Research Team Research Articles

The Permissibility of Biased AI in a Biased World: An Ethical Analysis of AI for Screening and Referrals for Diabetic Retinopathy in Singapore

AbstractA significant and important ethical tension in resource allocation and public health ethics is between utility and equity. We explore this tension between utility and equity in the context of health AI through an examination of a diagnostic AI screening tool for diabetic retinopathy developed by a team of researchers at Duke-NUS in Singapore. While this tool was found to be effective, it was not equally effective across every ethnic group in Singapore, being less effective for the minority Malay population than for the Chinese majority. We discuss the problematic normative nature of bias in health AI and explore the ways in which bias can interact with various forms of social inequalities. From there, we examine the specifics of the diabetic retinopathy case and weigh up specific trade-offs between utility and equity. Ultimately, we conclude that it is ethically permissible to prioritise utility over equity where certain criteria hold. Given that any medical AI is more likely than not to have lingering bias due to bias in the training data that may reflect other social inequalities, we argue that it is permissible to implement an AI tool with residual bias where: (1) its introduction reduces the influence of biases (even if overall inequality is worsened), and/or (2) where the utility gained is significant enough and shared across groups (even if unevenly).

Codesign of a Neurological Physiotherapy Student-Led Clinic With Students and Patients: An Exploratory Qualitative Study.

This study explores students' and patients' views of a UK physical therapy student-led clinic (SLC) for neurological rehabilitation and, using a codesign approach, it proposes an optimal design of a physical therapy SLC for neurological rehabilitation for patient participation and student learning. There is a paucity of literature examining experiences of neurological rehabilitation SLCs. Although research supports the utilization of codesign methodologies with patients and for curriculum development, there remains a gap regarding its application to SLCs in physical therapy for individuals with neurological conditions. Convenience sampling was used to recruit 4 patient and 4 student participants to take part in the study. This qualitative study employed exploratory codesign based on the participatory action research approach. Three online codesign workshops were facilitated by the research team. Thematic analysis of each workshop informed the outline for the next. Patients perceived that the SLC improved their overall well-being, and they highly valued being able to access rehabilitation. Students reported that they developed a range of clinical skills through participation in the SLC but would have liked a more in-depth orientation. The codesign process identified 5 key elements for the optimal design of the physical therapy neurological SLC: student support, continuity, supervision, peer-assisted learning, and orientation. Findings suggest that the SLC provides both a quality learning experience and a patient service, which is safe, effective, and sustainable. Future research should be undertaken with different stages of students and in different university settings. The codesign approach has been shown to be feasible for students and patients and could be used across other aspects of curriculum design. This novel study using codesign methodology provides initial findings of key elements to optimize SLCs in neurological physical therapy, to enhance student learning and patient experience.

Evaluation and Use of Natural Language Processing (NLP) Reasoning and Classification Models to Support Clinical Trial Patient Identification and Enrollment in the Community Oncology Setting

Clinical trial research in oncology relies heavily on clinical documentation within the electronic medical record (EMR) to ascertain patient eligibility in clinical trials based on inclusion and exclusion criteria. The structured data elements within the EMR serve as the primary information source for defining patient cohorts, with clinical cancer stage and performance status being two pivotal criteria determining trial eligibility. The challenge arises from the inconsistent availability of clinical stage and performance status data within the structured fields of the EMR despite their consistent presence in clinical notes. Additionally, there is a deficiency of standardization of this data that exists in the unstructured field. Hence, due to lack of structured data and standardization of said data, there are limitations in developing artificial intelligence (AI) models. To increase the comprehensiveness of clinical records, a clinical research team at a community oncology practice was consulted to identify requirements and extract essential clinical features from de-identified data. The methods outlined in this paper focused on eliminating false positives to allow future development of Large Language Models (LLM) using the outputted structured fields which resulted in an increase in patient record completeness with high accuracy. The accuracy ranged from 97.5-97.75% for the models that were developed. Out of the 60,000+ patients, the numerical staging, TNM (tumor, node, metastasis) staging, and Karnofsky performance score models added a structured field for 29.62%, 21.01%, and 40.64% patients respectively. Additionally, a semi-supervised NLP algorithm was applied on the performance status algorithm which achieved a mean absolute error (MAE) of 1.57. This work demonstrates the use case of natural language processing (NLP) in optimizing the clinical research enrollment process by providing an efficient and accurate method to detect key clinical values in unstructured patient data. Similar methodology with more advanced algorithms such as LLM can be employed to detect additional patient elements such as molecular biomarkers, imaging reports, postoperative surgical outcomes (i.e., clear margins etc.) and patient treatment outcomes using the extracted structured fields.

COVID-19 and Female Genital Mutilation/Cutting and child marriage: An online multi-country cross sectional survey.

Female Genital Mutilation/Cutting (FGM/C) and child marriage are prevalent in many countries in Asia and Africa. These practices are a violation of human rights and have significant impacts on the physical and mental well-being of those affected. COVID-19 restrictions such as lockdowns and closure of schools may have influenced the occurrence of FGM/C and child marriage. This analysis reported on the impact of these restrictions on FGM/C and child marriage. The International Sexual Health And REproductive Health (I-SHARE) research team organised a multi-country online survey. Sampling methods included convenience samples, online panels, and population-representative samples. Data collected included the impact of COVID-19 restrictions on the occurrence, intention to practice and change in plans to organise FGM/C and child marriage. Data were analysed from 14 countries that reported on FGM/C and child marriage using basic descriptive statistics. Given it was an online survey, we had more responses from urban areas. Among the 22,724 overall participants, 8,829 participants (38.9%) responded to the survey items on FGM/C and child marriage and were included in this analysis. 249 (3.4%) participants stated that FGM/C occurred in their community during COVID-19. Out of this, COVID-19 affected the plans of 26 (20%) participants intending to organise circumcision and 15% of participants planned to organise FGM/C earlier. People with a worry about finances during COVID-19 were more likely to have an earlier plan to organise FGM/C during COVID-19. In total, 1,429 (13%) participants reported that child marriage occurred in their community. The pandemic affected plans of 52 (13%) participants intending to arrange child marriage and 7.7% (29/384) participants expressed intent to arrange the marriage sooner than planned. People with financial insecurities during COVID-19 were more likely to arrange a child marriage earlier. Thus, our study found that the pandemic impacted plans related to FGM/C and child marriage practices, resulting in many carrying out the practices sooner or later than initially planned.

Health Literacy in Africa—A Scoping Review of Scientific Publications

Africa’s health landscape is rapidly changing, requiring new solutions such as a focus on health literacy. However, there is currently a limited overview of the development and application of health literacy in African countries and societies. This scoping review aims to analyze scientific publications on health literacy in Africa with regards to research approaches, historical developments, geographic origins, target populations and settings, and topical interests. The research followed Arksey and O’Malley six steps of scoping reviews and employed the Joanna Briggs Institute’s PCC method for search string formulation and the PRISMA-SCR checklist for reporting. On 11 July 2022, the following six databases were searched for scientific articles including included reports, policy briefs, book chapters, and research publications: PubMed, PsycINFO, Cochrane Library, ERIC, African Journals Online, and African Index Medicus. A total of 336 articles were identified. The research team co-developed a codebook and three researchers independently extracted data. The analysis provided the most comprehensive overview of the current scope and scale of health literacy in Africa to date. The publications represented 37 of the 54 African Union countries and dated back to 2001, although most were published in the last decade. The content analysis identified 13 broad themes, including mental health, communicable diseases, non-communicable diseases, maternal health, digital health, information and communication, health care, prevention and health promotion, conceptual perspectives, cultural perspectives, and outcomes and measurement. The analysis of target groups revealed a wide range of actors involved in different settings, mostly in health care or community settings. These comprehensive and novel findings can be used to prioritize future actions for public and professional capacity building, policy development, and improved practice to improve health literacy for all in Africa.

История становления и развития Краснодарской научной медицинской школы анестезиологии и реаниматологии

Today, a relevant aspect of developing a competent understanding of medicine as a complex science interconnected with a number of humanities disciplines is to consider its history through the prism of the most outstanding research teams of scientific medical schools. The presented article is devoted to consideration of the historical path of formation and development of the scientific medical school of anesthesiology and resuscitation in Kuban. The authors provide data on the prerequisites (conditions for improving knowledge about anesthesiology and resuscitation in the region) and the main stage of this process. The materials of the historiographic research were data from archival funds, in particular the state archive of the Krasnodar Territory and the Museum of History of the Kuban State Medical University, personal collections of members of the scientific school, as well as specialized literature within the scope of the work. The research methodology involved the use of chronological, biographical, analytical and narrative methods.

몽골 카라코룸의 네스토리우스파 기독교유적 연구

This paper examines the possibility that a complex architectural site, excavated by the Mongol-German joint research team from 2006 to 2009, located in the northern outskirts of Karakorum, may have been a Nestorian Christian church. The rectangular complex, surrounded by earthen-walls, can be divided into two phases based on the building's layout and overlapping architectural features. The initial structure within the complex had a unique configuration, with a large room at the front directly connected to a smaller room at the back, situated centrally within the walled area. Unlike traditional Mongolian architecture, which typically faces south, this building faced east, and it is notable for having an altar in the smaller rear room. Artifacts found at the site include fragments of a cross, characteristic of Nestorian Christianity, and bronze artifacts resembling candlesticks popular in medieval Europe. These findings strongly suggest that the site was a Nestorian Christian church during the Mongol Empire. The site's location in the northern outskirts of Karakorum aligns with the description of a Nestorian Christian church in William of Rubruck’s book. Additionally, the basic rectangular layout with a niche(apse) at the end containing an altar, as found in Central Asian Nestorian churches, further supports this identification. Radiocarbon dating indicates that the church was constructed in the early 13th century. The excavation revealed that the church was destroyed by fire. However, after the church's destruction, three tiled buildings with a different layout were immediately erected on the site. The structure and artifacts suggest that these buildings were likely a Buddhist temple. Additionally, a significant number of cattle horns were found inside the side buildings, suggesting that specific ritual activities took place at this location.

Retraction of "Home visiting impacts during the pandemic: Evidence from a randomized controlled trial of Child First" by Xia et al. (2023).

Reports the retraction of "Home visiting impacts during the pandemic: Evidence from a randomized controlled trial of child first" by Samantha Xia, Mervett Hefyan, Meghan P. McCormick, Maya Goldberg, Emily Swinth and Sharon Huang (Journal of Family Psychology, 2023[Aug], Vol 37[5], 569-580). This article is being retracted at the request of the publisher, and the editor and all authors of the original article consented. The MDRC study team identified two caregivers who were enrolled at baseline but were, themselves, minors. (The following abstract of the original article appeared in record 2023-81526-001.) Existing research has found that home visiting programs for families with young children can improve children's development and strengthen caregiver and family well-being. However, the pandemic created numerous challenges for home visiting programs, forcing them to deliver services online or in a hybrid format to respond to pandemic-related challenges. Questions remain about the impacts of these programs when delivered at-scale via a hybrid model, especially during this uniquely challenging time. The present study reports 12-month impacts from a randomized controlled trial of Child First-an evidence-based home visiting program that provides psychotherapeutic, parent-child intervention (children ages 0-5) embedded in a coordinated system of care-when implemented as a hybrid service. This study estimates impacts within four domains: families' receipt of services, caregiver psychological well-being and parenting, child behavior, and family economic well-being. After randomly assigning families (N = 226) to receive Child First or typical community services, the research team surveyed caregivers (N = 183) about a year after study enrollment. Results from regression models with site fixed effects revealed suggestive evidence that Child First reduced caregivers' job loss, residential mobility, and self-reported substance abuse, and increased receipt of virtual services during the pandemic. There were null impacts on caregivers' psychological well-being, families' involvement with the child welfare system, children's behaviors, and other indicators of economic well-being. Implications for future research and policy are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Identification of key narratives to assess students’ perception of social reality

Introduction. The article presents the results of the research investigation on identifying key narratives in the perception of the external social environment by university students on the example of St. Petersburg Peter the Great Polytechnic University (hereinafter referred to as SPbPU). The aim of the article is to identify key narratives (images of the present, past, and future) to assess students’ perception of social reality, to substantiate key needs of students in the field of soft skills development and to summarize the practices in the field of teaching these skills in SPbPU. Materials and Methods. The key methods of obtaining research data include the survey, participant observation of the research team members within the framework of professional activities, analysis of documents on the issues of teaching and assessment of teaching Soft Skills disciplines. The methods of semantic analysis, generalization, comparison, data visualization, and verification were used in order to collect data, process and present them. Results. The authors identified key narratives in the perception of the external social environment by university students, including peculiarities of the perception of enlarged groups in social, humanitarian and technical fields of study. The data on the key needs of young people within the framework of Soft Skills acquisition and the experience of implementing such disciplines on the example of SPbPU were generalized. During the study, a search semantic analysis of existing evaluative acronyms was applied to investigate the existing image of reality perception in the target group, and the DICE acronym was introduced to summarize the desired image of the future in university students. The practical results of the research consist in the possibilities to assess the potential of practices in the disciplines within the framework of «Soft Skills» in SPbPU and modernization of similar practices in other universities. Conclusions. The article concludes about the need to build an effective feedback system with university students, which will allow, based on specialized Soft Skills practices, to respond flexibly to needs in the field of deficit skills and competencies of students and ensure their acquisition. In addition, the importance of identifying the existing narratives in the youth environment in the field of perception of social environment and social time to realize the educational, communicative and moral functions of higher education institutions is shown.

Research of decision-making artificial intelligence for oral implantation

The oral implant surgery robot could achieved basic "surgical operation intelligence"; however, "implant decision intelligence" has not yet been achieved. The author previously discussed the specific concept of implant decision artificial intelligence. During our exploration of implant decision intelligence, our team further integrated the clinical diagnosis and treatment process of oral implantation, along with the data characteristics of decision indicators and the distribution characteristics of demographic information. As a result, we identified five key scientific and technological issues in the process of oral implant decision intelligence, namely the construction of a specialized annotation database for oral implantation, the prediction of quantitative indicators, the application of three-dimensional imaging, the solution of data imbalance within indicators, and the joint output of multi-property and multimodal indicators in clinical pathways. This paper will review artificial intelligence research in oral implantology and our team's research progress, elaborating on the aforementioned challenges in intelligentization. It aims to provide references for addressing the mentioned scientific issues and guiding future research directions in the construction of implant decision intelligence in oral medicine.

Patient-initiated follow-up supported by asynchronous telemedicine versus usual care in spondyloarthritis (TeleSpA-study): a randomised controlled trial of clinical and cost-effectiveness.

With rising health-care expenditures and workforce shortages, sustainable alternatives to traditional outpatient follow-up strategies are required to optimise care efficiency. We aimed to investigate the cost-effectiveness and clinical effectiveness of patient-initiated follow-up (PIFU) supported by asynchronous telemedicine for patients with spondyloarthritis compared with usual care in daily practice. TeleSpA was a multicentre, pragmatic, open-label, randomised controlled trial. Patients with spondyloarthritis and stable disease were randomly assigned (1:1) to either the PIFU and asynchronous telemedicine group or usual care group. All patients received a scheduled outpatient visit at baseline and after 1 year. Patients were monitored remotely at 6 months (PIFU and asynchronous telemedicine) or at the discretion of the treating rheumatologist (usual care). The primary outcome was the number of rheumatology visits within a 1-year period. A trial-based 1-year health-economic evaluation from a Dutch health-care perspective (only including health-care costs) and societal perspective (also including travel costs and work productivity losses), per the Dutch guidelines was used to estimate cost-effectiveness. The safety analysis was done in the intention-to-treat population and was based on spontaneous reports of adverse events and serious adverse events or as observed by the research team. The primary analysis was in the intention-to-treat population. Individuals with relevant lived experience were involved in the study design. This trial was registered with the Dutch National Trial Register (NL71041.068.19) and ClinicalTrials.gov (NCT04673825) and is completed. Between Dec 2, 2020, and June 20, 2022, 200 patients were randomly assigned to PIFU and asynchronous telemedicine (n=100) or usual care (n=100). 79 (40%) of 200 participants were women, 121 (60%) were men, and the mean age was 55·0 years (SD 11·9). After 1 year, the mean number of rheumatology visits was 1·9 (SD 1·5) for the PIFU and asynchronous telemedicine group and 2·6 (1·3) in the usual care group (mean difference -0·7 [95% CI -1·0 to -0·3]; 25·4% reduction; p<0·0001). PIFU and asynchronous telemedicine was cost-effective from a health-care perspective, saving health-care costs (-€180 [95% CI -921 to 560]) without a loss in quality-adjusted life-years (0·004 [95 % CI -0·022 to 0·030]). Seven non-trial-related adverse events occurred in the PIFU and asynchronous telemedicine group and eight in usual care group (including one death). PIFU and asynchronous telemedicine resulted in significant and clinically meaningful reductions in rheumatology visits. This was not at the expense of health outcomes and saved health-care costs. Dutch Arthritis Society.

Determinants of knowledge transfer activities among university researchers: a systematic review

Purpose This systematic review aims to identify the key determinants of knowledge transfer (KT) activities among researchers. Design/methodology/approach This study systematically reviewed KT literature in academic settings from 1995–2023. The authors searched Web of Science and Scopus using predefined keywords, following PRISMA guidelines for screening and eligibility assessment. From 158 selected articles, the authors extracted data and conducted a descriptive analysis to map KT activities’ evolution. A narrative synthesis approach categorized determinants of researchers’ KT activities. Findings The systematic review findings revealed a general conceptual framework that categorizes the identified determinants of KT into four categories. At the individual level, the factors are related to the sociodemographic characteristics of the researcher (e.g. gender, age, experience), their psychological aspects (e.g. attitude, intrinsic motivation, intention) and personal characteristics (e.g. self-efficacy, communication skills). At the research team level, leadership style and team dynamics. At the organizational level, the findings emphasize university characteristics (e.g. size, structure and ranking), KT culture installed and university resources. At the inter-organizational level, the key determinants were funding sources, network strength and trust. Research limitations/implications The studies included in our database were different in terms of contexts, country of the study, the disciplines of KT and the types of KT activities examined. This variety restricts the direct comparison of research findings thus the generalizability of our conclusions. Future research should focus on specific contexts, disciplines, countries or types of KT activities to provide generalizable findings. Practical implications A better understanding of all the factors influencing KT among university researchers is essential for several reasons. First, it will enable the government to develop effective policies to promote KT ecosystems. Second, universities can create strategies, policies and programs to support researchers’ engagement in KT activities. Finally, researchers can be more strategic in their KT efforts. Originality/value This systematic review contributes to the literature by providing a comprehensive conceptual framework that identifies KT determinants at different levels and fills a gap in the existing literature that only addresses specific aspects of KT determinants. This framework can be a theoretical reference for future empirical studies. Furthermore, it practically provides recommendations for different actors including, government, universities and researchers.

How sector fluidity (knowledge-intensiveness and innovation) shapes startups’ resilience during crises

In the context of the crises, this study sheds light on the varying impact of crises on startups in different sectors and outlines the specific resilience practices utilized in response, recovery, and growth phases. The research team conducted qualitative analysis on 18 public discussion interviews featuring key stakeholders in the Indian startup ecosystem, which included 51 chief executive officers, founders, cofounders, and venture capitalists who reflected on COVID-19. The study found that high-fluidity sectors (highly knowledge-intensive and innovative) leverage their agility through resourcefulness and customer value creation. In contrast, low-fluidity sectors (low in knowledge intensiveness) primarily focus on operational adjustments. As the transition goes from response to recovery, high-fluidity sectors prioritize digital transformation and strategic shifts, while low-fluidity sectors continue to cope. In the growth phase, high-fluidity startups exhibit growth aspirations, while low-fluidity ones emphasize business model innovation. This research provides valuable sector-specific insights into resilience and highlights the evolution of these strategies throughout a crisis, thereby enhancing our understanding of startup resilience in the context of the crisis.

AI predictive modeling of survival outcomes for renal cancer patients undergoing targeted therapy.

Renal clear cell cancer (RCC) is a complex disease that is challenging to predict patient outcomes. Despite improvements with targeted therapy, personalized treatment planning is still needed. Artificial intelligence (AI) can help address this challenge by developing predictive models that accurately forecast patient survival periods. With AI-powered decision support, clinicians can provide patients with tailored treatment plans, enhancing treatment efficacy and quality of life. The study analyzed 267 patients with renal clear cell carcinoma, focusing on 26 who received targeted drug therapy. The data was refined by excluding 8 patients without enhanced CT scans. The research team categorized patients into two groups based on their expected lifespan: Group 1 (over 3 years) and Group 2 (under 3 years). The UPerNet algorithm was used to extract features from CT tumor markers, validating their effectiveness. These features were then used to develop an AI-based predictive model trained on the dataset. The developed AI model demonstrated remarkable accuracy, achieving a rate of 93.66% in Group 1 and 94.14% in Group 2. In conclusion, our study demonstrates the potential of AI technology in predicting the survival time of RCC patients undergoing targeted drug therapy. The established prediction model exhibits high predictive accuracy and stability, serving as a valuable tool for clinicians to facilitate the development of more personalized treatment plans for patients. This study highlights the importance of integrating AI technology in clinical decision-making, enabling patients to receive more effective and targeted treatment plans that enhance their overall quality of life.

A holistic approach to supporting death in the home: Implementation of a home hospice program in a northern community–A study protocol

Introduction To enhance support for individuals at end of life to die at home, a new community-driven home-based hospice program was developed–Home Hospice. This wholistic hospice care program, co-designed by hospice care staff, community end-of-life care providers, researchers, and health systems decision-makers, will provide around the clock care to clients and their families. Methods and analysis This mixed methods study, guided by a process evaluation framework, will use secondary client and caregiver data collected as part of regular Home Hospice program processes, as well as primary interview data collected from caregivers at least three months post-death of the client and from hospice staff and volunteers involved in the Home Hospice program. Analysis will include descriptive statistical analysis of quantitative data and thematic analysis employing an inductive and a deductive qualitative analysis approach. Ethics Ethics approval has been received from the University of Northern British Columbia (File No: 6009117). All individuals and caregivers who enroll in the Home Hospice program will be invited to participate in this study. At three months post-death of the client, hospice staff will contact caregivers to ask if they would like to participate in a one-on-one interview with a research team member. Staff and volunteers will also be eligible to participate in one-on-one interviews with research team members. De-identified participant data will be provided by hospice staff to the research team. All participants will provide informed consent prior to participation in the study. Dissemination This study will use an integrated Knowledge Translation/Knowledge Mobilization (iKTKM) lens wherein the research team will work closely and meaningfully with knowledge users and community partners at all stages. Evidence-based and targeted iKTKM products will be created, including community event presentations and social media posts to share findings with participant and community audiences. Further, findings will be disseminated at conferences, workshops, and policy rounds with academic and decision-making audiences. Preliminary and full project findings will be published in high-quality open access journals. Strengths and limitations of this study Co-design of Home Hospice program and evaluation metrics involves researchers, hospice staff, health systems decision-makers, and community members. Evaluation metrics involve prospective collection of service utilization from client, family, hospice, and health systems perspectives. Integrated knowledge translation approach which frames the knowledge dissemination plan for the study findings focuses on a range of audiences, including local citizens, hospice and community end-of-life care providers, health systems decision-makers, and academic professionals. As a one-year pilot study, the number of clients who may be able to participate in this program will be approximately 50 persons.

Addressing Opportunity Gaps in Higher Education in Prison Programs

ABSTRACT In this article, we draw from our collaboration across a diverse cadre of colleagues who have focused on different aspects of teaching, higher education, and carcerality. In particular, our research team, known as STEM-OPS (STEM Opportunities in Prison Settings), studied higher education in prison with a specific focus on science, technology, engineering, and mathematics (STEM) and incarceration. We present interrelated findings from interviews across four people who are formerly incarcerated. Most Higher Education in Prison (HEP) programs are taught by university professors who are experts in content areas (such as science, chemistry, and math) and not pedagogy. As such, we believe teacher educators have an opportunity and an obligation to build professional learning opportunities related to pedagogy to support these instructors’ practices.

Strategy of user-driven re-design for inclusivity: Schuster Park in Rome

The paper presents the results of a research carried out by the Department of Architecture of Roma Tre University about user-driven re-design of public spaces, with the aim of transforming them into accessible and inclusive public spaces. Activities are related to the case of Schuster Park in Rome, whose re-functionalisation in terms of accessibility and inclusiveness is currently being planned. With this target, the research team, during the support phase for a preliminary feasibility study, experimented with a recursive participatory model, which can also be applied to other contexts related to public spaces.

Interpretation of statistical findings in randomised trials: a survey of statisticians using thematic analysis of open-ended questions

SummaryBackgroundDichotomisation of statistical significance, rather than interpretation of effect sizes supported by confidence intervals, is a long-standing problem.MethodsWe distributed an online survey to clinical trial statisticians across the UK, Australia and Canada asking about their experiences, perspectives and practices with respect to interpretation of statistical findings from randomised trials. We report a descriptive analysis of the closed-ended questions and a thematic analysis of the open-ended questions.ResultsWe obtained 101 responses across a broad range of career stages (24% professors; 51% senior lecturers; 22% junior statisticians) and areas of work (28% early phase trials; 44% drug trials; 38% health service trials). The majority (93%) believed that statistical findings should be interpreted by considering (minimal) clinical importance of treatment effects, but many (61%) said quantifying clinically important effect sizes was difficult, and fewer (54%) followed this approach in practice.Thematic analysis identified several barriers to forming a consensus on the statistical interpretation of the study findings, including: the dynamics within teams, lack of knowledge or difficulties in communicating that knowledge, as well as external pressures. External pressures included the pressure to publish definitive findings and statistical review which can sometimes be unhelpful but can at times be a saving grace. However, the concept of the minimally important difference was identified as a particularly poorly defined, even nebulous, construct which lies at the heart of much disagreement and confusion in the field.ConclusionThe majority of participating statisticians believed that it is important to interpret statistical findings based on the clinically important effect size, but report this is difficult to operationalise. Reaching a consensus on the interpretation of a study is a social process involving disparate members of the research team along with editors and reviewers, as well as patients who likely have a role in the elicitation of minimally important differences.

Behavioral Nudges to Encourage Appropriate Antimicrobial Use Among Health Professionals in Uganda

Background/Objectives: Antimicrobial resistance (AMR) is a global public health concern exacerbated by inappropriate antimicrobial prescribing practices, particularly in low-resource settings such as Uganda. The research aimed to develop a culturally sensitive behavioral intervention, leveraging a “nudge” strategy, to improve healthcare provider adherence to the 2016 Uganda Clinical Guidelines (UCG 2016) in five Ugandan hospitals. This intervention formed part of broader antimicrobial stewardship initiatives led by the United States Agency for International Development Medicines, Technologies, and Pharmaceutical Services Program. Methods: This study employed a mixed-methods approach, combining formative research and behavioral intervention. Guided by the Deloitte Behavioral Insights Framework, the research team conducted key informant interviews to identify prescribing barriers and motivators and developed three suitable behavioral interventions: perceived monitoring, ward leaderboards, and educational workshops. The study evaluated the interventions’ impact through point prevalence surveys (PPS), using the World Health Organization PPS methodology at three stages: pre-intervention, immediate post-intervention, and one-month post-intervention. Results: Key behavioral themes across individual, social, environmental, and organizational elements informed the intervention design and implementation. The behavioral intervention package increased antimicrobial prescription compliance with the UCG 2016 from 27% at baseline to 50% immediately post-intervention, though these effects diminished at one-month post-intervention. Conclusions: Our study addresses an existing gap in behavioral nudges-based operational research on antimicrobial prescribing in low- and middle-income countries. These results showed an immediate improvement in adherence to the UCG 2016 among healthcare providers in Ugandan hospitals, though the effect was attenuated at one-month follow-up. Despite the attenuation, behavior change presents a feasible, cost-effective, and sustainable approach to improving antimicrobial prescribing practices and addressing AMR.

Proportion of secondary bacterial infections among the SARS-COV-2 patients admitted in the selected health facilities in Mombasa and Nairobi counties in Kenya

Background: There is still scarcity of evidence on proportion of secondary bacterial infections among SARS-COV-2 patients in Kenya. This study therefore sought to determine the proportion of secondary bacterial infections among SARS-COV-2 patients in ICUs in the selected health facilities in Mombasa and Nairobi Counties. Methods: The retrospective cross-sectional sampled the records of 385 SARS-COV-2 patients admitted and administered antibiotics during treatment in the intensive care units (ICU) in the six health facilities that acted as isolation and treatment centers for SARS-COV-2 patients between 13th March 2020 and 31st December 2021. The research team reviewed the medical records of the SARS-COV-2 positive patients and extracted the patient demographic data, medical history, underlying co-morbidities, clinical symptoms, laboratory findings, management and treatment measures and antimicrobial susceptibility tests. Results: 47.3% of the patients in the study had secondary bacterial infections. Significant majority of patients of these patients were smokers (n=158, 86.8%, p≤0.05), had very high fever at admission in the ICU (n=139, 76.4%, p=0.033) and were administered iron supplement during the hospital stay (n=125, 68.7%, p=0.027). Conclusions: SARS-COV-2 patients who smoke, report high fever at admission in the ICU and given iron supplement during their stay in the health facility tend to have a high prevalence of secondary bacterial infections.