Analysis Of Free-text Responses Research Articles

Stalking, harassment, gendered abuse, and violence towards politicians in the COVID-19 pandemic and recovery era.

High levels of harassment and threats against parliamentarians are being reported internationally, especially in the social media space. This is occurring alongside changes in our social landscape, with increasing political polarisation and the ongoing ramifications from the COVID-19 pandemic. Harassment of politicians has been shown to have implications for psychological wellbeing and physical safety. To investigate harassment and violence towards parliamentarians in the COVID-19 pandemic and recovery era, including whether there had been a change in its nature and quantity, and to explore the contribution of social media. A survey of all New Zealand's parliamentarians was fielded in 2022, focusing on their experiences of harassment analysed quantitatively and with manifest and latent content analysis of free text responses. Data were disaggregated and compared by gender. Secondary analyses were conducted on similar data collected from parliamentarians in 2014 to compare trends over time. We obtained a cleaned achieved survey sample of 54 Members of Parliament (MPs). Harassment was reported by 98% of respondents, ranging from disturbing communication to actual physical violence. The vast majority of MPs endorsed multiple modalities of harassment occurring on multiple occasions. Ninety-six percent of MPs had been harassed over social media, with over half being threatened, including threats of physical violence (40%), sexual violence (14%), threats made towards MP's family members (19%), threats towards staff (12%), and death threats (27%). Almost all forms of harassment had increased significantly since 2014. Most MPs reported experiencing abuse related to the Government response to the COVID-19 pandemic (e.g. lockdowns and vaccine mandates). Many MPs commented that the frequency and intensity of abuse increased markedly during the COVID pandemic and had not subsequently abated. Women were at significantly higher risk of certain types of social media harassment including gendered abuse, sexualised comments, threat of sexual violence, and threats toward their family. Harassment of parliamentarians is an escalating issue. Online threats and misogyny are increasingly apparent. This harassment has significant psychosocial costs for victims, their family and staff, and for democratic processes.

Overnight In-House Critical Care Resource Intensivist Improves General Surgery Resident Education.

24/7 critical care staffing has become more commonplace, and their impact on resident training must be carefully considered. At our institution, the Critical Care Resource Intensivist (CCRI) model was implemented to provide in-house dedicated faculty responsible solely for the provision of critical care overnight. An anonymous survey was distributed to all general surgery residents to evaluate CCRI's impact on education and autonomy. Descriptive statistics were completed for quantitative data. Qualitative analysis of free text responses was completed to identify consensus themes. Responses from 26 residents demonstrated they associated CCRI with improved resident education, supervision, and patient care, without limiting autonomy. Qualitative analysis yielded 7 themes, reflecting improvements in patient care and safety, progression of care, operations and procedures, improved education, availability, and independence, but noted potential for conflict. Our findings show 24/7 dedicated intensivist staffing can enhance general surgery resident education without limiting autonomy.

Community pharmacists' perceptions on managing people with oral health problems-A prioritisation survey.

Alternative sources of oral health information are likely to be of benefit to the public, particularly where access to dental services is limited. There is evidence that community pharmacists are willing to advocate for oral health, but it is unclear what is needed to develop this role. The aims of this study were to obtain the views of community pharmacy staff on the frequency and type of oral health conditions they encounter challenges in management and training/research priorities. An anonymous online survey targeted pharmacy staff and elicited quantitative data related to the types and frequencies of oral health conditions experienced. Participants were stratified by age, gender, ethnicity, experience and setting. Free text responses allowed participants to detail challenging aspects of patient management, their priorities for service development and future research. Reflexive thematic analysis of free text responses identified key themes. Oral/facial pain and swelling were seen weekly by most respondents, and daily by 28.8%. Other commonly presenting conditions were ulcers, dry-mouth, thrush and denture issues. Challenges in managing oral health conditions included: access to NHS dentistry, awareness of referral pathways, examination/diagnosis and understanding 'Red Flags'. Acute and chronic oral health conditions commonly present to community pharmacists who lack necessary knowledge/training, which may result in missing 'red flag' symptoms for oral cancer or acute facial swellings which can be life threatening. There is a need to support pharmacists, who are willing to act as oral health advocates, in recognition, prevention and onward referral for oral diseases.

What helps patients access web-based services in primary care? Free-text analysis of patient responses to the Di-Facto questionnaire

BackgroundThe National Health Service (NHS) and general practice are increasingly adopting digital services. These services can impact both positively and negatively upon patient experiences, and access to digital services is not equal amongst all groups. Within a wider project examining digital facilitation (the Di-Facto study) our team conducted a patient survey amongst English primary care practices aiming to investigate patient views of what supports uptake and use of web-based services. This paper reports on the analysis of the free-text responses from the patient survey.MethodsThe Di-Facto patient survey was distributed to practices in eight clinical commissioning groups (CCGs) in England between 2021–2022. We examined free-text responses to two questions relating to access to primary care web-based and support for web-based services. We used qualitative reflexive thematic analysis based on a six-stage process to analyse responses.ResultsOf the 3051 patients who responded to the Di-Facto survey, 2246 provided a free-text response. We present our findings in two major themes: systems and structures and their impact on use of web-based services, and ‘what works for me’, a description of how respondents described what worked, or did not work in terms of their interactions with web-based services. Respondents described how the technology, such as poor practice website design, confusion over multiple digital apps, data security and concerns about eConsultation offerings impacted on use of web-based services. Respondents described practice level barriers, such as a lack of or inconsistent provision, which prevented optimal use of web-based services. Respondents described personal and technical barriers that impacted on their use of digital services, and described which web-based services worked well for them. Respondents felt that web-based services were not a replacement for face-to-face interactions with a doctor.ConclusionsThis analysis of free-text responses from a large patient survey highlights the system, practice, and person level barriers and facilitators to use of digital services in primary care. With an increasing push towards digital solutions in NHS primary care, practices should consider the design, rollout and communication of their web-based services to support patient access.

Why do people use ChatGPT? Exploring user motivations for generative conversational AI

Generative conversational artificial intelligence (AI), such as ChatGPT, has attracted substantial attention since November 2022. The advent of this technology showcases the vast potential of such AI for generating and processing text and raises compelling questions regarding its potential usage. To obtain the requisite knowledge of users’ motivations in adopting this technology, we surveyed early adopters of ChatGPT (n = 197). Analysis of free text responses within the uses and gratifications (U&G) theoretical framework shows six primary motivations for using generative conversational AI: productivity, novelty, creative work, learning and development, entertainment, and social interaction and support. Our study illustrates how generative conversational AI can fulfill diverse user needs, surpassing the capabilities of traditional conversational technologies, for example, by outsourcing cognitive or creative works to technology.

Identifying the motives for and against drinking during pregnancy and motherhood, and factors associated with increased maternal alcohol use

Abstract Aim Maternal drinking (alcohol use during pregnancy/motherhood) is a hidden public health concern which can have significant negative effects on the woman and child. This pilot survey explored several domains that might influence maternal drinking. Subject and methods Two cross-sectional, online surveys recruited (1) women who were pregnant and (2) mothers who were not pregnant. Surveys captured data on alcohol use and harmful drinking, attitudes on and motives for drinking/not drinking, and perceived barriers to drinking less. Content analysis of free text responses complemented quantitative data. Results In this convenience sample of 836 pregnant women and 589 mothers, 91% of pregnant women and 28% of mothers reported abstinence. Of those reporting alcohol use, median consumption was 2.3 units/week in pregnant women, and 6.9 units/week in non-pregnant mothers. Of mothers currently drinking, 25.1% reported hazardous or harmful levels. Heavier drinking was associated with numerous motives, including using alcohol as a coping strategy. Child welfare was a key motivating factor for not drinking, as were practical issues of motherhood. The stresses of motherhood were a perceived barrier to reducing drinking, and mothers reported more barriers than pregnant women. Conclusion Stress reduction motives may be a risk factor for heavier maternal drinking, while motives for not drinking seem to be focused on child welfare and maternal well-being. Stress and a lack of knowledge about how to reduce drinking appear to be barriers for mothers to change their drinking behaviour. These findings can inform the development of effective public health interventions to reduce maternal drinking.

The U.S. Supreme Court Dobbs decision’s impact on the future plans of 2023 residency graduates at the University of Utah

This study aimed to understand how the Dobbs decision impacted graduating resident physicians in Utah and to understand residents' perspectives on abortion access. We invited all 2023 graduating residents at the University of Utah, from all specialties, to participate in this survey. We analyzed univariate relationships between respondent demographics and change of career plans post-Dobbs. We also performed a thematic analysis of free text responses. We received responses from 85 residents (55% of all graduating residents from the University of Utah) representing 19 specialties. Six (7%) residents changed their practice location due to the Dobbs decision. Most residents supported and wanted to advocate for legal abortion. In a thematic analysis, many graduating residents do not want to live in an abortion-restrictive state. The Dobbs decision impacts physicians across all specialties, not just obstetrician/gynecologists. Future research into the impact of the Dobbs decision should include physicians of all specialties.

Variable Practice, Variable Results: Impact of Postinterview Communication Practices Among Critical Care Medicine/Pulmonary and Critical Care Medicine Fellowship Applicants and Program Directors

BackgroundWhile post-interview communication (PIC) guidelines exist, adherence is voluntary. There are no studies of PIC practices in Critical Care Medicine (CCM) and Pulmonary and Critical Care Medicine (PCCM) fellowship recruitment. Research QuestionWhat is the frequency, format, goals, and content of PIC between CCM/PCCM applicants and program directors (PD)? What is the impact of PIC on applicant and program rank order lists (ROL)? Study Design and MethodsCCM/PCCM applicants and PDs were separately surveyed after the 2022-2023 National Resident Matching Program Specialty Match. Surveys included multiple-choice, Likert-scale, and two free text questions. Thematic content analysis of free text responses was performed. ResultsOne-third of eligible participants responded (applicants: n=373, 34%; PDs: n=86, 32%). Applicant respondents applied to CCM (19%), PCCM (69%), or both (12%). PDs represented CCM (17%), PCCM (57%), or both (26%) programs. Applicant (66%) and PD (49%) respondents reported initiating PIC. PIC did not impact ROL decision for most applicants (73%) or PDs (83%), though 21% of applicants and 17% of PDs moved programs or applicants up on their ROL in response to PIC. A quarter (23%) of applicants strongly agreed or agreed that PIC was helpful in creating their ROL, 27% strongly disagreed or disagreed, and 29% were neutral. PIC challenges identified by both groups included time, lack of uniformity, peer pressure, misleading language, and uncertainty about motives, rules, and response protocols. InterpretationPIC is common among CCM/PCCM applicants and PDs. About 50% of applicants and 20% of PDs share ranking intentions via PIC. While PIC did not impact ROL for most applicants and PDs, a minority of applicants and PDs moved programs up on their ROL after receiving PIC from the other party. Applicants have mixed perspectives on PIC value. Applicants and PDs alike desire clear guidance on PIC to minimize ambiguous and misleading communication.

How and to what extent did the Coventry City of Culture ‘City Host’ volunteer programme affect the volunteers’ mental wellbeing? A qualitative study

BackgroundA team of volunteers, known as City Hosts, were recruited to support UK City of Culture 2021 awarded to Coventry. City Hosts held various roles facilitating cultural event delivery and promoting a positive experience for visitors. This study aimed to (i) understand how and to what extent the volunteering programme impacted volunteer subjective wellbeing, and (ii) explore the mechanisms of change and intermediate outcomes between volunteering and subjective wellbeing.MethodsThis qualitative study comprised inductive and deductive analysis of data collected through semi-structured interviews, conducted between December 2021–May 2022 with City Hosts. This was complimented with secondary qualitative analysis of free text responses within Monitoring and Evaluation data collected from City Hosts in surveys conducted in August and November 2021, and April 2022.ResultsApproximately 180 City Hosts responded to the free text questions in each survey and 27 completed interviews. Analysis of data collected from City Hosts suggested positive wellbeing impacts from volunteering and supported theorised pathways to improved wellbeing. Strengths of the City Host programme included (i) facilitating the full range of mechanisms of change that mediate improved volunteer wellbeing, particularly promoting social connections and developing a strong role and group identity and (ii) flexibility around what volunteers do, how much, and how often.ConclusionsThis study offers lessons for others designing volunteering programmes who wish to promote wellbeing among associated volunteers. We also offer evidence that exposure to culture may be one mechanism by which volunteering can improve wellbeing.

A survey of dental professionals' opinions around the use of antibiotics in molar 3 extractions and dental implant placement.

This survey was conducted to determine the type and frequency of antibiotics (AB) use for the prevention of infections in dental third molar (M3) extraction and implantation procedures (DIP) among UK dentists and the opinions underpinning their practice. Systematic reviews of the evidence were undertaken alongside this survey of practicing dentists in the United Kingdom to identify the opinions and practices of those undertaking the procedures.With ethical approval, a survey was designed for online delivery and was sent to every dental practitioner in the UK with a publicly available email address or social media contact. The opening page provided the project information sheet and proceeding to complete and submit the questionnaire was considered consent to participate. The online survey was circulated to 900 identified addresses and a total of 145 responses were received. Responses were collated in Microsoft® Excel™ and analyzed using IBM® SPSS™ plus thematic analysis of free text responses. There were 42% of participants (n=61) who discouraged AB prophylactic use in M3 extractions in people with no systemic conditions and who also preferred postoperative AB use when required. Where, 57.9% of respondents (n=84) supported the short-term use of ABs (5-7 days) for M3 extraction and 53% (n=77) in DIP placement in patients with no relevant medical history. As an ad hoc finding, dentists reported on the negative impact of heavy smoking and oral parafunctional behavior on DIP success. The use of antibiotics and broad spectrum antibiotics remains higher than current guidelines would recommend. Further research is required to clarify the specific risks arising from underlying medical conditions to further clarify where prophylaxis is required.

Patient-reported experiences and satisfaction with head and neck surgery outreach clinics in regional New South Wales, Australia: A cross-sectional survey.

Head and neck surgery services are increasingly being centralised in Australia. Outreach models can overcome burdens of travel that patients in regional and rural areas experience when attending routine appointments, by providing services closer to home. To explore patient-reported experiences and satisfaction with regional outreach services for head and neck surgery in Australia. Patients who attended two regional outreach clinics in New South Wales (NSW), Australia, were surveyed over a 6-month period. Patients completed the Outpatient Cancer Clinics Survey (2020 version) that explored perceptions and experiences of the clinic. Patients with cancer were asked to complete the Edmonton Symptom Assessment System and the Communication and Attitudinal Self-Efficacy scale. Descriptive statistics and analysis of data was performed, and results were compared to the NSW statewide Outpatient Cancer Clinics Survey (2020). Content analysis of free text responses was performed. Some 128 patients responded (56% response rate; mean age 67.2 years, 46.1% female). Compared to the 2020 NSW survey, a higher proportion of patients in our cohort responded positively to 14 of the 26 questions, with the greatest differences observed for questions regarding waiting area comfort (+12.1%, p = 0.008), being informed about different treatment options (+9.5%, p = 0.04), and issues relating to parking (+9.5%, p = 0.03). A lower proportion of our sample responded positively to the question about whether health professionals knew enough about their medical history (-19.3%, p < 0.001). Respondents appreciated having a local clinic that helped them avoid travel to major cities and associated expenses and highlighted benefits of expert consultation and timeliness of investigations. However, cost of appointments and level of reimbursements remain barriers for some patients. Patients had a high level of satisfaction with regional outreach clinics for head and neck surgery across most domains, indicating patients highly value this service.

The Power Hour of Writing: An empirical evaluation of our online writing community

The “Power Hour of Writing” is an institution-led approach which brings together staff and postgraduate research students in a community that encourages participants to write regularly as part of their academic practice, helping to develop sustainable habits. This research into the “Power Hour of Writing” combines analysis of participant numbers with qualitative analysis of free text responses from online surveys taken at three different time points. Three themes emerged and were evident across all three surveys, independent of their time point: The importance of community; making writing a legitimate part of people’s everyday work; and accountability, which is built into the structure of the “Power Hour Of Writing”. Our research indicates that regular, short timeslots for writing can have a valuable impact on staff and postgraduate researchers. Not only did this intervention help build the community at a time while people were working even more in isolation due to the pandemic, but it also highlighted to participants that protecting time for writing benefits their work.

The Patient's perspective: A review of the results from a radiotherapy patient experience survey in the North-West of England

IntroductionA patient experience survey was undertaken for patients completing radiotherapy at the three Northwest of England Radiotherapy Providers. MethodsA previously reported National Radiotherapy Patient Experience Survey was adapted and undertaken in the Northwest of England. Quantitative data was analysed to establish trends. Frequency distribution was applied to appraise the number of participants selecting each of the pre-determined responses. Thematic analysis of free text responses was conducted. ResultsThe questionnaire received 653 responses from the 3 providers across seven departments. Thematic analysis revealed 3 themes; logistics, information and operational. ConclusionThe results indicate that the majority of patients are satisfied with their treatment and care. Patients' responses indicate areas for improvements. Expectancy theory states that an individual's satisfaction is related to the difference between expected service and the service received. Consequently, when reviewing services and developing improvement it is important to understand patients' expectations. This regional survey starts to capture what people receiving radiotherapy expect from the service and the professionals delivering their treatment. Implications for practiceThis survey responses make a case for reviewing the information provision pre and post radiotherapy. This includes clarifying the understanding of consent for treatment including the intended benefits and potential late effects. There is an argument to offer information sessions prior to radiotherapy to achieve more relaxed and informed patients. A recommendation from this work is for the radiotherapy community undertake a national radiotherapy patient experience survey, facilitated via the 11 Radiotherapy ODNs. A national radiotherapy survey has multiple benefits to inform improvements in practice. This includes benchmarking services against national averages. This approach is aligned with the principles of the service specification in terms of reducing variation and increasing quality.

Examiner perceptions of the MRCGP recorded consultation assessment for general practice licensing during COVID-19: cross-sectional study

BackgroundThe Recorded Consultation Assessment (RCA) was developed rapidly during the COVID-19 pandemic to replace the Clinical Skills Assessment (CSA) for UK general practice licensing. Our aim was to evaluate examiner perceptions of the RCA.MethodsWe employed a cross-sectional design using a questionnaire survey of RCA examiners with attitudinal (relating to examiners thoughts and perceptions of the RCA) and free text response options. We conducted statistical descriptive and factor analysis of quantitative data with qualitative thematic analysis of free text responses.ResultsOverall, 182 of 260 (70%) examiners completed the questionnaire. Responders felt that consultations submitted were representative of the work of a typical GP during the pandemic and provided a good sample across the curriculum. They were also generally positive about the logistic, advisory and other support provided as well as the digital platform. Despite responders generally agreeing there was sufficient information available in video or audio consultations to judge candidates’ data gathering, clinical management, and interpersonal skills, they were less confident about their ability to make judgments of candidates’ performance compared with the CSA. The qualitative analysis of free text responses detailed the problems of case selection and content, explained examiners’ difficulties when making judgments, and detailed the generally positive views about support, training and information technology. Responders also provided helpful recommendations for improving the assessment.ConclusionThe RCA was considered by examiners to be feasible and broadly acceptable, although they experienced challenges from candidate case selection, case content and judgments leading to suggested areas for improvement.

Differentiated mental health patterns in pregnancy during COVID-19 first two waves in Sweden: a mixed methods study using digital phenotyping.

To utilize modern tools to assess depressive and anxiety symptoms, wellbeing and life conditions in pregnant women during the first two waves of the COVID-19 pandemic in Sweden. Pregnant women (n = 1577) were recruited through the mobile application Mom2B. Symptoms of depression, anxiety and wellbeing were assessed during January 2020-February 2021. Movement data was collected using the phone's sensor. Data on Google search volumes for "Corona" and Covid-related deaths were obtained. Qualitative analysis of free text responses regarding maternity care was performed. Two peaks were seen for depressive symptoms, corresponding to the two waves. Higher prevalence of anxiety was only noted during the first wave. A moderating effect of the two waves in the association of depression, anxiety, and well-being with Covid deaths was noted; positive associations during the first wave and attenuated or became negative during the second wave. Throughout, women reported on cancelled healthcare appointments and worry about partners not being allowed in hospital. The association of mental health outcomes with relevant covariates may vary during the different phases in a pandemic, possibly due to adaptation strategies on a personal and societal/healthcare level. Digital phenotyping can help healthcare providers and governmental bodies to in real time monitor high-risk groups during crises, and to adjust the support offered.

Food Values, Food Purchasing, and Eating-Related Outcomes Among a Sample of Quebec Adults During the COVID-19 Pandemic.

Purpose: This investigation evaluated food values, food purchasing, and other food and eating-related outcomes during the COVID-19 pandemic in Quebec, Canada. The role of stress in eating outcomes was also examined.Methods: An online household survey was conducted among Quebec adults aged ≥18 years (n = 658). Changes in outcomes during, as compared to before, the pandemic were evaluated using descriptive statistics and thematic analysis of free text responses. Eating outcomes by daily stress level (low, some, high) were assessed using Cochran-Armitage test for trend.Results: Most respondents reported increased importance and purchasing of local food products (77% and 68%, respectively) and 60% reported increased grocery spending (mean ± standard deviation: 28% ± 23%). Respondents with a higher daily stress level had a higher frequency of reporting eating more than usual compared to before the pandemic (low stress 21%, some stress 34%, high stress 39%, p-trend <0.0001). Free text responses described more time spent at home as a reason for eating more than usual.Conclusions: To support healthy eating during and post-pandemic, dietitians should consider patients' mental/emotional well-being and time spent at home. Moreover, support of local food products may provide opportunities to promote healthy eating, sustainability, and post-pandemic resiliency of food systems.

Interprofessional education programs to foster the use of Learning Health Systems

Healthcare management continues to worsen, with process inefficiencies, wastage, unsafe practices and accordingly, non-optimal patient care. The concept of the Learning Health Systems (LHS) demonstrates the potential for the utilisation of health data in real time, through rapid and continuous cycles of data interrogation, implementation of insights into practice, and eventually practice change (Friedman &amp; Flynn, 2019). Yet, the lack of appropriately skilled workforce results in an inability to leverage existing data to design innovative solutions. We identified a need to develop tailored professional development programs to foster skilled interdisciplinary learning communities in the healthcare workforce, as well as digital health champions that understand each other’s roles and capabilities, to collaboratively solve these complex problems. Thus, we have developed multiple educational programs of work, including a professional development short course and a year-long Academy Fellowship program, to teach LHS principles. The short course is wholly online, open to interdisciplinary professionals working in the digital health arena. To foster interprofessional learning, we assigned participants into working groups of five interprofessional members, who worked together and shared knowledge, perspectives and experiences in workshop activities throughout the 13-week course. We employed a flipped classroom approach, utilising various eLearning tools such as crowdsourced evidence synthesis Mind Maps; Jupyter Notebooks for hands on data interrogation, data visualisation and interpretation of machine learning models; clinical process modelling software (LucidChart); and virtual care platform for prototype testing digital health solutions (Datos), which showcasing the potential of technology. We undertook a mixed methods evaluation, to determine the utility and success of our programming. This framework consisted of pre and post-surveys with identical measures of self-efficacy, ratings scales for engagement, usefulness, applicability and value for various aspects of the course. Participants were also invited to participate in a semi-structured interview post course. This allowed a deeper dive into themes relating to utility, barriers, recommendations for future applicability, and evolving digital health identity. The evaluation results demonstrated that participants found the teaching model useful, engaging, applicable and valuable to their daily tasks and workplace LHS projects. Self-efficacy scales revealed a significant increase in perceive confidence. From interviews and analysis of free text responses, we discovered that the program gave participants a shared language and common understanding to converse with other interprofessional peers; transformed their perceptions of their role and the potential of data and technologies; provided a framework to organise their transformation plans; and finally provided a toolkit to refer to and operate from. The most notable observation from the LHS Academy Fellows, was a significant increase in the number of fellows identifying themselves as leaders at the end of their foundational coursework compared to at the start of the program. It is clear that in order to transform healthcare systems to their full potential, it requires a workforce with an understanding of LHS and the potential of data driven approaches, as well as an appreciation for the need for diversly skilled learning communities to tackle these problems together.

Fixing the System: Strategies to Support Women in Academic Medicine.

"It feels like we are constantly treading water to just stay afloat and get by." (Female, Parent, Faculty, 6-10 years in practice)1 Gender disparities are well documented in academic medicine, including the representation of women in authorship, speaking opportunities, and other measures of academic productivity.2,3 Unfortunately, the COVID-19 pandemic has further exacerbated this gender divide,4 which threatens women's career advancement and risks accelerating the attrition of women from academic medicine.5 Women faculty with children are particularly vulnerable and more likely than faculty without children to consider departing academic medicine.6 Although the societal view of women as caregivers is not new, the increased demands placed on caregivers during the COVID-19 pandemic have been unprecedented. In this month's issue of Hospital Pediatrics, Sharp et al. describe a survey study revealing that women pediatricians who were parents were significantly more likely to report decreased academic productivity during the COVID-19 pandemic compared to men with children.1 The authors' qualitative thematic analysis of free text responses provides further insight into key stress points for women physicians during the pandemic. While the focus of Sharp et al.'s survey was on childcare, the highlighted points of stress likely also apply to women in other caregiving roles, such as caring for elderly parents. The authors call for intentional change from institutions, grant funding agencies, medical societies, journals, and leaders to support all women in medicine. We review key strategies that each of these stakeholders can take to promote meaningful and sustainable change.

Exploring the Impact of Using Patient-Specific 3D Prints during Consent for Skull Base Neurosurgery.

Objectives Informed consent is fundamental to good practice. We hypothesized that a personalized three-dimensional (3D)-printed model of skull base pathology would enhance informed consent and reduce patient anxiety. Design Digital images and communication in medicine (DICOM) files were 3D printed. After a standard pre-surgery consent clinic, patients completed part one of a two-part structured questionnaire. They then interacted with their personalized 3D printed model and completed part two. This explored their perceived involvement in decision-making, anxiety, concerns and also their understanding of lesion location and surgical risks. Descriptive statistics were used to report responses and text classification tools were used to analyze free text responses. Setting and Participants In total,14 patients undergoing elective skull base surgery (with pathologies including skull base meningioma, craniopharyngioma, pituitary adenoma, Rathke cleft cyst, and olfactory neuroblastoma) were prospectively identified at a single unit. Results After 3D model exposure, there was a net trend toward reduced patient-reported anxiety and enhanced patient-perceived involvement in treatment. Thirteen of 14 patients (93%) felt better about their operation and 13/14 patients (93%) thought all patients should have access to personalized 3D models. After exposure, there was a net trend toward improved patient-reported understanding of surgical risks, lesion location, and extent of feeling informed. Thirteen of 14 patients (93%) felt the model helped them understand the surgical anatomy better. Analysis of free text responses to the model found mixed sentiment: 47% positive, 35% neutral, and 18% negative. Conclusion In the context of skull base neurosurgery, personalized 3D-printed models of skull base pathology can inform the surgical consent process, impacting the levels of patient understanding and anxiety.

Barriers and enablers of weight management after breast cancer: a thematic analysis of free text survey responses using the COM-B model

BackgroundWeight gain is common after breast cancer. The aim of this study was to identify and describe the barriers to and enablers of successful weight management for women with breast cancer.MethodsThis was a combined inductive and deductive framework analysis of free text responses to an anonymous cross-sectional survey on weight after breast cancer. Women were recruited mainly through the Breast Cancer Network Australia Review and Survey Group. We applied deductive thematic analysis to free text responses to questions on barriers, enablers, research priorities, and one open-ended question at the end of the survey using the Capability, Opportunity, Motivation and Behaviour (COM-B) model as a framework. Subthemes that arose from the inductive analysis were mapped onto the COM-B model framework. Findings were used to identify behaviour change intervention functions.ResultsOne hundred thirty-three women provided free text responses. Most women were of Caucasian origin and had been diagnosed with non-metastatic breast cancer, with a mean age of 59.1 years. Women's physical capability to adopt and sustain healthy lifestyle habits was significantly affected by treatment effects and physical illness, and some lacked psychological capability to self-regulate the face of stress and other triggers. Limited time and finances, and the social impact of undergoing cancer treatment affected the ability to control their diet. Frustration and futility around weight management were prominent. However, some women were confident in their abilities to self-regulate and self-monitor lifestyle behaviours, described support from friends and health professionals as enablers, and welcomed the physical and psychological benefits of being active in the context of embracing transformation and self-care after cancer.ConclusionWomen need specific advice and support from peers, friends and families and health professionals. There is a substantial gap in provision of supportive care to enable women to adopt and sustain healthy lifestyles. Environmental restructuring (including financial support), incentivization (creating an expectation of looking and feeling better), persuasion and coercion (aiming to prevent recurrence), and equipping women with specific knowledge and skills, would also facilitate optimal lifestyle behaviours and weight management.