, analogy, and understanding) to enhance storage of a movement as an internal representation. Finally, in the absence of formal coaching, performers use their knowledge of learning to appoint informal leaders. Implications for practice are discussed.