5-point Scale Research Articles

Optimal child-led goal setting practices for school-aged children with a disability or delay: an international Delphi consensus study

Aim To achieve expert consensus on optimal child-led goal setting and evaluation practices for school-aged children (5 ≤ 17 years) who have a disability or delay. Method A three-round, eDelphi consensus design was used. In Round 1, expert allied health professionals identified factors important during child-led goal setting for: (i) planning, (ii) process steps and tools, and (iii) support strategies. Factors were collated into items for Rounds 2 and 3. Participants rated item agreement on a 7-point Likert scale. Consensus was determined as ≥75% of participants in agreement or disagreement. Results Sixty professionals from nine countries and six disciplines participated. Of 323 unique items generated, 159 (50%) reached consensus. Strong agreement was reached for goal setting and evaluation “process steps” and “support strategies” to engage children. It was strongly recommended that allied health professionals should tailor their processes to each child’s individual needs, provide ability-specific strategies and resources, and empower children to share their perspectives. Fewer items reached consensus for “planning” and “tools” to guide child-led goal setting. Interpretation Professional experts agree that children can be actively involved in goal setting and evaluation. Future research should focus on tools and technologies to support child-led goal setting for children with diverse abilities.

Validation of the Multidimensional Scale of Perceived Social Support among LGBT population in Serbia

Abstract Background Social support represents the belief that one is valued, cared for, and loved by others in a social network and a lack of it may lead to adverse outcomes such as a relapse into depression or emotional distress in physically ill patients. The Multidimensional Scale of Perceived Social Support (MSPSS) is an instrument aimed to measure an individual’s perception of how much he or she receives outside social support. This study aimed to examine the validity and reliability of the Serbian version of MSPSS in a sample of LGBT population in Serbia. Methods The cross-sectional study included 504 respondents, members of the LGBT population living in Serbia. The instrument used was the MSPSS as a self-report measure, containing twelve items rated on a 7-point Likert scale. MSPSS consists of three sub-scales: Family, Friends, and Significant Others. Exploratory (EFA) and confirmatory factor analyses (CFA) were performed with two independent random samples. Results The average score on the scale of social support was 5.58±0.84 (scale of social support by family 4.62±1.41, scale of social support by friends 5.93± 1.99, and scale of social support by the significant others 6.20±0.96, respectively). The Cronbach’s alpha for the entire social support scale was α = 0.772. The three-factor structure of the MSPSS was proved with EFA and CFA. The factor loadings varied between 0.630-0.817. The three factors explained a total of 52.68% of the variance (factor 1- 28.62%, factor 2. 13.16%, factor 3- 10,90%). The three-factor model was adopted during the CFA when the three-factor model CFI (comparative fit index) was 0.969. Conclusions The MSPSS has shown good reliability, internal validity and construct validity and can be used as a convenient measure of social support among the LGBT population. Both EFA and CFA yield a three-factor structure consistent with the theory underlying the measure’s development. Key messages • The results of the study suggest that the Multidimensional Scale of Perceived Social Support has acceptable psychometric properties for use with the LGBT population. • This study supports the use of the MSPSS for assessing community-based collaboration using the three-factor model among the LGBT population.

Envisioning telemedicine in the EU health systems: Insights from policy experts and cancer patients

Abstract Background Conducted as part of WP4 (Sustainability) of the eCAN Joint Action, the aim of this foresight exercise was to understand how telemedicine services in EU-Member States (MS) could be implemented in a patient-centric way to tackle cancer. Methods Based on a literature review, we identified factors that impact on the implementation of telemedicine in EU MS; these were integrated to an online survey. Health policy experts were invited to rank 34 factors using a 7-point Likert scale to better understand the barriers and facilitators of telemedicine services at the health system level, whilst patient associations ranked 28 other factors to capture end-users’ view. Next, survey respondents were invited to a foresight workshop to collect qualitative data and gain a forward-looking perspective. Results 20 health policy experts working in digital health across 14 EU MS, predominantly from Ministries of Health, and 8 cancer patient associations from 5 EU MS responded to the surveys. For a sustainable integration of telemedicine services in the EU, policy experts recommend developing a clear legal framework, embracing a hybrid healthcare model, and enhancing digital literacy. They stress the importance of telemedicine as a complementary tool, advocating for solid IT infrastructure, privacy safeguards, and the integration of health equity. Similarly, cancer patients emphasise the importance of being able to choose between telemedicine and in-person visits, focusing on personal interaction. They advocate for the involvement of patients in the design and testing of telemedicine services, ensuring solutions meet their preferences. Conclusions Policy experts and patients are in favour of hybrid models for cancer care. Recommended public health actions include: i) develop legal frameworks to complement in-person care with telemedicine; ii) boost digital literacy and IT infrastructure, ensuring privacy and health equity; and iii) involve patients in design for tailored services. Key messages • Both the EU Member States and cancer patients view telemedicine as a useful and complementary tool, however, not as a replacement for in-person healthcare services. • Both the EU Member States and cancer patients champion telemedicine with a focus on equity, privacy, digital literacy and a hybrid model of care that respects patient preferences for cancer treatment.

Barriers to Personalised Prevention: Perspectives from a Multi-Stakeholder Consultation

Abstract Background The high and increasing burden of Non-Communicable Diseases (NCDs) demands a healthcare shift towards prevention. Personalised preventive interventions (PPIs) that consider biological, sociocultural, environmental, and behavioural characteristics of individuals, are not as widely adopted as other personalised medicine approaches. To identify the main barriers and gaps that are hindering the adoption of PPIs in healthcare systems, we consulted a wide range of European stakeholders, including health professionals, policy makers, citizens and patients, and researchers. Methods The consultation process included experts’ interviews and an online survey, taking place over 10 months in 2023/2024. Interviews were analysed using qualitative Thematic Analysis. The online survey development was based on the barriers identified by the interviewed experts, complemented with findings from the literature. Respondents scored their level of agreement/disagreement using a 6-point Likert scale. Descriptive statistical analysis was performed. Results A total of 26 semi-structured interviews and 270 complete surveys were obtained. Overall, the main barriers highlighted were: 1) Health systems strategies are geared towards curative care and not prevention. 2) Awareness and understanding of the concept of PPIs is low. 3) There is a lack of basic and life-long training for health professionals on PPIs; 4) There is insufficient evidence for PPIs to raise the necessary policymakers’ interest. 5) Health literacy of citizens and patients is low. 6) There is insufficient prevention research, evidence of cost-efficiency and regulation procedures for translation into health practice. Conclusions Identified barriers are interconnected and the challenges extend beyond prevention to personalized medicine interventions. Collaborative efforts are needed to elevate visibility and engage stakeholders, facilitating integration of PPIs into healthcare systems for widespread adoption. Key messages • This consultation offers valuable insights on challenges that need to be addressed to enable the integration of PPIs into healthcare and reduce the burden of NCDs. • Investments in disease prevention and PPIs should stand as a global key priority.

Non-contrast-enhanced MR-angiography of the abdominal arteries: intraindividual comparison between relaxation-enhanced angiography without contrast and triggering (REACT) and 4D contrast-enhanced MR-angiography.

To evaluate Relaxation-Enhanced Angiography without Contrast and Triggering (REACT), a novel 3D isotropic flow-independent non-contrast-enhanced magnetic resonance angiography (non-CE-MRA) for imaging of the abdominal arteries, by comparing image quality and assessment of vessel stenosis intraindidually with 4D CE-MRA. Thirty patients (mean age 35.7 ± 16.8years; 20 females) referred for the assessment of the arterial abdominal vasculature at 3T were included in this retrospective, single-centre study. The protocol comprised both 4D CE-MRA and REACT (navigator-triggering, Compressed SENSE factor 10, nominal scan time 02:54min, and reconstructed voxel size 0.78 × 0.78 × 0.85 mm3). Two radiologists independently evaluated 14 abdominal artery segments for stenoses, anatomical variants, and vascular findings (aortic dissection, abdominal aorta aneurysms and its branches). Subjective image quality was assessed using a 4-point Likert scale (1 = non-diagnostic, 4 = excellent). REACT had a total acquisition time of 5:36 ± 00:40min, while 4D CE-MRA showed a total acquisition time (including the native scan and bolus tracking sequence) of 3:45 ± 00:59min (p = 0.001). Considering 4D CE-MRA as the reference standard, REACT achieved a sensitivity of 87.5% and specificity of 100.0% for relevant (≥ 50%) stenosis while detecting 89.5% of all vascular findings other than stenosis. For all vessels combined, subjective vessel quality was slightly higher in 4D CE-MRA (3.0 [IQR: 2.0; 4.0.]; P = 0.040), although comparable to REACT (3.0 [IQR: 2.0; 3.5]). In a short scan time of about 5min, REACT provides good diagnostic performance for detection of relevant stenoses, variants, and vascular findings of the abdominal arteries, while yielding to 4D CE-MRA comparable image quality.

Exploring the role of AI-driven chatbots in patient care: a critical evaluation amidst healthcare staff shortages

Abstract Background Amidst the backdrop of staff shortages in healthcare systems, patients and their families are increasingly turning to chatbots, powered by Large Language Models (LLMs), for information about their medical conditions. These AI-driven chatbots, capable of generating human-like responses across a broad range of topics, have become a prevalent tool in the healthcare landscape. Given the proliferation of these chatbots, it is crucial to evaluate the quality and accuracy of the responses they provide. Methods We selected five freely accessible chatbots (Bard, Microsoft Copilot, PiAI, ChatGPT, and ChatSpot) for our study. These chatbots were posed questions spanning three medical fields: cardiology, cardio-oncology, and cardio-rheumatology. The responses generated by the chatbots were then compared against established guidelines from the European Society of Cardiology, American Academy of Dermatology, and American Society of Clinical Oncology. In addition to the content, the readability of the responses was evaluated using four different readability scales: the Flesch Reading Scale, Gunning Fog Scale Level, Flesch-Kincaid Grade Level, and Dale-Chall Score. To assess the accuracy of the responses in accordance with the medical guidelines, two independent medical professionals rated them on a 3-point Likert scale (0 - incorrect, 1 - partially correct or incomplete, 2 - correct). This allowed us to gauge the compliance of the chatbot responses with the medical guidelines. Results Results: In our study, we posed a total of 45 questions to each of the chatbots. Out of the five chatbots, Microsoft Copilot, PiAI, and ChatGPT were able to respond to all the questions. The length of the responses varied, with PiAI providing the shortest average response length of 7.26 words, and Bard providing the longest at 18.9 words. In terms of readability, the Flesch Reading Ease Scale scores ranged from 17.67 (ChatGPT) to 39.34 (Bard), indicating the relative complexity of the responses. The Flesch-Kincaid Grade Level, which reflects the academic grade level required to comprehend the text, ranged from 14.02 (PiAI) to 15.97 (ChatGPT). The Gunning Fog Scale Level, another measure of readability, varied from 15.77 (Bard) to 19.73 (ChatGPT). Lastly, the Dale-Chall Score, which assesses the understandability of the text, ranged from 10.24 (Bard) to 11.87 (ChatGPT). These results highlight the variability in the readability and complexity of responses generated by different chatbots. Readability analysis is presented in table 1. Conclusion This study indicates that chatbots vary in length, quality and readability. They answer each question in their way, based on data they have pulled from the network. Our data suggests that people who want information from a chatbot need to be careful and verify the answers they get.

Introducing online narrated video animations to facilitate patients' understanding of cardiac procedures in a high-volume tertiary centre

Abstract Introduction Discussions about the benefits and risks of invasive procedures, including their alternatives, are an integral part of certain patient consultations in Cardiology. However, patients absorb only a fraction of the information shared during a single encounter, often due to time constraints, leading to an incomplete understanding. Video animation tools were designed to better facilitate communication and consolidate patient (and family members) understanding in advance of their procedure. Purpose We are a high-volume tertiary cardiac centre, and we aimed to assess real-world patient feedback having introduced an online cardiac video animation tool into our organisation. Methods In July 2022, we obtained unlimited patient access to a digital tool that offers short, multi-language narrated video animations covering the breadth of cardiac procedures (cardiac intervention, electrophysiology, structural and cardiac surgery). It is accessible on any device, including a desktop, laptop, or mobile phone. Specifically, we purchased password protected access to 31 video animations in three local languages. Web-links and QR codes for each video animation were designed. These were shared with patients and family members during different stages of the patients’ journey through the hospital. We sampled qualitative feedback from a cohort of patients attending pre-assessment clinic, measured on our electronic patient record via a 3-point Likert scale. Results As illustrated in Figure 1, we adapted our patient pathway to integrate use of this resource in the patient journey by 1) notifying patients during their out-patient cardiologist consultation; 2) emailing video links integrated within an e-consent process; 3) introducing video links as QR codes in patient letters; 4) reminding patients during their nurse-led pre-assessment clinic; 5) via hospital poster advertisements; 6) and on the front page of the hospital website. Since its introduction 18 months ago, 20,607 animation views have occurred, with 90% watched to completion. The three most popular animations were "angiogram/angioplasty" (4135), atrial fibrillation ablation (1415), and TAVI (1243). From July 2022 to December 2023, 1,878 patients have attended our nurse led pre-assessment clinic, and we sampled qualitative feedback from about 20% (342 patients). As demonstrated in Figure 2, 84% of patients felt the procedural video animations were quite helpful/very helpful. The remaining 16% found it "not helpful", with anecdotal reasons being "inability to access the technology", "feeling already adequately informed", or "not wanting to know". Conclusion In our high-volume tertiary centre, online narrated video animations discussing cardiac procedures were successfully implemented into our patient pathway and deemed helpful by the majority of our patients.Fig1.Process map of the patient journeyFig2.Patients’ feedback regarding video

Clinical management and outcomes of patients with infective endocarditis according to frailty status

Abstract Background infective endocarditis (IE) remains a severe condition associated with a remarkably high mortality in certain groups of patients Purpose the aim of this study was to compare both the clinical management and short and mid-term prognosis of patients with IE according to their frailty status. Methods: a total of 200 cases of confirmed IE were consecutively collected in two tertiary hospitals between September 2016 and February 2021, and prospectively followed during one year after diagnosis. Patients were categorised according to the 5-item FRAIL scale as: Group A (n=48), for scores >2, and Group B (n=152), for scores <=2. Results mean age was 70 [SD 15] years, 64% were men and community-acquired infections were 69%. Baseline and clinical data are shown in Table 1. Enterococci were more frequent in Group A, but no significant differences were found regarding infection site, presence of vegetations or periannular complications, time to diagnosis or length of stay. During hospitalization, acute heart failure, delirium and bronchoaspiration were more common among frail patients. Unlike 18F-FDG PET/CT, which was more frequently done in Group B (34 vs 17%, p 0.03), transesophageal echocardiography was similarly performed between groups (92 vs 97%, p 0.08). Less frail patients underwent cardiac surgery (42 vs 68%, p 0.001), with a larger proportion of inoperable patients despite meeting surgical criteria (29 vs 12%, p 0.002). In-hospital mortality was higher in Group A, both overall and by therapeutic strategies, except in those inoperable patients with surgical indication but treated conservatively, where mortality did not differ between groups. Among survivors who completed follow-up (n=144), although recurrence rates were similar, readmission (75 vs 35%, p <0.001) and all-cause mortality rates (36 vs 5%, p <0.001) in Group A exceeded those from Group B. Predictors of in-hospital and 1-year mortality were assessed by logistic regression (Fig. 1), confirming the independent prognostic role of baseline FRAIL score in patients with IE [OR 1.5 (1.2-2.3) and 2.0 (1.5-2.6), respectively, for every additional scale point]. Conclusions frail patients with IE were older, more prone to enterococcal infections and in-hospital complications and had greater comorbidity burden. Both PET/CT and cardiac surgery were less performed in this group, which was characterized by a higher predicted surgical risk, as well as a worse short and mid-term prognosis.

JOBS Program Germany for health promotion among the unemployed

Abstract Aim The unemployed suffer from poorer health than the employed, especially in terms of mental health. At the same time, health promotion reaches unemployed less than employed. The “JOBS Program” is an intervention for the unemployed to promote health. It has shown positive effects in the USA and Finland. The aim of this confirmatory study (Hollederer & Jahn, 2023; Jahn & Hollederer, 2024) was to investigate whether the JOBS Program produces similar effects in Germany. Methods A multicenter randomized controlled trial was applied to compare an intervention group (IVG) with a waiting control group (WCG) before (T0; n = 94), shortly after (T1; n = 65) the intervention and about 6 months after the intervention (T2; n = 43). Fourteen JOBS Program trainings have been conducted. Additionally, JOBS Program trainers were interviewed via voluntary computer-assisted web interviews (resulting in 28 interviews). Results JOBS Program Germany was beneficial. Following changes in the primary outcomes were identified from T0 to T1: Compared to the WCG, a multivariate regression estimated that the IVG had (1) a 0.34 scale point higher level of self-rated general health (p = 0.025; scale range: 1-5 points), (2) a 14.52 scale point higher level of mental well-being (p = 0.004), and (3) a 2.74 scale point higher level of life satisfaction (p = 0.049). About 6 months after the training had been conducted (T2), participants in the JOBS training showed better general health status (0.41-point; p = 0.016) compared to the WCG. Furthermore, 78.5% of the JOBS Program trainers were rather or very satisfied with the theoretical contents and 85.7% with the practical implementation. A central obstacle to the implementation was the COVID-19 pandemic. Conclusions This study provides evidence for the effectiveness of the JOBS Program with respect to the above outcomes, and for older and long-term unemployed, suggesting the benefit of regular implementation for different groups of unemployed in Germany. Key messages • The results of the confirmatory study show positive effects of the JOBS Program on the general health status and unemployment-related mental burden among unemployed people in Germany. • The introduction of the JOBS Program as a nationwide intervention in Germany could be an intervention approach for the unemployed to achieve better health.

Effect of Mechanical Keyboard Switch and Backlight Status on Typing Performance and User Experience

Mechanical keyboards are one of the most used keyboards in daily work, and as the core component of a mechanical keyboard, keyswitches’ characteristics have been widely researched during the last several decades. Meanwhile, keyboards’ backlight design has become an emerging market trend, even though its actual influence on user experience remains unknown. Our study investigated the influence of keyboard switch characteristics and backlight states on typing performance and subjective typing experience. Thirty-three participants were involved in an English-language typing task on keyboards with four typical switches (red, black, brown, and blue types). Software was used to automatically record typing speed and accuracy, and a 7-point Likert subjective scale was used to evaluate typing experience. Results showed that tactile characteristics performed better than linear switches in typing speed, accuracy, and subjective refresh feeling in pair comparison of blue and red switches, and turning on the backlight effect improved typing speed, refreshing feeling, and pleasure. Among six physical characteristics of switches measured in the experiment, pre travel, reset travel, make force, and bottom force contributed more to better typing performance and subjective experience. Our findings provide keyboard manufacturers and researchers with a reference to optimize users’ typing experience.

Associations between stigma and depression among college-attending women with endometriosis symptoms

Background: Endometriosis is a debilitating and highly stigmatized chronic condition. The relationship between stigma and depressive symptoms among college-attending women with endometriosis symptoms was examined. Method: Data were analyzed from a cross-sectional online survey of undergraduate women (N = 424). Mean anticipated, internalized, and enacted stigma values were calculated. Logistic regression assessed the relationship between stigma score and depressive symptoms. Results: Mean stigma scores were 1.98 (anticipated), 1.46 (internalized), and 1.59 (enacted) on a 5-point scale (1 being the lowest and 5 being the highest); 24.1% reported moderately severe/severe depressive symptoms. In adjusted models, stigma was associated with an increased likelihood of moderately severe/severe depressive symptoms (anticipated (aOR = 1.96, 95% CI:1.49–2.59); internalized (aOR =2.67, 95% CI: 1.88–3.85); enacted (aOR = 1.28, 95% CI: 1.16–1.42)). Conclusion: College attending-women with endometriosis symptoms experience stigma which is significantly associated with depressive symptoms. Stigma reducing interventions are warranted and may have mental health benefits.

Effect of Dexmedetomidine with or without Midazolam during procedural dental sedation in children: a randomized controlled clinical trial

BackgroundDental anxiety is a global problem in the realm of pediatric dentistry. The use of procedural sedation is recommended to avoid substandard or unsafe dental treatment in preschoolers. This study aimed to compare the effect sedation with Dexmedetomidine with or without Midazolam in terms of sedation level, analgesic effect and ease of treatment completion in preschool children.MethodsA triple blind randomized controlled clinical trial comprised 72 healthy uncooperative children, 4–6 years old, were randomly allocated into three groups of 24 patients each: Group I patients were sedated with nebulized 5 μg/kg Dexmedetomidine (DEX), Group II with nebulized 3 μg/kg DEX followed by nebulized 0.3 mg/kg Midazolam (MID), and Group III with nebulized 0.5 mg/kg MID. Along the session, the three regimens were assessed and compared during the sedation level (children responsiveness) using the Modified Observer’s Assessment of Alertness/Sedation Scale, the analgesic effect using the Face, Leg, Activity, Cry, Consolability scale and ease of treatment completion using a separate 5-point scale. Vital signs were recorded before and during sedation, until full recovery.ResultsA significant difference was detected regarding children responsiveness during operative procedure in favour of DEX in comparison to MID and DEX/MID groups (P = 0.045). Within the DEX group, a significant difference was recorded regarding children responsiveness at optimum sedation and during the operative procedure (P = 0.04). Although, the analgesic effects of sedative drugs showed no statistically significant difference among the study groups (P = 0.20), the ease of treatment completion was statistically higher in the DEX than MID and DEX/MID groups (P = 0.03).ConclusionDexmedetomidine provides a moderate level of sedation, that allowed better patient cooperation, and easy completion of performed dental procedures.

Perceptions of nursing graduates regarding artificial intelligence interviews: A Q-methodology study

Background & Aim: The integration of Artificial Intelligence (AI) in recruitment processes is increasingly prevalent, particularly within medical institutions. AI interviews are becoming a common practice, and their impact on the perceptions and experiences of candidates is a subject of growing interest. Nursing graduates, who are often at the forefront of medical practice, frequently encounter these AI-driven evaluations during their job searches. This study attempted to examine the perception of AI interviews among nursing graduates who have experienced AI interviews in medical institutions. Methods & Materials: The Q-methodology was applied by selecting 34 Q samples from the 102 concourses extracted through a literature review and in-depth clinical interviews with nursing graduates. The P sample consisted of 35 nursing graduates who had experienced AI interviews. Data were collected using the PQ Method's Q-methodology program, measured on a 9-point scale frame, and Q samples were normally distributed. Results: The study identified four factors of perception: Proactive AI Interview Preparation, Negative Perception of AI Interviews, Positive Perception of AI Interviews, and Critical Acceptance of AI Interviews. Conclusion: In conclusion, perceptions of AI interviews can be categorized into four main types, highlighting both the positive and negative aspects of this technology. The positive aspects include efficiency, fairness, and convenience, while the negative aspects involve concerns about privacy, bias, and the lack of human elements. To design AI interview programs tailored to specific job roles, it is crucial to balance these pros and cons. Additionally, reducing the burden of AI interviews through informative resources and pre-training programs is essential. For successful implementation, ongoing improvements, transparency, and a balanced integration of human judgment are necessary.

Study on Science Laboratories of Government Colleges of Sindh Province

The success of any nation depends very largely upon in its advancement in science and technology. For the development of scientific approach among students, science laboratories play pivotal role. So, the ongoing study was conducted to investigate the status-co of science laboratories working at government Intermediate collages in District Hyderabad. The descriptive type of research was used for this study and followed by survey methods. For the purpose of data collection, a close- ended questionnaire was developed on the pattern of Five Point Scale the systematic random sampling was used to draw the sample sizes from the population. The same questionnaires were administered to each size i.e. Lecturers, Students and Lab. Attendants/ In charges. Data reveals that in most of government colleges possessed their own separate laborites for chemistry, physics and biology. The shortage of consumable and non-consumable item was observed. In nut shell, the science Laboratories in Government Intermediate Colleges are not working effectively. In this way the quality of education is in science subjects are at alarm.

Design and implementation of a project management training program to develop workforce ready skills and career readiness in STEM PhD students and postdoctoral trainees

A growing number of STEM doctorates pursue careers across the broader biomedical workforce, including industry, policy, and healthcare. Graduate and postdoctoral trainees need training to develop professional skills that prepare them for diverse workforce options. Through engagement with faculty and trainees, we determined that formal management skills are underdeveloped in trainees, particularly around managing projects in a way that is translatable to broader industries. At Georgetown University Medical Center, we adapted Kern's six-steps of curriculum design to develop the Academy for Transferable Management Skills (ATMS) program to help graduate and postdoctoral trainees develop linear experience in utilizing project management tools in their academic research contexts. ATMS includes a self-paced online CANVAS course with learning objectives and content modules that map to the project management cycle from initiation to closure, developed in consultation with PhD-level industry experts. From 2021–2024, 25 trainees have completed the ATMS program, including the capstone project and posttest evaluation. Trainees also complete brief quizzes after each module as a formative assessment of learning. The pre-test evaluation (n = 92) revealed a baseline of project management “pain points” regularly encountered by trainees (risk management, project charters, work breakdown structures, and managing project scope). Posttest data (n = 25) reveal a significant increase (p < 0.0001) in project management self-efficacy measures across the aforementioned pain point scales. Notably, 100% of trainees indicated that they may/would refer the program to colleagues. ATMS offers trainees the flexibility to pick frameworks that apply to their projects with trainees planning to use project schedules (84%), Work Break Down Structures (80%), lessons learned reports (68%), and communication plans (68%) in their work. This integrated experiential learning approach equips trainees to develop and execute their projects according to industry-informed project management principles, which allows them to perform their current research more efficiently and to utilize project management frameworks in a way that is directly transferable to broad careers.

Extubation Advisor: Implementation and Evaluation of A Novel Extubation Clinical Decision Support Tool.

Extubation Advisor (EA) is a novel software tool that generates a synoptic report for each Spontaneous Breathing Trial (SBT) conducted to inform extubation decision-making. To assess bedside EA implementation, perceptions of utility, and identify barriers and facilitators of use. We conducted a phase I mixed-methods interventional study in three mixed intensive care unit (ICUs) in two academic hospitals. We interviewed critical care physicians (MDs) and respiratory therapists (RTs) regarding user-centered design principles and usability. We evaluated our ability to consent participants (feasibility threshold 50%), capture complete data (threshold 90%), generate and review EA reports in real-time (thresholds 75% and 80%, respectively), and MD perception of tool usefulness (6-point Likert scale). We analyzed interview transcripts using inductive coding to identify facilitators and barriers to EA implementation and perceived benefit of tool use. We enrolled 31 patients who underwent 70 SBTs. Although consent rates [31/31 (100%], complete data capture [68/68 (100%)], and EA report generation [68/70 (97.1%)] exceeded feasibility thresholds, reports were reviewed by MDs for [55/70 (78.6%)] SBTs. Mean MD usefulness score was 4.0/6. Based on feedback obtained from 36 interviews (15 MDs, 21 RTs), we revised the EA report twice and identified facilitators (ability to track patient progress, enhance extubation decision-making, and provide support in resource-limited settings) and barriers (resource constraints, need for education) to tool implementation. Half of respondents (9 MDs, 9 RTs; combined 50%) perceived definite or potential benefit to EA tool use. This is the first study of a waveform-based variability-derived, predictive clinical decision support tool evaluated in adult ICUs. Our findings support the feasibility of integrating the EA tool into bedside workflow. Clinical trials are needed to assess the utility of the EA tool in practice and its impact on extubation decision-making and outcomes. NCT04708509.

Microneedling With Topical Insulin Versus Microneedling With Placebo in the Treatment of Postacne Atrophic Scars: A Randomized Control Trial.

Among the treatment modalities for post-acne scars, microneedling is considered a safe and effective method. To compare the efficacy and safety of combined microneedling with topical insulin versus microneedling with placebo (topical saline) in treating atrophic acne scars. Twenty-one patients with atrophic post-acne scars were randomized and treated in a split face manner with 4 sessions at 3-week intervals of microneedling using dermapen, followed by application of insulin on one side of the face and saline (placebo) on the other side. Evaluation of response was done before the sessions and after 1 month of the last session using the Global Scarring Grading System of Goodman & Baron and Lipper & Perez scores, Patient reported acne scar improvement using a 4-point scale, patient satisfaction, and the facial acne scar quality of life tools. Both therapeutic modalities yielded a statistically significant improvement of atrophic acne scars. By comparing both modalities, there was no statistical significance regarding clinical improvement and side effects. Using topical insulin combined with microneedling may have a value in improving atrophic acne scars, suggesting further evaluation using different delivery systems, insulin formulations, and assessment modalities.

19 How are paediatric tertiary care hospitals structured to respond to the needs of children with medical complexity during acute deteriorations? A landscape study in Canada

Abstract Background Children with medical complexity (CMC) are at risk of unplanned healthcare visits especially due to acute clinical deteriorations. Complex care (CC) programs help facilitate the needs of CMC. Objectives To identify the organizational and administrative resources available for the care of CMC in Canadian tertiary care paediatric hospitals and to assess how physicians believe these resources are adapted to the specific urgent needs of CMC. Design/Methods In this observational study, key informants representing complex care (CC) and paediatric emergency medicine (PEM) services from 15 paediatric tertiary care hospitals in Canada completed cross-sectional structured questionnaires. Participants were identified through national research networks (Pediatric Emergency Research Canada (PERC), Pediatric Inpatient Research Network (PIRN) and by snowball sampling. Utilizing the Lime Survey web application, two questionnaires (one for PEM, one for CC) were develop based on a literature review and following Burns methodology. Verbal questionnaires were administered via a secured teleconference application or completed digitally. Descriptive data were generated using Excel and SPSS v.29. Results From 09/2022 to 09/2023, 93% (28/30) key informants completed questionnaires (15 PEM, 13 CC, Table 1). Across the 15 sites, 12 had a CC program or clinic. Information about established CC programs was available for 10 sites (Table 2), from participating CC informants: 4/10 offered outpatient services; 6/10 offered inpatient and outpatient services; 8/10 offered last minute appointments for CMC. CC programs had variable staffing: mostly physicians (median 3 FTE, range: 0.2-6) and nurse practitioners (0.75 FTE, range: 0-9) or registered nurses (0.9 FTE, 0-8). CC informants reported offering an ED consultation service at 8/10 sites, while 6/12 PEM participants reported access to such a service. CC informants reported that their program rarely offered consultations during weekends (2/10) or nights (1/10). Across all sites, PEM informants reported good access to documents to help with continuity of care including emergency care plans (13/15), medical history (14/15), goals of care (13/15). Using an 11-point scale, CC informants rated their hospital’s median ability to meet the outpatient needs of CMC as 6.5 (range: 0-10), and their ED’s median ability to meet the needs of CMC as 7 (range 5-10). PEM informants reported their median ability to meet the needs of CMC as 8 (range 6-9). Informants made suggestions to improve the ED care of CMC (Table 3). Conclusion There exists wide variation in the structures caring for CMC and their availability in case of acute needs. National collaboration between CC and PEM teams may facilitate the design of programs to improve the acute outpatient care of CMC.

Assessment of Farmer’s Attitude towards Drip and Traditional Irrigation System in Junagadh District, Gujarat

Cotton (Gossypium herbaceum) is a leading natural fiber crop that is cultivated for its soft, fluffy staple fiber. Drip irrigation is a method of irrigation wherein water is carried to the plant under low pressure, through small diameter plastic pipes and delivered at the root zone drop by drop through an emitting device. The research was conducted in Junagadh district, utilizing a multistage sampling technique. A total of 160 farmers comprising 80 drip irrigation user and 80 conventional irrigation system users were surveyed. Likert’s scale with three point scale was used to analyse attitude towards the drip and traditional irrigation system by using 10 statements for each respondents. The farmers in the research area having positive attitudes toward the drip irrigationmethods as positive trend with value 66.25% was observed among drip respondents. This positive attitude reflects the behavioural intention towards the acceptance of irrigation systems. The study also revealed that 48.75% of the non-adopter farmers had the positive attitude toward the traditional irrigation methods whereas 51.25% of them had a negative and neutral attitude.

Comparative evaluation of analgesic efficacy of buprenorphine transdermal patch and fentanyl transdermal patch in the management of postoperative pain after lower limb surgery

Background: Postoperative pain represents a significant medical issue that needs immediate attention. Despite advancements in pain management, managing postoperative pain remains challenging. Transdermal drug delivery systems (TDDS) offers a straightforward, reliable, non-invasive, and patient-friendly approach for alleviating post-surgical pain. Hence, this study was planned to evaluate the analgesic efficacy of buprenorphine and fentanyl transdermal patch in the management of post-operative pain after lower limb surgery. Methods: In this prospective, randomised study, 82 adult patients of either sex undergoing elective lower limb surgery were randomly allocated into two groups- Group A (Transdermal Buprenorphine 20 mg patch) and Group B (Transdermal Fentanyl 50 mcg patch). Postoperative pain was assessed by 10-point Visual Analogue Scale (VAS) every 6 hours following surgery on the first day and then daily for next 4 days. All patients were also monitored for total rescue analgesic requirement, drug-related adverse effect and haemodynamic status. Statistical analysis was carried out using student t-test and Chi-square test. A p-value <0.05 was considered significant. Results: The mean pain intensity scores were found to be significantly different (p<0.0001) between the two groups, with VAS scores consistently lower in Buprenorphine group as compared to Fentanyl group. Also, Buprenorphine group had the lowest demand for rescue analgesic, with 58.5% of patients requiring two administrations and 36.6% needing only one. Patients belonging to Fentanyl group exhibited higher occurrence of nausea (46.3%), vomiting (46.3%) and pruritus (31.7%). Conclusions: Our study concludes that transdermal patch of buprenorphine demonstrates superior efficacy and safety profile as compared to fentanyl patch for post-operative pain management in lower limb surgeries.