Support Health Care Professionals Research Articles

Self-care styles of patients with chronic obstructive pulmonary disease: A mixed methods case study

BackgroundIn people affected by chronic obstructive pulmonary disease (COPD), self-care is crucial for improving quality of life, decreasing symptom burden, and reducing health care-related costs. Unlike other chronic conditions, little is known about the factors that influence different self-care styles in COPD patients. ObjectivesTo explore the factors that could influence the self-care styles of patients with COPD. MethodsA mixed methods case study design was used. Quantitative and qualitative data were collected at the same stage in a purposive sample of patients with COPD through questionnaires, interviews, and focus groups. Data were analyzed separately and then integrated to compare the cases. ResultsThirty-seven patients with COPD were recruited from an outpatient clinic, pulmonary rehabilitation unit and online in a patient support group. On average, participants scored below the level of adequacy in all self-care dimensions. Self-care maintenance was influenced by patient age, education level, and economic status. Most participants reported performing self-care behaviors, while some did not because they found it difficult or because they did not recognize their importance. When the quantitative and qualitative data of patients with higher and lower levels of self-care were integrated, four different styles of self-care were identified according to COPD severity, psychological distress and level of self-efficacy: proactive, inactive, reactive, and hypoactive. ConclusionsPersonal, clinical, psychological, and social factors not only influence the level of self-care performed by COPD patients but also contribute to the understanding of different self-care styles. This knowledge could support health care professionals in tailoring educational interventions.

Protocols for breaking bad news in health care: a scoping review protocol.

This scoping review will map the available evidence on communication protocols for breaking bad news to adult patients and their families in health care. Breaking bad news to adult patients and their families is a challenging task for health care professionals. To address these challenges, communication protocols have been developed to support health care professionals in breaking bad news in a compassionate and effective manner while respecting each patient's individuality. This scoping review will consider all studies that focus on communication protocols (original or adapted versions) to break bad news to adult patients and/or their families (adults) in any health care context, regardless of the approach (face-to-face, telephone, video, or other). Quantitative, qualitative, and mixed methods studies, systematic reviews, and text and opinion papers will be considered for inclusion in this review. This review will be conducted in accordance with the JBI methodology for scoping reviews. The search strategy will aim to locate both published and unpublished evidence in English, Spanish, and Portuguese. The databases to be searched include CINAHL Plus Complete (EBSCOhost), MEDLINE (PubMed), Academic Search Complete, Psychology and Behavioral Sciences Collection, Scopus, and Web of Science Core Collection. Gray literature will also be searched for. Two independent reviewers will independently perform study selection and data extraction. Data will be extracted using a data extraction tool developed by the reviewers. Any disagreements that arise between the reviewers will be resolved through discussion or with an additional reviewer. Data will be presented in tabular and narrative format. https://osf.io/s6ru7/.

Experience of integrating mobile applications in the self-management of patients with heart failure

Abstract Background Self-management in patients with heart failure is important in terms of their prognosis and quality of life. The use of mobile applications in the self-management of patients with heart failure has been suggested to improve their knowledge of the disease and quality of life. However, there are limited data on the experiences of patients with heart failure when mobile applications are integrated into their routine as a self-management intervention. Purpose We aimed to determine the experiences of patients with heart failure who incorporated the use of mobile applications as a self-management intervention. Methods In this qualitative cross-sectional study, participants were purposive-sampled at a university hospital, and semi-structured interviews were conducted with both male and female patients, aged 40–70 years, with a diagnosis of chronic heart failure (ACCF/AHA stage C). Data were collected between December 2022 and April 2023. All interviews were audio-recorded and transcribed verbatim, followed by content analyses. The mobile application used in this study recorded and managed patients’ subjective symptoms and daily life as cloud data and allowed healthcare professionals to access the data using a dedicated terminal. Results Four themes were identified from the data: 1) patients used the mobile application in their own way through trial and error; 2) the support of healthcare professionals through the mobile application increased patients’ sense of self-efficacy; 3) using the mobile application made them feel secure as they always felt connected; and 4) some patients struggled to incorporate new technology into their self-management. Most participants in this study had a positive experience of using the mobile application for self-management in their own way with the support of healthcare professionals, including gaining a sense of self-efficacy and security. On the other hand, some patients had a negative experience, such as not looking at the mobile application for a while or discontinuing self-management because they felt burdened by the introduction of this new self-management method. Conclusions Both positive and negative aspects of the experiences of patients with heart failure with adopting a mobile application for self-management were identified. Psychological support is essential when patients incorporate mobile applications into their routine as a self-management intervention.

A qualitative exploration of perceived challenges and opportunities in the implementation of injury prevention and management in amateur female sport.

Coaches, practitioners, and leadership in amateur female sport must navigate many obstacles in the pursuit of athlete availability and optimal performance. The present study aims to evaluate opportunities and challenges to both injury prevention and management in amateur female sport, as experienced by mixed-gender coaches, allied healthcare professionals, and general practitioners. Semi-structured virtual interviews of coaches, allied healthcare professionals, and general practitioners (N = 25), recruited via convenience snowball sample. Data transcribed verbatim with reflexive thematic analysis through a critical realism framework. Female-specific issues, education, and resource capital were challenges to the implementation of injury prevention and management in amateur female sport, thus negatively impacting on performance, prevention, and rehabilitation. Opportunities for improved care for female athletes were developing communication and relationships, outsourcing responsibility, and providing greater education, in response to desires for such, and lastly exposure to elite sport and national governing bodies' protocols. In amateur female sport, developing communication pathways and relationships, along with upskilling coaches, can help better support female athletes, coaches, and healthcare professionals. Leaders and stakeholders must advocate for and support greater education, resourcing, and an understanding of female-specific issues in amateur female sport. It is intended that these findings will provide evidence and opportunities for discourse between stakeholders in amateur female sport to improve standard of supports for female athletes, coaches, and healthcare professionals. These findings may also help practitioners better exploit opportunities and circumvent challenges to improve the welfare and performance of amateur female athletes.

Systematic review and narrative synthesis of the experiences of individuals with chronic pain participating in digital pain management interventions.

The use of digital pain management interventions has grown since the Covid 19 pandemic. The aim of this study was to systematically review and synthesise evidence from qualitative studies regarding the experiences of individuals with chronic pain participating in digital pain management interventions in primary care and community settings. Fourteen databases were searched, as well as citation tracking and hand-searching reference lists of included articles. The latest search was completed by 07/07/2023. Qualitative studies of patient and carer perspectives of digital pain management interventions for adults aged 18 and over with non-malignant chronic pain were included. All studies were appraised for quality using the Critical Appraisal Skills Programme Qualitative Checklist. A narrative synthesis approach was used to synthesise the findings. Normalisation Process Theory was used to understand how individuals with chronic pain make sense of digital pain management interventions and incorporate knowledge, skills and strategies learnt into their day-to-day lives. Eleven studies, encompassing both digital applications for use on smartphones/ mobile devices and user-directed online modular programmes, were included in the synthesis. Three main themes and related subthemes were identified from the included studies: 1) Making sense of the digital intervention (Subthemes: Tailoring to user's needs; Human contact and support; Accessibility of the digital intervention; Personal and environmental factors affecting engagement with digital interventions); 2) Initiating and Maintaining Behaviour Change (Subthemes: Planning activity; Being active); and 3) Personal Growth (Subthemes: Gaining understanding and skills; Gaining and acting on feedback; Negotiating a new relationship with pain). Recommendations. The key recommendations from our findings are that digital pain management interventions should provide: Specific and tailored information for individual participants.Focus on changing attitudes and behaviours and reframing perceptions of pain.Structured goal setting with prompts to review goals.Potential healthcare professional support alongside the digital intervention.Limitations of the review. To reduce bias, it would have been preferable for more than one author to independently fully analyse each paper and to identify themes and sub-themes. Instead, the identified themes and sub-themes were discussed with two other authors in the team (ES, LW) to reach a consensus view on final themes and sub-themes. One author (JS) received a Research Internship and Research Initiation Award funded by NIHR Applied Research Collaboration (ARC) Wessex (https://www.arc-wx.nihr.ac.uk/) and NHS England (https://www.england.nhs.uk/). The protocol for this review was registered with the National Institute of Health Research (NIHR) PROSPERO international database for registering systematic reviews (PROSPERO Registration Number CRD42021257768).

An investigation into parental awareness of the importance of gut health in infancy and of the effect of mode of delivery and gestational age on their infant’s gut health

The early establishment of the gut microbiome during the first 1000 days of life is crucial for health and development during childhood and beyond(1,2). The composition of the microbiome is influenced by various factors including mode of delivery, gestational age, feeding method, medication use, and other early life experiences(1). Disruptions to optimal early microbial colonisation, as presented with preterm infants, and infants delivered via caesarean section, can compromise microbial diversity which in turn may manifest in health problems(2,3). This study aims to investigate parental awareness around infantile gut health to establish potential gaps in the education provided by healthcare professionals (HCPs).This study involved the distribution of a 15-item questionnaire to parents of infants aged 0-12 months, via a parenting platform, ‘everymum.ie’. Descriptive statistics were conducted using IBM SPSS V29. Frequencies, Cross-tabulations and Pearson Chi-Squares were performed to analyse categorical variables (significance at p≤0.05).A total of 933 valid responses were collected. The majority of respondents were female (98%), aged between 25 and 44 years (95%) and had received third level education (85%). Of the sample, 76% did not receive any information from a HCP on the importance of their infant having a healthy gut. Only 15% of parents received this information before their infant’s birth and 22% received this information after. Furthermore, 89% of respondents did not receive any information from a HCP about the role of pre- or probiotics for their infant’s gut health.Of the 364 parents (39%) who gave birth via caesarean section, 70% were not aware that mode of delivery was linked to their infant’s gut health and 73% did not receive information on the importance of their infant having a healthy gut. Almost 7% of the sample (n=64) had a premature infant. Of this subgroup, only 22% received information after their infant was born on the importance of gut health in infants. Furthermore, 86% of parents with a preterm infant did not receive information about the role of prebiotics or probiotics in relation to their infant’s gut health. There was no significant difference in the information provided to those with or without a preterm infant, and those who gave birth vaginally or via caesarean section, where p=0.950 and p=0.824, respectively.This study highlights gaps in parental knowledge around infantile gut health and in the education provided by HCPs. Preterm infants and those born via caesarean section are particularly at risk of disruptions to optimal early microbial colonisation and these parents may potentially benefit from information on the importance of supporting their infant’s gut microbiome for long term health and development. Further support and education for HCPs appears necessary to help deliver this message to parents to reduce the burden of health problems during infancy.

Cardiac arrest in school: the role of teachers as BLS-D providers

The implementation of BLS-D training courses in the school setting aims to increase the number of future citizens competent in the recognition and treatment of out-of-hospital cardiac arrest to increase overall survival. It is important to make teachers and students aware of their social responsibilities, consolidating collaboration with healthcare professionals. The present study investigates, through a cross-sectional cognitive survey, the perception of the importance of knowledge and diffusion of basic BLS manoeuvres and early defibrillation in the treatment of cardiac arrest. An anonymous questionnaire was sent to secondary school teachers, divided into 14 questions: 12 items in closed form according to the Delphi method and the 5-point Likert rating scale, and the last two with different response methods. The total number of teachers who participated in the survey was 120. The majority of respondents believe that it is essential to know and transmit notions related to BLS-D to students, without the need to have an official certification as an instructor. Most of the teachers consider useful to have specific information on the placement and use of the defibrillator, to set reminder systems on life-saving manoeuvres and to share protocols on the management of cardiac arrest. The introduction of BLS-D training at school determines a constant increase in competent students and therefore the birth of a network of people educated in the management of out-of-hospital cardiac arrest. The teaching skills of teachers also allow them to identify the best strategies to make the learning method clear and valid for students. The autonomy of teachers in fulfilling the role of instructors is still poorly consolidated and shared, thus requiring the support of healthcare professionals.

Exploring Anesthesia Provider Preferences for Precision Feedback: Preference Elicitation Study.

Health care professionals must learn continuously as a core part of their work. As the rate of knowledge production in biomedicine increases, better support for health care professionals' continuous learning is needed. In health systems, feedback is pervasive and is widely considered to be essential for learning that drives improvement. Clinical quality dashboards are one widely deployed approach to delivering feedback, but engagement with these systems is commonly low, reflecting a limited understanding of how to improve the effectiveness of feedback about health care. When coaches and facilitators deliver feedback for improving performance, they aim to be responsive to the recipient's motivations, information needs, and preferences. However, such functionality is largely missing from dashboards and feedback reports. Precision feedback is the delivery of high-value, motivating performance information that is prioritized based on its motivational potential for a specific recipient, including their needs and preferences. Anesthesia care offers a clinical domain with high-quality performance data and an abundance of evidence-based quality metrics. The objective of this study is to explore anesthesia provider preferences for precision feedback. We developed a test set of precision feedback messages with balanced characteristics across 4 performance scenarios. We created an experimental design to expose participants to contrasting message versions. We recruited anesthesia providers and elicited their preferences through analysis of the content of preferred messages. Participants additionally rated their perceived benefit of preferred messages to clinical practice on a 5-point Likert scale. We elicited preferences and feedback message benefit ratings from 35 participants. Preferences were diverse across participants but largely consistent within participants. Participants' preferences were consistent for message temporality (α=.85) and display format (α=.80). Ratings of participants' perceived benefit to clinical practice of preferred messages were high (mean rating 4.27, SD 0.77). Health care professionals exhibited diverse yet internally consistent preferences for precision feedback across a set of performance scenarios, while also giving messages high ratings of perceived benefit. A "one-size-fits-most approach" to performance feedback delivery would not appear to satisfy these preferences. Precision feedback systems may hold potential to improve support for health care professionals' continuous learning by accommodating feedback preferences.

A chain mediation model on organizational support and turnover intention among healthcare workers in Guangdong province, China.

The outbreak of the Coronavirus Disease 2019 pandemic has presented significant difficulties for healthcare workers worldwide, resulting in a higher tendency to quit their jobs. This study aims to investigate the correlation between organizational support, work-family-self balance, job satisfaction, and turnover intention of healthcare professionals in China's public hospitals. A cross-sectional survey was conducted on 5,434 health workers recruited from 15 public hospitals in Foshan municipality in China's Guangdong province. The survey was measured by organizational support, work-family-self balance, job satisfaction, and turnover intention using a five-point Likert scale. The association between organizational support, work-family-self balance, job satisfaction, and turnover intention was investigated using Pearson correlation analysis and mediation analysis through the PROCESS macro (Model 6). Organizational support indirectly affected turnover intention through three pathways: the mediating role of work-family-self balance, job satisfaction, and the chain mediating role of both work-family-self balance and job satisfaction. Health administrators and relevant government sectors should provide sufficient organizational support, enhance work-family-self balance and job satisfaction among healthcare workers, and consequently reduce their turnover intentions.

Development of Recommendations for the Digital Sharing of Notes With Adolescents in Mental Health Care: Delphi Study.

In many countries, health care professionals are legally obliged to share information from electronic health records with patients. However, concerns have been raised regarding the sharing of notes with adolescents in mental health care, and health care professionals have called for recommendations to guide this practice. The aim was to reach a consensus among authors of scientific papers on recommendations for health care professionals' digital sharing of notes with adolescents in mental health care and to investigate whether staff at child and adolescent specialist mental health care clinics agreed with the recommendations. A Delphi study was conducted with authors of scientific papers to reach a consensus on recommendations. The process of making the recommendations involved three steps. First, scientific papers meeting the eligibility criteria were identified through a PubMed search where the references were screened. Second, the results from the included papers were coded and transformed into recommendations in an iterative process. Third, the authors of the included papers were asked to provide feedback and consider their agreement with each of the suggested recommendations in two rounds. After the Delphi process, a cross-sectional study was conducted among staff at specialist child and adolescent mental health care clinics to assess whether they agreed with the recommendations that reached a consensus. Of the 84 invited authors, 27 responded. A consensus was reached on 17 recommendations on areas related to digital sharing of notes with adolescents in mental health care. The recommendations considered how to introduce digital access to notes, write notes, and support health care professionals, and when to withhold notes. Of the 41 staff members at child and adolescent specialist mental health care clinics, 60% or more agreed with the 17 recommendations. No consensus was reached regarding the age at which adolescents should receive digital access to their notes and the timing of digitally sharing notes with parents. A total of 17 recommendations related to key aspects of health care professionals' digital sharing of notes with adolescents in mental health care achieved consensus. Health care professionals can use these recommendations to guide their practice of sharing notes with adolescents in mental health care. However, the effects and experiences of following these recommendations should be tested in clinical practice.

“As a parent, I want to do more for my child”: A phenomenological approach to understanding the experiences of parents involved in surgical decision-making for children with congenital hand anomalies

BackgroundA congenital anomaly of the hand can affect both function and appearance, and places a stressful psychological burden on the family, especially parents. Surgery during infancy may prevent later disabilities, but little is known of the importance of parents’ involvement in these decisions in terms of psychological adjustment or treatment satisfaction. ObjectiveTo understand parents' perceptions of involvement in their child's surgery for limb anomaly, and their preferences for the support of healthcare professionals. Results should lead to recommended interventions to improve familial adjustment to the child's condition. MethodsQualitative data was collected from semi-structured confidential self-reported interviews of 35 parents (65.7 % mothers) of children who had received reconstructive surgery for congenital hand anomaly (at age 24.89 ± 9.26 months); interviews were coincident with the 1-month postoperative follow-up. The parents ranged in age, gender, educational background, economic status, and type of anomaly. Data analysis referenced Colaizzi's phenomenological approach. ResultsThe concerns of the parents were consolidated into three themes: attitudes toward Parental involvement in surgical decision-making; status of parental involvement in Surgical decision-making; and need for help and support. ConclusionSome parents were comfortable leaving surgical decisions entirely to the medical staff, but most preferred active participation and were disappointed at their lack of inclusion. The maximum benefit from surgery for congenital abnormalities in infancy is achieved when the parents and extended families have access to the expertise, skills, encouragement, and psychological support of healthcare providers.

Full title: “Hopes, worries and expectations” experiences of pregnancy with inflammatory bowel disease: An interpretative phenomenological analysis study

Background and AimsInflammatory Bowel Disease (IBD) affects many women of childbearing age. High levels of voluntary childlessness and high levels of pregnancy-related fears have been reported amongst these patients in several quantitative studies. We investigated the lived experiences of pregnant patients to better understand decision-making processes around family planning. MethodsNine participants between 7 and 34 weeks pregnant (6 Crohn's Disease/3 Ulcerative Colitis), with an age range of 22–39 were recruited prospectively from three United Kingdom hospitals. Semi-structured interviews were conducted, and audio recorded. Interpretative phenomenological analysis was used to interpret the data. ResultsTwo main themes emerged: 1) IBD is perceived as a threat to family planning; and 2) healthcare professional advice, support, and reassurance was important. IBD was viewed as a potential threat to fertility and reproductive health. Consequently, women's lived experience of pregnancy is shaped by anxiety and pregnancy-related worries for mother and baby. Mothers actively sought out expert medical assurances to alleviate some of the perceived fears. ConclusionPrevious research has repeatedly found that women with IBD exhibit high levels of pregnancy-related worries and anxieties. Our findings find that high levels of anxiety are due to patients’ perceptions that IBD is a threat to their reproductive health and their offspring. Women relied on a medicalized discourse to understand their IBD experiences during pregnancy and actively sought biomedical resources for assistance before and during pregnancy. Consultants should be aware that when dealing with pregnant patients, some women may experience anxiety and require extra support.

#2002 Impact of personalized nutrition care in patients with advanced chronic kidney disease: ERCANUT RCT

Abstract Background and Aims A careful dietary plan is part of an integral treatment of patients with chronic kidney disease (CKD) stages 3 to 5 not on dialysis. It aims to slow disease progression, mitigate metabolic derangements and maintain adequate nutritional status. However, the dietary plan can overwhelm patients, affect their social life and increase anxiety and depression. Therefore, effective nutritional strategies are needed to improve the quality of the diet while also maintaining the quality of life (QoL). We analyzed the impact of personalized nutrition care (PNC) with a nutritional educational program on QoL, nutritional status, and anxiety and depression in patients with advanced CKD. Method ERCANUT is a 3-months RCT comprising 76 adult patients with GFR <30 ml/min/1.73 m2 who were randomized to study group (n = 38), which received PNC combined with a nutritional education program, or to the control group (n = 38) that received general dietary recommendations. Both groups received dietary counseling from the same dietitian to follow a healthy and protein-controlled diet (0.65-0.8 g/kg/day) based on Mediterranean pattern. The nutritional educational program in the study group consisted in three one-hour sessions, using nutritional coaching. Patients and relatives received information about healthy diet and lifestyle. They were encouraged to increase their physical activity. In addition, during the follow-up period (3 months), they had the support of health care professionals by phone calls and text messages. Baseline and 3-month data were collected: QoL (KDQOLTM-36), nutritional status (anthropometry and bioelectrical impedance) and grade of anxiety and depression (HADS). Dietary adherence was assessed using the short version of the Mediterranean diet adherence questionnaire. All patients were counselled by a dietitian to follow a diet containing whole grain foods, vegetables and fruits, nuts and extra virgin olive oil as the main dietary fat. Plant protein (legumes) was preferred over animal protein, especially processed meat and red meat. Patients were advised to reduce the intake of ultra-processed foods (UPFs). Only in case of the study group, they received a personalized diet according to their food preferences, energy and nutrients requirements and physical activity level. They were also supported by a cookbook created especially for the study. Results After three months, 67 patients (mean age 66.1 ± 14.9 years; 68% men; mean GFR 22.2 ± 3.1 mL/min/1.73 m2) finalized the study (control group n = 34, study group n = 33). No significant differences were observed between groups regarding age, sex, body mass index (BMI), serum albumin and Charlson index at baseline. QoL improved in 4 out of 5 domains in the study group (as can be seen in Table 1 as an increase in score), while in the control group there is a worsening in effects of disease and disease burden (score reduction at 3 months). In addition, anxiety and depression scores declined in the study group but not in the control group. In both groups, the adherence to the Mediterranean diet increased and BMI and markers of body fat decreased. Lean mass and phase angle decreased only in the control group. Conclusion This RCT shows that having the support of a dietitian improved dietary quality and markers of body fat, and the use of PNC with nutritional educational program improved aspects of QoL, reduced anxiety and depression, and maintained lean mass and phase angle. Therefore, the support from a dietitian and use of PNC in clinical practice seems to be effective in improving QoL, anxiety and depression.

ChatGPT's Efficacy in Queries Regarding Polycystic Ovary Syndrome and Treatment Strategies for Women Experiencing Infertility.

This study assesses the efficacy of ChatGPT-4, an advanced artificial intelligence (AI) language model, in delivering precise and comprehensive answers to inquiries regarding managing polycystic ovary syndrome (PCOS)-related infertility. The research team, comprising experienced gynecologists, formulated 460 structured queries encompassing a wide range of common and intricate PCOS scenarios. The queries were: true/false (170), open-ended (165), and multiple-choice (125) and further classified as 'easy', 'moderate', and 'hard'. For true/false questions, ChatGPT-4 achieved a flawless accuracy rate of 100% initially and upon reassessment after 30 days. In the open-ended category, there was a noteworthy enhancement in accuracy, with scores increasing from 5.53 ± 0.89 initially to 5.88 ± 0.43 at the 30-day mark (p < 0.001). Completeness scores for open-ended queries also experienced a significant improvement, rising from 2.35 ± 0.58 to 2.92 ± 0.29 (p < 0.001). In the multiple-choice category, although the accuracy score exhibited a minor decline from 5.96 ± 0.44 to 5.92 ± 0.63 after 30 days (p > 0.05). Completeness scores for multiple-choice questions remained consistent, with initial and 30-day means of 2.98 ± 0.18 and 2.97 ± 0.25, respectively (p > 0.05). ChatGPT-4 demonstrated exceptional performance in true/false queries and significantly improved handling of open-ended questions during the 30 days. These findings emphasize the potential of AI, particularly ChatGPT-4, in enhancing decision-making support for healthcare professionals managing PCOS-related infertility.

Supporting healthcare professionals from ethnic minority backgrounds to 'Step Into' a clinical academic career.

There is a need to develop research focussed healthcare professionals with the clinical experience and academic skills to meet the needs of a diverse population. Yet, healthcare professionals from ethnic minority backgrounds are often faced with personal, structural or organisational barriers, which prevent them from accessing and applying for development opportunities. To undertake an evaluation of the Step into Clinical Academic Careers' programme. The programme was designed specifically for nurses, midwives and allied healthcare professionals (NMAHPs) working in NHS organisations, from ethnic minority backgrounds, who had the ambition to pursue a research or clinical academic career. Qualitative individual interviews and online evaluations were conducted to identify the views, perspectives and experiences of participants who undertook the programme. Participants were also followed up after 6 months. Participants provided insights into four key areas relating to outcomes of the programme. These were (1) increased confidence, (2) increased motivation, (3) developing networks and (4) inspiring people. Organisations must work purposefully and collaboratively to realise equitable support for individuals from ethnic minority backgrounds, through targeted mentoring and leadership development training. Failure to do this will result in a continuation of limited diversity amongst clinical academic and clinical research leaders.

Commentary: Supporting healthcare professionals from ethnic minority backgrounds to 'Step Into' a clinical academic career.

Commentary: Supporting healthcare professionals from ethnic minority backgrounds to 'Step Into' a clinical academic career.

Insights of Healthcare Professionals into Medical Writing Support at a Tertiary Care Hospital in Saudi Arabia.

The demand for medical writing is on the rise in academic and medical entities worldwide. However, a huge disparity in the perception of professional medical writing arises from inadequate education and regularity in service quality and potential ethical challenges. Hence, we aimed to examine the knowledge, attitude, and perception toward professional medical writing support (PMWS) of healthcare professionals at King Fahad Medical City (KFMC). An observational cross-sectional study was conducted using a questionnaire that was validated for its accuracy and clarity by an expert panel in academic integrity. The self-administered questionnaires were distributed to 200 healthcare professionals from a broad range of specialties throughout KFMC. The socio-demographic characteristics and healthcare professionals' knowledge, attitudes, and perceptions were recorded. The responses were quantitatively evaluated using a 5-point Likert Scale and analyzed using the Statistical Package for Social Sciences 25 (IBM, New York, United States). 162 healthcare professionals in KFMC filled in the questionnaire completely. Most respondents agreed that it was acceptable for medical writers to help with writing publications and that they offered a valuable service. Concerning association with socio-demographic characteristics, the mean score of knowledge was found to be significantly related to those with age ≥45 years (p<0.001), PhD degree (p=0.044), >5 years of research experience (p<0.001), and being a faculty/consultant (p=0.005). No significant association was found with the mean total score of attitude. Participants having >5 years of research experience were found to have a higher significant level of perception (p=0.004). Our study highlights that PMWS is relatively well-utilized and perceived positively within KFMC. There is a need for further research and education of ethics regarding the use of PMWS.

Large Language Models and User Trust: Consequence of Self-Referential Learning Loop and the Deskilling of Health Care Professionals.

As the health care industry increasingly embraces large language models (LLMs), understanding the consequence of this integration becomes crucial for maximizing benefits while mitigating potential pitfalls. This paper explores the evolving relationship among clinician trust in LLMs, the transition of data sources from predominantly human-generated to artificial intelligence (AI)-generated content, and the subsequent impact on the performance of LLMs and clinician competence. One of the primary concerns identified in this paper is the LLMs' self-referential learning loops, where AI-generated content feeds into the learning algorithms, threatening the diversity of the data pool, potentially entrenching biases, and reducing the efficacy of LLMs. While theoretical at this stage, this feedback loop poses a significant challenge as the integration of LLMs in health care deepens, emphasizing the need for proactive dialogue and strategic measures to ensure the safe and effective use of LLM technology. Another key takeaway from our investigation is the role of user expertise and the necessity for a discerning approach to trusting and validating LLM outputs. The paper highlights how expert users, particularly clinicians, can leverage LLMs to enhance productivity by off-loading routine tasks while maintaining a critical oversight to identify and correct potential inaccuracies in AI-generated content. This balance of trust and skepticism is vital for ensuring that LLMs augment rather than undermine the quality of patient care. We also discuss the risks associated with the deskilling of health care professionals. Frequent reliance on LLMs for critical tasks could result in a decline in health care providers' diagnostic and thinking skills, particularly affecting the training and development of future professionals. The legal and ethical considerations surrounding the deployment of LLMs in health care are also examined. We discuss the medicolegal challenges, including liability in cases of erroneous diagnoses or treatment advice generated by LLMs. The paper references recent legislative efforts, such as The Algorithmic Accountability Act of 2023, as crucial steps toward establishing a framework for the ethical and responsible use of AI-based technologies in health care. In conclusion, this paper advocates for a strategic approach to integrating LLMs into health care. By emphasizing the importance of maintaining clinician expertise, fostering critical engagement with LLM outputs, and navigating the legal and ethical landscape, we can ensure that LLMs serve as valuable tools in enhancing patient care and supporting health care professionals. This approach addresses the immediate challenges posed by integrating LLMs and sets a foundation for their maintainable and responsible use in the future.

Improving supportive, palliative and end of life care for teenagers and young adults with cancer in adult haematology services.

Adolescents with haematological malignancies within adult services, in the UK from 16years old, have unique needs and require developmentally targeted services and approaches to care delivery. High-risk intensive treatments are common for this cohort and a better understanding of what individualised supportive and palliative care means in this context is required. Being known and understood as an emerging adult, with particular recognition of developmental stage, is an essential component of quality measures and underpins the adolescent, and caregiver, experience when faced with an uncertain or poor cancer prognosis (UPCP). Healthcare professionals (HCPs) can experience increased emotional labour and feelings of professional inadequacy when caring for adolescents with UPCP. Therapeutic alliance improves HCPs understanding of optimum individualised care by improving communication and supported decision making. Access to training and support for HCPs is required to address the emotional impact of therapeutic alliance with teenage/adolescent and young adults (T/AYAs) with advanced cancer. Investment in therapeutic alliance, alongside robust support mechanisms and targeted training, can improve the skills, confidence and wellbeing for HCPs, and can also ensure optimum individualised care for T/AYAs with UPCP. Evidence for optimum care for adolescents with advanced cancer is relatively scarce, especially for younger T/AYAs (16-24) in the UK who sit within adult services. Further evaluation of the impact of current UK expertise, services and programs are needed to inform future development.

Miniature mass spectrometer-based point-of-care assay for quantification of metformin and sitagliptin in human blood and urine.

Metformin (MET) and sitagliptin (STG) are widely used as the first-line and long-term oral hypoglycemic agents for managing type 2 diabetes mellitus (T2DM). However, the current lack of convenient and rapid measurement methods poses a challenge for individualized management. This study developed a point-of-care (POC) assay method utilizing a miniature mass spectrometer, enabling rapid and accurate quantification of MET and STG concentrations in human blood and urine. By combining the miniature mass spectrometer with paper spray ionization, this method simplifies the process into three to four steps, requires minimal amounts of bodily fluids (50 μL of blood and 2 μL of urine), and is able to obtain quantification results within approximately 2min. Stable isotope-labeled internal standards were employed to enhance the accuracy and stability of measurement. The MS/MS responses exhibited good linear relationship with concentration, with relative standard deviations (RSDs) below 25%. It has the potential to provide immediate treatment feedback and decision support for patients and healthcare professionals in clinical practice.