Current Experience Research Articles

Characteristics of parent-child separation related to bullying involvement among left-behind children in China

Parent-child separation due to internal migration is prevalent in China. However, few studies have focused on the associations between different characteristics of parent-child separation and children’s involvement in bullying. We conducted a cross-sectional study among 2,355 fifth-to eighth-grade students in China, using self-reported questionnaires to investigate the associations between children’s bullying involvement (i.e., bullies, victims, bully-victims) and different characteristics of parent-child separation resulting from parental migration. Bivariate and multivariate analyses were conducted to explore these associations. Among all respondents, 17.3% reported being victims of bullying, 3.8% reported being bullies, and 2.7% reported being bully-victims. Compared to children with no left-behind experiences, those with current left-behind experiences were more likely to be victims and bully-victims. Children left behind by parent(s) at the age of three years or younger were more likely to be victims (aOR = 1.66, 95% CI [1.22, 2.25], p = .001), bullies (aOR = 1.88, 95% CI [1.02, 3.52]), and bully-victims (aOR = 2.17, 95% CI [1.04, 4.71]). Children left behind for seven years or longer were more likely to be victims (aOR = 1.49, 95% CI [1.12, 2.00], p = .007), bullies (aOR = 2.03, 95% CI [1.15, 3.69]), and bully-victims (aOR = 2.13, 95% CI [1.06, 4.50]). The identified characteristics of parent-child separation associated with bullying involvement hold implications for parental decisions regarding internal migration, interventions, and policymaking for preventing bullying among left-behind children.

Current Psychotic-Like Experiences Among Chinese College Students: Prevalence, Correlates, and Its Relationship with Suicidal Ideation.

Current psychotic-like experiences (PLEs) are prevalent among adolescents. However, epidemiological data on the prevalence rate of current PLEs among college students and its clinical correlates are scarce and limited. To address this study gap, this study aimed to investigate the prevalence and correlates of current PLEs among Chinese college students. A cross-sectional study was designed with a sample of 18,578 college students in China. Each participant completed a survey on social-demographic characteristics variables, PLEs, sleep disturbance, depression, anxiety, and suicidal ideation. Logistic regression analyses were conducted to explore the influential factors for PLEs among all participants and suicidal ideation among those with PLEs. Among Chinese college students, 40.3% of the participants reported having at least one PLE in the past month, while 7.5% had frequent PLEs. Males, age, residence location in town, left-behind experiences, poor family economic status, chronic physical illness, family history of mental disorder, BMI ≥ 28 [obesity], sleep disturbance, depression, anxiety, and suicidal ideation were independent correlates for frequent PLEs. Furthermore, the prevalence of suicidal ideation among participants with frequent PLEs was 32.1%. Lower grades, sleep disturbance, depression, and anxiety were independent predictors of suicidal ideation among college students who experience PLEs frequently. Current PLEs are widespread among Chinese college students. Suicidal ideation is largely prevalent among individuals who suffer frequent PLEs, suggesting that special measures and attention should be provided to these students based on relevant factors to prevent their suicidal ideation and behavior.

An integrated methodology for significant wave height forecasting based on multi‐strategy random weighted grey wolf optimizer with swarm intelligence

AbstractWhile wave energy is regarded as one of the prominent renewable energy resources to diversify global low‐carbon generation capacity, operational reliability is the main impediment to the wide deployment of the related technology. Current experience in wave energy systems demonstrates that operation and maintenance costs are dominant in their cost structure due to unplanned maintenance resulting in energy production loss. Accurate and high performance simulation forecasting tools are required to improve the efficiency and safety of wave converters. This paper proposes a new methodology for significant wave height forecasting. It is based on incorporating swarm decomposition (SWD) and multi‐strategy random weighted grey wolf optimizer (MsRwGWO) into a multi‐layer perceptron (MLP) forecasting model. This approach takes advantage of the SWD approach to generate more stable, stationary, and regular patterns of the original signal, while the MsRwGWO optimizes the MLP model parameters efficiently. As such, forecasting accuracy has improved. Real wave datasets from three buoys in the North Atlantic Sea are used to test and validate the forecasting performance of the proposed model. Furthermore, the performance is evaluated through a comparison analysis against deep‐learning based state‐of‐the‐art forecasting models. The results show that the proposed approach significantly enhances the model's accuracy.

Real-world analyses of mortality risk after androgen deprivation therapy initiation in Black vs. White patients with prostate cancer.

84 Background: 2 studies found significantly longer overall survival in Black vs. White patients with metastatic castration-resistant prostate cancer (PCa): a 2019 meta-analysis of 9 phase III trials and a 2020 registry study. Our real-world data study compared all-cause mortality risk for Black vs. White PCa patients. Compared to the prior studies, our study encompasses a broader scope and is not exclusive to men with castration-resistant PCa. Methods: Data were collected from the Decision Resources Group Real World Evidence repository, which links medical and prescription claims, and US Electronic Healthcare Records. The analysis set included PCa patients who received ≥1 androgen deprivation therapy (ADT) injection between 1991-2020. Cox regression was used to compare all-cause mortality rates between White and Black patients. Multivariable regression model accounted for the following variables: baseline metastasis, BMI, oncology vs. urology setting, antagonist vs. agonist, personal major adverse cardiovascular event (MACE) history, tobacco history, baseline PSA (>4 vs. ≤4 ng/mL), race (White vs. Black), statin use, increasing age per year, ethnicity (non-Hispanic vs. Hispanic), increasing ADT exposure per year, diabetes, hypertension, and family MACE history. Results: 44,439 patients were included for the all-patient analyses. 34,762 patients were included in the Black vs White analyses: 5,817 and 28,945 were Black and White, respectively. Overall, mortality risk was 2.6% and 17% at 1 and 4 years after ADT initiation, respectively. Mortality risk after ADT initiation was 1.6% and 2.6% at 1 year and 11.7% and 18.1% at 4 years for Black and White patients, respectively. Both unadjusted (HR=1.66, 95% CI 1.53-1.80, p<0.05) and adjusted (HR=1.24, 95% CI 1.01-1.52, p<0.05) mortality risks were higher for White vs. Black patients. Conclusions: All-cause mortality incidence was higher in White vs. Black patients. Adding to the body of evidence, our research also reveals that Black race is associated with a protective effect on survival for all-cause mortality in men undergoing ADT. Potential hypotheses for higher mortality in White vs. Black patients include survival bias to MACE (i.e., Black patients may have died from PCa before having MACE), survival bias to be diagnosed with PCa (i.e., Black patients may have higher rate of CV death and kidney failure prior to PCa diagnosis), and protective effects of higher BMI in Black patients against cancer cachexia. The large size (~45,000 patients from a database with >300 million patients), long follow-up (10 years for some patients), recent clinical experience (99% from 2010-2020), and diversity of the dataset give weight to the results being an accurate representation of current clinical experience. Future studies should confirm our findings that White PCa patients have higher mortality risk and investigate the above hypotheses.

UK endoscopy trainer survey: perspectives on current endoscopy training delivery, experience, barriers and opportunities

ObjectiveUK endoscopy training is delivered by trainers possessing well developed endoscopy and teaching skills to help learners perform high-quality endoscopy. Train The Trainer (TTT) courses are effective, but additional trainer...

중등학교 사회과 교사의 사회적 소수자 관련 수업 실태

This study aims to understand the current experiences of secondary school social studies teachers in teaching lessons related to social minorities, and to explore ways to improve the way social minorities are addressed in the curriculum, textbooks, and lessons. To achieve these goals, I conducted a survey and interviews. 66 secondary school social studies teachers nationwide participated in the survey and 5 in the interviews. Based on the results of the survey and interviews, the current secondary school social studies teachers are teaching “dry” classes that rely on textbooks and avoid controversy as much as possible due to their caution towards students who belong to social minorities and students who have negative attitudes towards social minorities. The implications of the findings are discussed in terms of the social studies curriculum and textbooks as follows. First, in terms of the social studies curriculum, it is suggested that more detailed guidelines for teaching about social minorities should be provided. Secondly, I suggest that the way in which social studies textbooks address ‘values issues’ needs to be reviewed and revised.

Mujeres como territorio de despojo: extractivismo, femicidios y violencia de género en el norte de Chile

This text explores different socio-historical and theoretical contents that shape the current experiences of women who live in the territories of what is known today as the north of Chile. The objective is to contribute to the theoretical approach in the analysis of social and gender inequalities in a context marked by mining extractivism and the vulnerability of its inhabitants. From a gender perspective, we analyze extractivism in the area and its consequences beyond environmental issues. The main conclusion is that the intersection of the issues addressed requires complex analyses where they can converge to strengthen the fusion of issues with a denouncing and innovative perspective.

A national survey of digital health company experiences with electronic health record application programming interfaces.

This study sought to capture current digital health company experiences integrating with electronic health records (EHRs), given new federally regulated standards-based application programming interface (API) policies. We developed and fielded a survey among companies that develop solutions enabling human interaction with an EHR API. The survey was developed by the University of California San Francisco in collaboration with the Office of the National Coordinator for Health Information Technology, the California Health Care Foundation, and ScaleHealth. The instrument contained questions pertaining to experiences with API integrations, barriers faced during API integrations, and API-relevant policy efforts. About 73% of companies reported current or previous use of a standards-based EHR API in production. About 57% of respondents indicated using both standards-based and proprietary APIs to integrate with an EHR, and 24% worked about equally with both APIs. Most companies reported use of the Fast Healthcare Interoperability Resources standard. Companies reported that standards-based APIs required on average less burden than proprietary APIs to establish and maintain. However, companies face barriers to adopting standards-based APIs, including high fees, lack of realistic clinical testing data, and lack of data elements of interest or value. The industry is moving toward the use of standardized APIs to streamline data exchange, with a majority of digital health companies using standards-based APIs to integrate with EHRs. However, barriers persist. A large portion of digital health companies use standards-based APIs to interoperate with EHRs. Continuing to improve the resources for digital health companies to find, test, connect, and use these APIs "without special effort" will be crucial to ensure future technology robustness and durability.

National Identity and Foreign Borrowing in the Legal Forms of Personnel Management: History and Modernity

Relevance. The introduction of special rules for the use of foreign vocabulary in the texts of public acts, improving the form of a business letter, modifying the structure of documents in accordance with the powers of public authorities are trends in the current and past Russian administration experience. Both in the modern and historical and legal context of scientific research, it is relevant to consider state approaches in the field of regulating official paperwork, which are aimed at forming a stable management model in accordance with domestic national interests and values. The purpose of the study is to establish the relationship between elements of national identity and foreign models in the state personnel practice of document flow in Russia in the 18th century, which is useful for taking into account this experience in modern transformations of the foundations of legal and business writing.Objective: are to consider legislative innovations in terms of regulating the field of record keeping and personnel management; to identify forms of record keeping in the XVIII century and socio-political factors influencing their application; a retrospective assessment of the methodology for drafting texts of government acts.Methodology. The methodology is based on comparative legal, comparative historical, historical legal and systemic research methods.The results of the study indicate the improvement of grammatical, stylistic, translation and other business skills and competencies of personnel of public authorities. A historical and legal analysis of the directions of development of personnel management revealed an active borrowing of foreign vocabulary in the execution of administrative acts. The clerical mechanism of interdepartmental communication gradually became more complicated, and the procedure for receiving and responding to petitions from private individuals was regulated. Conclusion. The experience of forming the Russian management and personnel practice of paperwork, developing in conditions of value crises and political contradictions, is important for taking into account the political and legal measures carried out in the modern state.

Client’s Experiences on Skilled Delivery Services among Women of Reproductive Age in Rural Communities in Kenya

Background: Globally Skilled delivery services are critical aspects to combat Maternal and neonatal mortality. In Kenya, skilled deliveries account for 62% of all deliveries; unskilled deliveries pose a higher risk of maternal and neonatal mortality and morbidity. The maternal mortality ratio in Kenya is currently 462 per thousand live births, with 40% of these deaths occurring at home. The main objective of the study was to explore the experiences of women of reproductive age on skilled delivery services.
 Materials And Methods: The baseline study was conducted between November 2022 and January 2023. It employed a cross-sectional research design involving 347 women of reproductive age. The study aimed to examine their current practices, challenges, and experiences with skilled delivery services. Focus Group Discussions (FGDs) were conducted with 48 recently delivered women (within one year), as well as with 48 Community Health Volunteers (CHVs) and 10 Community Extension Workers (CHEWs). In-depth interviews were also held with local health facility administrators. Quantitative data analysis was performed using SPSS version 25.0. Measures of central tendency were employed for continuous data tabulation. The analyzed data was then presented through charts, tables, and frequencies. The qualitative data underwent thematic arrangement and analysis using NVIVO version 13 and then triangulated with descriptive data.
 Results: The results revealed that (90.6%) of women's previous childbirth experiences influenced their utilization of skilled birth attendance services in subsequent pregnancies. Women who had never given birth in health facilities or had chosen home births were less likely to utilize skilled birth attendance services.
 Conclusion and Recommendations: This study identified factors influencing skilled birth attendance use in Kandara SubCounty, highlighting the role of previous childbirth experiences, health facility-related factors, and danger signs during pregnancy. To improve utilization, interventions should focus on health facility conditions, health worker attitudes, and community awareness programs.

Ecological Momentary Assessment of Self-Reported Kratom Use, Effects, and Motivations Among US Adults

Kratom products, which are sold legally in most of the US, contain alkaloids with opioidergic, adrenergic, and serotonergic activity. Millions of people use kratom to relieve pain, improve mood, or self-manage substance use disorders (SUDs). Kratom use has primarily been examined via surveys, in which recall biases among satisfied users may lead to minimization of transient negative outcomes. Further prospective study of kratom use, such as with ecological momentary assessment (EMA), is needed. To characterize proximal motivators, effects, and patterns of kratom use and to assess whether use frequency is associated with motivations, effects, past-year criteria for SUD for kratom (KUD), or other substance use. For this prospective cross-sectional study, an intensive longitudinal smartphone-based EMA in which participants' current behaviors and experiences were repeatedly sampled in real time was conducted between July 1 and October 31, 2022. Participants comprised a convenience sample of US adults who used kratom at least 3 days per week for at least 4 weeks at the time of online screening. Criteria for past-year KUD were based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Data analysis was performed between November 2022 and November 2023. The exposure was 13 401 kratom-use events across 15 days. A baseline survey covering demographics, health, kratom attitudes and behaviors, use motivations, other substance use, and KUD was administered before EMA. Data for the following EMA entries were then collected: event-contingent entries for kratom use (product, dose, and proximal motivations), follow-up entries (short-term effects and consequences of use events), random-prompt entries (mood), beginning-of-day entries (effects of kratom on sleep), and end-of-day entries (daily subjective descriptions of kratom effects). Bayesian regression was used to estimate means and credible intervals. A total of 357 participants completed the EMA. Their mean (SD) age was 38.0 (11.1) years; more than half were men (198 [55.5%]). Participants reported overall motivators of use on the baseline survey that involved managing psychiatric and SUD problems, but proximal motivators evaluated during the EMA involved situation-specific needs such as increasing energy and productivity and decreasing pain. Acute effects were considered congruent with daily obligations. Use patterns, despite having some distinguishing features, were generally similar in their motivators and effects; participants used kratom predominantly during the daytime and seemed to find use frequencies that suited their needs. Higher use patterns were associated with symptoms of physical dependence (eg, withdrawal or tolerance). Co-used substances included caffeine, nicotine, vitamins, and cannabis. Most participants in this study reported using kratom in a seemingly nonproblematic way. When such use appeared problematic, the key element was usually that withdrawal avoidance became a proximal motivator. Longitudinal studies examining changes in kratom use patterns and effects over time are needed.

Patient and caregiver perceptions of the possibility of home blood transfusions.

Patients with hematologic malignancies (HM) often develop transfusion dependence. The patient and caregiver burdens associated with the need for frequent transfusions are high. Home blood transfusions has the potential to reduce these burdens, but is not widely practiced in the United States. We designed a qualitative study to evaluate the patient and caregiver perceptions of the potential for a home blood transfusion program. Eligible patients included Adult (≥18 years) patients who were English speaking and met the definition for transfusion dependence within 3 months of study enrollment. We identified and interviewed eligible participants (patients and caregivers), using a semi-structured interview guide to elicit patient perceptions of the acceptability, barriers, and benefits related to home blood product transfusions. Interviews were audio recorded and transcribed. Results were imported into NVivo 12 (version 12; QSR International, Burlington, VT) for coding and analysis. We recruited participants until we reached thematic saturation, which occurred at 29 participants (20 patients, 9 caregivers). Among the 20 patient participants, nine had MDS (45%) and 11 had acute leukemia (55%). Most of the patients (60%) reported getting one transfusion per week. Four themes emerged when the participants discussed their perception regarding the potential of a home blood transfusion program: (1) current in-person experience, (2) caregiver burden, (3) perceptions of home blood transfusions, and (4) interest in participating in a home blood transfusion program. The concept of home blood transfusions was well received and further research to study its implementation is warranted.

Unification of Ukrainian Society in a Postwar Period as a Preventive Mechanism to Avert the Crisis of State

The study involves the analysis of unification of Ukrainian society in a postwar period to prevent the crisis of state system. It is claimed, that upon the war termination the issue of creation of universal Ukrainian society forming model arises, which is supposed to represent a symbiosis of foundations of nationwide well-being and prospects of Ukraine strategic development. It is shown, that the existent division of society into those who stayed in Ukraine and those who left for other countries can scale up in a long run. The loss of conceptual univocity in the course of developing such categories as “victim,” “patriot,” “traitor” and “savior” in civil society bears evidence to the mobility of self-identification process of existing population clusters and possible appearance of new categories of populace in the not so distant future. The rationalization for human capital is provided as well as the necessity of having regard to the mentioned factor while elaborating the postwar country development strategy. Special attention is paid to the problem of implementation of repatriation policy. Its types are defined, and the mostly acceptable options for Ukraine are characterized, including the direct and active or in direct and mediated state’s stimulation of nationals’ returning to the ethnical Homeland. Based on the conducted analysis of current experience of European countries, it was concluded that it is the controlled process of return migration that is the key component of consistent country development.

Impact of COVID-19-Related Personal Protective Equipment Changes on Dental Education: A Qualitative Study to Explore Faculty and Student Perspective.

COVID-19 pandemic and its related personal protective equipment have impacted all aspects of dental education. The qualitative study assesses the impact of COVID-19-related changes and their effects on students' clinical learning from student and faculty perspectives. This qualitative study involved third- and fourth-year predoctoral dental students and full-time dental clinical faculty. A semistructured interview guide was used. The interview guide consisted of seven open-ended questions about the impact of the new COVID-19-related infection control procedures on students' learning experience in the dental clinic. Interviews were recorded, transcribed verbatim, and analyzed using a basic interpretative approach by two independent researchers. Emerged themes were identified. Twelve faculty members and 21 students participated in six focus groups. Three major themes emerged from the analysis: learning challenges, learning opportunities, and long-term impact. Students identified four categories of learning challenges: communication, visualization, clinical exposure, and heat. Five learning challenges identified by faculty were: faculty burnout, service delivery challenges, material wastage, teaching difficulties, and lack of comprehensive care. The five learning opportunities students identified were autonomy, preparedness, efficiency, safety, and personalized feedback. Learning opportunities identified by faculty were time management, autonomy, and preparedness. Three categories of long-term impact on students identified were future opportunities, adaptation, and postgraduation plans. Faculty identified apathy, career re-evaluation, and adaption as the long-term impact of COVID-19-related changes. Although the new COVID-19-related infection control procedures and regulations in the dental school clinical setting come with learning challenges, students and faculty also saw learning opportunities through increased autonomy, preparedness, and efficiency. The impact of COVID-19 extends beyond the current learning experiences as it may modify students' long-term plans.

A Sibling’s Sense of Self

It is commonly viewed that siblings of those with disabilities are positioned as caregivers and tasked to support their sibling with a disability. Family members of those with disabilities are particularly viewed as impacted heavily by the burden of care placed on them. However, truth be told, there are many influential and positive attributes that are acquired by one’s upbringing and living with a family member who has a disability. Typically overlooked by researchers in the field, there are dismissed perceptions of family members that should be accounted for. Further, individuals who have grown up alongside of members of their family with a disability have unique perceptions that influence their self-perceptions and ways of living. This study found that an individual with a sibling with a disability has experienced in childhood up to current time circumstantial practices relative to their family position which influence the way they currently carry and perceive themselves. Further indicated in this study is the importance of family relationships, dynamics and stability in support of the care to the sibling with a disability. Particular qualities and characteristics are highlighted in this study to showcase the intricate yet complex lives of individuals with siblings who have disabilities. Proven is the need for augmented initiatives and enhanced supports to address gaps and needs among individual family members who are related to someone with a disability. The objective of this study was to gain a deeper understanding of how individuals perceive themselves based on their experiences growing up with a family member who identifies as having a disability. The aim was to investigate the perceived experiences of these individuals and their reflections on their personal identities and sense of perception. A total of 10 individuals over the age of 18 who have siblings with disabilities from across Ontario, Canada completed virtual or in-person interviews. To reflect participants' upbringing, current experiences, and anticipated future roles within their families, themes naturally surfaced and were identified as means to represent consistent data responses. In general, the findings revealed a range of experiences that impact their sense of self and family responsibilities. Many unique and positive perceptions of self were conveyed by participants in reference to their lived experiences. This study fills gaps in disability studies by highlighting the positive outcomes of sibling relationships and the unique lived experiences of individuals who have siblings with disabilities. It emphasizes the importance of recognizing an individuals’ experiences and stories relative to having a sibling with a disability.

Gastroenterology trainee experience, confidence and satisfaction in nutrition training: a cross-sectional survey in the UK

IntroductionNutrition is an essential part of gastroenterology specialist training. There is limited evidence of trainee experience in this area. The shorter training programme introduced in 2022 may lead to reduced...

Including English learners in multi-tiered systems of support (MTSS) in reading: A CHAT-informed mixed methods investigation

Effective inclusion of English Learners (ELs) in multi-tiered systems of support (MTSS) is necessary for this growing subset of students to access the intended outcomes of MTSS, specifically improved academic outcomes. Facilitating MTSS systems that are appropriately responsive to the heterogeneous needs of ELs may be particularly challenging. In the current study, Cultural Historical Activity Theory (CHAT) guided survey and interview data collection and analysis of elementary teachers’ current experiences with including ELs in MTSS for reading. Quantitative findings indicated inclusive practices were common and that teacher perceptions about including ELs in MTSS were generally positive. Qualitative findings identified several sources of tension; these tensions are described and used to guide the identification of changes that have the potential for further improving MTSS for ELs.

Patient Perspectives of Center-Specific Reporting in Kidney Failure Care: An Australian Qualitative Study

IntroductionPublic reporting of quality of care indicators in healthcare is intended to inform consumer decision-making, however people may be unaware such information exists or it may not capture their priorities. The aim of this study was to understand the views of people with kidney disease about public reporting of dialysis and transplant centre outcomes. MethodsThis qualitative study involved twenty-seven patients with lived experience of kidney disease in Australia who participated across eleven online focus groups between August and December 2022. Transcripts were analysed thematically. ResultsPatients from all Australian states and territories participated, with 22 (81%) having a functioning kidney transplant and 22 (81%) having current or previous experience of dialysis. Five themes were identified: 1) Surrendering to the health system, 2) The complexity of quality, 3) Benefits for patient care and experience, 4) Concerned about risks and unintended consequences, 5) Optimising the impact of data. ConclusionPatients desire choice among kidney services but perceive this as rarely possible in the Australian context. Health professionals are trusted to make decisions about appropriate centres. Public reporting of centre outcomes may induce fear and a loss of balanced perspective, but was supported by all participants and represents an opportunity for self-advocacy and informed decision-making. Strategies to mitigate potential risks include availability of trusted clinicians and community members to aid in data interpretation, providing context about centres and patients, and framing statistics to promote positivity and hope.

Problems of information support of the logistics process

The article discusses modern logistics processes and related problems. The main emphasis is placed on the ongoing changes associated with computerization and informatization penetrating into all spheres of our life. Having identified information not only as a resource of economic activity, but also as a potentially problematic system, nevertheless, the need to attract information resources to management within the framework of the logistics process has been proven. Problems of information support for the transportation process are considered in the aspects of information about the condition of the cargo and its location; tracking and monitoring of vehicles in the format of basic programs for tracking the movement of goods, namely: warehouse management systems; transport tracking and monitoring systems; programs for managing transport logistics processes. The article also examines the current domestic experience and practice of using information technologies, indicates the obstacles to their implementation, and develops directions for computerization in the field of logistics. In conclusion, the main promising directions for the development of information support for the transport process are the use of the capabilities of artificial intelligence and machine learning; the development of digital platforms that will allow logistics companies to improve the interaction of all participants in the transport market and the development of autonomous vehicles.

Training, experience, and perceptions of chest tube insertion by higher speciality trainees: implications for training, patient safety, and service delivery

BackgroundSeldinger Chest Tube Insertion (CTI) is a high acuity low occurrence procedure and remains a core capability for UK physician higher speciality trainee’s (HST). A multitude of factors have emerged which may affect the opportunity of generalists to perform CTI. In view of which, this paper sought to establish the current experiences, attitudes, training, and knowledge of medical HST performing Seldinger CTI in acute care hospitals in the Peninsula deanery.MethodsA Scoping review was performed to establish the UK medical HST experience of adult seldinger CTI. Synonymous terms for CTI training were searched across Cochrane, ERIC, Pubmed and British education index databases. Following which, a regional survey was constructed and completed by HST and pleural consultants from five hospitals within the Peninsula deanery between April–July 2022. Data collected included participants demographics, attitudes, training, experience, and clinical knowledge. Outcomes were collated and comparisons made across groups using SPSS. A p-value of < 0.05 was defined as significant.ResultsThe scoping review returned six papers. Salient findings included low self-reported procedural confidence levels, poor interventional selection for patient cases, inadequate site selection for CTI and 1 paper reported only 25% of respondents able to achieve 5–10 CTI annually. However, all papers were limited by including grades other than HST in their responses.The regional survey was completed by 87 HST (12 respiratory, 63 non-respiratory medical HST and 12 intensivists/anaesthetists HST). An additional seven questionnaires were completed by pleural consultants. Respiratory HSTs performed significantly more Seldinger CTI than general and ICM/anaesthetic registrars (p < 0.05). The percentage of HST able to achieve a self-imposed annual CTI number were 81.8, 12.9 and 41.7% respectively. Self-reported transthoracic ultrasound competence was 100, 8 and 58% respectively (p < 0.001). The approach to clinical management significantly differed with national guidance with pleural consultants showing an agreement of 89%, respiratory HST 75%, general HST 52% and ICM/anaesthetic HST 54% (p = 0.002).ConclusionCompared to respiratory trainees, non-respiratory trainees perform lower numbers of Seldinger CTI, with lower confidence levels, limited knowledge, and a reduced perceived relevance of the skill set. This represents a significant training and service challenge, with notable patient safety implications.