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Chappell P, Dias A, Bakhai M, Ledger J, Clarke GM. How is primary care access changing? A retrospective, repeated cross-sectional study of patient-initiated demand at general practices in England using a modern access model, 2019-2022. BMJ Open 2023; 13:e072944. [PMID: 37591638 PMCID: PMC10441067 DOI: 10.1136/bmjopen-2023-072944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/26/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVES To explore trends in patient-initiated requests for general practice services and the association between patient characteristics including demographics, preferences for care and clinical needs and modes of patient contact (online vs telephone), and care delivery (face-to-face vs remote) at practices using a modern access model. DESIGN Retrospective repeated cross-sectional study spanning March 2019 to February 2022. SETTING General practices in England using the askmyGP online consultation system to implement a modern general practice access model using digital and non-digital (multimodal) access pathways and digitally supported triage to manage patient-initiated requests. PARTICIPANTS 10 435 465 patient-initiated requests from 1 488 865 patients at 154 practices. RESULTS Most requests were initiated online (72.1% in 2021/2022) rather than by telephone. Online users were likely to be female, younger than 45 years, asking about existing medical problems, had used the system before and frequent attenders (familiar patients). During the pandemic, request rates for face-to-face consultations fell while those for telephone consultations and online messages increased, with telephone consultations being most popular (53.8% in 2021/2022). Video was seldom requested. More than 60% of requests were consistently delivered in the mode requested. Face-to-face consultations were more likely to be used for the youngest and oldest patients, new medical problems, non-frequent attenders (unfamiliar patients) and those who requested a face-to-face consultation. Over the course of the study, request rates for patients aged over 44 years increased, for example, by 15.4% (p<0.01) for patients aged over 74 years. Rates for younger patients decreased by 32.6% (p<0.001) in 2020/2021, compared with 2019/2020, before recovering to prepandemic levels in 2021/2022. CONCLUSIONS Demand patterns shed light on the characteristics of patients making requests for general practice services and the composition of the care backlog with implications for policy and practice. A modern general practice access model can be used effectively to manage patient-initiated demand.
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Affiliation(s)
- Paul Chappell
- NHS England, London, UK
- Improvement Analytics Unit, The Health Foundation, London, UK
| | - Alison Dias
- NHS England, London, UK
- Improvement Analytics Unit, The Health Foundation, London, UK
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Sedgwick R, Bittar A, Kalsi H, Barack T, Downs J, Dutta R. Investigating online activity in UK adolescent mental health patients: a feasibility study using a natural language processing approach for electronic health records. BMJ Open 2023; 13:e061640. [PMID: 37230520 PMCID: PMC10230886 DOI: 10.1136/bmjopen-2022-061640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/19/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES To assess the feasibility of using a natural language processing (NLP) application for extraction of free-text online activity mentions in adolescent mental health patient electronic health records (EHRs). SETTING The Clinical Records Interactive Search system allows detailed research based on deidentified EHRs from the South London and Maudsley NHS Foundation Trust, a large south London Mental Health Trust providing secondary and tertiary mental healthcare. PARTICIPANTS AND METHODS We developed a gazetteer of online activity terms and annotation guidelines, from 5480 clinical notes (200 adolescents, aged 11-17 years) receiving specialist mental healthcare. The preprocessing and manual curation steps of this real-world data set allowed development of a rule-based NLP application to automate identification of online activity (internet, social media, online gaming) mentions in EHRs. The context of each mention was also recorded manually as: supportive, detrimental or neutral in a subset of data for additional analysis. RESULTS The NLP application performed with good precision (0.97) and recall (0.94) for identification of online activity mentions. Preliminary analyses found 34% of online activity mentions were considered to have been documented within a supportive context for the young person, 38% detrimental and 28% neutral. CONCLUSION Our results provide an important example of a rule-based NLP methodology to accurately identify online activity recording in EHRs, enabling researchers to now investigate associations with a range of adolescent mental health outcomes.
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Affiliation(s)
- Rosemary Sedgwick
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - André Bittar
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Herkiran Kalsi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tamara Barack
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Johnny Downs
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Rina Dutta
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Goldsmith LP, Rowland-Pomp M, Hanson K, Deal A, Crawshaw AF, Hayward SE, Knights F, Carter J, Ahmad A, Razai M, Vandrevala T, Hargreaves S. Use of social media platforms by migrant and ethnic minority populations during the COVID-19 pandemic: a systematic review. BMJ Open 2022; 12:e061896. [PMID: 36396309 PMCID: PMC9676419 DOI: 10.1136/bmjopen-2022-061896] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Migrants and ethnic minority groups have been disproportionately impacted by COVID-19 and have lower levels of vaccine uptake in some contexts. We aimed to determine the extent and nature of social media use in migrant and ethnic minority communities for COVID-19 information, and implications for preventative health measures including vaccination intent and uptake. DESIGN A systematic review of published and grey literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched databases including Embase, Web of Science, PubMed NIH, CINAHL, facilitated through the WHO Global Research on COVID-19 database from 31 December 2019 to 9 June 2021. ELIGIBILITY CRITERIA FOR STUDY SELECTION Research reporting the use of social media by migrants and/or ethnic minority groups in relation to COVID-19. DATA EXTRACTION We extracted data on key outcomes, study design, country, population under study and sample size. RESULTS 1849 unique records were screened, and 21 data sources were included, including populations in the UK, USA, China, Jordan, Qatar and Turkey. We found evidence of consistent use of a range of social media platforms for COVID-19 information in some migrant and ethnic minority populations (including WeChat, Facebook, WhatsApp, Instagram, Twitter, YouTube), which may stem from difficulty in accessing COVID-19 information in their native languages or from trusted sources. Some evidence suggested circulating misinformation and social media use may be associated with lower participation in preventative health measures, including vaccine intent and uptake, findings which are likely relevant to multiple population groups. CONCLUSIONS Social media platforms are an important source of information about COVID-19 for some migrant and ethnic minority populations. Urgent actions and further research are now needed to better understand effective approaches to tackling circulating misinformation, and to seize on opportunities to better use social media platforms to support public health communication and improve vaccine uptake. REGISTRATION This study has been registered with PROSPERO (CRD42021259190).
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Affiliation(s)
- Lucy Pollyanna Goldsmith
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- Population Health Research Institute, St George's University of London, London, UK
| | - May Rowland-Pomp
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Kristin Hanson
- Faculty of Health, Social Care and Education, Kingston University, Kingston-Upon-Thames, London, UK
| | - Anna Deal
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Alison F Crawshaw
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Sally E Hayward
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Felicity Knights
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- Population Health Research Institute, St George's University of London, London, UK
| | - Jessica Carter
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Ayesha Ahmad
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
| | - M Razai
- Population Health Research Institute, St George's University of London, London, UK
| | - Tushna Vandrevala
- Faculty of Health, Social Care and Education, Centre for Applied Health and Social Care Research, Kingston University, Kingston, Surrey, UK
| | - Sally Hargreaves
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
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Cooke S, Nelson D, Green H, McPeake K, Gussy M, Kane R. Rapid systematic review on developing web-based interventions to support people affected by cancer. BMJ Open 2022; 12:e062026. [PMID: 36691118 PMCID: PMC9454073 DOI: 10.1136/bmjopen-2022-062026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/21/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To systematically identify and explore the existing evidence to inform the development of web-based interventions to support people affected by cancer (PABC). DESIGN A rapid review design was employed in accordance with the guidance produced by the Cochrane Rapid Reviews Methods Group and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. A rapid review was chosen due to the need for a timely evidence synthesis to underpin the subsequent development of a digital resource (Shared Lives: Cancer) as part of an ongoing funded project. METHODS AND OUTCOMES Keyword searches were performed in MEDLINE to identify peer-reviewed literature that reported primary data on the development of web-based interventions designed to support PABC. The review included peer-reviewed studies published in English with no limits set on publication date or geography. Key outcomes included any primary data that reported on the design, usability, feasibility, acceptability, functionality and user experience of web-based resource development. RESULTS Ten studies were identified that met the pre-specified eligibility criteria. All studies employed an iterative, co-design approach underpinned by either quantitative, qualitative or mixed methods. The findings were grouped into the following overarching themes: (1) exploring current evidence, guidelines and theory, (2) identifying user needs and preferences and (3) evaluating the usability, feasibility and acceptability of resources. Resources should be informed by the experiences of a wide range of end-users taking into consideration current guidelines and theory early in the design process. Resource design and content should be developed around the user's needs and preferences and evaluated through usability, feasibility or acceptability testing using quantitative, qualitative or mixed methods. CONCLUSION The findings of this rapid review provide novel methodological insights into the approaches used to design web-based interventions to support PABC. Our findings have the potential to inform and guide researchers when considering the development of future digital health resources. TRIAL REGISTRATION NUMBER The review protocol was registered on the Open Science Framework (https://osf.io/ucvsz).
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Affiliation(s)
- Samuel Cooke
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - David Nelson
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK
- Macmillan Cancer Support, London, UK
| | - Heidi Green
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Kathie McPeake
- Macmillan Cancer Support, London, UK
- NHS Lincolnshire Clinical Commissioning Group, Lincoln, UK
| | - Mark Gussy
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK
| | - Ros Kane
- School of Health and Social Care, University of Lincoln, Lincoln, UK
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Naumann DN, McMenemy L, Beaven A, Bowley DM, Mountain A, Bartels O, Booker RJ. Secure app-based secondary healthcare clinical decision support to deployed forces in the UK Defence Medical Services. BMJ Mil Health 2022:e002172. [PMID: 35914807 DOI: 10.1136/military-2022-002172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/21/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Modern instant messaging systems facilitate reach-back medical support for Defence Medical Services (DMS) by connecting deployed clinicians to remote specialists. The mobile app Pando (Forward Clinical, UK) has been used for this purpose by the DMS via the 'Ask Advice' function. We aimed to investigate the usage statistics for this technology in its first 1000 days to better understand its role in the DMS. METHODS An observational study was undertaken using metadata extracted from the prospective database within the application server for clinical queries between June 2019 and February 2022. These data included details regarding number and name of specialties, timings, active users per day and the number of conversations. RESULTS There were 29 specialties, with 298 specialist users and 553 requests for advice. The highest volume of requests were for trauma and orthopaedics (n=116; 21.0%), ear, nose and throat (n=67; 12.1%) and dermatology (n=50; 9.0%). There was a median of 164 (IQR 82-257) users logged in per day (range 2-697). The number of requests during each day correlated with the number of users on that day (r=0.221 (95% CI 0.159 to 0.281); p<0.001). There were more daily users on weekdays than weekends (215 (IQR 123-277) vs 88 (IQR 58-121), respectively; p<0.001). For the top 10 specialties, the median first response time was 9 (IQR 3-42) min and the median time to resolution was 105 (IQR 21-1086) min. CONCLUSION In the first 1000 days of secure app-based reach-back by the DMS there have been over 500 conversations, responded to within minutes by multiple specialists. This represents a maturing reach-back capability that may enhance the force multiplying effect of defence healthcare while minimising the deployed 'medical footprint'. Further discussions should address how this technology can be used to provide appropriately responsive clinical advice within DMS consultant job-planned time.
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Affiliation(s)
- David N Naumann
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - L McMenemy
- Institute of Naval Medicine, Defence Medical Services, Gosport, UK
- Centre for Blast Injury Studies, Imperial College London, London, UK
| | - A Beaven
- Orthopaedics, Army Medical Service 202 Midlands Field Hospital Reserve, Birmingham, UK
| | - D M Bowley
- Royal Centre for Defence Medicine, Defence Medical Services, Birmingham, UK
| | - A Mountain
- Academic Department of Trauma & Orthopaedics, Royal Centre for Defence Medicine, Birmingham, UK
| | - O Bartels
- Medical Information Services, HQ Defence Medical Services, Lichfield, UK
| | - R J Booker
- Research & Clinical Innovation, HQ Defence Medical Services and jHub-Med, London, UK
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Stacey JE, Atkin C, Henshaw H, Roberts KL, Allen HA, Justice LV, Badham SP. Does audio-visual information result in improved health-related decision-making compared with audio-only or visual-only information? Protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e059599. [PMID: 35487743 PMCID: PMC9058802 DOI: 10.1136/bmjopen-2021-059599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Making health-related decisions can be difficult due to the amount and complexity of information available. Audio-visual information may improve memory for health information but whether audio-visual information can enhance health-related decisions has not been explored using quantitative methods. The objective of this systematic review is to understand how effective audio-visual information is for informing health-related decision-making compared with audio-only or visual-only information. METHODS AND ANALYSIS Randomised controlled trials (RCTs) will be included if they include audio-visual and either audio-only or visual-only information provision and decision-making in a health setting. Studies will be excluded if they are not reported in English. Twelve databases will be searched including: Ovid MEDLINE, PubMed and PsychINFO. The Cochrane Risk of Bias tool (V.7) will be used to assess risk of bias in included RCTs. Results will be synthesised primarily using a meta-analysis; where quantitative data are not reported, a narrative synthesis will be used. ETHICS AND DISSEMINATION No ethical issues are foreseen. Data will be disseminated via academic publication and conference presentations. Findings may also be published in scientific newsletters and magazines. This review is funded by the Economic and Social Research Council. PROSPERO REGISTRATION NUMBER CRD42021255725.
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Affiliation(s)
| | | | - Helen Henshaw
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute for Health and Care Research (NIHR), Nottingham Biomedical Research Centre, Nottingham, UK
| | | | - Harriet A Allen
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Lucy V Justice
- NTU Psychology, Nottingham Trent University, Nottingham, UK
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Ngusie HS, Ahmed MH, Kasaye MD, Kanfe SG. Utilisation of health management information and its determinant factors among health professionals working at public health facilities in North Wollo Zone, Northeast Ethiopia: a cross-sectional study. BMJ Open 2022; 12:e052479. [PMID: 35383058 PMCID: PMC8984035 DOI: 10.1136/bmjopen-2021-052479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The study aimed to assess health management information utilisation and associated factors among health professionals working at public health facilities in North Wollo Zone, Northeast Ethiopia. SETTING The study was conducted at public health facilities in the North Wollo Zone, Northeast Ethiopia. PARTICIPANTS A total of 664 (56.3% male and 43.7% female) health professionals participated in the study. All health professionals permanently working in North Wollo Zone were included in this study. However, health professionals who were not present during the data collection period by any means and who had less than 6 months of experience were not included in this study. PRIMARY AND SECONDARY OUTCOME MEASURES The main outcome measure was health management information utilisation. RESULT About 58.4% (n=388) (95% CI: 54.4% to 62.0%) of the study participants use health management information. The multivariable logistic regression model indicated that participants who had managerial positions are more likely to use health management information with an adjusted OR (AOR) of 3.11 and 95% CI 1.84 to 5.24. Similarly, having a good motivation level (AOR=4.42 (95% CI: 2.82 to 6.93)), perceived good culture of health information (AOR=6.17 (95% CI: 3.35 to 11.36)), a standard set of indicators (AOR=4.11 (95% CI: 2.65 to 6.38)), having good governance of health information system (AOR=1.75 (95% CI:1.13 to 2.72)) and health management information system (HMIS) training (AOR=3.10 (95% CI: 1.89 to 5.07)) were the predictors positively associated with higher utilisation of health management information. CONCLUSION This study revealed that utilisation of health management information was still inadequate. Enhancing motivation, building a culture of information use, having standardised indicators, strengthening the governance of health information systems and comprehensive HMIS training were measures to be taken to improve utilisation of health management information in this study setting.
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Affiliation(s)
- Habtamu Setegn Ngusie
- Department of Health Informatics, College of Health Science, Mettu University, Mettu, Ethiopia
| | | | - Mulugeta Desalegn Kasaye
- Department of Health Informatics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Shuma Gosha Kanfe
- Department of Health Informatics, College of Health Science, Mettu University, Mettu, Ethiopia
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Abstract
INTRODUCTION More than 50 million people worldwide are living with dementia in 2020, and this number is expected to double every 20 years. Physical exercise is a growing field in non-pharmacological interventions for dementia care. Due to public health measures during the COVID-19 pandemic, more people have considered adapting to technology-based exercise via digital devices. This scoping review will explore evidence relating to the use of technology-based group exercise by people with dementia or mild cognitive impairment. METHODS AND ANALYSIS This review will follow the Joanna Briggs Institute scoping review methodology to review literature published between June and December 2021. This review is designed to identify existing types of technology-based group exercise interventions for people with dementia. The review will provide a synthesis of current evidence on the outcome and impacts of technology-based group exercise. The context of this review will include homes, assisted living facilities and memory care services but exclude hospitals. The review will include a three-step search strategy: (a) identify keywords from MEDLINE and Embase, (b) search using the identified keywords in databases (MEDLINE/PubMed, CINAHL, Web of Science, Embase, Cochrane Library, PsychInfo and Google) and (c) review references from included studies to identify additional studies. Only studies in English will be included. Four researchers will independently assess titles and abstracts and then review the full text of the selected articles, applying the inclusion criteria. The extracted data will be presented in tables and summarised narratively. ETHICS AND DISSEMINATION Scoping review data will be collected from publicly available articles; research ethics approval is not required. The findings will be disseminated to healthcare practitioners and the public through a peer-reviewed publication and conference presentations.
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Affiliation(s)
- Lillian Hung
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- School of Nursing, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Hannah Levine
- Charles E Schmidt College of Medicine, Marcus Institute of Integrative Health at FAU Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Paavan Randhawa
- Faculty of General Sciences, Langara College, Vancouver, British Columbia, Canada
| | - Juyoung Park
- College of Social Work and Criminal Justice, Phyllis and Harvey Sandler School of Social Work, Florida Atlantic University, Boca Raton, Florida, USA
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Dening J, George ES, Ball K, Mohebbi M, Shariful Islam SM. Randomised controlled trial of a web-based low carbohydrate diet intervention for adults with type 2 diabetes: the T2Diet study protocol. BMJ Open 2022; 12:e054594. [PMID: 35190434 PMCID: PMC8862456 DOI: 10.1136/bmjopen-2021-054594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Type 2 diabetes (T2D) management frequently involves a multidisciplinary care team. However, standard care for patients with T2D is the central role of the general practice physician, and consists of routine appointments to monitor glycaemic status and overall health. Dietary modification is an essential component of T2D management. Evidence suggests that a low carbohydrate diet (LCD) provides better clinical outcomes for people with T2D compared with other diets. However, providing dietary support in face-to-face settings is challenged by issues of availability and accessibility. Provided in conjunction with standard care, digital interventions can help bridge this gap. The objective of this paper is to describe the protocol of a randomised controlled trial (RCT) of a web-based intervention that will evaluate the effectiveness of standard care plus web-based LCD intervention when compared with standard care only. METHODS AND ANALYSIS In a two-arm parallel RCT, 100 adults with non-insulin-dependent T2D aged between 40 and 89 years will be randomised to either a theoretically informed 16-week automated web-based LCD intervention plus standard care or standard care only. LCD recommendations emphasise consuming nutrient-dense whole foods and encourage a daily carbohydrate goal of 50-100 g, with an objective of achieving 10% to <26% carbohydrates from total energy intake. Assessments will take place at baseline and 16 weeks. The primary outcome will be haemoglobin A1c. Additional data collected will include dietary intake, self-efficacy, weight and height, anti-diabetes medication and dosages, and diabetes-related comorbidities. Process evaluation will consist of a mixed-methods assessment of website engagement metrics, user experience and participants' perspectives. ETHICS AND DISSEMINATION All study procedures have been approved by the Deakin University Human Research Ethics Committee (2020-349). Study findings will be disseminated widely through public, professional and academic presentation and publication. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12621000096853).
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Affiliation(s)
- Jedha Dening
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Elena S George
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
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Livingston PM, Russell L, Orellana L, Winter N, Jefford M, Girgis A, Austin D, O E, Mihalopoulos C, Ugalde A, Chambers R, Phipps-Nelson J, Herath D, Botti M, Rasmussen B, Whitfield K, Ftanou M, Smith AB, Pilatti K, Sara S, Wootten A, Gillan K, Singh M, Campbell D, Pillay B, White V. Efficacy and cost-effectiveness of an online mindfulness program (MindOnLine) to reduce fear of recurrence among people with cancer: study protocol for a randomised controlled trial. BMJ Open 2022; 12:e057212. [PMID: 35022179 PMCID: PMC8756286 DOI: 10.1136/bmjopen-2021-057212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Fear of cancer recurrence (FCR) is a common condition among cancer survivors that can lead to significant levels of distress, anxiety and depression. Online mindfulness programmes may provide the mechanism to support cancer survivors manage FCR and distress, and improve people's well-being over the short, medium and long term. The primary aim of this study is to determine the potential efficacy of MindOnLine, a 9 session mindfulness-based programme for survivors of breast, prostate and colorectal cancer. A formal economic programme will also be conducted. METHODS AND ANALYSIS A single-blind randomised controlled trial to determine the efficacy and cost-efficacy of a MindOnLine programme for cancer survivors. A total of 400 people living with cancer will be recruited via online advertisements on social media platforms, peak consumer advocacy groups or through outpatient services at healthcare providers across Victoria, Australia. People will be randomly allocated to either the MindOnLine programme (n=200) or waitlist control (n=200). Participant assessments will occur at baseline, at 9 weeks and 9-month follow-up. The primary outcome is change in Fear of Recurrence Index Score total score between baseline and 9 weeks; secondary outcomes are changes in depression and anxiety, quality of life and mindfulness. The economic analysis comprises a cost-consequences analysis where all outcomes will be compared with costs. ETHICS AND DISSEMINATION Ethics approval was obtained from the Peter MacCallum Cancer Centre (20-53) and Deakin University (2020-284). All participants will be required to provide written informed consent. Findings will be disseminated in peer reviewed journals and among key stakeholder organisations including hospitals, cancer and community organisations and Government. If successful the project will be rolled out nationally with a formal implementation plan. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (12620000645954); Pre-results. Registered 6 June 2020, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379520&isReview=true.
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Affiliation(s)
- Patricia M Livingston
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Lahiru Russell
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Natalie Winter
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Michael Jefford
- Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool BC, New South Wales, Australia
| | - David Austin
- Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Eric O
- Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Cathrine Mihalopoulos
- Institute for Health Transformation, School of Health and Social Development, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Anna Ugalde
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Richard Chambers
- Centre for Contemplative & Consciousness Studies, Monash University, Melbourne, Victoria, Australia
| | - Jo Phipps-Nelson
- Health Services Research & Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Dishan Herath
- Cancer Services, Western Health, Melbourne, Victoria, Australia
| | - Mari Botti
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Epworth HealthCare, Melbourne, Victoria, Australia
| | - Bodil Rasmussen
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Cancer Services, Western Health, Melbourne, Victoria, Australia
| | - Kathryn Whitfield
- Cancer Support Treatment and Research Unit; Community Based Health Services; Commissioning and System Improvement, Department of Health, Melbourne, Victoria, Australia
| | - Maria Ftanou
- Department of Clinical Psychology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Allan Ben Smith
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool BC, New South Wales, Australia
| | - Kirsten Pilatti
- Breast Cancer Network Australia, Melbourne, Victoria, Australia
| | - Sally Sara
- Nursing Programs, Prostate Cancer Foundation of Australia, St Leonards, New South Wales, Australia
| | | | - Kate Gillan
- Clinical Services, Epworth HealthCare, Richmond, Victoria, Australia
| | - Madhu Singh
- Andrew Love Cancer Centre, Barwon Health, University Hospital, Geelong, Victoria, Australia
| | - David Campbell
- Andrew Love Cancer Centre, Barwon Health, University Hospital, Geelong, Victoria, Australia
| | - Brindha Pillay
- Department of Clinical Psychology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Victoria White
- School of Psychology, Deakin University, Geelong, Victoria, Australia
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11
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Del Fava E, Cimentada J, Perrotta D, Grow A, Rampazzo F, Gil-Clavel S, Zagheni E. Differential impact of physical distancing strategies on social contacts relevant for the spread of SARS-CoV-2: evidence from a cross-national online survey, March-April 2020. BMJ Open 2021; 11:e050651. [PMID: 34675016 PMCID: PMC8532142 DOI: 10.1136/bmjopen-2021-050651] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We investigate changes in social contact patterns following the gradual introduction of non-pharmaceutical interventions and their implications for infection transmission in the early phase of the pandemic. DESIGN, SETTING AND PARTICIPANTS We conducted an online survey based on targeted Facebook advertising campaigns across eight countries (Belgium, France, Germany, Italy, the Netherlands, Spain, UK and USA), achieving a sample of 51 233 questionnaires in the period 13 March-12 April 2020. Poststratification weights based on census information were produced to correct for selection bias. OUTCOME MEASURES Participants provided data on social contact numbers, adoption of protective behaviours and perceived level of threat. These data were combined to derive a weekly index of infection transmission, the net reproduction number [Formula: see text] . RESULTS Evidence from the USA and UK showed that the number of daily contacts mainly decreased after governments issued the first physical distancing guidelines. In mid-April, daily social contact numbers had decreased between 61% in Germany and 87% in Italy with respect to pre-COVID-19 levels, mostly due to a contraction in contacts outside the home. Such reductions, which were uniform across age groups, were compatible with an [Formula: see text] equal or smaller than one in all countries, except Germany. This indicates lower levels of infection transmission, especially in a period of gradual increase in the adoption rate of the face mask outside the home. CONCLUSIONS We provided a comparable set of statistics on social contact patterns during the COVID-19 pandemic for eight high-income countries, disaggregated by week and other demographic factors, which could be leveraged by the scientific community for developing more realistic epidemic models of COVID-19.
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Affiliation(s)
- Emanuele Del Fava
- Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Jorge Cimentada
- Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Daniela Perrotta
- Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany
| | - André Grow
- Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Francesco Rampazzo
- Saïd Business School, Leverhulme Centre for Demographic Science, and Nuffield College, University of Oxford, Oxford, UK
| | - Sofia Gil-Clavel
- Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Emilio Zagheni
- Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany
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12
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Wenzel L, Heesen C, Scheiderbauer J, van de Loo M, Köpke S, Rahn AC. Evaluation of an interactive web-based programme on relapse management for people with multiple sclerosis (POWER@MS2): study protocol for a process evaluation accompanying a randomised controlled trial. BMJ Open 2021; 11:e046874. [PMID: 34598981 PMCID: PMC8488740 DOI: 10.1136/bmjopen-2020-046874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Process evaluations accompanying complex interventions examine the implementation process of the underlying intervention, identify mechanisms of impact and assess contextual factors. This paper presents the protocol for a process evaluation conducted alongside the randomised controlled trial POWER@MS2. The trial comprises the evaluation of a web-based complex intervention on relapse management in 188 people with multiple sclerosis conducted in 20 centres. The web-based intervention programme focuses on relapse treatment decision making and includes a decision aid, a nurse-led webinar and an online chat. With the process evaluation presented here, we aim to assess participants' responses to and interactions with the intervention to understand how and why the intervention produces change. METHODS AND ANALYSIS A mixed methods design is used to explore the acceptance of the intervention as well as its use and impact on participants. Participants are people with multiple sclerosis, neurologists, nurses and stakeholders. Quantitative semistandardised evaluation forms will be collected throughout the study. Qualitative semistructured telephone interviews will be conducted at the end of the study with selected participants, especially people with multiple sclerosis and neurologists. Quantitative data will be collected and analysed descriptively. Based on the results, the qualitative interviews will be conducted and analysed thematically, and the results will be merged in a joint display table. ETHICS AND DISSEMINATION The process evaluation has received ethical approval from the Ethical Committee of the University of Lübeck (reference 19-024). Findings will be disseminated in peer-reviewed journals, at conferences, meetings and on relevant patient websites. TRIAL REGISTRATION NUMBER NCT04233970.
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Affiliation(s)
- Lisa Wenzel
- Institute of Nursing Science, University of Cologne, Cologne, Germany
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jutta Scheiderbauer
- Stiftung für Selbstbestimmung und Selbstvertretung von MS-Betroffenen, Trier, Germany
| | - Markus van de Loo
- German Multiple Sclerosis Self-help Society, Federal Association, Hannover, Germany
| | - Sascha Köpke
- Institute of Nursing Science, University of Cologne, Cologne, Germany
| | - Anne Christin Rahn
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
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13
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Nagel J, Gilbert C, Duchesne J. Novel 3D printable powered air purifying respirator for emergency use during PPE shortage of the COVID-19 pandemic: a study protocol and device safety analysis. BMJ Open 2021; 11:e049605. [PMID: 34446492 PMCID: PMC8392741 DOI: 10.1136/bmjopen-2021-049605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To design a low-cost 3D printable powered air-purifying respirator (PAPR) that meets National Institute for Occupational Safety and Health (NIOSH) standard for flow rate and Occupational Safety and Health Administration (OSHA) standard for particle filtration for loose-fitting PAPRs and that can be made with a 3D printer and widely available materials. DESIGN Detailed description of components, assembly instructions and testing of a novel PAPR design in an academic laboratory following respective protocols. The assembled PAPR must meet NIOSH standards of flow rate, 170 L/min; OSHA fit factor for particle filtration, ≥250 and maintain positive pressure during regular and deep breathing. MAIN OUTCOME MEASURES The PAPR design was run through a series of tests: air flow (L/min), particle filtration (quantitative and qualitative) and positive pressure measured inside the helmet (mm Hg). RESULTS Flow rate was 443.32 L/min (NIOSH standard: minimum 170 L/min) and overall fit factor for particle filtration was 1362 (OSHA pass level: ≥500), n=1. The device passed qualitative particle filtration, n=2, and measured peak pressure of 6mm Hg (>0 mm Hg indicates positive pressure) in the helmet, n=1. CONCLUSIONS The Hygieia PAPR is a low-cost, easily accessible, just-in-time 3D printable PAPR design that meets minimum NIOSH and OSHA standards for flow-rate and particle filtration for loose-fitting PAPR devices to be made and used when industry-made designs are unavailable.
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Affiliation(s)
- Jorge Nagel
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | | | - Juan Duchesne
- Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Eager MM, Capella SC, Willman A, Taylor N. CPD in the remote environment: a role for practice-based small group learning ?. BMJ Mil Health 2021:bmjmilitary-2021-001788. [PMID: 34433577 DOI: 10.1136/bmjmilitary-2021-001788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/13/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Continuous professional development (CPD) is recognised as essential and mandated by the Royal College of General Practitioners and other medical professional colleges. However, it can be difficult to maintain when deployed and remote from normal training and support structures. There is no literature directly discussing how military doctors in the deployed and remote environment maintain CPD and if practice-based small group learning (PBSGL) could be an appropriate tool to facilitate this in future. AIM To describe the CPD experience of medical officers (MOs) working for the Defence Medical Services (DMS) and assess if offering PBSGL would be welcomed and likely beneficial. DESIGN AND SETTING This is a quantitative survey of doctors working in primary care within the DMS. METHOD A questionnaire was designed to elicit opinions, current practice and previous experience of CPD within the deployed and firm base environments. It also aimed to elicit prior experience of and appetite for PBSGL as a solution. This was then distributed via email to MOs working for the DMS. RESULTS 130 responses (25%) were received. 122 (96%) had heard of PBSGL, 56% had participated in PBSGL in the firm base. 60% agreed or strongly agreed PBSGL was an effective way to maintain CPD. 73% reported eLearning as a mode of maintaining CPD while deployed or working in a remote environment. CONCLUSION This study demonstrated that many general practitioners deployed to remote locations feel that CPD provision could be improved and that PBSGL is a potential solution.
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Affiliation(s)
| | | | - A Willman
- Academic Department of Military General Practice, RCDM, Birmingham, UK
| | - N Taylor
- Academic Department of Military General Practice, RCDM, Birmingham, UK
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Mehta S, Ghezzi D, Catalani A, Vanzolini T, Ghezzi P. Online information on face masks: analysis of websites in Italian and English returned by different search engines. BMJ Open 2021; 11:e046364. [PMID: 34244263 PMCID: PMC8275368 DOI: 10.1136/bmjopen-2020-046364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 06/21/2021] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Countries have major differences in the acceptance of face mask use for the prevention of COVID-19. This work aims at studying the information online in different countries in terms of information quality and content. DESIGN Content analysis. METHOD We analysed 450 webpages returned by searching the string 'are face masks dangerous' in Italy, the UK and the USA using three search engines (Bing, Duckduckgo and Google) in August 2020. The type of website and the stance about masks were assessed by two raters for each language and inter-rater agreement reported as Cohen's kappa. The text of the webpages was collected from the web using WebBootCaT and analysed using a corpus analysis software to identify issues mentioned. RESULTS Most pages were news outlets, and few (2%-6%) from public health agencies. Webpages with a negative stance on masks were more frequent in Italian (28%) than English (19%). Google returned the highest number of mask-positive pages and Duckduckgo the lowest. Google also returned the lowest number of pages mentioning conspiracy theories and Duckduckgo the highest. Webpages in Italian scored lower than those in English in transparency (reporting authors, their credentials and backing the information with references). When issues about the use of face masks were analysed, mask effectiveness was the most discussed followed by hypercapnia (accumulation of carbon dioxide), contraindication in respiratory disease and hypoxia, with issues related to their contraindications in mental health conditions and disability mentioned by very few pages. CONCLUSIONS This study suggests that: (1) public health agencies should increase their web presence in providing correct information on face masks; (2) search engines should improve the information quality criteria in their ranking; (3) the public should be more informed on issues related to the use of masks and disabilities, mental health and stigma arising for those people who cannot wear masks.
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Affiliation(s)
- Shaily Mehta
- Brighton and Sussex Medical School, Brighton, UK
| | - Daria Ghezzi
- Homerton College, University of Cambridge, Cambridge, UK
| | - Alessia Catalani
- School of Biotechnology, University of Urbino Carlo Bo, Urbino, Italy
| | - Tania Vanzolini
- School of Biotechnology, University of Urbino Carlo Bo, Urbino, Italy
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16
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Birckhead B, Eberlein S, Alvarez G, Gale R, Dupuy T, Makaroff K, Fuller G, Liu X, Yu KS, Black JT, Ishimori M, Venuturupalli S, Tu J, Norris T, Tighiouart M, Ross L, McKelvey K, Vrahas M, Danovitch I, Spiegel B. Home-based virtual reality for chronic pain: protocol for an NIH-supported randomised-controlled trial. BMJ Open 2021; 11:e050545. [PMID: 34130965 PMCID: PMC8207994 DOI: 10.1136/bmjopen-2021-050545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Chronic pain is highly prevalent and associated with a large burden of illness; there is a pressing need for safe, home-based, non-pharmacological, interventions. Virtual reality (VR) is a digital therapeutic known to be effective for acute pain, but its role in chronic pain is not yet fully elucidated. Here we present a protocol for the National Institute of Health (NIH) Back Pain Consortium (BACPAC) VR trial that evaluates the effectiveness of three forms of VR for patients with chronic lower back pain (cLBP), a highly prevalent form of chronic pain. METHODS AND ANALYSIS The NIH BACPAC VR trial will randomise 360 patients with cLBP into one of three arms, each administered through a head-mounted display: 1) skills-based VR, a program incorporating principles of cognitive behavioural therapy, mindful meditation and physiological biofeedback therapy using embedded biometric sensors; 2) distraction-based VR, a program using 360-degree immersive videos designed to distract users from pain; and 3) sham VR, a non-immersive program using two-dimensional videos within a VR headset. Research participants will be monitored for 12 weeks using a combination of patient-reported outcomes administered via REDCap (Research Electronic Data Capture), wearable sensor data collected via Fitbit Charge 4 and electronic health record data. The primary outcome will be the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference scale. Secondary outcomes will include PROMIS Anxiety, PROMIS Sleep Disturbance, opioid prescription data and Pain Catastrophizing Scale Short Form. A subgroup analysis will explore patient level predictors for VR efficacy. ETHICS AND DISSEMINATION Ethics approval was obtained from the Institutional Review Board of Cedars-Sinai Health System in April 2020. The results will be disseminated in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04409353.
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Affiliation(s)
- Brandon Birckhead
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sam Eberlein
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Genie Alvarez
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Rebecca Gale
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Taylor Dupuy
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Katherine Makaroff
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Garth Fuller
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Xiaoyu Liu
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kyung-Sang Yu
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Biomedical Sciences, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - J T Black
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mariko Ishimori
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Swamy Venuturupalli
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Joseph Tu
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Tom Norris
- American Chronic Pain Association, Rocklin, California, USA
| | - Mourad Tighiouart
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Lindsey Ross
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Karma McKelvey
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mark Vrahas
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Itai Danovitch
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Brennan Spiegel
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
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17
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Juraskova I, Laidsaar-Powell R, Keast R, Schofield P, Costa DS, Kay J, Turner S, Koczwara B, Saunders C, Jefford M, Yates P, Boyle F, White K, Miller A, Morton RL, Butt Z, Butow P. eTRIO trial: study protocol of a randomised controlled trial of online education modules to facilitate effective family caregiver involvement in oncology. BMJ Open 2021; 11:e043224. [PMID: 34049902 PMCID: PMC8166623 DOI: 10.1136/bmjopen-2020-043224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Informal family caregivers play a crucial role in cancer care. Effective caregiver involvement in cancer care can improve both patient and caregiver outcomes. Despite this, interventions improving the caregiver involvement are sparse. This protocol describes a randomised controlled trial evaluating the combined effectiveness of novel online caregiver communication education modules for: (1) oncology clinicians (eTRIO) and (2) patients with cancer and caregivers (eTRIO-pc). METHODS AND ANALYSIS Thirty medical/radiation/surgical oncology or haematology doctors and nurses will be randomly allocated to either intervention (eTRIO) or control (an Australian State Government Health website on caregivers) education conditions. Following completion of education, each clinician will recruit nine patient-caregiver pairs, who will be allocated to the same condition as their recruiting clinician. Eligibility includes any new adult patient diagnosed with any type/stage cancer attending consultations with a caregiver. Approximately 270 patient-caregiver pairs will be recruited. The primary outcome is caregiver self-efficacy in triadic (clinician-patient-caregiver) communication. Patient and clinician self-efficacy in triadic communication are secondary outcomes. Additional secondary outcomes for clinicians include preferences for caregiver involvement, perceived module usability/acceptability, analysis of module use, satisfaction with the module, knowledge of strategies and feedback interviews. Secondary outcomes for caregivers and patients include preferences for caregiver involvement, satisfaction with clinician communication, distress, quality of life, healthcare expenditure, perceived module usability/acceptability and analysis of module use. A subset of patients and caregivers will complete feedback interviews. Secondary outcomes for caregivers include preparedness for caregiving, patient-caregiver communication and caring experience. Assessments will be conducted at baseline, and 1 week, 12 weeks and 26 weeks post-intervention. ETHICS AND DISSEMINATION Ethical approval has been received by the Sydney Local Health District Human Research Ethics Committee (REGIS project ID number: 2019/PID09787), with site-specific approval from each recruitment site. Protocol V.7 (dated 1 September 2020) is currently approved and reported in this manuscript. Findings will be disseminated via presentations and peer-reviewed publications. Engagement with clinicians, media, government, consumers and peak cancer groups will facilitate widespread dissemination and long-term availability of the educational modules. TRIAL REGISTRATION NUMBER ACTRN12619001507178.
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Affiliation(s)
- Ilona Juraskova
- School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Faculty of Science, Camperdown, New South Wales, Australia
| | - R Laidsaar-Powell
- School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Faculty of Science, Camperdown, New South Wales, Australia
| | - Rachael Keast
- School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Faculty of Science, Camperdown, New South Wales, Australia
| | - Penelope Schofield
- Department of Psychology, and Iverson Health Innovation Research Institute, Swinburne University, Melbourne, Victoria, Australia
- Behavioural Sciences Unit, Health Services Research and Implementation Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Daniel Sj Costa
- Pain Management Research Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia
| | - Judy Kay
- School of Computer Science, The University of Sydney, Faculty of Engineering, Sydney, New South Wales, Australia
| | - Sandra Turner
- Department of Radiation Oncology, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Bogda Koczwara
- Flinders University School of Medicine, Adelaide, South Australia, Australia
| | - Christobel Saunders
- Division of Surgery, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Michael Jefford
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Patsy Yates
- Centre for Cancer and Palliative Care Outcomes, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Frances Boyle
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Patricia Ritchie Centre for Cancer Care & Research, Mater Hospital, Sydney, New South Wales, Australia
| | - Kate White
- Susan Wakil School of Nursing and Midwifery, Cancer Nursing Research Unit, University of Sydney, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
| | - Annie Miller
- Cancer Information and Support Services Division, Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
| | - Zoe Butt
- School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Faculty of Science, Camperdown, New South Wales, Australia
| | - Phyllis Butow
- School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Faculty of Science, Camperdown, New South Wales, Australia
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Abstract
BACKGROUND Virtual reality (VR) is a technology that produces a virtual manifestation of the real world. In recent years, VR has been increasingly used as a tool in medical education. The use of VR in medical education has large potential, as it allows for distance learning and training which may be challenging to deliver in real life. VR encompasses different tools and applications. There is a need to explore how VR has been employed in medical education to date. OBJECTIVE The objective of this scoping review is to conceptualise the VR tools available and the applications of VR in undergraduate medical education as reported in the literature. This scoping review will identify any gaps in this field and provide suggestions for future research. METHODS AND ANALYSIS The relevant studies will be examined using the Joanna Briggs Institute methodological framework for scoping studies. A comprehensive search from a total of six electronic databases and grey literature sources will be performed. The reference list of included studies will be screened for additional studies. The screening and data extraction will be done in parallel and independently by two review authors. Any discrepancies will be resolved through consensus or discussion with a third review author. A data extraction form has been developed using key themes from the research questions. The extracted data will be qualitatively analysed and presented in a diagrammatic or tabular form, alongside a narrative summary, in line with Preferred Reporting Items for Systematic Reviews and Meta-Analysis: extension for Scoping Reviews reporting guidelines. ETHICS AND DISSEMINATION All data will be collected from published and grey literature. Ethics approval is therefore not a requirement. We will present our findings at relevant conferences and submit them for publications in peer-reviewed journals.
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Affiliation(s)
- Jiang Haowen
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Bhone Myint Kyaw
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Lorainne Tudor Car
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Primary Care and Public Health, Imperial College London, London, UK
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19
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Cuteanu A, Seguin M, Ziebland S, Pope C, Leydon G, Barnes R, Murray E, Atherton H, Stevenson F. Qualitative study: patients' enduring concerns about discussing internet use in general practice consultations. BMJ Open 2021; 11:e047508. [PMID: 33910948 PMCID: PMC8094327 DOI: 10.1136/bmjopen-2020-047508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To examine patients' accounts of their use of the internet before seeing a general practitioner (GP) using thematic analysis of semistructured interviews. DESIGN Qualitative semistructured interview study with transcripts analysed thematically. SETTING Primary care patients consulting with 10 GPs working at 7 GP practices of varying sizes and at a range of locations around London and the Southeast of England. PARTICIPANTS 28 adult patients: 16 women and 12 men ranging in age from 18 to 75 from a range of self-defined ethnic backgrounds. Participants were selected based on instances when the patients reported having used the internet before the consultation, when patients referred to the internet in the consultation or when the physician used the internet or made reference to it during the consultation. RESULTS Patients report that they can find health information online that they believe is reliable and helpful for both themselves and their GP. However, they report uncertainty about how to share internet-based findings and reluctance to disclose their efforts at researching health issues online for fear of appearing disrespectful or interfering with the flow of the consultation. CONCLUSIONS Despite the democratisation of access to information about health due via the internet, patients continue to experience their use of the internet for health information as a sensitive and potentially problematic topic. The onus may well be on GPs to raise the likelihood (without judgement) that patients will have looked things up before consulting and invite them to talk about what they found.
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Affiliation(s)
- Anita Cuteanu
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Maureen Seguin
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Geraldine Leydon
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Rebecca Barnes
- Centre for Academic Primary Care, School for Social and Community Medicine, Bristol University, Bristol, UK
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Helen Atherton
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
| | - Fiona Stevenson
- Research Department of Primary Care and Population Health, University College London, London, UK
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20
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McMillan B, Davidge G, Brown L, Lyons M, Atherton H, Goulding R, Mold F, Morris RL, Sanders C. A qualitative exploration of patients' experiences, needs and expectations regarding online access to their primary care record. BMJ Open 2021; 11:e044221. [PMID: 33707271 PMCID: PMC7957122 DOI: 10.1136/bmjopen-2020-044221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Primary care records have traditionally served the needs and demands of clinicians rather than those of the patient. In England, general practices must promote and offer registered patients online access to their primary care record, and research has shown benefits to both patients and clinicians of doing so. Despite this, we know little about patients' needs and expectations regarding online access to their record. This study explored what patients and carers want from online access to their electronic primary care health record, their experiences of using it, how they would like to interact with their record and what support they may need. DESIGN Focus groups and semistructured interviews using purposive sampling to achieve a good sociodemographic spread. Interviews were digitally audiorecorded, transcribed and coded using an established thematic approach. SETTING Focus groups and interviews were conducted in community settings in the UK. PARTICIPANTS Fifty-four individuals who were either eligible for the National Health Service Health Check, living with more than one long-term condition or caring for someone else. RESULTS Participants views regarding online access were categorised into four main themes: awareness, capabilities, consequences and inevitability. Participants felt online access should be better promoted, and suggested a number of additional functions, such as better integration with other parts of the healthcare system. It was felt that online access could improve quality of care (eg, through increased transparency) but also have potential negative consequences (eg, by replacing face to face contact). A move towards more online records access was considered inevitable, but participants noted a need for additional support and training in using the online record, especially to ensure that health inequalities are not exacerbated. CONCLUSIONS Discussions with patients and carers about their views of accessing online records have provided useful insights into future directions and potential improvements for this service.
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Affiliation(s)
- Brian McMillan
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Gail Davidge
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Lindsey Brown
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Moira Lyons
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Helen Atherton
- Warwick Medical School, Social Science and Systems in Health, University of Warwick, Coventry, UK
| | - Rebecca Goulding
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Freda Mold
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Rebecca L Morris
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Caroline Sanders
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
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21
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Fewings H, Lee AJ. Enriching outcomes for persons with intellectual disabilities: choice, individuality and collaboration are key to effective eHealth. Evid Based Nurs 2021; 25:24. [PMID: 33558213 DOI: 10.1136/ebnurs-2020-103362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Heidi Fewings
- Faculty of Health Sciences, University of Hull Faculty of Health and Social Care, Hull, UK
| | - Amanda J Lee
- Faculty of Health Sciences, University of Hull Faculty of Health and Social Care, Hull, UK
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22
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Muller I, Stuart B, Sach T, Hooper J, Wilczynska S, Steele M, Greenwell K, Sivyer K, Yardley L, Williams HC, Chalmers JR, Leighton P, Howells LM, Ridd MJ, Lawton S, Griffiths G, Nuttall J, Langan SM, Roberts A, Ahmed A, Kirk H, Becque T, Little P, Thomas KS, Santer M. Supporting self-care for eczema: protocol for two randomised controlled trials of ECO (Eczema Care Online) interventions for young people and parents/carers. BMJ Open 2021; 11:e045583. [PMID: 33550268 PMCID: PMC7925854 DOI: 10.1136/bmjopen-2020-045583] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/22/2020] [Accepted: 01/20/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Eczema care requires management of triggers and various treatments. We developed two online behavioural interventions to support eczema care called ECO (Eczema Care Online) for young people and ECO for families. This protocol describes two randomised controlled trials (RCTs) aimed to evaluate clinical and cost-effectiveness of the two interventions. METHODS AND ANALYSIS: Design: Two independent, pragmatic, unmasked, parallel group RCTs with internal pilots and nested health economic and process evaluation studies. Setting: Participants will be recruited from general practitioner practices in England. Participants: Young people aged 13-25 years with eczema and parents and carers of children aged 0-12 years with eczema, excluding inactive or very mild eczema (five or less on Patient-Oriented Eczema Measure (POEM)). Interventions: Participants will be randomised to online intervention plus usual care or to usual eczema care alone. Outcome measures: Primary outcome is eczema severity over 24 weeks measured by POEM. Secondary outcomes include POEM 4-weekly for 52 weeks, quality of life, eczema control, itch intensity (young people only), patient enablement, health service and treatment use. Process measures include treatment adherence, barriers to adherence and intervention usage. Our sample sizes of 303 participants per trial are powered to detect a group difference of 2.5 (SD 6.5) in monthly POEM scores over 24 weeks (significance 0.05, power 0.9), allowing for 20% loss to follow-up. Cost-effectiveness analysis will be from a National Health Service and personal social service perspective. Qualitative and quantitative process evaluation will help understand the mechanisms of action and participant experiences and inform implementation. ETHICS AND DISSEMINATION The study has been approved by South Central Oxford A Research Ethics Committee (19/SC/0351). Recruitment is ongoing, and follow-up will be completed by mid-2022. Findings will be disseminated to participants, the public, dermatology and primary care journals, and policy makers. TRIAL REGISTRATION NUMBER ISRCTN79282252.
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Affiliation(s)
- Ingrid Muller
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Beth Stuart
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Tracey Sach
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Julie Hooper
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Sylvia Wilczynska
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Mary Steele
- Department of Psychology, University of Southampton, Southampton, UK
| | - Kate Greenwell
- Department of Psychology, University of Southampton, Southampton, UK
| | - Katy Sivyer
- Department of Psychology, University of Southampton, Southampton, UK
- Department of Psychology, University of Portsmouth, Portsmouth, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Joanne R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Paul Leighton
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Laura M Howells
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Matthew J Ridd
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Sandra Lawton
- Department of Dermatology, Rotherham NHS Foundation Trust, Rotherham, UK
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Jacqui Nuttall
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Sinead M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Amanda Roberts
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Amina Ahmed
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Hayden Kirk
- Neurological Rehabilitation, Solent NHS Trust, Southampton, UK
| | - Taeko Becque
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Paul Little
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Miriam Santer
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
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Brassey J, Price C, Edwards J, Zlabinger M, Bampoulidis A, Hanbury A. Developing a fully automated evidence synthesis tool for identifying, assessing and collating the evidence. BMJ Evid Based Med 2021; 26:24-27. [PMID: 31467247 DOI: 10.1136/bmjebm-2018-111126] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 01/06/2023]
Abstract
Evidence synthesis is a key element of evidence-based medicine. However, it is currently hampered by being labour intensive meaning that many trials are not incorporated into robust evidence syntheses and that many are out of date. To overcome this, a variety of techniques are being explored, including using automation technology. Here, we describe a fully automated evidence synthesis system for intervention studies, one that identifies all the relevant evidence, assesses the evidence for reliability and collates it to estimate the relative effectiveness of an intervention. Techniques used include machine learning, natural language processing and rule-based systems. Results are visualised using modern visualisation techniques. We believe this to be the first, publicly available, automated evidence synthesis system: an evidence mapping tool that synthesises evidence on the fly.
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Affiliation(s)
| | | | | | - Markus Zlabinger
- Institute of Information Systems Engineering, TU Wien (Vienna University of Technology), Vienna, Austria
| | - Alexandros Bampoulidis
- Institute of Information Systems Engineering, TU Wien (Vienna University of Technology), Vienna, Austria
- Research Studio Data Science, RSA FG, Vienna, Austria
| | - Allan Hanbury
- Institute of Information Systems Engineering, TU Wien (Vienna University of Technology), Vienna, Austria
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24
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Heyerdahl LW, Vray M, Leger V, Le Fouler L, Antouly J, Troit V, Giles-Vernick T. Evaluating the motivation of Red Cross Health volunteers in the COVID-19 pandemic: a mixed-methods study protocol. BMJ Open 2021; 11:e042579. [PMID: 33500285 PMCID: PMC7839304 DOI: 10.1136/bmjopen-2020-042579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Voluntary organisations provide essential support to vulnerable populations and front-line health responders to the COVID-19 pandemic. The French Red Cross (FRC) is prominent among organisations offering health and support services in the current crisis. Comprised primarily of lay volunteers and some trained health workers, FRC volunteers in the Paris (France) region have faced challenges in adapting to pandemic conditions, working with sick and vulnerable populations, managing limited resources and coping with high demand for their services. Existing studies of volunteers focus on individual, social and organisational determinants of motivation, but attend less to contextual ones. Public health incertitude about the COVID-19 pandemic is an important feature of this pandemic. Whether and how uncertainty interacts with volunteer understandings and experiences of their work and organisational relations to contribute to Red Cross worker motivation is the focus of this investigation. METHODS AND ANALYSIS This mixed-methods study will investigate volunteer motivation using ethnographic methods and social network listening. Semi-structured interviews and observations will illuminate FRC volunteer work relations, experiences and concerns during the pandemic. A questionnaire targeting a sample of Paris region volunteers will allow quantification of motivation. These findings will iteratively shape and be influenced by a social media (Twitter) analysis of biomedical and public health uncertainties and debates around COVID-19. These tweets provide insight into a French lay public's interpretations of these debates. We evaluate whether and how socio-political conditions and discourses concerning COVID-19 interact with volunteer experiences, working conditions and organisational relations to influence volunteer motivation. Data collection began on 15 June 2020 and will continue until 15 April 2021. ETHICS AND DISSEMINATION The protocol has received ethical approval from the Institut Pasteur Institutional Review Board (no 2020-03). We will disseminate findings through peer-reviewed articles, conference presentations and recommendations to the FRC.
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Affiliation(s)
- Leonardo W Heyerdahl
- Anthropology & Ecology of Disease Emergence Unit/Global Health, Institut Pasteur, Paris, France
| | - Muriel Vray
- Emerging Diseases Epidemiology Unit/Global Health, Institut Pasteur, Paris, France
| | - Vincent Leger
- Fondation de la Croix-Rouge francaise, Croix-Rouge francaise, Paris, France
| | | | - Julien Antouly
- Fondation de la Croix-Rouge francaise, Croix-Rouge francaise, Paris, France
| | - Virginie Troit
- Fondation de la Croix-Rouge francaise, Croix-Rouge francaise, Paris, France
| | - Tamara Giles-Vernick
- Anthropology & Ecology of Disease Emergence Unit/Global Health, Institut Pasteur, Paris, France
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25
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Abstract
OBJECTIVES The COVID-19 outbreak in Singapore has largely centred around migrant worker dormitories, comprising over 90% of all cases in the country. Dormitories are home to a culturally and linguistically distinct, low-income population, without on-site healthcare after-hours. The primary objective of this study was to assess the engagement and utilisation of a simple, low-cost, accessible, mobile health solution for remote self-reporting of vital parameters in dormitory residents with COVID-19. DESIGN Retrospective review of medical care. SETTING Two large migrant worker dormitories with a combined population of 31 546. PARTICIPANTS All COVID-19-affected residents housed in dormitories during the study period. INTERVENTION All residents were taught to use a chat assistant to self-report their temperature, heart rate and oxygen saturations. Results flowed into a dashboard, which alerted clinicians of abnormal results. OUTCOMES The primary outcome measure was engagement rate. This was derived from the total number of residents who registered on the platform over the total number of COVID-19-affected residents in the dormitories during the study period. Secondary outcome measures included outcomes of the alerts and subsequent escalations of care. RESULTS 800 of the 931 COVID-19-affected residents (85.9%) engaged with the platform to log a total of 12 511 discrete episodes of vital signs. Among 372 abnormal readings, 96 teleconsultations were initiated, of which 7 (1.8%) were escalated to emergency services and 18 (4.9%) were triaged to earlier physical medical review on-site. CONCLUSIONS A chat-assistant-based self-reporting platform is an effective and safe community-based intervention to monitor marginalised populations with distinct cultural and linguistic backgrounds, living communally and affected by COVID-19. Lessons learnt from this approach may be applied to develop safe and cost-effective telemedicine solutions across similar settings.
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Affiliation(s)
- Stephanie Q Ko
- Division of Advanced Internal Medicine, University Medicine Cluster, National University Hospital, Singapore
| | - Benjamin M Y Hooi
- Division of Advanced Internal Medicine, University Medicine Cluster, National University Hospital, Singapore
| | - Chieh-Yang Koo
- Department of Cardiology, National University Heart Centre, Singapore
| | - Daniel W P Chor
- Department of Emergency Medicine, National University Hospital, Singapore
| | - Zheng Jye Ling
- Department of Medical Informatics, National University Health System, Singapore
| | - Yen-Lin Chee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Wei-Ying Jen
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
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26
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Gilbert S, Mehl A, Baluch A, Cawley C, Challiner J, Fraser H, Millen E, Montazeri M, Multmeier J, Pick F, Richter C, Türk E, Upadhyay S, Virani V, Vona N, Wicks P, Novorol C. How accurate are digital symptom assessment apps for suggesting conditions and urgency advice? A clinical vignettes comparison to GPs. BMJ Open 2020; 10:e040269. [PMID: 33328258 PMCID: PMC7745523 DOI: 10.1136/bmjopen-2020-040269] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To compare breadth of condition coverage, accuracy of suggested conditions and appropriateness of urgency advice of eight popular symptom assessment apps. DESIGN Vignettes study. SETTING 200 primary care vignettes. INTERVENTION/COMPARATOR For eight apps and seven general practitioners (GPs): breadth of coverage and condition-suggestion and urgency advice accuracy measured against the vignettes' gold-standard. PRIMARY OUTCOME MEASURES (1) Proportion of conditions 'covered' by an app, that is, not excluded because the user was too young/old or pregnant, or not modelled; (2) proportion of vignettes with the correct primary diagnosis among the top 3 conditions suggested; (3) proportion of 'safe' urgency advice (ie, at gold standard level, more conservative, or no more than one level less conservative). RESULTS Condition-suggestion coverage was highly variable, with some apps not offering a suggestion for many users: in alphabetical order, Ada: 99.0%; Babylon: 51.5%; Buoy: 88.5%; K Health: 74.5%; Mediktor: 80.5%; Symptomate: 61.5%; Your.MD: 64.5%; WebMD: 93.0%. Top-3 suggestion accuracy was GPs (average): 82.1%±5.2%; Ada: 70.5%; Babylon: 32.0%; Buoy: 43.0%; K Health: 36.0%; Mediktor: 36.0%; Symptomate: 27.5%; WebMD: 35.5%; Your.MD: 23.5%. Some apps excluded certain user demographics or conditions and their performance was generally greater with the exclusion of corresponding vignettes. For safe urgency advice, tested GPs had an average of 97.0%±2.5%. For the vignettes with advice provided, only three apps had safety performance within 1 SD of the GPs-Ada: 97.0%; Babylon: 95.1%; Symptomate: 97.8%. One app had a safety performance within 2 SDs of GPs-Your.MD: 92.6%. Three apps had a safety performance outside 2 SDs of GPs-Buoy: 80.0% (p<0.001); K Health: 81.3% (p<0.001); Mediktor: 87.3% (p=1.3×10-3). CONCLUSIONS The utility of digital symptom assessment apps relies on coverage, accuracy and safety. While no digital tool outperformed GPs, some came close, and the nature of iterative improvements to software offers scalable improvements to care.
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Affiliation(s)
| | | | | | | | | | - Hamish Fraser
- Brown Center for Biomedical Informatics, Brown University, Rhode Island, USA
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Abstract
INTRODUCTION With the advancements in wearable electronics, electronically integrated smart garments started to transpire in our daily lives. Smart garment technologies are incorporated into sportswear applications to enhance the well-being and performance of athletes. Smart garments applications in the sports sector are increasing, and the variety of smart garment applications available in the literature is overwhelming. Therefore, it is essential to compare the vast array of technologies incorporated in smart garments for athletes to understand the knowledge gaps for future studies. The protocol paper aims to examine the smart garments used in the sports domain to enhance the health and well-being of athletes. METHODS AND ANALYSIS Relevant studies will be retrieved using predefined search terms from Scopus, Web of Science, Science Direct, PubMed and IEEE Xplore. The retrieved articles will be eliminated in two phases: title and abstract screening and full-text screening. The included articles will be primary studies published in the English language within the last 10 years. Subsequently, the included articles will be further studied to extract data using a data extraction form. The extracted data will undergo a thematic analysis. Also, quantitative analysis will be carried out using descriptive statistics. ETHICS AND DISSEMINATION The results of this review will provide a comprehensive understanding of smart garment concepts used in the sports domain. The findings of this scoping review will be shared through a journal publication and a conference presentation. Ethical approval is not needed for this scoping review. PROTOCOL REGISTRATION NUMBER DOI 10.17605/OSF.IO/34MF2 (https://osf.io/34mf2).
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Affiliation(s)
- Abdullah Al Mahmud
- School of Design; Centre for Design Innovation, Swinburne University of Technology, Melbourne, Victoria, Australia
| | | | - Blair Kuys
- School of Design; Centre for Design Innovation, Swinburne University of Technology, Melbourne, Victoria, Australia
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28
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Dost S, Hossain A, Shehab M, Abdelwahed A, Al-Nusair L. Perceptions of medical students towards online teaching during the COVID-19 pandemic: a national cross-sectional survey of 2721 UK medical students. BMJ Open 2020; 10:e042378. [PMID: 33154063 PMCID: PMC7646323 DOI: 10.1136/bmjopen-2020-042378] [Citation(s) in RCA: 355] [Impact Index Per Article: 88.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To investigate perceptions of medical students on the role of online teaching in facilitating medical education during the COVID-19 pandemic. DESIGN Cross-sectional, online national survey. SETTING Responses collected online from 4th May 2020 to 11th May 2020 across 40 UK medical schools. PARTICIPANTS Medical students across all years from UK-registered medical schools. MAIN OUTCOME MEASURES The uses, experiences, perceived benefits and barriers of online teaching during the COVID-19 pandemic. RESULTS 2721 medical students across 39 medical schools responded. Medical schools adapted to the pandemic in different ways. The changes included the development of new distance-learning platforms on which content was released, remote delivery of lectures using platforms and the use of question banks and other online active recall resources. A significant difference was found between time spent on online platforms before and during COVID-19, with 7.35% students before versus 23.56% students during the pandemic spending >15 hours per week (p<0.05). The greatest perceived benefits of online teaching platforms included their flexibility. Whereas the commonly perceived barriers to using online teaching platforms included family distraction (26.76%) and poor internet connection (21.53%). CONCLUSIONS Online teaching has enabled the continuation of medical education during these unprecedented times. Moving forward from this pandemic, in order to maximise the benefits of both face-to-face and online teaching and to improve the efficacy of medical education in the future, we suggest medical schools resort to teaching formats such as team-based/problem-based learning. This uses online teaching platforms allowing students to digest information in their own time but also allows students to then constructively discuss this material with peers. It has also been shown to be effective in terms of achieving learning outcomes. Beyond COVID-19, we anticipate further incorporation of online teaching methods within traditional medical education. This may accompany the observed shift in medical practice towards virtual consultations.
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Affiliation(s)
| | - Aleena Hossain
- Faculty of Medicine, Imperial College of Science Technology and Medicine, London, UK
| | - Mai Shehab
- Guy's Campus, King's College London School of Medicine, London, UK
| | - Aida Abdelwahed
- Faculty of Medicine, Imperial College of Science Technology and Medicine, London, UK
| | - Lana Al-Nusair
- Faculty of Medicine, Imperial College of Science Technology and Medicine, London, UK
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Wang C, Xie A, Wang W, Wu H. Association between medical students' prior experiences and perceptions of formal online education developed in response to COVID-19: a cross-sectional study in China. BMJ Open 2020; 10:e041886. [PMID: 33122327 PMCID: PMC7597486 DOI: 10.1136/bmjopen-2020-041886] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES (1) Understanding the characteristics of online learning experiences of Chinese undergraduate medical students; (2) Investigating students' perceptions of ongoing online education developed in response to COVID-19 and (3) Exploring how prior online learning experiences are associated with students' perceptions. DESIGN Students' familiarity with online learning modes and corresponding perceived usefulness (PU) according to their previous experiences were investigated using an online survey. The survey also collected data on students' perceptions through their evaluation of and satisfaction with current online learning. SETTING In response to the educational challenges created by COVID-19, medical schools in China have adopted formal online courses for students. PARTICIPANTS The questionnaire was sent to 225 329 students, of whom 52.38% (118 080/225 329) replied, with valid data available for 44.18% (99 559/225 329). METHODS Pearson correlations and t-tests were used to examine the relationship between familiarity and PU. Multiple linear regression and logistic regression analyses were used to determine the impact of prior learning experiences and its interactions with gender, area, learning phase and academic performance on students' perceptions. RESULTS Students' PU had a significant positive correlation with their familiarity with online learning modes (p<0.01). Students' evaluation of and satisfaction with their current online education were positively associated with their familiarity (β=0.46, 95% CI 0.45 to 0.48, p<0.01; OR 1.14, 95% CI 1.13 to 1.14, p<0.01) with and PU (β=3.11, 95% CI 2.92 to 3.30, p<0.01; OR 2.55, 95% CI 2.37 to 2.75, p<0.01) of online learning. Moreover, the higher the students' learning phases, the lower the associations between PU and students' evaluation of and satisfaction with ongoing online education. CONCLUSIONS Medical students in China have experiences with various online learning modes. Prior learning experiences are positively associated with students' evaluation of and satisfaction with current online education. Higher learning phases, in which clinical practices are crucial, and high academic performance led to lower evaluation and satisfaction scores.
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MESH Headings
- Betacoronavirus
- COVID-19
- China
- Coronavirus Infections/epidemiology
- Coronavirus Infections/prevention & control
- Education, Distance/methods
- Education, Medical, Undergraduate/organization & administration
- Education, Medical, Undergraduate/trends
- Female
- Humans
- Male
- Models, Educational
- Models, Organizational
- Needs Assessment
- Pandemics/prevention & control
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/prevention & control
- Qualitative Research
- SARS-CoV-2
- Social Perception
- Students, Medical/psychology
- Young Adult
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Affiliation(s)
- Cixiao Wang
- School of Educational Technology, Faculty of Education, Beijing Normal University, Beijing, China
| | - A'na Xie
- National Center for Health Professions Education Development, Peking University, Beijing, China
| | - Weimin Wang
- National Center for Health Professions Education Development, Peking University, Beijing, China
- Peking University Health Science Center, Peking University, Beijing, China
| | - Hongbin Wu
- National Center for Health Professions Education Development, Peking University, Beijing, China
- Institute of Medical Education, Peking University, Beijing, China
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Lapointe A, Laramée C, Belanger-Gravel A, Buckeridge DL, Desroches S, Garriguet D, Gauvin L, Lemieux S, Plante C, Lamarche B. NutriQuébec: a unique web-based prospective cohort study to monitor the population's eating and other lifestyle behaviours in the province of Québec. BMJ Open 2020; 10:e039889. [PMID: 33115902 PMCID: PMC7594370 DOI: 10.1136/bmjopen-2020-039889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION The epidemic of non-communicable diseases including cardiovascular diseases and type 2 diabetes is attributable in large part to unhealthy eating and physical inactivity. In the fall of 2016, the Québec government launched its first-ever Government Health Prevention Policy (Politique gouvernementale de prévention en santé (PGPS)) to influence factors that lead to improved health status and quality of life as well as reduced social inequalities in health in the population of Québec. NutriQuébec is a web-based prospective open cohort study whose primary aim is to provide essential data for the evaluation of the PGPS on the Québec population's eating and other lifestyle behaviours over time. METHODS AND ANALYSIS Over a first phase of 3 years, NutriQuébec will enrol 20 000 adults living in the province of Québec in Canada through a multimedia campaign designed to reach different segments of the population, including subgroups with lower socioeconomic status. Participants will be invited to complete on a web platform nine core questionnaires on a yearly basis. Questionnaires will assess several dimensions related to lifestyle, including eating and physical activity behaviours, as well as a large number of personal characteristics and global health status. Temporal trends in eating and lifestyle behaviours will be analysed in relation to the implementation of the PGPS to provide essential data for its evaluation at a population level. Data analyses will use sociodemographic weights to adjust responses of participants to achieve, so far as is possible, representativeness of the adult Québec population. ETHICS AND DISSEMINATION Université Laval Research Ethics Board approved the NutriQuébec project. Data analysis, presentations in conferences and publication of manuscripts are scheduled to start in 2020. TRIAL REGISTRATION NUMBER NCT04140071.
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Affiliation(s)
- Annie Lapointe
- Centre NUTRISS, INAF, Université Laval, Quebec City, Quebec, Canada
| | | | - Ariane Belanger-Gravel
- Centre NUTRISS, INAF, Université Laval, Quebec City, Quebec, Canada
- Department of Information and Communication, Université Laval, Quebec city, Quebec, Canada
- Quebec Heart and Lung Institute, Quebec city, Quebec, Canada
| | - David L Buckeridge
- School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | - Sophie Desroches
- Centre NUTRISS, INAF, Université Laval, Quebec City, Quebec, Canada
- School of Nutrition, Université Laval, Quebec City, Quebec, Canada
| | - Didier Garriguet
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Lise Gauvin
- Centre de recherche du CHUM, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Simone Lemieux
- Centre NUTRISS, INAF, Université Laval, Quebec City, Quebec, Canada
- School of Nutrition, Université Laval, Quebec City, Quebec, Canada
| | - Céline Plante
- Institut national de santé publique du Québec, Quebec City, Quebec, Canada
| | - Benoit Lamarche
- Centre NUTRISS, INAF, Université Laval, Quebec City, Quebec, Canada
- School of Nutrition, Université Laval, Quebec City, Quebec, Canada
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Hendriks RA, de Jong PGM, Admiraal WF, Reinders MEJ. Uncovering motivation and self-regulated learning skills in integrated medical MOOC learning: a mixed methods research protocol. BMJ Open 2020; 10:e038235. [PMID: 33109653 PMCID: PMC7592287 DOI: 10.1136/bmjopen-2020-038235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/28/2020] [Accepted: 09/24/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Massive Open Online Courses (MOOCs) are informal learning environments. Since a few years, MOOCs are being reused and integrated in formal medical education. However, what constitutes optimal integration is still unclear. In this mixed methods study protocol we describe how we will investigate three MOOC integration designs using the same MOOC. THIS STUDY HOLDS MULTIPLE OBJECTIVES: (1) Describe motivation profiles in medical students that learn in integrated MOOCs, and discern if motivation profiles are associated with specific MOOC integration designs; (2) investigate how psychological needs of medical students are satisfied or frustrated in different MOOC integration designs; (3) investigate the relationship between autonomous motivation to learn in an integrated MOOC and use of self-regulated learning skills in that MOOC; (4) uncover processes that are involved in goal acceptance or rejection of medical students in integrated medical MOOC designs with assigned learning goals; and (5) identify obstacles medical students encounter when learning with assigned learning goals in integrated medical MOOCs. METHODS AND ANALYSIS Objectives 1 and 2 will be pursued with a cross-sectional study design, objective 3 with an observational cohort study design and objectives 4 and 5 with a qualitative interview study design. All medical students in one of three MOOC integration designs at Leiden University Medical Center (LUMC) will be invited to participate. Primary endpoints for objectives 1 and 2 are motivation profiles, and variety in need satisfaction and frustration. For objective 3 the primary endpoints are autonomous motivation and self-regulated online learning. For objectives 4 and 5 primary endpoints are process themes regarding goal acceptance or rejection, and perceived obstacles when working with assigned online learning goals. ETHICS AND DISSEMINATION This study has been approved by the Educational Research Review Board of the LUMC. Planned dissemination of findings include three presentations at (inter)national conferences and three research articles.
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Affiliation(s)
- Renée A Hendriks
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter G M de Jong
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilfried F Admiraal
- ICLON Leiden University Graduate School of Teaching, Leiden University, Leiden, The Netherlands
| | - Marlies E J Reinders
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
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Affiliation(s)
- Ana Manzar
- St George's University of London, London, UK
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Fan KS, Ghani SA, Machairas N, Lenti L, Fan KH, Richardson D, Scott A, Raptis DA. COVID-19 prevention and treatment information on the internet: a systematic analysis and quality assessment. BMJ Open 2020; 10:e040487. [PMID: 32912996 PMCID: PMC7485261 DOI: 10.1136/bmjopen-2020-040487] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the quality of information regarding the prevention and treatment of COVID-19 available to the general public from all countries. DESIGN Systematic analysis using the 'Ensuring Quality Information for Patients' (EQIP) Tool (score 0-36), Journal of American Medical Association (JAMA) benchmark (score 0-4) and the DISCERN Tool (score 16-80) to analyse websites containing information targeted at the general public. DATA SOURCES Twelve popular search terms, including 'Coronavirus', 'COVID-19 19', 'Wuhan virus', 'How to treat coronavirus' and 'COVID-19 19 Prevention' were identified by 'Google AdWords' and 'Google Trends'. Unique links from the first 10 pages for each search term were identified and evaluated on its quality of information. ELIGIBILITY CRITERIA FOR SELECTING STUDIES All websites written in the English language, and provides information on prevention or treatment of COVID-19 intended for the general public were considered eligible. Any websites intended for professionals, or specific isolated populations, such as students from one particular school, were excluded, as well as websites with only video content, marketing content, daily caseload update or news dashboard pages with no health information. RESULTS Of the 1275 identified websites, 321 (25%) were eligible for analysis. The overall EQIP, JAMA and DISCERN scores were 17.8, 2.7 and 38.0, respectively. Websites originated from 34 countries, with the majority from the USA (55%). News Services (50%) and Government/Health Departments (27%) were the most common sources of information and their information quality varied significantly. Majority of websites discuss prevention alone despite popular search trends of COVID-19 treatment. Websites discussing both prevention and treatment (n=73, 23%) score significantly higher across all tools (p<0.001). CONCLUSION This comprehensive assessment of online COVID-19 information using EQIP, JAMA and DISCERN Tools indicate that most websites were inadequate. This necessitates improvements in online resources to facilitate public health measures during the pandemic.
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Affiliation(s)
- Ka Siu Fan
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Nikolaos Machairas
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital, London, UK
| | - Lorenzo Lenti
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | | | - Aneya Scott
- St George's University Hospitals NHS Foundation Trust, London, UK
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Trethewey SP, Beck KJ, Symonds RF. Experience and perspectives of primary care practitioners on the credibility assessment of health-related information online. Postgrad Med J 2020; 97:608-610. [PMID: 32796110 DOI: 10.1136/postgradmedj-2020-138111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2020] [Indexed: 11/03/2022]
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Moradian S, Krzyzanowska M, Maguire R, Kukreti V, Amir E, Morita PP, Liu G, Howell D. Feasibility randomised controlled trial of remote symptom chemotherapy toxicity monitoring using the Canadian adapted Advanced Symptom Management System (ASyMS-Can): a study protocol. BMJ Open 2020; 10:e035648. [PMID: 32554724 PMCID: PMC7313714 DOI: 10.1136/bmjopen-2019-035648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Technology is emerging as a solution to develop home-based, proactive 'real-time' symptom monitoring and management in cancer care. The Advanced Symptom Monitoring and Management System-Canada (ASyMS-Can) is a remote phone-based symptom management system that enables real-time remote monitoring of systemic chemotherapy toxicities. METHODS AND ANALYSIS This study is an open-label, prospective, mixed-method, Phase II, 2-arm parallel group assignment (ASyMS-Can vs usual care) feasibility study in patients with cancer receiving systemic (neo-adjuvant or adjuvant) chemotherapy at Princess Margaret Cancer Centre. A total of 114 patients will be recruited in oncology clinics prior to initiation of chemotherapy. Patients in both arms will complete a demographic and a set of questionnaires at enrolment, mid and end of treatment. Patients in intervention arm will be provided with an encrypted, secure, preprogrammed ASyMS phone for symptom reporting daily for the first 14 days of each chemotherapy treatment cycle up to sixth cycle (16 weeks). Feasibility metrics (recruitment, retention and protocol adherence) and outcomes to assess impact of ASyMS-Can include symptom severity, emotional distress, quality of life and acceptability to patients and clinicians. ETHICS AND DISSEMINATION The study has received ethical and institutional approvals from the University Health Network. Dissemination will include presentations at national/international conferences, and publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03335189.
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Affiliation(s)
- Saeed Moradian
- School of Nursing, York University Faculty of Health, Toronto, Ontario, Canada
| | - Monika Krzyzanowska
- University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Roma Maguire
- University of Strathclyde Department of Computer and Information Sciences, Glasgow, UK
| | - Vishal Kukreti
- Division of Medical Oncology and Hematology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Eitan Amir
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Plinio P Morita
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Geoffrey Liu
- University Health Network and Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Doris Howell
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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Choi AW, Xu RS, Jacob S, Dulmage BO, Colavincenzo ML, Robinson JK, Xu S. Visual perception training: a prospective cohort trial of a novel, technology-based method to teach melanoma recognition. Postgrad Med J 2020; 95:350-352. [PMID: 31266882 DOI: 10.1136/postgradmedj-2018-136379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Andrew Wonho Choi
- Internal Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA.,Dermatology, University of California San Diego Health System, San Diego, California, USA
| | - Rebecca S Xu
- Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Saya Jacob
- Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brittany O Dulmage
- Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Maria L Colavincenzo
- Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - June K Robinson
- Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Shuai Xu
- Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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Trethewey SP, Beck KJ, Symonds RF. The FPM International Awards for Medical Writing in Social Media: a step in the right direction. Postgrad Med J 2020; 96:304. [PMID: 32241882 DOI: 10.1136/postgradmedj-2020-137772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2020] [Indexed: 11/04/2022]
Affiliation(s)
| | | | - Rehan F Symonds
- Oak Tree Surgery, Liskeard, Cornwall, UK.,Cornwall Clinical Research Group, Cornwall, UK
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Adams CE, Montgomery AA, Aburrow T, Bloomfield S, Briley PM, Carew E, Chatterjee-Woolman S, Feddah G, Friedel J, Gibbard J, Haynes E, Hussein M, Jayaram M, Naylor S, Perry L, Schmidt L, Siddique U, Tabaksert AS, Taylor D, Velani A, White D, Xia J. Adding evidence of the effects of treatments into relevant Wikipedia pages: a randomised trial. BMJ Open 2020; 10:e033655. [PMID: 32086355 PMCID: PMC7045027 DOI: 10.1136/bmjopen-2019-033655] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To investigate the effects of adding high-grade quantitative evidence of outcomes of treatments into relevant Wikipedia pages on further information-seeking behaviour by the use of routinely collected data. SETTING Wikipedia, Cochrane summary pages and the Cochrane Library. DESIGN Randomised trial. PARTICIPANTS Wikipedia pages which were highly relevant to up-to-date Cochrane Schizophrenia systematic reviews that contained a Summary of Findings table. INTERVENTIONS Eligible Wikipedia pages in the intervention group were seeded with tables of best evidence of the effects of care and hyperlinks to the source Cochrane review. Eligible Wikipedia pages in the control group were left unchanged. MAIN OUTCOME MEASURES Routinely collected data on access to the full text and summary web page (after 12 months). RESULTS We randomised 70 Wikipedia pages (100% follow-up). Six of the 35 Wikipedia pages in the intervention group had the tabular format deleted during the study but all pages continued to report the same data within the text. There was no evidence of effect on either of the coprimary outcomes: full-text access adjusted ratio of geometric means 1.30, 95% CI: 0.71 to 2.38; page views 1.14, 95% CI: 0.6 to 2.13. Results were similar for all other outcomes, with exception of Altmetric score for which there was some evidence of clear effect (1.36, 95% CI: 1.05 to 1.78). CONCLUSIONS The pursuit of fair balance within Wikipedia healthcare pages is impressive and its reach unsurpassed. For every person who sought and clicked the reference on the 'intervention' Wikipedia page to seek more information (the primary outcome), many more are likely to have been informed by the page alone. Enriching Wikipedia content is, potentially, a powerful way to improve health literacy and it is possible to test the effects of seeding pages with evidence. This trial should be replicated, expanded and developed. TRIAL REGISTRATION NUMBER IRCT2017070330407N2.
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Affiliation(s)
- Clive E Adams
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Tony Aburrow
- Health Sciences, Research, John Wiley Ltd, Chichester, UK
| | - Sophie Bloomfield
- Department of Critical Care, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
| | - Paul M Briley
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Ebun Carew
- General Medicine, Nottingham University Hospitals Healthcare NHS Trust, Nottingham, Nottinghamshire, UK
| | | | - Ghalia Feddah
- Emergency Department, Gold Coast University Hospitals, Gold Coast, Queensland, Australia
| | - Johannes Friedel
- Faculty Management and Business Science, University of Aalen, Aalen, Germany
| | - Josh Gibbard
- The Acute Stroke Unit - Huggett Suite, Royal Lancaster Infirmary, Lancaster, UK
| | - Euan Haynes
- Haematology, Gateshead Health NHS Foundation Trust, Gateshead, Gateshead, UK
| | - Mohsin Hussein
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester, Leicester, UK
| | - Mahesh Jayaram
- Psychaitry, University of Melbourne, Melbourne, Victoria, Australia
| | - Samuel Naylor
- Emergency Department, Gold Coast University Hospitals, Gold Coast, Queensland, Australia
| | - Luke Perry
- Department of Anaesthesia, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Lena Schmidt
- Bristol Medical School, University of Bristol Faculty of Health Sciences, Bristol, Bristol, UK
- Fakultät Gesundheit, Sicherheit und Gesellschaft, Hochschule Furtwangen University, Furtwangen, Germany
| | - Umer Siddique
- Community Recovery Psychiatry, North East London NHS Foundation Trust, London, UK
| | - Ayla Serena Tabaksert
- Liaison Psychiatry, Northumbria Healthcare NHS Foundation Trust, North Shields, Tyne and Wear, UK
| | | | - Aarti Velani
- Acute Medicine, Lewisham and Greenwich NHS Trust, London, UK
| | - Douglas White
- Accident and Emergency, Epsom and Saint Helier University Hospitals NHS Trust Epsom Hospital, Epsom, Surrey, UK
| | - Jun Xia
- Nottingham Ningbo GRADE Centre, Nottingham China Health Institute, The University of Nottingham Ningbo, Ningbo, China
- Division of Epidemiology and Public Health, School of Medicine, The University of Nottingham, Nottingham, UK
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Affiliation(s)
- Kaye Rolls
- Centre for Applied Nursing Research, Western Sydney University, Penrith South, New South Wales, Australia
| | - Debbie Massey
- School of Health and Human Services, Southern Cross University, Bilinga, New South Wales, Australia
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Abstract
OBJECTIVES The objective of this study was to explore the access to, and perceived utility of, various simulation modalities by in-service healthcare providers in a resource-scarce setting. SETTING Paediatric training workshops at a national paediatric conference in Nigeria. PARTICIPANTS All 200 healthcare workers who attended the workshop sessions were eligible to participate. A total of 161 surveys were completed (response rate 81%). PRIMARY AND SECONDARY OUTCOME MEASURES A paper-based 25-item cross-sectional survey on simulation-based training (SBT) was administered to a convenience sample of healthcare workers from secondary and tertiary healthcare facilities. RESULTS Respondents were mostly 31-40 years of age (79, 49%) and women (127, 79%). Consultant physicians (26, 16%) and nurses (56, 35%) were in both general (98, 61%) and subspecialty (56, 35%) practice. Most had 5-10 years of experience (62, 37%) in a tertiary care setting (72, 43%). Exposure to SBT varied by profession with physicians more likely to be exposed to manikin-based (29, 30% physicians vs 12, 19% nurses, p<0.001) or online training (7, 7% physician vs 3, 5% nurses, p<0.05). Despite perceived barriers to SBT, respondents thought that SBT should be expanded for continuing education (84, 88% physician vs 39, 63% nurses, p<0.001), teaching (73, 76% physicians vs 16, 26% nurses, p<0.001) and research (65, 68% physicians vs 14, 23% nurses, p<0.001). If facilities were available, nearly all respondents (92, 98% physicians; 52, 96% nurses) would recommend the use of online simulation for their centre. CONCLUSIONS The access of healthcare workers to SBT is limited in resource-scarce settings. While acknowledging the challenges, respondents identified many areas in which SBT may be useful, including skills acquisition, skills practice and communication training. Healthcare workers were open to the use of online SBT and expressed the need to expand SBT beyond the current scope for health professional training in Nigeria.
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Affiliation(s)
- Rachel Umoren
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | | | - Ireti B Fajolu
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Beatrice N Ezenwa
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Patricia Akintan
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Emeka Chukwu
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Chuck Spiekerman
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
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Affiliation(s)
- Heather Murray
- Departments of Emergency Medicine and Public Health Sciences, Queen's University, Kingston, Ontario, Canada
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Erguera XA, Johnson MO, Neilands TB, Ruel T, Berrean B, Thomas S, Saberi P. WYZ: a pilot study protocol for designing and developing a mobile health application for engagement in HIV care and medication adherence in youth and young adults living with HIV. BMJ Open 2019; 9:e030473. [PMID: 31061063 PMCID: PMC6501960 DOI: 10.1136/bmjopen-2019-030473] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Youth and young adults bear a disproportionate share of the HIV burden and there is a critical need for interventions to curb health disparities experienced among these age groups. The purpose of our research is to build on our theory-guided model and formative research to develop a mobile health application, called WYZ, for improved engagement in HIV care and antiretroviral therapy adherence, and pilot test it among youth and young adults living with HIV (YLWH). In this paper, we explain the design and development of WYZ for YLWH, describe the design of a forthcoming pilot trial for evaluating the feasibility and acceptability of WYZ and compare WYZ with other mobile health applications being developed to improve engagement in HIV care and antiretroviral medication adherence. METHODS AND ANALYSIS We used an agile methodology, shown to be useful in software development, and elicited feedback during beta testing to develop WYZ. WYZ is a modular, adaptive and personalised intervention delivered via a mobile phone. It is grounded in the information, motivation, behaviouralskills model which has been valuable for understanding and guiding the development of interventions for complex health behaviours. WYZ was created in collaboration with YLWH aged 18-29 years using a human-centred design approach that emphasises understanding the perspective of the users of the technology. WYZ is intended to improve engagement in HIV care by: (1) enhancing medication adherence self-efficacy, (2) increasing awareness and use of community resources, (3) reducing barriers to communication between youth and their healthcare team, and (4) providing a secure platform for the formation of a private online community of YLWH. We will conduct a 6-month single-arm pilot study to examine feasibility and acceptability of WYZ among 76 YLWH who live or receive care in the San Francisco Bay Area. All study activities, including recruitment, screening, enrolment, study assessments, provision of incentives and exit interviews, will be conducted remotely. We will explore feasibility and acceptability outcomes of the intervention using quantitative and qualitative methods. ETHICS AND DISSEMINATION Study staff will obtain written consent for study participation from all participants. This study and its protocols have been approved by the University of California San Francisco (UCSF) Institutional Review Board. Study staff will work with the UCSF Center for AIDS Prevention Studies' Community Engagement Core and the Youth Advisory Panel to disseminate results to the participants and the community using presentations, community forums, journal publications and/or social media. TRIAL REGISTRATION NUMBER NCT03587857; Pre-results.
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Affiliation(s)
- Xavier A. Erguera
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Mallory O. Johnson
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Torsten B. Neilands
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Theodore Ruel
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Beth Berrean
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sean Thomas
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Parya Saberi
- Medicine, University of California San Francisco, San Francisco, California, USA
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Gentile AJ, La Lima C, Flygare O, Enander J, Wilhelm S, Mataix-Cols D, Rück C. Internet-based, therapist-guided, cognitive-behavioural therapy for body dysmorphic disorder with global eligibility for inclusion: an uncontrolled pilot study. BMJ Open 2019; 9:e024693. [PMID: 30904854 PMCID: PMC6475214 DOI: 10.1136/bmjopen-2018-024693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Cognitive-behavioural therapy (CBT) has been shown to be an effective treatment for body dysmorphic disorder (BDD), but access to treatment around the world is limited. One way to increase access is to administer CBT remotely via the internet. This study represents the first effort to remotely deliver a therapist-supported, internet-based CBT treatment with no restrictions on enrolment based on geographical location, and it aims to assess whether this treatment can be delivered safely across international borders, with outcomes comparable to previous BDD-NET trials. DESIGN Uncontrolled clinical trial. PARTICIPANTS Patients (n=32) in nine different countries were recruited primarily through internet advertisements. INTERVENTION BDD-NET is a 12-week treatment, consisting of eight treatment modules previously shown to be effective in a Swedish version. SETTING Therapists based at a single, secondary care centre in Sweden provided active guidance and feedback throughout the treatment via asynchronous electronic messages. MAIN OUTCOME MEASURE The clinician-administered Yale-Brown Obsessive Compulsive Scale for BDD (BDD-YBOCS). Symptom severity was assessed pretreatment, mid-treatment (6 weeks), post-treatment and at the 3-month follow-up. RESULTS There were significant improvements on BDD-YBOCS scores (F(3, 71.63)=31.79, p<0.001), that were maintained at 3-month follow-up. Mean differences from baseline in BDD-YBOCS scores were -8.12 (week 6), -12.63 (post-treatment) and -11.71 (3-month follow-up). 47% and 50% of participants were considered treatment responders at post-treatment and 3-month follow-up, respectively. Additionally, remission rates were 28% at post-treatment and 44% at 3-month follow-up. The treatment was also deemed acceptable by patients. CONCLUSIONS The results suggest that BDD-NET can be safely and effectively delivered across international borders to a culturally diverse sample. Larger scale randomised controlled trials with more participants from non-Western cultures are warranted to further validate the cross-cultural generalisability of this treatment. TRIAL REGISTRATION NUMBER NCT03517384.
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Affiliation(s)
- Andrew J Gentile
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Christopher La Lima
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Oskar Flygare
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Jesper Enander
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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Abstract
OBJECTIVE To test patients' willingness to share and link their prior Google search histories with data from their electronic medical record (EMR), and to explore associations between search histories and clinical conditions. DESIGN Cross-sectional study of emergency department (ED) patients from 2016 to 2017. SETTING Academic medical centre ED. PARTICIPANTS A total of 703 patients were approached; 334 of a volunteer sample of 411 (81%) reported having a Google account; 165 of those (49%) consented to share their Google search histories and EMR data; 119 (72%) were able to do so. 16 (13%) of those 119 patients had no data and were not included in the final count. Patients under the age of 18 or with a triage level of 1 were considered ineligible and were not approached. MAIN OUTCOME MEASURES Health relatedness of searches in the remote past and within 7 days of the ED visit, and associations between patients' clinical and demographic characteristics and their internet search volume and search content. RESULTS The 103 participants yielded 591 421 unique search queries; 37 469 (6%) were health related. In the 7 days prior to an ED visit, the percentage of health-related searches was 15%. During that time, 56% of patients searched for symptoms, 53% for information about a hospital and 23% about the treatment or management of a disease. 53% of participants who used Google in the week leading up to their ED visit searched for content directly related to their chief complaint. CONCLUSIONS Patients were willing to allow researchers simultaneous access to their Google search histories and their EMR data. The change in volume and content of search activity prior to an ED visit suggests opportunities to anticipate and improve health care utilisation in advance of ED visits.
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Affiliation(s)
- Jeremy M Asch
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Digital Health, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - David A Asch
- Center for Digital Health, Penn Medicine, Philadelphia, Pennsylvania, USA
- The Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Elissa V Klinger
- Center for Digital Health, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Justine Marks
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Digital Health, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Norah Sadek
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Raina M Merchant
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Digital Health, Penn Medicine, Philadelphia, Pennsylvania, USA
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Huang X, Smith MC, Jamison AM, Broniatowski DA, Dredze M, Quinn SC, Cai J, Paul MJ. Can online self-reports assist in real-time identification of influenza vaccination uptake? A cross-sectional study of influenza vaccine-related tweets in the USA, 2013-2017. BMJ Open 2019; 9:e024018. [PMID: 30647040 PMCID: PMC6340631 DOI: 10.1136/bmjopen-2018-024018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The Centers for Disease Control and Prevention (CDC) spend significant time and resources to track influenza vaccination coverage each influenza season using national surveys. Emerging data from social media provide an alternative solution to surveillance at both national and local levels of influenza vaccination coverage in near real time. OBJECTIVES This study aimed to characterise and analyse the vaccinated population from temporal, demographical and geographical perspectives using automatic classification of vaccination-related Twitter data. METHODS In this cross-sectional study, we continuously collected tweets containing both influenza-related terms and vaccine-related terms covering four consecutive influenza seasons from 2013 to 2017. We created a machine learning classifier to identify relevant tweets, then evaluated the approach by comparing to data from the CDC's FluVaxView. We limited our analysis to tweets geolocated within the USA. RESULTS We assessed 1 124 839 tweets. We found strong correlations of 0.799 between monthly Twitter estimates and CDC, with correlations as high as 0.950 in individual influenza seasons. We also found that our approach obtained geographical correlations of 0.387 at the US state level and 0.467 at the regional level. Finally, we found a higher level of influenza vaccine tweets among female users than male users, also consistent with the results of CDC surveys on vaccine uptake. CONCLUSION Significant correlations between Twitter data and CDC data show the potential of using social media for vaccination surveillance. Temporal variability is captured better than geographical and demographical variability. We discuss potential paths forward for leveraging this approach.
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Affiliation(s)
- Xiaolei Huang
- Department of Information Science, University of Colorado, Boulder, Colorado, USA
| | - Michael C Smith
- Department of Engineering Management and Systems Engineering, George Washington University, Washington, District of Columbia, USA
| | - Amelia M Jamison
- Center for Health Equity, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - David A Broniatowski
- Department of Engineering Management and Systems Engineering, George Washington University, Washington, District of Columbia, USA
| | - Mark Dredze
- Department of Computer Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sandra Crouse Quinn
- Center for Health Equity, School of Public Health, University of Maryland, College Park, Maryland, USA
- Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Justin Cai
- Department of Computer Science, University of Colorado, Boulder, Colorado, USA
| | - Michael J Paul
- Department of Information Science, University of Colorado, Boulder, Colorado, USA
- Department of Computer Science, University of Colorado, Boulder, Colorado, USA
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Peng J, Clarkin C, Doja A. Uncovering cynicism in medical training: a qualitative analysis of medical online discussion forums. BMJ Open 2018; 8:e022883. [PMID: 30341130 PMCID: PMC6196850 DOI: 10.1136/bmjopen-2018-022883] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 09/07/2018] [Accepted: 09/12/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The development of cynicism in medicine, defined as a decline in empathy and emotional neutralisation during medical training, is a significant concern for medical educators. We sought to use online medical student discussion groups to provide insight into how cynicism in medicine is perceived, the consequences of cynicism on medical trainee development and potential links between the hidden curriculum and cynicism. SETTING Online analysis of discussion topics in Premed101 (Canadian) and Student Doctor Network (American) forums. PARTICIPANTS 511 posts from seven discussion topics were analysed using NVivo 11. Participants in the forums included medical students, residents and practising physicians. METHODS Inductive content analysis was used to develop a data-driven coding scheme that evolved throughout the analysis. Measures were taken to ensure the trustworthiness of findings, including duplicate independent coding of a sub-sample of posts and the maintenance of an audit trail. RESULTS Medical students, residents and practising physicians participating in the discussion forums engaged in discourse about cynicism and highlighted themes of the hidden curriculum resulting in cynicism. These included the progression of cynicism over the course of medical training as a coping mechanism; the development of challenging work environments due to factors such as limited support, hierarchical demands and long work hours; and the challenge of initiating change due to the tolerance of unprofessionalism and the highly stressful nature of medicine. CONCLUSION Our unique study of North American medical discussion posts demonstrates that cynicism develops progressively and is compounded by conflicts between the hidden and formal curriculum. Online discussion groups are a novel resource to provide insight into the culture of medical training.
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Affiliation(s)
- Jenny Peng
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Chantalle Clarkin
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Asif Doja
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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van Beusekom I, Bakhshi-Raiez F, de Keizer NF, Dongelmans DA, van der Schaaf M. Lessons learnt during the implementation of a web-based triage tool for Dutch intensive care follow-up clinics. BMJ Open 2018; 8:e021249. [PMID: 30249628 PMCID: PMC6157570 DOI: 10.1136/bmjopen-2017-021249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Screening for symptoms of postintensive care syndrome is based on a long list of questionnaires, filled out by the intensive care unit (ICU) survivor and manually reviewed by the health professional. This is an inefficient and time-consuming process. The aim of this study was to evaluate the feasibility of a web-based triage tool and to compare the outcomes from web-based questionnaires to those from paper-based questionnaires. DESIGN A mixed-methods study. SETTING Nine Dutch ICU follow-up clinics. PARTICIPANTS 221 ICU survivors and 14 health professionals. INTERVENTIONS A web-based triage tool was implemented by nine ICU follow-up clinics. End users, that is, health professionals were interviewed in order to evaluate the feasibility of the triage tool. ICU survivors were invited to fill out web-based questionnaires 3 months after hospital discharge. PRIMARY OUTCOMES Outcomes of the questionnaires were merged with clinical data from a national quality registry to assess the differences in outcomes between paper-based and web-based questionnaires. RESULTS 221 ICU survivors received an invitation to fill out questionnaires, 93 (42.1%) survivors did not respond to the invitation. Respondents to the web-based questionnaires (n=54) were significantly younger and had a significantly longer ICU stay than those who preferred the paper-based questionnaires (n=74). The prevalence of mental, physical and nutritional problems was high, although comparable between the groups. Health professionals' interviews revealed that the software was complex to use (n=8) and although emailing survivors is very convenient, not all survivors have an email address (n=7). CONCLUSIONS Web-based screening software has major benefits compared with paper-based screening. However, implementation has shown to be rather difficult and there are important barriers to consider. Although different in age, the health status is comparable between the users of the web-based questionnaire and paper-based questionnaire.
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Affiliation(s)
- Ilse van Beusekom
- Academic Medical Center, Department of Medical Informatics, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- National Intensive Care Evaluation (NICE) foundation, Amsterdam, The Netherlands
| | - Ferishta Bakhshi-Raiez
- Academic Medical Center, Department of Medical Informatics, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- National Intensive Care Evaluation (NICE) foundation, Amsterdam, The Netherlands
| | - Nicolette F de Keizer
- Academic Medical Center, Department of Medical Informatics, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- National Intensive Care Evaluation (NICE) foundation, Amsterdam, The Netherlands
| | - Dave A Dongelmans
- Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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Abstract
It can be challenging to decide which evidence synthesis software to choose when doing a systematic review. This article discusses some of the important questions to consider in relation to the chosen method and synthesis approach. Software can support researchers in a range of ways. Here, a range of review conditions and software solutions. For example, facilitating contemporaneous collaboration across time and geographical space; in-built bias assessment tools; and line-by-line coding for qualitative textual analysis. EPPI-Reviewer is a review software for research synthesis managed by the EPPI-centre, UCL Institute of Education. EPPI-Reviewer has text mining automation technologies. Version 5 supports data sharing and re-use across the systematic review community. Open source software will soon be released. EPPI-Centre will continue to offer the software as a cloud-based service. The software is offered via a subscription with a one-month (extendible) trial available and volume discounts for 'site licences'. It is free to use for Cochrane and Campbell reviews. The next EPPI-Reviewer version is being built in collaboration with National Institute for Health and Care Excellence using 'surveillance' of newly published research to support 'living' iterative reviews. This is achieved using a combination of machine learning and traditional information retrieval technologies to identify the type of research each new publication describes and determine its relevance for a particular review, domain or guideline. While the amount of available knowledge and research is constantly increasing, the ways in which software can support the focus and relevance of data identification are also developing fast. Software advances are maximising the opportunities for the production of relevant and timely reviews.
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Affiliation(s)
- Sophie Elizabeth Park
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - James Thomas
- EPPI-Centre, Institute of Education, University College London, London, UK
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Lavoie P. Web-based educational intervention improves enrolled nurses' knowledge and performance with deteriorating patients. Evid Based Nurs 2018; 21:55. [PMID: 29437693 DOI: 10.1136/eb-2017-102832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2017] [Indexed: 06/08/2023]
Affiliation(s)
- Patrick Lavoie
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
- Faculty of Nursing, Universite de Montreal, Montreal, Quebec, Canada
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