Analysis Of Free-text Responses Research Articles

Oncology patients’ perspectives on remote patient monitoring for COVID-19.

1504 Background: Oncology patients are particularly vulnerable to adverse outcomes from COVID-19 and require careful monitoring to identify early deterioration and render higher level care when indicated. Several institutions launched remote patient monitoring programs (RPMPs) to care for patients with COVID-19. We describe patients’ perspectives on a COVID-19 RPMP at a National Comprehensive Cancer Center. Methods: Adult patients who had either tested positive for COVID-19 on an outpatient microbiology test or were discharged after hospitalization for the virus were eligible. Patients enrolled in the RPMP received a daily 10-question electronic patient-reported outcome assessment of COVID-19 symptoms and their responses generated alerts to a centralized monitoring team for new or worsening symptoms. A subset of high-risk patients also received a pulse oximeter which alerted when blood oxygen levels dropped below 93%. RPM was discontinued 14 days after a patient’s positive test result and following 3 days without worsening symptoms or fever. Patients who exited the program and had completed at least one assessment were sent a patient engagement survey. The objective of the survey was to evaluate the patient’s experience with digital monitoring and symptom management for COVID-19. The assessment was structured with objective response questions, including a net promoter score, and free text questions to elicit patient perspectives on RPM value. Free text responses were analyzed using grounded theory to identify primary themes regarding perceived value. Results: The survey was distributed to 452 patients; 241 responded as of June 10, 2020 (53% completion rate). The net promoter score was 91%. The table provides responses to objective questions. Qualitative analysis of free text responses identified the primary themes regarding patient perceived value which included: 1) Security: patients appreciated that the RPMP provided a clinical safety net; 2) Connection: patients appreciated the link to their clinical team during a period of isolation; 3) Empowerment: patients appreciated that the RPMP provided education on the virus and symptom management. Conclusions: RPMPs are perceived to be of value to oncology patients with COVID-19. A key barrier to maintaining these programs is cost. Policymakers should consider how these programs can be reimbursed in the future so that they can continue to provide care to vulnerable patients and keep them at home out of the acute care setting.[Table: see text]

Mental health among outpatient reproductive health care providers during the US COVID-19 epidemic

IntroductionBoth inpatient and outpatient providers may be at increased risk of stress, anxiety and depression from their roles as health providers during the COVID-19 epidemic. This study explores how the US COVID-19 epidemic has increased feelings of stress, anxiety and depression among outpatient reproductive health providers.MethodsWe conducted a survey with open-ended responses among outpatient reproductive health providers across the U.S. engaged in contraceptive care to collect data on their experiences with stress, anxiety and depression during the COVID-19 epidemic. The study population included physicians, nurses, social workers, and other health professions [n = 288]. Data were collected from April 21st–June 24th 2020. We used content analysis of free text responses among providers reporting increased stress, anxiety or depression.ResultsTwo-thirds (184) of providers reported increased stress and one-third (96) reported increased anxiety or depression related to care provision during the COVID-19 epidemic. The major sources of stress, anxiety and depression were due to patient care, worry about becoming infected or infecting family members, work- and home-related concerns, experiencing provider burnout, and fear of the unknown. Concerns about quality of patient care, providers’ changing responsibilities, lack of personal protective equipment, and difficulty coping with co-worker illness and absence all contributed to provider stress and anxiety. Worries about unemployment and childcare responsibilities were also highlighted. Providers attributed their stress, anxiety or depression to feeling overwhelmed, being unable to focus, lacking sleep, and worrying about the unknown.ConclusionsUS outpatient providers are experiencing significant stress, anxiety, and depression during the US COVID-19 epidemic. Policy and programmatic responses are urgently needed to address the widespread adverse mental health consequences of this epidemic on outpatient providers, including reproductive health providers, across the US.Plan English summaryBoth inpatient and outpatient providers may be at increased risk of stress, anxiety and depression from their roles as health providers during the COVID-19 epidemic. This study explores how the US COVID-19 epidemic has increased feelings of stress, anxiety and depression among outpatient reproductive health providers across the US. We conducted a survey from April 21st to June 24th, 2020 among outpatient reproductive health providers, including physicians, nurses, social workers and other health professions. We asked open-ended questions to understand why providers reported increased stress, anxiety and/or depression. Two-thirds (184) of providers reported increased stress and one-third (96) reported increased anxiety or depression from care provision during the COVID-19 epidemic. Major sources of stress, anxiety and depression were due to patient care, worry about becoming infected or infecting family members, work- and home-related concerns, experiencing provider burnout, and fear of the unknown. Concerns about quality of patient care, providers’ changing responsibilities, lack of personal protective equipment, and difficulty coping with co-worker illness and absence all contributed to provider stress and anxiety. Worries about unemployment and childcare responsibilities were also highlighted. Providers attributed their stress, anxiety or depression to feeling overwhelmed, being unable to focus, lacking sleep, and worrying about the unknown. This study highlights that US outpatient reproductive health providers are experiencing significant stress, anxiety, and depression during the US COVID-19 epidemic. Policy and programmatic responses are urgently needed to address the widespread adverse mental health consequences of this epidemic on outpatient providers, including reproductive health providers, across the US.

Patient Symptoms and Experience Following COVID-19: Results from a UK Wide Survey

Objectives: To investigate the experience of people who continue to be unwell after acute COVID-19, often referred to as ‘long COVID’, both in terms of their symptoms and their interactions with healthcare.Design: We conducted a mixed-methods analysis (quantitative and qualitative) of responses to a survey accessed through a UK online post-COVID support and information hub between April 2020 and December 2020 about people’s experiences after having acute COVID-19.ParticipantsOf 3290 respondents, 78% were female, median age range 45-54 years, 92.1% reported white ethnicity; 12.7% had been hospitalised. 494 respondents (16.5%) completed the survey between 4 and 8 weeks of the onset of their symptoms, 641 (21.4%) between 8 and 12 weeks and 1865 (62.1%) more than 12 weeks after.Results: The ongoing symptoms most frequently reported were; breathing problems (92.1%), fatigue (83.3%), muscle weakness or joint stiffness (50.6%), sleep disturbances (46.2%), problems with mental abilities (45.9%) changes in mood, including anxiety and depression (43.1%) and cough (42.3%). Symptoms did not appear to be related to the severity of the acute illness or to the presence of pre-existing medical conditions. Analysis of free text responses revealed three main themes (1) Experience of living with COVID-19 – physical and psychological symptoms that fluctuate unpredictably; (2) Interactions with healthcare; (3) Implications for the future – their own condition, society and the healthcare system and the need for research. Conclusion: People living with persistent problems after the acute phase of COVID-19 report multiple and varying symptoms that are not necessarily associated with initial disease severity or the presence of pre-existing health conditions. Many have substantial unmet needs and experience barriers to accessing healthcare. Consideration of patient perspective and experiences will assist in the planning of services to address this.Funding Statement: KP was supported by the Imperial College Clinician Investigator Scholarship. KP would like to acknowledge the National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London for their support. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of HealthDeclaration of Interests: None declared.Ethics Approval Statement: Ethical approval was granted by the Imperial College Research Governance and Integrity Team (RGIT) (ICREC Ref: 20IC6625). All survey respondents consented to the use of their responses for analysis and publication.

Low Fidelity Simulation on Sensory Impairments in Older Adults: Undergraduate Nursing Students’ Self-Reported Perceptions on Learning

Globally, the population is living longer and by 2050, it is predicted to reach 2.1 billion people. Sensory and cognitive impairments are common long-term conditions among older Europeans and have considerable functional, social, emotional and economic impacts on the individual and those caring for them. Nurses have frequent encounters with patients with these impairments and are expected to prioritise people, assess their needs and accommodate practice to meet these needs. In order to develop the requisite knowledge and understanding to support people living with these impairments, student nurses require an immersive and experiential approach to learning as opposed to just information transfer. This study reports on a cross-sectional analysis of a low fidelity simulation on sensory impairments as part of a wider dementia curriculum in semester one of the undergraduate nursing programme at the University of Highlands and Islands. Findings from an online questionnaire-based survey and content analysis of free text responses revealed that students found the simulation activities critical for gaining subject knowledge, understanding and insight. This study concluded that low-fidelity simulation of sensory/cognitive impairments, within the context of a broader curriculum of supportive activities, can be effective at developing relevant knowledge, understanding and gaining insights in this subject area among undergraduate nursing students.

Hearing the voices of Australian healthcare workers during the COVID-19 pandemic

BackgroundThe statistics of healthcare worker (HCW) COVID-19 infections do not convey the lived experience of HCWs during the pandemic. This study explores the working conditions and issues faced by Australian...

COVID-19 related concerns of people with long-term respiratory conditions: a qualitative study

BackgroundThe COVID-19 pandemic is having profound psychological impacts on populations globally, with increasing levels of stress, anxiety, and depression being reported, especially in people with pre-existing medical conditions who appear to be particularly vulnerable. There are limited data on the specific concerns people have about COVID-19 and what these are based on.MethodsThe aim of this study was to identify and explore the concerns of people with long-term respiratory conditions in the UK regarding the impact of the COVID-19 pandemic and how these concerns were affecting them. We conducted a thematic analysis of free text responses to the question “What are your main concerns about getting coronavirus?”, which was included in the British Lung Foundation/Asthma UK (BLF-AUK) partnership COVID-19 survey, conducted between the 1st and 8th of April 2020. This was during the 3rd week of the UK’s initial ‘social distancing measures’ which included advice to stay at home and only go outside for specific limited reasons.Results7039 responses were analysed, with respondents from a wide range of age groups (under 17 to over 80), gender, and all UK nations. Respondents reported having asthma (85%), COPD (9%), bronchiectasis (4%), interstitial lung disease (2%), or ‘other’ lung diseases (e.g. lung cancer) (1%). Four main themes were identified: (1) vulnerability to COVID-19; (2) anticipated experience of contracting COVID-19; (3) pervasive uncertainty; and (4) inadequate national response.ConclusionsThe COVID-19 pandemic is having profound psychological impacts. The concerns we identified largely reflect contextual factors, as well as their subjective experience of the current situation. Hence, key approaches to reducing these concerns require changes to the reality of their situation, and are likely to include (1) helping people optimise their health, limit risk of infection, and access necessities; (2) minimising the negative experience of disease where possible, (3) providing up-to-date, accurate and consistent information, (4) improving the government and healthcare response.

Analysis of Free-Text Responses in an International Myeloproliferative Neoplasms Patient Survey to Assess Impact of the COVID-19 Pandemic on Clinical Care

BackgroundThe COVID-19 pandemic continues to challenge effective treatment delivery to hematologically-compromised patients, including those with myeloproliferative neoplasms (MPNs). MPNs are characterized by clonal proliferation of hematopoietic cell lines in bone marrow. As such, increasing reports of COVID-19 related thrombotic events highlight how MPN patients are at an increased risk in navigating potential complications during this pandemic. Mitigation strategies to lesson MPN patient exposure to COVID-19 are vital. Though, such efforts come at an inherent cost to effective healthcare delivery. Restriction of regular in-clinic treatments and reported shortages of MPN pharmacotherapies present these patients with diminishing continued care.To understand how MPN patient care has been impacted by COVID-19, an internet-based questionnaire was deployed surveying a variety of disease and pandemic related items (reported elsewhere; Palmer J et al, ASH 2020 submitted). A single free-text response item instructed respondents to: “Please tell us anything else (bad or good) about how the COVID-19 outbreak has impacted your MPN care.” This qualitative analysis evaluated first-hand comments directly from patients in order to form a richer understanding of how those with MPNs have been managing disease-related care amidst this pandemic.MethodsThis COVID-19 survey was hosted via Mayo Clinic's secured REDCap system for online surveys and posted on MPN organizational partner websites. Surveys were completely anonymous. The free-text responses describing impacts to MPN care were each independently reviewed by 2 individuals for overall sentiment (positive, negative, both, or neutral [no impact]) and categorized for themes. The 2 reviewers were assessed for agreement. Conflicting reviews were evaluated then adjudicated by an algorithm for cases meeting selected conditions or by lead author review for all remaining cases. Descriptive statistics are reported.ResultsOf the 1217 consenting adult patients participating in the overall COVID-19 study, 824 provided free-text responses. Of these, respondent MPN diagnoses included, essential thrombocythemia (n=324, 39%), polycythemia vera (n=251, 30%), myelofibrosis (n=153, 19%), and other/undisclosed (96, 12%); 69% (n=567) were female; median age was 63 (range 21-93); 38% (n=313) were from the US, 38% (n=313) UK, and 24% (n=198) other/unknown.There was 89% (n=734) sentiment agreement between reviewers. Free-text responses about the impact of COVID-19 on MPN care were 49% (n=400) negative, 21% (n=177) positive, 8% (n=65) both positive and negative, and 22% (n=182) neutral/no impact. Table 1 shows a selection of MPN patient free-text responses reflecting common negative and positive sentiment themes.Negative impact (n=400): The most common negative impact involved delays or cancellations of visits or perceived inaccessibility to regular providers (n=261, 65%). Primarily this sentiment was driven by lack of clinic availability and restrictions at treatment centers or by providers. However, some respondents reported delaying or canceling visits themselves due to fear of COVID-19 exposure. Perceived health consequences from this delay were also expressed. There were 129 (32%) respondents with concern regarding changes or access to medications, including explicit drug supply shortages. Some patients resorted to self-adjusting medications and reusing single-use supplies. General anxiety, stress, and isolation were also reported (n=98, 25%).Positive impact (n=177): Availability of telemedicine comprised the majority of positive impacts of the pandemic (n=95, 54%), with many noting the reduced travel time to visits. Routine local testing coupled with follow-up telemedicine was favorable. Despite general positivity towards telemedicine, some reported preferences for in-person visits; commenting that telemedicine was impersonal, difficult to schedule or receive virtual communication, and expressed concern for lack of spleen examinations during virtual visits.ConclusionPositive and negative aspects were reported including MPN-specific issues. Healthcare systems should use such data to emerge from the COVID-19 pandemic and retain the positive impacts such as telemedicine, while developing education materials and other resources to address the reported negative impacts where possible.DisclosuresMesa:CTI BioPharma: Research Funding; Promedior: Research Funding; Novartis: Consultancy; Sierra Oncology: Consultancy; Samus Therapeutics: Research Funding; Genentech: Research Funding; AbbVie: Research Funding; Incyte: Research Funding; LaJolla Pharmaceutical Company: Consultancy; Bristol Myers Squibb: Research Funding.

Stress Management and Resiliency Training for Healthcare Professionals: A Mixed-Methods, Quality-Improvement, Cohort Study.

To assess the effects of a multi-modal resilience program, the Stress Management and Resiliency Training (SMART) Program, on healthcare professional well-being and job satisfaction. This pilot, mixed-methods, quality improvement, cohort study assessed perceived stress, physical and mental health, job satisfaction, burnout, and value of the curriculum to attendees. Participants experienced a significant reduction in perceived stress (P < 0.001) and significant improvements in global mental health (P = 0.001), physical health (P = 0.045), and job satisfaction (P = 0.047). There was no significant improvement in burnout. Qualitative analysis of free text responses revealed appreciation for the skills taught, increased resiliency, and a positive impact on relationships. Delivering the SMART Program to healthcare professionals is feasible and may serve as a useful tool for reducing stress and increasing resilience.

Self-Reported Patterns of Use of Alcohol and Drugs After Suicide Bereavement and Other Sudden Losses: A Mixed Methods Study of 1,854 Young Bereaved Adults in the UK.

BackgroundBereavement, particularly by suicide, is associated with an excess risk of mortality and of physical and psychological morbidity. Use of alcohol as a coping mechanism is suggested as a contributing factor. However, studies describing substance use after bereavement rely on diagnostic data, lacking a more fine-grained understanding of patterns of substance use when grieving. We aimed to use mixed methods to compare patterns of substance use after bereavement by suicide and other sudden deaths among young adults in the UK.MethodsUsing an online survey throughout 37 UK higher education institutions we collected free text responses from 1,854 young adults who had experienced sudden bereavement. We conducted content analysis of free text responses to an open question about patterns of alcohol and drug use following the bereavement, measuring frequencies of coded categories. Collapsing these categories into binary outcomes reflecting increased use of alcohol or drugs, we used multivariable logistic regression to quantify the associations between mode of bereavement and increased post-bereavement substance use.ResultsOf 1,854 eligible respondents, 353 reported bereavement by suicide, 395 by accidental death, and 1,106 by sudden natural causes. The majority of the sample reported no increase in their use of alcohol (58%) or unprescribed drugs (85%) after the bereavement. Overall 33% had increased their alcohol use at some point after the bereavement, whilst 12% had increased their use of drugs. People bereaved by suicide were significantly more likely to describe an increase in substance use (adjusted OR = 1.29; 95% CI = 1.00–1.66; p = 0.049) than people bereaved by sudden natural causes, as were people bereaved by non-suicide unnatural deaths (adjusted OR = 1.32; 95% CI = 1.03–1.68; p = 0.026).ConclusionJust under half of young UK adults who experience sudden bereavement increase their alcohol use afterwards, and very few increase their use of drugs. People bereaved by suicide or non-suicide unnatural deaths may be more likely than people bereaved by sudden natural causes to use substances as part of the grieving process, and may have a greater need for monitoring of potential harms. Understanding the reasons for substance use will help primary care and bereavement practitioners screen and address needs appropriately.

Gender Can Influence Student Experiences in MD-PhD Training.

Background: Female physician-scientists have led major advances in medicine broadly and particularly in women's health. Women remain underrepresented in dual MD-PhD degree programs that train many physician-scientists despite gender parity among medical and biomedical research students. Materials and Methods: To explore how the training environment might be experienced differently for male and female students in one MD-PhD program, the authors analyzed gender differences in annual symposium speakers with exact binomial tests, student participation as question-askers at a weekly seminar with logistic regression, and number of publications with quasi-Poisson generalized linear models. They compared male and female students' perceptions of gender-based discrimination using a survey, including qualitative analysis of free text responses. The program consisted of 71 total students in the 2017-2018 and 2018-2019 academic years. Female students comprised 42.0% (81/191) of program matriculants from 1997 to 2019. Results: Male and female students were equally likely to present at the annual program symposium, but faculty (p = 0.001) and keynote (p = 0.012) presenters were more likely to be male. Compared with male counterparts, female students asked fewer seminar questions (p < 0.005) and female speakers received more questions (p = 0.03). Female students perceived less support and differed from men in reasons for asking or not asking seminar questions. Free text responses described repeated small acts of discrimination toward women with cumulative impact. Positive program changes followed presentation of findings to program leaders and students. Conclusions: The authors identified several aspects of one MD-PhD program that could discourage career or training persistence of female students. Increasing awareness of these issues was temporally related to positive programmatic changes.

Experiences of support garments following bowel stoma formation: analysis of free-text responses in a cross-sectional survey

AimTo explore the experiences of support garments when adjusting to bodily change following bowel stoma formation.DesignThematic analyses of free-text responses in a cross-sectional survey of the stoma population in 2018.MethodsFree-text...

An Analysis of Free-text Responses by Individuals Enrolled in the National Amyotrophic Lateral Sclerosis (ALS) Registry (P4.6-005)

An Analysis of Free-text Responses by Individuals Enrolled in the National Amyotrophic Lateral Sclerosis (ALS) Registry (P4.6-005)

Effectiveness of regional medical schools in attracting and retaining students for early-career practice in the local area: The James Cook University experience.

The regionally based James Cook University medical school in northern Australia has focused its selection processes and curriculum on recruiting, training and graduating doctors to address local workforce needs. This study investigates if James Cook University's regionally based medical school model promotes graduates undertaking internship in local regional hospitals. Cross-sectional survey of final year James Cook University Bachelor of Medicine, Bachelor of Surgery graduates towards the end of the 2016 and 2017 academic years (n=207; response rate=58%). Multivariate (binary outcomes) logistic regression analysis identified the personal and curriculum factors predicting students' choice to do their internship in northern Australia supported by content analysis of free text responses to expand on quantitative associations. Students applied to medicine at James Cook University because there was: "an undergraduate program" (62%); "reputation for a good course/quality graduates" (59%); and "interest in rural medicine or Indigenous health" (39%). Internship in northern Australian hospitals was predicted by: "familiarity with the hospital in Years 5 and 6"; "having a northern Australia hometown at time of application to medical school"; "an interest in rural medicine or Indigenous health"; and "interns have better learning experiences in regional teaching hospitals". The findings suggest regionally based medical schools can promote early-career rural practice by incorporating purposive selection, a rurally focused curriculum supported by quality clinical training experiences in local hospitals and a sufficient number of locally available intern places. However, it is likely regionally based medical schools also require locally available specialty training pathways to support rural practice in the longer term.

Value and Barriers to Use of the SIMPL Tool for Resident Feedback

The System for Improving and Measuring Procedural Learning (SIMPL) is a smart-phone application used to provide residents with an evaluation of operative autonomy and feedback. This study investigated the perceived benefits and barriers to app use. A database of previously performed SIMPL evaluations was analyzed to identify high, low, and never users. Potential predisposing factors to use were explored. A survey investigating key areas of value and barriers to use for the SIMPL application was sent to resident and faculty users. Respondents were asked to self-identify how often they used the app. The perceived benefits and barriers were correlated with the level of usage. Qualitative analysis of free text responses was used to determine strategies to increase usage. General surgery training programs who are members of the Procedural Learning and Safety Collaborative. Surgical residents and faculty. At least 1 SIMPL evaluation was created for 411 residents and 524 faculty. Thirty percent of both faculty and residents were high-frequency users. Thirty percent of faculty were never users. One hundred eighty-eight residents and 207 faculty (response rate 46%) completed the survey. High-frequency resident users were more likely to perceive a benefit for both numerical evaluations (76% vs 30%) and dictated feedback (92% vs 30%). Faculty and residents commonly blamed each other for not creating and completing evaluations regularly (87% of residents, 81% of faculty). Suggested strategies to increase usage included reminders and integration with existing data systems. Frequent users perceive value from the application, particularly from dictated feedback and see a positive impact on feedback in their programs. Faculty engagement represents a major barrier to adoption. Mechanisms which automatically remind residents to initiate an evaluation will help improve utilization but programs must work to enhance faculty willingness to respond and dictate feedback.

118. Important Health And Parenting Topics Caregivers of Adolescents Want More Guidance On In The Primary Care Setting

Primary care can be an important setting for caregivers to receive additional guidance regarding their adolescent’s health, parenting and positive family development. The purpose of this study was to explore health and parenting topics caregivers wished to receive more guidance on from their adolescent’s primary care provider. The study sample included caregivers of adolescents (ages 12-18) who attended an outpatient pediatric clinic in Marion County, Indiana (Jun. 2017 – Aug. 2017) and had completed a computer-generated health risk screener. Caregivers were invited to participate in a phone survey within 48 hours of the clinic visit. The survey instrument collected demographic data and asked caregivers to rank various health topics (e.g., sex, stress management) and parenting topics (e.g., communication, discipline) in terms of importance on a Likert scale (not important (1) to very important (3)). Participants were encouraged to provide additional health or parenting information they wished to receive from their adolescent’s provider. Descriptive statistics and qualitative analysis were used to determine the outcomes of the study. In total, 104 caregivers completed the survey, most of the participants were female (93.3%), a large majority were African American (70.2%), and the average age was 41.76 years (SD = 9.66). The demographics of the teen patient were as follows: 51% male, 75% African American, mean age 14.58 years (SD = 1.86). From a list of 15 health topics, caregivers ranked “mental health” as the highest in terms of importance (M = 2.69, SD = 0.58), and “help with mobile technology” as the lowest (M = 2.19, SD = 0.85). Sixty-four (61.5%) caregivers reported wanting additional health related information from their adolescent’s provider. Based on qualitative analysis of free text responses, caregivers wanted more information regarding general teen health (28%), nutrition and exercise (19%), mental health (17%), sexual health (16%), behavioral concerns (13%), and academic concerns (6%). Interestingly, 13% of caregivers reported their adolescent’s provider already covers everything within a visit. In terms of importance of parenting topics, caregivers ranked “communication” as the most important parenting topic (M = 2.49, SD = 0.77) and “discipline” as the least (M = 2.14, SD = 0.85). Forty (38.5%) caregivers wished to receive additional parenting related information from their adolescent’s provider. Specifically, they wanted more information about: relational aspects of parenting (23%), counseling teen on nutrition and exercise (13%), difficult conversations with teen (i.e., sex, divorce, etc) (13%), normal teen development (13%), dealing with violence (10%), stress management (8%), parental monitoring (5%), health concerns (5%), and other (3%). No differences were found between caregivers who reported wanting more health or parenting information from their adolescent’s provider and those who reported not needing any additional information. Caregivers of adolescents report many health and parenting topics as important and wish to speak with their adolescent’s primary care provider about these topics. Incorporating additional information about these topics in primary care visits could improve the caregivers experience and provide them with additional resources for supporting their teen’s health and positive family development.

Competence Revisited in a Rural Context.

General competencies developed in undergraduate and graduate medical education are sometimes promoted as applicable in any practice context. However, rural practice presents challenges and opportunities that may require unique training. The objectives of this national survey of both undergraduate and graduate medical educators and practicing physicians were to further develop a previously published list of competency domains for working in rural communities and to assess their relative importance in education and practice. Using six rural competency domains first refined with a national group at the Society of Teachers of Family Medicine Annual Meeting in Baltimore in 2008, the authors employed a snowball strategy to survey medical educators and physicians regarding the importance and relevance of this list and to solicit additional domains and competencies. All six domains were considered important, with average responses for each domain ranging from 4.16 to 4.78 on a 5-point Likert scale (1-not important; 5-extremely important). Unique relevance to rural practice was more varied, with average responses for domains ranging from 2.36 to 3.6 (1-not at all unique; 5-extremely unique). Analysis of free text responses identified two important new domains-Comprehensiveness and Agency/Courage-and provided clarification of some competencies within existing domains. This study validates and further elaborates dimensions of competence believed to be important in rural practice. The authors propose these domains as a common language and framework for addressing the unique challenges and opportunities that training and practicing in a rural setting present.

What are the best and worst things about having a father in UK Armed Forces? Analysis of free text responses

ObjectiveThis study aims to explore what adolescents report as the best and worst aspects of having a father in the UK military.MethodsQualitative data were collected from 171 adolescents aged 11–16...

A Comparative Physiology Course May Encourage Academic Careers in Renal Fellows

Educational innovations in nephrology have focused largely on attracting trainees to the field, but few efforts have influenced the career development of nephrology fellows. We investigated the impact of an annual, week-long summer course titled “Origins of Renal Physiology” on academic career development by conducting a survey study of course participants and a control group of renal fellows who did not participate in the course. The survey elicited reasons for course attendance, perceptions of the course, and current career paths of respondents. We compared career trajectories and academic productivity between course participants and non-participants. Fellows attended the course primarily to review physiology in a novel educational setting and to gain long-term understanding of concepts in renal physiology. Course participants reported significantly higher current engagement in research than non-participants, especially in basic science. Analysis of free-text responses about the course’s most positive attributes identified four themes: interactions/networking, hands-on laboratory experience, mentorship, and unique learning environment. The course appears to have offered an innovative learning opportunity that fostered mentorship and peer-to-peer networking in a scientific, relaxed, and supportive learning environment. Emphasizing the role of basic science research and its application to clinical care through such courses may stimulate the interests of fellows into research and academic careers.

GPs' and community pharmacists' opinions on medication management at transitions of care in Ireland.

The aim of this study was to survey GPs and community pharmacists (CPs) in Ireland regarding current practices of medication management, specifically medication reconciliation, communication between health care providers and medication errors as patients transition in care. A national cross-sectional survey was distributed electronically to 2364 GPs, 311 GP Registrars and 2382 CPs. Multivariable associations comparing GPs to CPs were generated and content analysis of free text responses was undertaken. There was an overall response rate of 17.7% (897 respondents-554 GPs/Registrars and 343 CPs). More than 90% of GPs and CPs were positive about the effects of medication reconciliation on medication safety and adherence. Sixty per cent of GPs reported having no formal system of medication reconciliation. Communication between GPs and CPs was identified as good/very good by >90% of GPs and CPs. The majority (>80%) of both groups could clearly recall prescribing errors, following a transition of care, they had witnessed in the previous 6 months. Free text content analysis corroborated the positive relationship between GPs and CPs, a frustration with secondary care communication, with many examples given of prescribing errors. While there is enthusiasm for the benefits of medication reconciliation there are limited formal structures in primary care to support it. Challenges in relation to systems that support inter-professional communication and reduce medication errors are features of the primary/secondary care transition. There is a need for an improved medication management system. Future research should focus on the identified barriers in implementing medication reconciliation and systems that can improve it.

Push and stay factors affecting Irish medical student migration intentions.

A significant proportion of medical students in Ireland have demonstrated strong intentions to migrate following their graduation. Factors influencing these intentions are poorly understood. Our study aimed to investigate 'push' and 'stay' factors that may influence the migration plans of medical students. Cross-sectional survey of 2273 medical students in Ireland using a mixed methods approach. Survey was completed by 2273 medical students, of which 263 provided free text data that are analysed in this paper. Identified push factors include negative perception regarding career opportunities, working conditions and lifestyle, while family was the only identified strong stay factor. Qualitative analysis of free text responses revealed themes that included training, career, personal and financial factors. This study has provided insight into the factors that influence medical student migration intentions. There is a strong need for all stakeholders to collectively discuss and engage in possible solutions.