Using the Internet to conduct surveys of health professionals: a valid alternative?

Current opinion on laryngeal electromyography

PURPOSE

This study evaluates expert opinion on laryngeal electromyography (LEMG).

METHODS

A cross-sectional design was used to conduct an online survey of LEMG experts in 2021. They were questioned about the number LEMG performed annually, type of electrodes used, sector worked in, pain during the test, placement of the needle electrodes, interpretation of electrical muscle parameters, diagnosis of neuromuscular injury, prognostic sensitivity in vocal fold paralysis (VFP), laryngeal dystonia, tremor and synkinesis and quantifying LEMG.

RESULTS

Thirty-seven professionals answered (23 Spanish and 14 from other countries), with a response rate of 21.56%. All physicians used LEMG. 91.9% had one- or two-years' experience and 56.8% performed 10-40 LEMG per year. 70.3% were otolaryngologists and 27%, neurologists. In 89.1% of cases, a team of electrodiagnostic physician and otolaryngologist performed LEMG. 91.3% of Spanish respondents worked in Public Health, 7.14% of other nationalities; 37.8% in a university department. Bipolar concentric needles electrodes were used by 45.9% and monopolar concentric by 40.5%. 57% professionals considered good patients' tolerance to the test. LEMG sensitivity was regarded as strong, median and interquartile range were 80.0 [60.0;90.0] to diagnose peripheral nerve injuries, less for other levels of lesions, and strong to evaluate prognosis, 70.0 [50.0;80.0]. Respondents believe locate the thyroarytenoid and the cricothyroid muscles with the needle, 80.0 [70.0;90.0], as opposed to 20.0 [0.00;60.0] the posterior cricoarytenoid. The interpretation of the electrical parts of the LEMG was strong, 80.0 [60.0;90.0]. LEMG identify movements disorders, 60.0 [20.0;80.0], and synkinesis, 70.0 [30.0;80.0]. The professionals prefer quantitative LEMG, 90.0 [60.0;90.0].

CONCLUSIONS

The experts surveyed consider LEMG that is well tolerated by patients. The insertional and spontaneous activity, recruitment and waveform morphology can be assessed easily. LEMG is mainly useful in the study of peripheral nerve injuries, and its value in VFP prognosis is considered strong.

The use of self-protective measures to prevent COVID-19 spread: an application of the health belief model

This study uses a health belief model to examine the preventive behavioral orientation or self-protective measures adopted by people in the face of the current COVID-19 pandemic. A total of 603 participants were selected from the city of Bangalore, India. The data was collected through an online survey with participants' age varying between 17 and 54 and mean as 23 years (SD = 4.32). The findings revealed that perceived barrier has significant negative impact, while perceived threat, perceived consequences, perceived benefits, community and individual self-efficacy, and general health cues have a positive influence on an individual's intention to follow self-protective measures against COVID-19. Based on the constructs of the health belief model, this study proposes multiple health-related interventions to reduce the spread of COVID-19.

The status of ART in the public health sector in Africa: a multi-country survey

RESEARCH QUESTION

What is the current availability of treatment with assisted reproductive technology (ART) in the public sector in Africa, and what are the facilitators and barriers towards its provision?

DESIGN

Cross-sectional quantitative and qualitative data were collected in two phases from February 2020 to October 2021. Key informants were identified from countries known to provide ART in Africa based on data from the African Network and Registry for Assisted Reproductive Technology and the 2019 Surveillance from the International Federation of Fertility Societies. Quantitative data were collected via a structured questionnaire (Phase 1); public centre-specific quantitative and qualitative data were then collected via a semi-structured questionnaire followed by a virtual interview (Phase 2). Data were analysed descriptively.

RESULTS

Informants from 18 countries reported the existence of 185 ART centres in 16 countries. Twenty-four centres (13.0%) in 10 of 16 countries (62.5%) were public. The majority of public centres (20/22 [90.9%]) reporting on ART performed <500 ART cycles per annum. Although public institutions covered most of the cost for ART, copayments from patients were universally required. The number of ART cycles per annum was inversely correlated to the copayment. Lack of policy and legislation, high costs and bureaucratic obstacles were identified by participants as the leading challenges in the delivery of public service ART.

CONCLUSION

Lack of public ART services leads to chronic and profound health inequities. Enablers of public service ART in the region are the same known to support ART services in general, namely policy and legislation, appropriate funding and good health service infrastructure. Addressing these requires the collated efforts of many stakeholders.

Measuring Knowledge of Healthcare Providers on Pediatric Palliative Care with an Online Questionnaire Based on the National Core Curriculum in Italy

There is a lack of highly reliable tools evaluating healthcare professionals' competences on Pediatric Palliative Care (PPC) and Pain Therapy (PT). The aim of this study is to document the development of an online questionnaire to assess Perceived, Wished and Actual Knowledge of healthcare workers on PPC/PT. The tool was built on the basis of the Italian Society for Palliative Care PPC Core Curriculum (CC) for physicians, nurses and psychologists. Face validity, internal consistency and the underlying structure were evaluated after a field testing in a referral hospital, Friuli-Venezia Giulia, Italy. One hundred five respondents completed the questionnaire. High internal consistency for both scales of Perceived and Wished Knowledge was found (α = 0.95 and α = 0.94, respectively). Psychologists reported higher levels of self-Perceived skills on the psychosocial needs of the child and family at the end of life (p = 0.006), mourning (p = 0.003) and ethics and deontology in PT/PC (p = 0.049). Moreover, when Actual Knowledge was tested, they also provided the highest number of correct answers (p = 0.022). No differences were found by profession for Wished Knowledge. The questionnaire showed promising psychometric properties. Our findings suggest the need of continuous training in this field and identify contents to be addressed in future training programs.

Clinician Perspectives on Clinical Decision Support for Familial Hypercholesterolemia

Familial Hypercholesterolemia (FH) is underdiagnosed in the United States. Clinical decision support (CDS) could increase FH detection once implemented in clinical workflows. We deployed CDS for FH at an academic medical center and sought clinician insights using an implementation survey. In November 2020, the FH CDS was deployed in the electronic health record at all Mayo Clinic sites in two formats: a best practice advisory (BPA) and an in-basket alert. Over three months, 104 clinicians participated in the survey (response rate 11.1%). Most clinicians (81%) agreed that CDS implementation was a good option for identifying FH patients; 78% recognized the importance of implementing the tool in practice, and 72% agreed it would improve early diagnosis of FH. In comparing the two alert formats, clinicians found the in-basket alert more acceptable (p = 0.036) and more feasible (p = 0.042) than the BPA. Overall, clinicians favored implementing the FH CDS in clinical practice and provided feedback that led to iterative refinement of the tool. Such a tool can potentially increase FH detection and optimize patient management.

Osteoporosis management by primary care physicians in Singapore: a survey on osteoporosis guidelines utilisation and barriers to care

This study seeks to understand the knowledge/utilisation of osteoporosis guidelines among PCPs in Singapore, their confidence in and barriers to osteoporosis management. Knowledge and usage of guidelines was associated with confidence in management. Effective guideline adoption is therefore crucial. PCPs also need systemic support to overcome barriers to osteoporosis care.

PURPOSE

Primary care physicians (PCPs) are at the forefront of offering osteoporosis screening and treatment. However, osteoporosis remains under-treated in primary care, despite the existence of osteoporosis clinical practice guidelines for PCPs. This study aims to determine the self-reported knowledge and utilisation of local osteoporosis guidelines and associated sociodemographic factors and to determine the confidence and barriers to osteoporosis screening and management among PCPs in Singapore.

METHODS

An anonymous web-based survey was conducted. PCPs in public and private practice were invited to participate in the self-administered survey via e-mail and messaging platforms. Chi-square test was performed for bivariate analysis; multivariable logistic regression models were used for factors with p value < 0.2.

RESULTS

Three hundred thirty-four complete survey datasets were processed for analysis. Two hundred fifty-one PCPs (75.1%) had read the osteoporosis guidelines. 70.5% self-reported good knowledge, and 74.9% use the guidelines. PCPs who self-reported good guideline knowledge (OR = 5.84; 2.96-11.49) and utilisation (OR = 4.54; 2.21-9.34) were more likely to perceive confidence in osteoporosis management. PCPs' perception that patients had other medical priorities during the consultation (79.3%) was the commonest barrier to screening. Limited anti-osteoporosis medication (54.1%) in the practice was a hindrance to management. Polyclinic-based PCPs frequently cited the lack of consultation time as a barrier; more systemic barriers were faced by PCPs in private practices.

CONCLUSION

Most PCPs know and use the local osteoporosis guidelines. Knowledge and usage of guidelines was associated with confidence in management. Strategies to address the prevalent barriers to osteoporosis screening and management faced by PCPs are needed.

Clinician perspectives on implementation of digitally fabricated complete dentures: A national survey of prosthodontists

STATEMENT OF PROBLEM

Research on implementation factors for digitally fabricated complete dentures is sparse.

PURPOSE

The purpose of this survey of prosthodontists was to explore the current usage of conventionally and digitally fabricated complete dentures and to identify factors that may impact their use.

MATERIAL AND METHODS

A confidential cross-sectional survey consisting of 20 questions was conducted in 2019 using the Qualtrics Research Suite. The survey was distributed via electronic mail to all 1820 members of the American College of Prosthodontics. Frequency distributions, chi-squared tests, and Fisher exact tests were used to analyze the data and compare subgroups (α=.05).

RESULTS

The response rate was 16.8% (N=305). A total of 31.5% of respondents were implementing digitally fabricated complete dentures, 36.6% were interested in learning and/or incorporating them, 37.7% reported that they had not tried them, and 12.7% had tried them but were not interested in using them again. When asked which factors were important when considering the implementation of digitally fabricated complete dentures, 55.8% indicated laboratory costs, 72.1% total chair time spent, and 81.9% patient satisfaction. Prosthodontists who graduated from dental school after about 1991 were more interested in learning about and incorporating digitally fabricated complete dentures than earlier graduates (P=.02).

CONCLUSIONS

The survey results indicate that prosthodontists are implementing digitally fabricated complete dentures in clinical practice but not at the rate that might be expected of a technology that has been available for nearly a decade. Factors reported to matter in the decision to implement this technology were decreased time, overall cost, and improved patient satisfaction.

Performance assessment of primary health care facilities in Brazil: Concordance between web-based questionnaire and in-person interviews with health personnel

This study is a concordance analysis comparing answers to two external assessment tools for Primary Health Care (PHC) facilities that use two different data collection methodologies: (a) external assessment through structured interviews and direct observation of facilities conducted by the National Program for Improvement of Access and Quality of Primary Care (AE-PMAQ-AB), and (b) a computerized web-based self-administered questionnaire for Assessment of the Quality of Primary Health Care Services (QualiAB). The two surveys were answered by 1,898 facilities located in 437 municipalities in the state of São Paulo, Brazil, between 2017 and 2018. Both surveys aimed to assess the management and organization of PHC facilities. A total of 158 equivalent questions were identified. The answers were grouped by thematic similarity into nine domains: Territory characteristics; Local management and external support; Structure; Health promotion, disease prevention, and therapeutic procedures; Attention to unscheduled patients; Women's health; Children's health; Attention to chronic conditions; and Oral health. The results show a high level of concordance between the answers, with 81% of the 158 compared questions showing concordance higher than 0.700. We showed that the information obtained by the web-based survey QualiAB was comparable to that of the structured interview-based AE-PMAQ-AB, which is considered the gold standard. This is important because web-based surveys are more practical and convenient, and do not require trained interviewers. Online assessment surveys can allow immediate access to answers, reports and guidelines for each evaluated facility, as provided by the QualiAB system. In this way, the answers to this type of survey can be directly employed by users, allowing the assessment to fulfill all phases of an assessment process.

Does usage of monetary incentive impact the involvement in surveys? A systematic review and meta-analysis of 46 randomized controlled trials

BACKGROUND

Surveys are an effective method for collecting a large quantity of data. However, incomplete responses to these surveys can affect the validity of the studies and introduce bias. Recent studies have suggested that monetary incentives may increase survey response rates. We intended to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of monetary incentives on survey participation.

METHODS

A systematic search of electronic databases was conducted to collect studies assessing the impact of monetary incentives on survey participation. The primary outcome of interest was the response rates to incentives: money, lottery, and voucher. We used the Cochrane Collaboration tool to assess the risk of bias in randomized trials. We calculated the rate ratio (RR) with its 95% confidence interval (95% CI) using Review Manager Software (version 5.3). We used random-effects analysis and considered the data statistically significant with a P-value <0.05.

RESULTS

Forty-six RCTs were included. A total of 109,648 participants from 14 countries were involved. The mean age of participants ranged from 15 to more than 60 years, with 27.5% being males, 16.7% being females, and the other 55.8% not reported. Our analysis showed a significant increase in response rate in the incentive group compared to the control group, irrespective of the incentive methods. Money was the most efficient way to increase the response rate (RR: 1.25; 95% CI: 1.16,1.35; P = < 0.00001) compared to voucher (RR: 1.19; 95% CI: 1.08,1.31; P = < 0.0005) and lottery (RR: 1.12; 95% CI: 1.03,1.22; P = < 0.009).

CONCLUSION

Monetary incentives encourage the response rate in surveys. Money was more effective than vouchers or lotteries. Therefore, researchers may include money as an incentive to improve the response rate while conducting surveys.

Antibiotic deprescribing: Spanish general practitioners' views on a new strategy to reduce inappropriate use of antibiotics in primary care

BACKGROUND

A doctor may recommend that a patient stop an antibiotic course before its scheduled completion time if further treatment may cause more harm than benefit.

OBJECTIVES

This study explores general practitioners' (GP) opinions about the use of antibiotic deprescribing (AD) in general practice.

METHODS

A cross-sectional, questionnaire-based study answered from February to March 2022. GPs (n = 6,083) affiliated with the largest Spanish scientific society of primary care were invited to participate. The survey included two statements related to use and fourteen views about AD rated by GPs using a 5-item Likert scale.

RESULTS

Eleven hundred and seven doctors completed the surveys (18.2%), of whom 92.5% (95% confidence interval [CI] 90.8-94%) reported having used the AD strategy in their practice at least once. GPs felt very confident in using a deprescribing strategy in patients with common cold and influenza (97.6% and 93.5%, respectively) but less with acute bronchitis (45.5%); 12.1% (95% CI, 10.2-14.2%) considered this practice harmful to patients. Respondents reported using AD more frequently when they initiated the antibiotic course (96.8%; 95% CI, 95.5-97.7) than when the treatment was initiated by another doctor (52.3%; 95% CI, 49.3-55.3%). However, doctors aged >60 years were more prone to use AD compared with younger colleagues (64.5% vs. 50%; p < 0.005).

CONCLUSION

The GPs in this study employ the strategy of AD. Nonetheless, essential differences lie in their views of the way the strategy is used. Further studies are warranted to explore the beliefs behind these perceptions and promote wider use of AD by GPs.

Perfil da fisioterapia na reabilitação de indivíduos com doença de Alzheimer: um estudo transversal

RESUMO O estudo analisou o perfil de atuação dos fisioterapeutas do Rio de Janeiro (RJ) e do Rio Grande do Sul (RS) no manejo da pessoa com doença de Alzheimer (DA). Foram obtidas 256 respostas a um questionário enviado via endereço eletrônico dos Conselhos Regionais de Fisioterapia e Terapia Ocupacional das regiões 2 (RJ) e 5 (RS) - CREFITOS 2 e 5 -, entre março e dezembro de 2020. O questionário tinha 36 perguntas fechadas, cujas variáveis foram agrupadas em: (1) caracterização da amostra; (2) dados específicos sobre a profissão de fisioterapeuta; e (3) questões relacionadas à DA. Neste artigo serão analisadas apenas as questões relacionadas à DA. Todas as questões eram de múltipla escolha, com 2 até 15 opções de resposta. A maioria dos respondentes (88,3%) já atendeu paciente com DA, mas 50,8% fariam uma revisão de literatura para atender novamente esses pacientes. O principal objetivo relatado no manejo do indivíduo com DA foi “retardar a progressão das perdas motoras”. As condutas foram significativamente diferentes conforme a fase da doença (p<0,001). Mais de 85% citaram como benefício que a fisioterapia “retarda a dependência física”. Este estudo deixa evidente a necessidade de mais pesquisas que abordem especificamente as fases intermediária e avançada da DA, pois, até o momento, a literatura se mostra inconclusiva e com pouca evidência em relação à fisioterapia no manejo dessas pessoas, impossibilitando a criação de manuais e/ou padronização de condutas específicas a cada estágio da doença.

Profile of physical therapy in the rehabilitation of individuals with Alzheimer’s disease: a cross-sectional study

ABSTRACT This study analyzes the working profile of physical therapists from the states of Rio de Janeiro (RJ) and Rio Grande do Sul (RS) in the management of people with Alzheimer’s disease (AD). A total of 256 responses were obtained to a questionnaire sent via the electronic address of the Regional Councils of Physical Therapy and Occupational Therapy (CREFITOS) 2 (RJ) and 5 (RS), from March to December 2020. The questionnaire comprises 36 closed questions, the variables of which were grouped into: (1) sample characterization; (2) specific data on the profession of physical therapist; and (3) issues related to AD. In this article, only issues related to AD will be analyzed. All questions were multiple choice with 2 to 15 options of answer. Most respondents (88.3%) had already treated patients with AD, but 50.8% needed to review the literature to assist these patients. The main objective reported in the management of the individual with AD was to “delay the progression of motor losses.” The practices were significantly different according to the stage of the disease (p<0.001). More than 85% of the participants cited as a benefit that physical therapy “delays physical dependence.” This study shows the need for further studies that specifically address the intermediate and advanced stages of AD since the current literature is inconclusive and with little evidence regarding physical therapy in the management of this population, making it impossible to create manuals and /or standardization of specific practices for each stage.

Real and Perceived Discordance in Physicians and U.S. Adults' Beliefs Regarding the Causes and Controllability of Type 2 Diabetes

Discordance between physicians and patients' health beliefs can impede health communication efforts. However, little research considers physicians' perceptions of patient beliefs, despite the importance of perceptions in shaping communication. In the current work, we examine instances of actual and perceived discordance between physicians and U.S. adults' beliefs regarding the causes and controllability of type 2 diabetes. 229 family physicians completed an online survey measuring their health beliefs and perceptions of their patients' beliefs. Physicians' responses were contrasted against beliefs from a national survey sample of 1,168 U.S. adults. T-tests assessed whether (a) physicians' beliefs diverged from the national sample's beliefs (actual discordance), (b) physicians perceived that their health beliefs diverged from their patients' beliefs (perceived discordance), and (c) physicians' perceptions of patient beliefs diverged from the national sample's beliefs (accuracy of perceived discordance). Findings revealed evidence of actual discordance; compared to the national sample, physicians were more likely to attribute type 2 diabetes to genes (versus lifestyle factors) and perceived greater control over developing diabetes. Moreover, although physicians perceived discordance between their own and their patients' beliefs, data from the national sample suggested that these gaps were less substantial than physicians expected. In particular, findings showed that physicians generally overestimated discordance, expecting that people would be less likely to (1) attribute the development of diabetes to lifestyle factors (versus genes), and (2) perceive control over developing diabetes, than was actually reported. Implications of actual and perceived discordance for effective health communication and patient education are discussed.

Explaining trip generation during the COVID-19 pandemic: A psychological perspective

Introduction

The present study investigated the extent of reduction in the generation of non-essential trips (i.e., for shopping, personal, social, and entertainment reasons) due to the COVID-19 pandemic and the role of psychological factors (including deliberate planning and personal moral obligations) in explaining the change.

Method

We collected data through an internet survey conducted from April to June 2020. We recruited the respondents (N = 369) from a young segment of the population in Iran. The hypothesised model framework included the components of the theory of planned behaviour (including attitudes, subjective norms, perceived behavioural control, and intention to reduce non-essential trips) along with personal moral obligation. The framework also consisted of socio-demographic characteristics of age, gender, income, car ownership and trip distance. A structural equation model was developed to explain trip reduction at an aggregated level for four non-essential trip purposes (i.e., shopping, personal, social, and entertainment). In the aggregated model, trip-reducing behaviour represents the change in the number of trips for all non-essential purposes. We also tested the same framework, to explain trip reduction for each of the trip purposes, separately.

Results

On average, the study participants reduced their non-essential trips by 60% during the pandemic compared with in the pre-COVID-19 period. Men were less likely than women to reduce the rate of their trips during the pandemic. The SEM demonstrated that the theory of planned behaviour predicted trip-generation behaviour during the abnormal situation represented by the pandemic. Perceived behavioural control both directly and indirectly impacted trip reduction. However, personal moral obligations failed to provide a direct explanation for trip generation reduction. According to the hypothesised model, the results for different trip purposes were also mostly in line with those from the aggregated model.

Conclusions

The findings imply that participants in our sample made deliberate and planned psychological decisions (aligned with the theory of planned behaviour) regarding potential travel behavioural decisions during the COVID-19 pandemic. The findings also highlighted that perceived behavioural control grows in importance alongside growth in difficult circumstances.

Perceptions and Opinions Towards Data-Sharing: A Survey of Addiction Journal Editorial Board Members

Background

We surveyed addiction journal editorial board members to better understand their opinions towards data-sharing.

Methods

Survey items consisted of Likert-type (e.g., one to five scale), multiple-choice, and free-response questions. Journal websites were searched for names and email addresses. Emails were distributed using SurveyMonkey. Descriptive statistics were used to characterize the responses.

Results

We received 178 responses (of 1039; 17.1%). Of these, 174 individuals agreed to participate in our study (97.8%). Most respondents did not know whether their journal had a data-sharing policy. Board members "somewhat agree" that addiction journals should recommend but not require data-sharing for submitted manuscripts [M=4.09 (SD=0.06); 95% CI: 3.97-4.22]. Items with the highest perceived benefit ratings were "secondary data use (e.g., meta-analysis)" [M=3.44 (SD=0.06); 95% CI: 3.31-3.56] and "increased transparency" [M=3.29 (SD=0.07); 95% CI: 3.14-3.43]. Items perceived to be the greatest barrier to data-sharing included "lack of metadata standards" [M=3.21 (SD=0.08); 95% CI: 3.06-3.36], "no incentive" [M=3.43 (SD=0.07); 95% CI: 3.30-3.57], "inadequate resources" [M=3.53 (SD=0.05); 95% CI: 3.42-3.63], and "protection of privacy"[M=3.22 (SD=0.07); 95% CI: 3.07-3.36].

Conclusion

Our results suggest addiction journal editorial board members believe data-sharing has a level of importance within the research community. However, most board members are unaware of their journals' data-sharing policies, and most data-sharing should be recommended but not required. Future efforts aimed at better understanding common reservations and benefits towards data-sharing, as well as avenues to optimize data-sharing while minimizing potential risks, are warranted.

WHO Standards-based questionnaire to measure health workers' perspective on the quality of care around the time of childbirth in the WHO European region: development and mixed-methods validation in six countries

OBJECTIVES

Develop and validate a WHO Standards-based online questionnaire to measure the quality of maternal and newborn care (QMNC) around the time of childbirth from the health workers' perspective.

DESIGN

Mixed-methods study.

SETTING

Six countries of the WHO European Region.

PARTICIPANTS AND METHODS

The questionnaire is based on lessons learnt in previous studies, and was developed in three sequential phases: (1) WHO Quality Measures were prioritised and content, construct and face validity were assessed through a Delphi involving a multidisciplinary board of experts from 11 countries of the WHO European Region; (2) translation/back translation of the English version was conducted following The Professional Society for Health Economics and Outcomes Research guidelines; (3) internal consistency, intrarater reliability and acceptability were assessed among 600 health workers in six countries.

RESULTS

The questionnaire included 40 items based on WHO Standards Quality Measures, equally divided into four domains: provision of care, experience of care, availability of human and physical resources, organisational changes due to COVID-19; and its organised in six sections. It was translated/back translated in 12 languages: Bosnian, Croatian, French, German, Italian, Norwegian, Portuguese, Romanian, Russian, Slovenian, Spanish and Swedish. The Cronbach's alpha values were ≥0.70 for each questionnaire section where questions were hypothesised to be interrelated, indicating good internal consistence. Cohen K or Gwet's AC1 values were ≥0.60, suggesting good intrarater reliability, except for one question. Acceptability was good with only 1.70% of health workers requesting minimal changes in question wording.

CONCLUSIONS

Findings suggest that the questionnaire has good content, construct, face validity, internal consistency, intrarater reliability and acceptability in six countries of the WHO European Region. Future studies may further explore the questionnaire's use in other countries, and how to translate evidence generated by this tool into policies to improve the QMNC.

TRAIL REGISTRATION NUMBER

NCT04847336.

Are They Still Friends? Friendship Stability of Adolescents With Chronic Pain: 1-Year Follow-Up

Most adolescents identify their best friend as their main source of social support. Adolescents with chronic pain (ACP) report the loss of friendships due to pain. Friendships protect against loneliness and depression, yet adolescents with pain experience increased levels of loneliness and depression compared to peers. This longitudinal study examines the friendship stability of dyads that included an adolescent with chronic pain compared to non-pain friendship dyads as well as the factors contributing to a friendship breakup. Eighty-three participants from 61 same-sex friendship dyads across 3 sites participated in a 1-year follow-up survey designed to capture friendship features, indices of social-emotional well-being, pain characteristics, and friendship stability. Chi-square, repeated measures ANOVA, and logistic regression were used to analyze the data. Dyads that included an ACP experienced higher rates of friendship breakup. The shorter length of friendship and having chronic pain predicted a friendship breakup at time 2. ACP continues to experience worse scores on indices of social-emotional well-being that are not predicted with a friendship breakup. Understanding what contributes to positive long-term friendships for those with pain may inform strategies to maintain and improve friendships for those with pain and who experience social challenges.

Demand for mitigating the risk of COVID-19 infection in public transport: The role of social trust and fatalistic beliefs

The rapid surge of COVID-19 cases worldwide drew attention to COVID-19 infection as a new source of risk in transport. The virus introduced a need for viral transmission mitigation as a major priority when selecting a mode of travel, and caused a significant drop in public transport use. The recovery of public transport use in the post-COVID period requires that the transport authorities favourably address people's demand for mitigation of the risk of COVID-19 transmission in public transport. The present study aims to explore the role of risk perception, worry and priority of COVID-19 risk reduction along with fatalistic beliefs and public trust in authorities in explaining public demand for risk mitigation. The present study is among the first to investigate the role of fatalistic beliefs, social trust and risk perception for public transport and public demand for risk mitigation. The link between priority of infection prevention and demand for risk mitigation has also been less explored in public transport research. An online survey was conducted among university students in Iran between 19th April and 16th June 2020, during the first wave of the pandemic, when the country was a major epicentre of the disease. A total of 271 out of 370 respondents whose dominant mode on university travels was public transport were included in the analysis. Results of structural equation modelling confirmed the paradox of trust, indicating that social trust is negatively associated with perceived risk of COVID-19 infection, which in turn may lead people to place less importance on COVID-19 prevention as a priority in travel mode choice, and consequently demand less risk mitigation efforts to prevent COVID-19 infection in public transport. Dissimilar to trust, however, the results revealed no relationship between fatalistic beliefs and risk perception, but a significant direct effect of fatalistic beliefs on demand for risk mitigation. To reinforce public demand for mitigating the risk of COVID-19 in public transport, the study calls on policymakers to exploit public trust resources for more effective risk communication, through disseminating the gradually accumulating evidence-based information regarding the infectivity and the virulence of COVID-19 and the scientific risk of infection. The study also underlined the potential importance of considering fatalistic beliefs when developing effective risk communication policies and practices to enhance public support for COVID-19 risk mitigation in public transport.

Surgery versus conservative management of stable thoracolumbar fracture: the PRESTO feasibility RCT

BACKGROUND

There is informal consensus that simple compression fractures of the body of the thoracolumbar vertebrae between the 10th thoracic vertebra and the second lumbar vertebra without neurological complications can be managed conservatively and that obvious unstable fractures require surgical fixation. However, there is a zone of uncertainty about whether surgical or conservative management is best for stable fractures.

OBJECTIVES

To assess the feasibility of a definitive randomised controlled trial comparing surgical fixation with initial conservative management of stable thoracolumbar fractures without spinal cord injury.

DESIGN

External randomised feasibility study, qualitative study and national survey.

SETTING

Three NHS hospitals.

METHODS

A feasibility randomised controlled trial using block randomisation, stratified by centre and type of injury (high- or low-energy trauma) to allocate participants 1 : 1 to surgery or conservative treatment; a costing analysis; a national survey of spine surgeons; and a qualitative study with clinicians, recruiting staff and patients.

PARTICIPANTS

Adults aged ≥ 16 years with a high- or low-energy fracture of the body of a thoracolumbar vertebra between the 10th thoracic vertebra and the second lumbar vertebra, confirmed by radiography, computerised tomography or magnetic resonance imaging, with at least one of the following: kyphotic angle > 20° on weight-bearing radiographs or > 15° on a supine radiograph or on computerised tomography; reduction in vertebral body height of 25%; a fracture line propagating through the posterior wall of the vertebra; involvement of two contiguous vertebrae; or injury to the posterior longitudinal ligament or annulus in addition to the body fracture.

INTERVENTIONS

Surgical fixation: open spinal surgery (with or without spinal fusion) or minimally invasive stabilisation surgery. Conservative management: mobilisation with or without a brace.

MAIN OUTCOME MEASURE

Recruitment rate (proportion of eligible participants randomised).

RESULTS

Twelve patients were randomised (surgery, n = 8; conservative, n = 4). The proportion of eligible patients recruited was 0.43 (95% confidence interval 0.24 to 0.63) over a combined total of 30.7 recruitment months. Of 211 patients screened, 28 (13.3%) fulfilled the eligibility criteria. Patients in the qualitative study (n = 5) expressed strong preferences for surgical treatment, and identified provision of information about treatment and recovery and when and how they are approached for consent as important. Nineteen surgeons and site staff participated in the qualitative study. Key themes were the lack of clinical consensus regarding the implementation of the eligibility criteria in practice and what constitutes a stable fracture, alongside lack of equipoise regarding treatment. Based on the feasibility study eligibility criteria, 77% (50/65) and 70% (46/66) of surgeons participating in the survey were willing to randomise for high- and low-energy fractures, respectively.

LIMITATIONS

Owing to the small number of participants, there is substantial uncertainty around the recruitment rate.

CONCLUSIONS

A definitive trial is unlikely to be feasible currently, mainly because of the small number of patients meeting the eligibility criteria. The recruitment and follow-up rates were slightly lower than anticipated; however, there is room to increase these based on information gathered and the support within the surgical community for a future trial.

FUTURE WORK

Development of consensus regarding the population of interest for a trial.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN12094890.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 62. See the NIHR Journals Library website for further project information.

Assessment of blood pressure skills and belief in clinical readings

Background

Accurate blood pressure (BP) measurement is essential for the diagnosis and management of hypertension. In clinical practice, BP is estimated using noninvasive methods with significant variability of application of guidelines in clinical practice, impacting the accuracy and certainty of BP measurements.

Objective

We sought to assess how BP is measured in clinical practice.

Methods

A survey was administered through professional societies that included predominantly cardiologists. Assessment of adherence to guideline recommendations for BP assessment was measured and compared to the level of confidence in clinic BP measurement.

Results

There were 571 surveys completed. The majority of respondents were cardiologists (61.1%), with 47 preventive cardiologists. BP was routinely checked in both arms by 53% at the initial visit, 48% check BP once each visit, and 64% wait 5 min before initial BP assessment. Automated BP assessment is used by 58% respondents. The majority (83%) trust their BP readings, and those who trust their BP readings are more likely to perform the initial BP assessment themselves, compared to those who do not trust the clinic BP readings (30.2% vs. 13.6%, P = 0.009). Accurate BP measurement is performed by 23% of cardiologists, and more likely performed accurately by a preventive cardiologist (38.3%) compared with other cardiologists (20.0%, P = 0.007). Accurate BP measurement is more likely for those who perform the initial BP themselves rather than any other staff (36.8% vs. 17.9%; P<0.001); and for those who repeat BP manually (80% vs. 54%; P<0.001), compared to those who do not measure BP accurately. Despite the inaccuracy of BP measurement, there is a high level of confidence in the BP readings.

Conclusions

Accurate BP assessment continues to remain suboptimal in clinical practice. Reliability of BP assessment requires education, identifying barriers to implementation of recommendations and engagement of the entire team to improve BP assessment.

Capacity development and safety measures for health care workers exposed to COVID-19 in Bangladesh

Background

The safety of health care workers (HCWs) in Bangladesh and the factors associated with getting COVID-19 have been infrequently studied. The aim of this study was to address this gap by assessing the capacity development and safety measures of HCWs in Bangladesh who have been exposed to COVID-19 and by identifying the factors associated with respondents’ self-reported participation in capacity development trainings and their safety practices.

Methods

This cross-sectional study was based on an online survey of 811 HCWs working at 39 dedicated COVID-19 hospitals in Bangladesh. A pretested structured questionnaire consisting of questions related to respondents’ characteristics, capacity development trainings and safety measures was administered. Binary logistic regressions were run to assess the association between explanatory and dependent variables.

Results

Among the respondents, 58.1% had been engaged for at least 2 months in COVID-19 care, with 56.5% of them attending capacity development training on the use of personal protective equipment (PPE), 44.1% attending training on hand hygiene, and 35% attending training on respiratory hygiene and cough etiquette. Only 18.1% reported having read COVID-19-related guidelines. Approximately 50% of the respondents claimed that there was an inadequate supply of PPE for hospitals and HCWs. Almost 60% of the respondents feared a high possibility of becoming COVID-19-positive. Compared to physicians, support staff [odds ratio (OR) 4.37, 95% confidence interval (CI) 2.25–8.51] and medical technologists (OR 8.77, 95% CI 3.14–24.47) were more exhausted from working in COVID-19 care. Respondents with longer duty rosters were more exhausted, and those who were still receiving infection prevention and control (IPC) trainings were less exhausted (OR 0.54, 95% CI 0.34–0.86). Those who read COVID-19 guidelines perceived a lower risk of being infected by COVID-19 (OR 0.44, 95% CI 0.29–0.67). Compared to the respondents who strongly agreed that hospitals had a sufficient supply of PPE, others who disagreed (OR 2.68, 95% CI 1.31–5.51) and strongly disagreed (OR 5.05, 95% CI 2.15–11.89) had a higher apprehension of infection by COVID-19.

Conclusion

The findings indicated a need for necessary support, including continuous training, a reasonable duty roster, timely diagnosis of patients, and an adequate supply of quality PPE.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07071-2.

Referral practices of medical practitioners in central South Africa to physiotherapy services for patients living with musculoskeletal conditions

BACKGROUND

Musculoskeletal diseases (MSDs) are a major cause of disability worldwide. It is essential to address effective MSD management, including appropriate referrals to physiotherapists and other healthcare professionals. Limited information is available regarding the referral practices of medical practitioners for patients with MSD. The doctors' referral practices to physiotherapists can impact the patient population and the South African health system.

OBJECTIVES

To investigate or understand the referral practices of medical practitioners in Bloemfontein, South Africa, to physiotherapy services, for individuals living with MSD.

METHOD

A quantitative study approach, implementing a semi-structured questionnaire, was used. Forty-nine participants completed the questionnaire.

RESULTS

The referral of patients with MSDs by medical practitioners to physiotherapy services varied and multidimensional factors influenced their referral practices. Medical practitioners were unsure of the specific role played by physiotherapists in the management of individuals living with MSD. A need for improved relationships and communication between medical practitioners and physiotherapists was identified.

CONCLUSIONS

Medical practitioners regularly referred individuals living with MSD to physiotherapists, but referral practices should be optimised in terms of evidence-based practice and the use of specialised physiotherapy services. In an attempt to decrease the burden of MSD, adequate awareness should be created for improved referral practices between medical practitioners and physiotherapists.

CLINICAL IMPLICATIONS

Collaborative development of detailed guidelines for apt, evidence-based referrals should be developed, to ensure early detection and management of individuals living with MSD. Health care professionals should be educated and encouraged to refer individuals living with MSD to physiotherapists for appropriate management with clinical benefits including improvement of HRQOL and cost effectiveness of this management not only to the individual but also to the health system in South Africa. Physiotherapists should try to communicate their role in the treatment of individuals living with MSD to medical practitioners for the benefit of the patient.

Global parental leave in surgical careers: differences according to gender, geographical regions and surgical career stages

BACKGROUND

There is a lack of information regarding the provision of parental leave for surgical careers. This survey study aims to evaluate the experience of maternity/paternity leave and views on work-life balance globally.

METHODS

A 55-item online survey in 24 languages was distributed via social media as per CHERRIES guideline from February to March 2020. It explored parental leave entitlements, attitude towards leave taking, financial impact, time spent with children and compatibility of parenthood with surgical career.

RESULTS

Of the 1393 (male : female, 514 : 829) respondents from 65 countries, there were 479 medical students, 349 surgical trainees and 513 consultants. Consultants had less than the recommended duration of maternity leave (43.8 versus 29.1 per cent), no paid maternity (8.3 versus 3.2 per cent) or paternity leave (19.3 versus 11.0 per cent) compared with trainees. Females were less likely to have children than males (36.8 versus 45.6 per cent, P = 0.010) and were more often told surgery is incompatible with parenthood (80.2 versus 59.5 per cent, P < 0.001). Males spent less than 20 per cent of their salary on childcare and fewer than 30 hours/week with their children. More than half (59.2 per cent) of medical students did not believe a surgical career allowed work-life balance.

CONCLUSION

Surgeons across the globe had inadequate parental leave. Significant gender disparity was seen in multiple aspects.

Behavioural insights (BI) for childhood development and effective public policies in Latin America: a survey and a randomised controlled trial

OBJECTIVES

We developed (a) a survey to investigate the knowledge of childhood health experts on public policies and behavioural insights (BI), as well as its use in Latin American and the Caribbean countries (LACs), and (b) an intervention (randomised controlled trial) to test the influence of nudges on the effect of a simulated public health programme communication.

PARTICIPANTS AND SETTINGS

A total of 2003 LACs childhood health professionals participated in the study through a Hispanic online platform.

PRIMARY AND SECONDARY OUTCOMES

We used regression models analysing expertise-related information, individual differences and location. We extracted several outcome variables related to (a) 'Public Policy Knowledge Index' based on the participants' degree of knowledge on childhood health public policies and (b) BI knowledge, perceived effectiveness and usefulness of a simulated public programme communication. We also analysed a 'Behavioural Insights Knowledge Index' (BIKI) based on participants' performance in BI questions.

RESULTS

In general, health professionals showed low BI knowledge (knowledge of the term BI: χ²=210.29, df=1 and p<0.001; BIKI: χ²=160.5, df=1 and p<0.001), and results were modulated by different factors (age, academic formation, public policy knowledge and location). The use of BI principles for the communication of the public programme revealed higher impact and clarity ratings from professionals than control messages.

CONCLUSIONS

Our findings provide relevant knowledge about BI in health professionals to inform governmental and non-governmental organisations' decision-making processes related with childhood public policies and BI designs.

Clinical practices of speech-language pathologists working with 12- to 16-year olds in Australia

Purpose: The current landscape of speech-language pathology (SLP) services for 12- to 16-year olds in Australia remains largely unchartered. Implementing the Speech Pathology 2030 vision necessitates mapping current services, and gaps in services, provided by speech-language pathologists (SLPs). However, the last survey of Australian SLPs' practices with young people was conducted in 2005. The aim of this study was to bridge the service delivery information gap.Method: Ninety-six SLPs working with 12- to 16-year olds in Australia completed an anonymous online survey consisting of binary choice, multiple choice, and Likert scale questions. A theoretical approach to service delivery based on response to intervention models underpinned question design.Result: SLP clinical practices remain traditional, following an impairment/diagnostic model. Additionally, there is an inequitable provision of SLP services across states/territories of Australia, according to whether or not there is government provision for SLP services in public schools.Conclusion: The results suggest a need for standard government provision of SLP services across Australia to ensure equity of access. These findings inform our understanding of contemporary assessment and intervention practices of SLPs working with 12- to 16-year olds in Australia.

"It's good for the soul:" Perceptions of a formal junior faculty mentorship program at a large academic cancer centre

BACKGROUND

Mentorship fosters professional and personal growth; however, the components essential to program success remain unclear. Our objective was to evaluate and explore the impact of a junior faculty mentorship program within an academic radiation oncology department.

MATERIALS AND METHODS

In 2016, our institution implemented a junior faculty mentorship program consisting of: (1) an orientation handbook; (2) faculty development sessions; and (3) direct, one-to-one selection of a mentor. Confidentiality agreements are signed, a goals template is provided, and meeting dates are tracked. Mentors/mentees were invited to participate in a program evaluation using mixed-methodology: a questionnaire followed by a one-on-one semi-structured interview to explore perceptions of the program. Interviews were audiotaped and transcribed verbatim. Descriptive statistics summarized questionnaire results and thematic analysis summarized interview results.

RESULTS

Eleven junior faculty have selected 10 mentors. Of these, 17 completed the evaluation questionnaire (81%) (7 mentors, 10 mentees; 5 women, 12 men) and 13 were interviewed (62%) (5 mentors, 8 mentees; 3 women, 10 men). The majority (80%) have participated in the program for >2 years. Although most mentees report additional mentors, 30% report this as their sole mentorship relationship. Four themes emerged: (i) Components of an Ideal Mentoring Relationship, (ii) The Value of Mentorship, (iii) Sponsorship, in addition to Mentorship and (iv) Cultivating Departmental Bonds and Boundaries.

CONCLUSION

Implementation of a junior faculty mentorship program within an academic radiation oncology department is feasible. Participants expressed satisfaction with most formal program components. Many junior faculty have additional mentors; however, some do not, highlighting the importance of formal programs for professional development.

Barriers and facilitators to general practitioners participating in implementation research: a mixed methods systematic review protocol

OBJECTIVE

The aim of the review is to critically appraise and synthesize quantitative and qualitative evidence on the barriers and facilitators to general practitioners participating in implementation research for the purposes of evaluating translation of evidence into practice.

INTRODUCTION

General practice is a distinct medical specialty that requires its own specific research; therefore, general practitioner participation in research is key in translating new knowledge into practice. However, recruiting general practitioners to research as participants is challenging. Understanding general practitioner behavior in relation to their participation in implementation research is critical.

INCLUSION CRITERIA

Implementation studies that include general practitioners in primary health care settings will be considered. This review will consider quantitative, qualitative, and mixed methods studies from developed countries investigating barriers and facilitators to general practitioners participating in implementation research.

METHODS

The review will be conducted in accordance with JBI methodology for mixed methods systematic reviews. The main databases accessed will be MEDLINE and Scopus, and include studies published in English between 2008 and the present. Two independent reviewers will read and screen relevant articles, assess for quality, extract study characteristics, and synthesize data. This review is taking an integrated approach involving transformed quantitative data. Primary outcome measures will include study details and outcomes related to the research question. Qualitative and transformed quantitative data will be mapped to the Theoretical Domains Framework at extraction phase. Synthesis will include identified barriers and facilitators categorized using the Theoretical Domains Framework indicators to provide future research and implementation recommendations for recruiting general practitioners to implementation research.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO (CRD42020176759).

Organizational Readiness for Lung Cancer Screening: A Cross-Sectional Evaluation at a Veterans Affairs Medical Center

OBJECTIVES

Lung cancer has the highest cancer-related mortality in the United States and among Veterans. Screening of high-risk individuals with low-dose CT (LDCT) can improve survival through detection of early-stage lung cancer. Organizational factors that aid or impede implementation of this evidence-based practice in diverse populations are not well described. We evaluated organizational readiness for change and change valence (belief that change is beneficial and valuable) for implementation of LDCT screening.

METHODS

We performed a cross-sectional survey of providers, staff, and administrators in radiology and primary care at a single Veterans Affairs Medical Center. Survey measures included Shea's validated Organizational Readiness for Implementing Change (ORIC) scale and Shea's 10 items to assess change valence. ORIC and change valence were scored on a scale from 1 to 7 (higher scores representing higher readiness for change or valence). Multivariable linear regressions were conducted to determine predictors of ORIC and change valence.

RESULTS

Of 523 employees contacted, 282 completed survey items (53.9% overall response rate). Higher ORIC scores were associated with radiology versus primary care (mean 5.48, SD 1.42 versus 5.07, SD 1.22, β = 0.37, P = .039). Self-identified leaders in lung cancer screening had both higher ORIC (5.56, SD 1.39 versus 5.11, SD 1.26, β = 0.43, P = .050) and change valence scores (5.89, SD 1.21 versus 5.36, SD 1.19, β = 0.51, P = .012).

DISCUSSION

Radiology health professionals have higher levels of readiness for change for implementation of LDCT screening than those in primary care. Understanding health professionals' behavioral determinants for change can inform future lung cancer screening implementation strategies.

Attitude of Physicians towards Periodontal Disease and Diabetes Mellitus Screening in Dental Clinics in Thailand

BACKGROUND

Diabetes mellitus (DM) is one of the top causes of death in many places of the world. Diagnosing DM in the early stage is necessary to avoid severe cases and death.

OBJECTIVES

To evaluate the knowledge of association between DM and periodontal disease (PD) among Thai physicians and assess their attitudes towards DM screening in dental clinics in Thailand.

METHODS

Online survey of currently practicing physicians in Thailand was conducted on voluntary basis using the newly developed questionnaire.

RESULT

We received 403 responses that are statistically sufficient to represent the entire population of currently practicing physicians in Thailand. A total of 97.3% of all responses indicate that Thai physicians have knowledge about the association between DM and PD. More than 90% know that DM has an effect on PD; however, 70% know about the effect of untreated PD in DM patients. Most of physicians think that DM screening in dental clinics is important (79.1%) and are ready to accept referred cases for definite DM diagnosis from a dentist (84.1%). The concerned issues among the participants were the accuracy of the test results in DM screening (73%) and ability of a dentist to perform the screening (71.5%).

CONCLUSIONS

The majority of participating physicians have adequate knowledge about the bidirectional relationship between DM and PD. They have a positive attitude towards DM screening in dental setting. The collaboration between physicians and dental professionals should be established to reduce the number of undiagnosed DM patients and enhance the medical care of DM patients.

Practices in research, surveillance and control of neglected tropical diseases by One Health approaches: A survey targeting scientists from French-speaking countries

One health (OH) approaches have increasingly been used in the last decade in the fight against zoonotic neglected tropical diseases (NTDs). However, descriptions of such collaborations between the human, animal and environmental health sectors are still limited for French-speaking tropical countries. The objective of the current survey was to explore the diversity of OH experiences applied to research, surveillance and control of NTDs by scientists from French-speaking countries, and discuss their constraints and benefits. Six zoonotic NTDs were targeted: echinococcoses, trypanosomiases, leishmaniases, rabies, Taenia solium cysticercosis and leptospiroses. Invitations to fill in an online questionnaire were sent to members of francophone networks on NTDs and other tropical diseases. Results from the questionnaire were discussed during an international workshop in October 2019. The vast majority (98%) of the 171 respondents considered OH approaches relevant although only 64% had implemented them. Among respondents with OH experience, 58% had encountered difficulties mainly related to a lack of knowledge, interest and support for OH approaches by funding agencies, policy-makers, communities and researchers. Silos between disciplines and health sectors were still strong at both scientific and operational levels. Benefits were reported by 94% of respondents with OH experience, including increased intellectual stimulation, stronger collaborations, higher impact and cost-efficiency of interventions. Recommendations for OH uptake included advocacy, capacity-building, dedicated funding, and higher communities' involvement. Improved research coordination by NTD networks, production of combined human-animal health NTD impact indicators, and transversal research projects on diagnostic and reservoirs were also considered essential.

Global burn care and the ideal burn dressing reloaded - A survey of global experts

PURPOSE

Burn care is a highly relevant medical specialty in every part of the world. Different infrastructure, healthcare systems and access to medical supplies lead to different needs, treatment strategies and outcomes. A fundamental tool in a burn care provider's armamentarium is the use of different dressings. Several studies have investigated the question of the ideal burn dressing, but none could achieve a proper global perspective. With advanced dressings being on the rise, we conducted this study to get a global understanding of the actual use and idea of the ideal burn dressing.

OBJECTIVE

The objective of this study was to investigate the understanding of an 'ideal burn dressing' on a global scale.

MATERIALS AND METHODS

A questionnaire about burn care and the ideal burn dressing has been created and translated to five of the most spoken languages world-wide (English, Spanish, French, Chinese, Indonesian). It has been uploaded to an online survey platform and sent out to burn experts worldwide. The voluntary participation was possible for a period of four weeks.

RESULTS

In total, 196 respondents from 49 countries participated in the study, yielding a response rate of 24.5%. The most important burn dressing characteristics in a cumulative ranking were (1) lack of adhesion (80.54%), (2) pain-free dressing change (79.87%), (3) requirement of fewer dressing changes, while in a linear ranking they were (1) anti-infective (35.14% 1st), pain-reduction (24.14% 2nd), and high absorbency (23.49% 3rd). Silver-based dressings are the most used dressings for superficial (45.21%) and deep (52.78%). 94.81% believe that the choice of burn dressing affects the outcome.

CONCLUSION

This investigation has delivered valuable insights into the global perspective of the ideal burn dressing. Yet, the question of the ideal burn dressing is still inconclusive. Wound dressing research is of fundamental interest for patients, healthcare providers and healthcare systems.

Beyond guidelines: analysis of current practice patterns of AANS/CNS tumor neurosurgeons

INTRODUCTION

Evidence-based medicine guidelines are increasingly published and sanctioned by organized neurosurgery. However, implementation, interpretation, and use of clinical guidelines may vary substantially on a regional, national and international basis. Survey research can help bridge the gap by providing a snapshot of neurosurgeon attitudes, knowledge, and practices. The American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS) Section on Tumors formed a Survey Committee to formalize the process by which surveys are submitted and reviewed before distribution to our membership. The goal of this committee is to provide peer-review so that collected information will be scientifically robust and useful to the neurosurgical community.

METHODS

Surveys submitted to the AANS/CNS tumor section between 2015 and 2019 were reviewed and metrics such as response rate and publication status assessed.

RESULTS

Six surveys were submitted to the Survey Committee of the AANS/CNS section on tumors between 2015 and 2019. Four have been circulated to section members, of which three have been published. Response rate has averaged 19% (range 16-23%), a majority of respondents (mean 70%) practice in academic settings.

CONCLUSIONS

The AANS/CNS Section on Tumors Survey Committee has and continues to help promote and improve the practice of surveying our community to answer important questions that can advance future training, research, and practice. There remains significant room for improvement in response rates, but ongoing tumor section efforts to increase member engagement will likely improve these numbers.

The effect of a web-push survey on physician survey responses rates: a randomized experiment

Background

Achieving a high response rate for physicians has been challenging, and with response rates declining in recent years, innovative methods are needed to increase rates. An emerging concept in survey methodology has been web-push survey delivery. With this delivery method, contact is made by mail to request a response by web. This study explored the feasibility of a web-push survey on a national sample of physicians.

Methods

A total of 1,000 physicians across six specialties were randomly assigned to a mail-only or web-push survey delivery. Each mode consisted of four contacts including an initial mailing, reminder postcard, and two additional follow-ups. Response rates were calculated using the American Association for Public Opinion Research's response rate 3 calculation. Data collection occurred between Febuary and April 2018; data were analyzed March 2019.

Results

Overall reponse rates for the mail-only versus web-push survey delivery were comparable (51.2% vs. 52.8%). Higher response rates across all demographics were seen in the web-push delivery, with the exception of pulmonary/critical care and physicians over the age of 65. The web-push survey yielded a greater response after the first mailing, requiring fewer follow-up contacts resulting in a more cost-effective delivery.

Conclusions

A web-push mail survey is effective in achieving a comparable response rate to traditional mail-only delivery for physicians. The web-push survey was more efficient in terms of cost and in receiving responses in a more timely manner. Future research should explore the efficiency of a web-push survey delivery across various health care provider populations.

Belief of having had unconfirmed Covid-19 infection reduces willingness to participate in app-based contact tracing

Contact tracing and lockdown are health policies being used worldwide to combat the coronavirus (COVID-19). The UK National Health Service (NHS) Track and Trace Service has plans for a nationwide app that notifies the need for self-isolation to those in contact with a person testing positive for COVID-19. To be successful, such an app will require high uptake, the determinants and willingness for which are unclear but essential to understand for effective public health benefit. The objective of this study was to measure the determinants of willingness to participate in an NHS app-based contact-tracing programme using a questionnaire within the Care Information Exchange (CIE)—the largest patient-facing electronic health record in the NHS. Among 47,708 registered NHS users of the CIE, 27% completed a questionnaire asking about willingness to participate in app-based contact tracing, understanding of government advice, mental and physical wellbeing and their healthcare utilisation—related or not to COVID-19. Descriptive statistics are reported alongside univariate and multivariable logistic regression models, with positive or negative responses to a question on app-based contact tracing as the dependent variable. 26.1% of all CIE participants were included in the analysis (N = 12,434, 43.0% male, mean age 55.2). 60.3% of respondents were willing to participate in app-based contact tracing. Out of those who responded ‘no’, 67.2% stated that this was due to privacy concerns. In univariate analysis, worsening mood, fear and anxiety in relation to changes in government rules around lockdown were associated with lower willingness to participate. Multivariable analysis showed that difficulty understanding government rules was associated with a decreased inclination to download the app, with those scoring 1–2 and 3–4 in their understanding of the new government rules being 45% and 27% less inclined to download the contact-tracing app, respectively; when compared to those who rated their understanding as 5–6/10 (OR for 1–2/10 = 0.57 [CI 0.48–0.67]; OR for 3–4/10 = 0.744 [CI 0.64–0.87]), whereas scores of 7–8 and 9–10 showed a 43% and 31% respective increase. Those reporting an unconfirmed belief of having previously had and recovered from COVID-19 were 27% less likely to be willing to download the app; belief of previous recovery from COVID-19 infection OR 0.727 [0.585–0.908]). In this large UK-wide questionnaire of wellbeing in lockdown, a willingness for app-based contact tracing over an appropriate age range is 60%—close to the estimated 56% population uptake, and substantially less than the smartphone-user uptake considered necessary for an app-based contact tracing to be an effective intervention to help suppress an epidemic. Difficulty comprehending government advice and uncertainty of diagnosis, based on a public health policy of not testing to confirm self-reported COVID-19 infection during lockdown, therefore reduce willingness to adopt a government contact-tracing app to a level below the threshold for effectiveness as a tool to suppress an epidemic.

Measures of the Degree of Departure from Ignorable Sample Selection

With the current focus of survey researchers on "big data" that are not selected by probability sampling, measures of the degree of potential sampling bias arising from this nonrandom selection are sorely needed. Existing indices of this degree of departure from probability sampling, like the R-indicator, are based on functions of the propensity of inclusion in the sample, estimated by modeling the inclusion probability as a function of auxiliary variables. These methods are agnostic about the relationship between the inclusion probability and survey outcomes, which is a crucial feature of the problem. We propose a simple index of degree of departure from ignorable sample selection that corrects this deficiency, which we call the standardized measure of unadjusted bias (SMUB). The index is based on normal pattern-mixture models for nonresponse applied to this sample selection problem and is grounded in the model-based framework of nonignorable selection first proposed in the context of nonresponse by Don Rubin in 1976. The index depends on an inestimable parameter that measures the deviation from selection at random, which ranges between the values zero and one. We propose the use of a central value of this parameter, 0.5, for computing a point index, and computing the values of SMUB at zero and one to provide a range of the index in a sensitivity analysis. We also provide a fully Bayesian approach for computing credible intervals for the SMUB, reflecting uncertainty in the values of all of the input parameters. The proposed methods have been implemented in R and are illustrated using real data from the National Survey of Family Growth.

Attitudes and Behavior towards Interprofessional Collaboration among Healthcare Professionals in a Large Academic Medical Center

The increasing rates of comorbidities among patients and the complexity of care have warranted interprofessional collaboration (IPC) as an important component of the healthcare structure. An initial step towards assessing the effectiveness of collaboration requires the exploration of the attitudes and experience of healthcare professionals towards IPC. This online survey aimed to examine the attitudes of healthcare professionals working in a large public academic medical center toward IPC in patient care and the healthcare team, and their behavior and experience regarding IPC. The rankings, according to the perceived importance among the respondents, of the four Interprofessional Education Collaborative (IPEC) core competencies (values/ethics, roles/responsibilities, interprofessional communication, teams/teamwork) were assessed. There were strong but varying levels of consensus among healthcare professionals (N = 551) that IPC facilitates efficient patient care, improves patient problem-solving ability, and increases better clinical outcomes for patients. They acknowledged that IPC promotes mutual respect within the healthcare team and providers’ ability to make optimal patient care decisions. However, overall more than 35% of the respondents did not attend multidisciplinary education sessions (grand rounds, seminars, etc.), and about 23% did not participate in bedside patient care rounds. Interprofessional communication was ranked as the most important IPEC core competence. Although the attitude towards IPC among healthcare professionals is strongly positive, many healthcare professionals face challenges in participating in IPC. Institutional policies that facilitate interprofessional learning and interactions for this group of healthcare professionals should be formulated. Online distance learning and interactions, and simulation-enhanced interprofessional education, are options for addressing this barrier. Hospital administrators should facilitate conducive work environments that promote IPC, based on IPEC core competencies, and promote programs that address the challenges of IPC.

Attitudes and practices of public health academics towards research funding from for-profit organizations: cross-sectional survey

Objectives

The growing trend of for-profit organization (FPO)-funded university research is concerning because resultant potential conflicts of interest might lead to biases in methods, results, and interpretation. For public health academic programmes, receiving funds from FPOs whose products have negative health implications may be particularly problematic.

Methods

A cross-sectional survey assessed attitudes and practices of public health academics towards accepting funding from FPOs. The sampling frame included universities in five world regions offering a graduate degree in public health; 166 academics responded. Descriptive, bivariate, and logistic regression analyses were conducted.

Results

Over half of respondents were in favour of accepting funding from FPOs; attitudes differed by world region and gender but not by rank, contract status, % salary offset required, primary identity, or exposure to an ethics course. In the last 5 years, almost 20% of respondents had received funding from a FPO. Sixty per cent of respondents agreed that there was potential for bias in seven aspects of the research process, when funds were from FPOs.

Conclusions

Globally, public health academics should increase dialogue around the potential harms of research and practice funded by FPOs.

Electronic supplementary material

The online version of this article (10.1007/s00038-020-01416-0) contains supplementary material, which is available to authorized users.

Dissemination of Prenatal Drinking Guidelines: A Preliminary Study Examining Personal Alcohol Use Among Midwives in a Southwestern US State

INTRODUCTION

The constellation of birth defects seen in fetuses exposed to alcohol in utero have been described as fetal alcohol spectrum disorders. Evidence suggests that health care providers' communication practices regarding prenatal alcohol use could have beneficial outcomes. There is a paucity of investigations, however, that have examined the health professionals' personal alcohol use and prenatal alcohol recommendations they provide.

METHODS

This study sought to examine and compare midwives' personal alcohol use and communication practices regarding prenatal alcohol consumption. Certified nurse-midwives (CNMs) and certified professional midwives (CPMs) in a southwestern US state participated. Inclusion criteria included training in prenatal care, labor, birth, and membership in a midwife professional organization. Personal drinking behaviors were assessed with Alcohol Use Disorder Identification Test-Consumption (AUDIT-C).

RESULTS

All midwives (N = 61; 100%) reported they typically screened a patient for alcohol use during an initial prenatal visit. However, 5 (8.2%) respondents opted for recommendations that advised patients to drink once in a while. Similarly, 4 (6.6%) midwives counseled no more than one drink per day. In the cohort of participants (n = 40) with AUDIT-C scores, 25 (62.5%) engaged in nonrisky drinking (AUDIT-C scores <3). Most respondents (n = 39 of 40; 97.5%) typically consumed 1 to 2 standard drinks on the day they drank. There was no statistically significant difference in mean overall AUDIT-C scores between CNMs and CPMs (P = .42). When examining midwives' (1) responses on the AUDIT-C questionnaire, (2) nonrisky or risky drinking behaviors, and 3) communication practices regarding prenatal alcohol use, Fisher's exact test showed no statistically significant differences between CNMs and CPMs.

DISCUSSION

Results of this study highlight the importance of advocating healthy lifestyles among health care professionals while also promoting communication practices that align with national alcohol guidelines. Future investigations that examine associations between health care professionals' personal alcohol use and type or effectiveness of services offered to patients may be beneficial.

Low Provider Knowledge Is Associated With Less Evidence-Based Lung Cancer Screening

BACKGROUND

Despite widespread recommendation and supportive policies, screening with low-dose CT (LDCT) is incompletely implemented in the US healthcare system. Low provider knowledge of the lung cancer screening (LCS) guidelines represents a potential barrier to implementation. Therefore, we tested the hypothesis that low provider knowledge of guidelines is associated with less provider-reported screening with LDCT.

PATIENTS AND METHODS

A cross-sectional survey was performed in a large academic medical center and affiliated Veterans Health Administration in the Mid-South United States that comprises hospital and community-based practices. Participants included general medicine providers and specialists who treat patients aged >50 years. The primary exposure was LCS guideline knowledge (US Preventive Services Task Force/Centers for Medicare & Medicaid Services). High knowledge was defined as identifying 3 major screening eligibility criteria (55 years as initial age of screening eligibility, smoking status as current or former smoker, and smoking history of ≥30 pack-years), and low knowledge was defined as not identifying these 3 criteria. The primary outcome was self-reported LDCT order/referral within the past year, and the secondary outcome was screening chest radiograph. Multivariable logistic regression evaluated the adjusted odds ratio (aOR) of screening by knowledge.

RESULTS

Of 625 providers recruited, 407 (65%) responded, and 378 (60.5%) were analyzed. Overall, 233 providers (62%) demonstrated low LCS knowledge, and 224 (59%) reported ordering/referring for LDCT. The aOR of ordering/referring LDCT was less among providers with low knowledge (0.41; 95% CI, 0.24-0.71) than among those with high knowledge. More providers with low knowledge reported ordering screening chest radiographs (aOR, 2.7; 95% CI, 1.4-5.0) within the past year.

CONCLUSIONS

Referring provider knowledge of LCS guidelines is low and directly proportional to the ordering rate for LDCT in an at-risk US population. Strategies to advance evidence-based LCS should incorporate provider education and system-level interventions to address gaps in provider knowledge.

Attitudes towards plagiarism among academics of the faculty of Medicine of Tunis

Assessing the extent of plagiarism within academics remains the first step in the fight against this behavior. The current study aimed to explore the attitudes of the Faculty of Medicine of Tunis (FMT)'s academics toward plagiarism. A cross-sectional study was conducted within the FMT during the 2018-2019 academic year. Data were collected using a questionnaire including the English version of the attitudes toward plagiarism questionnaire (ATPQ) which is composed of 29 statements divided into three attitudinal factors: positive, negative attitudes and subjective norms toward plagiarism. A total of 340 faculty members responded to the survey. The mean scores for both positive attitudes (28.8 ± 6.9) and subjective norms (24.6 ± 4.9) were between low to moderate and that of negative attitudes was moderate (22.4 ± 2.6). In multivariate analysis, participants with higher academic rank, those who had a good level of English or who attended English courses and those who attended workshops in scientific writing were less tolerant toward plagiarism. The implementation of courses on research practices as well as the introduction of medical English courses in the FMT's post graduate program could constitute relevant approaches to limit the extent of plagiarism.

Profile of acupuncture use among primary care physicians working in the Brazilian public healthcare system

BACKGROUND

An introductory acupuncture course has been offered to primary health care physicians and family medicine residents in southern Brazil since 2011.

OBJECTIVE

To analyze the profile of acupuncture utilization of primary care physicians who completed an introductory course of acupuncture between 2011 and 2018.

METHOD

A survey using an electronic questionnaire was sent to all 119 physicians who completed the course.

RESULTS

Fifty-five physicians answered the questionnaire. The majority of them reported continuation of the practice of acupuncture in scheduled appointments and on spontaneous demand. The most commonly used principles of point selection were traditional acupuncture point function, myofascial trigger point needling and point protocols. As barriers to the practice of acupuncture, time limitation and inadequate physical space were predominant. The participants described the problem-solving potential of the procedure and good patient acceptance as facilitators. The most common problems treated with acupuncture were musculoskeletal pain, and mood and anxiety disorders. A reduction in referrals to specialists and reduced prescription of pain medications were also reported. Most physicians answered that they often combined acupuncture with other medications or associated acupuncture with other complementary practices. The main adverse events reported by the participants were vascular trauma and fainting.

CONCLUSION

Most primary care physicians who completed the introductory course and answered the survey still used acupuncture in their routine, primarily for the management of musculoskeletal conditions and mental health conditions. These physicians reported reductions in specialist referrals and prescription of pain medication after integrating basic acupuncture skills into primary care practice.

The association of working alliance, outcome expectation, adherence and self-efficacy with clinical outcomes for Achilles tendinopathy: A feasibility cohort study (the MAP study)

INTRODUCTION

This study evaluated the feasibility of a large longitudinal cohort study utilizing an online platform to investigate the association and predictive relationship of working alliance, outcome expectations, adherence and self-efficacy with outcome in Achilles tendinopathy. The objectives were: (1) to determine the recruitment and retention rate and (2) to carry out preliminary data analysis of the selected variables and clinical outcomes.

METHODS

A multi-centred, longitudinal feasibility cohort study was used. Eligible participants were directed to a bespoke online platform hosting study information and the outcome measures in the form of an online questionnaire. Responses from the online questionnaire were collected on three occasions: at baseline, at 6 and at 12 weeks following completion of the first questionnaire. Feasibility outcomes (recruitment and retention rates) were described using descriptive statistics.

RESULTS

The website recorded a total 55 views. These 55 views resulted in 24 participants consenting to join the study. The questionnaire at baseline was started 63 times and completed on 60 separate occasions resulting in a 95% conversion rate. Retainment for completion of the questionnaire for a second time was 83.3% and for the third time was 66.6%. All questionnaires were completed fully yielding a missing data indicator of 0%.

CONCLUSIONS

Feasibility studies ask the question 'can this be done'? Based on the data from recruitment and rates and exploratory correlation analysis a future study can be done; this previously untested online platform appears feasible, but changes could be useful before proceeding to a much larger study.

Response to survey directed to patient portal members differs by age, race, and healthcare utilization

Health care systems are increasingly utilizing electronic medical record—associated patient portals to facilitate communication with patients and between providers and their patients. These patient portals are growing in recognition as potentially valuable research tools. While there is much information about the response rates and demographics of internet-based surveys as well as the demographics of patients who are portal members, not much is known about the response rate of internet-based surveys directed to a group of patient portal members or the demographics of which portal members respond to internet-based surveys issued within that specific population. The objective of these analyses was to determine the demographics of patient portal users who respond to an internet-based survey request. We hypothesized that respondents would more likely be: (1) older (65+), (2) European American, (3) married, (4) female, (5) college educated, (6) have higher medical care utilization, (7) have more comorbidities, and (8) have a private practice primary care physician (as opposed to a salaried group practice primary care physician). We found that our respondents tended to be older, of European geographic ancestry, and more frequent users of healthcare. While patient portal members are an easily identifiable and contactable group that are potentially valuable participants for research, it is important to understand that respondents to surveys solicited from this sampling frame may not be entirely representative. It will be important to develop strategies to more fully engage populations that represent the target population in order to increase overall and subgroup response rates.

The emerging contribution of speech and language therapists in awake craniotomy: a national survey of their roles, practices and perceptions

BACKGROUND

Awake craniotomy with electrical stimulation has become the gold standard for tumour resection in eloquent areas of the brain. Patients' speech during the procedure can inform the intervention and evidence for language experts to support the procedure is building. Within the UK a burgeoning speech and language therapist awake craniotomy network has emerged to support this practice. Further evidence is needed to underpin the specific contribution of speech and language therapists working within the awake craniotomy service.

AIMS

To investigate and analyse the current practices of speech and language therapists: their role, pre-, intra- and postoperative assessment, and management practice patterns and skill set within awake craniotomy.

METHODS & PROCEDURES

Speech and language therapists in the UK, who work in awake craniotomy, were invited to complete an online questionnaire. Participants were recruited via several networks supported by a social media campaign. Data were analysed using a mixed methodology approach including descriptive statistics, summative and conventional content analysis.

OUTCOMES & RESULTS

A total of 24 speech and language therapists completed the survey, an unknown proportion of the available population. All four UK countries were represented. The majority were highly specialist clinicians 58% (n = 14) with the remainder clinical leads 25% (n = 6) or specialist clinicians 17% (n = 14). Only 29% (n = 7) had funding for awake craniotomy or had awake craniotomy in their job description. Median experience with awake craniotomy was 3 years. Median estimated contact time per case was 10.3 h. Current intraoperative practice is characterized by a sustained period of real-time, dynamic, informal assessment of speech, language, oromotor and cognitive functions. Respondents described a range of intraoperative clinical deficits that, once detected, are immediately communicated to surgeons. There was evidence of variable and diverse language mapping practices and barriers to the translation of information at multidisciplinary team level. Barriers to participation in awake craniotomy included lack of: standardized validated language mapping methods, funding, standardized training methods and guidance to direct practice.

CONCLUSIONS & IMPLICATIONS

The evidence suggests areas of consistent practice patterns in preoperative preparation and intraoperative assessment. However, considerable variability exists within language testing and mapping that would benefit from validation. These speech and language therapists support improved outcomes of awake craniotomy by real-time intraoperative speech, language, oromotor and cognitive assessment, rapid detection of clinical deterioration and immediate communication to surgeons. Further research exploring intraoperative language testing, consistent use of language mapping terminology, and selection of test methods is recommended.

Research Competencies Assessment Instrument for Nurses: Preliminary Psychometric Properties

BACKGROUND AND PURPOSE

Clinician research competencies influence research use for evidence-based practice (EBP). We aimed to develop, refine, and psychometrically assess the Research Competencies Assessment Instrument for Nurses (RCAIN) to measure registered nurse research competencies (i.e., knowledge, skills, attitudes) focused on EBP-related domains: research process, knowledge synthesis, and knowledge translation activities.

METHODS

The preliminary psychometrics (face, content, construct/criterion validity) were evaluated based on 63 completed surveys.

RESULTS

The Cronbach's α coefficients were .871, .813, and .946 for each domain, respectively; interitem correlations ranged from .472 to .833 (explained variance: 68.5%). Three components/factors revealed: comprehension of and skills required in research process and application of knowledge and skills. The revised RCAIN consists of 19 five-point Likert-type questions.

CONCLUSIONS

The RCAIN assesses modifiable characteristics and explains variance in practice, health system, and patient outcomes. Further assessments are underway.

Indices of non-ignorable selection bias for proportions estimated from non-probability samples

Rising costs of survey data collection and declining response rates have caused researchers to turn to non-probability samples to make descriptive statements about populations. However, unlike probability samples, non-probability samples may produce severely biased descriptive estimates due to selection bias. The paper develops and evaluates a simple model-based index of the potential selection bias in estimates of population proportions due to non-ignorable selection mechanisms. The index depends on an inestimable parameter ranging from 0 to 1 that captures the amount of deviation from selection at random and is thus well suited to a sensitivity analysis. We describe modified maximum likelihood and Bayesian estimation approaches and provide new and easy-to-use R functions for their implementation. We use simulation studies to evaluate the ability of the proposed index to reflect selection bias in non-probability samples and show how the index outperforms a previously proposed index that relies on an underlying normality assumption. We demonstrate the use of the index in practice with real data from the National Survey of Family Growth.

A Cross-Sectional Web-Based Survey of Medical Practitioners in India to Assess their Knowledge, Attitude, Prescription Practices, and Barriers toward Opioid Analgesic Prescriptions

CONTEXT

Inadequate training of medical practitioners is a key factor responsible for inappropriate use of opioid analgesics.

AIMS

We assessed the current knowledge, attitude, prescribing practices, and barriers perceived by the Indian medical practitioners in three tertiary care hospitals toward the use of opioid analgesics.

SUBJECTS AND METHODS

Web-based survey of registered medical practitioner employed at three chosen tertiary health care institutions in New Delhi.

STATISTICAL ANALYSIS USED

Descriptive analysis of survey responses was carried out. Comparative analysis was done using Chi-square test, independent samples t-test, and Pearson correlation coefficient.

RESULTS

The response rate was 10.4% (n = 308). Two-thirds of the participants (61.7%) had never received formal pain management training, and 86.7% participants would like further training. Most participants (71.1%) agreed that opioids should be prescribed in cancer pain, while 26.3% agreed that opioids should be prescribed in noncancer pain. Half of the participants agreed that SOS (if necessary) dosing schedule (48.4%), low dosage (61.7%), and short duration of use (51.4%) could decrease the harmful effect of opioids. Lack of information about opioid-related policies and addiction potential were identified as the most common barriers to prescribing opioids. Those seeing more patients with chronic noncancer pain come across opioid misuse and diversion more often (P = 0.02). Those who understood addiction were more likely to agree that patients of chronic cancer pain with substance use disorders should be prescribed opioid analgesics (P < 0.01).

CONCLUSIONS

Indian medical practitioners felt the need for formal pain management training. There is a lack of consensus on how to manage the pain using opioid analgesics. Tough regulations on medical and scientific use of opioids are the most commonly reported barrier to prescribing them.