Members Of Working Group Research Articles

Methods for living guidelines: early guidance based on practical experience. Paper 3: selecting and prioritizing questions for living guidelines

ObjectivesThis article is part of a series on methods for living guidelines, consolidating practical experiences from developing living guidelines. It focuses on methods for identification, selection, and prioritization of clinical questions for a living approach to guideline development. Study Design and SettingMembers of the Australian Living Evidence Consortium, the National Institute of Health and Care Excellence and the US Grading of Recommendations, Assessment, Development and Evaluations Network, convened a working group. All members have expertize and practical experience in the development of living guidelines. We collated methods, documents on prioritization from each organization's living guidelines, conducted interviews and held working group discussions. We consolidated these to form best practice principles which were then edited and agreed on by the working group members. ResultsWe developed best practice principles for (1) identification, (2) selection, and (3) prioritization, of questions for a living approach to guideline development. Several different strategies for undertaking prioritizing questions are explored. ConclusionThe article provides guidance for prioritizing questions in living guidelines. Subsequent articles in this series explore consumer involvement, search decisions, and methods decisions that are appropriate for questions with different priority levels.

Construction of instrument for identifying conflict in working team

In modern society all spheres of our work and life are permeated with communications, which influence, determine and construct our indicators of success, satisfaction. The process of communication can be transformed in different directions, from the formation of long-term, trusting relationships, to conflict confrontation, resistance. In this regard, it is important to expand the knowledge of effective tools for identifying, regulating and forming constructive relationships between teams, groups, neutralizing the negative consequences of incipient or existing conflict. In this article, we present the problem of studying the different communication styles between members of work groups, which often leads to an increase in intergroup conflicts. This is detrimental to interpersonal relationships and work productivity. The subject of the study is the study of team interaction styles that are predictors of tensions leading to inter-group conflict. The task for developing this instrument is based on the assumption that different communication styles between group members lead to group dynamic tensions that may be stimulating and helpful for the team development, but also for generating conflict. The main research question is: “How can team developers and conflict counselors identify different communication styles in work groups and treat conflicts at a very early stage?” The purpose of this paper is to develop a tool for examining communication styles in work groups. The construction of the instrument and quality control is described, from theoretical justification to factor-analytic reduction of 12 items into 4 scales and quality control of the scales. The result is an easy-to-use tool with satisfactory quality that can be applied to groups with many members. It allows group members to carefully evaluate different communication styles and identify relevant differences. Based on it, group members can directly discuss the differences between communication styles and, if a tense situation or conflict arises, deal with them constructively. As a result, this will indicate better group work, trainings, examinations and further optimization of interaction tools.

UNCERTAINTY MANAGEMENT IN REGULATORY AND HEALTH TECHNOLOGY ASSESSMENT DECISION-MAKING ON DRUGS: GUIDANCE OF THE HTAi-DIA WORKING GROUP.

Uncertainty is a fundamental component of decision making regarding access to and pricing and reimbursement of drugs. The context-specific interpretation and mitigation of uncertainty remain major challenges for decision makers. Following the 2021 HTAi Global Policy Forum, a cross-sectoral, interdisciplinary HTAi-DIA Working Group (WG) was initiated to develop guidance to support stakeholder deliberation on the systematic identification and mitigation of uncertainties in the regulatory-HTA interface. Six online discussions among WG members (Dec 2021-Sep 2022) who examined the output of a scoping review, two literature-based case studies and a survey; application of the initial guidance to a real-world case study; and two international conference panel discussions. The WG identified key concepts, clustered into twelve building blocks that were collectively perceived to define uncertainty: "unavailable," "inaccurate," "conflicting," "not understandable," "random variation," "information," "prediction," "impact," "risk," "relevance," "context," and "judgment." These were converted into a checklist to explain and define whether any issue constitutes a decision-relevant uncertainty. A taxonomy of domains in which uncertainty may exist within the regulatory-HTA interface was developed to facilitate categorization. The real-world case study was used to demonstrate how the guidance may facilitate deliberation between stakeholders and where additional guidance development may be needed. The systematic approach taken for the identification of uncertainties in this guidance has the potential to facilitate understanding of uncertainty and its management across different stakeholders involved in drug development and evaluation. This can improve consistency and transparency throughout decision processes. To further support uncertainty management, linkage to suitable mitigation strategies is necessary.

One Health Initiative: Delusional Parasitosis Needs Assessment, Tennessee 2022

Abstract Delusional parasitosis (DP) is a false, persistent belief that an individual is infested with organisms, especially arthropods, of a parasitic nature. It is a complex and challenging problem that impacts healthcare, the pest management industry, state-led agriculture and health agencies, Extension professionals, and academia because of time burdens and frustration associated with interactions. To address the handling of suspected DP cases, we assembled a University of Tennessee One Health Initiative Working Group with individuals representing diverse disciplines and professions. The Working Group developed and conducted an online needs assessment of pest management, Extension, and health professionals to (i) understand their interactions with suspected DP cases and (ii) determine the educational resources used and needed. Of the pest management professionals and Extension personnel, 72.7% (n = 112) of the respondents indicated they had encountered someone with suspected DP within the last year. Those responding to suspected DP cases spent significantly more time and interactions than what was required for general inquiries. Seventy-three percent of respondents received specimens of which more were human derived (54.4%) than nonhuman derived (41.5%), potentially putting these nonhealthcare professionals at risk of potential contagion. We confirmed a lack of available resources, including protocols, training materials, and resources for expert medical referrals. Additionally, the staff responsible for handling these cases were concerned for their safety. After identifying the most pressing needs, the One Health Working Group members collaborated to produce comprehensive resources to assist professionals in identifying DP cases more quickly and efficiently routing them to essential care.

Entrustable Professional Activities for the Training of Postgraduate Primary Care Pediatricians.

Competency-based training is a model of medical education program that uses an organized framework of competencies to develop entrustable professional activities (EPAs) for each specialty. Implementation of EPAs varies by medical specialty and country. Although national models for primary care pediatrics have been suggested in the past, standardized EPAs have not been established. The authors, all members of the curriculum working group of the European Confederation of Primary Care Paediatricians, describe the development and design of a training model based on EPAs specifically for pediatricians in primary care. The objective was to facilitate and disseminate a training model that standardizes and improves training in primary care pediatrics. They aimed to make the model flexible enough so that it can be adapted to different training models and different European health systems. Between May 2017 and December 2019, the authors developed a framework that includes 7 domains of competencies for the training in pediatric primary care and a set of 11 core EPAs to guide the learning process. They structured each EPA as follows: title, activity profile, domains of competence, competencies within each domain, required knowledge and skills, learning objectives described in terms of outcomes, and a 3-stage rating supervision scale to evaluate the level of performance. The next step is the progressive implementation of these EPAs into the postgraduate primary care pediatrics training programs of European health systems. To support this implementation, the authors intend to develop training videos to assist in daily teaching of the EPAs. The authors will also develop a pan-European online resident forum designed specifically to facilitate EPA learning by sharing and discussing clinical cases. They plan to launch a pilot study on the use of the EPAs in primary care health centers in 6 European countries.

COGNITIVE DECLINE PUBLIC HEALTH SURVEILLANCE: EXPERT-GUIDED COLLABORATION FOR BRFSS MODULE REVISION

Abstract The Behavioral Risk Factor Surveillance System (BRFSS) Cognitive Decline Module collects population level data on subjective cognitive decline (SCD) — self-reported difficulties in thinking or memory — which can be one of the earliest warning signs of dementia. Originally devised in 2009, the module undergoes periodic revision to ensure it remains current, the data collected are actionable, and to encourage uptake of the module by state health agencies. In 2021, the Alzheimer’s Association and the Centers for Disease Control and Prevention’s Alzheimer’s Disease Program formed an expert workgroup to examine the ongoing value and relevance of the module and propose any improvements. Workgroup members included researchers, chronic disease directors, epidemiologists, survey methodologists, policy analysts, and BRFSS coordinators. Using a consensus-building process, the workgroup utilized pre-meeting worksheets to identify areas of agreement and disagreement which informed key debates during subsequent meetings. Among many factors, the workgroup assessed the existing module for accuracy and utility. Discussion centered on aligning language and concepts contained within the module’s questions with current scientific research on SCD and how to accurately and adequately assess the associated burden SCD imposes. People living with cognitive impairment were consulted during the revision process to ensure phrasing reflected their lived experience. The result was a consensus set of suggested revisions to the Cognitive Decline Module, submitted to CDC for review and approval. The robust process, involving a variety of stakeholders and perspectives, can serve as an efficient and effective model for ensuring the longevity and usefulness of population health surveillance.

Training and competency assessment of Clinical Embryologists and licensing of the profession in European countries.

How is the acquisition and testing of theoretical and practical knowledge in Clinical Embryology and the licensing of ART laboratory personnel carried out in European countries? Twelve out of 31 European countries have established some kind of verification of laboratory competency and skills in ART: in 7 countries, this was related to licensing, but where organized education for Clinical Embryologists existed, there were vast differences in the way these processes were undertaken. In 2015, a report by the ESHRE Embryology Certification Committee concluded that regardless of the large number of people working in IVF laboratories, Clinical Embryology was only recognized as an official profession in 3 out of 27 European national health systems. In most countries, Clinical Embryologists needed to be officially registered under an alternative profession and there were limited opportunities for organized education in this specialist field. Five years after this report, the ESHRE Working Group on Embryologist Training Analysis conducted a survey to collect detailed information about how Clinical Embryologists from different European countries are acquiring their theoretical knowledge and practical skills in ART, and how their level of education and competence in Clinical Embryology is verified. Two questionnaires about the possibilities for acquiring the education and training needed to work in ART and verification of this knowledge were prepared by the ESHRE Working Group on Embryologist Training Analysis. The first was sent in 2020 to a panel of invited lead European Embryologists who attended an Expert Meeting held in Rome, Italy. In order to have a more comprehensive and updated picture, in 2021 the same survey was also sent to the ESHRE Committee of National Representatives (CNRs). At the end of 2021, the second survey with specific questions, more focused on Clinical Embryologists' training and licencing, was sent to the CNRs who reported on verification of education in Clinical Embryology. The first survey consisted of 17 questions. It was initially submitted to 14 lead Embryologists and then resubmitted to the 34 ESHRE CNRs. Representatives from 31 countries responded. A second survey with 23 questions was sent to the 12 ESHRE CNRs who reported an established national system of verification of education in Clinical Embryology, with specific questions focused on the training of Clinical Embryologists. All 12 CNRs responded. Analysis showed that European national education programmes in Clinical Embryology could be split into 4 categories: non-existent (13 countries), recommended (5 countries), simple compulsory (9 countries), and complex compulsory (4 countries). A national document stating the minimum education requirements for staff to work in an IVF laboratory was reported by 19 respondents. The requirement to follow a prescribed theoretical and laboratory training programme in ART was compulsory in 9 and 10 countries, respectively. Some form of verification of laboratory skills, theoretical knowledge in ART, and continuing professional development was required in 12, 10, and 9 countries, respectively. A national trainee's logbook format was reported by seven respondents and a national tutorial system was available in six countries. Only seven countries had official licensing of ART laboratory staff. The title of Clinical Embryologist was not recognized in 13 countries and in 6 countries, it was used only by professional bodies, while in 12 countries the profession was at least cited in governmental regulations. The ESHRE Clinical Embryologist Certificate was officially recognized in eight countries. The survey took place in two steps and the results were then combined to provide a representative picture for most of the European countries sampled. The vast majority, but not all, of the CNRs answered the request to participate in the survey. The professional recognition of Clinical Embryology within Europe is steadily evolving. However, it remains a concern that many countries continue to not recognize Clinical Embryology as a profession, with a vast difference in the reported organization of educational and training programmes and verification of skills. It is recommended that a training programme for Clinical Embryology and ART in Europe should be standardized and relevant issues should be addressed by competent authorities and European Union institutions. ESHRE is best placed to take a leading role in this educational process. The Working Group members who are the authors of this article did not receive payments for the completion of this study. The authors have no conflicts of interest to declare.

Stakeholder insights into implementing a systems-based suicide prevention program in regional and rural Tasmanian communities

PurposeWith emerging evidence indicating that systems-based approaches help optimise suicide prevention efforts, the National Suicide Prevention Trial sought to gather evidence on the appropriateness of these approaches to prevent suicide among at-risk populations, in regional and rural communities throughout Australia. The Tasmanian component of the Trial implemented the LifeSpan systems framework across three distinct rural areas with priority populations of men aged 40–64 and people 65 and over. The University of Tasmania’s Centre for Rural Health undertook a local-level evaluation of the Trial.AimsTo explore key stakeholder perceptions of implementing a systems-based suicide prevention program in regional and rural communities in Tasmania, Australia.MethodThis study utilised qualitative methods to explore in depth, stakeholder perspectives. Focus groups and interviews were conducted with 46 participants, comprising Trial Site Working Group members (n = 25), Tasmania’s Primary Health Network employees (n = 7), and other key stakeholders (n = 14). Approximately half of participants had a lived experience of suicide. Data were thematically analysed using NVivo.ResultsKey themes centred on factors impacting implementation of the Trial. These included how the Trial was established in Tasmania; Working Group governance structures and processes; communication and engagement processes; reaching priority population groups; the LifeSpan model and activity development; and the effectiveness, reach and sustainability of activities.DiscussionCommunities were acutely aware of the need to address suicide in their communities, with the Trial providing resources and coordination needed for community engagement and action. Strict adherence to the Lifespan model was challenging at the community level, with planning and time needed to focus on strategies influencing whole or multiple systems, for example health system changes, means restriction. Perceived limitations around implementation concerned varied community buy-in and stakeholder engagement and involvement, with lack of role clarity cited as a barrier to implementation within Working Groups. Barriers delivering activities to priority population groups centred around socio-cultural and technological factors, literacy, and levels of public awareness. Working Groups preferred activities which build on available capital and resources and which meet the perceived needs within the whole community. Approaches sought to increase awareness of suicide and its prevention, relationships and partnerships, and the lived experience capacity in Working Groups and communities.ConclusionStakeholder insights of implementing the National Suicide Prevention Trial in regional and rural Tasmanian from this study can help guide future community-based suicide prevention efforts, in similar geographic areas and with high-risk groups.

Ritual Rules in Changing Circumstances: Break, Adapt or Maintain? An Introduction

This issue gathers some of the works presented by the members of the Ritual Year Working Group during the 15th Congress of the International Society for Ethnology and Folklore (SIEF) in Helsinki in June 2021. As the general theme of this congress was “Breaking the Rules? Power, Participation, Transgression”, most of the articles stick to this question and try to understand the relationship between rituals and (the breaking of) social rules. The authors address the major problem from several perspectives: the regulations for performing traditional rituals and the reasons for violating them; ritual behaviour on certain dates when the social norms, the hierarchies, and the gender roles are turned upside down; modification of the ritual year recommendations according to the new environment in emigration; etc. Transgression is seen as breaking the traditional foundations and also as a transition from real performance to virtual participation. And, as in June 2021 the entire world was subjected to the rules of COVID-19, some articles in particular attempt to address the pandemic’s impact on ritual sociability worldwide.

A New Phen X Collection: Sickle Cell Disease Psychosocial and Social Determinants of Health Protocols

Background: The PhenX (Phenotypes and eXposures) Toolkit (https://www.phenxtoolkit.org) is a web-based catalog of recommended measurement protocols and associated bioinformatics tools to assist with study design and facilitate cross-study data integration and analyses. The PhenX Toolkit currently includes measurement protocols from 29 research domains (e.g., Rare Genetic Conditions) and six collections that add depth to the Toolkit (e.g., Blood Sciences Research) and has over 4,200 registered users. Although an established resource that continues to expand content for investigators, the PhenX Toolkit does not currently contain measurement protocols specific to Sickle Cell Disease (SCD) Psychosocial or Social Determinants of Health (SDoH) outcomes. These outcomes were identified as key indicators by the National Academies of Sciences, Engineering and Medicine 2020 Report "Addressing Sickle Cell Disease: A Strategic Plan and Blueprint for Action.” This effort is supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) through co-funding to the "PhenX Toolkit-Expansion and Sustainability” project award. Methods: PhenX protocols are recommended by domain experts using a consensus-based process that includes scientific community input. To identify protocols for the new collection, the PhenX SCD Research and Scientific Panel (SRSP) provided a list of scope elements for consideration and selected investigators with relevant expertise in psychology, behavioral science, hematology, and nursing to form a Psychosocial and SDoH Working Group (WG). A modified Delphi process was used to develop consensus on the topics and protocols. A set of 18 scope elements was initially developed and distributed to the WG (round 1). In round 2, preliminary consensus was reached on 12 topics via a virtual WG meeting. In round 3, WG members virtually presented background and recommendations for measurement protocols for the 12 topics and discussed these and other related protocols already included in the PhenX Toolkit. Consensus was reached on 12 primary protocols to move to the next phase, community outreach. Preliminary protocols will be shared with the scientific community for a 2-week period in which the community will have the opportunity to review and comment on the proposed protocols. The Psychosocial and SDoH WG will consider the outreach feedback in selecting final protocols to include in the SCD Research Collections. Results: The 12 measurement protocols recommended to-date include transition readiness (e.g., Sickle Cell Transition Intervention Program - Readiness for Transition (TIP-RFT)), self-management, impact of early aging (e.g., reactions to loss), stigma, trust in medical care and research, resilience, spirituality, and responses to stress. Some measures include multiple versions (e.g., parent/caregiver, child, adolescent, adult). Another 7 protocols were suggested as appropriate for supplemental information for this collection (e.g., American Society of Hematology Sickle Cell Disease Transition Readiness Assessment). Conclusion: This presentation will review the outreach data and the final recommendations of the WG and SRSP. These additional protocols will enhance the existing SCD Research Collections and the individual and structural SDoH protocols in the PhenX Toolkit. Furthermore, these recommendations will promote the use of valid and reliable measurement tools to investigate psychosocial constructs and social determinants of health in SCD. Funding was provided by a Genomic Research Grant (U41HG007050) from NHGRI, with current or prior funding support from the National Institute on Drug Abuse (NIDA); Office of Behavioral and Social Sciences Research (OBSSR); National Institute of Mental Health (NIMH); National Heart, Lung, and Blood Institute (NHLBI); National Institute on Minority Health and Health Disparities (NIMHD); and Tobacco Regulatory Science Program (TRSP).

Establishing Covid-19 Research in UK Care Homes – Infrastructure Challenges for Trial Design

Abstract Background The Covid-19 pandemic brought into sharp relief the role that long-term care facilities play in health and social care of an aging population. It also cast a spotlight upon the need for high-quality research to assess the effectiveness of any care home interventions. The Prophylactic Therapies in Care Homes (PROTECT-CH) trial was one such study (funded by the UK National Institute for Health and Care Research). PROTECT-CH was designed to collect data in 200 care homes (approximately 6,400 residents), and whilst the changing epidemiology of Covid-19 in the UK (due to vaccination take-up) made this unfeasible other insights were gained about establishing large-scale research in care homes. Methods An iterative process evaluation of the set-up phase of a large, platform trial testing prophylactic measures in long-term care facilities. Including a documentary review of the PROTECT-CH working groups and an online survey of working group members. Results Documents were reviewed from 24 working groups, which in a hub and spoke model represented the PROTECT-CH trial infrastructure; representative of 20 of these groups completed an online survey about their organisation and working. Data demonstrated the number and organisation of individuals required to set up a large-scale care-home trial - 91 individuals representing a mix of academic, clinical, and methodological contributions from 25 organisations. Data demonstrated working groups specific to care home research, and activities designed to address the specific challenges of researching in care homes. PROTECT-CH produced dedicated training materials and reporting templates for care home research. PROTECT-CH established novel mechanisms for prescribing and clinical oversight in care home research. Conclusions PROTECT-CH has highlighted the complexity of establishing large, scale RCT research in long-term care facilities. It has produced resources which might be of use in subsequent care home research. Key messages • Infrastructure is required to support high quality research in long-term care facilities. • RCTs in long-term care facilities pose specific challenged to researchers.

From co-design to co-production: Approaches, enablers, and constraints in developing a public health, capacity-building solution.

Investigating how co-designed knowledge can be translated to co-produce a public health capacity-building solution for difficult-to-engage population groups drawing on the co-production experience of a prevention-focused, capacity-building mental health solution targeting primary producers. A qualitative study undertaken in rural and regional Victoria involving members of the design working group including project team (7px), digital design team (5px), marketing team (3px), and funding partner representatives. The study design involved reflective practice to collect data to identify the phases of co-production and assess the design working group members' experiences. The analysis involved inductive coding using Braun and Clarke's thematic analysis. Identifying major points of divergence and/or convergence; enablers and/or constraints; and ways to better navigate and strengthen the co-production process. Given members of the design working group, diverse skills sets divergence was experienced in all co-production phases. Divergence was also experienced between the project team and the funding partner given the uniqueness of working conditions and requirements of workers in the primary production industry. The project team applied an iterative development process to project management; encouraging iterative cycles to create/test/revise among the teams, and with the funding partner, until each was satisfied with the end result (convergence). When developing a co-created public health prevention campaign it is critical that the project team focuses on relationship building among the members of the design working group and ensures adequate resourcing, development of shared understanding of project goals and target audience, ongoing communication, and a commitment to working iteratively.

Canadian Rheumatology Association Recommendations for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis.

To develop Canadian recommendations for the screening, monitoring, and treatment of uveitis associated with juvenile idiopathic arthritis (JIA). Recommendations were developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach. A working group of 14 pediatric rheumatologists, 6 ophthalmologists, 2 methodologists, and 3 caregiver/patient representatives reviewed recent American College of Rheumatology (ACR)/Arthritis Foundation (AF) recommendations and worked in pairs to develop evidence-to-decision (EtD) tables. A survey to assess agreement and recommendations requiring group discussion was completed. EtD tables were presented, discussed, and voted upon at a virtual meeting, to produce the final recommendations. A health equity framework was applied to all aspects of the adolopment process including the EtD tables, survey responses, and virtual meeting discussion. The survey identified that 7 of the 19 recommendations required rigorous discussion. Seventy-five percent of working group members attended the virtual meeting to discuss controversial topics as they pertained to the Canadian environment, including timing to first eye exam, frequency of screening, escalation criteria for systemic and biologic therapy, and the role of nonbiologic therapies. Equity issues related to access to care and advanced therapeutics across Canadian provinces and territories were highlighted. Following the virtual meeting, 5 recommendations were adapted, 2 recommendations were removed, and 1 was developed de novo. Recommendations for JIA-associated uveitis were adapted to the Canadian context by a working group of pediatric rheumatologists, ophthalmologists with expertise in the management of uveitis, and parent/patient input, taking into consideration cost, equity, and access.

Drug allergy: A 2022 practice parameter update

Drug allergy: A 2022 practice parameter update

Answers to common questions about COVID-19 vaccines in children with cancer.

BackgroundThe SARS‐CoV‐2 outbreak in 2020 evolved into a global pandemic, and COVID‐19 vaccines became rapidly available, including for pediatric patients. However, questions emerged that challenged vaccine acceptance and use. We aimed to answer these questions and give recommendations applicable for use in pediatric patients with cancer by healthcare professionals and the public.MethodsA 12‐member global COVID‐19 Vaccine in Pediatric Oncology Working Group made up of physicians and nurses from all world regions met weekly from March to July 2021. We used a modified Delphi method to select the top questions. The Working Group, in four‐member subgroups, answered assigned questions by providing brief recommendations, followed by a discussion of the rationale for each answer. All Working Group members voted on each recommendation using a scale of 1 to 10, 10 being complete agreement. A “pass” recommendation corresponded to an agreement ≥7.5.ResultsWe selected 15 questions from 173 suggested questions. Based on existing published information, we generated answers for each question as recommendations. The overall average agreement for the 24 recommendations was 9.5 (95% CI 9.4–9.6).ConclusionTop COVID‐19 vaccine‐related questions could be answered using available information. Reports on COVID‐19 vaccination and related topics have been published at record speed, aided by available technology and the priority imposed by the pandemic; however, all efforts were made to incorporate emerging information throughout our project. Recommendations will be periodically updated on a dedicated website.

Development of a qualitative data analysis codebook informed by the i-PARIHS framework

BackgroundThe Integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and its predecessor, PARIHS, have been widely utilized in implementation studies. Although i-PARIHS developers have focused on creating tools to guide facilitators in its application in practice, tools are also needed for evaluation and research. Codebooks with clear and meaningful code labels and definitions are an important component of qualitative data analysis and have been developed for other widely used frameworks. There is no such codebook for i-PARIHS. Additionally, sub-constructs for the Innovation, Recipients, and Context constructs lack definitions, and there is no sub-classification of facilitation activities for the Facilitation construct. The lack of a standardized codebook hinders our ability to synthesize research findings across studies, explore and test the range of activities that are utilized in facilitation efforts, and potentially validate and further refine i-PARIHS. This paper describes a rigorous process of developing a detailed qualitative codebook informed by the i-PARIHS framework.MethodsA workgroup of qualitative researchers conducted a rigorous four-phase process to develop a codebook informed by i-PARIHS. In phase 1, workgroup members reviewed and discussed literature, consulted an organizational scientist, and drafted and refined subcodes and definitions for i-PARIHS constructs. In phase 2, they obtained feedback from an expert panel and further refined subcodes and definitions. In phase 3, they obtained feedback from i-PARIHS developers/experts and incorporated it into the codebook. Finally, two studies piloted the application of the codebook which informed the final version.ResultsThe resulting i-PARIHS-informed codebook includes definitions for the four main constructs of the framework: Innovation, Recipients, Context, and Facilitation; subcodes and definitions for characteristics of each of these constructs; and instructions for the suggested application of individual codes and use of the codebook generally.ConclusionsThe standardized codes and definitions in the codebook can facilitate data exploration, pattern identification, and insight development informed by the i-PARIHS framework. Qualitative analysts can also use them to explore interactions between i-PARIHS constructs, maximize the potential for comparing findings across studies, and support the refinement of the i-PARIHS framework using empirical findings from multiple studies.

Clinico-epidemiological profile of COVID-19 patients admitted during third wave of pandemic in a tertiary care hospital in New Delhi, India.

Even nearly two years after the first reported case, the novel coronavirus (SARS-CoV-2) continues to ebb and flow around the world. A retrospective cohort study was carried out to determine the clinico-epidemiological profile and outcome of the cases. The study analyzed secondary data from 827 patients who presented to our center with COVID-19-related illnesses between December 15, 2021, and February 15, 2022 (third wave in India). There was a significant difference in the vaccination status of patients treated at home and those admitted, with 87.9% having received two doses compared to 74% in the second group being unvaccinated. Patients who were isolated at home recovered at a rate of 99.4%, while hospitalized patients died at a rate of 26.5%. Vaccination reduces the severity of COVID-19; however, constant vigilance for new variants, precautionary measures, and increased vaccination drives are critical moving forward. *Other members of the Safdarjung Hospital COVID-19 working group: B. Lal (Medicine), Harish Sachdeva (Anaesthesiology), Santvana Kohli (Anaesthesiology), Amandeep Jaswal (Anaesthesiology), Sumitra Bachani (Obstetrics and Gynecology), Ajay Kumar (Pediatrics), Rohit Kumar (Pulmonary Medicine), Vidya Sagar Chaturvedi (Surgery), Vinod Chaitanya (Medicine).

Using an Annual Diversity, Equity and Inclusion Dashboard to Accelerate Change in Academic Radiology Departments

Despite widespread interest in creating a more equitable and inclusive culture, a lack of workforce diversity persists in Radiology, in part due to a lack of universal and longitudinal metrics across institutions. In an attempt to establish benchmarks, a subset of the Society of Chairs of Academic Radiology Departments (SCARD) Diversity, Equity and Inclusion (DEI) Committee volunteered to design a DEI dashboard as a potential tool for academic radiology programs to use to document and track their progress. This freely-available, modular dashboard includes suggested (plus optional department-defined) DEI activities/parameters and suggested assessment criteria across three domains: faculty, residents & fellows, and medical students; it can be completed, in whole or in part, by departmental leaders annually. The suggested metrics and their associated rubrics were derived from the collective experiences of the five working group members, all of whom are chairs of academic radiology departments. The resulting dashboard was unanimously approved by the remaining 14 DEI committee members and endorsed by the SCARD board of directors.

A large-scale retrospective analysis of copy number variations in single center using ACMG-ClinGen latest guidelines

Through a retrospective large sample analysis of copy number variants in single center, we explored the technical standards for the interpretation and reporting of constitutional copy-number variants (CNVs) jointly proposed by the American College of Medical Genetics and Genomics (ACMG) and the Clinical Genome Resource (ClinGen) in 2019, analyzing its impact on CNVs ratings and the improvement in the consistency of the classification of CNVs in clinical laboratories. 236 CNVs that assessed as pathogenic, uncertain significant (including likely pathogenic, uncertain and likely benign) by the 2011 ACMG guidelines between August 2018 and December 2019 in our center were re-analyzed. Four working group members of the center reclassified and evaluated 235 CNVs according to 2019 ACMG guidelines. The consistency of clinical significance classification of CNVs was 91% and the α test coefficient was 0.98 among four working group members. Compared with the 2011 and 2019 ACMG technical standards for the CNVs classification, evaluation of pathogenicity and uncertain significant is basically consistent. 90% (45/50) of likely pathogenic and likely benign CNVs were Re-evaluated as variants of uncertain significance, and the difference is significant. The new version ACMG/ClinGen guidelines for the evaluation of CNVs developed semi-quantitative point-based scoring system and help to improve the consistency in clinical classifications. It can also make the interpretation of CNVs more standardized and transparent.

Engaging frontline workers in policy development to support the implementation of measurement-based care: Lessons learned from a field-based workgroup.

Measurement-Based Care (MBC) is the use of patient-reported outcome measures repeatedly over the course of treatment to track progress and empower both providers and patients to collaboratively set goals and plan treatment. The Measurement-Based Care in Mental Health Initiative within the Department of Veterans Affairs' Office of Mental Health and Suicide Prevention partnered with the Post Traumatic Stress Disorder (PTSD) Mentoring Program to create an interdisciplinary field-based workgroup. The workgroup included psychologists, clinical social workers, and mental health counselors from PTSD Clinical Teams. The task of the workgroup was to create guidelines for best practice in delivery of MBC in PTSD Clinical Teams given anticipated policy requiring MBC to be used in PTSD Clinical Teams. Framed in the Strategic Action Field Framework for Policy Implementation Research, the current paper evaluates this hybrid top-down and bottom-up process of policy development. Major barriers included difficulty with the workgroup as an authentic bottom-up process, inability to reach the entire field (e.g., focus groups not widely attended by providers), and limited diversity in the workgroup. Facilitators included using consensus to make decisions, support provided to workgroup members by national operations partners, and collaboration and mutual respect among workgroup members. Workgroup members noted an equal, respectful partnership between operations partners and the workgroup; they reported feeling empowered and believed the viewpoints of the field were included in the guidelines. Further, due to the COVID-19 pandemic, the workgroup included more guidelines specific to telehealth into the guidelines. This hybrid model provides a process through which frontline workers can inform policy development and implementation.