Survey Of Clinicians Research Articles

PD12 An audit of the photodynamic therapy service at the Birmingham Skin Centre

Abstract Photodynamic therapy (PDT) is licensed in the UK for treating at least one nonmelanoma skin cancer and premalignant lesions. The PDT is a service offered at our centre but is anecdotally underutilized with no up-to-date outcome measures. The aim was to audit the PDT service at the Birmingham Skin Centre against the 2018 British Association of Dermatologists and British Photodermatology Group PDT guidelines, and make recommendations for improvement. Retrospective data were gathered on consecutive patients treated with topical PDT between 12 March 2019 and 28 August 2022 at the Birmingham Skin Centre and compared with the recommended audit points in the national guidelines. A clinician survey was conducted to assess service awareness, satisfaction and referral process. Thirty-four patients received topical PDT during the specified time period; two patients were excluded from data analysis as the last treatment fell within the 3-month assessment period (n = 32). Differentiation between ambulatory and standard PDT was not recorded. Treatment was licensed in all cases (n = 32): actinic keratosis (AK; n = 18), squamous cell carcinoma (SCC; n = 7) in situ, superficial basal cell carcinoma (BCC; n = 4), nodular BCC (n = 1) and other (n = 2). Clearance assessment at 3 months was recorded in 21 of 32 cases; accounting for this, the clearance rate for AK, SCC in situ and superficial BCC at 3 months after last treatment was 52% (n = 11/21; guideline recommendation ≥ 75%). Eleven of 32 patients treated for SCC in situ and superficial BCC within the data set were due 12-month clearance assessment. Four of 11 patients had clearance assessment recorded. Accounting for this, the clearance rate for SCC in situ and superficial BCC at 12 months after last treatment was 50% (n = 2/4; guideline recommendation ≥ 75%). No patient had an individual pain-management plan documented. Patient satisfaction of the service was recorded in 9% (n = 3/32) of cases; of these, 67% (n = 2/3) of patients were ‘very satisfied’ and 33% ‘satisfied’. Patient satisfaction of cosmetic result was recorded in one case as ‘excellent’. The PDT was a popular treatment method among the clinicians surveyed. Some clinicians asked for PDT-based teaching. The general consensus supported online referrals and documentation. The PDT is used for licensed indications and popular with clinicians in our department. Clearance rates at 3 (52%) and 12 (50%) months are below the national guideline recommendation of 75%. Limited documentation across audit points limits interpretation of clearance rates, patient satisfaction and adverse effects. We plan to implement a new standardized digital referral and documentation system to improve the service.

BI06 Short sharp shock or slow burn: clinician perspectives on treatment of actinic keratoses with 5-fluorouracil 5% cream monotherapy vs. 5-fluorouracil/calcipotriol ointment combination therapy

Abstract Actinic keratoses (AK) are common in immunocompromised patients and associated with increased risk of cutaneous squamous cell carcinoma (cSCC). The current standard of care is 5-fluorouracil cream 5% (5-FU) monotherapy for 4 weeks. In recent years, 5-FU cream and calcipotriol ointment (5-FU-Cal) combination AK therapy for 4–6 days has emerged as potentially more effective and better tolerated, although the original randomized controlled trial (RCT) excluded immunosuppressed patients. Previously, we shared immunosuppressed patients’ real-world perspectives of using 5-FU monotherapy vs. 5-FU-Cal combination therapy (Junejo MH, Demirel S, Matin R et al. Short shock or slow burn? Patient perspectives on treatment of actinic keratoses with 5-fluorouracil 5% cream monotherapy versus 5-fluorouracil plus calcipotriol combination therapy. Clin Exp Dermatol 2023; 48:31–2). The majority (81%) found 5-FU-Cal to be more effective than 5-FU monotherapy. Despite 47% reporting worse local skin reactions (LSRs), most preferred the 5-FU-Cal combination. We now report results from a clinician survey on the use of 5-FU monotherapy vs. 5-FU-Cal combination therapy for the treatment of AK. An online survey was sent to 200 UK consultant dermatologists. Fifty-seven (28.5%) completed the survey, all of whom reported using 5-FU monotherapy for treating AK in patients with prior cSCC; 43 (75%) reported this to be their preferred treatment. Most clinicians (n = 40; 70%) were aware of 5-FU-Cal combination therapy, although only 24 (42%) reported using it to treat AK in patients with prior cSCC. Of these, 18 (75%) used combination treatment for AK as part of field change, 14 (58%) used it for the treatment of patches of more than five AK and 13 (54%) used it for grouped AK. Very few (n = 4; 17%) used combination therapy for treatment of cSCC in situ (n = 4), single AK (n = 3) or superficial basal cell carcinoma (n = 1). Of 24 clinicians using 5-FU-Cal, the majority felt that patients developed LSRs often (n = 11; 46%) or always (n = 7; 29%); fewer felt that LSRs occurred sometimes (n = 5; 21%) or rarely (n = 1; 4%). Clinicians using combination therapy primarily felt the LSRs were moderate but not severe enough to require supplementary treatment or discontinuation (n = 17; 71%). Half (n = 12; 50%) of those using combination therapy felt patients did not signal a preference between 5-FU monotherapy vs. 5-FU-Cal combination therapy. Two-thirds (n = 38/57; 67%) of clinicians reported an interest in participating in a RCT comparing 5-FU vs. 5-FU-Cal vs. sunscreen alone for the treatment of AK in patients with prior cSCC. This is the first evaluation of clinician perspectives on the use of the newly emerging 5-FU-Cal therapy for AK. These data provide a rationale for the inclusion of combination 5-FU-Cal therapy in future studies using topical AK treatments for cSCC prevention in the UK.

PS04 Assessment and management of patients with vitiligo and psychological distress: clinician survey

Abstract Vitiligo is a common, pigmentary skin disorder, affecting 1% of people worldwide. People with vitiligo have a significantly higher prevalence of psychosocial comorbidities, including anxiety, depression and suicidal ideations, than nonaffected individuals (Ezzedine K, Eleftheriadou V, Jones H et al. Psychosocial effects of vitiligo: a systematic literature review. Am J Clin Dermatol 2021; 22:757–74). The British Association of Dermatologists’ (BAD) 2022 vitiligo guidelines recommend the assessment of psychosocial impact in all patients with vitiligo, with management tailored to severity (Eleftheriadou V, Atkar R, Batchelor J et al. BAD guidelines for the management of people with vitiligo 2021. Br J Dermatol 2022; 186:18–29). We conducted a UK-wide consultation exercise aimed at establishing the current assessment and management practices of patients with vitiligo who experience psychological distress due to their skin. This project was supported by the UK Dermatology Clinical Trials Network and was also distributed to BAD members. Seventy-eight responders completed the online questionnaire (83% doctors, 14% nurses and 3% psychologists). On average, responders reviewed eight patients with vitiligo in the clinic during the preceding 6 months; 37% of these patients were estimated to have moderate/severe psychological distress. Sixty-seven per cent reported routine screening for psychological impact using mainly the Dermatology Life Quality Index (56%) and Patient Health Questionnaire-9 (16%). Forty-eight per cent used no formal screening tool but asked general questions. Thirty-three per cent do not routinely screen for psychological impact. For the management of mild psychological distress, 83% of responders signpost to online resources or advise self-referral to local services; 16% wrote to the general practitioner only. For the management of moderate-to-severe psychological distress, 28% referred patients to psychiatric services, 29% to psychological services and 37% to community services. Four per cent stated they would not take any action. Interestingly, 18% were not aware of any available local, regional or national psychological services. Waiting times for urgent psychological input ranged from 2 months to 2 years. Eighty-seven per cent of responders felt that their patients with vitiligo would benefit from a tailor-made online psychological intervention targeting specific aspects of the condition and that patients with vitiligo would engage with it (80%). Digital accessibility was highlighted as the main concern by remaining responders. Sixty per cent of responders expressed interest in participating in a trial examining the effectiveness of an online-delivered psychological intervention for patients with vitiligo and moderate/severe psychological distress. In summary, significant variation exists in the assessment and management of patients with vitiligo and psychological distress. Our survey suggests an unmet need for such an online intervention and a need for educational resources to give to clinicians regarding pathways to mental health services.

Development and Evaluation of a Data-Driven, Interactive Workshop to Facilitate Communication and Teamwork in Ambulatory Medical Oncology Settings.

While adverse events and toxicities related to cancer drug therapy in the ambulatory oncology setting are common and often rooted in communication challenges, few studies have examined the problems of communication or tested tools to improve communication in this unique, high-risk setting. To determine the feasibility and acceptability of a virtual interdisciplinary communication Workshop designed to strengthen communication across ambulatory oncology teams members. Surveys of patients and clinicians in one ambulatory oncology clinic were analyzed and informed the communication intervention: an interdisciplinary virtual Workshop. Workshop evaluation included an implementation survey measure and a structured debrief with Workshop attendees. 87 patients and 56 clinicians participated in pre-workshop surveys that revealed patient satisfaction with timely care and information, yet a range of rating communication experiences with the clinical team, and clinicians perceiving a high amount of organizational safety, yet rated discussion of alternatives to normal work processes low. Survey results guided reflection and discussion within the Workshop. Six clinicians participated in the interactive Workshop. Feasibility and acceptability of the virtual Workshop were supported by formative and summative data, along with suggestions for improvement. The patient and clinician surveys coupled with an interactive virtual Workshop were feasible and acceptable. The Workshop identified opportunities for individual- and system-level improvements in clinical team communication. This promising strategy requires replication in larger, diverse practice samples. Clinicians accepted an interactive workshop that incorporated clinic-specific data and communication strategies. The program is feasible and acceptable in ambulatory oncology settings.

Patient Comments on the Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CG-CAHPS) Survey Reflect Improvements in Provider Behaviors From Coaching.

Patient experience survey data are used to examine the patient-centeredness of care, identify areas for improvement, and monitor interventions aimed to enhance the patient experience. Most healthcare organizations measure patient experience using Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. Studies have documented the use of CAHPS closed-ended survey responses for completing public reports, monitoring internal feedback and performance, identifying areas of improvement, and evaluating interventions to improve care. However, limited evidence exists on the utility of patients' comments on CAHPS surveys for evaluating provider-level interventions. To explore this potential, we examined comments on the CAHPS Clinician and Group (CG-CAHPS) 2.0 visit survey before and after a provider intervention. The "shadow coaching" intervention had been shown to improve provider performance and patient experience scores on the CG-CAHPS overall provider rating and provider communication composite. We examined how patient comments on the CG-CAHPS survey differed before and after shadow coaching of 74 providers. We described the valence (tone), content, and actionability of 1,935 comments-1,051 collected before coaching and 884 collected after coaching-to see how these aspects changed before and after providers were coached. Patient comments reflected improved CG-CAHPS scores after shadow coaching. The proportion of positive comments increased, and comments about doctors were more positive. Comments about time spent in the examination room decreased, apparently reflecting the decreased proportion of negative comments after coaching. Comments regarding three of the four aspects of provider communication asked on the CG-CAHPS survey were more positive after coaching (provider listens carefully, shows respect, spends enough time); the valence of comments about the fourth aspect (provider explains things in a way that is easy to understand) did not change. Also, comments describing an overall positive evaluation of the practice increased. Comments were generally less actionable after coaching, perhaps reflecting the increased positivity of the comments. Patient comments collected before the provider intervention reflected overall improvements in provider behavior, as indicated by medium-to-large statistically significant improvements in CG-CAHPS composite scores. These results suggest that patient comments from the CG-CAHPS survey can be used as input for quality improvement or an evaluation of provider-level interventions. Tracking the valence and content of comments about providers before and after an intervention to improve care is a practical method to learn how provider behavior changes.

Cluster-Randomized Comparative Effectiveness Trial of Physician-Directed Clinical Decision Support Versus Patient-Directed Education to Promote Appropriate Use of Opioids for Chronic Pain

We compared the effectiveness of physician-directed clinical decision support (CDS) administered via electronic health record versus patient-directed education to promote the appropriate use of opioids by conducting a cluster-randomized trial involving 82 primary care physicians and 951 of their patients with chronic pain. Primary outcomes were satisfaction with patient-physician communication consumer assessment of health care providers and system clinician and group survey (CG-CAHPS) and pain interference patient-reported outcomes measurement information system. Secondary outcomes included physical function (patient-reported outcomes measurement information system), depression (PHQ-9), high-risk opioid prescribing (>90 morphine milligram equivalents per day [≥90 mg morphine equivalent/day]), and co-prescription of opioids and benzodiazepines. We used multi-level regression to compare longitudinal difference-in-difference scores between arms. The odds of achieving the maximum CG-CAHPS score were 2.65 times higher in the patient education versus the CDS arm (P = .044; 95% confidence interval [CI] 1.03–6.80). However, baseline CG-CAHPS scores were dissimilar between arms, making these results challenging to interpret definitively. No difference in pain interference was found between groups (Coef = −0.64, 95% CI −2.66 to 1.38). The patient education arm experienced higher odds of Rx ≥ 90 milligrams morphine equivalent/day (odds ratio = 1.63; P = .010; 95% CI 1.13, 2.36). There were no differences between groups in physical function, depression, or co-prescription of opioids and benzodiazepines. These results suggest that patient-directed education may have the potential to improve satisfaction with patient-physician communication, whereas physician-directed CDS via electronic health records may have greater potential to reduce high-risk opioid dosing. More evidence is needed to ascertain the relative cost-effectiveness between strategies. PerspectiveThis article presents the results of a comparative-effectiveness study of 2 broadly used communication strategies to catalyze dialog between patients and primary care physicians around chronic pain. The results add to the decision-making literature and offer insights about the relative benefits of physician-directed versus patient-directed interventions to promote the appropriate use of opioids.

Exploring clinicians' beliefs and practices regarding Non-Invasive Ventilation devices: An international survey study

Introduction Non-invasive ventilation (NIV) has a significant role in supporting patients with respiratory failure with the goal of avoiding mechanical ventilation. Traditionally, NIV has been applied using dedicated NIV-specific devices but over the last decade, newer generation critical care ventilators have updated their capabilities to include NIV options with improved synchrony and leak compensation. No recent trials have compared the efficacy of new generation critical care ventilators to NIV ventilators. The purpose of this study was to evaluate clinicians attitudes and perceptions toward the use of NIV between the dedicated NIV and critical care ventilators. Methods An online survey of clinicians with seven questions regarding their thoughts and experience in using NIV in acute care settings was posted online and promoted through emails and social media. The survey was anonymous and an exemption of consent was obtained from the Institutional Review Board. Analysis of variants (ANOVA) was done for the total responses in each question, followed by multivariate analysis of variants (MANOVA) for responses per occupation. Results 514 responses from 54 countries were recorded. 151 from North America, 109 from South America, 125 from Europe, 97 from Asia, 21 from Africa, and 11 from Australia. 218 responders were physicians, 218 were respiratory therapists, 28 were nurses, and 50 were reported as other professionals (engineers, biomedical technicians). 346 (67.3%) reported using both types of ventilators for NIV, 91 (17.7%) use only NIV -specific devices, and 77 (15%) only use critical care ventilators (P 0.097), responses per occupation (P < 0.001). 290 (56.4%) have automatic synchronization software on either of their ventilators, 113 (22%) do not, while 111 (21.6%) are unsure if they do (P 0.22), with significant variation by occupation (P 0.008). Regarding synchrony, 233 (45.3%) said NIV ventilators are better, and 165 (32.1%) said critical care ventilators are better, while 116 (22.5%) said both are similar (P 0.59) with significant variation by occupation (P 0.04). Regarding leak compensation, 241 (46.9%) said NIV ventilators are better, and 146 (284%) said critical care ventilators are better, while 127 (24.7%) said both are similar (P 0.6) without significant variation by occupation (P 0.07). Regarding the general opinion of superiority, 273 (53.1%) said NIV ventilators are better, 131 (25.5%) said critical care ventilators are better, and 110 (21.4%) said both are similar (P 0.42) without significant variation by occupation (P 0.098). Conclusion Despite the lack of evidence, there is wide variability in opinion with no clear consensus regarding the clinicians’ attitude towards which ventilators are superior to use during NIV, especially according to surveyed occupation.

Barriers and enablers to implementing an induction of labour guideline: A clinician survey.

Clinical guidelines improve outcomes, but poor compliance with recommendations is common. Insight into perceived barriers and enablers to the implementation of guidelines can engage maternity care providers and inform strategies for effective implementation. To identify the perceived barriers and enablers to implementing the 2020 'Induction of Labour [IOL] in Aotearoa New Zealand; a Clinical Practice Guideline.' Electronic anonymous survey of clinical leaders in midwifery, obstetrics, and neonatology in New Zealand, from August to November 2021. Recruitment of participants was initially through provided lists of national clinical leads, followed by chain sampling. There were 32 of 89 surveys returned (36%). The most frequently identified enablers were implementation tools such as 'standardised IOL request form' and 'peer review process,' and administrative support and dedicated time. Six maternity hospitals already had peer review in place, whereby IOL requests that did not adhere to guidelines were reviewed by a multidisciplinary group of senior colleagues or peers, with individual feedback to the referring clinician. Attitudes in the form of 'existing systems, routines and culture' was the most frequently identified barrier, followed by external barriers such as 'lack of human resources.' Overall, few barriers were identified to implementing this guideline, and some of the key enablers were already in place. The identified enablers warrant future research to develop and evaluate effectiveness in improving outcomes.

Limitations in utilization and prioritization of standardized somatosensory assessments after stroke: A cross-sectional survey of neurorehabilitation clinicians

ABSTRACT Background and Purpose Somatosensory impairments are common after stroke, but receive limited evaluation and intervention during neurorehabilitation, despite negatively impacting functional movement and recovery. Objectives Our objective was to understand the scope of somatosensory assessments used by clinicians in stroke rehabilitation, and barriers to increasing use in clinical practice. Methods An electronic survey was distributed to clinicians (physical therapists, occupational therapists, physicians, and nurses) who assessed at least one individual with stroke in the past 6 months. The survey included questions on evaluation procedures, type, and use of somatosensory assessments, as well as barriers and facilitators in clinical practice. Results Clinicians (N = 431) indicated greater familiarity with non-standardized assessments, and greater utilization compared to standardized assessments (p < 0.0001). Components of tactile sensation were the most commonly assessed modality of somatosensation (25%), while proprioception was rarely assessed (1%). Overall, assessments of motor function were prioritized over assessments of somatosensory function (p < 0.0001). Discussion Respondents reported assessing somatosensation less frequently than motor function and demonstrated a reliance on rapid and coarse non-standardized assessments that ineffectively capture multi-modal somatosensory impairments, particularly for proprioceptive deficits common post-stroke. In general, clinicians were not familiar with standardized somatosensory assessments, and this knowledge gap likely contributes to lack of translation of these assessments into practice. Conclusions Clinicians utilize somatosensory assessments that inadequately capture the multi-modal nature of somatosensory impairments in stroke survivors. Addressing barriers to clinical translation has the potential to increase utilization of standardized assessments to improve the characterization of somatosensory deficits that inform clinical decision-making toward enhancing stroke rehabilitation outcomes.

Rapid transition to telepractice across the lifespan in speech-language pathology: Insight from a survey of clinicians in Canada

Purpose This study aims to describe the experiences and needs of Canadian speech-language pathologists (SLPs) who conducted communication assessments via telepractice across the lifespan during the first year (2020) of the COVID-19 pandemic. Method The present study consisted of an online survey that aimed to capture both quantitative aspects of telepractice-based communication assessment and the qualitative experience of shifting to telepractice. One hundred sixty-eight practicing SLPs across Canada participated in the survey, between September 2020 and January 2021. Quantitative results were analysed using descriptive statistics while open-ended responses were analysed using thematic analysis. Result SLPs identified challenges and opportunities relating to client and family engagement, access to and knowledge of technology, and the reliability of assessment tools. SLPs also identified a future need for online assessment materials and training, such as materials adapted for different communication needs (e.g. augmentative and alternative communication). Conclusion The present study contributes to a growing understanding worldwide of potential benefits and challenges related to telepractice, fuelled by the necessary shift in practices in our field during the COVID-19 pandemic. The results provide direction for continuing to build a valid and inclusive approach to telepractice in the future.

Consensus on the perceived presence of transtheoretical principles of change in routine psychotherapy practice: A survey of clinicians and researchers.

Goldfried (1982) hypothesized that there are five transtheoretical principles of change that guide routine psychotherapy practice. This survey investigated if there is consensus on the perceived presence of these principles in the approaches of a professionally diverse pool of psychotherapy clinicians and researchers. One thousand nine hundred ninety-eight participants, aged 21-85 years (M = 50.4 years, SD = 15.59) and representing a wide variety of theoretical orientations, completed an online survey. For consensus to be indicated, 95% confidence intervals of mean agreement scores had to be above 4.0 (out of 5). Mean agreement levels in response to "the extent to which you agree that the following principles are present in your own approach to psychotherapy" indicated consensus for all five principles: (a) fostering hope, positive expectations, and motivation (M = 4.58; 95% CI [4.53, 4.62]); (b) facilitating the therapeutic alliance (M = 4.76; 95% CI [4.73, 4.80]); (c) increasing awareness and insight (M = 4.66; 95% CI [4.63, 4.70]); (d) encouraging corrective experiences (M = 4.44; 95% CI [4.39, 4.48]); (e) emphasizing ongoing reality testing (M = 4.15; 95% CI [4.09, 4.20]). These findings were unaffected by age, gender, working patterns, practice (clinician or researcher), and years of experience; however, consensus on the final two principles was not indicated for both psychodynamic and experiential psychotherapists. The demonstrated consensus surrounding the transtheoretical principles of change corresponds with their consistently yielded outcome associations in previous research. The combination of these evidence sources points to the importance of the principles in routine psychotherapy practice, which warrants further investigation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Predictive value of clinician impression for readmission and postdischarge mortality among neonates and young children in Dar es Salaam, Tanzania and Monrovia, Liberia

BackgroundThere are no validated clinical decision aids to identify neonates and young children at risk of hospital readmission or postdischarge mortality in sub-Saharan Africa, leaving the decision to discharge a...

Using the Theoretical Domain Framework to understand what helps and hinders the use of different sensory approaches in Australian psychiatric units: A survey of mental health clinicians.

Although sensory approaches are recommended to relieve distress and agitation and reduce the use of seclusion and restraint, many Australian psychiatric units have struggled to sustain their practice. The aim of this study was to investigate the barriers and enablers influencing the use of different sensory approaches across one health region in Australia and to obtain recommendations for strategies to improve their use. This cross-sectional survey was informed by the Theoretical Domain Framework. Likert scale questions considered barriers and enablers to the use of non-weighted sensory interventions, weighted modalities, sensory rooms, and sensory assessments/plans. Open-ended questions explored participant concerns and recommendations to improve the use of sensory approaches. Participants (n= 211) were from nursing, allied health, medical, and peer support staff across inpatient psychiatric units. Factors most frequently identified as enablers for using sensory approaches were beliefs of positive benefits to consumers (e.g. decreasing distress and agitation); belief it was within the staff's role; and knowledge of the approaches. Limited time was the most common identified barrier. Factors statistically associated with more frequent use were knowledge, skills, confidence, availability, and easy access to sensory tools/equipment. Only 30% of participants were concerned about potential risks of sensory approaches, with this risk mitigated through adequate supervision and thorough risk assessment. Recommendations to improve practice included improved access to, and maintenance of, equipment, more training, and increased staffing. This study revealed how barriers and enablers vary for different sensory approaches and how these factors impact their frequency of use in psychiatric units. It provides insights into staff recommendations to improve the use of sensory approaches in one health region in Australia. This knowledge will lead to the development of implementation strategies to address identified barriers and improve the use of sensory approaches in psychiatric units.

Patient and clinician perspectives about cannabis use while receiving cancer treatment at a comprehensive cancer center (CCC).

e24169 Background: Cannabis is gaining popularity worldwide including in the United States with 37 states legalizing access to cannabis. Limited data exist regarding why patients are using cannabis while receiving anticancer treatments. Methods: Patients with cancer who received treatment at a National Cancer Institute (NCI) designated CCC were approached from August of 2021 to August of 2022 to participate in a cross-sectional survey as part of a national NCI-funded effort. Consenting patients completed a survey during a medical visit asking about cannabis use (past and present), reason for use (including if cancer-related), type of cannabis, and frequency of use. A follow-up phone call occurred within 30 days to confirm medications used, and to collect further details about cannabis use, if reported. A healthcare provider survey was also conducted to explore perspectives regarding patients’ use of cannabis during active treatment. Results: A total of 315 cancer patients completed the survey (43% response rate) with a median age of 60.7 (±12.8), 58% female, and a variety of cancer types (hematologic 21.3%, breast 17%, gastrointestinal 11.7%, lung 10.2%). The respondents were of a diverse racial/ethnic backgrounds (White 61.6%, Black 22.5%, Other 7.3%), education (high school 27%, college 42.5%, post-graduate 14.9%), and employment status (retired 35.2%, employed 25.7%, unemployed or disabled 21.9%). Among respondents, nearly half (48.4%) had used cannabis before, one-third (32.1%) had used cannabis since their cancer diagnosis, and almost one in five (18.5%) were currently using cannabis. Among current or past users of cannabis the forms used were smoked (31%), gummy (29%), liquid (19%), edible (7%), and pill (6%). The most common reported reasons for use by respondents were insomnia (79%), pain (72%), mood (68%), poor appetite (68%), and gastrointestinal symptoms (51%). For the clinician survey, a total of 165 completed surveys (25% response rate) were received. Approximately half of respondents were nurses (54% nurses, 22% advance practice providers, and 21% physicians) and of White race (73%) with a mean age of 46 years. Approximately one-fourth (24%) reported discussing the topic of cannabis and about half of these conversations (45%) were initiated by the respondent. The healthcare providers estimated 10% of patients with cancer overall were using cannabis and that one in four patients (23%) were using cannabis during cancer treatment. Four in ten (39%) clinicians felt comfortable in providing guidance to patients about cannabis use, and only one in eight (13%) felt knowledgeable about the topic of cannabis. Conclusions: Approximately one-fifth of patients with cancer receiving treatment are actively using cannabis, despite limited data regarding the efficacy of cannabis. Management of cancer symptoms were among key reasons that cancer patients used cannabis.

Betahistine Prescribing Practices in England: An Analysis of Prescribing and National Spending Pre- and Post-BEMED Trial.

Betahistine has not been proven to be superior to placebo in the BEMED study, a multicenter, double-blind, randomized, placebo controlled trial. Our study aimed to establish the prescribing practices of clinicians in England in relation to betahistine and to assess if there has been any change in prescribing practices since the publication of the BEMED trial. Retrospective study and clinician survey. All patients who were prescribed betahistine from primary care. Total quantity of betahistine prescribed and total actual cost. The average total monthly quantity prescribed was 11,143,253 tablets (range, 10,056,516-12,276,423). Prescribing did not decrease from the period before (January 2014-February 2016) to after (February 2016-February 2021) the publication of the BEMED trial, with the average monthly prescribing before publication being 11,294,848 tablets (range, 10,280,942- 12,276,423) and the average monthly prescribing after publication being 11,081,123 tablets (range, 10,056,516-11,915,707). The average actual monthly cost increased from the period before publication to after publication from a sum of £279,264.82 to a sum of £428,846.22. Most (90.5%) of the survey respondents prescribed betahistine for Menière's disease. Less than half (38.09%) prescribed betahistine for indications other than Menière's disease. Only 45.24% of the clinicians were aware of the results of the BEMED trial. Knowledge of the BEMED trial among otology and neurotology subspecialists is lacking. The results of the BEMED have made no difference to prescribing practice, and in fact, the cost of the medication to the health bill has increased.

Implementation of the C-BiLLT, an accessible instrument to assess language comprehension in children with limited motor and speech function: an international clinician survey

This study assessed implementation of the Computer-based Instrument for Low-motor Language Testing (C-BiLLT). The C-BiLLT is an accessible language comprehension assessment tool originally developed for children with cerebral palsy and complex communication needs. The purpose of the current study was to understand the clinical contexts in which the C-BiLLT is used in the Netherlands, Belgium, and Norway and assess barriers and facilitators to implementation. An online survey was distributed to rehabilitation clinicians working in the Netherlands, Dutch-speaking parts of Belgium, and Norway. A total of 90 clinicians reported their training in and use of the C-BiLLT; assessed its acceptability, appropriateness, and feasibility; and commented on perceived barriers as well as advantages of the tool. Acceptability, appropriateness, and feasibility were all rated highly. The C-BiLLT was used with various populations and age groups but most often with children who were younger than 12 years of age, and those with cerebral palsy. The main implementation facilitator was clinicians’ motivation; the main barriers were related to resources and complexity of cases. Findings suggest implementation of new assessment tools is an ongoing process that should be monitored following initial training, in order to understand clinical contexts in which the tools are being used.

Clinicians' and Users' Views and Experiences of a Tele-Mental Health Service Implemented Alongside the Public Mental Health System during the COVID-19 Pandemic.

A tele-mental health model called Head to Health was implemented in the state of Victoria, Australia to address the crisis caused by the COVID-19 pandemic. It was a free centralized intake service that adopted a targeted approach with several novel elements, such as stepped care and telehealth. This study examines the views and experiences of clinicians and service users of the tele-mental health service in the Gippsland region of Victoria during the COVID-19 pandemic. Data from clinicians were obtained via an online 10-item open-ended survey instrument and from service users through semi-structured interviews. Data were obtained from 66 participants, including 47 clinician surveys and 19 service user interviews. Six categories emerged from the data. They were: 'Conditions where use of tele-mental health is appropriate', 'Conditions where tele-mental health may not be useful', 'Advantages of tele-mental health', 'Challenges in using tele-mental health', 'Client outcomes with tele-mental health', and 'Recommendations for future use'. This is one of a few studies where clinicians' and service users' views and experiences have been explored together to provide a nuanced understanding of perspectives on the efficacy of tele-mental health when it was implemented alongside public mental health services.

A mixed-methods study to define Textbook Outcome for the treatment of patients with uncomplicated symptomatic gallstone disease with hospital variation analyses in Dutch trial data

BackgroundInternational consensus on the ideal outcome for treatment of uncomplicated symptomatic gallstone disease is absent. This mixed-method study defined a Textbook Outcome (TO) for this large group of patients. MethodsFirst, expert meetings were organised with stakeholders to design the survey and identify possible outcomes. To reach consensus, results from expert meetings were converted in a survey for clinicians and for patients. During the final expert meeting, clinicians and patients discussed survey outcomes and a definitive TO was formulated. Subsequently, TO-rate and hospital variation were analysed in Dutch hospital data from patients with uncomplicated gallstone disease. ResultsFirst expert meetings returned 32 outcomes. Outcomes were distributed in a survey among 830 clinicians from 81 countries and 645 Dutch patients. Consensus-based TO was defined as no more biliary colic, no biliary and surgical complications, and the absence or reduction of abdominal pain. Analysis of individual patient data showed that TO was achieved in 64.2% (1002/1561). Adjusted-TO rates showed modest variation between hospitals (56.6-74.9%). ConclusionTO for treatment of uncomplicated gallstone disease was defined as no more biliary colic, no biliary and surgical complications, and absence or reduction of abdominal pain.TO may optimise consistent outcome reporting in care and guidelines for treating uncomplicated gallstone disease.

Dietitian and nutrition-related practices and resources in Australian and New Zealand PICUs: A clinician survey

BackgroundRecommendations to facilitate evidence-based nutrition provision for critically ill children exist and indicate the importance of nutrition in this population. Despite these recommendations, it is currently unknown how well Australian and New Zealand (ANZ) paediatric intensive care units (PICUs) are equipped to provide nutrition care. ObjectivesThe objectives of this project were to describe the dietitian and nutrition-related practices and resources in ANZ PICUs. MethodsA clinician survey was completed as a component of an observational study across nine ANZ PICUs in June 2021. The online survey comprised 31 questions. Data points included reporting on dietetics resourcing, local feeding-related guidelines and algorithms, nutrition screening and assessment practices, anthropometry practices, and indirect calorimetry (IC) device availability and local technical expertise. Data are presented as frequency (%), mean (standard deviation), or median (interquartile range). ResultsSurvey responses were received from all nine participating sites. Dietetics staffing per available PICU bed ranged from 0.01 to 0.07 full-time equivalent (median: 0.03 [interquartile range: 0.02–0.04]). Nutrition screening was established in three (33%) units, all of which used the Paediatric Nutrition Screening Tool. Dietitians consulted all appropriate patients (or where capacity allowed) in six (66%) units and on a request or referral basis only in three (33%) units. All units possessed a local feeding guideline or algorithm. An IC device was available in two (22%) PICUs and was used in one of these units. ConclusionsThis is the first study to describe the dietitian and nutrition-related practices and resources of ANZ PICUs. Areas for potential improvement include dietetics full-time equivalent, routine nutrition assessment, and access to IC.

An evaluation of menopause service delivery during the COVID-19 pandemic.

To investigate the experience of remote outpatient menopause service delivery by clinicians and patients during the COVID-19 pandemic. Two surveys explored the experiences of patients and clinicians separately. Patients attending menopause clinics in the UK were directed to an online survey which included questions on demographics and on their experience of their most recent appointment. A clinician survey was shared to members of the British Menopause Society (BMS) via email and was made available on the BMS website. It contained questions on clinic characteristics and clinicians' experience of delivering remote menopause consultations. Surveys were available for completion between 01/12/2020 and 10/02/2021. Of 180 patients who completed the patient survey, 52% felt remote consultations were the same or better than face-to-face consultations, and 90% of patients felt a choice between remote and face-to-face consultations should be offered. Patients overall were satisfied with many aspects of care, though numerous problems were highlighted with appointment administration. Of 76 clinicians who completed the clinician survey, most found remote patient consultations either no different or a bit worse than face-to face consultations but found that they offered more flexibility. In some cases, significant rescheduling was necessary to accommodate for the clinical needs of the consultation. A 'one-size-fits-all' approach to managing the delivery of menopause care is not supported by patients or clinicians. There must be a robust process in place to avoid problems with appointment scheduling and associated communications. Lessons learned from the pandemic can help to provide holistic menopause care.