Free-text Answers Research Articles

Self-care strategies used by disaster responders after the 2023 earthquake in Turkey and Syria: a mixed methods study

BackgroundDisaster responders are exposed to several physical and mental health risks. This study aimed to describe self-care strategies used by disaster responders after the earthquake in Syria and eastern Turkey in February 2023.MethodsA study specific web-based questionnaire survey was used to collect quantitative and qualitative data according to a convergent mixed methods approach. Data from 252 disaster responders responding to the earthquakes in Turkey and Syria were analyzed using both descriptive and analytical statistics and summative content analysis of free-text answers. Data were collected in March to July, 2023.ResultsThe most used self-care strategies included resting, social support from colleagues in the field, extra intake of food or drink, and intake of medicines. The recovery strategies varied due to previous disaster response experience, indicating that supportive self-care strategies can be developed or learned.ConclusionGiven the extreme conditions and limited possibilities of external support, sufficient self-care is an essential competence among disaster responders. Self-care strategies can be both external processed such as intake of medicines, social support from others, and internal processes such as personal reflection. Providing oneself with self-care activities seems to be a skill developed with increasing experience supported by pre-deployment training. Therefore, to enhance resilience, self-care strategies should be encompassed in pre-disaster response training.

Qualitative Insights Into Healthcare Professionals’ Perceived Barriers in Providing Equitable and Patient-Centered Care to Members of the LGBTQI+ Community in Greece

LGBTQI+ individuals often face health disparities, with encumbered outcomes. We investigated the perspectives of a wide range of Greek health professionals using a battery of questionnaires examining LGBTQI+ health-related knowledge, attitudes, and clinical preparedness, while exploring the potential challenges they face when providing care for LGBTQI+ patients via qualitative analysis of their free text answers. In total, 220 health professionals participated, including physicians, nurses, dentists, physiotherapists, social workers, nutritionists, medical laboratory professionals, pharmacists, radiographers, and health promotion specialists. Four main themes were revealed concerning the barriers to providing equitable and patient-centered care to LGBTQI+ individuals: (1) Inadequate knowledge (1a. Distinctive health issues of the LGBTQI+ community, 1b. Community-related terminology), (2) Insufficient communication skills (2a. General approach of LGBTQI+ patients, 2b. Addressing LGBTQI+ individuals, 2c. Managing critical attitudes of colleagues/third parties), (3) Personal perceptions (3a. Attitudes toward the LGBTQI+ community, 3b. Perceptions on the necessity of sexual health history), and (4) Ambiguous bureaucratic procedures. Self-identification, contact with community members in personal life, as well as LGBTQI+ patients’ openness during the encounter were reportedly enabling inclusive care. Most participants (83.2%) expressed willingness for further training on LGBTQI+ health issues. Going forward, study participants identified this field, in conjunction with communication skills, as important areas of focus for training health providers and empowering them to provide equitable, patient-centered, high-quality care to the LGBTQI+ community.

A Simulation-Based Approach to Teach Interaction Effects in Postgraduate Biostatistics Courses

Simulation-based teaching can be a valuable method for learning statistical concepts. Its practical implementation for health-related subjects is seldomly evaluated. We propose a simulation-based approach to teach interaction effects in a postgraduate biostatistics course. We describe the steps involved in organizing and implementing a simulation-based activity and evaluate its execution. Mainly master and doctoral students in medical sciences (public health/epidemiology) participated to a 3-hr long online workshop on interaction effects. We presented one main learning activity, broken down into six progressive steps, from visualizing an interaction effect to investigating samples leading to erroneous inference. A total of 85 people attended of which 53 filled out an evaluation survey. Most (89%) of the respondents reported that the proposed activities helped them better understand interaction effects. A qualitative content analysis of free-text answers indicated that learning activities focusing on interaction effects in this way were useful for developing an understanding of both the meaning of statistical models and their interpretations. We conclude that a simulation-based approach can be a useful and interactive tool to create a valuable learning experience. The materials provided in this article can serve as a starting point for teachers who wish to implement such a method.

Strengths and weaknesses of automated scoring of free-text student answers

AbstractFree-text tasks, where students need to write a short answer to a specific question, serve as a well-established method for assessing learner knowledge. To address the high cost of manually scoring these tasks, automated scoring models can be used. Such models come in various types, each with its own strengths and weaknesses. Comparing these models helps in selecting the most suitable one for a given problem. Depending on the assessment context, this decision can be driven by ethical or legal considerations. When implemented successfully, a scoring model has the potential to substantially reduce costs and enhance the reliability of the scoring process. This article compares the different categories of scoring models across a set of crucial criteria that have immediate relevance to model employment in practice.

How Distressed Are Adolescent Students? A Mix-Method Study on High School Students in Northern Italy, Two Years after the Beginning of the COVID-19 Pandemic.

Adolescence is a central phase for the development of a person's identity, involving complex multidimensional changes and increasing vulnerability to distress. This study aimed to investigate the psychological well-being of adolescent students in Brescia (Northern Italy), two years after the beginning of the COVID-19 pandemic. An online survey investigated the extent and the reasons reported by high school students (13-21 years) for their emotional distress (ED), also considering other factors such as physical activity, nutrition, sleep and smartphone overuse. The main reasons for ED were classified through a qualitative analysis of the free-text answers. A total of 1686 students agreed to participate, and 50% showed a presence of ED. According to a multiple logistic analysis, adolescents were more at risk of ED if they were female (AdjOR 2.3), older (AdjOR 1.6), slept less than 8 h (AdjOR 1.5), perceived increased anxiety (AdjOR 3.4), and adopted certain eating behaviors, e.g., comfort food consumption (AdjOR 2.0). According to free-text answers, the main reasons for ED were "school pressure", "relationships with family and peers", "negative emotional states" and "the pandemic". The results show a high level of ED among adolescents, and the reported reasons may help to better address their psychological needs after the pandemic.

Evaluation of a Digital Previsit Tool for Identifying Stroke-Related Health Problems Before a Follow-Up Visit (Part 1): Survey Study.

Stroke may lead to various disabilities, and a structured follow-up visit is strongly recommended within a few months after an event. To facilitate this visit, the digital previsit tool "Strokehealth" was developed for patients to fill out in advance. The concept Strokehälsa (or Strokehealth) was initially developed in-house as a Windows application, later incorporated in 1177.se. The study's primary objective was to use a patient satisfaction survey to evaluate the digital previsit tool Strokehealth when used before a follow-up visit, with a focus on feasibility and relevance from the perspective of people with stroke. Our secondary objective was to explore the extent to which the previsit tool identified stroke-related health problems. Between November 2020 and June 2021, a web-based survey was sent to patients who were scheduled for a follow-up visit after discharge from a stroke unit and had recently filled in the previsit tool. The survey covered demographic characteristics, internet habits, and satisfaction rated using 5 response options. Descriptive statistics were used to present data from both the previsit tool and the survey. We also compared the characteristics of those who completed the previsit tool and those who did not, using nonparametric statistics. Free-text responses were thematically analyzed. All patients filling out the previsit tool (80/171; age: median 67, range 32-91 years) were community-dwelling. Most had experienced a mild stroke and reported a median of 2 stroke-related health problems (range 0-8), and they were significantly younger than nonresponders (P<.001). The survey evaluating the previsit tool was completed by 73% (58/80; 39 men). The majority (48/58, 83%) reported using the internet daily. Most respondents (56/58, 97%) were either satisfied (n=15) or very satisfied (n=41) with how well the previsit tool captured their health problems. The highest level of dissatisfaction was related to the response options in Strokehealth (n=5). Based on the free-text answers to the survey, we developed 4 themes. First, Strokehealth was perceived to provide a structure that ensured that issues would be emphasized and considered. Second, user-friendliness and accessibility were viewed as acceptable, although respondents suggested improvements. Third, participants raised awareness about being approached digitally for communication and highlighted the importance of how to be approached. Fourth, their experiences with Strokehealth were influenced by their perceptions of the explanatory texts, the response options, and the possibility of elaborating on their answers in free text. People with stroke considered the freely available previsit tool Strokehealth feasible for preparing in advance for a follow-up visit. Despite high satisfaction with how well the tool captured their health problems, participants indicated that additional free-text responses and revised information could enhance usability. Improvements need to be considered in parallel with qualitative data to ensure that the tool meets patient needs. Researchweb 275135; https://www.researchweb.org/is/vgr/project/275135.

Patient-reported outcomes and treatment adherence in type 2 diabetes using natural language processing: Wave 8 of the Observational International Diabetes Management Practices Study.

We analyzed patient-reported outcomes of people with type 2 diabetes to better understand perceptions and experiences contributing to treatment adherence. In the ongoing International Diabetes Management Practices Study, we collected patient-reported outcomes data from structured questionnaires (chronic treatment acceptance questionnaire and Diabetes Self-Management Questionnaire) and free-text answers to open-ended questions to assess perceptions of treatment value and side-effects, as well as barriers to, and enablers for, adherence and self-management. Free-text answers were analyzed by natural language processing. In 2018-2020, we recruited 2,475 patients with type 2 diabetes (43.3% insulin-treated, glycated hemoglobin (HbA1c) 8.0 ± 1.8%; 30.9% with HbA1c <7%) from 13 countries across Africa, the Middle East, Europe, Latin America and Asia. Mean ± standard deviation scores of chronic treatment acceptance questionnaire (acceptance of medication, rated out of 100) and Diabetes Self-Management Questionnaire (self-management, rated out of 10) were 87.8 ± 24.5 and 3.3 ± 0.9, respectively. Based on free-text analysis and coded responses, one in three patients reported treatment non-adherence. Overall, although most patients accepted treatment values and side-effects, self-management was suboptimal. Treatment duration, regimen complexity and disruption of daily routines were major barriers to adherence, whereas habit formation was a key enabler. Treatment-adherent patients were older (60 ± 11.6 vs 55 ± 11.7 years, P < 0.001), and more likely to have longer disease duration (12 ± 8.6 vs 10 ± 7.7 years, P < 0.001), exposure to diabetes education (73.1% vs 67.8%, P < 0.05), lower HbA1c (7.9 ± 1.8% vs 8.3 ± 1.9%, P < 0.001) and attainment of HbA1c <7% (29.7% vs 23.3%, P < 0.01). Patient perceptions/experiences influence treatment adherence and self-management. Patient-centered education and support programs that consider patient-reported outcomes aimed at promoting empowerment and developing new routines might improve glycemic control.

Evaluating and validating the Serious Slow Game Jam methodology as a mechanism for co-designing serious games to improve understanding of cybersecurity for different demographics

We present an evaluation of a Serious Slow Game Jam (SSGJ) methodology as a mechanism for co-designing serious games in the application domain of cybersecurity, to evaluate how the SSGJ methodology contributed to improving the understanding of cybersecurity for different demographics. The aim of this study was to evaluate how the SSGJ contributed to improving the understanding of cybersecurity for young persons between the ages of 11 and 16 years old who had no formal training or education in cybersecurity, and to validate and compare these results to previous work where the same SSGJ methodology was used with a different target demographic (i.e.,M.Sc. students with no formal training or education in secure coding). To this end, we engaged 23 participants between the ages of 11 and 16 years old for 5 consecutive days over a one-week period, in a multidisciplinary SSGJ involving domain-specific, pedagogical, and game design knowledge, and encouraged engagement in-between scheduled events of the SSGJ. Findings show improved confidence of participants in their knowledge of cybersecurity, for both demographics, after undertaking the Serious Slow Game Jam (from 41.2% to 76.5% for young persons, and from 12.5% to 62.5% for M.Sc. students). Free-text answers specifically indicate an improved understanding of cybersecurity in general, and one specific security vulnerability, attack or defence for a quarter of young persons, and the trichotomy of security vulnerabilities, attacks, and defences for three quarters of the M.Sc. students. Also, confidence in knowledge of game design improved for both demographics (from 47.1% to 82.4% for young persons and from 12.5% to 75% for M.Sc. students). The SSGJ methodology also successfully engaged both demographics of participants in-between scheduled days. Finally, two serious games in the application domain of cybersecurity are presented that were co-designed during the SSGJ with participants and produced as an output of the SSGJs.

Pediatric head injury guideline use in Sweden: a cross-sectional survey on determinants for successful implementation of a clinical practice guideline

BackgroundThe Scandinavian Neurotrauma Committee guideline (SNC-16) was developed and published in 2016, to aid clinicians in management of pediatric head injuries in Scandinavian emergency departments (ED). The objective of this study was to explore determinants for use of the SNC-16 guideline by Swedish ED physicians.MethodsThis is a nationwide, cross-sectional, web-based survey in Sweden. Using modified snowball sampling, physicians managing children in the ED were invited via e-mail to complete the validated Clinician Guideline Determinants Questionnaire between February and May, 2023. Baseline data, data on enablers and barriers for use of the SNC-16 guideline, and preferred routes for implementation and access of guidelines in general were collected and analyzed descriptively and exploratory with Chi-square and Fisher's tests.ResultsOf 595 invitations, 198 emergency physicians completed the survey (effective response rate 33.3%). There was a high reported use of the SNC-16 guideline (149/195; 76.4%) and a strong belief in its benefits for the patients (188/197; 95.4% agreement). Respondents generally agreed with the guideline's content (187/197; 94.9%) and found it easy to use and navigate (188/197; 95.4%). Some respondents (53/197; 26.9%) perceived a lack of organizational support needed to use the guideline. Implementation tools may be improved as only 58.9% (116/197) agreed that the guideline includes such. Only 37.6% (74/197) of the respondents agreed that the guideline clearly describes the underlying evidence supporting the recommendation. Most respondents prefer to consult colleagues (178/198; 89.9%) and guidelines (149/198; 75.3%) to gain knowledge to guide clinical decision making. Four types of enablers for guideline use emerged from free-text answers: ease of use and implementation, alignment with local guidelines and practice, advantages for stakeholders, and practicality and accessibility. Barriers for guideline use were manifested as: organizational challenges, medical concerns, and practical concerns.ConclusionsThe findings suggest high self-reported use of the SNC-16 guideline among Swedish ED physicians. In updated versions of the guideline, focus on improving implementation tools and descriptions of the underlying evidence may further facilitate adoption and adherence. Measures to improve organizational support for guideline use and involvement of patient representatives should also be considered.

Supporting advanced practice: feedback from a mental health, community and primary care advanced practice support project in South Yorkshire, UK

Background: Despite the significant input from Heath Education England (HEE), now NHS England (NHSE), there are still significant variations around advanced practice programmes, support and training, particularly in less developed areas such as mental health, community posts and primary care. To help target these areas, and to support the NHS Long Term Plan (2023) to increase the number of advanced clinical practitioners (ACPs), the Faculty of Advanced Practice South Yorkshire recruited three ACP leads from mental health, community, and primary care backgrounds to establish a support project led by one professional lead. These leads were able to utilise their lived experience of completing the ACP MSc programme and working as an ACP to help trainee advanced clinical practitioners (tACPs) navigate their journey. The ACP leads also developed a variety of educational events, which further supported the trainees' needs. Aim: This article reports the feedback given via an online questionnaire from trainees that accessed the project, which ended in March 2024. Its aim is to highlight the often-undervalued concept of using clinicians personal experience regarding advanced training and practice, to mentor, support and ultimately retain the future ACP workforce. Methods: An email with a link to a questionnaire was sent to 128 tACPs or recently qualified ACPs that had applied for their training via the Faculty of Advanced Practice South Yorkshire. The questionnaire, created in Microsoft Forms, was completed anonymously, and produced both numerical and free-text data. The questionnaire solicited feedback around: the number of contacts they had and how they contacted; the ACP leads; types of support accessed; and the educational events available. Free text answers were analysed by the author (CJ) and a second reviewer (SF) to generate a consensus on themes. Results: A total of 64 clinicians responded, of which 43 were tACPs, 10 were ACPs, five had other job titles (community matron, pharmacist, practice nurse) and five did not state what their job title was. Responses suggest that the support accessed from the project was highly beneficial and could not be gained elsewhere. A key factor in the project's success was the ACP leads' lived experience of having previously completed advanced practice training, as well as their ability to tailor learning events to the trainees' needs. Conclusion: Meeting the demands of ACP training in areas where the role is less established remains an ongoing challenge. It seems some of these challenges relate to the lack of practical support being provided by employers or higher education institutions, such as lived experience of completing the task of ACP training. Support projects, like the one discussed in this article, appear aptly placed to help fulfil these needs and begs the question ‘why aren't there more?’, especially when advanced practitioners are fundamental to the future healthcare workforce.

Survey comparing the treatment of central retinal artery occlusion with hyperbaric oxygen in Australia and New Zealand with the recommended guidelines as outlined by the Undersea and Hyperbaric Medical Society.

Central retinal artery occlusion (CRAO) presents suddenly causing painless loss of vision that is often significant. Meaningful improvement in vision occurs in only 8% of patients with spontaneous reperfusion. Hyperbaric oxygen treatment (HBOT) is considered to be of benefit if commenced before retinal infarction occurs. The Undersea and Hyperbaric Medical Society (UHMS) guidelines on the management of CRAO were last amended in 2019. This survey questioned Australian and New Zealand (ANZ) hyperbaric medicine units (HMUs) about the incidence of CRAO cases referred and compared their subsequent management against the UHMS guidelines. An anonymous survey via SurveyMonkey® was sent to all 12 ANZ HMUs that treat emergency indications, allowing for multiple choice and free text answers regarding their management of CRAO. One-hundred and forty-six cases of CRAO were treated in ANZ HMUs over the last five years. Most (101/146) cases (69%) were initially treated at a pressure of 284 kPa. This was the area of greatest difference noted in CRAO management between the UHMS guidelines and ANZ practice. Few ANZ HMUs strictly followed the UHMS guidelines. We suggest a more simplified management protocol as used by the majority of ANZ HMUs.

Reshaping free-text radiology notes into structured reports with generative question answering transformers

BackgroundRadiology reports are typically written in a free-text format, making clinical information difficult to extract and use. Recently, the adoption of structured reporting (SR) has been recommended by various medical societies thanks to the advantages it offers, e.g. standardization, completeness, and information retrieval. We propose a pipeline to extract information from Italian free-text radiology reports that fits with the items of the reference SR registry proposed by a national society of interventional and medical radiology, focusing on CT staging of patients with lymphoma. MethodsOur work aims to leverage the potential of Natural Language Processing and Transformer-based models to deal with automatic SR registry filling. With the availability of 174 Italian radiology reports, we investigate a rule-free generative Question Answering approach based on the Italian-specific version of T5: IT5. To address information content discrepancies, we focus on the six most frequently filled items in the annotations made on the reports: three categorical (multichoice), one free-text (free-text), and two continuous numerical (factual). In the preprocessing phase, we encode also information that is not supposed to be entered. Two strategies (batch-truncation and ex-post combination) are implemented to comply with the IT5 context length limitations. Performance is evaluated in terms of strict accuracy, f1, and format accuracy, and compared with the widely used GPT-3.5 Large Language Model. Unlike multichoice and factual, free-text answers do not have 1-to-1 correspondence with their reference annotations. For this reason, we collect human-expert feedback on the similarity between medical annotations and generated free-text answers, using a 5-point Likert scale questionnaire (evaluating the criteria of correctness and completeness). ResultsThe combination of fine-tuning and batch splitting allows IT5 ex-post combination to achieve notable results in terms of information extraction of different types of structured data, performing on par with GPT-3.5. Human-based assessment scores of free-text answers show a high correlation with the AI performance metrics f1 (Spearman's correlation coefficients>0.5, p-values<0.001) for both IT5 ex-post combination and GPT-3.5. The latter is better at generating plausible human-like statements, even if it systematically provides answers even when they are not supposed to be given. ConclusionsIn our experimental setting, a fine-tuned Transformer-based model with a modest number of parameters (i.e., IT5, 220 M) performs well as a clinical information extraction system for automatic SR registry filling task. It can extract information from more than one place in the report, elaborating it in a manner that complies with the response specifications provided by the SR registry (for multichoice and factual items), or that closely approximates the work of a human-expert (free-text items); with the ability to discern when an answer is supposed to be given or not to a user query.

Can narrative medicine methods improve well-being in patients with gastrointestinal malignancy?

e24091 A Pilot study - Can Narrative Medicine Methods Improve Well-being in Patients with Gastrointestinal Malignancy? Background: Patients with cancer often face profound physical and emotional challenges. Narrative medicine methods, involving discussions of and writing about creative texts, are utilized to help healthcare providers improve communication and process emotional experiences which, unexplored, may lead to poor well-being. We apply the narrative medicine method to patients with GI malignancies. Methods: The endpoints of this pilot study were feasibility - 7/10 participants completing 2 out of 3 sessions, and assessing the benefit of applying the practice to optimize well-being. 10 patients were identified by a single oncologist at USC/Norris cancer center to undergo three narrative medicine sessions. Sessions addressed themes relevant to well-being: Identity, Meaning making, and Finding joy. A survey with Likert scales (1-5) and free text answers, as well as interviews, were administered. Content analysis was done. ESAS scales were administered before sessions. Results: 7 of 10 patients have been assessed, completing all three sessions.Surveys were administered after session 3, interviews 1 month later. 5 was the most popular Likert choice. 7/7 chose a 5 for feeling comfortable and learning about themselves. In free text answers, 6/7 patient responses reflected themes of enhanced self-reflection, 2/7 improved perspective-taking, and 3/7 enhanced empathy for others. 1/7 said the sessions gave them hope for medical research, and 1/7 noted the sessions helped them tolerate chemotherapy. ESAS scores trending in a positive direction included pain, drowsiness, nausea, anxiety, and well-being. The interviews elicited the following themes: 7/7 noted the narrative medicine experience had been enjoyable, 6/7 noted enhanced meaning-making meaning and perspective-taking. 3/7 noted the sessions made them feel more positively about their healthcare experiences and helped them embrace their identities outside of cancer. 3/7 said the sessions improved their empathy for others. Other individual themes were: the sessions gave them hope, helped with self-reflection, encouraged seeking new experiences, helped them accept circumstances, enhanced connection to creativity and spirituality, and improved their ability to connect to others. Conclusions: This narrative medicine pilot project was feasible and patients were able to complete the assessment. The evaluative scores demonstrated that all participants felt comfortable participating. Additionally, the patients noted benefits related to well-being including but not limited to improved capacity for self-reflection, putting things in perspective, meaning-making, and noticing moments of joy. A larger study is planned to assess the benefits of this approach for patient well-being and clinical outcomes.

Rapid survey assessment: Barriers and facilitators to mammogram completion in English and Spanish-speaking patients in a federally qualified health center (FQHC) setting.

1587 Background: Mammography has decreased breast cancer mortality in the US by 40% since the 1980s; yet disparities in screening and outcomes persist in underserved populations. Many studies note language as a barrier to screening with lower mammogram completion amongst Spanish-speaking patients versus those with English language proficiency. At our health center, Spanish-speaking patients were more likely to complete screening mammography compared to patients with English proficiency (53% vs 31% in 2022). To understand this pattern and barriers and facilitators to breast cancer screening, we conducted a mixed methods rapid assessment survey as part of a quality improvement initiative. Methods: We developed a patient bilingual survey measuring knowledge, attitudes, and behaviors about breast cancer prevention and screening. We identified consecutive female patients (age 40-75 years) and extracted baseline demographic data from the electronic medical record. Surveys were distributed via our health center’s patient messaging service and responses stored on a secure platform. Data analysis included descriptive statistics, chi-squared testing between groups and qualitative analysis to identify common themes from free-text answers. Results: The overall response rate was 14% (N=732/5,332) in 30 days. Of the surveys completed, 37% were in Spanish. Spanish-speaking patients more strongly regarded mammography as safe and effective compared to English-speaking patients (p&lt;0.001). Spanish-speaking patients were more likely to view getting a mammogram as a priority (79% vs 65% p&lt;0.001) and noted speaking about breast cancer prevention in their communities more often (p&lt;0.006) as an important factor. Spanish-speaking patients primarily cited cost, scheduling, and language (p&lt;0.05) as barriers to mammogram completion, while English-speaking patients cited time constraints, transportation, and discomfort (p&lt;0.05) more frequently. Spanish-speaking patients were more likely to prefer speaking with a trusted community member or attending health fairs than English-speaking patients (P&lt;0.05). Conclusions: Our study demonstrates differences in attitudes, behaviors, and perceived barriers to mammography in English vs Spanish-speaking patients. The increased mammogram completion rate in Spanish-speaking patients may reflect more positive attitudes about screening and more discussion in the community amongst Spanish-speaking patients queried. Reported barriers to screening differed and will guide targeted QI interventions. We demonstrated feasibility and patient engagement in a diverse population using a message system built into our EHR in an FQHC setting. This survey study allows us to elevate patient voices, better understand gaps and preferences, and better tailor future interventions for cancer screening.

A national survey of clinicians’ opinions of rotational vaginal births

IntroductionMalposition of the fetal head, defined as occiput transverse or posterior positions, occurs in approximately 5% of births. At full cervical dilatation, fetal malposition is associated with an increased risk of rotational vaginal birth. There are three different rotational methods: manual rotation, rotational ventouse or rotational (Kielland’s) forceps. In the absence of robust evidence, it is not currently known which of the three methods is most efficacious, and safest for parents and babies. ObjectiveTo gain greater insights into opinions and preferences of rotational birth to explore the acceptability and feasibility of performing a randomised trial comparing different rotational methods. Material and methodsA survey was sent via email to obstetricians from the British Maternal Fetal Medicine Society, as well as expert obstetricians and active academics in ongoing research in the UK. The questions focussed on perceived competence, preferred rotational method, location (theatre or labour room), willingness to recruit to an RCT, and its outcome measures. Closed questions were followed by the option of free text to allow further comments. The free text answers underwent thematic analysis. Results252 consultant obstetricians responded. The majority stated they were competent in performing manual rotation (88.1%). Half felt proficient using Kielland’s rotational forceps (54.4%). Most obstetricians felt skilled in rotational ventouse (76.2%). Manual rotation was the preferred first rotational method of choice in cases of both occiput transverse and posterior positions. The decision for which rotational method to attempt first was considered case-dependent by many. Two thirds of obstetricians would usually conduct rotational births in theatre (67.9%). Over half (52%) do not routinely use intrapartum ultrasound. Most (62.7%) would be willing to recruit to a randomised controlled trial comparing manual versus instrumental rotation. Over half (57.2%) would be willing to recruit to the same RCT if they were the most senior doctor competent in rotational vaginal birth supervising a junior. ConclusionThere is a wide range of practice in conducting rotational vaginal births in the UK. An RCT to investigate the impact of different rotational methods on outcome would be both feasible and desirable, especially in research-active hospitals.

MRI reporting radiographers - Has there been a progression or regression in numbers and scope of practice?

IntroductionThe aim of this study was to determine whether there had been a progression or regression in the numbers and scope of practice of reporting radiographers in Magnetic Resonance Imaging (MRI) in the United Kingdom (UK), using data from a previous study conducted by the author in 2019/20 as a comparison. MethodsData was gathered via a survey sent to multiple users and groups of MRI Radiographers in the UK. The survey consisted of a questionnaire, using both numerical and free text answers to enable the responders to elaborate on their scope of practice whilst also allowing numerical data to be easily analysed. The responses were analysed for patterns and comparison was made with the data from the previous survey. The questionnaire was based on three main themes of those in training, those trained and those in practice. ResultsA total of 62 sites had radiographers in training (n =24) or trained (n = 125) in MRI reporting compared to 46 sites in the previous survey. The majority of responders were from England (n = 56/62) with only a few sites in Scotland (n = 4) and Wales (n = 2). There were 24 radiographers in training, a reduction compared to the previous survey and an increase in the number of radiographers trained (n = 80 to n = 125) and in practice (n = 57 to n = 84). Scope of practice had also increased with the addition of MRCPs, orbits and pituitary. ConclusionThis survey provides evidence that the number and scope of practice of MRI reporting radiographers within the UK has progressed when compared to a previous survey from 2019/20. The numbers however are still low and there remain significant geographical variations. The continued predominance of single handed practice is a concern and the reasons behind this and the slow expansion of skill mix reporting in this modality needs further investigation. Implications for practiceThis study provides evidence of the number and scope of practice of the radiographer reporting of MRI examinations in the UK. It also demonstrates that there has been an increase in scope and number of radiographers reporting MRI scans, this will provide evidence and proof of concept for departments looking to initiate or increase this practice.

Shining a spotlight on the inclusion of disabled participants in clinical trials: a mixed methods study

BackgroundIt is crucial to include a wide range of the population in clinical trials for the outcome to be applicable in real-world settings. Existing literature indicates that under-served groups, including disabled people, have been excluded from participating in clinical trials without justification. Exclusion from clinical trials exacerbates disparities in healthcare and diminishes the benefits for excluded populations. Therefore, this study was conducted to investigate potential obstacles that prevent disabled people from participating in clinical trials in the United Kingdom (UK).MethodsThe study was carried out through an explanatory sequential mixed methods design. The Imperial Clinical Trials Unit devised and implemented an online questionnaire-based survey (with open/closed-ended questions) and an online focus group discussion. The target population were disabled people, family members/carers of disabled people and staff involved in clinical trials, whereupon the sample was recruited by convenience sampling methods via posters and emails through various networks. The Qualtrics XM survey system was used as the host platform for the online survey, and Microsoft Teams was used for an online focus group discussion. The focus group discussion was conducted to gain a deeper understanding of the themes identified from the survey responses. We analysed responses to the survey via descriptive analysis and used thematic analysis to synthesise the free-text answers from the survey and focus group discussion.ResultsWe received 45 responses to the survey questionnaire and 5 disabled people took part in a focus group discussion. Our findings highlighted the differences between the perspectives of researchers and those “being researched” and different types of barriers experienced by disabled people: opportunity barriers (inadequate recruitment strategy and ambiguous eligibility criteria), awareness barriers (perception of disability) and acceptance/refusal barriers (available support and adjustment, and sharing of trial results).ConclusionOur findings support perspectives drawn from the Ford Framework regarding the need to consider all barriers, not just up to the point of enrolment into trials but also beyond the point of inclusion in clinical trials. We support calls for the introduction of legislation on including disabled people in clinical trials, implementation of industry/community-wide participatory approaches and the development of guidelines, a combined public–private approach.

Patient and public involvement and engagement (PPIE): how valuable and how hard? An evaluation of ALL_EARS@UoS PPIE group, 18 months on

BackgroundALL_EARS@UoS is a patient and public involvement and engagement (PPIE) group for people with lived experience of hearing loss. The purpose of the group is to share experiences of hearing loss and hearing healthcare, inform research and improve services for patients at University of Southampton Auditory Implant Service. A year after inception, we wanted to critically reflect on the value and challenges of the group. Four members of ALL_EARS@UoS were recruited to an evaluation steering group. This paper reports the evaluation of the group using the UK Standards for Public Involvement.MethodsAn anonymous, mixed-methods questionnaire was co-designed and shared with members of ALL_EARS@UoS using an online platform. The questionnaire was designed to capture satisfaction, individual feedback through free-text answers, and demographic information. Descriptive statistics have been used to express the satisfaction and demographic data. Reflexive thematic analysis has been used to analyse the free-text responses. Group engagement and activity data over time were monitored and collected.ResultsThe questionnaire response rate was 61% (11/18). Areas identified as strengths were ‘Communication’ and ‘Working together’. Five themes were developed from the thematic analysis; (1) Increased knowledge and awareness around the topic of hearing health for group members and wider society, (2) supporting research, (3) inclusivity within the group, (4) opportunity to make a difference for people in the future and (5) running of the group/group organisation. The data highlighted the value and challenges of PPIE. Members described feeling listened to and appreciation of being able to share experiences. Time of day and meeting format were identified as challenges as they affected who could attend the meetings. The ability to secure and maintain sufficient funding and time to support inclusive and diverse PPIE activities is a challenge for researchers.ConclusionsWe have identified how PPIE added value to both group members and researchers, emphasising the true benefit of PPIE. We have highlighted challenges we are facing and our plan to tackle these. We aim to continue to develop and sustain a group that reflects the diversity of the Deaf/deaf or hard of hearing community and of our local community.

Rebooting nuclear medicine specialist education under the COVID-19 pandemic: From plenary lectures to active e-learning.

Despite major reforms of specialist training in the Nordic countries towards concrete learning outcomes and promoting active learning, most specialist courses continue to be based on lectures. We redesigned our mandatory 5-day course in clinical nuclear medicine (NM) that was last held in 2016 towards active learning. Thirty 1-h lectures were replaced with 10 thematic blocks of 3 h each. Each block was taught by a single teacher in a blend of short introductory lectures alternating with small groups of residents reading NM cases from our newly established national case library in diagnostic format. Due to COVID-19, the entire course in 2021 needed to be run on a videoconferencing system rather than in a computer laboratory as had been originally planned. At the end of the course, we conducted the same anonymized survey as in 2016. All 19 course participants responded. 74% fully agreed that the e-course format had been 'good'. One hundred per cent fully agreed that the practical exercises were 'useful' versus 50% in 2016 (p < 0.001). In their free text answers on the merits or downsides of e-learning, 12/12 respondents only mentioned advantages. Our newly established library of anonymized teaching cases within our national health network is an effective tool for organising courses based on active learning. Despite the change towards distance learning enforced by the pandemic, course participants reported the same high levels of satisfaction with active learning in small groups as in the earlier traditional lecture-based course format.

A national survey of practice for the emergency fixation of testis.

Scrotal exploration for suspected testicular torsion is a common emergency procedure in the United Kingdom (UK). There is no universally agreed practice for how the testis should be fixed, or whether a nontorted testis should receive fixation. This survey aims to describe the methods used for emergency scrotal exploration and testicular fixation in the UK. An online survey was distributed to urologists, general surgeons and specialist paediatric surgeons in approved NHS trusts, and via the email lists of collaborating organisations. The survey questioned surgeons on their operative management of a variety of common diagnoses encountered during scrotal exploration using multiple choice and free-text answers. A total of 340 responses were received from 83 institutions. Respondents included urologists (consultants, 33%; trainees, 24%), paediatric surgeons (consultants, 12%; trainees, 16%) and general surgeons. In cases of torsion, respondents predominantly perform sutured fixation (74%); however, sutureless dartos pouch fixation was used frequently (37%) by paediatric surgeons. The finding of 'bell-clapper' anatomy without torsion prompts 69% of respondents to undertake sutured fixation, but alternative nontorsion diagnoses frequently prompt use of sutureless methods (53-66%). This study is the largest survey of methods for emergency scrotal exploration and describes current UK practice. The majority of surgeons prefer sutured fixation in cases of torsion and/or bell-clapper anomalies, and sutureless methods in the absence of it.