Free-text Responses Research Articles

Between what is and what could be: a survey of pharmacists' practices, attitudes, and beliefs in the provision of mental health care.

Pharmacists can have an essential role in providing care for patients with mental illness. There are gaps in the understanding of the current extent of pharmacists' involvement in caring for patients with mental illness and their readiness to effectively provide this care. To describe the current practices, attitudes, and beliefs of pharmacists in providing care to individuals with mental illness, and to assess factors that may impact these practices. An electronic questionnaire was emailed to pharmacists in Saskatchewan, Canada. Likert scale questions were utilized, and data were analyzed using descriptive statistics and content analysis for free-text responses. The response rate was 9.1% (n = 146/1596). Fewer than 20% of respondents reported they were providing the clinical services listed to most or all patients with mental illness, except for providing basic medication education (61%). Almost all agreed it is a pharmacist's role to provide all the services (61-98% for different services) and many were motivated to provide them (47-91%). The factors most frequently selected as having the greatest impact on service provision were insufficient knowledge (27%, n = 34) and competing priorities (19%, n = 24). Consistent with international trends, Saskatchewan pharmacists reported low provision of clinical services for individuals with mental illness, despite a readiness to provide these services. There is an opportunity and a need to better utilize pharmacists internationally in the provision of mental health care.

Dying and Death in a Pediatric Cardiac ICU: Mixed Methods Evaluation of Multidisciplinary Staff Responses.

Understanding factors influencing quality of pediatric end-of-life (EOL) care is necessary to identify interventions to improve family and staff experiences. We characterized pediatric cardiac ICU (PCICU) staff free-text survey responses to contextualize patterns in quality of dying and death (QODD) scoring. This mixed methods study reports on a cross-sectional survey of PCICU staff involved in patient deaths. Single, quaternary PCICU from 2019-2021. Multidisciplinary staff (bedside nurses, allied health professionals, and medical practitioners) rated QODD and voluntarily added free-text responses. We derived descriptive categories of free-text responses using content analysis. Response sentiment was classified as positive, negative or both positive and negative. We compared category and sentiment frequency by discipline, EOL medical intensity, years of experience and QODD score quartiles. None. Of 60 deaths and 713 completed staff surveys, 269 (38%) contained free-text responses, including 103 of 269 (38%) from nurses. Of six qualitative categories (i.e., relational dynamics, clinical circumstances, family experiences, emotional expressions, temporal conditions, and structural/situational factors), relational dynamics was most frequent (173 responses). When compared by discipline, family experiences were more common in nursing responses than medical practitioners or allied health. High intensity was associated with infrequent discussion of family experience and greater focus on temporal conditions and clinical circumstances. Emotional expressions and temporal conditions were more common in lowest QODD quartile surveys. Although 45% staff responses contained both sentiments, relational dynamics and family experiences were more likely positive. Negative sentiments were more common in the lowest QODD quartile surveys and responses containing temporal conditions or structural/situational factors. Synergistic relationships between the multidisciplinary team and family shaped clinician's positive responses. Attention to team dynamics may be a crucial ingredient in interventions to improve EOL care. Our data support that team-based education initiatives should consider differential foci between disciplines and EOL characteristics.

Gaps in Postnatal Support for Intended Parents.

To identify gaps in postnatal depression screening and support services for intended parents (parents who are intended to receive the baby from a gestational surrogacy pregnancy), also known as commissioned parents. This descriptive study used quantitative and free-text survey questions designed to assess postnatal depression screening and postnatal services available for all parents and, more specifically, for intended parents. The survey was sent to 2,000 randomly selected postpartum nurses in the United States who are members of the Association of Women's Health, Obstetric and Neonatal Nurses. Completion of the survey was offered to the 125 nurses who responded that they provided care for intended parents. Thirty-seven percent of respondents indicated that postpartum support services are available for both parents. Free-text responses describe a gap in postnatal services for intended parents. Although 85% of survey respondents reported that postpartum depression screening occurs in their setting, nurses reported neither fathers nor intended parents are screened for postnatal depression. This study expands the known gap in postnatal support services for intended parents, including postnatal depression screening. Recommendations for nurses working in the perinatal setting include providing consistent support for all parents as they transition to parenthood. Creating standardized policies and practices reflecting the diverse needs and cultures of intended parents can help direct all clinicians toward providing more significant support. Adapting current postnatal screening and support systems could provide a continuum of support for all families.

Evaluating Allied Health Clinical Placement Performance: Protocol for a Modified Delphi Study.

University-affiliated student-led health care services have emerged in response to the challenges faced by universities in securing quality clinical placements for health care students. Evidence of the health care benefits and challenges of student-led health care services is growing, while evidence of clinical placement performance remains variable and not generalizable. Though there have been previous attempts to develop a framework for evaluation of clinical placement performance, concerns have been raised about the applicability of these frameworks across the various placement settings. Additionally, the perspectives of all key stakeholders on the critical areas of clinical placement performance have yet to be considered. This study's objective is to gather information on areas of measurement related to student learning outcomes, experience of placement, and costs of placement and then develop consensus on which of those areas need to be included in a framework for evaluation of clinical placement performance within the context of student-led health care services. The aim of this paper is to outline a protocol for a modified Delphi study designed to gain consensus on what is important to measure when evaluating an allied health clinical placement. We will recruit up to 30 experts to a heterogeneous expert panel in a modified Delphi study. Experts will consist of those with firsthand experience either coordinating, supervising, or undertaking clinical placement. Purposive sampling will be used to ensure maximum variation in expert panel member characteristics. Experts' opinions will be sought on measuring student learning outcomes, student experience, and cost of clinical placement, and other areas of clinical placement performance that are considered important. Three rounds will be conducted to establish consensus on what is important to measure when evaluating clinical placement. Each round is anticipated to yield both quantitative data (eg, percentage of agreement) and qualitative data (eg, free-text responses). In each round, quantitative data will be analyzed descriptively and used to determine consensus, which will be defined as ≥70% agreement. Qualitative responses will be analyzed thematically and used to inform the subsequent round. Findings of each round will be presented, both consensus data and qualitative responses in each subsequent round, to inform expert panel members and to elicit further rankings on areas of measurement yet to achieve consensus. Data analysis is currently underway, with a planned publication in 2024. The modified Delphi approach, supported by existing research and its ability to gain consensus through multiround expert engagement, provides an appropriate methodology to inform the development of a framework for the evaluation of clinical placement performance in allied health service. DERR1-10.2196/44020.

GP specialty trainees' knowledge and values towards physical activity: a national survey of Scottish trainees.

Despite the known benefits of physical activity (PA), one-third of adults in the UK fail to meet recommended levels of PA. PA promotion in primary care has been shown to be effective at improving PA in patients but implementation of PA promotion by GPs remains poor. Research has shown a need to improve PA education in undergraduate medical education, but, to the authors' knowledge, no review of postgraduate medical education has been performed. To assess the knowledge and values of general practice specialist trainees (GPSTs) towards PA promotion in Scotland. Cross-sectional survey distributed to GPSTs in Scotland. A mixed-methods cross-sectional survey, informed by previous research, was developed and distributed to all (n = 1205) GPSTs in Scotland in December 2022. Descriptive statistics were used to analyse quantitative data. A content analysis of free-text responses was also performed. A total of 168 GPSTs responded, representing 13.9% of all GPSTs in Scotland. Of responders, 93.5% reported no previous experience in the subject of sports and exercise science and medicine. Overall, 38.9% of responders stated they were unaware of the current UK PA guidelines, with 33.9% unable to correctly identify the UK PA guidelines when presented with multiple choice options. In addition, 83.3% felt they had been inadequately trained to deliver PA advice during their medical training. This study highlights a lack of knowledge, confidence, and education in PA promotion in GPSTs in Scotland. Given the importance of primary prevention, this urgently needs to be addressed.

1291 Is the Trauma Meeting a Thing of the Past?

Abstract Aim This study explores the educational value of traditional trauma meetings and provides a unique solution to maximising the scholastic value for non-essential juniors. In October 2022, surgical trainee-led small group teaching sessions were initiated twice a week in place of the traditional trauma meetings. For the other three days, trauma meetings were attended. The objective was to provide frequent teaching of orthopaedics for non-essential junior doctors via trauma meeting simulations but with smaller chunks of useful content and in a more relatable, slower paced, and approachable environment. Method A 6-item feedback form with Likert scales and free text responses was filled out after each teaching session from October to November 2022. Understanding of orthopaedic topics prior to these sessions and after were evaluated as well as confidence in their clinical roles. Results Twenty feedback responses were recorded and analysed. An improvement from 30% to 80% in their understanding of orthopaedic content was seen after teaching, along with an average rating of 80% for application of knowledge to their clinical work and an average rating of 75% was given to confidence and understanding of discussions in subsequent trauma meetings. Conclusions This study reveals the educational limitations gained in trauma meetings for non-essential juniors and aims to optimise learning by introducing a more approachable ‘alternative trauma meeting’. Making knowledge more accessible cultivates insight and interest and increases clinical confidence. This implementation also provides teaching experiences for registrars and core trainees as well as encourages team building between trainees and non-essential juniors.

Upholding Our PROMISE: Underrepresented in Medicine Pediatric Residents' Perspectives on Interventions to Promote Belonging.

Underrepresented in medicine (UIM) residents experience challenges during training that threaten their sense of belonging in medicine; therefore, residency programs should intentionally implement interventions to promote belonging. This study explored UIM pediatric residents' perspectives on current residency program measures designed to achieve this goal. The authors conducted a secondary qualitative analysis as part of a national cross-sectional study, PROmoting Med-ed Insight into Supportive Environments (PROMISE), which explored pediatric residents' experiences and perspectives during training in relation to their self-identities. A 23-item web-based survey was distributed through the Association of Pediatric Program Directors Longitudinal Educational Research Assessment Network from October 2020 to January 2021. Participants provided free-text responses to the question "What are current measures that promote a sense of belonging for the UIM community in your training program?" The authors used conventional content analysis to code and identify themes in responses from UIM participants. Of the 1,748 residents invited to participate, 931 (53%) residents from 29 programs completed the survey, with 167 (18%) identifying as UIM. Of the 167 UIM residents, 74 (44%) residents from 22 programs responded to the free-text question. The authors coded more than 140 unique free-text responses and identified 7 major themes: (1) critical mass of UIM residents; (2) focused recruitment of UIM residents; (3) social support, including opportunities to build community among UIM residents; (4) mentorship; (5) caring and responsive leadership; (6) education on health disparities, diversity, equity, inclusion, and antiracism; and (7) opportunities to serve, including giving back to the local community and near-peer mentorship of UIM premedical and medical students. This is the first national study to describe UIM pediatric residents' perspectives on interventions that promote a sense of belonging. Programs should consider implementing these interventions to foster inclusion and belonging among UIM trainees.

61 “Research in Surgery – Building the Foundations” – a Mixed-Methods Evaluation of a New Collaborative Regional Teaching Series

Abstract Aim Research is integral to the progression of the surgical profession and requires a sustainable pipeline of diverse academics. Interest in academia begins at undergraduate level, however lack of exposure acts as a barrier to participation. We aimed to provide exposure to surgical academia via webinars and review the impact of this series. Method Four monthly sessions were delivered and facilitated in collaboration with medical students, foundation trainees, and surgical academics. Sessions covered core topics for students and foundation trainees, including audit/quality improvement, statistics, and research funding. Data were collected via post-event surveys which included scaled-based and free-text responses. These were analysed with appropriate statistics and thematic content analysis respectively. Results Across the sessions there were 79 attendances by 58 individuals. n = 52/58 were students, with 38% (n = 20/52) studying outside the region. The median overall rating was 8/10 (quartiles 8-10) and 98.7% (n = 78/79) would recommend to a colleague. Post-session confidence improved significantly for all sessions compared to pre-session confidence (p≤0.010 in all cases). Thematic content analysis summarised attendees learning points into three semantic themes. (1) how to access research opportunities, (2) pragmatic learning on undertaking research (including funding, statistics, and dissemination) and (3) the importance of mentorship and networking. Respondents valued the insights and experiences of facilitators. Improvements included shorter sessions and clearly explaining novel language. Conclusions Our results highlight the benefits of these sessions for providing exposure and improving understanding of surgical academia, with relevance for others aiming to engage students and doctors in academia. We plan future sessions building on this.

786 A Collaborative, Online, 'Near-Peer' Teaching Programme for Medical Schools with Short Breast Surgery Rotations

Abstract Aim The quality of teaching for breast surgery, a niche specialty that medical schools dedicate little placement time to, can vary from hospital to hospital. This single-centre cross-sectional study investigated whether a new near-peer teaching programme could improve this. Method An online teaching programme was created and executed by final year medical students (‘near-peers’) for penultimate year students rotating through a week-long Breast Surgery placement at a major teaching hospital in London, United Kingdom. It consisted of asynchronous pre-tutorial Single Best Answer questions and an online small group tutorial and was conducted every three weeks for a year. A mix of qualitative and quantitative data were collected using feedback forms. Results Thirty students opted in. The pre-tutorial SBAs were rated 4.07 out of 5, while the near-peer interactive tutorial scored 4.77 out of 5. Students’ self-reported confidence, on a scale of 1 to 5, increased significantly by an average of 1.5 points (p <0.001). Students also rated this programme either the same or more highly than all other teaching modalities available during these their clinical placements. Thematic analysis of free-text responses showed that students enjoyed the interactivity of the sessions, the exam relevance of the content covered, and the utility of this programme in consolidating information at the tail-end of their placements. Conclusions This novel interactive teaching programme was designed and executed relatively easily by near-peers, was received favourably in our pilot, and can be easily implemented for other 'short-rotation specialties' in medical school (e.g., urology, vascular surgery, ENT).

Readiness for Parkinson’s disease genetic testing and counseling in patients and their relatives in urban settings in the Dominican Republic

Genetic testing for Parkinson’s disease (PD) is increasing globally, and genetic counseling is an important service that provides information and promotes understanding about PD genetics and genetic testing. PD research studies have initiated outreach to underrepresented regions in North America, including regions in Latin America, such as the Dominican Republic (DR); some studies may include return of genetic test results. Thus, understanding what individuals know about PD, genetic testing for PD, and their interest in speaking with a genetic counselor, is crucial when assessing readiness. In this cross-sectional study, a survey was distributed to people with Parkinson’s disease (PwP) and their unaffected biological relatives in the DR. Questions assessed genetics knowledge, attitude toward genetic testing, and interest in genetic testing and counseling. Of 45 participants, 69% scored the maximum on the attitude scale, indicating an overall positive attitude toward genetic testing; 95% indicated interest in genetic testing for PD, and 98% were at least somewhat interested in meeting with a genetic counselor. The mean PD genetics knowledge score was similar to previously published data. Through free text responses, participants expressed a desire to know more about PD treatment and management, prevention, cause, and their personal risk for PD. These results provide further evidence of readiness for genetic testing in this country but also underscore some gaps in knowledge that should be addressed with targeted educational efforts, as part of building genetic testing and counseling capacities.

The use of locum doctors in the NHS – results of a national survey of NHS Trusts in England

BackgroundLocum working in healthcare organisations has benefits for individual doctors and organisations but there are concerns about the impact of locum working on continuity of care, patient safety, team function and cost. We conducted a national survey of NHS Trusts in England to explore locum work, and better understand why and where locum doctors were needed; how locum doctors were engaged, supported, perceived and managed; and any changes being made in the way locums are used.MethodsAn online survey was sent to 191 NHS Trusts and 98 were returned (51%) including 66 (67%) acute hospitals, 26 (27%) mental health and six (6%) community health providers. Data was analysed using frequency tables, t-tests and correlations. Free-text responses were analysed using thematic analysis.ResultsMost NHS Trusts use locums frequently and for varying lengths of time. Trusts prefer to use locums from internal locum banks but frequently rely on locum agencies. The benefits of using locums included maintaining workforce capacity and flexibility. Importantly, care provided by locums was generally viewed as the same or somewhat worse when compared to care provided by permanent doctors. The main disadvantages of using locum agencies included cost, lack of familiarity and impact on organisational development. Some respondents felt that locums could be unreliable and less likely to be invested in quality improvement. NHS Trusts were broadly unfamiliar with the national guidance from NHS England for supporting locums and there was a focus on processes like compliance checks and induction, with less focus on providing feedback and support for appraisal.ConclusionsLocum doctors provide a necessary service within NHS Trusts to maintain workforce capacity and provide patient care. There are potential issues related to the way that locums are perceived, utilised, and supported which might impact the quality of the care that they provide. Future research should consider the arrangements for locum working and the performance of locums and permanent doctors, investigating the organisation of locums in order to achieve safe and high-quality care for patients.

The Effect of Repeated Review of Course Content on Medium- and Long-Term Retention in an Elective Veterinary Cardiology Course.

Assessment in veterinary medicine is challenging given the high volume of material and high cognitive load. Differing opinions exist regarding the utility of comprehensive final examinations in veterinary courses. A mixed-methods prospective randomized trial was undertaken with veterinary students (n = 47) in an elective cardiology course. All students received identical content, which was presented through weekly in-class lectures (eight total lessons). They were given access to four different formats of study aids and completed quizzes of content knowledge within 1 week of each lesson. For the cumulative final examination (post-test), students were explicitly instructed to study only for four out of the eight lessons. Students then completed a delayed post-test 3-6 months after completion of the course. Quantitative and qualitative data were collected in the form of in-depth pre- and post-course surveys. Overall, studying a particular lesson for the post-test resulted in higher scores for six out of eight lessons in the post-test (p < .05) but did not result in significantly higher scores for any lesson in the delayed post-test. Time spent studying for individual quizzes, as well as other measures of study habits, decreased significantly throughout the semester. Among study aids, student preference was highest for instructor-provided graphic organizers, and this preference persisted across the semester with a shift away from instructor-provided outlines over time (p = .043). Free-text survey responses showed that students had realistic expectations for the impact of studying for the post-test and appreciated exposure to a variety of study aid formats. In an elective veterinary cardiology course, review of material prior to a cumulative final examination led to improved short-term performance but no difference in retention 3-6 months later.

Patient-reported experiences and satisfaction with head and neck surgery outreach clinics in regional New South Wales, Australia: A cross-sectional survey.

Head and neck surgery services are increasingly being centralised in Australia. Outreach models can overcome burdens of travel that patients in regional and rural areas experience when attending routine appointments, by providing services closer to home. To explore patient-reported experiences and satisfaction with regional outreach services for head and neck surgery in Australia. Patients who attended two regional outreach clinics in New South Wales (NSW), Australia, were surveyed over a 6-month period. Patients completed the Outpatient Cancer Clinics Survey (2020 version) that explored perceptions and experiences of the clinic. Patients with cancer were asked to complete the Edmonton Symptom Assessment System and the Communication and Attitudinal Self-Efficacy scale. Descriptive statistics and analysis of data was performed, and results were compared to the NSW statewide Outpatient Cancer Clinics Survey (2020). Content analysis of free text responses was performed. Some 128 patients responded (56% response rate; mean age 67.2 years, 46.1% female). Compared to the 2020 NSW survey, a higher proportion of patients in our cohort responded positively to 14 of the 26 questions, with the greatest differences observed for questions regarding waiting area comfort (+12.1%, p = 0.008), being informed about different treatment options (+9.5%, p = 0.04), and issues relating to parking (+9.5%, p = 0.03). A lower proportion of our sample responded positively to the question about whether health professionals knew enough about their medical history (-19.3%, p < 0.001). Respondents appreciated having a local clinic that helped them avoid travel to major cities and associated expenses and highlighted benefits of expert consultation and timeliness of investigations. However, cost of appointments and level of reimbursements remain barriers for some patients. Patients had a high level of satisfaction with regional outreach clinics for head and neck surgery across most domains, indicating patients highly value this service.

The Co-Design of an Embodied Conversational Agent to Help Stroke Survivors Manage Their Recovery

Whilst the use of digital interventions to assist patients with self-management involving embodied conversational agents (ECA) is emerging, the use of such agents to support stroke rehabilitation and recovery is rare. This iTakeCharge project takes inspiration from the evidence-based narrative style self-management intervention for stroke recovery, the ‘Take Charge’ intervention, which has been shown to contribute to significant improvements in disability and quality of life after stroke. We worked with the developers and deliverers of the ‘Take Charge’ intervention tool, clinical stroke researchers and stroke survivors, to adapt the ‘Take Charge’ intervention tool to be delivered by an ECA (i.e., the Taking Charge Intelligent Agent (TaCIA)). TaCIA was co-designed using a three-phased approach: Stage 1: Phase I with the developers and Phase II with people who delivered the original Take Charge intervention to stroke survivors (i.e., facilitators); and Stage 2: Phase III with stroke survivors. This paper reports the results from each of these phases including an evaluation of the resulting ECA. Stage 1: Phase I, where TaCIA V.1 was evaluated by the Take Charge developers, did not build a good working alliance, provide adequate options, or deliver the intended Take Charge outcomes. In particular, the use of answer options and the coaching aspects of TaCIA V.1 were felt to conflict with the intention that Take Charge facilitators would not influence the responses of the patient. In response, in Stage 1: Phase II, TaCIA V.2 incorporated an experiment to determine the value of providing answer options versus free text responses. Take Charge facilitators agreed that allowing an open response concurrently with providing answer options was optimal and determined that working alliance and usability were satisfactory. Finally, in Stage 2: Phase III, TaCIA V.3 was evaluated with eight stroke survivors and was generally well accepted and considered useful. Increased user control, clarification of TaCIA’s role, and other improvements to improve accessibility were suggested. The article concludes with limitations and recommendations for future changes based on stroke survivor feedback.

FTP4.5 ANKI digital flashcards: an effective tool for undergraduate musculoskeletal revision

Abstract Introduction ANKI is a programme that allows users to produce digital flashcards consisting of text, pictures and/or videos. It is based on the principle of active recall and spaced repetition creating an effective revision tool. This study investigated the benefits of ANKI digital flashcards used by 2nd year medical students when revising their musculoskeletal (MSK) module. Method A prospective study of 121 2nd year medical students at the Anglia Ruskin University. Learning objectives were stated at the start of each MSK lecture. Each student created ANKI flashcards for the learning objective assigned to them. These flashcards were combined to create a crowdsourced complete MSK deck available to the entire cohort. Anonymised student feedback was obtained at the beginning and end of the module. Results The mean value of a Likert scoring system (1least – 5most) from both surveys was used. Pre-assignment questions assessing students’ familiarity and aspiration towards ANKI: Use cards as part of revision =3.24; Comfort with IT systems=3.82; Familiar with ANKI system=4.04, Interest in using ANKI =3.88. Post assignment questions to assess the outcome success: Would you use ANKI for revision =4.55, Use ANKI in other modules =3.95. Free text responses included praise towards communal effort, manageable workload and creation of a revision resource. Conclusion ANKI provided an additional useful digital resource learning and revision for medical students. The cards created by students, for students, provided autonomy. However, this effected the quality of some slides. Overall, the feedback was positive with this assignment expanded to other modules.

ThTP6.7 Are we getting it right first time: a three hundred patient audit of operation note documentation

Abstract Aims Collaborative recommendations from the RCS, ASGBI, and GIRFT have been published regarding documentation for inguinal hernia repair, laparoscopic cholecystectomy and appendicectomy. This is built upon foundations which aim to mitigate litigation. A series of recommendations have been made to ensure the most salient points are covered. We retrospectively audited documentation in our local unit. Methods Data was retrieved from electronic medical records for operation notes coded to inguinal hernia repair (laparoscopic or open), laparoscopic appendicectomy and laparoscopic cholecystectomy at our District General Hospital. Documentation was evaluated according to the 26 point GIRFT Best Practice recommendations. Data collected was grouped into standard RCS note taking conventions: pre-operative, incision, findings, procedure, closure and post-operative. Results 300 electronic operation notes were collated from medical records for a period spanning four months. The majority (71%) of notes were written by registrars. Overall compliance with documentation for pre-operative and incision groups were 40% and 65% respectively. Documentation rates for operative findings were 60% and procedural technique was 48%. Adherence to recommendations for closure and post-operative plans were 75% and 59% respectively. Subgroup analysis revealed 96% compliance in sections which were built into the electronic operation note template compared with 44% of free text responses. Conclusions Documentation plays a pivotal factor in preventing litigation. We have identified inconsistencies in our local unit with regards to common general surgical procedures. Templated fields improved adherence to recommendations by over two fold. With digital operative notes becoming more commonplace, questions are raised as to whether documentation should adopt a partially templated format.

Complexity and practice on NHS mental health in-patient dementia assessment wards

PurposeThis study aims to address this need. In the UK, people with dementia admitted to National Health Service mental health in-patient dementia assessment wards [dementia assessment wards] present as complex and experience a number of changed behaviours, such as excessive walking, agitation and aggression. The complexity of the presentation of dementia has been identified as underpinning pre-and post-admission to these care environments, but limited study has so far been conducted to explore the boundaries and meaning of complexity and its relationship to dementia assessment ward practice.Design/methodology/approachAn online electronic survey of UK-based national dementia leaders was conducted in 2018. Nineteen completed questionnaires were returned, and mental health nurses comprised the largest sub-sample. Qualitative data of the free-text responses were analysed using manifest content analysis.FindingsFour routes to admission to a dementia assessment ward were identified. Multiplicity of needs and interconnectedness were seen as important domains in uncovering the meaning of complexity. The importance of life story and formulation approaches were highlighted. Challenges uncovered included, better understanding changed behaviour and its relationship to complexity, the need for understanding the boundaries of complexity and making visible care practices on these specific wards.Originality/valueFindings can be used to produce a heightened awareness about the meaning and function of complexity in dementia assessment wards. Policymakers and researchers need to increase the emphasis on this area of mental health and dementia care. Further training for the multidisciplinary team on formulation approaches could help to improve the evidence-base for practice.

The Perspectives of Health Care Providers on Adolescent Non-Suicidal Self-Injury

Objective This study examined the perspectives and strategies of care providers when managing adolescent non-suicidal self-injury in residential and acute inpatient units throughout the Midwest region. NSSI frequency, intensity, duration, onset, method, location, and interventions were examined, among other topics including care provider attitudes, service delivery type, ways to reduce NSSI behaviors, and whether any NSSI-specific interventions are used in psychiatric settings. Method Surveys were disseminated to nurses, practitioners, and clinicians at psychiatric hospitals in the Midwest region. All questions used free text responses and were developed from the Non-Suicidal Self-Injury Assessment Tool (NSSI-AT), the SOARS Model, and Clinician-Rated Severity of Non-suicidal Self-Injury Scale. Results The findings underscored the high incidence of NSSI among adolescent patients, highlighting the urgent need for creating hospital trainings and best practices for NSSI, among other topics such as routine physical check-ins and enhanced NSSI-specific interventions. Conclusion There is a concerning gap in the number of NSSI-specific interventions used by care providers in psychiatric inpatient facilities in the Midwest region of the United States. The need for targeted treatment, training, and programming for adolescent NSSI is essential.

Reliability and clinical utility of a novel telehealth-based goniometry approach to measure range of motion of the digits of the hand

BackgroundRange of motion (ROM) is an outcome measure commonly used when treating acute and chronic hand injuries and conditions. Increased adoption of telehealth service provision in hand therapy practice, influenced by the advent of COVID-19, has led to the need for a valid and reliable approach to measure the range of motion of the digits of the hand when providing hand therapy services using telehealth. PurposeTo determine if performing manual goniometry during a livestream teleconsultation is reliable and clinically useful to measure the range of motion of the fifth digit when providing hand therapy services using telehealth. Study DesignClinical measurement, repeated-measures study. MethodsAccording to a measurement protocol, 12 independent raters (who currently provide hand therapy services) each obtained several screen-based goniometric range of motion measurements of the fifth digit at 2-time points. Raters were surveyed on the clinical utility of the telehealth-based goniometry approach. Measures of relative and absolute reliability were calculated to evaluate test-retest and inter-rater reliability. Free-text responses were analyzed using content analysis. ResultsInter-rater reliability was excellent for all flexion and extension measures (intraclass correlation coefficient [ICC] ≥ 0.89) but poor for the arc of motion (ICC ≤ 0.67). Test-retest reliability was poor (ICC ≤ 0.43). No statistically significant differences between test and retest measurements were observed (P ≥ 0.24). The overall coefficient of variation indicated good precision (14.69%). Measurement error (≤6.07º) and limits of agreement (≤6.33) had acceptable levels to support clinical use. Content analysis revealed several practical considerations. ConclusionsThis study suggests that performing manual goniometry during a livestream teleconsultation is unreliable for measuring the range of motion of the fifth digit. However, when combined with patient-reported and functional outcomes, this approach may be suitable to facilitate a range of motion assessment for certain functions of telehealth service provision in hand therapy practice.

Exploring Flood Response Challenges, Training Needs, and the Impact of Online Flood Training for Lifeguards and Water Safety Professionals in South Africa.

Flooding is a significant cause of human and economic loss in the African region, including in South Africa. Flood mitigation and response in South Africa is challenging due to a range of environmental, infrastructure, and policy constraints. Lifeguards represent a potential additional workforce to bolster flood mitigation and response. This study aimed to explore the feasibility and acceptability of online flood safety training for water safety professionals in South Africa, as well as assess the current flood response capacity and future needs of this group. Online surveys were completed by a convenience sample of South African water safety professionals (including lifeguards) pre-and post a series of four online flood training workshops. Free text responses were thematically coded and flood knowledge was compared between the pre-and post-workshop survey respondents. Sixty-eight responses were analysed (64.7% pre-workshop phase; 63.2% male, 29.4% aged 50-59 years). A range of challenges in flood mitigation and response were identified including equipment, training, and a lack of government support. However, positives were also identified including respondents' willingness to assist in flood emergencies and good cooperation with neighbouring countries and across the region. Opportunities for better cross-municipal and government communication were discussed. In times of crisis, or in resource poor settings, water safety professionals can bolster traditional flood mitigation and response capacity. Opportunities exist to harness this willingness, but also improve cross-governmental and municipal knowledge sharing to improve future flood mitigation and response efforts in South Africa.