Service Workflow Research Articles

Pan-Arctic sea ice concentration from SAR and passive microwave

Abstract. Arctic sea ice monitoring is a fundamental prerequisite for anticipating and mitigating the impacts of climate change. Satellite-based sea ice observations have been subject to intense attention over the last few decades, with passive microwave (PMW) radiometers being the primary sensors for retrieving pan-Arctic sea ice concentration, albeit with coarse spatial resolutions of a few or even tens of kilometers. Spaceborne synthetic aperture radar (SAR) missions, such as Sentinel-1, provide dual-polarized C-band images with < 100 m spatial resolution, which are particularly well-suited for retrieving high-resolution sea ice information. In recent years, deep-learning-based vision methodologies have emerged with promising results for SAR-based sea ice concentration retrievals. Despite recent advancements, most contributions focus on regional or local applications without empirical studies on the generalization of the algorithms to the pan-Arctic region. Furthermore, many contributions omit uncertainty quantification from the retrieval methodologies, which is a prerequisite for the integration of automated SAR-based sea ice products into the workflows of the national ice services or for assimilation into numerical ocean–sea ice coupled forecast models. Here, we present ASIP (Automated Sea Ice Products): a new and comprehensive deep-learning-based methodology to retrieve high-resolution sea ice concentration with accompanying well-calibrated uncertainties from Sentinel-1 SAR and Advanced Microwave Scanning Radiometer 2 (AMSR2) passive microwave observations at a pan-Arctic scale for all seasons. We compiled a vast matched dataset of Sentinel-1 HH/HV (horizontal transmit, horizontal/vertical receive polarizations) imagery and AMSR2 brightness temperatures to train ASIP with regional ice charts as labels. ASIP achieves an R2 score of 95 % against a held-out test dataset of regional ice charts. In a comparative study against pan-Arctic ice charts and a PMW-based sea ice product, we show that ASIP generalizes well to the pan-Arctic region. Additionally, the comparison reveals that ASIP consistently produces relatively higher sea ice concentration than the PMW-based sea ice product, with mean biases ranging from 1.45 % to 8.55 %, and that the discrepancies are primarily attributed to disparities in the marginal ice zone.

“Working within broken systems”: Social workers bridge the fractures of U.S. healthcare: A qualitative inquiry on moral injury

Healthcare social workers (HSWs) in the United States are integral to interdisciplinary teams and health services. HSWs have a unique role in healthcare, as they care for their patients' psychosocial needs, through case management and clinical services. There is a gap in understanding how HSWs are impacted by their healthcare work. This study aims to understand the experience of moral injury, a marker of well-being, amongst HSWs in one state in the United States. Moral injury is the moral transgression (or boundary breaking) by oneself or someone in a position of power in high stakes situations and the negative outcomes of those experiences. Using a qualitative approach, semi-structured interviews were conducted with 24 HSWs in August of 2022. Thematic analysis was used to understand the lived experience of moral injury for HSWs. Three themes emerged: 1) HSWs’ definition and examples of moral injury; 2) HSWs situated in the “in-between” of policy and practice; and 3) upholding social work values within the medical model. These findings impact healthcare practice and policy, in delineating what falls within the bounds of social work, changing the workflow of health services, and creating further opportunities for interdisciplinary training, well-being initiatives, and systems-level changes. The findings from this work highlight the importance of understanding the moral impact of healthcare work on social workers, which should be further examined in depth not only amongst HSWs but also across the healthcare workforce.

Implementation of a Fracture Liaison Service in a tertiary hospital in Malaysia: a feasibility study.

To assess the feasibility of a Fracture Liaison Service in Malaysia and to benchmark our service against the International Osteoporosis Foundation Best Practice Framework. This feasibility study was conducted at a tertiary hospital in Malaysia from March 2021 to March 2022. Patients aged ≥ 50years admitted with fragility fractures were recruited. Excluded were those with poor prognosis or transferred out from the hospital during admission. Patients were screened, assessed, and followed up at months 4 and 12 post-fracture presentations. Data was collected using Microsoft Excel and the REDCap database. The feasibility of the Fracture Liaison Service was evaluated using the typology of feasibility. A total of 140 patients (female (93/140, 66.4%), median age 77 (IQR 72, 83), hip fractures (100/140, 65.8%)) were recruited into the Fracture Liaison Service. The recruitment rate was (140/215, 65.1%), as some patients were "missed" due to the COVID-19 pandemic. The completion rate was high (101/114, 88.6%). Among those indicated for antiosteoporosis medication, 82/100 (82%) were initiated on treatment. Various "Best Practice Standards," such as patient evaluation (140/140, 100%), fall prevention (130/140, 92.9%), and medication review standards (15/15, 100%) were high. Complicated referral pathways, inexperienced staff, lack of resources, and communication issues were some of the barriers identified while implementing the Fracture Liaison Service. Challenges were overcome by modifying the service workflow and coordinating with different departments. The Fracture Liaison Service was found to be feasible in Malaysia. It demonstrated promise in improving bone health management; however, several changes were needed to adapt the service to suit our environment.

Assessing Telemedicine Demand and Viability in Indonesian Geriatric Clinics: A Comprehensive HOT FIT and Sociotechnical Analysis.

The growing elderly population in Indonesia presents challenges for the healthcare system, prompting the exploration of telemedicine as a solution. However, its effective implementation in Indonesia faces obstacles. This research aimed to develop a comprehensive geriatric telemedicine framework in Padang City by studying multiple stakeholders. We employed qualitative methods, including in- -depth interviews, across two hospitals, a Health Office, and a Community Health Center, involving 18 elderly participants. The study identified ten key dimensions for geriatric telemedicine services: technology, Human-Computer Interface (HCI), infrastructure, system workflow, clinical content, people (diverse roles), organization (ecosystem, service workflow, internal and external regulations), and financing (social security agency on health and independent). We used the Human-Organization- Technology Fit and Sociotechnical System approaches for analysis. The study suggests implications for future implementation and advocates for broader participant involvement, information technology (IT) studies for system development, and longitudinal evaluations to assess the impact on elderly health outcomes.

The Changing Nature of Policing Studies in Türkiye

In Turkey, policing has been profoundly influenced by a heritage rooted in traditional law enforcement models derived from both Ottoman and global mentalities. This research addresses the reflections of the dynamic nature of policing reality in academic publications, examining the evolution of these studies both in content and structure. To this end, it presents a quantitative content analysis of the changing character of policing studies in Turkey, encompassing all publications produced up to 2023. A meticulously compiled dataset of 389 different articles from DergiPark, Turkey's online publication service and editorial workflow management system for academic journals, was utilized. Using a content scanning form, fundamental information such as publication year, author background, subject matter, and research methodology was systematically extracted. The data underwent descriptive analyses in SPSS, including frequency and cross-tabulation, to reveal significant trends and patterns. The findings demonstrate that Turkey's shifting political landscape has had a substantial quantitative and qualitative impact on policing research. Looking back over the years, it is evident that during coup periods, the content of police activities was quantitatively limited and lacked diversity. However, in periods without or with unsuccessful coups, there was a noticeable increase in the diversity and quantity of research. Despite advancements in policing studies, more methodologically rigorous and targeted research is needed to thoroughly examine the reality of policing in the academic field.

Change-readiness instrument for library managers: development and analysis of a scale

PurposeThis study focuses on developing a scale that encompasses aspects of readiness to change by library management in dealing with the next normal scenario in libraries. It investigates measuring change readiness in terms of library service operations, workflows, administration, programs and spaces, which can give an overview of a library institution's preparedness to meet new roles and expectations.Design/methodology/approachThe descriptive quantitative research was employed using a two-phase approach. It attempts to design an instrument referred to as change-readiness instrument for library managers (CRILM), which was derived from an original self-developed questionnaire consisting of a 20-item readiness-for-change attributes. Validity and reliability of CRILM were tested using Exploratory Factor Analysis and Cronbach’s Alpha. Sample size calculation was employed to determine the required number of subjects to participate in the study. Library managers who are head librarians from different types of libraries were the target samples. Content validation of the items was conducted for suitability and context.FindingsCRILM was tested both valid and reliable. The initial results yielded from the respondent sample indicated that CRILM is deemed suitable for measuring change-readiness among library managers and libraries. The factor-analyzed items were grouped into three subscales based on their characteristics, namely, flexibility in work and services, learning support readiness and adaptive to changing service environments.Research limitations/implicationsCRILM covered the major domains and constructs of change readiness in the context of a library setting. However, the scale should be subjected to further testing and use by a wider target group to strengthen its usability and confidence level. Item analysis was not employed.Practical implicationsThe results of the study offer help to library managers in assessing the readiness of their organizations to effectively manage change and be future-ready.Originality/valueThis study attempts to bridge the gap in readiness-for-change instruments by introducing a scale in the library service environment as a potential contribution in the practice of library management.

The Impact of Implementing a Picture Archiving and Communication System (PACS) on Minimum Service Standards in the Field of Radiology

The use of Picture Archiving and Communication System (PACS) has become an important step to increase the efficiency of radiology services. With PACS, fast access and flexibility in accessing patient medical images has had a major impact on reducing waiting times for radiology examination results. The aim of this research is to determine the waiting time for radiology services at the UPTD Embung Fatimah Regional Hospital, Batam City after implementing PACS. The research uses a mix-method method, namely research that combines quantitative and qualitative methods. Quantitative method by collecting service time data. Qualitative method by conducting in-depth interviews (in-depth interviews) and focus group discussions (FGD) to obtain information on perceptions from service implementers and users, then researchers will assess the impact of PACS on Minimum Service Standards (SPM) in the field of radiology at UPTD RSUD Embung Fatimah Batam city.The results of this research are that the use of PACS has significantly reduced radiology service time at the UPTD Embung Fatimah Regional Hospital, Batam City. There was a significant decrease in service time for outpatient services previously from 101.09 minutes to 62 minutes or 35.3%, for inpatient services from 108.26 minutes to 65.6 minutes or 41.04% and for CITO patients from 104.27 minutes to 60.5 minutes or 41.06% after application of PACS. The views of radiologists and radiographers regarding the differences in the quality of radiology services before and after using the PACS system show that there are better changes in the efficiency and quality of radiology services in hospitals. Stakeholder perceptions related to the speed of radiology service time after using the PACS system through various factors are considered to have a positive impact. Implementation of PACS clearly shows the potential for improving the efficiency, speed, and overall quality of radiology services. There was a significant reduction in waiting time for radiology examination services at the UPTD Embung Fatimah Hospital, Batam City after the implementation of PACS, which can provide an alternative in changing workflow and efficiency of radiology services.

Enhancing Hospital Pharmacy Operations Through Lean and Six Sigma Strategies: A Systematic Review.

Hospital pharmacies are integral to the healthcare system, and evaluating the factors influencing their efficiency and service standards is imperative. This analysis offers global insights to assist in developing strategies for future enhancements. The objective is to identify the optimal Lean Six Sigmamethodologies to improve workflow and quality of hospital pharmacy services. A strategic search, aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, encompassed an extensive range of academic databases, including Scopus, PubMed/Medline, Web of Science, and other sources for relevant studies published from 2009 to 2023. The focus was on management tactics and those examining outcomes, prioritizing publications reflecting pharmacy operations management's state. The quality of the selected articles was assessed, and the results were combined and analyzed. The search yielded 1,447 studies, of which 73 met the inclusion criteria. The systematic review found a low to moderate overall risk of bias. The number of publications roseduring the coronavirus disease (COVID-19) outbreak. Among studies, research output in the United States of Americarepresented26% of the total. Other countries such asIndonesia, Spain, Canada, China, Saudi Arabia, the United Arab Emirates, and the United Kingdom also made significant contributions. Each country accounted for 12%, 8%, 7%, 5%, 5%, 5%, and 5%, respectively. The pharmacy journals led with26 publications, and healthcare/medical with 14. The quality category came next with 12 articles, whileseven journals represented engineering.Studies used empirical and observational methods, focusing on practice quality enhancement. The process control plan had 26 instances, and the define, measure, analyze, improve, and control (DMAIC) was identified 13 times. The sort, set in order, shine, standardize, and sustain (5S)ranked third, totaling seven occurrences. Failure mode and effects analysis (FMEA) and root cause analysiswere moderately utilized, with six and four instances, respectively. Poka-Yoke (mistake-proofing measures) and value stream mappingwere each counted three times.Quality improvement and workflow optimization dominated managerial strategies in 22 (30.14%) studies each, followed by technology integration in 15 (20.55%). Cost, patient care, and staffing each featured in three (4.11%) studies, while two (2.74%) focused on inventory management. One (1.37%) study each highlighted continuing education, collaboration, and policy changes. Analysis of the 73 studies on Lean and Six Sigma in hospital pharmacy operations showed significant impacts, with 26% of studies reporting decreased medication turnaround time, 15% showing process efficiency improvements, and 11% each for enhanced inventory management and bottleneck/failure mode reduction. Additionally, 9% of studies observed decreased medication errors, 8% noted increased satisfaction and cost savings, 6% identified enhancements in clinical activities, 3% improved prescription accuracy, 2% reduced workflow interruptions, and 1% reported increased knowledge.Also, this study has identified key strategies for service delivery improvement and the importance of quality practices and lean leadership. To the best of the author's knowledge, this research is believed to be the first in-depth analysis of Lean and Six Sigma in the hospital pharmacy domain, spanning 15 years from 2009 to 2023.

Referral of patients from rural primary care clinics to telemedicine vendors for opioid use disorder treatment: A mixed-methods study.

Rural primary care clinics can expand their medication treatment for opioid use disorder (MOUD) capacity by coordinating care with external telemedicine (TM) vendors specializing in addiction medicine. This study used mixed methods to identify factors that influence patient referrals from rural primary care clinics to TM vendors for MOUD. Between July/August 2020 and January/February 2021, 582 patients with OUD were identified across six primary care sites; that included 68 referred to an external TM vendor to receive MOUD. Mixed effects logistic regression identified individual and site-level factors associated with being referred to the TM vendor. Clinic providers and staff participated in in-depth interviews and focus groups to discuss their considerations for referring patients to the TM vendor. Patient referrals were positively associated with local household broadband coverage (OR = 2.55, p < 0.001) and negatively associated with local population density (OR = 0.01, p = 0.003) and the number of buprenorphine prescribers in the county (OR = 0.85, p < 0.001). Clinic personnel expressed appreciation for psychiatric expertise and the flexibility to access MOUD brought by the TM vendor. Perceived concerns about TM referral included a lack of trust with external providers, uncertainty about TM service quality, workflow delays, and patients' technological and insurance challenges. This study revealed several clinic-level factors that may potentially influence patient referral to TM vendor services for MOUD. To facilitate the referral process and utilization of TM vendors, efforts should be made to foster open communication and trust between clinic providers and TM vendors, streamline workflows, and improve Internet access for patients.

A cloud infrastructure for enabling provision of the Material Testing as a Service (MTaaS)

This paper focuses on a ‘cloud infrastructure’ (MTaaS) that has been developed to support and coordinate integrated services and supply chain management. This will enable the seamless operation of a dynamic and adaptive system providing customer-centred material testing services. The cloud system is designed not only for decision making regarding the evaluation of the situations brought by industry and translating them into upscaling, characterisation and service workflows, but also for promoting existing products, improving facility usage and providing expertise consultancy. The development of MTaaS involves specifying the cloud infrastructure requirement, defining the back-end and front-end system architecture and modules, and outlining the operation fields of each module along with associated terminology, parameters and contents. This includes handling material testing service registration, verification, marketing, composition, preparation, offering, processing, monitoring as well as customer inquiries, monitoring and feedback. These efforts make MTaaS integrate product, service and customer-related information into a single platform, encompassing necessary operation related data, customer related data, inventory data and supply chain data.

Democratizing digital microfluidics by a cloud-based design and manufacturing platform.

Akin to the impact that digital microelectronics had on electronic devices for information technology, digital microfluidics (DMF) was anticipated to transform fluidic devices for lab-on-a-chip (LoC) applications. However, despite a wealth of research and publications, electrowetting-on-dielectric (EWOD) DMF has not achieved the anticipated wide adoption, and commercialization has been painfully slow. By identifying the technological and resource hurdles in developing DMF chip and control systems as the culprit, we envision democratizing DMF by building a standardized design and manufacturing platform. To achieve this vision, we introduce a proof-of-concept cloud platform that empowers any user to design, obtain, and operate DMF chips (https://edroplets.org). For chip design, we establish a web-based EWOD chip design platform with layout rules and automated wire routing. For chip manufacturing, we build a web-based EWOD chip manufacturing platform and fabricate four types of EWOD chips (i.e., glass, paper, PCB, and TFT) to demonstrate the foundry service workflow. For chip control, we introduce a compact EWOD control system along with web-based operating software. Although industrial fabrication services are beyond the scope of this work, we hope this perspective will inspire academic and commercial stakeholders to join the initiative toward a DMF ecosystem for the masses.

User Experience Research Techniques Facilitate Improvements for Access and Discovery Tools Managed by Technical Services Librarians

A Review of: Hill, K. (2020). Usability beyond the home page: Bringing usability into the technical services workflow. The Serials Librarian, 78 (1–4), 173–180. https://doi.org/10.1080/0361526X.2020.1702857 Objective – To demonstrate how user experience research techniques can be incorporated into technical services work. As proof of this concept, the author describes a case wherein a team of librarians, including one in a technical services role, deployed a user experience study to determine if students were able to successfully use LibGuides and the A-Z Database List to find subject-specific resources. The study also aimed to gauge the potential for several A-Z Database List interface redesign options. Design – A case study of user experience techniques applied to technical services projects, including a classic usability test of existing tools and an A/B/C comparison of potential interface redesigns. Setting – The library at the University of North Carolina Greensboro (UNCG), a public R2 university (doctoral university with high research activity). Subjects – Eleven student participants recruited through convenience sampling. Methods – The research team recruited study participants who were in the library at the time of the study, deselecting students from UNCG’s library school and those who were not currently affiliated with the university through an initial questionnaire. Eleven student participants were ultimately selected and led through a series of tasks related to finding subject-specific databases using the A-Z Database List and LibGuides. After the tasks for the A-Z Database List were completed, students were asked for their impression of two additional database list interfaces. Students were recorded throughout the tasks using the “talk aloud” method to provide researchers with insights on their thought processes and preferences. Following the study, researchers listened to the recordings, coding them as successful or incomplete and noting their observations for use in generalized findings. Main Results – Eight of eleven participants used the library’s main search box to locate a general resource for their major on the library’s homepage. When shown the A-Z Database List, ten out of eleven participants used the list to find a database for their major, while one used the link to “Research guides by subject” from that page. Comparisons of three A-Z Database List interfaces showed that most students preferred the Springshare Content Management System that allowed for filtering by subject area. When asked to find a research guide for their subject or major from the library’s homepage, nine out of eleven students clicked on the link labeled “Research guides by subject.” Starting from their subject guide, ten out of eleven could find a tab listing article databases. Nine participants noted that the number of databases listed on the guides was daunting. Conclusion – Results from the user experience study were used to support a redesign of the A-Z Database List using the Springshare Content Management System. The author regarded the experience as a whole as demonstrating how technical services librarians can become involved in user experience work and incorporate findings from usability studies into their management and design of tools that promote access and discoverability.

Examining Workflow for Simulated Pediatric Emergency Medical Services Care

Purpose: Workflow analysis is an important approach for understanding clinical care in complex systems. This is particularly true for low frequency events such as the care of children in the out-of-hospital setting. The purpose of this study was to characterize emergency medical service (EMS) workflow in the care of children during simulated emergency, prehospital encounters.&#x0D; Methods: This is a secondary analysis exploring high-fidelity videorecorded simulations, performed by emergency personnel. Two scenarios were used in 19 simulations which consisted of a 15-month and a 1-month old with respiratory decompensation and shock requiring intravenous fluid, respiratory support, and medication administration. One trained investigator performed review of the videos of teams EMS practitioners, quantifying the sequence and number of tasks performed and time to completion of the simulated intervention. The variance in sequence of tasks was quantified using the Levenshtein distance. We quantified the proportion of time with no activity (idle time) and temporal overlap (team multitasking time).&#x0D; Results: We identified 17 types of distinct tasks performed during the simulation. There was high variability across simulations in the sequences, types, and number of tasks performed. Team multitasking was noted in all scenarios, with a mean of 99% multitasking ratio (range: 52-202%). Mean proportion of idle time was 4% (range: 0-11%). Weight estimate, intravenous or intraosseous access, radio report, blood glucose level (BGL), medication administration, pulse check and respiration check were observed in all videos. Other tasks were observed in only a proportion of scenarios with varying frequencies. Median number of differences in sequence of tasks between scenarios was 15.&#x0D; Conclusions: Our analysis found a high percentage of team multitasking and significant variability in frequency and sequence of task completion. Further research is needed to assess the reasons and effect of this degree of variability on the efficiency and effectiveness of prehospital interventions.

Analisis Kesiapan Implementasi Rekam Medis Elektronik Menggunakan Instrumen CAFP (California Academy of Family Physicians) di Puskesmas Kartasura

Indonesian Ministry of Health Regulation No. 24 of 2022 on Medical Records requires all healthcare facilities must implement Electronic Medical Records (EMR) no later than December 31, 2023. Kartasura Primary Healthcare is one of the healthcare in Sukoharjo Regency that has not implemented EMR yet. A readiness analysis of EMRS is required to to improve service quality and workflow efficiency. CAFP instrument can be used for evaluating primary healthcare in transitioning to EMR. The purpose of this study is to determine the readiness of implementing EMR on management capacity, finance &amp; budgeting, operations, technology, and organizational alignment. This was a descriptive-quantitative- research. Sample was 9 people who selected by stratified random sampling. Data collection used interviews and documentation studies. Results showed that management capacity was in range II with average score 9.3; financial capacity and budget were in range III with average score 5.2; operational capacity was in range III with average score 3.5; technology capacity was in range III with average score 9.4; and organizational alignment capacity was in range II with average score 17.3. Overall readiness for EMR implementation at Kartasura Primary Healthcare was in range II. To increase financial &amp; budgetary, operational, and technological capacity, it is suggested to recruit IT team, EMR training, and EMR socialization to all potential users.

Investigational drugs services pharmacists education and workflow structure.

169 Background: Per NIH U.S. National Library of Medicine, 428,103 research studies are registered globally as of September 19th, 2022. Each institution must assess its institutional readiness as the complexity and volume of clinical trial increases. Institutional readiness helps assess the capacity of an institution to adopt new technologies and policies to accept, activate, and adjust research despite the complexity of the clinical trial. Clinical research pharmacists help improve the safety and quality of the research by reviewing the scientific literature and medication-related information to develop protocols and evaluate clinical trial feasibility as part of the scientific review committee while performing supportive pharmaceutical review of the protocol, preparation, storage, dispensing, and consulting clinical coordinators and sponsors on the logistics of the trial. Investigational drug service (IDS) also oversees institutional compliance with Good Clinical Practices (GCPs) and Good Manufacturing Practices (GMPs), FDA regulations, and laws. Lack of training for pharmacists, poor safety and quality control, lack of resources, and unstandardized approach to the management of investigational drug products can lead to discrepancy, delay in care, and ultimately, harm to the patient. This study will address the deficiency of institutional readiness to conduct clinical trials with investigational agents and introduce policies and procedures needed to be followed by pharmacists or pharmacy technicians to conduct research. Methods: To explore the challenges in clinical trials and compare work efficiency, work productivity, and growth in the investigational drug service (IDS) pharmacy. This study is conducted at a single-health system compromised of 7 satellite investigational pharmacy from June 2021 to August 2022. Interventions include Epic/Beacon training, CITI training, annual compounding competencies, protocol and procedure development, and Vestigo implementation. Data for inclusion was identified from (where Dr. Ayoubi got data from) were extracted and analyzed. Results: 71% decrease in # of protocols on the priority list to amend protocols. Informatics pharmacists build 190 protocols in one year. Revenue has doubled in one year. Productivity increased as time to verify is reduced by 9.43 minutes to verify an order and time to dispense is reduced by 31.3 min. Number of clinical trials designated to each pharmacist increased from 3-4 to 20 productions per month. Number of investigational drugs ordered increased by 89 last year. Conclusions: Education and Training remain one of the main set back to clinical trials growth, and proper training and education are the pillars to conducting clinical trials in a safe manner and promote growth.

European Society of Breast Imaging (EUSOBI) guidelines on the management of axillary lymphadenopathy after COVID-19 vaccination: 2023 revision

Axillary lymphadenopathy is a common side effect of COVID-19 vaccination, leading to increased imaging-detected asymptomatic and symptomatic unilateral axillary lymphadenopathy. This has threatened to negatively impact the workflow of breast imaging services, leading to the release of ten recommendations by the European Society of Breast Imaging (EUSOBI) in August 2021. Considering the rapidly changing scenario and data scarcity, these initial recommendations kept a highly conservative approach. As of 2023, according to newly acquired evidence, EUSOBI proposes the following updates, in order to reduce unnecessary examinations and avoid delaying necessary examinations. First, recommendation n. 3 has been revised to state that breast examinations should not be delayed or rescheduled because of COVID-19 vaccination, as evidence from the first pandemic waves highlights how delayed or missed screening tests have a negative effect on breast cancer morbidity and mortality, and that there is a near-zero risk of subsequent malignant findings in asymptomatic patients who have unilateral lymphadenopathy and no suspicious breast findings. Second, recommendation n. 7 has been revised to simplify follow-up strategies: in patients without breast cancer history and no imaging findings suspicious for cancer, symptomatic and asymptomatic imaging-detected unilateral lymphadenopathy on the same side of recent COVID-19 vaccination (within 12 weeks) should be classified as a benign finding (BI-RADS 2) and no further work-up should be pursued. All other recommendations issued by EUSOBI in 2021 remain valid.Graphical abstract

Evaluating GPT as an Adjunct for Radiologic Decision Making: GPT-4 Versus GPT-3.5 in a Breast Imaging Pilot

ObjectiveDespite rising popularity and performance, studies evaluating the use of large language models for clinical decision support are lacking. Here, we evaluate ChatGPT (Generative Pre-trained Transformer)-3.5 and GPT-4’s (OpenAI, San Francisco, California) capacity for clinical decision support in radiology via the identification of appropriate imaging services for two important clinical presentations: breast cancer screening and breast pain. MethodsWe compared ChatGPT’s responses to the ACR Appropriateness Criteria for breast pain and breast cancer screening. Our prompt formats included an open-ended (OE) and a select all that apply (SATA) format. Scoring criteria evaluated whether proposed imaging modalities were in accordance with ACR guidelines. Three replicate entries were conducted for each prompt, and the average of these was used to determine final scores. ResultsBoth ChatGPT-3.5 and ChatGPT-4 achieved an average OE score of 1.830 (out of 2) for breast cancer screening prompts. ChatGPT-3.5 achieved a SATA average percentage correct of 88.9%, compared with ChatGPT-4’s average percentage correct of 98.4% for breast cancer screening prompts. For breast pain, ChatGPT-3.5 achieved an average OE score of 1.125 (out of 2) and a SATA average percentage correct of 58.3%, as compared with an average OE score of 1.666 (out of 2) and a SATA average percentage correct of 77.7%. DiscussionOur results demonstrate the eventual feasibility of using large language models like ChatGPT for radiologic decision making, with the potential to improve clinical workflow and responsible use of radiology services. More use cases and greater accuracy are necessary to evaluate and implement such tools.

Re-establishing HIV/STI Testing Services Through University Student-Oriented Centers During the COVID-19 Pandemic.

The COVID-19 pandemic saw the disruption of HIV/STI testing services at crucial student-oriented spaces at the University of Michigan, including the Spectrum Center, an LGBTQ+ event and education space, and Wolverine Wellness, a well-being initiative through the University Health Services, alongside massive disruptions to testing seen elsewhere around the country (Zapata et al., 2022). HIV/STI testing resumed in October during the Fall 2021 semester at the University of Michigan at Wolverine Wellness and Spectrum Center. At the Spectrum Center, the oldest LGBTQ+ college center in the country, I had the unique opportunity to partner with professional and student staff to foster an environment sensitive to cultural needs, including awareness of how sexual and gender identity intersects with student sexual health and well-being. Additionally, at both sites, COVID-19 protocols from the state and university were also established in the new workflow of testing services. The re-introduction of HIV/STI testing services through student-oriented sites at the University of Michigan required a reassessment of work flow standards and engagement with the campus student population.

A Practice-Proven Adaptive Case Management Approach for Innovative Health Care Services (Health Circuit): Cluster Randomized Clinical Pilot and Descriptive Observational Study.

Digital health tools may facilitate the continuity of care. Enhancement of digital aid is imperative to prevent information gaps or redundancies, as well as to facilitate support of flexible care plans. The study presents Health Circuit, an adaptive case management approach that empowers health care professionals and patients to implement personalized evidence-based interventions, thanks to dynamic communication channels and patient-centered service workflows; analyze the health care impact; and determine its usability and acceptability among health care professionals and patients. From September 2019 to March 2020, the health impact, usability (measured with the system usability scale; SUS), and acceptability (measured with the net promoter score; NPS) of an initial prototype of Health Circuit were tested in a cluster randomized clinical pilot (n=100) in patients with high risk for hospitalization (study 1). From July 2020 to July 2021, a premarket pilot study of usability (with the SUS) and acceptability (with the NPS) was conducted among 104 high-risk patients undergoing prehabilitation before major surgery (study 2). In study 1, Health Circuit resulted in a reduction of emergency room visits (4/7, 13% vs 7/16, 44%), enhanced patients' empowerment (P<.001) and showed good acceptability and usability scores (NPS: 31; SUS: 54/100). In study 2, the NPS was 40 and the SUS was 85/100. The acceptance rate was also high (mean score of 8.4/10). Health Circuit showed potential for health care value generation and good acceptability and usability despite being a prototype system, prompting the need for testing a completed system in real-world scenarios. ClinicalTrials.gov NCT04056663; https://clinicaltrials.gov/ct2/show/NCT04056663.

Criteria and Terminology Applied to Language Impairments (CATALISE): A qualitative exploration of dissemination efforts to guide future implementation.

Developmental language disorder (DLD) is a condition which affects an individual's ability to use and understand language. Terminological confusion, and the use of non-evidence-based diagnostic criteria has impacted access to services for this population for several decades. Changes in terminology and diagnosis were proposed as part of a UK-based consensus study, Criteria and Terminology Applied to Language Impairments (CATALISE), in 2016 and 2017. Since the publication of the recommendations, there have been active efforts across several English-speaking countries to support uptake of these recommendations into policy and practice. The aim of the study was to explore the experiences of individuals who have been leading the dissemination of the CATALISE recommendations since their publication in 2017. The study was undertaken to inform future implementation efforts aimed at facilitating the adoption of the recommendations into policy and practice. Researchers, practitioners and parents from nine countries were recruited to the study (n = 27). Online focus groups and semi-structured interviews were conducted using topic guides informed by the Consolidated Framework for Implementation Research. Inductive thematic analysis was undertaken. Preliminary findings were member-checked prior to completion of the analysis. CATALISE recommendations were described as partially adopted by participants. Dissemination strategies included building a coalition, conducting educational meetings, and developing educational materials. Common barriers to implementation related to the complexity and compatibility of the recommendations, and practitioner confidence. Four themes were identified across the data set to guide future implementation efforts: (a) ride the wave, craft the narrative (b) reach across the divide, be brave (c) create space for multiple voices and, (d) support for speech and language therapistss on the front line. Individuals with DLD and their families should be included in future implementation planning. Engaged leadership is essential to address issues of complexity, compatibility, sustainability and practitioner confidence if CATALISE recommendations are to be integrated into service workflow and processes. Implementation science can provide a useful lens to progress future research in this area. What is already known on this subject Dissemination efforts have been undertaken to facilitate the uptake of recommendations from a UK-based consensus study (CATALISE) in relation to developmental language disorder since publication across several countries. What this study adds to existing knowledge The required changes in diagnostic practice are complex to implement. A lack of compatibility with healthcare processes and low practitioner self-efficacy were also identified as a challenge to implementation. What are the potential or actual clinical observations of this work? Parents and individuals with developmental language disorder need to be engaged as partners in future implementation planning. Organisational leaders need to facilitate the contextual integration of the changes within service systems. Speech and language therapists require ongoing case-based opportunities to enhance their confidence and clinical reasoning skills to implement CATALISE recommendations successfully in their everyday practice.