Future Consultation Research Articles

Routine outcomes to investigate differences between ethnic minorities and White British people presenting to emergency services for injury: the stakeholder consultation.

Research has found differences in processes and outcomes of care between people in ethnic minorities and White British populations in some clinical conditions, although findings have been mixed. The Building an understanding of Ethnic minority people's Service Use Relating to Emergency care for injuries study is investigating differences in presentation, experience and health outcomes between people from ethnic minorities and White British people who seek emergency health care for injury. Our aim was to consult with stakeholders to define measurable outcomes available in routine ambulance and emergency department data; to assess the appropriateness of existing outcome measures for ethnic minorities and White British people; and to identify any gaps. Clinicians, public contributors, researchers, people from the third sector, public health, healthcare inclusion were invited to join an online workshop to discuss routine outcomes. Twenty participants attended the stakeholder consultation, with only one being a public contributor, a limitation. Eleven were from a minority ethnic background and seven were female. The integrated list of outcomes included 25 items, combining routine outcomes from the Building an understanding of Ethnic minority people's Service Use Relating to Emergency care for injuries protocol and literature (n = 17) with additional outcomes (n = 8). Notably, the initial list lacked provisions for safeguarding referrals and cases of treatment refusal, which were new additions. Safety concerns arose due to the lack of safeguarding referrals, treatment refusal and self-discharge. Factors such as pre-existing health conditions, injury location and experiences of discrimination were identified as possible influences on care quality and waiting times for ethnic minority patients. Although the number of stakeholders taking part in our consultation was low, their participation identified outcomes not found in routine data, supporting the adoption of a mixed-methods approach to answer our research questions. A future consultation could look to include more public members and wider range of clinicians including those who work in safeguarding and rehabilitation services. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR132744.

Involving patients and the public in research using linked confidential patient information without consent: a case study on the COloRECTal cancer data Repository (CORECT-R)

Objective and ApproachIn 2017, the charity Cancer Research UK funded a UK Colorectal Cancer Intelligence Hub to create the COloRECTal cancer data Repository (CORECT-R). This was intended to be a single research data system that links all datasets across the UK relevant to colorectal cancer and makes them available for research. As the four home nations (i.e. England, Scotland, Wales and Northern Ireland) have distinct data governance policies, data access and linkage has proven challenging. It has not yet been possible to create a UK-wide resource, hence limiting the potential of the data available. To address this, the Hub has recently sought to gain new governance approvals to link data from the four home nations. As part of this process, we aimed to investigate public acceptability of using confidential patient information (CPI) without consent in CORECT-R. ResultsSeventy-five participants from a diverse background attended one of four online consultation sessions. Participants raised a number of issues and concerns, including ensuring transparency in the access and use of CPI by academic and commercial partners, and being well-informed of how to opt-out. With open communication and explanation of our approach, participants gave almost unanimous support on the intended CPI use. ImplicationsInnovation and collaboration between researchers, data custodians and the public are essential to drive responsible and meaningful uses of population data. We showed an exemplar of embedding patient and public involvement in designing data linkage research. Key areas identified from the sessions will form the basis of future consultations.

Two Approaches of ‘Proactive Consultation’: Towards Well-Functioning Clinical Ethics Consultation

AbstractIn recent years, the global need for clinical ethics consultation services (CECS) has increased to address ethical challenges, dilemmas, and moral distress in clinical environments. In Japan, many hospitals have introduced CECS over the past decade, but few such services work effectively because of the small number of consultations. To address this, we propose two proactive ethics consultation methods: inter-professional ethics rounds and patient note reviews. This paper provides a detailed explanation of these methods, complete with scenarios based on actual cases. These methods can make CECS ‘well-functioning’ by shifting the starting points of consultation from consultees to CECS providers. We then examine the impact and value of proactive ethics consultation as well as four critical factors for its success including attitude, positioning, and competency of proactive consultation teams. We believe our suggestions will provide valuable insights for future clinical ethics consultations and stimulate academic debate about what constitutes a ‘well-functioning’ CECS.

COMPRESSIVE STRENGTH PREDICTION FOR SELF-COMPACTING CONCRETE USING ARTIFICIAL NEURAL NETWORKS

This study investigates the relationship between concrete constituent materials, slump values, density, strain and compressive strength. The database was set in the laboratory by performing a quality assurance test on the constituent materials to ascertain their suitability for concrete work. For material procurement and selection, the British Standard Department of Environment DOE technique of concrete trial mix designs was used. In this study, twelve concrete mixes were utilized. Two simplified models were developed using the feedback network Artificial Neural Networks architecture (ANNs) with R version 4.0.5 and R studio version 1.2.5033. In the two models, an independent layer comprising six nodes and a dependent layer comprising two nodes were taken. Having carried out the sensitivity analysis, the capacity of the developed equation was evaluated in terms of error metrics MSE and RMSE. The grading envelope for river sand showed that the graph fell perfectly into grading envelope zone 2 while other constituent materials tested were all confirmed suitable for concrete works. The results of compressive strength were obtained from varied water-cement ratios used for the concrete trial mix design which ranges between 0.45 to 0.6. The compressive strength results showed that the results increased consistently for each design mix. It is worthy of note that the strength of the mix fell between grades 15, 20, 25 and 35 respectively for both the 7-day and 28-day strength accordingly. Conversely, the ANN models predicted both 7-day and 28-day strength close to the laboratory value. It is concluded that this research has demonstrated economic viability which would enhance overall construction planning efficiency for future researchers, consultants and contractors in the building industries.

Understanding adoption intention of virtual medical consultation systems: Perceptions of ChatGPT and satisfaction with doctors

This study examined the impact of perceptions of ChatGPT, the leading AI chatbot since November 2022, on the acceptance and perceived efficacy of future GPT-powered virtual medical consultation systems (GPT-VMCSs), as well as their influence on the propensity to adopt such systems amid debates over their suitability for medical consultations. By utilizing the technology acceptance model (TAM), this study differentiated between perceptions of ChatGPT and GPT-VMCS by assessing how these perceptions, along with doctor satisfaction, resistance, and ChatGPT usage, affect adoption intentions. Among the 2150 participants from 21 countries, 1038 who had used ChatGPT or observed its use were selected for hypothesis testing. The results indicated that the perceived usefulness (PU) of the GPT-VMCS was the strongest predictor of adoption intentions, with the perceived ease of use (PEOU) also playing a critical role. In contrast, resistance, which was positively influenced by doctor satisfaction, was negatively associated with adoption intentions. The quality of ChatGPT responses was positively correlated with GPT-VMCS PU, although direct usage of ChatGPT did not significantly affect adoption intentions. The study concludes with a discussion of both theoretical and practical implications.

A-I-D for Cascades: Designing a theory-informed intervention for addressing prescribing cascades in primary care

Abstract Introduction Prescribing cascades, which occur when a medication is used to treat the side effect of another medication, are important contributors to polypharmacy. There is an absence of studies that evaluate the implementation or impact of existing interventions to address prescribing cascades in practice. Aim To design theory-informed options for interventions to address prescribing cascades within interprofessional primary care teams. Methods The Behaviour Change Wheel (BCW) framework, and its eight steps, were applied to guide intervention development by the research team. Three target behaviours were drafted and prioritised for intervention development based on data collected as part of two qualitative studies exploring why and how cascades occur across practice settings.[1,2] A target behaviour was selected and the COM-B (capability, opportunity, motivation-behaviour) model was then applied to identify the relevant factors for interprofessional primary care teams. The BCW was used to determine the relevant intervention types and policy options for the behaviour. Next, corresponding behaviour change techniques (BCTs) were identified and intervention options drafted. Prioritisation of behaviours and intervention examples were guided by the APEASE criteria (Affordability, Practicability, Effectiveness/cost-effectiveness, Acceptability, Side-effects/safety, Equity). Results The three target behaviours involved supporting: 1) healthcare providers to ask about, investigate and manage cascades (often through deprescribing), 2) the public to ask about prescribing cascades, and 3) the public to share medication histories and experiences with healthcare providers. The team selected the healthcare provider behaviour, called A-I-D (ask, investigate, deprescribe), for intervention development. Psychological capability and physical opportunity were determined to be the most relevant COM-B components, corresponding to education, training, environmental restructuring, and enablement intervention types and the guidelines, communications and marketing, and service provision policy options within the BCW model. Ultimately, 10 intervention options comprised of BCTs were developed by the team, which are ready for further prioritisation by stakeholders. These can be grouped into three categories: provision of educational content or materials for use by clinicians, provision of consultation or training to support clinicians, and knowledge mobilisation strategies. Through the process, the team identified that development of a practice guidance tool, which assists healthcare providers to investigate and manage prescribing cascades, is needed to support further intervention development. Conclusion The BCW framework guided the design of intervention options that will support primary care clinicians practising in interprofessional teams to address prescribing cascades. A limitation of this work is that applying the BCW framework required several judgements by the team, comprised of scientists, pharmacists, and nurses but not a general practitioner physician. Many but not all have practised with primary care interprofessional teams. When identifying interventions for future consultation, it was determined that the development of a practice guidance tool (i.e., which assists with identifying, investigating, and managing prescribing cascades) underpinned all the proposed interventions for addressing prescribing cascades in practice. Further research is needed to determine what primary care clinicians will need in this practice guidance tool and how it will be used in practice, to support its development.

Improving healthcare delivery at a district hospital through teaching interns - A short report.

Every district in Malawi has at least two doctors managing the social and healthcare needs of the local population. The medical doctors at the district are involved in administrative work and have minimal time for clinical practice. As such in most district hospitals, clinical officers (COs) form the backbone of patient care provision. These are cadres that have a 3-year training in clinical medicine; they work side by side with medical assistants (MAs) and nurses. Apart from the Ministry of Health (MoH) workforce, the Department of Family Medicine (FM) of Kamuzu University of Health Sciences (KUHeS) has its main district site at Mangochi. Family physicians and residents from FM department assist in provision of mentorship and teaching to other cadres. Work-based learning requires various strategies and approaches. The experience reported here involves deliberate mentorship and support to enhance the learning of other cadres. Family medicine residents learn through the active participation in these sessions to become future consultants and leaders in primary health care.

The mosquitoes (Diptera: Culicidae) of Djibouti: bibliographical review (1970-2023)

The Republic of Djibouti is located in the Horn of Africa, on the Gulf of Aden and the Bab-el-Mandeb detroit, at the southern entrance to the Red Sea. Prior to its independence in 1977, the Republic of Djibouti was known by two names: "Côte française des Somalis" until 1967, then "Territoire Français de Afars et Issas". As part of our doctoral research on the ecology of mosquitoes in Djibouti, we noted a lack of information on the species encountered, and felt it essential to draw up a list of species before embarking on ecological monitoring. The aim of this work is to survey publications on mosquitoes in Djibouti and to synthesize data from this scientific literature in order to update the national inventory of Culicidae. An exhaustive search of electronic bibliographic databases (PubMed, Scopus, HAL Open Archive, Science Direct and Google Scholar) was carried out. Reference lists were filtered to access additional articles in order to obtain more data. Two keywords were used: "Djibouti" and "French Territory of Afars and Issas". A selection of scientific publications on Djibouti mosquitoes and/or diseases transmitted by mosquito vectors was made. Researches were conducted in articles selected. The names of the species listed were checked and validated by referring to the site Mosquito Taxonomic Inventory. A total of 13 studies, published between 1970 and 2023, were found. Over the years, the composition of the Culicidae fauna has become well known. In part, the movement of people traveling to and from neighboring countries has been linked to the detection of new species and the reappearance of mosquito species in Djibouti. Numerous studies have been carried out over the years, including purely taxonomic studies and others focusing on the incrimination of mosquito vectors and the characterization of the pathogens they transmit. A total of 37 species, belonging to two subfamilies (Anophelinae and Culicinae), of mosquitoes divided between 7 genera (Aedes, Anopheles, Culex, Culiseta, Lutzia, Mimomyia and Uranotaenia) have been mentioned across the country. The number of species per genus is distributed as follows: 5 species of Aedes including 1 subspecies, 14 species of Anopheles including two subspecies, 12 species of Culex including 1 subspecies, 1 species for each of the genera Culiseta and Lutzia and finally 2 species respectively for the genera Mimomiya and Uranotaenia. Five species have been incriminated as vectors of diseases such as malaria, dengue fever, yellow fever, West Nile virus and chikungunya. Others are known for their potential role in pathogen transmission, including Zika and Rift Valley virus. The bibliographical research enabled us to summarize the research carried out over more than half a century in the history of Djibouti, and to update the inventory of the country's mosquitoes, which now includes 37 species. Species names were reviewed and updated, and the case of Anopheles gambiae was also addressed. Two species mentioned as part of the Culicidae fauna of Djibouti appeared to be doubtful and are up for discussion. These results provide a useful information base for defining vector control priorities in Djibouti. They will also inform, guide and facilitate future consultations of our database. In addition, this study will help to identify research ways on mosquitoes in Djibouti.

Health problems and exposure to infectious risks in returning humanitarian aid workers.

Humanitarian aid workers are exposed to deployment-related health threats. Identifying subgroups at a higher risk of infection in this diverse population could help optimize prevention. We carried out a retrospective study based on anonymized data of humanitarian aid workers that visited our clinic for a post-deployment visit between 1 January 2018 and 31 December 2021. We conducted a descriptive analysis of basic demographic data, self-reported risk exposure and health problems encountered during deployment extracted from a standard questionnaire. The questionnaire was administered to 1238 aid workers during 1529 post-deployment medical consultations. The median age was 37.2years (IQR 31.7-44.3), and 718/1529 (47.0%) were female aid workers. The median duration of deployment was 6months (IQR 3-12months). Most deployments (1321/1529 (86.4%)) were for a medical organization and in Sub-Saharan Africa (73.2%). The most common risk exposures were contact with freshwater in schistosomiasis endemic regions (187/1308 (14.3%)), unprotected sexual contact with a person other than a regular partner (138/1529 (9.0%)), suspected rabies exposure (56/1529 (3.7%)) and accidental exposure to blood (44/1529 (2.9%)). Gastrointestinal problems (487/1529 (31.9%)), malaria (237/1529 (15.5%)) and respiratory tract infections (94/1529 (6,2%)) were the most encountered health problems. Fifteen volunteers (1%) were hospitalized during deployment and 19 (1.2%) repatriated due to health problems. Adherence to malaria chemoprophylaxis was poor, only taken according to the prescription in 355 out of 1225 (29.0%) of aid workers for whom prophylaxis was indicated. Humanitarian aid workers deployed abroad encounter significant rates of health problems and report a high level of risk exposure during their deployment, with the risks being greatest among younger people, those deployed to rural areas, and those working for non-medical organizations. These findings help guide future pre-deployment consultations, to increase awareness and reduce risk behaviour during deployment, as well as focus on adherence to medical advice such as malaria chemoprophylaxis.

(126) Medicolegal Considerations for Patients Undergoing Urologic Surgical Interventions and the Development of an Audio-Recording Application for use During Genital Gender-Affirming Surgical Consultation

Abstract Introduction Patient recollection of details discussed during medical consultation is often limited (Figure 1a). For genital gender-affirming surgery (gGAS) consultations, lengthy discussions and deep contemplation surrounding surgical options are critical. Inadequate communication can result in patient complaints and medico-legal action, whereupon issues such as a lack of discussion or poor documentation can lead to medico-legal liability against the care provider and hospital system. As a result, strategies must be developed to ensure that information discussed during complex medical consultations are made available so patients can properly weigh out the care options presented. Objective 1) Assess medico-legal incidents in Urologic and surgical specialties in the UK, US, and a Californian quaternary care center, 2) evaluate the advantages and feasibility of offering audio-recordings of patient consultations, and 3) create a user-friendly smartphone app for recording healthcare consultations. Methods A literature review evaluated current evidence on medical liability claims in the UK and US was conducted. Additionally, our center's Department of Risk Management provided information pertaining to medico-legal cases against our institution. Separately, gGAS patients consented to audio-record their consultation. Copies were provided to patients and kept in their medical records. A follow-up survey assessed its usefulness, and based upon patient feedback, a smartphone application was developed. Results A PubMed search yielded 921 results on "medical malpractice claims" from 2013–2023. In Urologic Surgery, 32 papers addressed medical malpractice, with 2 providing data over the last 15 years. In the UK, 660 claims were made from 2010–2020, of which 8.2% were due to poor communication (37 = informed consent; 17 = lack of follow-up). In the US, from 2020–2022, 38.3% of Urologists faced at least one legal proceeding in their career, and 5.3% were sued within 1 year for any reason. Our institution's Department of Risk Management reported 32% of lawsuits were related to surgical care. Informed consent involved 8% of cases and had a component in 32%. The average financial settlement for medical malpractice was $125,000.00 USD, and trial costs averaged $75,000.00 USD. 50/71 patients completed an anonymized, online survey post-audio recording. Positive results were noted regarding recording quality, comfort whilst being recorded, and wishes for future consultation recordings (Figure 1b). In addition, most patients felt less anxiety, and had greater confidence in their treatment choice (Figure 1c) Based upon patient responses, we developed a smartphone App which records 90 minutes of audio, allows for file and hyperlink attachments to be sent to patients before immediately deleting all information (Figure 1d). Routine use of audio-recordings led to a reduction in patient queries to our office. Conclusions Routine audio recording of patient consultations provides significant benefits with minimal cost to providers. As per our institution's Office of Risk Management, it offers protection against medico-legal risks. Adequate discussion, good documentation and providing adjuncts for patients can help prevent a large proportion of medicolegal complaints in addition to optimizing patient care. Considering that patients face similar challenges across different disciplines and regions, a larger study (multi-center, international, multi-language) is warranted. Disclosure No.

A277 SYNOPTIC REPORTING IN INFLAMMATORY BOWEL DISEASE

Abstract Background Inflammatory bowel disease is a chronic medical condition requiring regular clinical assessment and evaluation. Specialist involvement often occurs regularly to determine disease activity, progression, and consider therapeutic changes for disease control. The rapid advancement of scientific evidence and addition of novel medications have combined to make IBD care increasingly complex. Moreover, evolving standards of care have led to an increased burden of documentation. Synoptic reporting is a novel documentation method that standardizes the input of clinical data and generates comprehensive reports based on that data. It has yet to be widely accepted throughout medicine, but is commonly used in surgery and diagnostics. Advancements within IBD have amplified the need for meticulous reporting of patients' previous therapies and preventative health care: areas synoptic reporting excels in. Aims We analyzed for the presence of disease-related, treatment-based, and preventative health elements in consultation reports across standard of care and synoptic reporting methods. Methods We identified consecutive IBD consultations from Jan 1 2023 onwards for participating gastroenterologists, up to 10 reports for most clinicians, if available. Each report was labeled synoptic or standard reporting. Manual review was used to determine whether each element was present and coded in binary fashion, except for female reproductive health, which was absent, present, or N/A. For analysis, data was partitioned based on whether synoptic reporting was used, with the percentage of reports including each element being calculated based on this data. Comparisons for inclusion were then completed between the groups. Results We identified a total of 62 consultations with 19 utilizing synoptic reporting. Reporting methods fared similarly for age, sex, year of diagnosis, and summary of course. Synoptic reporting performed significantly better in reporting vaccinations, marijuana use, as well as B12, vitamin D, and ferritin levels. Differences exceeding 20% were found in the reporting of EIMs, CRC screening, and female reproductive health, though these were not at a level of statistical significance in this preliminary study. Conclusions We found through our analysis that synoptic reporting is a simple tool that creates reports with a greater inclusion of elements important for disease management and health maintenance. Relaying this information back to patients' practitioners can theoretically improve outcomes through better preventative care, active monitoring, and awareness of patients’ disease history by future consultants. Future research will focus on expanding the study population as well as gaining further insight into the utility of synoptic reporting in improving clinical communication and disease management. Funding Agencies None

(037) Medicolegal Considerations for Patients Undergoing Urologic Surgical Interventions and the Development of an Audio-Recording Application for Use During Genital Gender-affirming Surgical Consultation

Abstract Introduction Patient recollection of details discussed during medical consultation is often limited (Figure 1a). For genital gender-affirming surgery (gGAS) consultations, lengthy discussions and deep contemplation surrounding surgical options are critical. Inadequate communication can result in patient complaints and medico-legal action, whereupon issues such as a lack of discussion or poor documentation can lead to medico-legal liability against the care provider and hospital system. As a result, strategies must be developed to ensure that information discussed during complex medical consultations are made available so patients can properly weigh out the care options presented. Objective 1) Assess medico-legal incidents in Urologic and surgical specialties in the UK, US, and a Californian quaternary care center, 2) evaluate the advantages and feasibility of offering audio-recordings of patient consultations, and 3) create a user-friendly smartphone app for recording healthcare consultations. Methods A literature review evaluated current evidence on medical liability claims in the UK and US was conducted. Additionally, our center's Department of Risk Management provided information pertaining to medico-legal cases against our institution. Separately, gGAS patients consented to audio-record their consultation. Copies were provided to patients and kept in their medical records. A follow-up survey assessed its usefulness, and based upon patient feedback, a smartphone application was developed. Results A PubMed search yielded 921 results on "medical malpractice claims" from 2013-2023. In Urologic Surgery, 32 papers addressed medical malpractice, with 2 providing data over the last 15 years. In the UK, 660 claims were made from 2010-2020, of which 8.2% were due to poor communication (37 = informed consent; 17 = lack of follow-up). In the US, from 2020-2022, 38.3% of Urologists faced at least one legal proceeding in their career, and 5.3% were sued within 1 year for any reason. Our institution's Department of Risk Management reported 32% of lawsuits were related to surgical care. Informed consent involved 8% of cases and had a component in 32%. The average financial settlement for medical malpractice was $125,000.00 USD, and trial costs averaged $75,000.00 USD. 50/71 patients completed an anonymized, online survey post-audio recording. Positive results were noted regarding recording quality, comfort whilst being recorded, and wishes for future consultation recordings (Figure 1b). In addition, most patients felt less anxiety, and had greater confidence in their treatment choice (Figure 1c) Based upon patient responses, we developed a smartphone App which records 90 minutes of audio, allows for file and hyperlink attachments to be sent to patients before immediately deleting all information (Figure 1d). Routine use of audio-recordings led to a reduction in patient queries to our office. Conclusions Routine audio recording of patient consultations provides significant benefits with minimal cost to providers. As per our institution's Office of Risk Management, it offers protection against medico-legal risks. Adequate discussion, good documentation and providing adjuncts for patients can help prevent a large proportion of medicolegal complaints in addition to optimizing patient care. Considering that patients face similar challenges across different disciplines and regions, a larger study (multi-center, international, multi-language) is warranted. Disclosure No.

Evolving migraine management: Lithuania's telemedicine experience.

COVID-19 challenges have underscored the potential of telemedicine in migraine management. This study focuses on assessing patients' telemedicine experience for headache management in Lithuania and identifying key barriers and facilitators for its wider use. A nationwide e-survey was conducted in 2023 via the Lithuanian Association of Migraine Patients' website, social media platforms, websites of public and private healthcare facilities, and migraine self-help groups. The survey covered sociodemographics, migraine characteristics, previous experience with teleconsultations for headaches with neurologists and general practitioners (GP), perceived advantages and disadvantages of telehealth, and preferred future consultation types. Eight hundred and forty seven respondents with a confirmed migraine diagnosis were analyzed. The majority were female (97.2%), with a median age of 35 (IQR 30-42) years and an average of 5 (IQR 3-9) monthly headache days (MHDs). 7.0% of respondents had chronic migraine (CM). Prior teleconsultations for headaches were reported by 35.2% of respondents, 26.2% with a GP and 17.0% with a neurologist (p < 0.0001). Teleconsultation outcomes included continuation of a prescribed treatment (84.7% for GPs and 83.3% for neurologists, p = 0.7295), initiation of new acute medications (12.2% for GPs with 70.4% reported as effective and 27.1% for neurologists with 84.6% effective, p = 0.0005 and p < 0.0001, respectively). Reasons for not undergoing remote neurology consultations: the lack of inquiry (69.7%), unavailability from neurologists (18.1%) and respondent's opposition to remote consultations (12.2%). Patients evaluated their experience with remote neurology services better than that of GPs (p = 0.0289). 67.3% of respondents preferred a mixed-mode approach for future consultations. In-person-only preference (29.0%) correlated with multiple factors, including history of remote primary neurology consultations (OR 5.89, p = 0.0022), lower education (OR 2.20, p = 0.0001), physically demanding work (OR 1.95, p = 0.0001), and number of drawbacks in telemedicine identified (OR 1.30, p < 0.0001), and worse experience of a prior remote GP consultation (OR 0.704, p < 0.0001). The main indicator of preference for remote-only consultations was the perception of fewer telemedicine disadvantages (OR 0.503, p = 0.0007). Our findings confirm that telemedicine contributes to effective migraine management and is used limitedly in Lithuania. Despite one-third of respondents having experienced teleconsultations, significant barriers remain. Our study highlights a clear preference for a hybrid consultation type.

Stakeholder perspectives on the 2020 global health strategy of the German federal government

Abstract Background The second German Global Health Strategy was published in 2020 after a development process including a consultation with non-state stakeholders. To date, there has been no systematic investigation of these stakeholders’ perspectives regarding the consultation processes and strategy. Methods Semi-structured interviews were conducted with 11 German global health stakeholders involved in the consultation, with purposive sampling informed by a stakeholder mapping applying Clarke et al.'s (2018) situational analysis approach. Results The German government's initiative to consult stakeholders for the strategy development was positively perceived. Perspectives on the consultation process varied, especially regarding the framework conditions (e.g. time and resource constraints), structure and composition of the stakeholder groups (e.g. no adequate reflection of diverse positions) as well as the participatory nature and the representativeness of the stakeholders involved. A particular critique was the limited information provided about the strategy development process, especially once stakeholder position papers were submitted. The inclusion of climate change, human rights and health system strengthening were seen as strengths of the final strategy. Perceived exclusions or weaknesses were (forced) migration, health workforce and financing issues, which were attributed to disagreements in inter-ministerial coordination. The need for a concrete action plan and fostering coherence between ministries was seen as vital for the strategy's implementation. The strategy provides stakeholders with a way to strategically position and justify their own work, and their continued involvement in strategy implementation efforts is desired. Conclusions This study shows overall support for a participatory policy-making process and provides insights into stakeholder perspectives regarding the 2020 German Global Health Strategy, as well as ways future consultations can be strengthened. Key messages • Stakeholder perspectives on the 2020 German Global Health Strategy varied; identifying inclusion of social and planetary issues as strength, and exclusion of migration and an action plan as weakness. • Future global health strategy development processes should consider participatory approaches, transparent communication and stakeholder representativeness in stakeholder consultation.

News credibility and the quest for clicks

We examine a model of dynamic communication by a media outlet. In each period, the uninformed public can consult the outlet’s report at a cost. The outlet, which is primarily driven by profit maximization, has an incentive to induce uncertainty in order to encourage future consultation and thereby generate revenue. In an intermediate cost range, the public and the outlet may be worse off with a cheaper cost of access since it leads the outlet to distort information more, by making the public’s future consultation decision more responsive to the current report.

Effects of Social Support and Self-regulation on Changes in Exercise Behavior Among Infertile Women: A Cross-sectional Study for Comparison of External and Internal Factors

Background: Exercise behavior (EB) has a significant impact on infertility, but the magnitude of the effect is not easily determined. This study aimed to assess the effect of social support and self-regulation, as external and internal factors, on changes in EB among infertile women. Methods: This cross-sectional study was conducted on 483 infertile women in Sanandaj (Iran) in 2020. Samples were recruited from 35 comprehensive healthcare centers by convenience sampling. Standardized face-to-face interviews were conducted using valid and reliable instruments for the assessment of EB, social support, and self-regulation. The association between EB, social support, and self-regulation was evaluated by logistic regression models. Results: The majority of the participants (56.7%) had secondary infertility, while 70.8% of them did not perform any exercise. Self-regulation and social support were significantly higher in women with secondary infertility than in those with primary infertility (P&lt;0.01). Self-regulation was significantly lower in women whose height was below 160 centimeters (P&lt;0.05). Social support was significantly higher among participants aged≥35 years and weighing≥60 kg (P&lt;0.01). The odds of EB adoption increased with self-regulation and social support (odds ratio [OR]=1.05, 95% CI=1.02-1.09, P&lt;0.01; OR=1.06, 95% CI=1.02-1.11, P&lt;0.01). Conclusion: Social support and self-regulation almost equally influenced EB in infertile women. In future research, designing support and consultation programs can be considered to encourage infertile women to exercise.

Impact of ORBIS on public policies – open consultations of draft regulatory documents and the Pharmaceutical Strategy for Europe

Public policies and regulations strongly influence research and manufacturing in pharmaceutical sector. Therefore, it is of critical importance that these policies and regulations are of high quality as well as appropriately balanced between general rules and detailed solutions. The process of public consultations prolongs adoption of novel documents. On the other hand, comments from different stakeholders like academia, industry, public administration and patients allow 360-degree critical evaluation of the document and a better understanding of the topic. This mini-review summarizes the contributions of numerous members of ORBIS project team in open consultations of draft regulatory documents published by European Medicines Agency (EMA) and the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH). ORBIS project feedback on the Pharmaceutical Strategy for Europe is also presented. ORBIS project members contributed to open consultations of two ICH draft guidelines, and three EMA draft documents. ORBIS project was also active during the European Commission’s efforts to develop Pharmaceutical Strategy for Europe. The interaction between representatives of academic and industrial sectors allowed to form balanced comments. We hope that this paper will inspire more researchers to participate in future open consultations on public policies.

OS02.5.A DEVELOPMENT OF A PATIENT DECISION AID FOR PATIENTS WITH RECURRENT HIGH-GRADE GLIOMA - A CO-CREATION PROCESS

Abstract BACKGROUND Patients with high-grade gliomas (HGG) face a difficult decision when the tumor recurs. There are no curable treatments, and all palliative treatment options include risks of complications and adverse effects. In this situation, support is needed for patients to navigate between these trade-offs and make preference-sensitive decisions. Shared decision making (SDM) is an approach where a decision is made in collaboration between a clinician and a patient by combining the clinician’s scientific evidence and knowledge with the patient’s subjective values and preferences. SDM aims to make quality decisions congruent with the individual patient’s informed preferences and to support patients in the decisional process. Patient decision aids (PtDA’s) have proven to be an efficient tool for facilitating SDM. However, there are no PtDA’s available for patients with recurrent HGG. This study aimed to develop a PtDA in a co-creation process with patients with recurrent HGG and family caregivers MATERIAL AND METHODS Based on the International Patient Decision Aids Standards, our team developed a PtDA through an iterative process of drafting and re-drafting. Patients and family caregivers were involved throughout the process as active team members. The PtDA was alpha-tested using structured interviews and the Preparation for Decision Making Scale questionnaire to assess the understandability, acceptability, and perceived usefulness of the PtDA. Data were analyzed using descriptive statistics and a directed content-analysis approach. RESULTS The final draft of the PtDA contained six treatment and care options, including the option of doing nothing. A balanced presentation of benefits and disadvantages was described for each option. In the alpha test, 31 patients with HGG, family caregivers, and clinicians assessed the final draft of the PtDA and found it to be understandable and acceptable. Patients and family caregivers perceived the PtDA to have a higher level of usefulness in supporting and preparing for decision making than did the clinicians (p=0.05). Ten of 11 clinicians were willing to use the PtDA in future consultations. CONCLUSION The PtDA was assessed to be understandable and acceptable by patients, family caregivers, and clinicians. It was perceived to support and prepare patients with recurrent HGG for decision making, and the clinicians were willing to use it in consultations. The involvement of patients and family caregivers as team members added value to the development process and the PtDA. However, the most applicable model of patient involvement in neurooncological research must be further explored to identify the benefits and limitations of approaches.

Parent perceptions regarding virtual pediatric dental clinics during COVID-19 pandemic: a cross-sectional study.

To assess the attitudes and responses of parents of pediatric patients towards virtual dental clinics during COVID-19. A total of 102 parents of pediatric patients who were scheduled for virtual (video or telephonic) clinic appointments for new patient consultations and follow-up clinics were included in the study. Parents and patients could attend the virtual clinic from a personal computer, tablet, or smartphone. An electronic self-administered questionnaire was sent to the parents through email after consultation (video or telephonic) which consisted of demographic data and a ten-item, five-point Likert-scale assessing: (i) parent satisfaction; (ii) ease of use; (iii) the effectiveness including increasing access to clinical services; (iv) reliability of the teledentistry system and (v) usefulness for patients. Statistical analyses used were t-test, one-way ANOVA test, Shapiro-Wilk and histogram. Out of 102 parents, 52 attended video clinics and 50 attended the telephonic clinic. The majority of the parents were between 30-39 years of age, and about 73% had no previous experience with either virtual or telephonic consultation. Ninety-four percent of parents were satisfied with vide clinic consultation, and most of them agreed that accessing clinical services through a video clinic was easy to understand, comfortable, and time-saving. The majority of the parents (94%) agreed and strongly agreed that they will use video clinics again in the future for consultation. Parents' response to the use of virtual clinics for pediatric dentistry during COVID was positive. The majority of the parents stated that they would consider using teledentistry for future consultation.

The diabetes annual review in a postal box: a qualitative study exploring views of people with diabetes.

People with diabetes who do not attend their annual review appointments often have poorer glycaemic control and increased complication rates. A postal kit for self-collection of blood tests, urine samples, and anthropometric data may facilitate remote annual reviews and improve uptake. To explore views on a postal kit for annual review among people with diabetes and to collaborate with people living with diabetes to design and expand the scope of an annual review postal kit. We conducted semi-structured interviews and focus groups with adults with type 1 and type 2 diabetes. Purposive sampling was used to ensure 50% of study invites went to infrequent attenders of annual review appointments. Transcripts were collated and analysed thematically. Twenty-two participants took part, including nine infrequent attenders. All infrequent attenders and the majority of regular attenders responded positively to a postal kit, with convenience being the most prominent value described. Concerns raised related to personal capability of self-collection and the accuracy of results. Participants were asked for suggestions to improve the kit. The most common themes related to communication; participants wanted clearer information regarding the purpose of each test; they wanted feedback of their results through either a website or app with tailored advice for each result; and they wanted to utilise the kit to communicate their priorities for discussion at future consultations. Postal kits for annual reviews were well-received by people living with diabetes. Designed well, they have the potential to overcome far more than just the physical barriers to annual review attendance.