Communication Challenges Research Articles

Enhancing perspective-taking and empathy in children with autism spectrum disorder through asymmetric VR games and peer collaboration

ABSTRACT Children with ASD experience pervasive social cognitive impairments, primarily manifested as challenges in social communication and reciprocal social behavior. These inherent deficits indirectly affect the development, based on the Theory of Mind, and empathy capacity in children with ASD, which are crucial in developing social skills and communicative interaction abilities. Research suggests that children with ASD struggle to judge and interpret the intentions, behaviors, and metaphors involved in social interaction. This impacts their abilities to engage in effective interpersonal communication and social interaction. Therefore, the present study developed a tool called Share VR. This asymmetric VR technology combines peer collaboration and cooperative games to hone the empathetic abilities in children with ASD. The objective is to stimulate the application of their abilities while enhancing their understanding of others’ behavioral intentions. In the experimental verification phase, the study recruited five children with ASD and three typically developing children to participate in Asymmetric VR multiplayer games. The games involved cooperation, competition, and exploration across three different game levels. Further, we used a three-stage experimental validation using a multiple-baseline across subjects design to confirm whether this method effectively enables children with ASD to acquire empathy through peer collaboration, game participation, and cooperative assistance.

Medicine in the 21st Century: How Not to Lose the Art of Healing?

In our time of advanced technologies, the Internet, and the enormous acceleration of all areas of humanitarian activity, medical scientists make outstanding discoveries and innovations that revolutionize diagnostic approaches and treatment options, improve patient care, and enrich the way to a healthier world. Is there still a place for the art of medicine in the era of innovations and artificial intelligence? Although modern technology in the field of medicine with computerization of every aspect (including electronic medical records, laboratory data entry, images, patients' monitoring systems, etc.), young physicians, while embracing that innovation, should be trained in the development of clinical thinking and the establishment of personalized connections to the patients. Young physicians should be taught to adopt the ability to see, hear, and feel a patient's problems, formulate optimal management, and be empathetic to the patient's emotions and suffering. Communication skills are a key to successful medical practice and a part of "the Introduction to Clinic" course in almost all medical schools, but a substantial lack of time in clinical settings creates new challenges for communication between medical students, clinical teachers, and patients in medical schools. In many areas around the world, including Ukraine, this problem has been aggravated by wars, epidemics, pandemics, and natural disasters. At the same time, developing clinical observational skills remains an integral part of medical education and the basis of medical art. The art of a careful physical exam should not be lost behind a computer screen. Dnipro State Medical University has traditions of integrating centuries-old world historical experiences of teaching the art of healing into the philosophical concept of forming the critical clinical thinking of medical students. Our medical school has incorporated "diagnosing the canvas" into its curriculum. A thematic gallery of diagnostic symptoms and signs from great artists of all times and peoples has been created, expanding the young physicians' educational horizons in clinical thinking, empathy, and mercy.

Using incident reports to diagnose communication challenges for precision intervention in learning health systems: A methods paper

AbstractIntroductionPoor communication is a leading root cause of preventable maternal mortality in the United States. Communication challenges are compounded with the presence of biases, including racism. Hospital administrators and clinicians are often aware that communication is a problem, but understanding where to intervene can be difficult to determine. While clinical leadership routinely reviews incident reports and acts on them to improve care, we hypothesized that reviewing incident reports in a systematic way might reveal thematic patterns, providing targeted opportunities to improve communication in direct interaction with patients and within the healthcare team itself.MethodsWe abstracted incident reports from the Women's Health service and linked them with patient charts to join patient's race/ethnicity, birth outcome, and presence of maternal morbidity and mortality to the incident report. We conducted a qualitative content analysis of incident reports using an inductive and deductive approach to categorizing communication challenges. We then described the intersection of different types of communication challenges with patient race/ethnicity and morbidity outcomes.ResultsThe use of incident reports to conduct research on communication was new for the health system. Conversations with health system‐level stakeholders were important to determine the best way to manage data. We developed a thematic codebook based on prior research in healthcare communication. We found that we needed to add codes that were equity focused, as this was missing from the existing codebook. We also found that clinical and contextual expertise was necessary for conducting the analysis—requiring more resources to conduct coding than initially estimated. We shared our findings back with leadership iteratively during the work.ConclusionsIncident reports represent a promising source of health system data for rapid improvement to transform organizational practice around communication. There are barriers to conducting this work in a rapid manner, however, that require further iteration and innovation.

Montreal Cognitive Assessment Scores Do Not Associate With Communication Challenges Reported by Adults With Alzheimer's Disease or Parkinson's Disease.

Screening for cognitive-communication challenges in people with Alzheimer's disease (AD) or Parkinson's disease (PD) may benefit from multiple kinds of information about the client (e.g., patient-reported, performance-based). The purposes of this report are (a) to describe, using recently published score range descriptors (e.g., "mild," "moderate"), the patient-reported communication challenges of people with AD or PD using the Communicative Participation Item Bank (CPIB) and the Aphasia Communication Outcome Measure (ACOM); and (b) to examine the relationships between the performance-based Montreal Cognitive Assessment (MoCA), a cognitive screener, and patient-reported CPIB and ACOM scores. Participants were a convenience sample of 49 community-dwelling adults with AD or PD. Participants completed the measures in person as part of a larger assessment battery. MoCA total scores ranged from 7 to 28. CPIB T-scores fell in the following ranges: 31% were "within normal limits," 57% reflected "mildly" restricted participation, and 12% reflected "moderately" restricted participation. ACOM T-scores fell in the following ranges: 50% were either "within normal limits" or reflected "mild" impairment, 29% reflected "mild-moderately" impaired functional communication, and 21% reflected "moderately" impaired functional communication. There were only weak and nonsignificant correlations between T-scores on the ACOM or CPIB and scores on the MoCA, and there were no group differences on the ACOM or CPIB between individuals who screened positive versus negative on the MoCA. When screening individuals with AD or PD, patient-reported communication challenges seem to be complementary to information provided by the MoCA and perhaps most useful in screening for mild communication challenges.

An interdisciplinary integrated specialized one-stop outpatient clinic for idiopathic intracranial hypertension – an assessment of sick leave, presenteeism, and health care utilization

BackgroundManagement of idiopathic intracranial hypertension (IIH) is complex requiring contributions from multiple specialized disciplines. In practice, this creates considerable organizational and communicational challenges. To meet those challenges, we established an interdisciplinary integrated outpatient clinic for IIH with a central coordination and a one-stop- concept. Here, we aimed to evaluate effects of this concept on sick leave, presenteeism, and health care utilization.MethodsIn a retrospective cohort study, we compared the one-stop era with integrated care (IC, 1-JUL-2021 to 31-DEC-2022) to a reference group receiving standard care (SC, 1-JUL-2018 to 31-DEC-2019) regarding economic outcome parameters assessed over 6 months. Multivariate binary logistic regression models were used to adjust for confounders.ResultsBaseline characteristics of the IC group (n = 85) and SC group (n = 81) were comparable (female: 90.6% vs. 90.1%; mean age: 33.6 vs. 32.8 years, educational level: ≥9 years of education 60.0% vs. 59.3%; located in Vienna 75.3% vs. 76.5%). Compared to SC, the IC group showed significantly fewer days with sick leave or presenteeism (-5 days/month), fewer unscheduled contacts for IIH-specific problems (-2.3/month), and fewer physician or hospital contacts in general (-4.1 contacts/month). Subgroup analyses of patients with migration background and language barrier consistently indicated stronger effects of the IC concept in these groups.ConclusionsInterdisciplinary integrated management significantly improves the burden of IIH in terms of sick leave, presenteeism and healthcare consultations – particularly in socioeconomically underprivileged patient groups.

Project Management Practices and Implementation of Somali Humanitarian Fund Projects by Local Non-Governmental Organizations in Mogadishu, Somalia

The effective management and control of a project are fundamental to its success. In the context of intricate projects, such as those associated with the Somali Humanitarian Fund (SHF), strict adherence to a defined scope, schedule, and budget is crucial to attaining the desired outcomes. Humanitarian and Development (SHF) projects carried out by local NGOs in Mogadishu, Somalia. The specific goals of the study included scrutinizing the role of communication in SHF project performance, evaluating the impact of planning on project success, assessing the effects of financing on project performance, and determining the importance of monitoring and evaluation in the implementation of SHF projects. The study was grounded in the Theory of Change, Management by Objective Theory, Adaptive Structuration Theory, and the Theory of Constraints. Employing a descriptive survey design, the research involved a population of 50 SHF projects. Data collection utilized a semi-structured questionnaire, and the analysis was conducted using SPSS, with findings presented through mean scores, standard deviation, and percentages. The findings highlight the critical role of effective communication, comprehensive planning, adequate financing, and robust monitoring and evaluation (M&E) mechanisms in project success. Communication challenges were identified as hindrances to timely project completion, emphasizing the need for improved communication channels and strategies. Planning was deemed essential, but the recognition of inadequate planning as a challenge suggests a need for capacity building and best practice adoption. Financial support was seen as crucial, but there's room for improved assessment by financiers to ensure transparency. M&E processes were acknowledged as integral, yet areas like demonstrating corrective actions and aligning deliverables with objectives need attention for enhanced effectiveness and accountability. Recommendations include enhancing communication channels, bolstering planning capacities, improving financial management practices, and institutionalizing M&E processes. These steps aim to mitigate challenges, optimize resource utilization, and maximize the impact of SHF projects on vulnerable populations in Mogadishu.

Social communication and restricted, repetitive behavior as assessed with a diagnostic tool for autism (ADOS-2) in women with anorexia nervosa.

In anorexia nervosa (AN), the traits of autism spectrum disorder (ASD) are associated with poor outcomes. However, the subtle nature of these characteristics remains poorly understood. We investigated the in-depth patterns of ASD traits using Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) in women with AN. Of 28 women with ICD-10 AN, 16 (age 19-30 years) participated in the ADOS-2, a video-recorded, semistructured diagnostic assessment for social communication and interaction and restricted, repetitive behaviors and interests related to ASD. None of the participants had previously been diagnosed with ASD. Other measurements included the Eating Disorder Examination Questionnaire and the Wechsler Abbreviated Scale of Intelligence-IV. Five individuals (18% of all, 31% of those assessed) scored above the cutoff for autism in ADOS-2. They had challenges in social communication and interaction, manifesting as sustained difficulties in social relationships and deficits in conversation skills. Few described being frequently misunderstood by others, including in the eating disorder treatment settings. Three individuals showed prominent restricted and repetitive behaviors such as ritual seeking, eating-related routines, sensory sensitivity related to food texture and selective eating, and intense interest in specific topics. The mean duration of AN in women above the cutoff was twice as long compared with those below (12.3 vs. 6.2 years). The ASD-related characteristics and behavior appear to contribute to the manifestation and duration of AN in a subgroup of women. Among these women, the traits of ASD appear to be mixed with eating disorder symptoms, which should be taken into account in the treatment.

Application of Epidemiological Methods in a Large-Scale Cross-Sectional Study in 765 German Dairy Herds-Lessons Learned.

From 2016 to 2020, the "PraeRi" study, conducted by three German veterinary universities, was aimed at enhancing animal health and welfare in dairy farms. With 765 dairy farms visited and 101,307 animals examined, this study provided a basis for improving animal health and welfare. The study population comprised three different regions representing a broad variety of characteristics. To ensure representative estimates, a sample size of 250 farms was determined for each region, employing a stratified sampling plan based on farm size. According to the information provided by the farmers, the most commonly occurring disease in their herds was mastitis without general disorder (14.2% to 16.3% of the herd-depending on the region). For most disorders, prevalence data were lowest for the region South compared with the two remaining regions. Multivariable regression analyses were performed to identify risk factors for various target variables, and the results were communicated through individual reports and benchmarking flyers to participating farmers. The authors encountered challenges in management and communication due to the project's size in terms of personnel, data, and farms examined. Harmonizing data management and hypothesis testing across all involved parties added complexity.

“If we don't speak the language, we aren't offered the same opportunities”: Qualitative perspectives of palliative care access for women of color living with advanced breast cancer

ContextDespite efforts to enhance equity, disparities in early palliative care (PC) access for historically minoritized patients with advanced breast cancer (ABC) persist. Insight into patient and clinician perspectives are needed to inform future models aimed at improving equity in PC access and outcomes. ObjectivesTo explore qualitative barriers and facilitators to early PC access in an urban setting with Black and Latina women with ABC. MethodsIn this qualitative descriptive study, we conducted one-on-one interviews with Black and Latina women with ABC (N = 20) and interdisciplinary clinicians (N = 20) between February 2022 and February 2023. Participants were recruited from urban academic and community cancer clinics. Transcripts were analyzed using an inductive coding and thematic analysis approach. ResultsBarriers identified by both patients and clinicians included lack of communication between oncology, PC, and primary care teams, limited understanding of PC among patients and non-PC clinicians, language and health literacy-related communication challenges, and racism and marginalization, including implicit bias and lack of diverse racial/ethnic representation in the supportive care workforce. Facilitators identified by both patients and clinicians included patient-to-patient referrals, support groups breaking cultural stigma on topics including self-advocacy and PC, referrals from trusted providers, and community organizations’ abilities to overcome challenges related to social determinants of health, most specifically logistical and financial support. ConclusionsPatients and clinicians reported similar barriers and facilitators to PC access, most commonly through the lens of care coordination and communication. These findings will inform future adaptation of a culturally and linguistically care model to improve access to early PC services for Black and Latina women with ABC.

Challenges and benefits of telepathology in education: lessons learned from COVID-19-a systematic review.

The COVID-19 pandemic in 2020 posed significant communication challenges, especially in the healthcare sector. Telepathology provides a valuable means for healthcare providers to communicate. This study investigated the key challenges and benefits of telepathology in education through a systematic review of relevant studies conducted during this period. This systematic review was conducted in 2022. We utilized databases, including PubMed, Google Scholar and ScienceDirect. Our search was performed from 7 February 2022 to 13 February 2022. We selected articles based on inclusion criteria and used the Critical Appraisal Skills Program checklist to assess study strengths and limitations. We extracted data using a checklist and synthesized the results narratively. We initially identified 125 articles, and after screening, 15 were included in the study. These studies reported various challenges, including cost, technology, communication problems, educational difficulties, time wasting, legal issues and family distraction problems. Conversely, studies mentioned benefits, such as care improvement, better education, time efficiency, proper communication, cost and technology advancement. The results of this study will help future efforts and investigations to implement and set up telepathology. Based on our review, despite the challenges, the benefits of telepathology in education are greater than these obstacles, indicating its potential for future use.

The Role of Everyday Executive Function in Observed Social Symptoms of Autism Spectrum Disorder.

Recent research suggests there may be differences in the social presentations of autistic males and females. Camouflaging is believed to account for some of these differences and executive function (EF) may support compensatory social behaviors. As few studies have explored the role of sex and everyday EF when evaluating specific social difficulties among autistic youth, the present study seeks to address this. The Social Responsiveness Scale-2 (SRS-2) was used to measure types of social difficulties and the Behavioral Rating Inventory of Executive Function-2 (BRIEF-2) served as a measure of everyday EF. Four three-step hierarchical multiple regressions were conducted with SRS-2 social subscales as dependent variables. Autism symptom severity, BRIEF-2 EF Indices (i.e., behavioral, emotional, and cognitive regulation), and sex served as independent variables. Types of EF impairment significantly predicted social symptoms of autism. Behavioral dysregulation predicted all social symptoms assessed, cognitive dysregulation predicted social awareness and communication challenges, and emotion dysregulation predicted social motivation and communication difficulties. Sex significantly predicted social communication and cognition challenges, beyond the contributions of age, IQ, autism severity, and EF impairment. Findings from this study provide evidence for the contribution of EF to observed social symptoms of autism. Results suggest there may be sex-based differences in the relationship between EF and social problems for autistic youth. Implications and future directions are discussed.

Impact of Divorce on Parent-Child Relationships

Purpose: The general objective of this study was to explore the impact of divorce on parent- child relationships. Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library. Findings: The findings reveal that there exists a contextual and methodological gap relating to the impact of divorce on parent- child relationships. Preliminary empirical review revealed that divorce significantly influenced these dynamics, often leading to challenges in communication, emotional bonding, and co-parenting. Children of divorced parents experienced various emotional and psychological difficulties, such as insecurity and anxiety, with the disruption of family routines exacerbating these issues. However, the consequences varied based on factors like child age, gender, and family functioning. Despite these challenges, many children showed resilience over time, with factors like parental warmth and effective communication buffering the negative effects. Overall, understanding these complexities allowed for the development of strategies to support families during the transition process, promoting positive outcomes for children and families. Unique Contribution to Theory, Practice and Policy: The Attachment theory, Family Systems theory and Social Learning theory may be used to anchor future studies on the impact divorce has on parent- child relationships. By integrating multiple theoretical perspectives such as attachment theory and family systems theory, researchers gained a comprehensive understanding of the complexities surrounding divorce's effects on parent-child relationships. Evidence-based interventions, including parent education programs and family therapy, were recommended to support families during the divorce process. Moreover, policy reforms advocating for the protection of children's rights and access to supportive services were proposed. These recommendations aimed to enhance the well-being of children and families navigating the challenges of divorce, fostering healthier family dynamics and parent-child relationships.

Nurses’ experiences during the COVID-19 pandemic: A secondary data analysis examining interdisciplinary and peer communication

BackgroundCommunication with interdisciplinary team members was impacted during the start of the COVID-19 pandemic. Bedside nurses managed communication challenges with interdisciplinary team members while working under extremely stressful conditions created by a new and unknown infectious disease. This study examined data collected from a pre-existing qualitative study to answer the question: What communication challenges occurred among nurses and interdisciplinary team members during the beginning months of the COVID-19 pandemic? MethodsA qualitative secondary analysis of an existing dataset was undertaken. The original data were collected using semi-structured interviews conducted with a purposive sample of bedside nurses (n = 17). ResultsUsing thematic analysis, five themes related to communication among nurses and the interdisciplinary team emerged: 1) acknowledging PPE as a communication barrier, 2) questioning how to perform nursing tasks along with increasing workload, 3) developing innovative ways to deliver safe care, 4) experiencing frustrations about lack of communication with interdisciplinary team members, and 5) experiencing both support and criticism that affect working relationships. ConclusionsChallenges associated with communication during the early days of the COVID-19 pandemic became opportunities to build policies and procedures to support collaboration within the healthcare team. Support is necessary to prepare team members to collaborate efficiently during crisis situations. Developing a strategic plan to improve communication, lessen nurse burden, provide mental health support for nurses, while maintaining safe care are priorities in managing future emergency situations.

Partnering with Schools to Adapt a Team Science Intervention: Processes and Challenges

AbstractPublic schools are a major provider of mental health services for children in the US. Mental and behavioral health services range from universal programming to individualized clinical supports to address student needs. These services in schools are delivered by various professionals including non-teaching and teaching school personnel, school-employed clinicians, and/or contracted community mental health partners. Provision of mental health services requires complex coordination of providers across disciplines, although few professionals have training in multidisciplinary collaboration strategies. Attention to team processes, such as delineating team members' roles, improving communication, and identifying collaboration strategies, may impact the effectiveness of evidence-based mental health service provision in real world settings. One intervention, Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), has been used in healthcare with positive outcomes and has been adapted to educational settings. The current paper describes the community-partnered subsequent adaptation of TeamSTEPPS for schools. Needs assessment interviews identified challenges, successes, and goals for student mental health. Overarching themes extracted from interviews include limited resources at multiple levels (e.g., financial support, time, and personnel), communication challenges, and poor role clarity. A community advisory board provided guidance during the adaptation and implementation planning process. Adaptations to the intervention included tailoring the intervention to the school context and the development of flexible training plans. In addition, individualized implementation plans were developed with each school partner to mitigate foreseeable barriers to rolling-out TeamSTEPPS. Our team is currently piloting the adapted TeamSTEPPS intervention and implementation strategies in partnership with three school districts.

Abstract PO3-12-05: Patient (pt)-provider communication challenges about side effects/toxicities from metastatic breast cancer (mBC) treatments

Abstract Introduction: Treatment decisions for ER+/HER2- mBC may be influenced by pt knowledge about treatment side effects, which is shaped by pt-provider communication. We conducted a survey of pts with ER+/HER2- mBC to better understand pt expectations and experiences of treatment toxicities, the extent they were discussed by the pts’ medical team (MT), and the sources/types of side effect information pts prefer. Methods: The 55-question, online ESR1 QUAlity of Life Survey 3 (EQUALS 3) survey was emailed to US pts from the Cure Media Group and authors’ contacts, and posted to private BC Facebook and Twitter pt groups for 2 weeks in June 2023. Eligible pts had ER+/HER2- mBC and reported changing treatments due to progression. Pts received a $10 gift card at survey completion. Survey answers were descriptively summarized. Results: 213 pts completed the survey; they were < 60 yrs of age (77%), White (44%) or Hispanic/Latino (48%), peri-/postmenopausal (54%), and urban-area residents (51%); and had college education (71%) and household income >$50K (66%). Most pts were on 2nd (36%) or 3rd+ (51%) therapy lines. Current mBC treatments were endocrine therapy ± targeted agent (70%), antibody-drug conjugate (8%), chemotherapy (11%), and others (10%). Most pts’ oncologists were female (65%), BC specialists (51%), and from an academic hospital (61%). Only half (49%) of surveyed pts felt extremely/very comfortable discussing side effects with their MT. Although 86% felt well informed about treatment toxicities, MTs did not proactively ask about pts’ greatest concerns on side effects for 15% of pts, nor about what side effects pts would find tolerable or intolerable for 25%. Oncologist/MT inquired about acceptability of side effects most often with treatment change (25%) or when brought up by the pt (20%), and at every single visit for only 19% of pts. Most pts felt extremely prepared for treatment toxicities (78%) and well prepared to manage them (86%), but 19% of pts still felt that their MT did not provide optimal guidance on managing potential side effects. Pt-centered conversations were most often missing: what rare but serious side effects to expect (44%), how to deal with potential side effects (39%), and what common side effects to expect (32%). Pts also reported that the likelihood of experiencing side effects (40%), what rare but serious side effects to expect (39%), and how to deal with potential side effects (28%) were not well presented. To facilitate treatment decisions, pts would like more time discussing treatment options (48%) or side effects (39%); additional written or visual resources on side effects (29%, 23%, respectively) or efficacy (39%, 8%); and the ability to ask questions and receive meaningful answers (39%), talk to other pts (20%), or listen to videos of their stories (11%). Pt testimonials (45%), toxicity descriptions/examples (42%), and toxicity management strategies (36%) were the most common additional forms of information that pts would like to have had on side effects. Conclusion: In this survey of pts with ER+/HER2- mBC, not all pts were comfortable discussing treatment toxicities with their MT, but MTs are mostly addressing side effects. However, there is still room for communication improvement and additional forms of toxicity information are needed for optimal decision-making. Despite generally feeling well prepared for toxicities, a significant proportion of pts report that the range and specifics of side effects and how to manage them were missing or not well presented in MT discussions. This survey highlights the need to improve both provider and pt education with the goal of effectively communicating toxicity specifics of mBC therapies, as well as the need for standardized pt education tools detailing risks and benefits of mBC therapies to assist pts in shared decision-making conversations. Citation Format: Sarah Sammons, Jane Meisel, Timothy Pluard, Kelly Shanahan, Fumiko Chino, Dario Trapani, Dominic Carroll, Monica Kozlowski, Elizabeth Attias, Nicole Kuderer. Patient (pt)-provider communication challenges about side effects/toxicities from metastatic breast cancer (mBC) treatments [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-12-05.

Patient research partner involvement in rheumatology research: a systematic literature review informing the 2023 updated EULAR recommendations for the involvement of patient research partners

BackgroundPatient research partners (PRPs) are people with a disease who collaborate in a research team as partners. The aim of this systematic literature review (SLR) was to assess barriers and...

The Perspectives of Healthcare Professionals on the Strategies, Challenges, and Community Responses to Health System Response and Interventions Towards Lassa Fever Infections and Mortality in Sierra Leone.

Lassa fever is a critical public health issue in Sierra Leone that demands appropriate health system responses and interventions to mitigate infections and reduce mortality. A qualitative study was conducted to delve into healthcare workers' experiences with Lassa fever management and interventions across diverse healthcare settings in Sierra Leone, including the Eastern Province and Freetown's Directorate of Health Security and Emergency (DHSE). Engaging ten key informants through purposive sampling, the study employed NVivo version 10 for a detailed thematic analysis using Query and Coding to systematically identify, classify, and organize key themes regarding knowledge, diagnostics, management roles, and community impact. The findings indicate a well-informed healthcare workforce but highlight gaps in early detection, diagnostic accuracy, and procedural standardization. Concerns were raised about the potential overestimation of disease incidence due to improved diagnostics, suggesting a historical under-detection of Lassa fever. The analysis underscores the need for a multifaceted management approach, emphasizing international collaboration and culturally sensitive community engagement to effectively tackle the disease. A significant concern identified is the high mortality rate resulting from delayed referrals and communication challenges within the health system, leading to actionable recommendations for enhancing Lassa fever response strategies. The study's thematic analysis provides a nuanced understanding of the challenges and areas for improvement, emphasizing the critical role of healthcare professionals in combating Lassa fever. Combating Lassa fever in Sierra Leone demands an integrative strategy that extends beyond medical interventions to encompass educational and infrastructural enhancements. This research pays homage to the commitment of healthcare professionals, underscoring the importance of sustained support and recognition of their essential contributions to advancing Lassa fever management and interventions.

ChatGPT: May Help Inform Patients in Dental Implantology.

Patients may have high expectations regarding dental implants based on the source of their information, which can lead to challenges in clinical communication. This study aims to evaluate the quality of responses provided by Chat Generative Pre-trained Transformer (ChatGPT, OpenAI, USA), an artificial intelligence program, to patient questions in the field of dental implantology. This study was prospectively designed as a crosssectional study. Frequently asked questions by patients about general information on dental implantology (Part 1) and dental implant brands (Part 2) were posed to the ChatGPT program. Responses were independently assessed by oral and maxillofacial surgeons (Group 1: n=10), periodontologists (Group 2: n=10), prosthodontists (Group 3: n=10), and general dentists (Group 4: n=10) using the Global Quality Scale (GSQ). There were a total of 60 questions, with 30 questions in each part. Participants in the study were evenly distributed by gender (50% female, 50% male) with a mean age of 32.6±4.07 years. The mean years of experience were 8.2±3.12 years. There were no significant differences in mean age, gender, and years of experience among the groups (p>0.05). The overall mean GSQ score was 3.87±0.29. Part 1 had a mean score of 3.9±0.35, and Part 2 had a mean score of 3.85±0.29, with no statistically significant difference (p>0.05). The artificial intelligence platform may contribute to the additional education of patients in the field of dental implantology and aid in understanding treatment procedures. However, it is concerning that ChatGPT may exhibit bias regarding dental implant brands, which could impact patient guidance.

Challenges of disaster risk communication from the perspectives of experts and affected people: A conventional content analysis

Effective risk communication is essential for disaster risk management. It is necessary to understand the present contextual factors to select appropriate strategies to enhance risk communication. Therefore, this study aimed to explore the factors that create challenges for risk communication in Iran. Using a qualitative methodology, this research included 25 managers, rescuers, and event survivors with prior experience responding to disasters. Data were collected via semi-structured interviews and analyzed using conventional content analysis. Data analysis resulted in the identification of four categories and eleven subcategories related to the factors that facilitated the formation of challenging risk communication. These categories include distrust (distrust in public warnings, public distrust in relief organizations), ineffective information dissemination (ineffective informing authority, irresponsible dissemination of information, negligence in information transparency), insufficient educational communication (limited training capacity, universal education restriction, extensive educational infrastructure), and uncertain warning messages (uncertain content of warning messages, alert channels diversity, delayed warning messages). Multiple contextual elements thus contribute to ineffectual risk communication, the most significant of which is diminished public confidence in relief organizations. Identifying these factors provides a basis for relief organizations to anticipate and plan long-term strategies to improve communication between relief organizations and the public, thereby increasing the preparedness of individuals for disaster response.

The association of comorbid dementia with length of stay, cost and mortality among older adults in US acute hospitals: An observational study

BackgroundAlthough overall health and social care expenditures among persons with dementia are larger than for other diseases, the resource and cost implications of a comorbid diagnosis of dementia in acute hospitals in the U.S. are largely unknown. We estimate the difference in inpatient outcomes between similar hospital admissions for patients with and without comorbid dementia (CD). MethodsInpatient admissions, from the U.S. National Inpatient Sample (2016-2019), were stratified according to hospital characteristics and primary diagnosis (using ICD-10-CM codes), and entropy balanced within strata according to patient and hospital characteristics to create two comparable groups of admissions for patients (aged 65 years or older) with and without CD (a non-primary diagnosis of dementia). Generalised linear regression modelling was then used to estimate differences in length of stay (LOS), cost, absolute mortality risk and number of procedures between these two groups. ResultsThe final sample consisted of 8,776,417 admissions, comprised of 1,013,879 admissions with and 7,762,538 without CD. CD was associated with on average 0.25 (95% CI: 0.24 to 0.25) days longer LOS, 0.4 percentage points (CI: 0.37 to 0.42) higher absolute mortality risk, $1187 (CI: -1202 to -1171) lower inpatient costs and 0.21 (CI: -0.214 to -0.210) fewer procedures compared to similar patients without CD. ConclusionComorbid dementia is associated with longer LOS and higher mortality in acute hospitals but lower inpatient costs and fewer procedures. This highlights potential communication issues between dementia patients and hospital staff, with patients struggling to express their needs and staff lacking sufficient dementia training to address communication challenges.