Free-text Answers Research Articles

Patients’ suggestions for improvements to text-based e-consultations. An online survey of users of the national health portal in Norway

BackgroundIn recent years, text-based e-consultations have been widely implemented in general practice and are appreciated by patients for their convenience and efficiency. Policymakers aim to enhance patient access to clinical services with the general practitioner (GP) through text-based e-consultations. However, concerns are raised about their efficiency and security. We aimed to investigate users’ perceptions of potential improvements in the text-based e-consultation service provided by the national health portal in Norway.MethodWe conducted an online survey among users of text-based e-consultations with the GP on the national health portal Helsenorge. The survey was available from January-February 2023 and consisted of 20 questions. This study focused on the free-text answers to the question “Do you have any suggestions to improve the service?” The framework method was used for a thematic analysis of the answers.ResultsThe analysis of 2,954 free-text answers from users of the national e-consultation service resulted in six areas where suggestions for improvement were expressed. According to users, the service would benefit from: (1) a better set-up to facilitate the formulation of the patient's problem, (2) better value for money (in regards to both price and quality), (3) faster response time, (4) improved information and predictability about the status of the e-consultation (e.g., if it is received and when to expect an answer), (5) improvement in technical issues, and (6) improvement of access to dialogue-based services to replace or complement e-consultations.ConclusionThe analysis of users’ suggestions for improvements to the e-consultation service emphasised the need to customise the service to address individual patient needs. Users found a one-size-fits-all approach with mandatory questions, fixed pricing, and inflexible response times less appreciated. Some also felt forced to rely on e-consultations due to the perceived poor availability of other GP services. This highlights the importance of perceiving e-consultations not as a replacement for dialogue-enabled services, but rather as a potentially efficient addition, ensuring a well-tailored setup for appropriate patient use.

Perception of antimicrobial stewardship interventions in Swiss primary care: a mixed-methods survey.

With most of the antibiotic prescriptions occurring in primary care, antimicrobial stewardship (AMS) interventions must be known, welcomed, and used by primary care physicians (PCPs). The main objective of this study was to evaluate the present awareness about, use of, and perceived acceptability, appropriateness, and feasibility of a broad range of interventions. A cross-sectional survey was distributed to Swiss PCPs from December 2023 to February 2024. The survey focused on eight AMS interventions: shared decision-making tools, factsheets for physicians, Swiss Federal Office of Public Health (FOPH) information material, national antibiotic guidelines website, audit and feedback, communication skills training, as well as the use of point-of-care C-reactive protein (POC-CRP) and procalcitonin (POC-PCT) to guide prescription. PCPs' perceived acceptability, appropriateness, and feasibility were assessed using five-point Likert scales. General expectations regarding AMS were evaluated via qualitative analysis of free-text answers. Out of 7456 potentially eligible primary care physicians, 355 PCPs answered at least one question (response rate 4.7%). PCPs were most aware of biomarkers to guide antibiotic prescription in RTIs, such as POC-PCT (67.6%) and POC-CRP (61.1%), the FOPH awareness campaign (57.3%) and the national guidelines website (52.7%). All interventions were rated as acceptable, appropriate, and feasible, with respective mean scores out of five of 3.89, 3.91, and 3.81. Despite the high perceived acceptability, appropriateness, and feasibility of AMS interventions available for RTIs, their real-life impact may be hindered by insufficient awareness. Additional promotion of those tools could increase their uptake by physicians.

Evaluation of a Computer-Based Morphological Analysis Method for Free-Text Responses in the General Medicine In-Training Examination: Algorithm Validation Study.

The General Medicine In-Training Examination (GM-ITE) tests clinical knowledge in a 2-year postgraduate residency program in Japan. In the academic year 2021, as a domain of medical safety, the GM-ITE included questions regarding the diagnosis from medical history and physical findings through video viewing and the skills in presenting a case. Examinees watched a video or audio recording of a patient examination and provided free-text responses. However, the human cost of scoring free-text answers may limit the implementation of GM-ITE. A simple morphological analysis and word-matching model, thus, can be used to score free-text responses. This study aimed to compare human versus computer scoring of free-text responses and qualitatively evaluate the discrepancies between human- and machine-generated scores to assess the efficacy of machine scoring. After obtaining consent for participation in the study, the authors used text data from residents who voluntarily answered the GM-ITE patient reproduction video-based questions involving simulated patients. The GM-ITE used video-based questions to simulate a patient's consultation in the emergency room with a diagnosis of pulmonary embolism following a fracture. Residents provided statements for the case presentation. We obtained human-generated scores by collating the results of 2 independent scorers and machine-generated scores by converting the free-text responses into a word sequence through segmentation and morphological analysis and matching them with a prepared list of correct answers in 2022. Of the 104 responses collected-63 for postgraduate year 1 and 41 for postgraduate year 2-39 cases remained for final analysis after excluding invalid responses. The authors found discrepancies between human and machine scoring in 14 questions (7.2%); some were due to shortcomings in machine scoring that could be resolved by maintaining a list of correct words and dictionaries, whereas others were due to human error. Machine scoring is comparable to human scoring. It requires a simple program and calibration but can potentially reduce the cost of scoring free-text responses.

A new normal in primary care: the rapid normalization of a major eHealth program in public health centers

BackgroundThis study aimed to contribute to a better understanding of the context, mechanisms and outcomes in the implementation process of an eHealth video consultation program in primary care. The study focused on how the program is normalized in the primary care setting. The primary research question for this study is “in what ways is the implementation of video consultation normalized in primary care?”.MethodsThe qualitative design and content analysis of primary data from the transcripts were based on in-depth interviews, complemented with free-text answers to open-ended survey questions and various documents. The study focuses on the large-scale implementation of the public eHealth program Närhälsan Online, which represents more than 100 health centers in Sweden’s largest region of Västra Götaland. Multiagent perspectives on how the program is normalized were drawn from expressed perceptions by professions directly linked to both strategic and functional implementation, as well as administration and clinical operation.ResultsThis study both confirms and enhances the field with a theoretical contribution in six ways to the reviewed previous research, as well as showing practical implications. It also provides multi-agent perspectives on the rapid normalization of the implementation program studied.ConclusionsIn relation to the rapid progression of different initiatives in eHealth, this study contributes to perspectives on specific challenges as expressed by professions directly linked to both strategic and functional implementation as well as administration and clinical operation.

Clinical staff attitudes towards opt-out consent for blood-borne virus screening in emergency departments in England.

Opt-out screening for blood-borne viruses (BBVs) in emergency departments (EDs) has been established in areas with a high prevalence of HIV diagnoses in England. This multi-site study explored the attitudes of healthcare workers (HCWs) towards BBV screening in EDs post-implementation. This was a cross-sectional electronic survey of HCWs. Between November 2023 and February 2024, HCWs across 33 EDs in England participating in opt-out BBV screening were invited to complete a survey about the feasibility and acceptability of screening, including the opt-out consent process. Factors independently associated with acceptability of opt-out screening were identified using multivariable logistic regression. Free-text responses were analysed thematically. Responses from 610 HCWs in 19 EDs were provided: 50.4% were nurses, 43.1% doctors, and 6.5% other healthcare professionals. Acceptability of the screening programme and opt-out consent was high (90.3% and 77.7%, respectively), with some variation between EDs. Acceptability of opt-out consent was greater among doctors than among other HCWs, and among HCWs who proactively discussed screening further with patients who opted out. However, 50.8% of HCWs felt that patients should be verbally reminded at blood draw, and 44.3% of HCWs wanted more training in discussing opt-out screening with patients. Free-text answers suggested changes to test-ordering systems, including simple integration of tick boxes to document whether patients opted out and to block repeated testing. There was substantial support from ED HCWs for routine opt-out ED BBV screening, including opt-out consent. Key areas suggested for improvement included changes to test-ordering systems and additional training for HCWs. Frequent preference for verbal reminders at the point of blood draw suggests continued HIV testing exceptionalism.

Teaching innovation: enhancing undergraduate student pharmacist consultation skills by introducing ‘Fishbowl’ prescribing workshops

Abstract Introduction The new ‘Standards for the initial education and training of pharmacists’1 outline the skills, knowledge, and attributes required to enable pharmacists to independently prescribe at the point of registration. Third-year MPharm students at the University of Nottingham have previously practised consultation skills in professional practice workshops, conducting shorter form, over the counter-type consultations. These lacked the depth required for pharmacy students to develop skills they will now need. Therefore, we identified a requirement for advanced consultation practice, including prescribing, alongside clinical history taking, to better prepare students to be prescribers. Creation of a new module occurred, ‘Pharmaceutical Care and Prescribing’, including ‘Fishbowl’ workshops. ‘Fishbowl’ is a small group teaching method where an individual student engages in a discussion, while observers form a circle around them2. Students were able to ‘tap out’ of consultations at any point, to discuss consultation direction with their peers. Five case studies were written to incorporate a variety of clinical conditions, patient demographics and clinical settings, with a key emphasis of holistic, patient-centred care. All third-year students were timetabled for five workshops, in groups of around 25. Facilitators regularly discussed consultation progress, outstanding care issues and gave feedback on areas done well or needing improvement. Aim Do students perceive ‘Fishbowl’ workshops to enhance their clinical history taking skills and prescribing knowledge? Methods Following the five workshops, all third-year students (n=256) were invited via email to complete a Microsoft Forms questionnaire, to evaluate the workshop aims . The questionnaire included ten 5-point Likert-scale questions and free-text answers. Primarily quantitative methods were used with free-text responses used to contextualise results. This study obtained ethical approval from the University of Nottingham, School of Pharmacy Postgraduate Research Projects Ethical Approval group. Results 82 students (32%) completed the questionnaire. 91% of students felt they helped practice taking a clinical history. 80% of students felt they better understood how to include share care decision making into their consultations. One student commented, they were ‘very thought-provoking sessions and easy to interact and learn from each other’. 67% said the sessions helped them to better understand the pharmacist’s role in prescribing. With regards to prescribing awareness, a student commented ‘It would have been nice to have scenarios where we prescribed a POM in the end for more of the sessions to help us get used to thinking like prescribers.’ 85% of students would recommend the teaching technique to other MPharm students, 76% felt these sessions should be introduced in earlier years of the MPharm course. A few students commented that the facilitation style varied considerably depending on academics involved. Discussion/Conclusion ‘Fishbowl’ method of teaching provides a suitable environment for practising clinical history taking and prescribing and were generally well received by students. Further work is needed to integrate this teaching technique earlier in the MPharm programme. Facilitator skills play a significant part in student engagement, we need to ensure there is appropriate staff training to run this session type. Limitations of the study include lack of comparison against other student teaching tools.

What is Needed to Support Non-Urban Urology in the United States? Perspectives from Urologists in Rural and Underresourced Areas.

Twenty percent of Americans live in non-urban areas, and the challenges in providing high-quality health care in rural areas are well described. These challenges are further exacerbated by the fact that rural citizens are often older and sicker than their urban colleagues, as well as by the ongoing workforce shortage in urology. This study aims to describe the current practice experiences of non-metropolitan urologists (NMUs) in the United States. Based on the results of the 2022 American Urological Association Census, a secondary questionnaire was developed and distributed electronically to urologists who self-identified in the Census as practicing in non-metropolitan areas. Multiple choice answers were summarized as proportions and free-text answers were collected and grouped by theme. One hundred and thirteen of 552 (20.5%) urologists responded. Most respondents were male (92.9%), aged >55 years (76.1%), in practice >25 years, and in solo practice (25.5%) or a subspecialty group (20.8%). Stressors for NMUs included recruitment (61.3%), call concerns (59.3%), workforce issues (59.3%), difficulty interacting with tertiary medical centers (45.1%), and lack of resources (40.7%). Nearly half of respondents (48.5%) experience burnout more than once monthly, and 31.9% anticipate continuing their current practice and pace for the next five years. Call burden is the most likely reason to leave practice (40%). Most urologists practicing in non-metropolitan areas are older, endorse high rates of burnout, and have active plans to leave or decrease practice within five years. Understanding contemporary stressors can inform policies to support current and future NMUs.

Digital Storytelling as a Method of Achieving Visual Literacy

The research aims to explore the pedagogical benefits of the digital storytelling tool on the acquisition of visual literacy among higher education learners, as well as their personal attitudes during the process of completion of the specific task. Two main questions were asked: “Does digital storytelling support the development of key skills related to visual literacy?” and “Do the learners feel sufficiently engaged and motivated in the specific pedagogical tool of digital storytelling?” A qualitative approach was used using the method of direct observation and a survey with free-text answers. As in our case, Digital story is intended for students studying audiovisual disciplines in higher education, we have significantly raised the performance and assessment criteria so as to be adequate to the level of professional training to be covered by the relevant academic degree. The subjective evaluations of the students clearly showed a positive attitude towards the learning process, and the objective teaching observations brought out the presence of achievements in an upward direction. The important teaching conclusions are that, in a pedagogical aspect, Digital story fulfilled its purpose – to assist in a light and fun way to master audiovisual technical and creative skills at a high professional level, to engage learners with course content, to have a lasting impact on higher order visual literacy skills, to effectively develop visual thinking.

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.

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.

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.

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.