A very low response rate in an on-line survey of medical practitioners

Acceptance, Satisfaction, and Preference With Telemedicine During the COVID-19 Pandemic in 2021-2022: Survey Among Patients With Chronic Pain

BACKGROUND

The COVID-19 pandemic has forced many health care providers to make changes in their treatment, with telemedicine being expanded on a large scale. An earlier study investigated the acceptance of telephone calls but did not record satisfaction with treatment or patients' preferences. This warranted a follow-up study to investigate acceptance, satisfaction, and preferences regarding telemedicine, comprising of phone consultations, among health care recipients.

OBJECTIVE

The primary aim was to assess the acceptance and satisfaction of telemedicine during the subsequent months of 2021-2022, after the initial wave of the COVID-19 pandemic in Switzerland. Furthermore, we aimed to assess patients' preferences and whether these differed in patients who had already experienced telemedicine in the past, as well as correlations between acceptance and satisfaction, pain intensity, general condition, perception of telemedicine, and catastrophizing. Finally, we aimed to investigate whether more governmental restrictions were correlated with higher acceptance.

METHODS

An anonymous cross-sectional web-based survey was conducted between January 27, 2021, and February 4, 2022, enrolling patients undergoing outpatient pain therapy in a tertiary university clinic. We conducted a descriptive analysis of acceptance and satisfaction with telemedicine and investigated patients' preferences. Further, we conducted a descriptive and correlational analysis of the COVID-19 stringency index. Spearman correlation analysis and a chi-square test for categorical data were used with Cramer V statistic to assess effect sizes.

RESULTS

Our survey was completed by 60 patients. Telemedicine acceptance and satisfaction were high, with an average score of 7.6 (SD 3.3; on an 11-point Numeric Rating Scale from 0=not at all to 10=completely), and 8.8 (SD 1.8), respectively. Respondents generally preferred on-site consultations to telemedicine (n=35, 58% vs n=24, 40%). A subgroup analysis revealed that respondents who already had received phone consultation, showed a higher preference for telemedicine (n/N=21/42, 50% vs n/N=3/18, 17%; χ22 [N=60]=7.5, P=.02, Cramer V=0.354), as well as those who had been treated for more than 3 months (n/N=17/31, 55% vs n/N=7/29, 24%; χ22 [N=60]=6.5, P=.04, Cramer V=0.329). Acceptance of telemedicine showed a moderate positive correlation with satisfaction (rs{58}=0.41, P<.05), but there were no correlations between the COVID-19 stringency index and the other variables.

CONCLUSIONS

Despite high acceptance of and satisfaction with telemedicine, patients preferred on-site consultations. Preference for telemedicine was markedly higher in patients who had already received phone consultations or had been treated for longer than 3 months. This highlights the need to convey knowledge of eHealth services to patients and the value of building meaningful relationships with patients at the beginning of treatment. During the COVID-19 pandemic, the modality of patient care should be discussed individually.

Measuring e-Professional Behavior of Doctors of Medicine and Dental Medicine on Social Networking Sites: Indexes Construction With Formative Indicators

BACKGROUND

Previous studies have predominantly measured e-professionalism through perceptions or attitudes, yet there exists no validated measure specifically targeting the actual behaviors of health care professionals (HCPs) in this realm. This study addresses this gap by constructing a normative framework, drawing from 3 primary sources to define e-professional behavior across 6 domains. Four domains pertain to the dangers of social networking sites (SNSs), encompassing confidentiality, privacy, patient interaction, and equitable resource allocation. Meanwhile, 2 domains focus on the opportunities of SNSs, namely, the proactive dissemination of public health information and maintaining scientific integrity.

OBJECTIVE

This study aims to develop and validate 2 new measures assessing the e-professional behavior of doctors of medicine (MDs) and doctors of dental medicine (DMDs), focusing on both the dangers and opportunities associated with SNSs.

METHODS

The study used a purposive sample of MDs and DMDs in Croatia who were users of at least one SNS. Data collection took place in 2021 through an online survey. Validation of both indexes used a formative approach, which involved a 5-step methodology: content specification, indicators definition with instructions for item coding and index construction, indicators collinearity check using the variance inflation factor (VIF), external validity test using multiple indicators multiple causes (MIMIC) model, and external validity test by checking the relationships of the indexes with the scale of attitude toward SNSs using Pearson correlation coefficients.

RESULTS

A total of 753 responses were included in the analysis. The first e-professionalism index, assessing the dangers associated with SNSs, comprises 14 items. During the indicators collinearity check, all indicators displayed acceptable VIF values below 2.5. The MIMIC model showed good fit (χ213=9.4, P=.742; χ2/df=0.723; root-mean-square error of approximation<.001; goodness-of-fit index=0.998; comparative fit index=1.000). The external validity of the index is supported by a statistically significant negative correlation with the scale measuring attitudes toward SNSs (r=-0.225, P<.001). Following the removal of 1 item, the second e-professionalism index, focusing on the opportunities associated with SNSs, comprises 5 items. During the indicators collinearity check, all indicators exhibited acceptable VIF values below 2.5. Additionally, the MIMIC model demonstrated a good fit (χ24=2.5, P=.718; χ2/df=0.637; root-mean-square error of approximation<0.001; goodness-of-fit index=0.999; comparative fit index=1.000). The external validity of the index is supported by a statistically significant positive correlation with the scale of attitude toward SNSs (r=0.338; P<.001).

CONCLUSIONS

Following the validation process, the instrument designed for gauging the e-professional behavior of MDs and DMDs consists of 19 items, which contribute to the formation of 2 distinct indexes: the e-professionalism index, focusing on the dangers associated with SNSs, comprising 14 items, and the e-professionalism index, highlighting the opportunities offered by SNSs, consisting of 5 items. These indexes serve as valid measures of the e-professional behavior of MDs and DMDs, with the potential for further refinement to encompass emerging forms of unprofessional behavior that may arise over time.

Changes in oral home care and smoking habits during COVID-19 pandemic: A cross-sectional study

OBJECTIVES

The coronavirus disease-19 (COVID-19) pandemic has caused disruption in the health behavior in many aspects of life. While hand hygiene was promoted as one of the precautionary measures to mitigate and contain COVID-19, oral health and smoking might have received less attention in the media campaigns. The aim of this study was to examine health behavioral changes in terms of oral home care habits, smoking, and perception of dental care during the COVID-19 pandemic.

MATERIAL AND METHODS

An online survey was designed to assess oral home care, smoking habits, and attitude toward dental services of participants aged 18 years and older. The data were collected between September and November 2021. The strength of association between changes in oral home care habits, smoking, and attitude toward invasive/long dental procedures and each variable was measured by χ2 analysis. Estimates of relative risk were also calculated for all variables. Predictors of avoiding dental procedures were estimated by a binary logistic regression.

RESULTS

A total of 532 participants, based in the United Arab Emirates, took part in this online survey with a response rate of 88.7%. The age of the participants ranged between 18 and 67 with mean age of 34.9 ± 9.0 years. The majority of the participants have adopted changes in their routine oral home care habits, with 82.1% of them changing the toothbrush more frequently. Participants who changed their oral home care habits were more likely to have received sufficient information on the importance of maintaining oral health. Likewise, the changes in smoking habits were significantly associated with receiving information on the relationship between smoking and the severity of the COVID-19 (p < 0.001).

CONCLUSIONS

The findings showed that positive behavior toward oral home care and smoking was noticed during the pandemic particularly when public receives sufficient and up-to-date information.

The necessity of electrodiagnostic studies and ultrasound in ulnar nerve entrapment according to surgeons in the Netherlands

BACKGROUND

Ulnar nerve entrapment at the elbow (UNE) is the second most prevalent entrapment neuropathy after carpal tunnel syndrome. The objective of this study was to evaluate the expert opinion of different surgical disciplines regarding the need for electrodiagnostic or ultrasound confirmation of UNE and, if so, which test was preferred for confirmation.

METHODS

A questionnaire was sent to all neurosurgeons and plastic or hand surgeons in the Netherlands to evaluate the current practice in planning surgical treatment of UNE.

RESULTS

The response rate was 36.4 % (134 out of 368). 94 % of surgeons reported that > 95 % of their patients had EDX or ultrasound studies before surgery. 80.6 % of all surgeons who responded reported that they seldom operated on UNE without electrodiagnostic confirmation. Hand surgeons (25.9 %) were more willing to operate on clinically diagnosed UNE without EDX than neurosurgeons (9.4 %) CONCLUSIONS: Dutch surgeons prefer diagnostic confirmation of UNE either by ultrasound or EDX, with a preference for EDX and the vast majority of operated patients do have either EDX or ultrasound or both before surgery. Compared to neurosurgeons, hand surgeons are more willing to operate on patients with clinically defined UNE but normal electrodiagnostic studies.

Experiences of Residents and Fellows at Mayo Clinic After the Rapid Implementation of Telemedicine During the COVID-19 Pandemic

OBJECTIVE

The COVID-19 pandemic led to many changes across medical organizations and graduate medical education programs nationwide including the rapid implementation of telemedicine as a modality for delivering health care. The purpose of this study was to investigate the telemedicine experiences of residents and fellows with their self-reported level of preparedness, impact on their education including precepting, skill development, and patient-physician relationships, and perceptions of telehealth platforms and curricula in the future.

METHODS

A total of 365 Mayo Clinic residents and fellows across three sites (Florida, Arizona, and Minnesota) were identified as trainees who conducted at least one telemedicine encounter from January 1, 2020 to June 30, 2020 and were sent an electronic survey by e-mail.

RESULTS

There was a total of 103 completed surveys across various specialties with 58.3% female respondents, 63.1% residents, 35.0% fellows and 77.7% of respondents who attended medical school in the United States. Most trainees reported having very little to no exposure to telemedicine in their medical careers before the pandemic. The majority were satisfied with their first telemedicine encounter and found precepting comparable to in-person visits. The trainees in this study had a favorable view with 98.1% believing telemedicine will play a more prevalent role in the future and most agreed this should be included in medical school and residency training.

CONCLUSION

Our survey found that after the implementation of telemedicine during the COVID-19 pandemic, the experiences of trainees at a multi-site academic center were overall positive. More research is needed on the perceptions of skill development (physical exam and history taking) during a telemedicine encounter and outlining an optimal telemedicine curriculum that can improve confidence in trainees.

Workplace wellbeing among health care workers providing HIV services in primary care in Johannesburg: a mixed methods study

Background

Burnout among Health Care workers (HCWs) impacts on provider-patient relations and quality of care. Anova Health Institute (Anova) is a large South African non-profit organization and PEPFAR/USAID implementing partner. We conducted a study among HCWs providing HIV-related services in primary care settings in Johannesburg, South Africa, to examine levels of burnout, understand factors affecting workplace wellbeing, and explore strategies to prevent burnout.

Methods

We used a sequential mixed-method approach. Data were collected between February and April 2022. The first phase consisted of a survey using the Maslach Burnout Inventory Human Services Survey (MBI-HSS) to measure levels of burnout. We then interviewed a subset of survey participants to understand the experiences that may affect wellbeing. We used descriptive statistics to quantify burnout rates for each MBI dimension (emotional exhaustion, personal accomplishment, and depersonalization). Qualitative data analysis was guided by the Job Demands-Resources Framework that explores the interactions between demands and resources in the workplace.

Results

Survey findings (n = 194) revealed that although depersonalization rates were low at 6%, 21% of participants had high emotional exhaustion and 24% reported low professional accomplishment. Less than half (41%, n = 80) had scores in the high category for any one of the three MBI-HSS dimensions. The MBI-HSS dimensions differed significantly by type of work and job title. Roving positions (HCW working in more than one health facility) were more likely to experience higher emotional exhaustion and lower professional accomplishment. Qualitative findings (n = 25) indicate that a number of job demands, including high workload, inadequate mental health support, and challenging relationships with stakeholders, had a negative effect on HCWs' wellbeing. However, finding meaningfulness in their work, working as a team, and practicing autonomy were experienced as resources that reduced the negative effect of these demands.

Conclusion

While measured burnout syndrome rates were low, various experiences negatively impacted at least one in five HCW. We identified key resources that provided buffering against workplace stressors. We recommend that as well as addressing key drivers of burnout, access to these resources should be fostered, for example by strengthening interventions that offer recognition, and promoting team interactions through social activities and support groups.

Decisions and Decisional Needs of Canadians From all Provinces and Territories During the COVID-19 Pandemic: Population-Based Cross-sectional Surveys

BACKGROUND

Never before COVID-19 had Canadians faced making health-related decisions in a context of significant uncertainty. However, little is known about which type of decisions and the types of difficulties that they faced.

OBJECTIVE

We sought to identify the health-related decisions and decisional needs of Canadians.

METHODS

Our study was codesigned by researchers and knowledge users (eg, patients, clinicians). Informed by the CHERRIES (the Checklist for Reporting Results of Internet E-Surveys) reporting guideline, we conducted 2 online surveys of random samples drawn from the Leger consumer panel of 400,000 Canadians. Eligible participants were adults (≥18 years) who received or were receiving any health services in the past 12 months for themselves (adults) or for their child (parent) or senior with cognitive impairment (caregiver). We assessed decisions and decisional needs using questions informed by the Ottawa Decision Support Framework, including decisional conflict and decision regret using the Decision Conflict Scale (DCS) and the Decision Regret Scale (DRS), respectively. Descriptive statistics were conducted for adults who had decided for themselves or on behalf of someone else. Significant decisional conflict (SDC) was defined as a total DCS score of >37.5 out of 100, and significant decision regret was defined as a total DRS score of >25 out of 100.

RESULTS

From May 18 to June 4, 2021, 14,459 adults and 6542 parents/caregivers were invited to participate. The invitation view rate was 15.5% (2236/14,459) and 28.3% (1850/6542); participation rate, 69.3% (1549/2236) and 28.7% (531/1850); and completion rate, 97.3% (1507/1549) and 95.1% (505/531), respectively. The survey was completed by 1454 (97.3%) adults and 438 (95.1%) parents/caregivers in English (1598/1892, 84.5%) or French (294/1892, 15.5%). Respondents from all 10 Canadian provinces and the northern territories represented a range of ages, education levels, civil statuses, ethnicities, and annual household income. Of 1892 respondents, 541 (28.6%) self-identified as members of marginalized groups. The most frequent decisions were (adults vs parents/caregivers) as follows: COVID-19 vaccination (490/1454, 33.7%, vs 87/438, 19.9%), managing a health condition (253/1454, 17.4%, vs 47/438, 10.7%), other COVID-19 decisions (158/1454, 10.9%, vs 85/438, 19.4%), mental health care (128/1454, 8.8%, vs 27/438, 6.2%), and medication treatments (115/1454, 7.9%, vs 23/438, 5.3%). Caregivers also reported decisions about moving family members to/from nursing or retirement homes (48/438, 11.0%). Adults (323/1454, 22.2%) and parents/caregivers (95/438, 21.7%) had SDC. Factors making decisions difficult were worrying about choosing the wrong option (557/1454, 38.3%, vs 184/438, 42.0%), worrying about getting COVID-19 (506/1454, 34.8%, vs 173/438, 39.5%), public health restrictions (427/1454, 29.4%, vs 158/438, 36.1%), information overload (300/1454, 20.6%, vs 77/438, 17.6%), difficulty separating misinformation from scientific evidence (297/1454, 20.4%, vs 77/438, 17.6%), and difficulty discussing decisions with clinicians (224/1454, 15.4%, vs 51/438, 11.6%). For 1318 (90.6%) adults and 366 (83.6%) parents/caregivers who had decided, 353 (26.8%) and 125 (34.2%) had significant decision regret, respectively. In addition, 1028 (50%) respondents made their decision alone without considering the opinions of clinicians.

CONCLUSIONS

During COVID-19, Canadians who responded to the survey faced several new health-related decisions. Many reported unmet decision-making needs, resulting in SDC and decision regret. Interventions can be designed to address their decisional needs and support patients facing new health-related decisions.

Fostering telecompetence: A descriptive evaluation of clinical psychology predoctoral internship and postdoctoral fellowship implementation of telehealth education

PURPOSE

Telehealth education within clinical psychology predoctoral internships and postdoctoral fellowships has become a frequent recommendation designed to prepare future providers with evidence-informed telehealth skills that can be applied to rural populations. Unfortunately, the availability of telehealth training among internships and fellowships, as well as areas for growth, remains unclear. Thus, the current study evaluated graduate clinical psychology internship and fellowship integration of telehealth training components before and after the onset of COVID-19.

METHODS

Individuals representing 74 internships and 29 fellowships completed author-created REDCap-hosted demographic and telehealth training surveys.

FINDINGS

Before COVID-19, 2 internships and 4 fellowships reported implementing telehealth education, with a majority of materials for both types of programs being optional educational targets and generally encompassing 0-15 hours of student education. After the onset of COVID-19, 72 internships and 27 fellowships indicated implementing telehealth education, with a majority indicating materials as mandatory and encompassing between 0 and 50+ hours. Despite increases, 73.6% of internship programs and 62.1% of fellowship programs noted a desire for their students to receive additional telehealth education in the future. Integrated educational foci are discussed.

CONCLUSIONS

The current study demonstrated positive trends in the development of telehealth education among internships and fellowships. Nevertheless, some programs can likely benefit from additional integration of telehealth components, as well as more formal programming built around field-supported competencies and models. While work is required to further clarify field offerings, the current study provided a preliminary evaluation of internship and fellowship telehealth educational offerings.

Assessing the role of collectivism and individualism on COVID-19 beliefs and behaviors in the Southeastern United States

America's unique response to the global COVID-19 pandemic has been both criticized and applauded across political and social spectrums. Compared to other developed nations, U.S. incidence and mortality rates were exceptionally high, due in part to inconsistent policies across local, state, and federal agencies regarding preventive behaviors like mask wearing and social distancing. Furthermore, vaccine hesitancy and conspiracy theories around COVID-19 and vaccine safety have proliferated widely, making herd immunity that much more challenging. What factors of the U.S. culture have contributed to the significant impact of the pandemic? Why have we not responded better to the challenges of COVID-19? Or would many people in the U.S. claim that we have responded perfectly well? To explore these questions, we conducted a qualitative and quantitative study of Florida State University faculty, staff, and students. This study measured their perceptions of the pandemic, their behaviors tied to safety and community, and how these practices were tied to beliefs of individualism and collectivism. We found that collectivist orientations were associated with a greater likelihood of wearing masks consistently, severe interruptions of one's social life caused by the pandemic, greater concern for infecting others, and higher levels of trust in medical professionals for behavioral guidelines surrounding the pandemic. These associations largely persist even after adjusting for political affiliation, which we find is also a strong predictor of COVID-19 beliefs and behaviors.

Canadian Older Adults' Intention to Use an Electronic Decision Aid for Housing Decisions: Cross-sectional Web-Based Survey

BACKGROUND

Older adults with disabilities such as loss of autonomy face the decision of whether to stay at home or move to a health care facility such as a nursing home. Therefore, they may need support for this difficult decision.

OBJECTIVE

We assessed the intention of Canadian older adults to use an electronic decision aid (eDA) to make housing decisions and identified the factors that influenced their intention.

METHODS

We conducted a cross-sectional study using a web-based survey targeting older adults across 10 Canadian provinces and 3 territories. We included respondents from a web-based panel who were aged ≥65 years, understood English or French, had access to an electronic device with an internet connection, and had made a housing decision over the past few months or were planning to make a decision in the coming year. We based the web-based survey on the Unified Theory of Acceptance and Use of Technology (UTAUT). We adapted 17 UTAUT items to measure respondents' intention to use the eDA for housing decisions, as well as items measuring 4 intention constructs (performance expectancy, effort expectancy, social influence, and facilitating conditions). We also assessed eHealth literacy using both subjective and objective scales. We used descriptive statistics and multivariable linear regression analyses to identify the factors influencing the intention to use the eDA.

RESULTS

Of the 11,972 invited panelists, 1176 (9.82%) met the eligibility criteria, and 1000 (85.03%) respondents completed the survey. The mean age was 72.5 (SD 5.59) years. Most respondents were male (548/1000, 54.8%), White (906/1000, 90.6%), English speakers (629/1000, 62.9%), and lived in Ontario or Quebec (628/1000, 62.8%) and in urban areas (850/1000, 85%). The mean scores were 27.8 (SD 5.88) out of 40 for subjective eHealth literacy and 3.00 (SD 0.97) out of 5 for objective eHealth literacy. In our sample, the intention score was 4.74 (SD 1.7) out of 7. The mean scores of intention constructs out of 7 were 5.63 (SD 1.28) for facilitating conditions, 4.94 (SD 1.48) for performance expectancy, 5.61 (SD 1.35) for effort expectancy, and 4.76 (SD 1.59) for social influence. In the final model, the factors associated with intention included mother tongue (β=.30; P<.001), objective eHealth literacy (β=-.06; P=.03), performance expectancy (β=.55; P<.001), social influence (β=.37; P<.001), and facilitating conditions (β=.15; P<.001).

CONCLUSIONS

Findings from this pan-Canadian web-based survey on Canadian older adults suggest that their intention to use the eDA to make housing decisions is similar to the findings in other studies using UTAUT. The factors identified as influencing intention were mother tongue, objective eHealth literacy, performance expectancy, social influence, and facilitating conditions. These will guide future strategies for the implementation of the eDA.

Factors associated with workplace violence among healthcare workers in an academic medical center

PURPOSE

We examined demographic, work-related, and behavioral factors associated with witnessing and/or experiencing workplace violence among healthcare workers.

DESIGN AND METHODS

Utilizing a correlational design, we analyzed the data to determine the associative factors related to workplace violence among the participants.

FINDINGS

More than half of the participants (54.5%) reported witnessing (23.8%) or experiencing (30.7%) workplace violence. There were significant differences between health provider groups in witnessing or experiencing workplace violence (Χ²  = 41.9[df12], p < 0.0001). Moreover, the experience of workplace violence differed by practice setting (Χ²  = 65.9[df14], p < 0.0001), with highest rates occurring in psychiatric (45.1%) and emergency (44.1%) services.

PRACTICE IMPLICATIONS

Findings may inform research, policies, and practice interventions to assess risks for workplace violence and implement preventative policies within high-risk professional groups and settings.

Predictors of Decision Regret among Caregivers of Older Canadians Receiving Home Care: A Cross-Sectional Online Survey

Background. In Canada, caregivers of older adults receiving home care face difficult decisions that may lead to decision regret. We assessed difficult decisions and decision regret among caregivers of older adults receiving home care services and factors associated with decision regret. Methods. From March 13 to 30, 2020, at the outbreak of the COVID-19 pandemic, we conducted an online survey with caregivers of older adults receiving home care in the 10 Canadian provinces. We distributed a self-administered questionnaire through Canada’s largest and most representative private online panel. We identified types of difficult health-related decisions faced in the past year and their frequency and evaluated decision regret using the Decision Regret Scale (DRS), scored from 0 to 100. We performed descriptive statistics as well as bivariable and multivariable linear regression to identify factors predicting decision regret. Results. Among 932 participants, the mean age was 42.2 y (SD = 15.6 y), and 58.4% were male. The most frequently reported difficult decisions were regarding housing and safety (75.1%). The mean DRS score was 28.8/100 (SD = 8.6). Factors associated with less decision regret included higher caregiver age, involvement of other family members in the decision-making process, wanting to receive information about the options, and considering organizations interested in the decision topic and health care professionals as trustworthy sources of information (all P < 0.001). Factors associated with more decision regret included mismatch between the caregiver’s preferred option and the decision made, the involvement of spouses in the decision-making process, higher decisional conflict, and higher burden of care (all P < 0.001). Discussion. Decisions about housing and safety were the difficult decisions most frequently encountered by caregivers of older adults in this survey. Our results will inform future decision support interventions.

Clinical reasoning in dire times. Analysis of cognitive biases in clinical cases during the COVID-19 pandemic

Cognitive biases are systematic cognitive distortions, which can affect clinical reasoning. The aim of this study was to unravel the most common cognitive biases encountered in in the peculiar context of the COVID-19 pandemic. Case study research design. Primary care. Single centre (Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland). A short survey was sent to all primary care providers (N = 169) taking care of hospitalised adult patients with COVID-19. Participants were asked to describe cases in which they felt that their clinical reasoning was "disrupted" because of the pandemic context. Seven case were sufficiently complete to be analysed. A qualitative analysis of the clinical cases was performed and a bias grid encompassing 17 well-known biases created. The clinical cases were analyzed to assess for the likelihood (highly likely, plausible, not likely) of the different biases for each case. The most common biases were: "anchoring bias", "confirmation bias", "availability bias", and "cognitive dissonance". The pandemic context is a breeding ground for the emergence of cognitive biases, which can influence clinical reasoning and lead to errors. Awareness of these cognitive mechanisms could potentially reduce biases and improve clinical reasoning. Moreover, the analysis of cognitive biases can offer an insight on the functioning of the clinical reasoning process in the midst of the pandemic crisis.

Home care providers' perceptions of shared decision-making with older clients (and their caregivers): A cross-sectional study

Interprofessional care teams can play a key role in supporting older adults (and caregivers) in making informed health decisions, yet shared decision making is not widely practiced in home care. Based on an earlier needs assessment with older adults (and caregivers) with home care experience, we aimed to explore the perceptions of home care teams on the decisions facing their clients and their perceived involvement in shared decision making. A cross-sectional study was conducted with 614 home care providers (nurses, personal support workers, rehabilitation professionals) in three Canadian provinces (Quebec, Ontario, and Alberta). Home care providers considered the decision "to stay at home or move" as the most difficult for older adults. Those most frequently involved in decision making with older adults were family members and least involved were physicians. Although all home care providers reported high levels of shared decision-making, we detected an effect of respondent's discipline on self-perceived shared decision-making; nurses and rehabilitation professionals reported significantly higher levels of shared decision making than personal support workers. A more tailored approach is required to support shared decision making in interprofessional care teams.

Factors associated with psychological symptoms in hospital workers of a French hospital during the COVID-19 pandemic: Lessons from the first wave

Purpose

The COVID-19 pandemic has put hospital workers around the world in an unprecedented and difficult situation, possibly leading to emotional difficulties and mental health problems. We aimed to analyze psychological symptoms of the hospital employees of the Paris Saint-Joseph Hospital Group a few months after the 1st wave of the pandemic.

Participants and methods

From July 15 to October 1, 2020, a cross-sectional survey was conducted among hospital workers in the two locations of our hospital group using the Hospital Anxiety and Depression Scale (HADS) and Post-Traumatic Stress Disorder (PTSD) Checklist (PCL) to measure anxiety, depression, and PTSD symptoms. Factors independently associated with these symptoms were identified.

Results

In total, 780 participants (47% caregivers, 18% health administrative workers, 16% physicians, and 19% other professionals) completed the survey. Significant symptoms of anxiety, depression, and PTSD were reported by 41%, 21%, and 14% of the participants, respectively. Hierarchical regression analysis showed a higher risk of having psychological symptoms among those (1) who were infected by SARS-CoV-2 or had colleagues or relatives infected by the virus, (2) who retrospectively reported to have had an anxious experience during the first wave, and (3) with a previous history of burnout or depression. In contrast, job satisfaction appeared to be a protective factor. Overall, hospital workers showed the statistically same levels of anxiety, depression, and PTSD symptoms, regardless of their profession and whether they had worked in units with COVID-19 patients or not.

Conclusions

Our cross-sectional survey of 780 hospital workers shows that after the first wave, hospital employees had a significant burden of mental health symptoms. Specific preventive measures to promote mental well-being among hospital workers exposed to COVID-19 need to be implemented, first among particularly vulnerable staff, and then, for all hospital staff for whom anxiety is detected early, and not only those who were directly exposed to infected patients.

Script concordance test acceptability and utility for assessing medical students' clinical reasoning: a user's survey and an institutional prospective evaluation of students' scores

Script Concordance Testing (SCT) is a method for clinical reasoning assessment in the field of health-care training. Our aim was to assess SCT acceptability and utility with a survey and an institutional prospective evaluation of students' scores.With a user's online survey, we collected the opinions and satisfaction data of all graduate students and teachers involved in the SCT setting. We performed a prospective analysis comparing the scores obtained with SCT to those obtained with the national standard evaluation modality.General opinions about SCT were mostly negative. Students tended to express more negative opinions and perceptions. There was a lower proportion of negative responses in the teachers' satisfaction survey. The proportion of neutral responses was higher for teachers. There was a higher proportion of positive positions towards all questions among teachers. PCC scores significantly increased each year, but SCT scores increased only between the first and second tests. PCC scores were found significantly higher than SCT scores for the second and third tests. Medical students' and teachers' global opinion on SCT was negative. At the beginning SCT scores were found quite similar to PCC scores. There was a higher progression for PCC scores through time.

Implementation and initial analysis of Cardiff Model data collection procedures in a level I trauma adult emergency department

OBJECTIVES

Our understanding of community violence is limited by incomplete information, which can potentially be resolved by collecting violence-related injury information through healthcare systems in tandem with prior data streams. This study assessed the feasibility of implementing Cardiff Model data collection procedures in the emergency department (ED) setting to improve multisystem data sharing capabilities and create more representative datasets.

DESIGN

Information collection fields were incorporated into the ED electronic health record (EHR), which gathered additional information from patients reporting assaultive injuries. ED nurses were surveyed to evaluate implementation and feasibility of information collection. Logistic regression was performed to determine associations between missing location information and patient demographic data.

SETTING

60-bed academic level I trauma adult ED in a large Midwestern city.

PARTICIPANTS

2648 patients screened positive for assault injuries between 2017 and 2020. 198 patients were omitted due to age outside the range served by this ED. Unselected inclusion of 150 ED nurses was surveyed.

MAIN OUTCOME MEASURES

Main outcomes include nursing staff survey responses and ORs for providing complete injury information across various patient demographics.

RESULTS

Most ED nurses believed that information collection aligned with the hospital's mission (92%), wanted information collection to continue (88%), did not believe that information collection impacted their workflow (88%), and reported taking under 1 min to screen and document violence information (77%). 825 patients (31.2%) provided sufficient information for geospatial mapping. Likelihood of providing complete location information was significantly associated with patient gender, race, arrival means, accompaniment, trauma type and year.

CONCLUSIONS

It is feasible to implement information collection procedures about location-based, assault-related injuries through the EHR in the adult ED setting. Nurses reported being receptive to collecting information. Analyses suggest patient-level and time variables impact information collection completeness. The geospatial information collected can greatly improve preexisting law enforcement and emergency medical systems datasets.

Relevance of Otago University postgraduate programmes in women's health to general practice: a case study

INTRODUCTION There are important changes in the health care needs of women presenting to general practice in New Zealand, which prompted an evaluation of postgraduate training needs of general practitioners (GPs) who care for women in the community. AIM To evaluate the perceived relevance of the curriculum of Otago University postgraduate programmes in women's health to GPs' work profile to identify any need for curricular change. This study was also performed to investigate the need for refresher courses or a Master's degree in obstetrics, gynaecology and women's health. METHODS In total, 426 GPs and GP trainees who had completed the postgraduate Certificate and Diploma programmes in women's health were invited to complete an online survey. The survey consisted of multiple-choice questions with five-point Likert scale ratings to rate the relevance of papers to general practice, and options for free-text comments. RESULTS There were 86 responses (20.2% response rate) and we analysed 73 (17.1%). Curriculum modules related to gynaecological care were rated as more relevant than obstetric and newborn care. GPs suggested more training in contraception and management of infertility, abnormal uterine bleeding and pelvic pain including procedural skills such as insertion of long-acting reversible contraceptives, implants and intrauterine devices. An interest in a refresher course was indicated by 76.6% of GPs. DISCUSSION GPs recognised the need for enhanced training in women's gynaecological care. Revision of the postgraduate women's health curriculum and development of new refresher courses will enable GPs, trainees and prospective GPs to improve their care for women in the community.

A Decision Support Tool for Allogeneic Hematopoietic Stem Cell Transplantation for Children With Sickle Cell Disease: Acceptability and Usability Study

Background

Individuals living with sickle cell disease (SCD) may benefit from a variety of disease-modifying therapies, including hydroxyurea, voxelotor, crizanlizumab, L-glutamine, and chronic blood transfusions. However, allogeneic hematopoietic stem cell transplantation (HCT) remains the only nonexperimental treatment with curative intent. As HCT outcomes can be influenced by the complex interaction of several risk factors, HCT can be a difficult decision for health care providers to make for their patients with SCD.

Objective

The aim of this study is to determine the acceptability and usability of a prototype decision support tool for health care providers in decision-making about HCT for SCD, together with patients and their families.

Methods

On the basis of published transplant registry data, we developed the Sickle Options Decision Support Tool for Children, which provides health care providers with personalized transplant survival and risk estimates for their patients to help them make informed decisions regarding their patients’ management of SCD. To evaluate the tool for its acceptability and usability, we conducted beta tests of the tool and surveys with physicians using the Ottawa Decision Support Framework and mobile health app usability questionnaire, respectively.

Results

According to the mobile health app usability questionnaire survey findings, the overall usability of the tool was high (mean 6.15, SD 0.79; range 4.2-7). According to the Ottawa Decision Support Framework survey findings, acceptability of the presentation of information on the decision support tool was also high (mean 2.94, SD 0.63; range 2-4), but the acceptability regarding the amount of information was mixed (mean 2.59, SD 0.5; range 2-3). Most participants expressed that they would use the tool in their own patient consults (13/15, 87%) and suggested that the tool would ease the decision-making process regarding HCT (8/9, 89%). The 4 major emergent themes from the qualitative analysis of participant beta tests include user interface, data content, usefulness during a patient consult, and potential for a patient-focused decision aid. Most participants supported the idea of a patient-focused decision aid but recommended that it should include more background on HCT and a simplification of medical terminology.

Conclusions

We report the development, acceptability, and usability of a prototype decision support tool app to provide individualized risk and survival estimates to patients interested in HCT in a patient consultation setting. We propose to finalize the tool by validating predictive analytics using a large data set of patients with SCD who have undergone HCT. Such a tool may be useful in promoting physician-patient collaboration in making shared decisions regarding HCT for SCD. Further incorporation of patient-specific measures, including the HCT comorbidity index and the quality of life after transplant, may improve the applicability of the decision support tool in a health care setting.

Effects of financial incentives on volunteering for clinical trials: A randomized vignette experiment

BACKGROUND

Financial incentives may aid recruitment to clinical trials, but evidence regarding risk/burden-driven variability in participant preferences for incentives is limited. We developed and tested a framework to support real-world decisions on recruitment budget.

METHODS

We included two phases: an Anchoring Survey, to ensure we could capture perceived unpleasantness on a range of life events, and a Vignette Experiment, to explore relationships between financial incentives and participants' perceived risk/burden and willingness to participate in high- and low-risk/burden versions of five vignettes drawn from common research activities. We compared vignette ratings to identify similarly rated life events from the Anchoring Survey to contextualize ratings of study risk.

RESULTS

In our Anchoring Survey (n = 643), mean ratings (scale 1 = lowest risk/burden to 5 = highest risk/burden) indicated that the questions made sense to participants, with highest risk assigned to losing house in a fire (4.72), and lowest risk assigned to having blood pressure taken (1.13). In the Vignette Experiment (n = 534), logistic regression indicated that amount of offered financial incentive and perceived risk/burden level were the top two drivers of willingness to participate in four of the five vignettes. Comparison of event ratings in the Anchoring Survey with the Vignette Experiment ratings suggested reasonable concordance on severity of risk/burden.

CONCLUSIONS

We demonstrated feasibility of a framework for assessing participant perceptions of risk for study activities and discerned directionality of relationship between financial incentives and willingness to participate. Future work will explore use of this framework as an evidence-gathering approach for gauging appropriate incentives in real-world study contexts.

How Can We Develop an Efficient eHealth Service for Provision of Care for Elderly People with Balance Disorders and Risk of Falling? A Mixed Methods Study

This study aimed to identify relevant topics for the development of an efficient eHealth service for elderly people with balance disorders and risk of falling, based on input from physicians providing healthcare to this patient group. In the quantitative part of the study, an open multiple-choice questionnaire was made available on the website of the Portuguese General Medical Council to assess the satisfaction with electronic medical records regarding clinical data available, the time needed to retrieve data and the usefulness of the data. Of the 118 participants, 55% were dissatisfied/very dissatisfied with data availability and 61% with the time spent to access and update data related to the focused patient group. Despite this negative experience, 76% considered future e-Health solutions as pertinent/very pertinent. Subsequently, these findings were further explored with eight semi-structured interviews. The physicians confirmed the reported dissatisfactions and pointed out the lack of comprehensive data and system interoperability as serious problems, causing inefficient health services with an overlap of emergency visits and uncoordinated diagnostics and treatment. In addition, they discussed the importance of camera and audio monitoring to add significant value. Our results indicate considerable potential for e-Health solutions, but substantial improvements are crucial to achieving such future solutions.

Work environment, job satisfaction and burnout among Spanish dentists: a cross-sectional study

Background

The main aim of the present study was to examine the relationships among work environment, job satisfaction and burnout in dentists and to analyse the way in which certain sociodemographic variables, such as gender, professional experience and weekly working hours, predict the perception of the work environment.

Methods

A battery of online questionnaires was sent to 3876 dentists officially registered in the triple-province region of Valencia; the battery included the Survey of Organizational Attributes for Dental Care, the Warr–Cook–Wall Overall Job Satisfaction Scale, the Maslach Burnout Inventory and a series of sociodemographic questions formulated for the specific purpose of this study. To assess the relations with the independent variables, we calculated the Pearson correlation coefficient, the Z-scores were calculated to make effect sizes comparable, and the associations between the scales and the sociodemographic variables were investigated by adjusted multiple regression analysis.

Results

A total of 336 participants (9.4%) correctly completed the survey in this study. The mean (M) age was 37.6 years old (standard deviation (SD) = 9.6, median (M_e) = 34). Participants reported high scores on the work environment and job satisfaction scales, with only limited experiences of burnout (3.8%). Work environment and burnout were significantly and positively predicted by years of professional experience (β = .078; p = .000 and β = .107; p = .004, respectively), and job satisfaction was significantly and positively predicted by weekly hours of work (β = .022; p = .001), without significant differences according to gender.

Conclusions

Dentists who work over 20 hours a week and have more years of professional experience report having better perceptions of well-being at work, with no significant difference according to gender. It is important to highlight the aspects that improve well-being in dentistry to reduce burnout, which would lead to greater work engagement and better attention to patients.

Variability in Anesthesia Models of Care in Cardiac Surgery

The operating room in a cardiothoracic surgical case is a complex environment, with multiple handoffs often required by staffing changes, and can be variable from program to program. This study was done to characterize what types of practitioners provide anesthesia during cardiac operations to determine the variability in this aspect of care. A survey was sent out via a list serve of members of the cardiac surgical team. Responses from 40 programs from a variety of countries showed variability across every dimension requested of the cardiac anesthesia team. Given that anesthesia is proven to have an influence on the outcome of cardiac procedures, this study indicates the opportunity to further study how this variability influences outcomes and to identify best practices.

Mixed methods investigation of the use of telephone triage within UK veterinary practices for horses with abdominal pain: A Participatory action research study

BACKGROUND

Telephone triage is an integral part of modern patient care systems in human medicine, and a key component of veterinary practice care systems. There is currently no published research on telephone triage within the veterinary profession.

OBJECTIVE

To investigate current approaches to telephone triage of horses with abdominal pain (colic) in veterinary practice and develop new resources to support decision-making.

STUDY DESIGN

Participatory action research using mixed-methods approach.

METHODS

An online survey assessed current approaches to telephone triage of horses with colic in UK veterinary practices. Structured group and individual interviews were conducted with four equine client care (reception) teams on their experiences around telephone triage of colic. Evidence-based resources, including an information pack, decision flow chart and recording form, were developed and implemented within the practices. Participant feedback was obtained through interviews six months after implementation of the resources.

RESULTS

There were 116 participants in the online survey. Management and client care staff (53/116) felt less confident giving owner advice (p<0.01) and recognising critical indicators (p = 0.03) compared to veterinary surgeons and nurses (63/116). Thirteen themes were identified in the survey relating to owner advice; exercise and owner safety were most frequently mentioned, but conflicting guidance was often given. Fourteen client care staff were interviewed. They were confident recognising colic during a telephone conversation with an owner and identified the most common signs of critical cases as sweating and recumbency. The new resources received positive feedback; the decision flow chart and information on critical indicators were identified as most useful. After resource implementation, there was an increase in confidence in recognising critical cases and giving owners advice.

MAIN LIMITATIONS

Limited sample population.

CONCLUSIONS

This study described existing approaches to telephone triage, identified variations in advice given, and worked with client care teams to develop new resources to aid decision-making.

Protocol registration issues of systematic review and meta-analysis studies: a survey of global researchers

Background

Although protocol registration of systematic reviews/meta-analysis (SR/MA) is still not mandatory, it is highly recommended that authors publish their SR/MA protocols prior to submitting their manuscripts for publication as recommended by the Cochrane guidelines for conducting SR/MAs. our aim was to assess the awareness, obstacles, and opinions of SR/MA authors about the protocol registration process.

Methods

A cross-sectional survey study included the authors who published SR/MAs during the period from 2010 to 2016, and they were contacted for participation in our survey study. They were identified through the literature search of SR/MAs in Scopus database. An online questionnaire was sent to each participant via e-mail after receiving their approval to join the study. We have sent 6650 emails and received 275 responses.

Results

A total of 270 authors responses were complete and included in the final analysis. Our results has shown that PROSPERO was the most common database used for protocol registration (71.3%). The registration-to-acceptance time interval in PROSPERO was less than 1 month (99.1%). Almost half of the authors (44.2%) did not register their protocols prior to publishing their SR/MAs and according to their opinion that the other authors lack knowledge of protocol importance and mandance to be registered, was the most commonly reported reason (44.9%). A significant percenatge of respondents (37.4%) believed that people would steal their ideas from protocol databases, while only 5.3% reported that their SR/MA had been stolen. However, the majority (72.9%) of participants have agreed that protocol registries play a role in preventing unnecessary duplication of reviews. Finally, 37.4% of participants agree that SR/MA protocol registration should be mandatory.

Conclusion

About half of the participants believes that the main reason for not registering protocols, is that the other authors lack knowledge concerning obligation and importance to register the SR/MA protocols in advance. Therefore, tools should be available to mandate protocol registration of any SRs beforehand and increasing awareness about the benefits of protocol registration among researchers.

Broad Spectrum project: factors determining the quality of antibiotic use in primary care: an observational study protocol from Italy

INTRODUCTION

The overuse of antibiotics is causing worldwide spread of antimicrobial resistance (AMR). Compared with other countries, Italy has both high antibiotic consumption rates and high rates of AMR. Due to the fact that around 90% of antibiotics are prescribed by general practitioners (GPs), this study aims to measure the impact of knowledge, attitudes and sociodemographic and workplace-related factors on the quality of antibiotic prescriptions filled by GPs in the Italian Region of Sardinia.

METHODS AND ANALYSIS

Knowledge, attitude, sociodemographic and workplace-related factors deemed to influence physicians prescribing behaviour will be evaluated in a cross-sectional study conducted among all GPs of the Italian Region of Sardinia (n=1200). A knowledge and attitudes questionnaire (Knowledge and Attitudes on Antibiotics and Resistance - Italian version: ITA-KAAR) accompanied by a sociodemographic form will be linked to drug prescription data reimbursed by the National Health System. European Surveillance of Antibiotic Consumption quality indicators for outpatient antibiotic use will be calculated from drug prescription records. Every GP will be deemed to have demonstrated an adequate quality of prescriptions of antibiotics if half of the indicator score plus one is better than the median of the region. A multivariate Poisson regression model with robust variance estimation will be used to evaluate the impact of the determinants of antibiotic prescriptions on the actual prescribing quality of each physician.

ETHICS AND DISSEMINATION

The project has been approved by the ethics committee of the Regional Health Trust of Sardinia (176/2019/CE, 24 September 2019). The results will be useful to inform evidence-based interventions to tackle irrational antibiotic use in the community.

Cultural orientation and safety app for new and short-term health care providers in Nunavut

SETTING

One of the greatest challenges of Nunavut's health care system is its reliance on short-term professionals, many of whom are not oriented to the Inuit historical/cultural context and the organization of health care in the territory. Our objective was to develop a free iOS/Android app to address this knowledge gap.

INTERVENTION

We reviewed existing literature and interviewed key stakeholders to develop the content of the app covering the following: Inuit ways of communicating and expectations in the health care setting; Inuit history, settlement, and societal values (including a bibliography and a list of Inuktitut language phrases and resources); health care model (including referral pathways for tertiary care and mental health referrals); maps and community information; and useful information to prepare for your arrival. The app, HealthNU, was launched in September 2017. We targeted new and short-term health care providers in Nunavut, and the app has also been circulated and used by social workers, educators, and health care providers outside of the territory.

OUTCOMES

By September 5, 2019, the app had been downloaded more than 700 times. To evaluate the app, we conducted interviews and a brief survey with key stakeholders (n = 18), who indicated that (1) the app was easy to use; (2) the content was highly relevant and would result in improved cultural competencies; and (3) they would recommend the app to colleagues and were already using it for recruitment/orientation. Challenges and limitations included: ensuring practitioners "completed" all modules while reading/using the app, and low response rate among providers who were solicited for feedback.

IMPLICATIONS

HealthNU is an example of how technology solutions developed in partnership with community members, health care providers, researchers, and government can improve the quality of care for Nunavummiut. We are currently working with the Nunavut Department of Health to develop similar apps in other contexts.

A More Directive Living Will for Older Adult Patients with End-Stage Medical Conditions?

OBJECTIVES

Many older adult patients want to be treated aggressively for reversible conditions, even when their current quality of life is limited; however, most standard living wills focus on the very end of life and provide little guidance to acute care providers (ACPs) should their older adult patient be admitted with a potentially treatable acute condition and temporarily lose capacity. We developed what we believe is a more informational and directive living will for this population. We sought to determine whether ACPs would find our pilot living will more helpful when caring for their older adult patients.

METHODS

Convenience sample of members of the Society of Hospital Medicine (SHM). Respondents were asked to compare the pilot living will with their state form and then answer five attitudinal questions.

RESULTS

In total, 125 providers from 39 states completed the survey: 86% indicated that the pilot living will better helped them understand their patients' general end-of-life preferences, 87.5% indicated the pilot living will would be more helpful in making specific treatment decisions for their patients, and 85% indicated the pilot living will would better facilitate end-of-life discussions with surrogates.

CONCLUSIONS

Our results suggest that it is possible to design a functional advanced directive that better reflects the wishes of the older adult patient who wants to be treated aggressively in selected clinical situations. By more clearly defining these wishes, acute providers (eg, hospitalists, intensivists) can make more informed, patient-centered recommendations to surrogates.

An Exploration of Knowledge and Attitudes of Medical Students and Rheumatologists to Placebo and Nocebo Effects: Threshold Concepts in Clinical Practice

INTRODUCTION

Understanding placebo and nocebo responses (context/meaning effects [CMEs]) is fundamental to physician agency. Specific instruction in CMEs is often lacking in medical education. Patient-practitioner interactions may challenge medical students' understanding of biomedical causality and the nexus between this, practical ethics and professionalism across various conceptual and applied aspects of CMEs. This study compared the corpus of knowledge and phronesis related to CMEs between Australian graduate medical students and rheumatologists to gain a sophisticated understanding of this relationship to inform curriculum development.

METHOD

In 2013 and 2014, the authors surveyed third-year medical students undertaking a graduate programme in an Australian medical school and Australian rheumatologists to ascertain their understanding of placebo and nocebo responses. The survey ascertained (1) the alignment of the respondents' understanding of CMEs with accepted facts and concepts; (2) opinions on the ethical status of CMEs; and (3) responses to 2 scenarios designed to explore matters of biomedical causality, practical ethics and professionalism.

RESULTS

There were 88 completed surveys returned, 53 rheumatologists and 35 students. Similar proportions within each group identified CMEs, with most (n = 79/88 [89.8%]) correctly recognising a placebo (rheumatologists: 50 [94.3%], students: 29 [82.9%]) and approximately three-quarters (n = 65/88 [73.9%]) correctly recognising nocebo effects (rheumatologists: 39 [73.6%], students: 26 [74.3%]). Statistically significant differences between practitioners and students were observed in relation to the following: placebo responders and placebo responsiveness; placebos as a 'diagnostic tool'; placebos usage in clinical practice and research, and nocebo effects.

CONCLUSIONS

Physicians require an awareness of CMEs and the fact that they arise from and influence the effective agency of health care professionals. Curricular emphasis is needed to permit an honest assessment of the components that influence when, how and why patient outcomes arise, and how one's agency might have neutral or negative effects but could be inclined towards positive and away from negative patient outcomes.

Shared decision making: Does a physician's decision-making style affect patient participation in treatment choices for primary immunodeficiency?

Overall health care spending in the United States is equivalent to more than 15% of GDP, yet outcomes rank below the top 25 in most quality categories when compared with other Organization for Economic Cooperation and Development (OECD) countries. The majority of spending is consumed by small patient populations with chronic diseases. Experts believe increased patient-physician shared decision making (SDM) should result in better overall longitudinal care but understanding the physician's role in facilitating SDM is limited. Structural equation modelling was applied to results of a 2016 questionnaire-based survey of 330 US physicians who treat approximately 55% of primary immune deficiency requiring immune globulin therapy; it tested the relationship between slow/rational vs fast/intuitive decision-making styles and SDM as mediated by patient-centric care and moderated by physician's trust in the patient. The results showed a statistically significant relationship between slow/rational decision making and SDM. The results also suggest differences related to age, gender, education, and race but no differences related to trust.

Managers' perceptions of the effects of a national mandatory accreditation program in Danish hospitals. A cross-sectional survey

OBJECTIVE

This study aimed to examine and compare middle and senior hospital managers' perceptions of the effects of a mandatory accreditation program in Denmark, the Danish Healthcare Quality Program (Den Danske Kvalitetsmodel [DDKM]) after it was terminated in 2015.

DESIGN

A cross-sectional online questionnaire survey.

SETTING

All 26 somatic and psychiatric public hospitals in Denmark.

PARTICIPANTS

All senior and middle managers.

METHODS

A questionnaire with open and closed response (five-point Likert scale) questions. Quantitative data were analyzed descriptively and through ordered logistic regression by management level. Qualitative data were subjected to a software-assisted content analysis.

RESULTS

The response rate was 49% (533/1059). In both the qualitative and quantitative data sets, participants perceived the DDKM as having: led to an increased focus on registration, documentation and additional and unnecessary procedures. While the DDKM was perceived as increasing a focus on quality, the time required for accreditation was at the expense of patient care. There were significant differences by management level, with middle managers having more negative perceptions of the DDKM related to time spent on documentation and registration.

CONCLUSION

While the DDKM had some perceived benefits for quality improvement, it was ultimately considered time-consuming and outdated or having served its purpose. Including managers, particularly middle managers, in refinements to the new quality improvement model could capitalize on the benefits while redressing the problems with the terminated accreditation program.

Awareness of limited joint mobility in type 2 diabetes in general practice in the Netherlands: an online questionnaire survey

BACKGROUND

Next to the well-known micro- and macrovascular complications, type 2 diabetes mellitus (T2DM) is associated with musculoskeletal disorders of the upper extremities referred to as limited joint mobility (LJM), e.g. carpal tunnel syndrome (CTS) and adhesive capsulitis. Unrecognized and untreated LJM can lead to poor quality of life and non-compliance to diabetes treatment which aggravates LJM. Despite its reported higher prevalence in international prevalence studies, examination of the upper extremities is still no part of the regular diabetes mellitus (DM) check-ups. The primary aim of this study was therefore to evaluate the awareness of Dutch GPs and nurse practitioners concerning LJM. Secondary aims were to evaluate the current management of a patient with LJM, and to assess opinions regarding the question of who should screen for LJM if this is done in the near future.

METHODS

An online survey was conducted among 390 general practitioners (GPs) and 245 nurse practitioners (NPs) of three diabetes care groups in The Netherlands to assess their awareness of the association between DM and LJM.

RESULTS

Most GPs are not aware that LJM is a DM complication, with an unawareness for specific upper extremity disorders ranging from 59 to 73%. Of the NPs, 76% is not aware either. Only 41% of GPs would advise the most optimal treatment for diabetes patient with CTS. Finally, only 25% of the GPs believe that screening for LJM should be performed during the regular diabetes check-up compared to 63% of the NPs.

CONCLUSION

The majority of GPs and NPs are not aware of LJM as a T2DM complication. In contrast to NPs, most GPs do not believe that screening for LJM should be performed during the regular diabetes check-up.

Eating disorder services for young people in Ireland: perspectives of service providers, service users and the general adolescent population

OBJECTIVES

This paper illuminates how national eating disorder (ED) policy translates into day-to-day practice by exploring how ED services are experienced by those who deliver and use them.

METHODS

A mixed-methods approach was used, which combined qualitative and quantitative techniques. The paper collates data from three studies: (i) an interview study exploring the lived experiences of young people with EDs (n=8), their parents (n=5) and their healthcare professionals (n=3); (ii) a national survey of health professionals' perspectives on existing ED services (n=171); (iii) a nationwide survey of secondary-school students' eating concerns and patterns of help-seeking (n=290).

RESULTS

The qualitative interviews with young people and their parents revealed feelings of isolation and helplessness. Young people expressed interest in patient support groups, while parents desired greater support for the family unit. Parents were highly critical of available services, particularly in relation to access. These criticisms were echoed in the survey of healthcare professionals, who reported many barriers to delivering effective care. Clinicians were almost unanimous in calling for care pathways to be clarified via a standardised treatment protocol. The survey of adolescents indicated widespread reluctance to seek help regarding eating concerns: over one-third expressed concern about their own eating habits, but half of these had not divulged their concerns to anyone. Participants' preferred pathways of help-seeking revolved around family and friends, and adolescents were unsure about routes of access to professional support.

CONCLUSIONS

The research demonstrates that many aspects of national ED policy have not been implemented in practice. The paper highlights specific gaps and suggests ways they can be redressed.

Socioeconomic Status and Racial or Ethnic Differences in Participation: Web-Based Survey

Background

Web-based survey data collection has been widely used because of its advantages, although attaining and retaining participants can be challenging. There are several factors associated with successful Web-based survey participation; yet little is known regarding racial or ethnic and socioeconomic differences in the progress of a Web-based survey.

Objective

This study aimed to examine racial or ethnic and socioeconomic status (SES) differences in participation in a Web-based survey.

Methods

We conducted a secondary data analysis of a study dataset containing information on parents of preschool children. We used 2 phases of Web-based surveys: (1) screening questions including race or ethnicity information and (2) full survey with a consent form. Once potential participants submitted the screening questions, including their racial or ethnic information, the team sent the full survey link to potential participants who met study eligibility criteria. We calculated the proportion of racial or ethnic groups in each of the following areas: consent, partial survey completion, and total survey completion.

Results

A total of 487 participants (236 non-Hispanic white, 44 Hispanic, 137 black, and 70 Asian) completed initial screening questions, and a total of 458 participants met study eligibility criteria. Compared with black participants, non-Hispanic white and Asian participants were more likely to consent to participate in the study (odds ratio [OR] 1.73, 95% CI 1.08-2.78, P=.02; OR 2.07, 95% CI 1.04-4.13, P=.04, respectively). There was no racial or ethnic difference with respect to the completion of demographic questions or completion of a partial survey. Finally, compared with black participants, non-Hispanic white participants were more likely to complete the entire survey (OR 3.36, 95% CI 1.51-7.06, P<.001). With respect to SES, less educated non-Hispanic white participants were less likely to complete the survey compared with their counterparts with more education (OR 0.15, 95% CI 0.50-1.48, P<.001).

Conclusions

We found a significant difference among racial or ethnic groups as well as different education levels in Web-based survey participation. Survey researchers need to consider the SES and racial or ethnic differences in Web-based survey participation and develop strategies to address this bias in participation and completion in their research.

Ergonomic practices and musculoskeletal disorders among ophthalmologists in India: An online appraisal

Introduction:

Ergonomics in ophthalmology is neither taught during professional training nor does it readily receive consideration or priority in clinical practice. Owing to a high prevalence of musculoskeletal disorders among ophthalmologists, ergonomic awareness, and practices are vital in averting this modern epidemic.

Objective:

To assess the ergonomic practices and prevalence of self-reported musculoskeletal disorders among ophthalmologists in India.

Method:

An online survey was conducted among ophthalmologists who were registered with the All India Ophthalmological Society of India using a pre-tested and validated questionnaire.

Results:

The prevalence of self-reported musculoskeletal disorder in the 377 participants was 75.3% (284; 95% confidence interval: 70.6–79.5). Low back pain (149, 52.9%) was the most commonly reported symptom. Musculoskeletal disorder–attributed productivity loss was reported by 58.45% (166) of the respondents. Musculoskeletal disorder was most frequently associated with less than 10 years of work experience (odds ratio: 1.2; 95% confidence interval: 1.1–1.3, p = 0.01) and lack of good clinic (odds ratio: 1.7; 95% confidence interval: 1.1–2.7, p = 0.03) and operation room ergonomic practices (odds ratio: 1.8; 95% confidence interval: 1.1–2.9, p = 0.03). Only 27.9% (105) of the respondents had accessed information related to ergonomics in ophthalmic practice.

Conclusion:

The self-reported musculoskeletal disorder among ophthalmologists in India is quite high and significant enough to cause some degree of productivity loss. It is thus imperative to emphasize the implementation of good ergonomic practices, especially among relatively young ophthalmologists.

Do Physicians Prefer to Complete Online or Mail Surveys? Findings From a National Longitudinal Survey

Survey response rates for physicians are falling generally, and surveys of physicians tend to have lower response rates than those of the general population. To maximize response, respondents are often given a choice of modes in which to respond. The aim of this article is to describe mode response patterns and identify factors related to physicians’ decisions to complete surveys online rather than by mail. The data are from the fifth annual wave of the Medicine in Australia: Balancing Employment and Life longitudinal survey of physicians, in which there was a 43.5% response rate (10,746/24,711) and 33.7% of respondents completed the survey online. Online completion was more likely when the physician had completed the survey online in the previous wave, was a general practitioner rather than other medical specialist or doctor-in-training, worked in a remote location, and was young and male. Free-text spontaneous comments from respondents indicated that mode choice was based on a combination of preference, previous experience, and feasibility. These results provide support for the use of mixed mode survey designs, which can accommodate doctors with different mode preferences and cast doubt over the possibility of tailoring mode based on respondent characteristics.

Research as an event: a novel approach to promote patient-focused drug development

Patient groups are increasingly engaging in research to understand patients' preferences and incorporate their perspectives into drug development and regulation. Several models of patient engagement have emerged, but there is little guidance on how to partner with patient groups to engage the disease community. Our group has been using an approach to engage patient groups that we call research as an event. Research as an event is a method for researchers to use a community-centered event to engage patients in their own environment at modest incremental cost. It is a pragmatic solution to address the challenges of engaging patients in research to minimize patients' frustration, decrease the time burden, and limit the overall cost. The community, the event, and the research are the three components that constitute the research as an event framework. The community represents a disease-specific community. The event is a meeting of common interest for patients and other stakeholders, such as a patient advocacy conference. The research describes activities in engaging the community for the purpose of research. Research as an event follows a six-step approach. A case study is used to demonstrate the six steps followed by recommendations for future implementation.

International survey among orthopaedic trauma surgeons: Lack of a definition of fracture-related infection

INTRODUCTION

Fracture-related infection (FRI) is one of the most challenging musculoskeletal complications in orthopaedic-trauma surgery. Although the orthopaedic community has developed and adopted a consensus definition of prosthetic joint infections (PJI), it still remains unclear how the trauma surgery community defines FRI in daily clinical practice or in performing clinical research studies. The central aim of this study was to survey the opinions of a global network of trauma surgeons on the definitions and criteria they routinely use, and their opinion on the need for a unified definition of FRI. The secondary aims were to survey their opinion on the utility of currently used definitions that may be at least partially applicable for FRI, and finally their opinion on the important clinical parameters that should be considered as diagnostic criteria for FRI.

METHODS

An 11-item questionnaire was developed to cover the above-mentioned aims. The questionnaire was administered by SurveyMonkey and was sent via blast email to all registered users of AO Trauma (Davos, Switzerland).

RESULTS

Out of the 26'563 recipients who opened the email, 2'327 (8.8%) completed the questionnaire. Nearly 90% of respondents agreed that a consensus-derived definition for FRI is required and 66% of the surgeons also agreed that PJI and FRI are not equal with respect to diagnosis, treatment and outcome. Furthermore, "positive cultures from microbiology testing", "elevation of CRP", "purulent drainage" and "local clinical signs of infection" were voted the most important diagnostic parameters for FRI.

CONCLUSION

This international survey infers the need for a consensus definition of FRI and provides insight into the clinical parameters seen by an international community of trauma surgeons as being critical for defining FRI.

Effect of Recruitment Methods on Response Rate in a Web-Based Study for Primary Care Physicians: Factorial Randomized Controlled Trial

Background

Low participation rates are one of the most serious disadvantages of Web-based studies. It is necessary to develop effective strategies to improve participation rates to obtain sufficient data.

Objective

The objective of this trial was to investigate the effect of emphasizing the incentive in the subject line of the invitation email and the day of the week of sending the invitation email on the participation rate in a Web-based trial.

Methods

We conducted a 2×2 factorial design randomized controlled trial. We contacted 2000 primary care physicians from members of the Japan Primary Care Association in January 2017 and randomly allocated them to 1 of 4 combinations of 2 subject lines (presence or absence of an emphasis on a lottery for an Amazon gift card worth 3000 yen or approximately US $30) and 2 delivery days (sending the invitation email on Tuesday or Friday). The primary outcome was the response rate defined as the number of participants answering the first page of the questionnaire divided by the number of invitation emails delivered. All outcomes were collected between January 17, 2017, and February 8, 2017.

Results

We analyzed data from 1943 out of 2000 participants after excluding those whose email addresses were invalid. The overall response rate was 6.3% (123/1943). There was no significant difference in the response rates between the 2 groups regarding incentive in the subject line: the risk ratio was 1.12 (95% CI 0.80 to 1.58) and the risk difference was 0.7% (95% CI –1.5% to 2.9%). Similarly, there was no significant difference in the response rates between the 2 groups regarding sending the email on Tuesday or Friday: the risk ratio was 0.98 (95% CI 0.70 to 1.38) and the risk difference was –0.1% (95% CI –2.3% to 2.1%).

Conclusions

Neither emphasizing the incentive in the subject line of the invitation email nor varying the day of the week the invitation email was sent led to a meaningful increase in response rates in a Web-based trial with primary care physicians.

Trial Registration

University Hospital Medical Information Network Clinical Trials Registry UMIN000025317; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000029121 (Archived by WebCite at http://www.webcitation. org/6wOo1jl9t)

Factors Associated With Injury Among Employees at a U.S. Army Hospital

The purpose of this study was to investigate injury incidence and factors associated with injury among employees at a large U.S. Army hospital to inform injury prevention planning and health promotion education efforts. Demographics, health behaviors, and injury history were collected by survey from hospital employees between October and December 2014. Descriptive statistics were reported and factors associated with injury were determined using multiple logistic regression. Respondents (380; 56% females, 44% males; 54% active duty military, 45% civilians) reported a prevalence of unhealthy behaviors (e.g., not enough exercise [58%] and poor sleeping habits [49%]). Nearly half of respondents (47%) reported at least one occupational injury in the past 12 months. Leading mechanisms of injuries were repetitive overuse (36%), falls (15%), and single twisting movement/overexertion (14%). Leading activities at the time of injury were physical training (24%), walking/hiking (15%), and lifting or moving objects (11%). Factors associated with injury included active duty military status, less education, tobacco use, overuse of alcohol or drugs, and stress. Health education efforts and materials intended for hospital staff should incorporate identified modifiable injury risk factors (e.g., alcohol and drug use, stress, tobacco use, poor sleep). Injury prevention initiatives should focus on physical training, walking/hiking, and lifting. Establishment of surveillance and routine review of employee injury, illness, and health behavior data are recommended to monitor program effects and collect data necessary to inform future prevention priorities and planning.

The Prevalence of and Factors Associated with Neck, Shoulder, and Low-Back Pains among Medical Students at University Hospitals in Central Saudi Arabia

Aim

The study aim was to determine the prevalence of neck, shoulder, and low-back pains and to explore the factors associated with musculoskeletal pain (MSP) among medical students at university hospitals in central Saudi Arabia.

Method

This cross-sectional study was conducted at a government institution using an online self-administered, modified version of the Standardised Nordic Questionnaire in the English language.

Results

A total of 469 students responded to our survey. The prevalence of MSP in at least one body site at any time, in the past week, and in the past year was 85.3%, 54.4%, and 81.9%, respectively. Factors significantly associated with MSP in at least one body site at any time were being in the clinical year (P = 0.032), history of trauma (P  =  0.036), history of depressive symptoms (P < 0.001), and history of psychosomatic symptoms (P < 0.001). On multivariable regression analysis, factors associated with MSP were history of trauma (P = 0.016) and depressive (P = 0.002) or psychosomatic symptoms (P = 0.004).

Conclusion

MSP among Saudi medical students is high, particularly among those in the clinical years and those with history of trauma and with depressive or psychosomatic symptoms. Medical institutions should be aware of this serious health issue and preventive measures are warranted.

Lean healthcare from a change management perspective

Purpose - Lean healthcare is used in a growing number of hospitals to increase efficiency and quality of care. However, healthcare organizations encounter problems with the implementation of change initiatives due to an implementation gap: the gap between strategy and execution. From a change management perspective, the purpose of this paper is to increase scientific knowledge regarding factors that diminish the implementation gap and make the transition from the "toolbox lean" toward an actual transformation to lean healthcare. Design/methodology/approach - A cross-sectional study was executed in an operating theatre of a Dutch University Medical Centre. Transformational leadership was expected to ensure the required top-down commitment, whereas team leadership creates the required active, bottom-up behavior of employees. Furthermore, professional and functional silos and a hierarchical structure were expected to impede the workforce flexibility in adapting organizational elements and optimize the entire process flow. Findings - The correlation and regression analyses showed positive relations between the transformational leadership and team leadership styles and lean healthcare implementation. The results also indicated a strong relation between workforce flexibility and the implementation of lean healthcare. Originality/value - With the use of a recently developed change management model, the Change Competence Model, the authors suggest leadership and workforce flexibility to be part of an organization's change capacity as crucial success factor for a sustainable transformation to lean healthcare.

Preparedness of newly qualified doctors in Ireland for prescribing in clinical practice

AIM

The aim of the study was to investigate the level of preparedness of newly qualified Irish-trained doctors for prescribing, and to investigate their attitudes towards prescribing and prescribing education, through a national survey.

METHODS

A 29-item online survey was distributed to 686 newly qualified doctors 1 month prior to the completion of their first year of clinical practice (internship). Only graduates from Irish medical schools were included.

RESULTS

The response rate was 20.4% (n = 140; female : male 56%:44%). The majority of respondents felt confident in prescription writing (89%), medication history taking (81%) and accessing drug information in the hospital setting (80%). Only 58% of respondents felt confident in drug dose calculation, and 35% felt confident in preparing and administering drugs. When asked if their undergraduate medical education had prepared them for prescribing in clinical practice, 28% of respondents agreed. Confidence that their undergraduate education had prepared them was associated with receiving formal training in prescribing skills (P = 0.0045; 27% vs. 0%). Thirty-seven per cent of respondents agreed that they felt stressed about prescribing medications.

CONCLUSION

This survey of newly qualified doctors in Ireland found that only 28% of respondents agreed that their undergraduate medical education had prepared them for prescribing, which was comparable to a previous survey of UK medical students and graduates. Investigating confidence and preparedness for prescribing provides important insights for educators. Dedicated teaching of prescribing, with an emphasis on practical training and assessment, may help graduates to feel more prepared for the challenges of prescribing in the clinical setting.

Impact of the introduction of electronic prescribing on staff perceptions of patient safety and organizational culture

BACKGROUND

Electronic prescribing (EP) systems are online technology platforms by which medicines can be prescribed, administered, and stock controlled. The actual impact of EP on patient safety is not truly understood. This study seeks to assess the impact of the implementation of an EP system on safety culture, as well as assessing differences between clinical respondent groups and considering their implications.

METHODS

Staff completed a modified Safety Attitudes Questionnaire survey, 6 weeks following the introduction of EP across surgical services in a hospital in Dorset, England. Responses were assessed and differences between respondent groups compared. Rates of self-reported adverse events were compared before and after implementation.

RESULTS

Overall response rate was 34.5%. There was no significant difference between usage patterns and previous experience with EP between user groups. Overall safety was felt to have been reduced by the introduction of EP. Significant differences between clinician and nonclinicians were seen in ability to discuss errors (3.23 ± 0.5 versus 2.8 ± 0.69, P = 0.004), drug chart access, and ease of medication prescribing. Regression analysis did not identify any confounding factors. Despite a significant reduction in the adverse event rate in other divisions of the hospital that did not implement EP at the same time, this same reduction was not seen in the surgical department.

CONCLUSIONS

This is the first study to assess the impact of EP on safety culture using a validated assessment tool (Safety Attitudes Questionnaire). Overall safety culture deteriorated following introduction of EP. Problems with system usability/intuitiveness, nonstandardized implementation, and competence assessment strategies may have all contributed to this result. Centers seeking to implement EP in future must consider these factors to ensure a positive impact on patient safety and outcomes.

The perceptions of Australian oncologists about cognitive changes in cancer survivors

OBJECTIVE

Cancer-related cognitive changes (CRCC) can have a profound impact on a cancer survivor's quality of life. However, cancer survivors frequently report receiving limited information about their experience of CRCC from their oncology specialists. This qualitative study aimed to explore the perceptions of oncology specialists regarding CRCC and the potential for their views to influence their decisions about patient care.

METHODS

Thirteen medical oncologists and five radiation oncologists currently practising in Australia participated in this study. Data collection involved individual semi-structured interviews via telephone. Data were audio-recorded, transcribed verbatim and analysed using a thematic approach.

RESULTS

Four key themes emerged: (1) beliefs about the impact of priming on cancer survivors' perceived cognitive function, (2) perceptions of who is more likely to raise concerns of cognitive change, (3) uncertainty of how to best manage CRCC, and (4) the perceived role of oncologists in the management of CRCC.

CONCLUSIONS

CRCC and its impact on the cancer survivor's journey have been under-addressed by oncology specialists, and they are uncertain of potential management strategies. With cancer survival rates increasing, there is a need for specific interventions and management guidelines addressing CRCC and their effects on cancer survivors. Future exploration should focus on the survivor as central to their care and holistic approaches to CRCC management involving all members of the multidisciplinary team.

Follow-up Reality for Breast Cancer Patients - Standardised Survey of Patients and Physicians and Analysis of Treatment Data

Introduction: Currently, about 360 000 breast cancer patients who could, after completion of their primary therapy, take advantage of follow-up options are living in Germany. Up to now very little is known about the extent to which the available options are used and as to how the follow-up reality is experienced and evaluated. Thus, an explorative examination among the patients and their physicians was undertaken. Patients and Methods: All patients who underwent surgery in a certified breast centre between 2007 and 2013 received a standardised questionnaire; at the same time the physicians responsible for the follow-up were invited to answer a standardised questionnaire. Results: 920 patients (response rate: 61 %) with a median age of 65 years (32-95) could be analysed. 99 % of the participants stated that they regularly attended follow-ups. The personal contact with the physician (mean value: 4.4) and the reassurance that the cancer disease had not recurred (mean value: 4.5) were described on a scale of 0 to 5 to be two of the most important factors of the follow-up. Deficits were expressed with regard to psychosocial care (70 %) and the perception and treatment of physical complaints (55 %). In addition, 105 physicians returned completed questionnaires (response rate: 12 %). For asymptomatic patients the physicians performed the following examinations most frequently: anamnesis (92 %), physical examination (87 %) as well as laboratory tests (63 %) and tumour marker determinations (40 %). Conclusion: On the whole it became clear that the vast majority of the patients took advantage of the follow-up options. From the patient's perspective the importance of the follow-up lies in contact to the physician and the comforting assurance that the breast cancer has not relapsed. Deficits are seen in the psychosocial care and the perception and treatment of physical impairments. Not recommended examinations were employed by a significant proportion of the surveyed physicians.

Paediatricians' opinions of microneedle-mediated monitoring: a key stage in the translation of microneedle technology from laboratory into clinical practice

Microneedle (MN) arrays could offer an alternative method to traditional drug delivery and blood sampling methods. However, acceptance among key end-users is critical for new technologies to succeed. MNs have been advocated for use in children and so, paediatricians are key potential end-users. However, the opinions of paediatricians on MN use have been previously unexplored. The aim of this study was to investigate the views of UK paediatricians on the use of MN technology within neonatal and paediatric care. An online survey was developed and distributed among UK paediatricians to gain their opinions of MN technology and its use in the neonatal and paediatric care settings, particularly for MN-mediated monitoring. A total of 145 responses were obtained, with a completion response rate of 13.7 %. Respondents believed an alternative monitoring technique to blood sampling in children was required. Furthermore, 83 % of paediatricians believed there was a particular need in premature neonates. Overall, this potential end-user group approved of the MN technology and a MN-mediated monitoring approach. Minimal pain and the perceived ease of use were important elements in gaining favour. Concerns included the need for confirmation of correct application and the potential for skin irritation. The findings of this study provide an initial indication of MN acceptability among a key potential end-user group. Furthermore, the concerns identified present a challenge to those working within the MN field to provide solutions to further improve this technology. The work strengthens the rationale behind MN technology and facilitates the translation of MN technology from lab bench into the clinical setting.

An international survey to identify the intrinsic and extrinsic factors of research studies most likely to change orthopaedic practice

Objectives

Evidence -based medicine (EBM) is designed to inform clinical decision-making within all medical specialties, including orthopaedic surgery. We recently published a pilot survey of the Canadian Orthopaedic Association (COA) membership and demonstrated that the adoption of EBM principles is variable among Canadian orthopaedic surgeons. The objective of this study was to conduct a broader international survey of orthopaedic surgeons to identify characteristics of research studies perceived as being most influential in informing clinical decision-making.

Materials and Methods

A 29-question electronic survey was distributed to the readership of an established orthopaedic journal with international readership. The survey aimed to analyse the influence of both extrinsic (journal quality, investigator profiles, etc.) and intrinsic characteristics (study design, sample size, etc.) of research studies in relation to their influence on practice patterns.

Results

A total of 353 surgeons completed the survey. Surgeons achieved consensus on the ‘importance’ of three key designs on their practices: randomised controlled trials (94%), meta-analyses (75%) and systematic reviews (66%). The vast majority of respondents support the use of current evidence over historical clinical training; however subjective factors such as journal reputation (72%) and investigator profile (68%) continue to influence clinical decision-making strongly.

Conclusion

Although intrinsic factors such as study design and sample size have some influence on clinical decision-making, surgeon respondents are equally influenced by extrinsic factors such as investigator reputation and perceived journal quality.

Cite this article: Dr M. Ghert. An international survey to identify the intrinsic and extrinsic factors of research studies most likely to change orthopaedic practice. Bone Joint Res 2016;5:130–136. DOI: 10.1302/2046-3758.54.2000578.