Providing Information To Patients Research Articles

Nurse-led immunotreatment DEcision Coaching In people with Multiple Sclerosis (DECIMS) – A cluster- randomised controlled trial and mixed methods process evaluation

ObjectiveTo evaluate a nurse-led decision coaching programme aiming to redistribute health professionals’ tasks to support immunotherapy decision-making in people with multiple sclerosis (MS). MethodsCluster-randomised controlled trial with an accompanying mixed methods process evaluation (2014 - 2018). We planned to recruit 300 people with clinically isolated syndrome or relapsing-remitting MS facing immunotherapy decisions in 15 clusters across Germany. Participants in the intervention clusters received up to three decision coaching sessions by a trained nurse and access to an evidence-based online information platform. In the control clusters, participants also had access to the information platform. The primary outcome was informed choice after six months, defined as good risk knowledge and congruent attitude and uptake. ResultsTwelve nurses from eight clusters participated in the decision coaching training. Due to insufficient recruitment, the randomised controlled trial was terminated prematurely with 125 participants (n = 42 intervention clusters, n = 83 control clusters). We found a non-significant difference between groups for informed choice favouring decision coaching: odds ratio 1.64 (95% CI 0.49–5.53). ConclusionsResults indicate that decision coaching might facilitate informed decision-making in MS compared to providing patient information alone. Practice implicationsBarriers have to be overcome to achieve structural change and successful implementation.

P184 Geographical variations in delivery of intravenous treatments for ANCA-associated vasculitis

Abstract Background/Aims Timely access to intravenous immunosuppressant therapy is essential to effectively manage systemic vasculitis; however, significant variations in care and outcomes exists across centres. We systematically evaluated access to treatment for ANCA-associated vasculitis across the UK and Ireland. Methods This multi-method study included: a survey of 87 UK and Ireland Vasculitis Society sites and 11 Scottish Health Boards between Nov 2020 and June 2021; interviews with staff and patients with systemic vasculitis. Survey data was analysed descriptively. Interviews were audio or video recorded and analysed thematically. Results 59 responses from 51 Trusts/Health Boards across Scotland (n = 11), England (n = 33), Wales (n = 2), and Ireland (n = 5) included equal numbers of rheumatology and nephrology vasculitis services across diverse healthcare settings. 67 healthcare professionals across six case studies in Scotland (n = 3) and England (n = 3) and 32 patients with systemic vasculitis were interviewed. Services faced significant challenges in prescribing and delivering high-cost drugs to manage systemic vasculitis: balancing accountability versus bureaucracy, and tensions between different specialties looking after vasculitis patients when implementing access to high-cost drugs via multi-disciplinary networks. There was significant variation in how services delivered intravenous treatments: 10%(5/51) used inpatient beds; 35% (18/51) accessed another specialty unit or shared a daycase facility; 65% (33/51) used their own specialty daycase unit. Average wait time for urgent IV treatment was 2.67 days (range 1-10 days). 18% of services had waiting times >7 days, and of those 67% accessed intravenous treatments via another daycase facility. Specific challenges in accessing daycase facilities included availability of slots and staff, particularly in shared units, due to competition with other services and limited awareness of the importance of timely treatment for systemic vasculitis. This could impact on timing and treatment decisions e.g., prolonged steroid prescriptions. Staff training, competencies and governance to deliver cytotoxic drugs was problematic, particularly for smaller services, and 70% of services said national training modules would be helpful. Oncology units could provide workarounds but daycase nurses with vasculitis knowledge were a valuable source of advice and support for patients attending for treatments, identifying medical issues and arranging assessment if required. Conclusion There is significant variation in access to intravenous treatment for systemic vasculitis. Healthcare organisations should ensure timely access to urgent intravenous treatment for systemic vasculitis within 7 days and appropriately trained staff. National training modules for non-cancer chemotherapy could facilitate equitable access to training. Where treatment is delivered via other units, greater awareness of systemic vasculitis would help provision of information and support for patients. Disclosure W. James: None. A. Nicoll: None. L. Locock: None. L. Harper: None. M. Little: None. N. Basu: None. R.J. Hollick: None.

Development of Podcasts in a Hospital Setting: A User-Centered Approach

Patient information plays a pivotal role in preparing individuals for hospital visits and empowering them to actively participate in decision-making processes regarding their healthcare. However, many patients face challenges related to reading comprehension. In response, podcasts have become a popular, user-friendly medium for sharing essential and easily understandable information in an engaging format. The aim of the present project was to use a user-centered approach to develop podcasts providing patient information prior to hospital visits. We aimed to describe the steps of the development in detail with the purpose of inspiring podcast development in the future. In Phase 1 we conducted interviews with patients and focus groups with clinicians based on the “empathy map” method, with the purpose of exploring patients’ needs on which to subsequently build the podcasts’ content and format. In Phase 2 we produced and refined the podcasts on the basis of feedback from clinician- and patients representatives. Our results indicated the importance of clear and concise language, personalization of communication, and content alignment with patients’ needs. Our project resulted in a description of each step of the development that can be used as inspiration for others who wish to take a user-centered approach to podcast development.

Performance of cell-free DNA testing for common fetal trisomies in triplet pregnancies.

In singleton pregnancies, the use of cell-free DNA (cfDNA) analysis as a screening test for common fetal trisomies has spread worldwide though we still lack sufficient data for its use in triplet pregnancies. The objective of this study is to assess the performance of cfDNA testing in detecting fetal aneuploidies in triplet pregnancies as a first-tier test. We performed a retrospective cohort study including data from pregnant women with a triplet pregnancy who underwent cfDNA testing between May 1, 2017, and January 15, 2020. cfDNA was obtained by massive parallel sequencing (VeriSeq NIPT solution; Illumina®). The objectives of the study were to assess the diagnostic performance of cfDNA testing for trisomy 21 (T21) (primary outcome), trisomy 18 (T18) and 13 (secondary outcomes). During the study period, cfDNA testing was performed in 255 women with triplet pregnancy, of which 165 (64.7%) had a neonatal outcome available. Three tests were positive for T21, one of which was confirmed by an antenatal karyotype, and the other was confirmed at birth. The third case did not undergo an invasive procedure and was not confirmed at birth (false positive). In one case, cfDNA testing was positive for T18 and was confirmed by an antenatal karyotype. There were no cases of trisomy 13 in the cohort. The no-call rate was 2.4% at first sampling. Fifty-eight (22.7%) women had embryo reduction, which in 40 (69%) of whom was performed after the cfDNA test result. cfDNA testing could be offered as primary screening for main fetal aneuploidies in triplet pregnancies after provision of appropriate patient information.

ChatGPT as a Source of Patient Information for Lumbar Spinal Fusion and Laminectomy: A Comparative Analysis Against Google Web Search.

Retrospective Observational Study. The objective of this study was to assess the utility of ChatGPT, an artificial intelligence chatbot, in providing patient information for lumbar spinal fusion and lumbar laminectomy in comparison with the Google search engine. ChatGPT, an artificial intelligence chatbot with seemingly unlimited functionality, may present an alternative to a Google web search for patients seeking information about medical questions. With widespread misinformation and suboptimal quality of online health information, it is imperative to assess ChatGPT as a resource for this purpose. The first 10 frequently asked questions (FAQs) related to the search terms "lumbar spinal fusion" and "lumbar laminectomy" were extracted from Google and ChatGPT. Responses to shared questions were compared regarding length and readability, using the Flesch Reading Ease score and Flesch-Kincaid Grade Level. Numerical FAQs from Google were replicated in ChatGPT. Two of 10 (20%) questions for both lumbar spinal fusion and lumbar laminectomy were asked similarly between ChatGPT and Google. Compared with Google, ChatGPT's responses were lengthier (340.0 vs. 159.3 words) and of lower readability (Flesch Reading Ease score: 34.0 vs. 58.2; Flesch-Kincaid grade level: 11.6 vs. 8.8). Subjectively, we evaluated these responses to be accurate and adequately nonspecific. Each response concluded with a recommendation to discuss further with a health care provider. Over half of the numerical questions from Google produced a varying or nonnumerical response in ChatGPT. FAQs and responses regarding lumbar spinal fusion and lumbar laminectomy were highly variable between Google and ChatGPT. While ChatGPT may be able to produce relatively accurate responses in select questions, its role remains as a supplement or starting point to a consultation with a physician, not as a replacement, and should be taken with caution until its functionality can be validated.

Quality of life, hearing results, patient satisfaction and postoperative complications of day-case versus inpatient unilateral cochlear implantation in adults: a randomized controlled, equivalence trial

ObjectiveTo investigate the hypothesis that day-case cochlear implantation is associated with equal quality of life, hearing benefits and complications rates, compared to inpatient cochlear implantation.Study designA single-center, non-blinded, randomized controlled, equivalence trial in a tertiary referral center.MethodsThirty adult patients with post-lingual bilateral sensorineural hearing loss eligible for unilateral cochlear implantation surgery were randomly assigned to either the day-case or inpatient treatment group. The effect on general quality of life, patient satisfaction, (subjective) hearing improvement, postoperative complications and causes of crossover and/or readmission were assessed using questionnaires, auditory evaluations and patients’ charts over a follow-up period of 1 year.ResultsOverall quality of life measured by the HUI3 was equal between the day-case (n = 14) and inpatient group (n = 14). The overall patients’ satisfaction showed a slight favor towards an inpatient approach. There was no significant difference in the subjective and objective hearing improvement between both treatment groups. During the 1-year follow-up period no major complications occurred. Minor complications occurred intraoperatively in three day-case patients resulting in three out of nine admissions of day-case patients. Other causes of admission of day-case patients were nausea and vomiting (n = 1), drowsiness (n = 1), late scheduled surgery (n = 2), social reasons (n = 1), or due to an unclear reason (n = 1). No patients required readmission.ConclusionWe found equal outcomes of QoL, patient satisfaction, objective, and subjective hearing outcomes between day-case and inpatient unilateral cochlear implantation. Nine out of 14 day-case patients were admitted for at least one night postoperatively (crossover). No major complications occurred in both groups. A day-case approach seems feasible when using specific patient selection, surgical planning and the preoperative provision of patient information into account. Besides this, the familiarity with a day-case approach of both patient and the surgical team can increase the feasibility of day-case surgery.Level of evidence1.

Optometrist to Operation: Patients' Perspective on the Innovative Use of Quick Response (QR) Code-Linked Patient Information Video on Cataract Surgery.

Background This study aimed to explore patients' subjective utility for a patient information video (PIV) on cataract surgery and analyse the use of a quick response (QR) code as a mode of delivery of the PIV. Methods A total of 500 patients were included in the study. All patients were given a paper form of the patient information leaflet (PIL) as the standard of care (SoC) in addition to a digital QR code to access a supplementary PIV. The questionnaire explored the patients' understanding of cataracts, the risks and benefits of cataract surgery, and their experience accessing and using the QR code. Results A total of 321 responses were collected (64% response rate). The majority were female (55%), with a mean age of 75 years. Among these, 69% (n = 222/321) managed to watch the video. A statistically significant association was reported between prior experience with QR codes and the ability to watch the video (p<0.001). The most common reason for not watching the video was no device (n=54/99, 54%). Ninety-one percent of the patients who watched the video expressed a desire for additional healthcare videos in the future. Overall, most patients (n=170/222, 76%) acknowledged that the PIV was easier to understand when compared to paper-format information, with a minority of patients reporting the PIV missing information that was covered on paper (n=2/222). Conclusions The provision of PIV supplementation as a part of the cataract surgery referral pathway is an innovative method of providing patient information in a more interactive way, with positive feedback from patients.

The perspective of Polish patients with rheumatoid arthritis - treatment expectations, patient-reported outcomes, and digital literacy (the SENSE study).

A widely accepted treat-to-target strategy for rheumatoid arthritis (RA) requires the patient's perspective in making treatment decisions. However, data on treatment preferences and expectations of Polish patients with RA are scarce. The aim of the study was to determine the satisfaction with treatment and the nature of therapeutic preferences and expectations of Polish patients with moderate to severe RA. Fifty-two adult Polish patients with moderately to highly active RA were asked to complete patient-reported outcomes and patient-provided information questionnaires. Additionally, patient sociodemographic and clinical data and information on patient current and planned treatment strategies were collected. The mean global assessment of patient satisfaction with treatment was 64.1 ±24.6, below the level of indicating satisfaction. Rheumatoid arthritis negatively impacted patients' lives, resulting in a 37.8% impairment of work efficiency and 45% impairment of total activity. Primary treatment expectations for patients were lasting relief of RA symptoms, reduced pain and swelling in joints, increased flexibility of joints, and general improvement of arthritis. The most acceptable potential side effect was weight gain and the least acceptable were increases in the risk of cardiovascular disease, infection, and malignancies. The rapid onset of the drug effect (up to 1 week) was a preference of 48.1% of patients. Access to internet health resources was important for 44.2% of patients, but the median total eHealth literacy score in the study population was 24.0 (interquartile range: 20.5-28.0, range 8-37), which means low digital health literacy (DHL). Understanding these treatment preferences and expectations of patients with RA is essential for clinical practitioners to facilitate shared treatment decision-making. Digital health literacy data suggest the need of further improvement.

ChatGPT and Patient Information in Nuclear Medicine: GPT-3.5 Versus GPT-4.

The GPT-3.5-powered ChatGPT was released in late November 2022 powered by the generative pretrained transformer (GPT) version 3.5. It has emerged as a readily accessible source of patient information ahead of medical procedures. Although ChatGPT has purported benefits for supporting patient education and information, actual capability has not been evaluated. Moreover, the March 2023 emergence of paid subscription access to GPT-4 promises further enhanced capabilities requiring evaluation. Methods: ChatGPT was used to generate patient information sheets suitable for gaining informed consent for 7 common procedures in nuclear medicine. Responses were generated independently for both GPT-3.5 and GPT-4 architectures. Specific procedures were selected that had a long-standing history of use to avoid any bias associated with the September 2021 learning cutoff that constrains both GPT-3.5 and GPT-4 architectures. Each information sheet was independently evaluated by 3 expert assessors and ranked on the basis of accuracy, appropriateness, currency, and fitness for purpose. Results: ChatGPT powered by GPT-3.5 provided patient information that was appropriate in terms of being patient-facing but lacked accuracy and currency and omitted important information. GPT-3.5 produced patient information deemed not fit for the purpose. GPT-4 provided patient information enhanced across appropriateness, accuracy, and currency, despite some omission of information. GPT-4 produced patient information that was largely fit for the purpose. Conclusion: Although ChatGPT powered by GPT-3.5 is accessible and provides plausible patient information, inaccuracies and omissions present a risk to patients and informed consent. Conversely, GPT-4 is more accurate and fit for the purpose but, at the time of writing, was available only through a paid subscription.

1080 A Quality Improvement Project Developing a 'Return to Scan' Failsafe Protocol for Barnsley Hospital Emergency Department Patients with Suspected Cauda Equina and Renal Colic

Abstract Aim A staff survey noted patients returning for scans for suspected cauda equina and renal colic were on occasion not returning or returning late. Overall, staff and patient experience were poor and posed risk to patients. To improve this, aims were to develop a standard process for recording ED patients due to return for scan and formalised information about this process to be provided to the patient. Method Three cycles were completed. Staff surveys identified areas of concern, supported by a fishbone diagram and process map. A proforma and patient information sheet were developed. Further staff surveys assessed satisfaction and effectiveness of the changes, leading to replacement of the proforma with a patient notes sticker. A booking system was created identifying patients to reception staff. Further cycles identified 64 patients in a 3-month period by suspected diagnosis using SNOMED codes. Records were accessed electronically using Mediviewer to review documentation and time returned for scan. Results 98% of patients returned for scan. Process followed: 36% of patients returned late, with an average of 22 minutes and maximum of 40 minutes late. Process not followed: 36% of patients returned late, with an average of 58 minutes and maximum of 219 minutes late. The process was followed correctly in 17% of cases. Conclusions Patients were late by a shorter on average time when the process was followed - with providing patient information having the greatest positive impact. Staff education may improve process compliance which is poor. Patient experience and barriers to returning on time must be explored.

Can ChatGPT, an Artificial Intelligence Language Model, Provide Accurate and High-quality Patient Information on Prostate Cancer?

To evaluate the performance of ChatGPT, an artificial intelligence language model, in providing patient information on prostate cancer, and to compare the accuracy, similarity, and quality of the information to a reference source. Patient information material on prostate cancer was used as a reference source from the website of the European Association of Urology Patient Information. This was used to generate 59 queries. The accuracy of the model's content was determined with F1, precision, and recall scores. The similarity was assessed with cosine similarity, and the quality was evaluated using a 5-point Likert scale named General Quality Score (GQS). ChatGPT was able to respond to all prostate cancer-related queries. The average F1 score was 0.426 (range: 0-1), precision score was 0.349 (range: 0-1), recall score was 0.549 (range: 0-1), and cosine similarity was 0.609 (range: 0-1). The average GQS was 3.62 ± 0.49 (range: 1-5), with no answers achieving the maximum GQS of 5. While ChatGPT produced a larger amount of information compared to the reference, the accuracy and quality of the content were not optimal, with all scores indicating need for improvement in the model's performance. Caution should be exercised when using ChatGPT as a patient information source for prostate cancer due to limitations in its performance, which may lead to inaccuracies and potential misunderstandings. Further studies, using different topics and language models, are needed to fully understand the capabilities and limitations of AI-generated patient information.

Enhancing potential impact of hospital discharge interventions for patients with COPD: a qualitative systematic review

BackgroundPatients with chronic obstructive pulmonary disease (COPD) are frequently readmitted to hospital resulting in avoidable healthcare costs. Many different interventions designed to reduce hospital readmissions are reported with limited evidence for effectiveness. Greater insight into how interventions could be better designed to improve patient outcomes has been recommended.AimTo identify areas for optimisation within previously reported interventions provided to reduce COPD rehospitalisation to improve future intervention development.MethodsA systematic review was conducted by searching Medline, Embase, CINAHL, PsycINFO, and CENTRAL in June 2022. Inclusion criteria were interventions provided to patients with COPD in the transition from hospital to home or community. Exclusion criteria were lack of empirical qualitative results, reviews, drug trials, and protocols. Study quality was assessed using the Critical Appraisal Skills Programme tool and results were synthesised thematically.ResultsA total of 2,962 studies were screened and nine studies included. Patients with COPD experience difficulties when transitioning from hospital to home. It is therefore important for interventions to facilitate a smooth transition process and give appropriate follow-up post-discharge. Additionally, interventions should be tailored for each patient, especially regarding information provided.ConclusionVery few studies specifically consider processes underpinning COPD discharge intervention implementation. There is a need to recognise that the transition itself creates problems, which require addressing, before introducing any new intervention. Patients report a preference for interventions to be individually adapted—in particular the provision of patient information. Whilst many intervention aspects were well received, feasibility testing may have enhanced acceptability. Patient and public involvement may address many of these concerns and greater use of process evaluations should enable researchers to learn from each other’s experiences.Trial registrationThe review was registered in PROSPERO with registration number CRD42022339523.

P-277 Can a validated, livebirth predictive, in-house morphokinetic algorithm, score embryos according to maternal age; providing more information, for patients, regarding chance of success?

Abstract Study question How does a livebirth (LB) prediction algorithm, built in-house on data from 6228 known outcomes from all ages, perform when categorised by female age? Summary answer The algorithm scored and ranked embryos accurately for clinical outcome (FH) regardless of female age; with proportions of poor prognosis embryos highest in older patients. What is known already Time-lapse incubation enables development of predictive algorithms using key morphokinetic variables to score embryos according to potential for clinical outcomes. Maternal age is associated with embryo quality and implantation. Understanding whether kinetic events are influenced by increasing age may benefit embryo selection and patient information provision. There is little evidence of a correlation between advancing maternal age and morphokinetics, although incidence of abnormal cleavage is linked to aneuploidy and reduced blastulation. Predictive algorithms are generally applied to embryos irrespective of oocyte age but are they effective in selecting the optimum embryo for transfer comparatively across differing maternal age groups? Study design, size, duration A retrospective, comparative analysis of 10034 transferred embryos from 2011 to 2022 in 11 sister fertility clinics. Embryos were cultured for 4 - 6 days in time-lapse incubation before transfer (Embryoscope, Vitrolife). A score was derived using a prospectively validated in-house statistical algorithm, assessing 6 manually annotated morphokinetic variables (t3,t4,t5,t8,tSB,and tB) and trophectoderm grade. Embryos were scored 1 to10 for increasing live birth (LB) potential. Participants/materials, setting, methods All transferred embryos were assessed for age of the patient or donor at treatment, traceable to an algorithm score (1-10) with known implantation, defined by presence of fetal heart (KID-FH). Embryos were assigned to two age groups, &amp;lt; 38 years (n6948) or &amp;gt; = 38 years (n3086) and compared according to the distribution of algorithm scores. Comparative significance of the two groups, against each other and the whole cohort, was assessed for significance using chi-squared. Main results and the role of chance Comparison of the KID-FH per score, for age groups revealed increasing implantation rates and effective ranking per score in each age group, &amp;lt;38 KID-FH scores 1 to10; 9.6%,17.8%, 25.7%, 24.3%, 28.3%, 38.2%, 41.4%, 48.4%, 54.6% and 57.8% and for &amp;gt; = 38 score 1-10; 2.0%, 3.8%, 5.9%, 9.9%, 10.8%, 17.9%, 22.2%, 22.0% 31.6% and 36.8%. KID-FH increased incrementally with increasing score in both maternal age groups, demonstrating that the algorithm is predictive irrespective of maternal age. The percentage incidence of scores were compared, &amp;lt;38 years, score 1 to 10; 3.8%, 4.6%, 4.5%, 5.0%, 6.2%, 7.5%, 9.3%, 12.4%, 16.8%, 29.8% versus &amp;gt; = 38 years 1 to 10; 8.0%, 9.4%, 7.1%, 9.2%, 8.7%, 9.4%,10.5%,11.0%, 11.2%,15.4%. There were significantly higher numbers of embryos with lower scores (p = 0.01) in the &amp;gt; = 38 age group (scores 1-6) than the &amp;lt;38 age group. The younger ages conversely, had significantly greater high scoring embryos 9-10, (p = 0.01), score 7 to 8 were comparable across the age groups. The algorithm score is effective in determining implantation potential irrespective of maternal age. Embryos with poorer implantation potential are present in significantly greater numbers in the older age group and this age group attains significantly fewer high potential embryos when compare to younger patient embryos. Limitations, reasons for caution The data for this analysis was determined from multiple clinics within a fertility group operating under uniform practices. The derived algorithm variables and outcomes may not be transferable to another clinic setting. Follow up is required for known live birth outcomes to confirm comparative prediction to KID-FH per age group. Wider implications of the findings The algorithm score infers embryo competence irrespective of age with differences existing only in the prevalence of low and high scores. This algorithm differentiation promises to inform clinicians and patients regarding their chance of success, when utilised to assess embryos. Morphology alone does not have this breadth or predictive capability Trial registration number N/A

Landscape of cancer biomarker testing in England following genomic services reconfiguration: insights from a nationwide pathologist survey

AimsCancer diagnostics have been evolving rapidly. In England, the new National Health Service Genomic Medicine Service (GMS) provides centralised access to genomic testing via seven regional Genomic Laboratory Hubs. The...

Systematic review of clinical practice guidelines for acne vulgaris published between January 2017 and July 2021.

Acne is very common, can cause considerable negative impact on quality of life and there is increasing concern over the use of long courses of oral antibiotics for this condition. (1) To critically appraise reporting in acne guidelines and compare this with previous systematic review of acne guidelines. (2) Examine acne treatment guidance on pre-specified acne treatments of interest and compare between acne guidelines. Searches for new or updated guidelines were carried out in MEDLINE, Embase, Google Scholar, LILACS from 1 January 2017 to 31 July 2021, supplemented by searching a guideline-specific depository and checking for updates to guidelines included in previous review. We included guidelines, consensus statements or care protocols on the medical treatment of acne vulgaris in adults and/or children and excluded those that focused on a single intervention or subgroup of acne, regional adaptations of guidelines or guidelines included in previous review. AGREE II checklist was applied to critically appraise reporting of guidelines. Results were synthesised narratively. Of 807 abstracts identified nine guidelines were identified that were eligible for inclusion. All guidelines had AGREE II scores above average in at least one domain and reporting was substantially improved compared to the systematic review of acne carried out 5years previously. There was consensus between guidelines on the key role of topical treatments as first-line acne treatment and most recommended continuing topical treatments as maintenance therapy. There was considerable variation between guidelines on classification of severity, indications for commencing oral antibiotics and on maximum duration of oral antibiotics. However, there was consensus on the need for co-prescription of a non-antibiotic topical treatment when using oral antibiotics. There were notable differences on recommendations regarding provision of information for patients on how to use topical treatments or how to mitigate against side effects. Substantial differences in classification of acne severity hampered comparisons between guidelines. Although development and reporting of guidelines has improved over the past 5years, differences in key recommendations remain, possibly reflecting uncertainties in the underlying evidence base. Differences between guidelines could have substantial implications for prevalence of antibiotic prescribing for acne.

Conformer-Based Dental AI Patient Clinical Diagnosis Simulation Using Korean Synthetic Data Generator for Multiple Standardized Patient Scenarios.

The goal of clinical practice education is to develop the ability to apply theoretical knowledge in a clinical setting and to foster growth as a professional healthcare provider. One effective method of achieving this is through the utilization of Standardized Patients (SP) in education, which familiarizes students with real patient interviews and allows educators to assess their clinical performance skills. However, SP education faces challenges such as the cost of hiring actors and the shortage of professional educators to train them. In this paper, we aim to alleviate these issues by utilizing deep learning models to replace the actors. We employ the Conformer model for the implementation of the AI patient, and we develop a Korean SP scenario data generator to collect data for training responses to diagnostic questions. Our Korean SP scenario data generator is devised to generate SP scenarios based on the provided patient information, using pre-prepared questions and answers. In the AI patient training process, two types of data are employed: common data and personalized data. The common data are employed to develop natural general conversation skills, while personalized data, from the SP scenario, are utilized to learn specific clinical information relevant to a patient's role. Based on these data, to evaluate the learning efficiency of the Conformer structure, a comparison was conducted with the Transformer using the BLEU score and WER as evaluation metrics. Experimental results showed that the Conformer-based model demonstrated a 3.92% and 6.74% improvement in BLEU and WER performance compared to the Transformer-based model, respectively. The dental AI patient for SP simulation presented in this paper has the potential to be applied to other medical and nursing fields, provided that additional data collection processes are conducted.

Assessment of Available Online Website and YouTube Resources for Patients with Abdominal Aortic Aneurysms

Over the last decade, patients displayed a greater tendency to search for online information related to their health before seeking advice from a clinician. This study aims to determine the current quality and educational content of online patient information for abdominal aortic aneurysms (AAA). In March 2022, the three most popular search engines by market shares (Google, Yahoo! and Bing) and the video platform YouTube were interrogated for the term "abdominal aortic aneurysm". Validated scoring tools were used to assess quality and readability of the top 50 results for each search engine and to evaluate reliability and educational quality of the first 20 YouTube videos returned by the search. A custom-made scoring system was used to assess content. 45 unique websites were analysed, 29% of which held Health on the Net (HoN) Certification. Median FRE (IQR) was 56.4 (50.4-62.75), with the average website falling under the "difficult to read" category. Median Michigan score (IQR) was 38.5 (32-43.5), reflecting "weak" quality. Websites with higher content-specific score had significantly higher median Michigan score. Sixty percent of websites discussed benefit and risks related to AAA treatment and only 31% discussed advantages and disadvantages of open vs endovascular treatment. No websites mentioned the volume-outcome relationship in aneurysm surgery. 8 unique YouTube videos were assessed. Median JAMA score (IQR) was 2 (2-2.25). Median Global Quality Score (GQS) score (IQR) was 3 (2-4). Median content score was 1 (0-2). The current average online information on AAA is of 'weak' quality and 'difficult' (i.e., above the standard reading ability of a 13 to 15 years old) readability. Healthcare providers should focus on the provision of better AAA-focused patient information (e.g. appropriately referenced, regularly reviewed and limiting advertisements where possible). The involvement of patient advisory groups during resource development is highly recommended.

Health and quality of life after discharge from hospital: A prospective study on opioid treatment for acute pain after trauma or surgery

ObjectivesThe aim of this study was to examine opioid use, health, quality of life, and pain after discharge from hospital in opioid naïve patients receiving opioid treatment for sub acute pain after trauma or surgery. MethodsA prospective cohort with a four-week follow-up was conducted. Of the 62 patients included, 58 remained in the follow-up. The following questionnaires were assessed: Numeric Rating Scale for pain (NRS), EQ-5D-5L (health-related quality of life) and EQ-VAS (self-reported health). Paired t-test, two-sample t-test and chi square test were used in the study. ResultsEvery fourth participant still received opioid treatment at follow-up, and reported no significant increase in EQ-VAS. Overall, an improvement in EQ-5D-5L (0.569 (SD = 0.233) to 0.694 (SD = 0.152), p < 0.001) and EQ-VAS (55 (SD = 20) to 63 (SD = 18), p = 0.001) from baseline to follow-up was found. Pain intensity decreased in the same period (6.4 (SD = 2.2) to 3.5 (SD = 2.6), p < 0.001). An unmet need for information regarding pain management was reported by 32% of the participants. ConclusionsOur findings show that patients with acute pain, treated with opioids, reported improved pain intensity, health-related quality of life and self-reported health four weeks after discharge. There is room for improvement regarding the provision of patient information on pain management.

High-dose chemotherapy with stem cell rescue to treat stage III homologous deficient breast cancer: factors influencing clinical implementation

BackgroundHigh-dose chemotherapy with autologous stem cell rescue (HDCT) is a promising treatment for patients with stage III, HER2-negative, homologous recombination deficient (HRD) breast cancer. Clinical effectiveness and cost-effectiveness are currently under investigation in an international multicenter randomized controlled trial. To increase the chance of successful introduction of HDCT into daily clinical practice, we aimed to identify relevant factors for smooth implementation using an early comprehensive assessment framework.MethodsThis is a qualitative, multi-stakeholder, exploratory research using semi-structured interviews guided by the Constructive Technology Assessment model, which evaluates the quality of a novel health technology by clinical, economic, patient-related, and organizational factors. Stakeholders were recruited by purposeful stratified sampling and interviewed until sufficient content saturation was reached. Two researchers independently created themes, categories, and subcategories by following inductive coding steps, these were verified by a third researcher.ResultsWe interviewed 28 stakeholders between June 2019 and April 2021. In total, five overarching themes and seventeen categories were identified. Important findings for optimal implementation included the structural identification and referral of all eligible patients, early integration of supportive care, multidisciplinary collaboration between- and within hospitals, (de)centralization of treatment aspects, the provision of information for patients and healthcare professionals, and compliance to new regulation for the BRCA1-like test.ConclusionsIn anticipation of a positive reimbursement decision, we recommend to take the highlighted implementation factors into consideration. This might expedite and guide high-quality equitable access to HDCT for patients with stage III, HER2-negative, HRD breast cancer in the Netherlands.

YouTube as a source of patient information for pterygium surgery.

Patients use the YouTube platform to get information about pterygium surgery, and this affects the treatment decisions of the patients. The purpose of this study was to analyze the quality and reliability of YouTube videos as educational resources about pterygium surgery. This is a register-based retrospective study. This was a retrospective, record-based study. A YouTube search was performed using the terms 'pterygium surgery' and 'pterygium eye surgery', resulting in the evaluation of a total of 200 videos. In the end, 122 English-language videos about pterygium surgery were recruited to study. All videos were rated with the DISCERN, the Journal of the American Medical Association (JAMA), and the Global Quality Score (GQS) systems. The mean DISCERN, JAMA, and GQS values were 38.9 ± 10.9, 1.8 ± 0.8, and 2.2 ± 1, respectively. The YouTube videos about pterygium surgery had been uploaded by a physician in 63 (51.6%) and non-physicians in 59 (48.4%) cases. There was no significant difference between the two groups in terms of general characteristics and scores. Our results show that YouTube videos about pterygium surgery have low quality and credibility and are not sufficient in terms of providing patient information. Not applicable.