Clinician Perceptions Research Articles

"No Matter the Age or Medical Complexity, People Benefit From That Intensity of Exercise": A Mixed-Methods Study Describing Rehabilitation Provider Perceptions of High-Intensity Resistance Training Among Veterans Receiving Post-Acute Care.

In skilled nursing facilities (SNFs), i-STRONGER is a novel, high-intensity resistance training approach that incorporates progressive resistance training to promote greater improvements in patient function compared to usual care. To inform large-scale expansion of i-STRONGER as standard-of-care in SNFs, this mixed-methods study assessed rehabilitation providers' perceptions of i-STRONGER and purported needs for its adoption. Forty-three rehabilitation providers participated in an 18-week, interactive i-STRONGER training program. Post-training, the validated Perceived Characteristics of Intervention Scale was used to evaluate i-STRONGER relative advantage, compatibility with practice, complexity, potential for reinvention (ie, adaptability), trialability, and risk. Providers reported the top 3 needs for successful i-STRONGER adoption and described i-STRONGER perceptions in training modules and focus groups. A convergent mixed-methods design was used to evaluate and describe clinician perceptions of i-STRONGER. i-STRONGER program conceptually aligned with providers' practice. The patterns and was endorsed as feasible and adaptable as part of patient care; however, initial hesitancies surrounding patients' physical abilities and motivation were noted as barriers and appeared to reflect negative age-related beliefs and attitudes within SNF cultures. Providers feared patients would be unwilling or unable to engage with i-STRONGER activities due to their age, deconditioning, medical complexity, or expectation that rehabilitation should feel "easier." As providers began implementing i-STRONGER in real-time, concerns surrounding i-STRONGER's potential risks lessened as providers observed improvements in patient function and motivation, and patients were described as "embracing" i-STRONGER principles. Patient acceptance and satisfaction, equipment, time, and clear communication among providers were cited as critical needs for i-STRONGER adoption. With i-STRONGER, a safe and effective approach for delivering resistance training to older adults in SNF settings, "seeing is believing." Real-time implementation of i-STRONGER facilitated an evolution of perspective among providers, fueled by observable, positive changes in patient function and affect as well as unexpected patient participation. Findings support i-STRONGER use in SNF settings, provided that specific training strategies showcase older adults with medical complexity participating in progressive resistance training.

Perceptions of Endocrine Clinicians Regarding Climate Change and Health

The effects of climate change on the endocrine system are increasingly recognized. We aimed to evaluate endocrine clinicians’ perspectives on climate change awareness and knowledge, motivation for action, and the need for climate health curricula. We designed an online questionnaire with endocrine-specific questions about climate change, which was shared through social media and email. Study data were collected between 9/2022 and 11/2022. Analyses were primarily descriptive. There were 164 responses; 98% were physicians, with a median age of 41 years. The majority (95%) reported that climate change is happening; 52% reported that they are very worried. Knowledge about climate change and health was variable (6.7% very, 40% moderately, 35% modestly, 17.7% not at all), with variable concerns regarding patient effects. The top endocrine climate–health concerns were reduced exercise, malnutrition, and weather-related disruptions. Most respondents agreed that climate change and health topics should be integrated into medical education (72.8% strongly agree or agree). The three resources perceived as most helpful were continuing medical education, patient resources, and policy statements. Endocrine clinicians are aware of and worried about climate change, with varying levels of knowledge and concern about climate change and health effects. We also exposed an untapped interest in developing endocrine-specific climate and health curricula.

Challenges in Care Provision for Children and Adolescents With Differences of Sex Development.

The ideal model of care for individuals with Differences of Sex Development (DSD) continues to evolve, with multiple models proposed. This study aimed to explore current care models for individuals with DSD in Australia and New Zealand (NZ) and to identify clinician perceptions of gaps and barriers in current practice. Cross-sectional anonymous online questionnaire, conducted via Research Electronic Data Capture (REDCap) software. Clinicians involved in the diagnosis and management of individuals with DSD in Australia and NZ were contacted through multimodal recruitment approaches. Themes included demographics of respondents, preferred terminology, composition of the DSD multidisciplinary team (MDT) and availability of a database. Seventy-nine eligible participants from centers in all states and territories of Australia and NZ commenced the survey with 63 complete responses. Almost One-third (31%) of participants are not currently part of a DSD MDT meeting at their center. While three quarters (76%) of respondents identified changes to DSD care over the past 5 years, three quarters (75%) also identified barriers to current care provision. Only 20% of respondents reported psychology being a current part of their MDT and 70% identified psychology as a desired but missing part of their team. Responses to the survey identify gaps and barriers to DSD care across Australia and NZ, particularly a lack of psychosocial supports. Current models fall short of international recommendations and services need to explore the reasons for these gaps further.

Exploring the Perspectives of Canadian Clinicians Regarding Digitally Delivered Psychotherapies Utilized for Trauma-Affected Populations.

Many clinical sites shifted towards digital delivery of mental health services during the COVID-19 pandemic. There is still much to learn regarding tailoring digitally delivered interventions for trauma-affected populations. The current study examined the perceptions of Canadian mental health clinicians who provided digitally delivered psychotherapies utilized for trauma-affected populations. Specifically, we explored the shift to digital health use, what changed with this rapid shift, what needs, problems, and solutions arose, and important future considerations associated with delivering trauma-focused and adjunct treatments digitally. Survey data were collected from 12 Canadian mental health clinician participants. Surveys were adapted from the Alberta Quality Matrix of Health and Unified Theory of Acceptance and Use of Technology model. As a follow-up, the participants were invited to participate in either a semi-structured qualitative interview or focus group to further explore their perspectives on digitally delivered trauma-focused and adjunct therapies. Twenty-four clinician participants partook in an interview or focus group. The participants in this study supported the use of digitally delivered psychotherapies utilized for trauma-affected populations, sharing that these interventions appeared to offer similar quality of care to in-person delivery. Further research is required to address clinicians' concerns with digital delivery (e.g., patient safety) and identify other avenues in which digitally delivered psychotherapies utilized for trauma-affected populations can be engaged with and improved upon.

Understanding Knowledge, Attitude, and Perception of Indian Clinicians in the Management of Resource-challenged Type 2 Diabetes Mellitus Patients in India - DESERVE India Expert Opinion: Part 1

Introduction: Type 2 diabetes mellitus (T2DM), once perceived as a condition prevalent among affluent elderly urban residents, now affects a more diverse demographic, including populations from less-privileged and rural communities. While providing optimal care, clinicians face challenges, such as the financial constraints of T2DM patients. This underscores the urgent need for affordable interventions to enhance patient outcomes and the necessity for a comprehensive understanding of clinician knowledge, attitudes, and perceptions (KAPs). The aim of this study was to develop a consensus of Indian clinicians to emphasize the need for awareness and access to high-quality, affordable interventional approaches for effectively managing resource-challenged T2DM patients in India. Methods: A mixed method study, including 590 clinicians and 60 subject matter experts, assessed their KAPs regarding managing >18 years of adult resource-challenged (deserving) T2DM patients. A structured questionnaire gathered data on clinicians’ clinical and management practices. Four days in-depth interview with 60 subject matter experts also facilitated the expert opinion development process, ensuring a comprehensive and reliable study. Data were analyzed using SPSS Version 29, with statistical significance at P < 0.05. Results: The findings of this study, based on the responses of 590 clinicians, are significant. About 38.64% of the clinicians encountered 1–5 resource-challenged T2DM patients daily, while 40.33% encountered 6–15 patients, reflecting a significant patient load. Concerning follow-up duration, 59.10% reported 1–3 months, highlighting the challenges in maintaining regular follow-ups. Over 80% agreed that these patients struggle to afford treatment and often miss follow-up appointments, seeking alternative therapies due to financial constraints, which can lead to suboptimal glycemic control (P < 0.001). In addition, 82.00% agreed that high cost and lack of financial resources as the primary reason for medication non-adherence. The majority of clinicians agreed that “Glipizide + Metformin could be optimally used for these patients” (P < 0.001). The expert panel identified financial constraints, lifestyle modification difficulties, and psychological challenges as key issues in managing resource-challenged T2DM patients in India. Conclusion: Clinicians and the expert panel agreed on several critical issues, including financial constraints and challenges in adopting lifestyle modifications to manage resource-challenged (deserving) T2DM patients. There is agreement on prescribing low-cost glucose-lowering medications with metformin and glipizide combinations to improve patient adherence and outcomes in resource-constrained settings.

Exploring UK clinician perceptions of through-knee amputation compared to above-knee amputation: a mixed methods study

Background Through-knee amputation (TKA) has potential advantages over above-knee amputation (AKA) but is rarely performed in the United Kingdom (UK). This mixed methods study aimed to explore clinicians’ perceptions of TKA compared to AKA. Method An online survey of vascular surgeons, prosthetists, and physiotherapists between May 2019 and April 2020. Follow-up semi-structured interviews explored themes from the survey. Thematic analysis was used to draw conclusions from the data. Results Seventy-eight clinicians returned surveys, and follow-up interviews were completed with 21 clinicians. Reported advantages of TKA include its long lever and the femoral condyles to anchor (suspend) the prosthesis. Perceived disadvantages include poor wound healing and unsatisfactory prosthetic appearance. The interviews uncovered ineffective communication along the amputation pathway, contributing to a compartmentalised approach to amputation surgery and rehabilitation. Clinicians with strong feelings against TKA and a lack of desire/perceived ability to drive change from clinicians in favour of TKA are barriers to increasing its use. Conclusion Current TKA surgery and rehabilitation practice is based on personal opinions, assumptions, or “accepted wisdom” and lacks an underpinning evidence base. Overall, opinions of TKA are divided, with conflicting views between different professional groups, highlighting the importance of multidisciplinary decision-making. Implications for rehabilitation Through-knee amputation has advantages and disadvantages compared to above-knee amputation which have been observed in clinical practice. Decision regarding level of amputation should involve multiple members of the multidisciplinary team. Lack of amputation pathway guidance and communication barriers prevent effective multidisciplinary collaboration.

Remote appointments in orthodontics and oral and maxillofacial surgery: Part 2 clinician perceptions.

To assess clinician perceptions of and satisfaction with remote appointments in orthodontics and oral and maxillofacial surgery (OMFS). Cross-sectional questionnaire-based study. Orthodontic and OMFS departments in six acute NHS hospital Trusts in the UK. A total of 36 (a mixture of consultants, specialty doctors, registrars and therapists in both orthodontics and OMFS) completed responses were received. Once piloted, questionnaires were disseminated across six hospital Trusts to orthodontic and OMFS clinicians. A combination of face-to-face (F2F) and online dissemination was used. A total of 28 of 36 (77.8%) questionnaires were completed, 75% (n = 21) by orthodontic clinicians and 25% (n = 7) by OMFS clinicians. A 100% (n = 21) response rate was achieved for orthodontic clinicians, compared to a 47% (n = 7/15) response rate for OMFS clinicians. High levels of clinician satisfaction were found for clinician confidentiality; however, concerns remained around patient confidentiality and the inability to conduct a clinical examination. The majority (n = 21, 75%) of clinicians felt that remote appointments had their place in the post-pandemic era, particularly for retainer reviews in orthodontics and biopsy results in OMFS. When appropriately triaged, the majority of remote appointments do save a face-to-face visit, and there is a place for remote platforms in both specialties going forward. However further research is required in the post-pandemic era to ascertain the full long-term applicability of remote orthodontic and OMFS consultations.

"FBT Is for the Rich": A Qualitative Study Examining Clinicians' Experiences and Perceptions of Treatment Access and Engagement for Diverse Families in Family-Based Treatment.

Family-based treatment (FBT) is the leading evidence-based treatment for adolescent eating disorders, but research exploring access and engagement in FBT is sparse. This paper focuses on findings from a broader study, specifically addressing the social determinants of health (SDH) impeding access and engagement in FBT for diverse families (i.e., families belonging to identity groups subject to systemic barriers and prejudices). Forty-one FBT clinicians were recruited globally using purposive and snowball sampling. Clinicians participated in individual interviews or focus groups, discussing their experiences engaging diverse families in FBT. Qualitative data were transcribed verbatim and analyzed using reflexive thematic analysis. The findings underscore the pervasive impact of SDH on equitable access to FBT, specifically, the critical need for tailored approaches by clinicians to enhance access and engagement in FBT for diverse families experiencing practical, resource, and systemic barriers. Recommendations include broader dissemination of FBT knowledge, telehealth options to mitigate geographical barriers, community resource collaborations, and sensitivity to cultural and systemic factors impacting treatment engagement. Results of this study may inform future FBT planning (tailoring treatment approaches to address barriers), clinician training, clinical decision-making tools, and opportunities for supporting under-resourced families within the model, leading to more equitable FBT treatment access and engagement for diverse families.

Factors that contribute to the perceived treatment effect of spinal manipulative therapy in a chiropractic teaching clinic: a qualitative study

BackgroundDespite the progress made in better understanding the potential mechanisms of spinal manipulative therapy (SMT) and its treatment effects, a knowledge gap continues to exist when identifying the specific factors that contribute to the perceived treatment effect associated with SMT. The purpose of the study was to explore the perceptions of chiropractic clinicians, interns, and patients regarding what factors during a doctor-patient encounter contribute to the perceived treatment effect associated with SMT.MethodsThis study used convenience sampling to enroll participants from a chiropractic teaching clinic in the United States. Semi-structured interviews were used as the main form of data collection, which took place from January-April 2024. The data was subsequently analyzed using thematic analysis and organized into themes through an iterative open coding process.ResultsSix rounds of interviews were conducted for a total of 18 interviews. Each round consisted of one patient who received treatment including SMT, one intern who performed the treatment, and one clinician who oversaw the treatment. After analyzing the interview data, the following five themes were identified: Treatment Outcome, Therapeutic Alliance, Adjunctive Therapies, Significance of Cavitation, and Psychomotor Skills. Each theme consisted of multiple subthemes which were mentioned by the participant groups at varying frequencies. Patients frequently mentioned the importance of improvement in symptoms following treatment, as well as good communication skills and the use of adjunctive therapies. Interns valued functional change following treatment, while clinicians focused on confidence levels and psychomotor skills. There were differing views on the significance of cavitation, ranging from indifference to an indication of a successful treatment.ConclusionThis qualitative study identified several themes which describe factors that may contribute to the perceived effect associated with SMT. In addition to the psychomotor skills required to perform SMT, educators and practitioners should consider factors such as the therapeutic alliance between patient and provider, use of adjunctive therapies, and assessment of the outcome associated with the intervention.

Self-Collection for HPV-Based Cervical Screening: Knowledge and Attitudes of Australian Health Care Workers in an Area With Low Screening Rates, July-November 2023.

Cervical screening is crucial for early detection of and ultimately eliminating cervical cancer. Conventional methods for cervical screening that rely on clinician collection of specimens encounter barriers, including embarrassment, discomfort, accessibility, and cultural concerns. Self-collection offers a promising solution to promote cervical screening among underscreened populations. Both methods are available to screen eligible patients since changes to the Australian screening program in 2022. We surveyed Australian health care workers at medical practices in an area with low screening rates on their views about self-collection from July through November 2023. Findings revealed gaps in knowledge about appropriate test use and test accuracy. In addition, findings showed a preference for clinician collection and perceptions that their patients lack confidence in self-collection and lack the willingness to learn about self-collection for cervical screening. Lack of up-to-date information on self-collection logistics and accuracy and pessimistic views on the ability of patients to perform self-collection can hinder the use of self-collection for cervical screening. Addressing these concerns through comprehensive education, easy-to-access guidelines, and interventions designed to support self-collection as part of routine practice is essential, especially for improved participation among under- or never-screened patients.

Emergency clinician perceptions of end-of-life care in Irish emergency departments: a cross-sectional survey

BackgroundPatients with end-of-life care (EoLC) needs present to the emergency departments (ED) frequently and at times, it can be difficult to provide a high standard of care. Within the Irish...

Understanding Therapeutic Experience: A Qualitative Evaluation of Virtual and In-Person Treatment.

Introduction Following the COVID-19 pandemic, there was adoption of virtual psychotherapy. There are a number of benefits and drawbacks to telehealth video conferencing that are experienced by both clients and clinicians. The current qualitative study sought to outline the advantages and disadvantages that clients and clinicians have personally experienced in virtual versus in-person therapy in an effort to identify the reasons for which one medium may be preferred over another. Methods The research was conducted from March 20, 2023, to April 3, 2023. The interviews with 32 individuals (14 clients and 18 clinicians) took place via Zoom video conferencing. Thematic analysis of the empirical material was conducted until fit and significance were met. Application of empirical principles of qualitative research was complete when categories were saturated, and no new themes had emerged. Results Results indicated that virtual care is appreciated for its convenience and ease, which allows clients to attend sessions even when physical barriers limit them (i.e., sickness, vacation, and between meetings or classes). In terms of maximizing the therapeutic process, this study found that in-person care has a number of benefits that are weakened or diminished when one switches to a virtual setting. Being in-person was reported to have a significant therapeutic impact in terms of attendance, engagement, participation, understanding nonverbal communications, and developing rapport with one's clinician and fellow clients. Conclusion The results of this study present an overview of clientand clinician perceptions of the therapeutic impact of modes of therapy (virtual, in-person). While there is no strong evidence to suggest that one mode of care is clinically indicated over the other, the data outlines the benefits and drawbacks of both.

Perceptions of clinicians and research ethics boards regarding ethical issues in investigator-initiated trials: a multicenter qualitative study in China

PurposeThis multicenter qualitative study aimed to explore the perceptions of clinicians and research ethics boards (REBs) regarding ethical issues in Investigator Initiated Trials (IITs).MethodsBetween February and April 2024, semi-structured interviews were conducted with 27 participants from 15 tertiary hospitals, including clinical doctors and members of REBs. Responses were grouped and analyzed using a descriptive phenomenological approach.ResultsClinicians expressed challenges in navigating the formal review process due to limited access to information and unclear guidelines. Academic review highlighted a deficiency in research literacy among clinical investigators, leading to flawed study design. Ethical review revealed concerns about inadequate ethical awareness among clinicians, resulting in failed ethical approvals. Moreover, delays in review processes and resource shortages were noted, hindering the efficient conduct of IITs.ConclusionThe findings underscore the need for comprehensive training programs to enhance clinicians’ research literacy and ethical awareness. Establishing a comprehensive system to support IITs, including enhanced guidance and support from REBs, is essential to ensure the quality and integrity of IITs in China.

Clinicians' Preferences and Perceptions of Iron Supplementation in the Treatment of Anemia in Indian Settings: Emphasis on Liposomal Iron Formulations

Clinicians' Preferences and Perceptions of Iron Supplementation in the Treatment of Anemia in Indian Settings: Emphasis on Liposomal Iron Formulations

A qualitative study of perceptions of the care pathway for familial hypercholesterolemia: screening, diagnosis, treatment, and family cascade screening

BackgroundFamilial hypercholesterolemia (FH) is an autosomal dominant genetic condition that carries increased risk for premature atherosclerotic cardiovascular disease, cardiovascular events, and death. Due to low uptake of evidence-based practices, up to 80% of FH patients remain undiagnosed and most are undertreated. This project aimed to understand patient and clinician perceptions across the care pathway of evidence-based diagnosis and treatment of FH, to inform implementation strategy design for two clinical trials seeking to increase evidence-based care.MethodsWith input from FH experts, we identified key points along the FH care pathway that might be targeted with broad-scale implementation efforts, including: (a) identification of the need for screening; (b) completion of screening test(s); (c) diagnosis; (d) connection to treatment; and (e) family cascade screening (a process used to identify and screen relatives of individuals diagnosed with FH). Then, we conducted qualitative interviews with patients who had participated in a prior FH quality improvement initiative and with clinicians who treat high cholesterol. We analyzed data using thematic analysis.ResultsWe interviewed 21 patients and 17 clinicians. Patient themes offered insights related to the impact of family history, reactions to a diagnosis of high cholesterol and/or FH, experiences with FH treatment and clinical care, perceptions of tools to diagnose FH, motivations and preferences for FH screening efforts, and reactions to family screening. Clinician themes offered insights into the perceived value of FH screening and diagnosis, current FH-related practice and context, and attitudes toward tools to aid clinical practice. In both sets of interviews, confusion and misconceptions about what makes FH unique and its clinical implications were common, as were concerns about logistics and competing priorities.ConclusionQualitative inquiry generated insights into several modifiable patient and clinician determinants of engagement with evidence-based implementation along the FH care pathway, many of which can be targeted with behavioral economics strategies that simplify complex decisions and by addressing informational and emotional needs. These findings offer actionable insights to inform future implementation research that seeks to close the evidence-to-practice gap in diagnosis and delivery of evidence-based care for FH.

Parent and Primary Care Clinician Perceptions About Pediatric Hypertension

Despite published guidelines and a prevalence of pediatric hypertension of approximately 3%, less than 25% of affected children are identified, with 60% not receiving any intervention despite detection. Understanding the knowledge and perceptions of parents or caregivers and health care teams is crucial to identify factors that may contribute to these unacceptably low detection rates. To examine the knowledge and perceptions of parents and health care teams regarding pediatric hypertension to identify common themes contributing to low hypertension detection. This qualitative study, interviewed parents of children diagnosed with hypertension who did not follow up within 1 year after diagnosis and health care clinicians (medical assistants, nurses, managers, pediatricians, and nurse practitioners) across 10 clinics in Delaware and Pennsylvania between November 1, 2022, and March 31, 2023. With the use of an inductive thematic approach, codes were developed and themes identified by multidisciplinary research investigators. A total of 38 stakeholders (mean [range] age, 43 [25-64] years; 33 [86%] female), including 13 parents and 25 health care clinicians, were interviewed. The parent sample was diverse based on race (5 [46%] Black, 5 [38%] White, and 3 [23%] other race), ethnicity (5 [38%] Hispanic and 8 [62%] non-Hispanic), and Child Opportunity Index (5 [38%] very low or low, 3 [23%] moderate, and 5 [38%] high or very high). Parents and clinicians demonstrated awareness of the significance of pediatric hypertension. Parents thought blood pressure checks were important; however, clinicians often had competing priorities during annual visits. Both groups expressed skepticism about high blood pressure readings, attributing them to situational factors or white coat syndrome. Parents and clinicians shared concerns about medication use and preferred lifestyle change. Parents advocated for further testing, whereas clinicians exhibited varying perspectives on additional diagnostics, emphasizing targeted testing strategies and cautious medication approaches. In this qualitative study of parents and clinicians, both groups were skeptical of blood pressure readings and expressed concerns about medication use, with a preference for lifestyle changes over medication. Improving detection may require better measurement tools, reassurance about medications, and clear communication on the role of nonpharmacologic treatments, while future interventions should incorporate the perspectives of both parents and clinicians to develop practical strategies for managing pediatric hypertension.

Clinician perception of the relationship between mental health, health-related social needs, and diabetes outcomes

Clinician perception of the relationship between mental health, health-related social needs, and diabetes outcomes

Comparative Analysis of Healthcare Quality Between the University Hospital of the West Indies and Public Hospitals in Jamaica.

Objective This study aims to assess the quality of healthcare services at the University Hospital of the West Indies (UHWI), a quasi-public hospital, compared to public hospitals in Jamaica, examining both patient and clinician perceptions. Methods This cross-sectional study included one hundred patients (30 males, 70 females) aged 22 to 95, and 52 clinicians (29 females, 23 males) from 10 hospitals, comprising UHWI and nine public hospitals, were surveyed. Quality assessment encompassed structural adequacy, time management, privacy protection, competency, and healthcare standards. Data collection occurred through both interview-administered and self-administered questionnaires. Statistical analysis was then done using the chi-square test. Results Clinicians at UHWI perceived structural adequacy differently than public hospitals, with 63% (n=10) agreeing on cubicle space sufficiency at UHWI versus disagreement among public hospital clinicians. Consultation times were varied, with longer durations reported at UHWI. Privacy concerns were more pronounced among UHWI patients. Overall, patient satisfaction was higher at public hospitals (n=56.80%) compared to UHWI (n=15.50%). Conclusion The study compared healthcare quality and patient satisfaction between quasi-public and public hospitals in Jamaica. Contrary to expectations, healthcare quality was the same between the two types of hospitals. Patients at public hospitals reported higher satisfaction levels, challenging the assumption that paying for services correlates with higher satisfaction. The study underscores the complexity of assessing healthcare quality. It suggests that investments in resources and service delivery are needed across all hospitals to improve patient experiences and outcomes in Jamaica.

"It's Just Really Important for Us All to Be on the Same Page": Qualitative Evaluation of Factors That Influence Written Mobility Communication.

Poor interdisciplinary team communication is a known barrier to increasing inpatient mobility. Understanding why and how clinicians from different disciplines communicate about mobility would help inform communication improvements. This qualitative interview study aimed to describe and explore clinician perceptions about written mobility communication and perceived barriers and enablers to this communication. A rapid deductive qualitative approach was used to efficiently capture information for local improvement. Clinicians (physical therapists, nurses, physicians, and occupational therapists) working on 3 internal medicine wards in a metropolitan teaching hospital in Brisbane, Australia were purposefully sampled and invited to participate in individual interviews. Questions were based on the Consolidated Framework for Implementation Research. Interviews were recorded, transcribed, and analyzed using deductive and inductive thematic methods. From 17 interviews, key themes identified that written communication about patient mobility is important and valued by clinicians; clinicians learn documentation on the job, often from physical therapists; clinicians are not aware of organizational responsibility for mobility communication; multiple purposes for written communication contribute to multiple locations and inconsistency; and clinicians perceive that improvement would require a multidisciplinary and multilevel approach. Suggestions for improvement included the use of a common language, consistent use of existing bedside communication tools, and clearer responsibility for written communication about mobility. Written communication about patient mobility was valued by clinicians, and a range of barriers to effective interdisciplinary communication was identified. Clear professional roles and responsibility for written mobility communication are important. Suggestions for improvement included an interdisciplinary language supported by multidisciplinary education and organizational governance. Written communication about patient mobility is recognized as critical to safe, high-quality hospital care. Our findings suggest that successful mobility communication improvements must involve multiple disciplines and include clear organizational governance to support staff training, clear role responsibilities, and quality monitoring. This study found that staff on a medical ward think writing about mobility is important for patient and staff safety. Having clear roles and responsibilities for writing about mobility is important and consistency may be improved through education and training.

LW-MorphCNN: a lightweight morphological attention-based subtype classification network for lung cancer

Abstract Lung cancer is generally considered one of the most deadly cancers globally. If it can be identified early and diagnosed correctly, the survival probability of patients can be significantly improved. In this process, histopathological examination is a commonly used method for diagnosing and detecting lung cancer. It is crucial to accurately identify lung cancer subtypes from histopathological images, as this helps doctors formulate effective treatment plans. However, the visual inspection in histopathological diagnosis requires a large amount of time and also depends on the subjective perception of clinicians. Therefore, this paper proposes a lightweight lung cancer subtype classification network based on morphological attention (LW-MorphCNN), which is used to automatically classify the histopathological images of benign lung tumors, ADC (adenocarcinoma), and SCC (squamous cell carcinoma) provided in the public dataset LC25000 (Lung and Colon). This paper takes histopathological images as input and conducts a comparative analysis with classic networks such as VGG16, VGG19, DenseNet121, and ResNet50, as well as existing classification methods proposed in the same work. The network proposed in this paper is superior to other networks in terms of parameter quantity and performance, with an accuracy rate and F1 - score reaching 99.47% and 99.44% respectively. Clinicians can install the provided LW-MorphCNN in the hospital to confirm the diagnosis results.