Text Comments Research Articles

An Item–Item Collaborative Filtering Recommender System Based on Item Reviews: An Approach with Deep Learning

Item−item collaborative filtering is a sub-type of a recommender system that applies the items’ similarities for recommending a new set of items to the user. Usually, a traditional recommender system utilizes items’ ratings given by the user for deducing their preferences for recommending items. However, for the popularity of social platforms, users are now more familiar to write textual comments known as reviews about items based on their experiences rather than giving a rating, because rating any item limits a user to manifest the degree of satisfaction towards the item. As a result, the items’ reviews become a precious source of information that could enhance the system’s performance. In this paper, a novel recommendation approach has been proposed by applying a recurrent neural network to incorporate items’ reviews with the recommender system. The recurrent neural network is a deep learning-based approach that can distribute the text to the relevant classes. Thus, the proposed approach has applied long short-term memory which is a modern formation of recurrent neural network that is applied to compute items’ rating scores from the items’ reviews. Then, the score is used to define the uniformity of items by using the Jaccard and Pearson correlation coefficient. The proposed approach has been evaluated by two familiar datasets named Yelp & Amazon datasets. Also, it is found that the proposed approach surpasses the traditional techniques and also improved the accuracy of prediction for the Yelp dataset by approximately in respect of 1.37% mean absolute error, 2.17% precision, 2.08% recall, and 2.11% f-measure. Furthermore, the proposed approach increased the recommendation performance for Amazon dataset on average in term of 1.34% mean absolute error, 2.09% precision, 2.53% recall, and 2.32% f-measure, respectively.

Nature and extent of disruptions to staff clinical supervision practices in health care settings due to COVID-19: A survey study.

To investigate the impact of the COVID-19 pandemic on clinical supervision practices of health care workers in health care settings in one Australian state. A bespoke survey was developed and administered online using Qualtrics™. The survey consisted of Likert scale and closed questions, with options for free text comments. Numerical data were analysed descriptively and using Chi-Square tests. Textual data were analysed through content analysis. Of the 178 survey respondents, 42% were from allied health disciplines, 39% from nursing and midwifery, and 19% from medicine. The type and mode (i.e., face-to-face, telesupervision) of clinical supervision prior to the pandemic and at the time of survey completion (i.e., July-August 2021) were similar. Eighteen percent of respondents had a change in supervision arrangements but only 5% had a change in supervisor. For the 37% who changed roles due to COVID-19, 81% felt their current supervisor was still able to support them, 69% were still having their supervisory needs met. Analyses of textual data resulted in the development of two categories: Supervision deteriorating, and some clinical supervision functions (i.e., formative and restorative) being more impacted than others (i.e., normative). There were substantial disruptions to several parameters of clinical supervision due to COVID-19, that may pose a threat to high quality supervision. Health care workers reported pandemic-induced stress and mental health challenges that were not always addressed by effective restorative supervision practices.

Visitors’ satisfaction towards indoor environmental quality in Australian hotels and serviced apartments

Tourism is Australia’s fourth-largest exporting sector, yet insufficient research has been done on how satisfied guests are with the indoor environmental quality (IEQ) of Australian guest homes. This project utilised web-mining, natural language processing and aspect-based sentiment analysis to analyse visitors’ IEQ satisfaction in Australian tourist accommodations across ten tourism cities. By analysing 543,213 IEQ-related reviews from 1397 hotels and serviced apartments with two-stars and above at the Booking.com, guests’ text comments were classified by semi-supervised word-embedding based models into nine IEQ dimensions. Using a cutting-edge custom-trained bidirectional context-aware deep sequence model, sentiment scores were computed to estimate the degree of IEQ satisfaction. Results showed that guests were most dissatisfied with facilities, cleanliness and maintenance, and acoustics. IEQ dissatisfaction reduced as the buildings’ star ratings rose, except for thermal, lighting, exterior view, and layout and design dimensions. There was a small effect of seasonal fluctuations on the levels of dissatisfaction with thermal conditions, indoor air quality, and cleanliness and maintenance. All IEQ dimensions, excluding indoor air quality, showed small effects on the percentage of dissatisfied visitors across climate zones. During the pandemic, there was a significant decline in the guests’ evaluation scores. Notwithstanding, the IEQ satisfaction was scarcely affected by COVID-19, except for indoor air quality, cleanliness and maintenance, and facilities. This study’s findings can serve as a rationale for the Australian hospitality industry to enhance visitor satisfaction.

Investigating the Point of View of Project Management Practitioners on Technical Debt - A Study on Stack Exchange

Context: Technical debt (TD) can bring short-term benefits to software projects, but its presence is associated with issues such as decreasing product quality. Recent literature has proposed various approaches for identifying and managing TD, but most of them focus on the software developers’ point of view. Little is known about how project management practitioners perceive and manage TD items. Goal: This work aims to investigate how project management practitioners discuss and experience TD. Method: To achieve this goal, our work mines, curates, and selects a total of 108 TD-related discussions on the Stack Exchange Project Management (SEPM) Q&A site. These discussions amount to 547 posts and 882 text comments on the subject. We analyze this data set quantitatively and qualitatively, using open coding to derive TD types, indicators, and management practices. Results: We identified 74 indicators used for recognizing debt items and 126 TD management practices. The types of debt most discussed at SEPM are process and people debts. This contradicts studies done with developers where code and design debts are most discussed. Conclusion: The perspective considered by project management practitioners to analyze the TD phenomenon is different from the one considered by other roles in the software development process. Our work organizes the identified TD indicators and management practices into a Sankey diagram, which may assist TD management practitioners and serve as guidance for future research on the subject.

Entrustable professional activities (EPAs) for undergraduate medical education – development and exploration of social validity

BackgroundThe development of entrustable professional activities (EPAs) as a framework for work-based training and assessment in undergraduate medical education has become popular. EPAs are defined as units of a professional activity requiring adequate knowledge, skills, and attitudes, with a recognized output of professional labor, independently executable within a time frame, observable and measurable in its process and outcome, and reflecting one or more competencies. Before a new framework is implemented in a specific context, it is valuable to explore social validity, that is, the acceptability by relevant stakeholders.AimThe aim of our work was to define Core EPAs for undergraduate medical education and further explore the social validity of the constructs.Method and materialIn a nationwide collaboration, EPAs were developed using a modified Delphi procedure and validated according to EQual by a group consisting of teachers nominated from each of the seven Swedish medical schools, two student representatives, and an educational developer (n = 16). In the next step, social validity was explored in a nationwide survey. The survey introduced the suggested EPAs. For each EPA, the importance of the EPA was rated, as was the rater’s perception of the present graduates’ required level of supervision when performing the activity. Free-text comments were also included and analyzed.ResultsTen Core EPAs were defined and validated. The validation scores for EQual ranged from 4.1 to 4.9. The nationwide survey had 473 responders. All activities were rated as “important” by most responders, ranging from 54 to 96%. When asked how independent current graduates were in performing the ten activities, 6 to 35% reported “independent”. The three themes of the free text comments were: ‘relevant target areas and content’; ‘definition of the activities’; and ‘clinical practice and learning’.ConclusionTen Core EPAs were defined and assessed as relevant for Swedish undergraduate medical education. There was a consistent gap between the perceived importance and the certainty that the students could perform these professional activities independently at the time of graduation. These results indicate that the ten EPAs may have a role in undergraduate education by creating clarity for all stakeholders.

'A human face and voice': transgender patient-educator and medical student perspectives on gender-diversity teaching

BackgroundTransgender and gender diverse (TGD) people face many obstacles in accessing health care, including discrimination, institutional bias, and clinician knowledge deficits. We developed a clinical skills and education module on gender-affirming care for pre-clinical medical students, in collaboration with a TGD-led civil society organisation. The module consisted of an educational session followed by preceptor-facilitated small group tutorials, led by TGD patient-educators (n = 22) who used their lived experience to explore medical history-taking and broader issues related to TGD healthcare with students (n = 199). This study aimed to explore the views of students and TGD patient-educators on the structure, delivery and impact of the module.MethodsAnalysis of responses of TGD patient-educators and students to the module (2020 and 2021), in post-intervention surveys using open-ended questions for TGD patient-educators (18 responses from 22 educators) and free text comments as part of a quantitative survey for medical students (89 responses).ResultsResponses from students and patient-educators to the session were highly positive. Students and patient-educators emphasised that the teaching session succeeded through elevating the centrality of shared experience and creating a safe space for learning and teaching. Safety was experienced by patient-educators through the recognition of their own expertise in a medical environment, while students reported a non-judgemental teaching space which allowed them to explore and redress recognised limitations in knowledge and skill. Patient-educators described their motivation to teach as being driven by a sense of responsibility to their community. Preceptor attitudes may function as a barrier to the effectiveness of this teaching, and further attention should be paid to supporting the education of clinical facilitators in TGD health.ConclusionThe experiences of TGD patient-educators and medical students in this study suggest that this model of teaching could serve as a transferable template for TGD health and the inclusion of other historically marginalised groups in medical education.

'Being and becoming a practice educator': An AHP online programme.

Five higher education institutions (HEIs) in Scotland with qualifying allied health professional (AHP) programmes developed an online programme in practice education. This paper focuses on the design, development and evaluation of this programme. The programme was developed using the ADDIE approach for instructional design and was launched on TURAS (NHS e-learning platform) in November 2020. In November 2021, an online questionnaire was distributed to evaluate the e-learning programme and AHPs' preferences for future practice education training. Of the 407 responses, 95% (n = 388) were working in the NHS. There was no preference for online or face-to-face format of training. For the majority, having flexibility of time and place was deemed to be important to manage learning particularly given high workloads and staff shortages. Out of the 29% (n = 118) who answered questions regarding the programme, more than 60% (n > 75) of respondents reported it was well organised, the content relevant and would support their learning. Free text comments suggested a desire for networking opportunities to discuss learning. An e-learning programme for new and existing AHP practice educators in Scotland was developed and launched in November 2020. Key feedback from participants was that they wanted to have opportunities for interaction with other learners to discuss and share their learning whether this was online or face-to-face. The programme now forms the foundation education in practice education for AHPs in Scotland and is supplemented with networking opportunities through synchronous online training with HEIs and via NHS Education for Scotland's virtual community.

Newly diagnosed type 2 diabetes – does New Zealand General Practice adequately prepare patients to self-manage their Condition?

BackgroundType 2 diabetes mellitus (T2D) is predominantly managed in primary care, and patients need to be provided with appropriate knowledge and education to understand how to best self-manage their condition. For optimal T2D self-management, primary care teams should share this information from the time of diagnosis. Little is currently known about how and when these resources are being provided to patients with T2D in New Zealand.MethodsAn online survey was carried out between Oct 2022 and Feb 2023. Patients diagnosed with T2D after Jan 2020 were invited to participate, with recruitment occurring via primary care and social media. Questions included information about demographics, diagnosis, provision of education resources and/or referral services as well as about current diabetes management. All responses were analysed with chi square tests. Free-text comments were summarised only.ResultsA total of 203 participants from across New Zealand completed the survey, but 18 were excluded due to being diagnosed more than 3 years ago, or self-reporting with type 1 diabetes rather than T2D. Nearly three quarters (70.7%) of participants reported that they were given appropriate resources to understand and manage their T2D, though half of these would have like more information. Overall, family and friends, self-led research and healthcare-provided education were equally useful, though this differed by ethnic groups. Similarly, approx. 70% of patients thought that medications had been well explained. Free text comments suggested a need for more targeted information around food choice and insulin use as well as a need for empathy and appropriate language from healthcare providers.ConclusionsPrimary care appears to be providing most newly diagnosed patients with appropriate resources to understand and manage their T2D, but there is room for improvement with up to a third of participants not understanding how to manage foods, medication and lifestyle choices to optimise health outcomes. Further work is required to address this gap and should include the use of culturally-appropriate materials to meet the multi-ethnic population needs.

Nanopublications for Biodiversity Go Live

A nanopublication is the smallest unit of publishable information: a scientifically meaningful assertion about anything that can be uniquely identified and attributed to its author(s) and serve to communicate a single statement, its original source (provenance) and citation record (publication info) (Mons and Velterop 2009, Kuhn et al. 2021). Nanopublications are fully expressed in both human-readable and machine-interpretable formats and can be cited thorugh their unique URI identifiers (IDs). The development of the concept, formats and use cases of biodiversity-specific nanopublications started back in 2016 (Penev et al. 2016). Recently, Pensoft and Knowledge Pixels created a workflow to publish nanopublications related to a published article (Fig. 1). At its core, the generic biodiversity nanopublication consists of a triple structure with a Subject element, a Relation element, and an Object element. The Subject element refers to a specific organism identified by an Organism ID, or groups of organisms (Taxa, identified by Taxon Concept IDs). Universal Unique Identifiers (UUIDs) are minted for both in all cases, although if the given organism already has an identifier, e.g., from digitised collections or observations, then this identifier can be specified too. The Organism is linked via class membership (rdf:type) to a Taxon Concept, which is identified with another UUID that is minted upon nanopublication creation. The need to mint IDs is due to the fact that Organism or Taxon Concept IDs (which refer to taxon names but also details about their interpretation and use) are not currently available in any comprehensive vocabulary or database. The minted Taxon Concept IDs are further defined by linking them to a Taxon Name ID from Catalogue of Life / ChecklistBank (via a relation called "has Taxon Name") and by linking to Taxon Name's concept (interpretation of the name) by a publication's Digital Object Identifier (DOI) or TreatmentBank entry (via a relation called "used as defined in"). Apart from assigning a Taxon Concept, the subject organism can optionally be linked to a life cycle stage (based on the Uber-anatomy (UBERON) Ontology) and to occurrence data via Occurrence ID. The Relation element expresses the association between Subject and Object, according to a particular ontology (e.g., Relation Ontology). The Object element may have different formats. In the template “Association between organisms" the Object has the same structure as the Subject; while in the template “Association between an organism and environment”, the Object is a type of habitat available from the Environment Ontolog (ENVO). In addition to an assertion, a nanopublication has a provenance record (e.g., DOI of the article where the assertion has been published) and the type of evidence entered in the BasisOfRecord field. The publication info always contains the ORCID (Open Researcher and Contributor ID) of the nanopublication's creator, and the timestamp of creation. Another type of nanopublication template annotates an entire article or selected text from it by using the ORCID of the creator as the Subject, the article's DOI as the Object, and the Citation Typing Ontology (CiTO) to express evaluation of the article (e.g., “supports”, “agrees with”, “discusses”). These templates are complemented by free text comments and are available under the Nanopub tab on the article webpages at several Pensoft journals (see example and blog). Nanopublications can also prompt other types of publications, e.g., hypotheses, to become more machine-interpretable, as discussed for invasion biology (Heger et al. 2023).

Delphi consensus study and clinical practice guideline development for functional electrical stimulation to support upright mobility in people with an upper motor neuron lesion.

A Clinical Practice Guideline (CPG) is required to provide guidance on optimal service delivery for Functional Electrical Stimulation (FES) to support upright mobility in people living with mobility difficulties due to an upper motor neuron lesion, such as stroke or multiple sclerosis. A modified Delphi consensus study was used to provide expert consensus on best practice. A Steering Group supported the recruitment of an Expert Panel, which included a range of stakeholders who participated in up to three survey rounds. In each round, panelists were asked to rate their agreement with draft statements about best practice using a 6-point Likert scale and add free text to explain their answer. Statements that achieved over 75% agree/strongly agree on the Likert scale were included in the CPG. Those that did not were revised based on free text comments and proposed in the next survey round. The first round included 82 statements with seven substatements. Sixty-five people (84% response rate) completed survey round 1 leading to 62 statements and four substatements being accepted. Fifty-six people responded to survey round 2, and consensus was achieved for all remaining statements. The accepted statements are included within the CPG and provide recommendations about who can benefit from FES and how they can be optimally supported through FES service provision. As such the CPG will support advocacy for, and optimal design of, FES services.

Impact Calculation of The Players Using the Cricket Commentary Corpus

This research paper focuses on the use of natural language processing techniques for extracting insights from cricket commentary. This study proposes a framework that considers the commentary text, evaluates each player’s performance, and gives valuebased scores to define their impacts. This research relies on sentiment analysis, topic modeling, and NER to analyze a large corpus of cricket commentary data and develop a model for calculating the impacts of the players. The findings of this study will be of great interest to sports analysts, coaches, players, and fans of the game. This research explores cricket analytics and performance evaluation evolution, utilizing advanced textual analysis on cricket commentary to uncover hidden dimensions of player performance. This study has the potential to revolutionize player performance evaluation in cricket by identifying ”hidden gems” that may have been overlooked based on conventional statistics alone.

Can storytelling of women’s lived experience enhance empathy in medical students? A pilot intervention study

Purpose This pilot study aimed to investigate the acceptability and efficacy of a patient storytelling intervention (live and recorded) on empathy levels of medical students. Materials and methods Medical students participated in a storytelling intervention that had three components: listening to live or recorded stories from women with abnormal uterine bleeding, reflective writing, and a debriefing session. Empathy scores of students pre- and post-intervention were measured using the Jefferson Scale of Empathy-student version (JSE-S). Students also completed a feedback survey. Descriptive and inferential statistics were used to analyse quantitative data and content analysis was used for text comments. Results Both live and recorded storytelling interventions had positive effects on student’s empathy scores post intervention. Overall, students were satisfied with the intervention and reported that it improved their understanding of life experiences of women. Suggestions were made for an in-person storytelling session and interactive discussion after listening to each story. Conclusion A storytelling intervention has the potential to improve medical students’ empathy and understanding of lived experience of women with health conditions. This could be valuable when student-patient interactions are limited in healthcare settings, or to enable stories of small numbers of patient volunteers to reach students.

Building consensus on the selection criteria used when providing regional anaesthesia for rib fractures. An e-Delphi study amongst a UK-wide expert panel

BackgroundRib fractures are associated with significant morbidity and mortality, and providing adequate analgesia is paramount in preventing early complications from these injuries. Multiple regional anaesthetic techniques can be used to provide analgesia for these injuries; however, few evidence-based guidelines exist for their use. The aim of this study was to establish consensus within an expert group on the selection criteria used when choosing regional anaesthetic techniques for rib fractures. MethodsThe Delphi technique is a mixed-methods study format which uses a longitudinal survey process to develop consensus opinion amongst an expert group. A three-round modified e-Delphi study was undertaken using an online survey platform. Round one established cohort characteristics and identified key factors considered important by the group when selecting regional anaesthetic techniques for rib fractures. Subsequent rounds used Likert scales and free text comments to rate the participants’ level of agreement with various statements generated from the first-round responses. The final consensus threshold was established as at least 70% of respondents stating, ‘Strongly Disagree’ or ‘Disagree’ or alternatively ‘Agree’ or ‘Strongly Agree’. ResultsAn expert panel of UK-based consultants in anaesthesia and/or intensive care medicine was recruited. Participants worked in a variety of tertiary- and non-tertiary trauma care settings and were varied in their years of experience, approximate annual rib fracture caseload and preference for various anaesthetic techniques in rib fracture management. 54 participants took part in round one and generated 60 statements which were further analysed in an iterative process involving a total of three rounds. A total of 28 statements ultimately reached the pre-defined threshold for consensus within the expert group. ConclusionsThis e-Delphi study succeeded in building consensus across multiple statements relating to the selection criteria for regional anaesthesia in patients with rib fractures. These consensus statements can inform clinical practice, guide future research priorities and can be integrated into decision-making pathways across multiple hospital settings.

Patient experiences of outpatient hysteroscopy

ObjectivesPatient perspectives have an important role in improving the quality of outpatient hysteroscopy (OPH) services. Understanding women’s experiences can help provide important insights regarding the OPH journey. The purpose of this paper is to share perspectives and reflect on the experiences of women that participated in a national benchmarking OPH survey. In addition, we explore the correlation between women’s experience of OPH and reported pain scores. Material and methodsOver a two-month period, 5151 women took part in the national OPH survey. Free text comments relating to women’s OPH experience, collected as part of the survey, were subjected to qualitative analysis using NVivo 12 software to provide a better understanding of the OPH journey. In addition, correlations were drawn between the qualitative and quantitative data collected for pain scores and satisfaction using SPSS software. Results1720 (33.3%) women provided comments on their OPH experience. Qualitative thematic analysis generated themes that were divided into positive (82%) and negative (7%) experiences of care. Potential areas of improvement in relation to the OPH service were highlighted in 11% of themes. Most women regarded OPH as a safe, tolerable, and well delivered outpatient service. Quantitative analysis showed that 1829 (35.5%) women reported procedural pain between 70 and 100 mm. These women reported equivalent quality of care on a 10 cm visual analogue scale (9.71 [SD1.04] vs. 9.76 [0.73]; P = 0.06) but were more likely to decline having the procedure done in the same way again (19.4% vs. 3.1%; RR 6.30, 95% CI 5.06 to 7.83) compared to women with pain scores < 70 mm. ConclusionQualitative data supports the usefulness, safety, tolerability, and acceptance of hysteroscopy in an outpatient setting by most women. However, the reasons for high procedural pain, poor tolerability and negative experiences warrant review and exploration of both individual patient and relevant institutional factors including training, equipment, and local processes.

A user-feedback indicator framework to understand cultural ecosystem services of urban green space

Cultural ecosystem services (CES) are intangible benefits humans derive from the ecosystem, closely related to residents' spiritual enrichment, perceptual development, entertainment, and aesthetics. Despite the growing recognition of CES, there remains a need for a public understanding of CES performance in terms of indicators content, change and occurrence. This study developed a three-level indicator framework for evaluating urban green spaces CES at the design level. We integrated seven categories of CES indicators as primary indicators of the framework. Based on text comments in social media data, a bottom-up approach was adopted to collect CES-related words as the secondary indicators and elements. We evaluated the CES performance in union square park using the established framework. The results indicate that interactive activities are the most popular CES in the park, while the sense of place, social relationship and educational functions fail to receive a wide response, which should be given strong attention. The leading indicators within the park exhibit consistent trends in seasonal and demographic changes. In addition, there are co-occurrences between CES indicators, mainly manifested in interactive activities, aesthetic values, and health benefits, and the degree of co-occurrence varies. The CES framework proposed in this study measures the CES perception within urban green spaces, provides a detailed explanation of CES indicators, and forms an effective theoretical basis for future park management and development.

Pharmacy professionals’ perceptions of educational supervision in primary care through the lens of Proctor’s model

BackgroundEducational supervision plays a vital role in postgraduate medical education and more recently in pharmacy and advanced clinical practitioner training in England. Proctor’s three-function model of clinical supervision (consisting of formative, restorative, and normative functions) is assumed to apply to educational supervision, but this has not been tested empirically. The aim of this study was to establish perceptions of the purpose of educational supervision from the perspective of primary care pharmacy professionals enrolled on a national training pathway in England.MethodsUsing a mixed methods design, data were collected using a validated 25-item online survey and respondents were invited to add comments explaining their responses. The survey was sent to all 902 learners enrolled on a postgraduate training pathway for pharmacy professionals working in primary care. Principal components analysis (PCA) was used to interpret patterns in the survey data, and framework analysis of qualitative free text comments was used to identify themes and aid interpretation of quantitative findings.ResultsOne hundred eighty-seven pharmacy professionals responded (response rate 20.7%). PCA extracted three factors explaining 71.5% of the total variance. Factor 1 corresponded with survey items linked to the formative function of Proctor’s model, while factor 2 corresponded with survey items linked to the restorative function. No items corresponded with the normative function. Framework analysis of qualitative free-text comments identified two themes: learning support, which corresponded with factor 1; and personal support, which corresponded with factor 2.ConclusionsThis study identified that pharmacy professionals perceived educational supervision to perform two functions, formative (educational) and restorative (pastoral), but did not perceive it to perform a normative (surveillance) function. Educational supervision has the potential to support allied health professionals advancing their roles and we suggest the need for more research to develop models of effective educational supervision which can inform practice.

Defining a Meṇḍaka Question in the Questions of Milinda and Its Commentarial Texts

Defining a Meṇḍaka Question in the Questions of Milinda and Its Commentarial Texts

Experiences of being at high-risk during the COVID-19 pandemic and its impact on emotional well-being and daily life in people with chronic conditions: a qualitative study

BackgroundWith its health risks and extensive disruption to everyday life, the SARS-CoV-2 (COVID-19) pandemic has affected the lives of billions of people. People with chronic conditions are particularly susceptible to severe illness if infected by COVID-19, and they have repeatedly been urged to take stringent steps to ‘shield’ themselves from the virus. It is argued that the negative impact of isolation and other lockdown-related restrictions on emotional well-being and daily life may be most prominent among people at increased risk for severe illness from COVID-19. This qualitative thematic analysis aimed to explore how individuals with chronic conditions perceived the risk posed by COVID-19 and to understand how being at high risk affected their emotional well-being and everyday life.MethodsThe study is a thematic analysis of qualitative data consisting of semi-structured interviews with adults affected by at least one chronic condition supplemented with free text comments from a PRO-based survey.ResultsBased on 17 semi-structured interviews and 144 free text comments from a PRO-based survey three thematic patterns representing diverse COVID-19-related risk experiences were extracted: (1) Feeling vulnerable and at risk, (2) Uncertainty about being at risk, and (3) Distancing from the high-risk label.ConclusionsThe risk of COVID-19 impacted the participants’ everyday lives and emotional well-being in various ways. Some participants felt vulnerable and at risk causing them and their families to take on far-reaching precautions with significant consequences for their everyday life and emotional well-being. Some participants expressed uncertainty associated with whether they were at increased risk. Such uncertainty gave rise to dilemmas about how to navigate their everyday life. Other participants did not identify themselves as at higher risk and took no special precautions. Such a lack of perceived risk may undermine their motivation for taking preventive measures, which calls for public attention regarding current or future pandemics.

Intensive and comprehensive aphasia therapy—a survey of the definitions, practices and views of speech and language therapists in the United Kingdom

AbstractBackgroundResearch evidence suggests aphasia therapy must be delivered at high intensity to effect change. Comprehensive therapy, addressing all domains of the International Classification of Functioning, Disability and Health, is also called for by people with aphasia and their families. However, aphasia therapy is rarely intense or comprehensive. Intensive Comprehensive Aphasia Programmes (ICAPs) were designed to address this challenge, but such programmes are not widely implemented.AimsThis study surveyed the views of UK‐based speech and language therapists (SLTs) regarding intensive and comprehensive aphasia therapy. It explored definitions of intensive and comprehensive therapy, patterns of provision, views about candidacy and barriers/facilitators. It also investigated awareness of ICAPs and perceived potential of this service model. Differences across UK regions and workplace settings were explored.Methods &amp; ProceduresAn e‐survey ran for 5 months. Quantitative data were analysed using descriptive and inferential statistics. Qualitative free text comments were analysed using content analysis.Outcomes &amp; ResultsTwo hundred twenty‐seven respondents engaged in the e‐survey. Definitions of intensive aphasia therapy did not reach UK clinical guideline/research‐level thresholds for most of the sample. Those providing more therapy provided definitions with higher standards of intensity. Mean therapy delivered was 128 min/week. Geographical location and workplace setting influenced the amount of therapy delivered. The most frequently delivered therapy approaches were functional language therapy and impairment‐based therapy. Cognitive disability and fatigue were concerns for therapy candidacy. Barriers included lack of resources and low levels of optimism that issues could be solved. 50% of respondents were aware of ICAPs and 15 had been involved in ICAP provision. Only 16.5% felt their service could be reconfigured to deliver an ICAP.Conclusions &amp; ImplicationsThis e‐survey evidences a mismatch between an SLT's concept of intensity and that espoused by clinical guidelines/research. Geographical variations in intensity are concerning. Although a wide range of therapy approaches are offered, certain aphasia therapies are delivered more frequently. Awareness of ICAPs was relatively high, but few respondents had experience of this model or felt it could be executed in their context. Further initiatives are needed if services are to move from a low‐dose or non‐comprehensive model of delivery. Such initiatives might include but not be confined to wider uptake of ICAPs. Pragmatic research might also explore which treatments are efficacious with a low‐dose model of delivery, given that this model is dominant in the United Kingdom. These clinical and research implications are raised in the discussion.What this paper addsWhat is already known on this subject There is a gap between the high intensity of aphasia treatment provided in research versus mainstream clinical settings. A lower standard of 45 min/day set by UK clinical guidelines is also not achieved. Although speech and language therapists (SLTs) provide a wide range of therapies, they typically focus on impairment‐based approaches.What this study adds This is the first survey of UK SLTs asking about their concept of intensity in aphasia therapy and what types of aphasia therapy they provide. It explores geographical and workplace variations and barriers and facilitators to aphasia therapy provision. It investigates Intensive Comprehensive Aphasia Programmes (ICAPs) in a UK context.What are the clinical implications of this work? There are barriers to the provision of intensive and comprehensive therapy in the United Kingdom and reservations about the feasibility of ICAPs in a mainstream UK context. However, there are also facilitators to aphasia therapy provision and evidence that a small proportion of UK SLTs are providing intensive/comprehensive aphasia therapy). Dissemination of good practice is necessary and suggestions for increasing intensity of service provision are listed in the discussion.

Developing the Royal College of Emergency Medicine's advanced clinical practitioners in the Wessex region: design, implementation and review of a regional training programme

Background: Since 2015, the Royal College of Emergency Medicine (RCEM) has championed an advanced clinical practitioner (ACP) credentialling process for clinicians working in advanced practice roles in the emergency department. While this process ensures a standard of advanced practice that is both governable and robust, it requires structure and support to complete successfully. This article reports the design and implementation of a regional programme aimed at supporting trainees through the RCEM ACP training process to the point of credentialling. Methods: A regional training programme was implemented and a mixed-methods approach (that included a quantitative analysis of training programme completion rates and a qualitative review of trainee feedback) was used to analyse the outcomes. The programme incorporated a structured educational programme, educational supervision and annual review, alongside integration into the deanery school board and facilitation of training time. Results: Between 2016 and 2022, a total of 46 trainee RCEM ACPs were recruited to the programme. Of these, 19 had credentialled by spring 2022 and 20 were in ongoing training, aiming for credentialling. During this time, these participants accounted for 19% of the nationally credentialled ACP workforce (19 of 99). Since 2020, the first pass rate for programme trainees has been 71%, compared to the national average of 38%. Credentialled ACPs, when asked how well the programme prepared them to credential with the RCEM, responded positively, with most scoring the programme between 4 and 5, with 5 being marked as ‘excellent’. Free text comments in feedback on the programme were collated and reviewed for common themes resulting in key themes of ‘supportive’, ‘excellence’ and ‘adequate preparation for credentialling’. Conclusion: Meeting the criteria for RCEM credentialling as an ACP is a demanding process that requires support and structure. The development and implementation of a regional training programme not only meets these requirements but yields higher credentialling success rates and creates trainee satisfaction in the process.