Automated data collection tool for real-world cohort studies of chronic hepatitis B: Leveraging OCR and NLP technologies for improved efficiency

Background

Collecting and standardizing clinical research data is a very tedious task. This study is to develop an intelligent data collection tool, named CHB-EDC, for real-world cohort studies of chronic hepatitis B (CHB), which can assist in standardized and efficient data collection.

Methods

CHB_EDC is capable of automatically processing various formats of data, including raw data in image format, using internationally recognized data standards, OCR, and NLP models. It can automatically populate the data into eCRFs designed in the REDCap system, supporting the integration of patient data from electronic medical record systems through commonly used web application interfaces. This tool enables intelligent extraction and aggregation of data, as well as secure and anonymous data sharing.

Results

For non-electronic data collection, the average accuracy of manual collection was 98.65 %, with an average time of 63.64 min to collect information for one patient. The average accuracy CHB-EDC was 98.66 %, with an average time of 3.57 min to collect information for one patient. In the same data collection task, CHB-EDC achieved a comparable average accuracy to manual collection. However, in terms of time, CHB-EDC significantly outperformed manual collection (p < 0.05). Our research has significantly reduced the required collection time and lowered the cost of data collection while ensuring accuracy.

Conclusion

The tool has significantly improved the efficiency of data collection while ensuring accuracy, enabling standardized collection of real-world data.

Common misconceptions and good practices in qualitative research in school psychology

After a long journey in relative obscurity, qualitative research is being accepted in the field of school psychology. As more school psychology researchers and graduate students adopt it as part of their scholarly endeavors, we reflect on the qualitative research published in school psychology since 2006 in terms of what has been done so far and what can be improved going forward. This act of academic retrospection can strengthen qualitative research in school psychology by helping to identify areas of strength and weakness. We read all qualitative studies published in seven school psychology journals between 2006 and 2021 to understand their methodological character. In Section I, we discuss the methodological trends (e.g., approach to inquiry, data collection methods, data analysis strategies) we found. In Section II, we reflect upon this corpus and identify some common misconceptions about qualitative methodologies that stood out to us. We clarify these misconceptions and highlight some examples of 'good' practices in these articles that could be adopted by other researchers. Finally in Section III, we provide some general recommendations about developing school psychologists' understanding of and the ability to conduct qualitative research.

Development and validation of an open-source pipeline for automatic population of case report forms from electronic health records: a pediatric multi-center prospective study

BACKGROUND

Clinical trials and registry studies are essential for advancing research and developing novel treatments. However, these studies rely on manual entry of thousands of variables for each patient. Repurposing real-world data can significantly simplify the data collection, reduce transcription errors, and make the data entry process more efficient, consistent, and cost-effective.

METHODS

We developed an open-source computational pipeline to collect laboratory and medication information from the electronic health record (EHR) data and populate case report forms. The pipeline was developed and validated with data from two independent pediatric hospitals in the US as part of the Long-terM OUtcomes after Multisystem Inflammatory Syndrome In Children (MUSIC) study. Our pipeline allowed the completion of two of the most time-consuming forms. We compared automatically extracted results with manually entered values in one hospital and applied the pipeline to a second hospital, where the output served as the primary data source for case report forms.

FINDINGS

We extracted and populated 51,845 laboratory and 4913 medication values for 159 patients in two hospitals participating in a prospective pediatric study. We evaluated pipeline performance against data for 104 patients manually entered by clinicians in one of the hospitals. The highest concordance was found during patient hospitalization, with 91.59% of the automatically extracted laboratory and medication values corresponding with the manually entered values. In addition to the successfully populated values, we identified an additional 13,396 laboratory and 567 medication values of interest for the study.

INTERPRETATION

The automatic data entry of laboratory and medication values during admission is feasible and has a high concordance with the manually entered data. By implementing this proof of concept, we demonstrate the quality of automatic data extraction and highlight the potential of secondary use of EHR data to advance medical science by improving data entry efficiency and expediting clinical research.

FUNDING

NIH Grant 1OT3HL147154-01, U24HL135691, UG1HL135685.

Response is increased using postal rather than electronic questionnaires - new results from an updated Cochrane Systematic Review

BACKGROUND

A decade ago paper questionnaires were more common in epidemiology than those administered online, but increasing Internet access may have changed this. Researchers planning to use a self-administered questionnaire should know whether response rates to questionnaires administered electronically differ to those of questionnaires administered by post. We analysed trials included in a recently updated Cochrane Review to answer this question.

METHODS

We exported data of randomised controlled trials included in three comparisons in the Cochrane Review that had evaluated hypotheses relevant to our research objective and imported them into Stata for a series of meta-analyses not conducted in the Cochrane review. We pooled odds ratios for response using random effects meta-analyses. We explored causes of heterogeneity among study results using subgroups. We assessed evidence for reporting bias using Harbord's modified test for small-study effects.

RESULTS

Twenty-seven trials (66,118 participants) evaluated the effect on response of an electronic questionnaire compared with postal. Results were heterogeneous (I-squared = 98%). There was evidence for biased (greater) effect estimates in studies at high risk of bias; A synthesis of studies at low risk of bias indicates that response was increased (OR = 1.43; 95% CI 1.08-1.89) using postal questionnaires. Ten trials (39,523 participants) evaluated the effect of providing a choice of mode (postal or electronic) compared to an electronic questionnaire only. Response was increased with a choice of mode (OR = 1.63; 95% CI 1.18-2.26). Eight trials (20,909 participants) evaluated the effect of a choice of mode (electronic or postal) compared to a postal questionnaire only. There was no evidence for an effect on response of a choice of mode compared with postal only (OR = 0.94; 95% CI 0.86-1.02).

CONCLUSIONS

Postal questionnaires should be used in preference to, or offered in addition to, electronic modes.

Disseminating Methods in Nursing Research

Research methods papers are a valuable resource to researchers and clinicians that highlight novel yet effective methodologies and approaches to conducting research. Clinicians can use the knowledge generated from unique research methods to conduct quality, evidence-based practice, and quality improvement projects, and nurse researchers can benefit from the lessons learned by others to improve the rigor of future studies. This paper defines research methods papers, provides an overview of their importance, including examples from the literature, and highlights important considerations when writing and disseminating the findings of research methods.

Exploring non-iterative time trade-off methods for valuation of EQ-5D-5L health states

INTRODUCTION

The composite time trade-off (cTTO) method is used as the primary method for valuing EQ-5D-5L health states, but it requires intensive interviewer training and stringent quality control, which increases the burden of conducting cTTO studies. In this study, two non-iterative variants of the TTO method, non-stopping TTO (nTTO) and open-ended TTO (oTTO), were tested head-to-head with the cTTO method aiming to reduce the administration burden.

METHODS

31 EQ-5D-5L health states from an orthogonal array was selected and valued by a general public sample in China. Data were collected by 7 interviewers with all interviewers performed an equal number of interviews using all three TTO methods. We compared the value distribution, logical consistency, administration burden, and modeling performance of these three TTO methods.

RESULTS

In total, 422 participants participated in the valuation interviews, with 139 using the nTTO method, 140 using the oTTO method, and 143 using the cTTO method. Both oTTO and nTTO methods saved around 10 min for conducting an interview. The mean values of three methods were similar with each method showed different characteristics in their value distributions. cTTO outperformed the other two methods in terms of modeling performance.

DISCUSSION

Both non-iterative TTO methods showed potential for valuing EQ-5D health states, although their data distributions and modeling performance were inferior to the cTTO method. The results of this study showed the potential of these two alternative non-iterative TTO methods.

[Transfemoral amputation due to uncontrollable infections after implantation of a total knee endoprosthesis]

INTRODUCTION

In the evaluation of an internal analysis of data on the increased effort for nursing during rehabilitation of patients with amputations in the Baumrainklinik of the HELIOS Rehabilitation Center Bad Berleberg, the number of patients with transfemoral amputations (TFA) due to uncontrollable multiple infections after implantation of a total knee endoprosthesis (total knee arthroplasty, TKA) was clearly emphasized.

OBJECTIVE

This article discusses the results of a retrospective, patient-controlled trial (PCT) and compares these with the data of the German Endoprosthesis Registry (EPRD). The study concentrated on patients who were admitted to rehabilitation after a TFA due to an uncontrollable infection after implantation of a knee TKA. The primary aims were the identification of patients who developed an uncontrollable infection after TKA with subsequent TFA and the comparison with national and international revision and amputation rates after TKA.

METHOD

An analysis of the medical history questionnaire was carried out for all 787 patients with amputation of the lower extremities who underwent rehabilitation in the time period from 1st January 2007 to 31st December 2015. The patient records were systematically analyzed based on the standardized documentation methods of the medical and nursing personnel using the Barthel index, the activity/function classes, phantom pain and length of stay, including demography, infection history and insurance company.

RESULTS

The analysis showed that 10 patients, 2.29% of all TFA, suffered the loss of a lower extremity due to an uncontrollable TKA infection. The revision rate 3 years after primary TKA in Germany is 3.0% (EPRD annual report 2023), whereas values of 1-4% are given in the international literature (status 2020). In the patient group of the EPRD, in 2022 revision surgery was necessary due to an infection in 15.0% of the cases. The current statistics of the EPRD (annual report 2023) show that 3 years after the initial revision surgery due to an infected TKA another revision was necessary in 23.5-30% of cases.

CONCLUSION

These numbers are alarming and should be critically evaluated and monitored. The future aim is to identify the causes of infections, systematic errors in the TKA and the pathogens that lead to infections after TKA and to correlate the associations.

[DIVERGesTOOL-development of a toolbox for the assessment of sex/gender diversity]

In health research, there is a need for comprehensive survey instruments capable of assessing the multidimensionality and variability of sex/gender. The research project DIVERGesTOOL was conducted in response to this need, which has become increasingly evident in recent years. The aim was to develop an application-oriented toolbox for the assessment of sex/gender diversity in quantitative health-related research in Germany.The development process followed a participatory design, as representatives of large epidemiological studies in Germany were directly involved. During four collaborative workshops, a toolbox was developed that contains several different elements. The basic items are a generally usable set of three different questionnaire items based on the two-step approach. They are recommended as a replacement for the binary sex or gender item that are currently routinely used in health-related research. In addition, the toolbox contains further exemplary questionnaire items for specific research questions or study populations. The developed items were supplemented with detailed instructions for their application and additional information. The toolbox is an open online resource accessible to any user ( https://www.uni-bremen.de/divergestool-projekt/divergestool-toolbox ).In the long term, the DIVERGesTOOL is intended to support researchers in integrating sex/gender diversity into their own research and thus to contribute to more sex/gender sensitivity in health-related research and valid findings.

Technical article: Overview of hospital-based data capture systems that acquire continuous ECG and physiologic data

Data capture systems that acquire continuous hospital-based electrocardiographic (ECG) and physiologic (vital signs) data can foster robust research (i.e., large sample sizes from consecutive patients). However, the application of these systems and the data generated are complex and requires careful human oversight to ensure that accurate and high quality data are procured. This technical article will describe two different data capture systems created by our research group designed to examine false alarms associated with alarm fatigue in nurses. The following aspects regarding these data capture systems will be discussed: (1) history of development; (2) summary of advantages, challenges, and important considerations; (3) their use in research; (4) their use in clinical care; and (5) future developments.

Incidence of public health surveillance-reported Clostridioides difficile infections in thirteen countries worldwide: A narrative review

Clostridioides difficile infection (CDI) is an important cause of morbidity and mortality worldwide. Data from public health surveillance systems are important for estimating country-level CDI burden. CDI surveillance can be population-based or hospital-based. Population-based surveillance results in overall estimates of CDI incidence (cases per 100,000 population-per-year), and hospital-based surveillance results in estimates of hospital-based CDI incidence (cases per 10,000 patient-days) or CDI admission rates (cases per 1,000 admissions). We sought to better understand temporal trends in CDI incidence reported in publicly available surveillance data worldwide and describe varying surveillance methods. We identified 13 countries in Europe, North America, and Oceania with publicly available population-based and/or hospital-based CDI surveillance data in online reports and/or dashboards. Additional countries in Europe, in particular, also conduct hospital-based CDI surveillance. Inconsistent CDI case definitions and surveillance approaches between countries limit the interpretability of multi-country comparisons. Nonetheless, publicly available CDI surveillance data enabled us to compare CDI incidence among countries with population-based and/or hospital-based surveillance systems and to describe trends in CDI incidence within countries over time. The highest CDI incidence is in the United States. While there have been recent declines in CDI incidence in all countries, the CDI burden remains high, and the need persists for CDI prevention strategies in communities and healthcare settings.

Institution-Wide Retreats Foster Organizational Learning and Action at a Comprehensive Cancer Center

Providing safe and informed healthcare for sexual and gender minority (SGM) individuals with cancer is stymied by the lack of sexual orientation and gender identity (SOGI) data reliably available in health records and by insufficient training for staff. Approaches that support institutional learning, especially around sensitive topics, are essential for hospitals seeking to improve practices impacting patient safety and research. We engineered annual institutional retreats to identify and unify stakeholders, promote awareness of gaps and needs, identify initiatives, minimize redundant projects, and coordinate efforts that promote improvements in SGM cancer care, education, and research. The 2022 and 2023 retreats employed a 4-h hybrid format allowing virtual and in-person engagement. Retreat organizers facilitated small-group discussions for brainstorming among participants. We performed descriptive statistics from retreat evaluations. The retreats engaged 104 attendees from distinct departments and roles. Participants expressed robust satisfaction, commending the retreat organization and content quality. Notably, the first retreat yielded leadership endorsement and funding for a Quality Improvement pilot to standardize SOGI data collection and clinical staff training. The second retreat provided a platform for updates on focused efforts across the institution and for receiving direction regarding national best practices for SGM care and research. We report the processes and outcomes of institution-wide retreats, which served as a platform for identifying gaps in organizational healthcare practices and research for SGM individuals with cancer. The strategies described herein may be readily scaled at other cancer hospitals seeking to learn and enact system-wide practice changes that support the needs of SGM patients and families.

Comparison and combination of three data sources from patient medical records to determine optimal quantification of postoperative morbidity according to the Clavien Dindo Classification and the Comprehensive Complication Index. A prospective study

INTRODUCTION

It is currently unknown which data sources from the clinical history, or combination thereof, should be evaluated to achieve the most complete calculation of postoperative complications (PC). The objectives of this study were: to analyze the morbidity and mortality of 200 consecutive patients undergoing major surgery, to determine which data sources or combination collect the maximum morbidity, and to determine the accuracy of the morbidity reflected in the discharge report.

METHODS

Observational and prospective cohort study. The sum of all PC found in the combined review of medical notes, nursing notes, and a specific form was considered the gold standard. PC were classified according to the Clavien Dindo Classification and the Comprehensive Complication Index (CCI).

RESULTS

The percentage of patients who presented PC according to the gold standard, medical notes, nursing notes and form were: 43.5%, 37.5%, 35% and 18.7% respectively. The combination of sources improved CCI agreement by 8%-40% in the overall series and 39.1-89.7 % in patients with PC. The correct recording of PC was inversely proportional to the complexity of the surgery, and the combination of sources increased the degree of agreement with the gold standard by 35 %-67.5% in operations of greater complexity. The CDC and CCI of the discharge report coincided with the gold-standard values in patients with PC by 46.8% and 18.2%, respectively.

CONCLUSIONS

The combination of data sources, particularly medical and nursing notes, considerably increases the quantification of PC in general, most notably in complex interventions.

European Board and College of Obstetrics and Gynaecology position statement on maternal mortality surveillance in Europe

Maternal mortality data and review are important indicators of the effectiveness of maternity healthcare systems and an impetus for action. Recently, a rising incidence of maternal mortality in high income countries has been reported. Various publications have raised concern about data collection methods at country level, as this usually relies mainly on national vital statistics. It is therefore essential that the collected data are complete and accurate and conform to international definitions and disease classification. Accurate data and review can only be truly available when an Enhanced Obstetric Surveillance System is in place. EBCOG calls for action by national societies to work closely with their respective ministries of health to ensure that high quality surveillance systems are in place.

Mapping the Clinical Pathway for Patients Undergoing Vestibular Schwannoma Resection

BACKGROUND

The introduction of the electronic health record (EHR) has improved the collection and storage of patient information, enhancing clinical communication and academic research. However, EHRs are limited by data quality and the time-consuming task of manual data extraction. This study aimed to use process mapping to help identify critical data entry points within the clinical pathway for patients with vestibular schwannoma (VS) ideal for structured data entry and automated data collection to improve patient care and research.

METHODS

A 2-stage methodology was used at a neurosurgical unit. Process maps were developed using semi-structured interviews with stakeholders in the management of VS resection. Process maps were then retrospectively validated against EHRs for patients admitted between August 2019 and December 2021, establishing critical data entry points.

RESULTS

In the process map development, 20 stakeholders were interviewed. Process maps were validated against EHRs of 36 patients admitted for VS resection. Operative notes, surgical inpatient reviews (including ward rounds), and discharge summaries were available for all patients, representing critical data entry points. Areas for documentation improvement were in the preoperative clinics (30/36; 83.3%), preoperative skull base multidisciplinary team (32/36; 88.9%), postoperative follow-up clinics (32/36; 88.9%), and postoperative skull base multidisciplinary team meeting (29/36; 80.6%).

CONCLUSIONS

This is a first use to our knowledge of a 2-stage methodology for process mapping the clinical pathway for patients undergoing VS resection. We identified critical data entry points that can be targeted for structured data entry and for automated data collection tools, positively impacting patient care and research.

Using Comics as Data Collection and Training Tools to Understand and Prevent Provider-Enacted HIV Stigma

Comic storyboards that participants co-create can function as generative data collection tools when integrated into interviews or focus groups in a qualitative-rhetorical study. As a preliminary stage of a study, user testing comic storyboards can help ensure that they are generative and participant-informed, the latter being especially important when researching issues related to participant vulnerability, such as stigma. This article discusses the exigency, user testing, adaptation, and affordances of comic storyboards as data collection or story elicitation tools in a study of provider-enacted HIV stigma. Our user testing of comics storyboards enabled us to implement more responsive, participant-centered, and participatory forms of data collection. Given that the goal of this study is to develop anti-stigma provider training materials in the form of comics, participants' contributions through user testing not only helped us improve our data collection in the main study, but also generated input that informed our conceptualization and drafting of provider training comics.

Mapping the Apps: Ethical and Legal Issues with Crowdsourced Smartphone Data using mHealth Applications

More than 5 billion people in the world own a smartphone. More than half of these have been used to collect and process health-related data. As such, the existing volume of potentially exploitable health data is unprecedentedly large and growing rapidly. Mobile health applications (apps) on smartphones are some of the worst offenders and are increasingly being used for gathering and exchanging significant amounts of personal health data from the public. This data is often utilized for health research purposes and for algorithm training. While there are advantages to utilizing this data for expanding health knowledge, there are associated risks for the users of these apps, such as privacy concerns and the protection of their data. Consequently, gaining a deeper comprehension of how apps collect and crowdsource data is crucial. To explore how apps are crowdsourcing data and to identify potential ethical, legal, and social issues (ELSI), we conducted an examination of the Apple App Store and the Google Play Store in North America and Europe to identify apps that could potentially gather health data through crowdsourcing. Subsequently, we analyzed their privacy policies, terms of use, and other related documentation to gain insights into the utilization of users' data and the possibility of repurposing it for research or algorithm training purposes. More specifically, we reviewed privacy policies to identify clauses pertaining to the following key categories: research, data sharing, privacy/confidentiality, commercialization, and return of findings. Based on the results of these app search, we developed an App Atlas that presents apps which crowdsource data for research or algorithm training. We identified 46 apps available in the European and Canadian markets that either openly crowdsource health data for research or algorithm training or retain the legal or technical capability to do so. This app search showed an overall lack of consistency and transparency in privacy policies that poses challenges to user comprehensibility, trust, and informed consent. A significant proportion of applications presented contradictions or exhibited considerable ambiguity. For instance, the vast majority of privacy policies in the App Atlas contain ambiguous or contradictory language regarding the sharing of users' data with third parties. This raises a number of ethico-legal concerns which will require further academic and policy attention to ensure a balance between protecting individual interests and maximizing the scientific utility of crowdsourced data. This article represents a key first step in better understanding these concerns and bringing attention to this important issue.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41649-024-00296-3.

A deep dive into green infrastructure failures using fault tree analysis

Green Infrastructure has transformed traditional urban stormwater management systems by fostering a wide range of service functions. Despite their popularity, green infrastructure's performance can deteriorate over their lifecycle, leading to operational failures. The operation of green infrastructure has predominantly relied on reactive maintenance strategies. To anticipate malfunctions and enhance the performance of green infrastructure in the long run, failure data needs to be recorded so that deterioration processes and component vulnerabilities can be recognized, modelled and included in predictive maintenance schemes. This study investigates possible failures in representative GIs and provides insights into the most important events that should be prioritized in the data collection process. A method for qualitative Fault Tree Analysis using minimal cut sets are introduced, aiming to identify potential failures with the minimum number of events. To identify events of interest fault trees were constructed for bioswales, rain gardens and green roofs, for three groups of service function failures, namely runoff quantity control, runoff quality control and additional service functions. The resulting fault trees consisted of 45 intermediate and 54 basic events. The minimal cut set analysis identified recurring basic events that could affect operation among all three green infrastructure instances. These events are 'trash accumulation', 'clogging due to sediment accumulation', and 'overly dense vegetation'. Among all the possible cut sets, events such as 'plants not thriving', 'invasive plants taking over', and 'deterioration caused by external influences' could potentially disrupt most of the service functions green infrastructure provides. Furthermore, the analysis of interactions between component failures shows vegetation and filter media layer failures have the highest influence over other components. The constructed fault trees and identified basic events could be potentially employed for additional research on data collection processes and calculating the failure rates of green infrastructure and as a result, contribute to a shift toward their proactive operation and maintenance.

Survey Methodology for Data Collection and Analysis in Nutrition and Dietetics Research

This article is part of a series of articles in the Journal of the Academy of Nutrition and Dietetics exploring the importance of research design, epidemiological methods, and statistical analysis as applied to nutrition and dietetics research. The purpose of this ongoing statistical portfolio is to assist registered dietitian nutritionists and nutrition and dietetic technicians, registered with interpreting nutrition research and applying scientific principles to produce high-quality data analysis. A survey is a systematic method for collecting reportable information on a topic of interest. Developing, adapting, and conducting survey research is a complex process; its aim is to collect accurate and useful data for the intended purpose and context. This article, which accompanies a companion article on electronic survey research, is an overview of survey methodology for data collection and analysis in nutrition and dietetics research. Its purpose is to highlight the general principles and components of survey development and survey administration that would maximize the validity of the data obtained. The goal is to provide a practical guide on the design and implementation of a survey as a method for data collection. Supporting figures are provided for use in direct application by practitioners and students.

Injury and illness surveillance monitoring in team sports: a framework for all

BACKGROUND

Sport-related injuries and illnesses can negatively impact athlete welfare at all standards of participation in team sports. Injury and illness surveillance (IIS), and the development of monitoring systems, initiates the sequence of injury and illness prevention. Operational IIS monitoring systems help to appraise epidemiological estimates of injury and illness incidence and burden in various athlete populations. However, the methodological underpinnings of various monitoring systems are not harmonized or widely documented, with the presence of efficient and successful programmes rarely showcased at non-elite levels. The aim is to provide a framework that guides the development of IIS, which will enhance overall surveillance, to indirectly inform injury prevention strategies.

METHODS

The process involved all members of the research group initially discussing the research gaps, scope of the project, and the aims of the article. Unique experiences were shared, and specific and global challenges and barriers to IIS at all standards of team sport participation were identified. A tiered system of data collection with corresponding content were produced, with experiences and guidance provided throughout the article.

RESULTS

The literature has been reviewed and using first-hand experience in conducting IIS programmes in complex and diverse sport settings, the authors have identified key enablers and barriers for best practise as time, technological and human resources, reporter/practitioner training, and medical expertise. Areas of greatest importance regarding the conducting of IIS have been outlined, providing guidance and recommendations across all levels of team sport participation. These areas include definitions, data context, collection procedures, handling, security, ethics, storage, dissemination, quality, compliance, and analysis. Given the barriers to IIS, 3-tiered levels of data collection and content have been proposed. The levels indicate data collection variables, with a focus on sufficiency and achievability, aiming to support the successful conducting of IIS in team sports across all standards of participation. Future opportunities in IIS have been discussed, with several predictive measures and analytical techniques expanded upon.

CONCLUSIONS

The framework provides universal guidance for implementing IIS monitoring systems, facilitating athletes, coaches, parents/guardians, governing bodies and practitioners to implement IIS processes, identify challenges, complete analysis, and interpret outcomes at all standards of participation.

Saturation in qualitative research: An evolutionary concept analysis

Background and Aim

Qualitative research plays an important role in improving nursing knowledge. Understanding the concept of saturation is essential to conducting rigorous qualitative research that contributes to evidence-based practice. The purpose of this study is to clarify the concept of saturation in qualitative research.

Method

Evolutionary concept analysis was performed. A literature search was conducted using a variety of online databases for the years 2005- 2023. In total, 33 articles and books were analyzed using thematic analysis to identify the attributes, antecedents and consequences of saturation. The validity of the data was obtained by examining the analysis process by two independent researchers.

Results

Saturation in qualitative research is a context-dependent, subjective process that requires detailed systematic analysis. Saturation is used in four ways in qualitative research: theoretical saturation, data saturation, code or thematic saturation, and meaning saturation. The antecedents of saturation were classified into two categories: study related factors and researcher related factors. The consequences of saturation were identified as: ensuring credibility and quality in qualitative research and time, energy and budget saving.

Conclusion

This concept analysis serves to enhance the understanding of the concept of saturation, thereby offering valuable resources for qualitative researchers. By gaining a profound comprehension of saturation and its various types, researchers can ensure the validity of their studies while also optimizing time and resource allocation by avoiding redundant data collection. Future investigation warranted to elucidate how factors associated with reaching saturation impact estimations sample size.

Strategies to increase survey participation: A randomized controlled study in a population of breast cancer survivors

BACKGROUND

Data collection by mailing questionnaires to the study population is one of the main research methods in epidemiologic studies. As participation rates are decreasing, easy-to-implement and cost-effective strategies to increase survey participation are needed. In this study, we tested the effect of a pragmatic combination of evidence-based interventions.

METHODS

We conducted a two-armed randomized controlled trial, nested in a cohort of breast cancer survivors (n = 1000) in the setting of a health outcomes survey. The intervention arm received a postal pre-notification, a non-monetary incentive (ballpoint with the study logo) and an alternative invitation letter in which several lay-out and textual adjustments were implemented according to behavioural science techniques. The alternative invitation letter also contained a QR-code through which an information video about the study could be accessed. The control arm was invited according to standard practice. Participants had the option to fill-out a questionnaire either on paper or online. A questionnaire with more than 50% of the questions answered classified as participation.

RESULTS

Overall participation rate was 62.9%. No significant difference in participation rate was observed between intervention and control arm (64.5% vs 61.3%, Risk Ratio (RR) 1.05, 95% CI [0.96 - 1.16]). Older age at study (>65 vs <51 years), and high socio-economic status (highest vs lowest quartile) were associated with higher participation rates (RR 1.30, 95% CI [1.07 - 1.57] and 1.24, 95% CI [1.09 - 1.42] respectively). In-situ carcinoma compared to invasive cancer and longer interval since treatment were associated with lower participation (RR 0.86, 95% CI [0.74 - 0.99] and RR 0.92, 95% CI [0.87 - 0.99] per 5 year increase, respectively).

CONCLUSION

Overall, the combination of four interventions tested in this study did not improve survey participation among breast cancer survivors. The overall participation rate was relatively high, possibly due to the study population of cancer survivors.

Comparison of Enhanced and Standard Data Sheets on Treatment Fidelity and Data Collection for Tact Training

Specifically designed data sheets have been recommended to assist with the fidelity of implementation of treatment procedures. The present study extended previous research (e.g., Bottini et al. Behavior Analysis: Research & Practice 21(2), 140-152, 2021; LeBlanc et al. Behavior Analysis in Practice 13(1), 53-62, 2020) by comparing an enhanced data sheet (i.e., the inclusion of randomized targets, prompts for treatment components of securing attending and reinforcement) to a standard data sheet (i.e., targets not preset, no prompts for treatment components) on the fidelity of tact training of features. Ten behavior therapists participated in each condition (n = 20). Participants first watched a brief instructional video explaining the teaching procedure and their assigned data sheet, followed by conducting a treatment session with a confederate serving as a child with autism spectrum disorder. The enhanced data sheet resulted in higher fidelity on multiple variables including randomizing of targets and data collection.

Ambient air concentrations of plant protection products: Data collection for the combined air concentration database and associated risk assessment

CropLife Europe collected literature values from monitoring studies measuring air concentrations of Plant Protection Products (PPPs) that may be inhaled by humans located in rural areas but not immediately adjacent to PPP applications. The resulting "Combined Air Concentration Database" (CACD) was used to determine whether air concentrations of PPPs reported by the French "Agency for Food, Environmental and Occupational Health & Safety" (ANSES) are consistent with those measured by others to increase confidence in values of exposure to humans. The results were put into risk assessment context. Results show that 25-90% of samples do not contain measurable PPP concentrations. Measured respirable fractions were below EU default air concentrations used for risk assessment for resident exposure by the European Food Safety Authority. All measured exposures in the CACD were also below established toxicological endpoints, even when considering the highest maximum average reported concentrations and very conservative inhalation rates. The highest recorded air concentration was for prosulfocarb (0.696 μg/m³ measured over 48 h) which is below the EFSA default limit of 1 μg/m³ for low volatility substances. In conclusion, based on the CACD, measured air concentrations of PPPs are significantly lower than EFSA default limits and relevant toxicological reference values.