Prognostic accuracy of eight triage scores in suspected COVID-19 in an Emergency Department low-income setting: An observational cohort study

Introduction

Previous studies deriving and validating triage scores for patients with suspected COVID-19 in Emergency Department settings have been conducted in high- or middle-income settings. We assessed eight triage scores' accuracy for death or organ support in patients with suspected COVID-19 in Sudan.

Methods

We conducted an observational cohort study using Covid-19 registry data from eight emergency unit isolation centres in Khartoum State, Sudan. We assessed performance of eight triage scores including: PRIEST, LMIC-PRIEST, NEWS2, TEWS, the WHO algorithm, CRB-65, Quick COVID-19 Severity Index and PMEWS in suspected COVID-19. A composite primary outcome included death, ventilation or ICU admission.

Results

In total 874 (33.84 %, 95 % CI:32.04 % to 35.69 %) of 2,583 patients died, required intubation/non-invasive ventilation or HDU/ICU admission . All risk-stratification scores assessed had worse estimated discrimination in this setting, compared to studies conducted in higher-income settings: C-statistic range for primary outcome: 0.56-0.64. At previously recommended thresholds NEWS2, PRIEST and LMIC-PRIEST had high estimated sensitivities (≥0.95) for the primary outcome. However, the high baseline risk meant that low-risk patients identified at these thresholds still had a between 8 % and 17 % risk of death, ventilation or ICU admission.

Conclusion

None of the triage scores assessed demonstrated sufficient accuracy to be used clinically. This is likely due to differences in the health care system and population (23 % of patients died) compared to higher-income settings in which the scores were developed. Risk-stratification scores developed in this setting are needed to provide the necessary accuracy to aid triage of patients with suspected COVID-19.

Can all healthy adults use the current evidential breath alcohol analysers? An investigation using a large spirometry database

People failing to give a specimen of breath at a police station are assumed to be deliberately obstructive and are charged with Failure to Provide under the Road Traffic Act 1988. However, spirometry records of 281,210 healthy individuals from UK BioBank showed that a significant minority cannot use existing evidential breath analysis machines. Women were three times more likely to be unable to use them than men (1.64% vs 0.54%) with the risk rising with age six-fold from those in their 40s (0.43%) to 2.7% in their 70s, with women more affected (0.65% to 3.8%). Short stature was a further risk factor: 2.6% of men and 3.8% of women below the 2nd percentile of height could not use the current machines, with almost one in ten elderly, short women unable to do so, while smokers aged 50+ were twice as likely as non-smokers of the same age to be unable to provide breath specimens.

Training and testing of a gradient boosted machine learning model to predict adverse outcome in patients presenting to emergency departments with suspected covid-19 infection in a middle-income setting

COVID-19 infection rates remain high in South Africa. Clinical prediction models may be helpful for rapid triage, and supporting clinical decision making, for patients with suspected COVID-19 infection. The Western Cape, South Africa, has integrated electronic health care data facilitating large-scale linked routine datasets. The aim of this study was to develop a machine learning model to predict adverse outcome in patients presenting with suspected COVID-19 suitable for use in a middle-income setting. A retrospective cohort study was conducted using linked, routine data, from patients presenting with suspected COVID-19 infection to public-sector emergency departments (EDs) in the Western Cape, South Africa between 27th August 2020 and 31st October 2021. The primary outcome was death or critical care admission at 30 days. An XGBoost machine learning model was trained and internally tested using split-sample validation. External validation was performed in 3 test cohorts: Western Cape patients presenting during the Omicron COVID-19 wave, a UK cohort during the ancestral COVID-19 wave, and a Sudanese cohort during ancestral and Eta waves. A total of 282,051 cases were included in a complete case training dataset. The prevalence of 30-day adverse outcome was 4.0%. The most important features for predicting adverse outcome were the requirement for supplemental oxygen, peripheral oxygen saturations, level of consciousness and age. Internal validation using split-sample test data revealed excellent discrimination (C-statistic 0.91, 95% CI 0.90 to 0.91) and calibration (CITL of 1.05). The model achieved C-statistics of 0.84 (95% CI 0.84 to 0.85), 0.72 (95% CI 0.71 to 0.73), and 0.62, (95% CI 0.59 to 0.65) in the Omicron, UK, and Sudanese test cohorts. Results were materially unchanged in sensitivity analyses examining missing data. An XGBoost machine learning model achieved good discrimination and calibration in prediction of adverse outcome in patients presenting with suspected COVID19 to Western Cape EDs. Performance was reduced in temporal and geographical external validation.

External validation of triage tools for adults with suspected COVID-19 in a middle-income setting: an observational cohort study

BACKGROUND

Tools proposed to triage ED acuity in suspected COVID-19 were derived and validated in higher income settings during early waves of the pandemic. We estimated the accuracy of seven risk-stratification tools recommended to predict severe illness in the Western Cape, South Africa.

METHODS

An observational cohort study using routinely collected data from EDs across the Western Cape, from 27 August 2020 to 11 March 2022, was conducted to assess the performance of the PRIEST (Pandemic Respiratory Infection Emergency System Triage) tool, NEWS2 (National Early Warning Score, version 2), TEWS (Triage Early Warning Score), the WHO algorithm, CRB-65, Quick COVID-19 Severity Index and PMEWS (Pandemic Medical Early Warning Score) in suspected COVID-19. The primary outcome was intubation or non-invasive ventilation, death or intensive care unit admission at 30 days.

RESULTS

Of the 446 084 patients, 15 397 (3.45%, 95% CI 34% to 35.1%) experienced the primary outcome. Clinical decision-making for inpatient admission achieved a sensitivity of 0.77 (95% CI 0.76 to 0.78), specificity of 0.88 (95% CI 0.87 to 0.88) and the negative predictive value (NPV) of 0.99 (95% CI 0.99 to 0.99). NEWS2, PMEWS and PRIEST scores achieved good estimated discrimination (C-statistic 0.79 to 0.82) and identified patients at risk of adverse outcomes at recommended cut-offs with moderate sensitivity (>0.8) and specificity ranging from 0.41 to 0.64. Use of the tools at recommended thresholds would have more than doubled admissions, with only a 0.01% reduction in false negative triage.

CONCLUSION

No risk score outperformed existing clinical decision-making in determining the need for inpatient admission based on prediction of the primary outcome in this setting. Use of the PRIEST score at a threshold of one point higher than the previously recommended best approximated existing clinical accuracy.

LMIC-PRIEST: Derivation and validation of a clinical severity score for acutely ill adults with suspected COVID-19 in a middle-income setting

BACKGROUND

Uneven vaccination and less resilient health care systems mean hospitals in LMICs are at risk of being overwhelmed during periods of increased COVID-19 infection. Risk-scores proposed for rapid triage of need for admission from the emergency department (ED) have been developed in higher-income settings during initial waves of the pandemic.

METHODS

Routinely collected data for public hospitals in the Western Cape, South Africa from the 27th August 2020 to 11th March 2022 were used to derive a cohort of 446,084 ED patients with suspected COVID-19. The primary outcome was death or ICU admission at 30 days. The cohort was divided into derivation and Omicron variant validation sets. We developed the LMIC-PRIEST score based on the coefficients from multivariable analysis in the derivation cohort and existing triage practices. We externally validated accuracy in the Omicron period and a UK cohort.

RESULTS

We analysed 305,564 derivation, 140,520 Omicron and 12,610 UK validation cases. Over 100 events per predictor parameter were modelled. Multivariable analyses identified eight predictor variables retained across models. We used these findings and clinical judgement to develop a score based on South African Triage Early Warning Scores and also included age, sex, oxygen saturation, inspired oxygen, diabetes and heart disease. The LMIC-PRIEST score achieved C-statistics: 0.82 (95% CI: 0.82 to 0.83) development cohort; 0.79 (95% CI: 0.78 to 0.80) Omicron cohort; and 0.79 (95% CI: 0.79 to 0.80) UK cohort. Differences in prevalence of outcomes led to imperfect calibration in external validation. However, use of the score at thresholds of three or less would allow identification of very low-risk patients (NPV ≥0.99) who could be rapidly discharged using information collected at initial assessment.

CONCLUSION

The LMIC-PRIEST score shows good discrimination and high sensitivity at lower thresholds and can be used to rapidly identify low-risk patients in LMIC ED settings.

Promoting Well-being Among Informal Caregivers of People With HIV/AIDS in Rural Malawi: Community-Based Participatory Research Approach

BACKGROUND

People living with HIV/AIDS and their informal caregivers (usually family members) in Malawi do not have adequate access to patient-centered care, particularly in remote rural areas of the country because of the high burden of HIV/AIDS, coupled with a fragmented and patchy health care system. Chronic conditions require self-care strategies, which are now promoted in both developed and developing contexts but are still only emerging in sub-Saharan African countries.

OBJECTIVE

This study aims to explore the effects of the implementation of a short-term intervention aimed at supporting informal caregivers of people living with HIV/AIDS in Malawi in their caring role and improving their well-being. The intervention includes the dissemination of 6 health advisory messages on topics related to the management of HIV/AIDS over a period of 6 months, via the WhatsApp audio function to 94 caregivers attending peer support groups in the rural area of Namwera.

METHODS

We adopted a community-based participatory research approach, whereby the health advisory messages were designed and formulated in collaboration with informal caregivers, local medical physicians, social care workers, and community chiefs and informed by prior discussions with informal caregivers. Feedback on the quality, relevance, and applicability of the messages was gathered via individual interviews with the caregivers.

RESULTS

The results showed that the messages were widely disseminated beyond the support groups via word of mouth and highlighted a very high level of adoption of the advice contained in the messages by caregivers, who reported immediate (short-term) and long-term self-assessed benefits for themselves, their families, and their local communities.

CONCLUSIONS

This study offers a novel perspective on how to combine community-based participatory research with a cost-effective, health-oriented informational intervention that can be implemented to support effective HIV/AIDS self-care and facilitate informal caregivers' role.

1482 Prognostic accuracy of triage tools for adults with suspected COVID-19 in a middle-income setting

Aims, Objectives and Background

Uneven vaccination in low- and middle-income settings and less resilient health care provision mean that emergency health care systems may still be at risk of being overwhelmed during periods of increased COVID-19 infection. Risk stratification tools proposed to allow rapid triage of need for admission in ED settings have almost exclusively been developed and validated in high-income settings during early waves of the pandemic.

Our study aimed to estimate the accuracy of risk-stratification tools recommended to predict severe illness in adults with suspected COVID-19 infection in the Western Cape of South Africa.

Method and Design

An observational cohort study using routinely electronically collected clinical information in all state-run hospitals in the Western Cape between 27th August 2020 and 11th March 2022 was conducted to assess performance of the PRIEST tool, NEWS2, the WHO algorithm, CRB-65, TEWS, Quick Covid Severity Index and PMEWS in patients with suspected COVID-19. The primary outcome was death, respiratory support or ICU admission.

Abstract 1482 Figure 1

Performance of tools predicting composite primary outcome for total study period

Abstract 1482 Figure 2

Performance of tools predicting composite primary outcome for the Omicron period

Abstract 1482 Table 1

Triage tool diagnostic accuracy statistics (95% CI) for predicting any adverse outcome (entire study period)

ToolN*C-statisticThresholdN (%) above thresholdSensitivitySpecificityPPVNPVCRB-65432,5840.70(0.70, 0.71)>0102,964 (23.8%)0.61(0.61, 0.61)0.78(0.77, 0.78)0.09(0.09, 0.09)0.98(0.98, 0.98)NEWS2433,1010.80(0.79, 0.80)>1178835 (41.3%)0.83(0.83, 0.83)0.6(0.6,0.6)0.07(0.07–0.07)0.99(0.99, 0.99)PMEWS438,8100.79(0.79, 0.79)>2199,386 (45.4%)0.85(0.85, 0.85)0.56(0.56, 0.56)0.06(0.06, 0.07)0.99 (0.99,0.99)PRIEST438,8800.82(0.82, 0.82)>4158,893 (36.2%)0.83(0.83, 0.83)0.65 (0.65,0.66)0.08(0.08, 0.08)0.99(0.99, 0.99)WHO437,8500.71(0.71, 0.72)>0235,775 (53.8%)0.82(0.81, 0.82)0.47(0.47, 0.47)0.05(0.05, 0.05)0.99(0.99, 0.99)TEWS432,6120.72(0.71, 0.72)>2134,097 (31%)0.62(0.62, 0.62)0.70(0.70, 0.70)0.07(0.07, 0.07)0.98(0.98, 0.98)Quick COVID446,0880.70(0.69, 0.70)>335,145 (7.9%)0.33(0.33, 0.33)0.93(0.93, 0.93)0.14(0.14, 0.14)0.98(0.98, 0.98)

*Patients with <3 parameters were excluded from analysis when estimating performance

Abstract 1482 Table 2

Triage tool diagnostic accuracy statistics (95% CI) for predicting any adverse outcome (Omicron period)

ToolN*C-statisticThresholdN (%) above thresholdSensitivitySpecificityPPVNPVCRB-65136,9610.69(0.68, 0.70)>031,373 (22.9%)0.59(0.59, 0.59)0.78(0.78, 0.78)0.05(0.05, 0.05)0.99(0.99, 0.99)NEWS2137,1250.77(0.76, 0.78)>176,183 (55.6%)0.87(0.87, 0.87)0.45(0.45, 0.45)0.03(0.03, 0.03)0.99(0.99, 0.99)PMEWS138,9540.76(0.75, 0.76)>259,876 (43.1%)0.80(0.80, 0.80)0.58(0.58, 0.58)0.04(0.04, 0.04)0.99(0.99, 0.99)PRIEST158,8930.78(0.77, 0.79)>446,529 (33.5%)0.75(0.75, 0.75)0.67(0.67, 0.67)0.04(0.04, 0.04)0.99(0.99, 0.99)WHO138,6660.62(0.61, 0.63)>072,599 (52.4%)0.70(0.70, 0.70)0.48(0.48, 0.48)0.03(0.03, 0.03)0.99(0.99, 0.99)TEWS136,9670.73(0.72, 0.74)>239,509 (28.8%)0.64(0.64, 0.64)0.72(0.72, 0.72)0.04(0.04, 0.04)0.99(0.99, 0.99)Quick COVID1405200.61(0.60, 0.63)>38,210(6.4%)0.17(0.17, 0.17)0.94(0.94, 0.94)0.06(0.06, 0.06)0.98(0.98, 0.98)

*Patients with <3 parameters were excluded from analysis when estimating performance

Results and Conclusion

Of the 446,084 patients, 15,397 patients (3.45%, 95% CI:34% to 35.1%) experienced the primary outcome. Figure 1 presents the ROC curves for the triage tools for the total study period and figure 2 for the period of the Omicron wave. NEWS2, PMEWS, PRIEST tool and WHO algorithm identified patients at risk of adverse outcomes at recommended cut-offs with moderate sensitivity (>0.8) and specificity ranging from 0.47 (NEWS2) to 0.65 (PRIEST tool). The low prevalence of the primary outcome, especially in the Omicron period, meant use of these tools would have more than doubled admissions with only a small reduction in risk of false negative triage.

Triage tools developed specifically in low- and middle-income settings may be needed to provide accurate risk prediction. Existing triage tools may need to be used at varying thresholds to reflect different baseline-line risks of adverse outcomes in different settings.

LMIC-PRIEST: Derivation and validation of a clinical severity score for acutely ill adults with suspected COVID-19 in a middle-income setting

Background

Uneven vaccination and less resilient health care systems mean hospitals in LMICs are at risk of being overwhelmed during periods of increased COVID-19 infection. Risk-scores proposed for rapid triage of need for admission from the emergency department (ED) have been developed in higher-income settings during initial waves of the pandemic.

Methods

Routinely collected data for public hospitals in the Western Cape, South Africa from the 27 th August 2020 to 11 th March 2022 were used to derive a cohort of 446,084 ED patients with suspected COVID-19. The primary outcome was death or ICU admission at 30 days. The cohort was divided into derivation and Omicron variant validation sets. We developed the LMIC-PRIEST score based on the coefficients from multivariable analysis in the derivation cohort and existing triage practices. We externally validated accuracy in the Omicron period and a UK cohort.

Results

We analysed 305,564, derivation 140,520 Omicron and 12,610 UK validation cases. Over 100 events per predictor parameter were modelled. Multivariable analyses identified eight predictor variables retained across models. We used these findings and clinical judgement to develop a score based on South African Triage Early Warning Scores and also included age, sex, oxygen saturation, inspired oxygen, diabetes and heart disease. The LMIC-PRIEST score achieved C-statistics: 0.82 (95% CI: 0.82 to 0.83) development cohort; 0.79 (95% CI: 0.78 to 0.80) Omicron cohort; and 0.79 (95% CI: 0.79 to 0.80) UK cohort. Differences in prevalence of outcomes led to imperfect calibration in external validation. However, use of the score at thresholds of three or less would allow identification of very low-risk patients (NPV ≥0.99) who could be rapidly discharged using information collected at initial assessment.

Conclusion

The LMIC-PRIEST score shows good discrimination and high sensitivity at lower thresholds and can be used to rapidly identify low-risk patients in LMIC ED settings.

What is already known on this subject

Uneven vaccination in low- and middle-income countries (LMICs) coupled with less resilient health care provision mean that emergency health care systems in LMICs may still be at risk of being overwhelmed during periods of increased COVID-19 infection.Risk-stratification scores may help rapidly triage need for hospitalisation. However, those proposed for use in the ED for patients with suspected COVID-19 have been developed and validated in high-income settings.

What this study adds

The LMIC-PRIEST score has been robustly developed using a large routine dataset from the Western Cape, South Africa and is directly applicable to existing triage practices in LMICs.External validation across both income settings and COVID-19 variants showed good discrimination and high sensitivity (at lower thresholds) to a composite outcome indicating need for inpatient admission from the ED.

How this study might affect research practice or policy

Use of the LMIC-PRIEST score at thresholds of three or less would allow identification of very low-risk patients (negative predictive value ≥0.99) across all settings assessedDuring periods of increased demand, this could allow the rapid identification and discharge of patients from the ED using information collected at initial assessment.

Evaluating a pedagogical approach to promoting academic integrity in higher education: An online induction program

Academic integrity is at the heart of excellent education. However, resources explaining the concept tend to be definition-driven, while using complex language and sometimes even an austere tone designed to discourage students from breaches. This study aims to design and evaluate an online module at a UK University across 2 years, designed to improve students’ understanding of concepts of academic integrity and practice. The module includes a range of interactive resources (e.g., gamified quizzes and e-booklets) and was made available to a large cohort of postgraduate students (448). The study adopts a mixed-methods approach composed of three sequential phases involving first collecting students’ views on existing academic integrity resources (7 students participating in a focus group and 39 competing a questionnaire), then developing a range of new ones based on students’ feedback to form the content of the module, and finally gathering students’ evaluation on the newly created resources (sample size: 361 students). Results illustrate a clear improvement in relation to the accessibility, usefulness and understandability of new resources. Results also highlight a remarkable increase in student confidence levels regarding academic integrity. Students also considered the new module as more appealing and informative. This manuscript offers a good example of a pedagogical approach aimed at promoting academic integrity in an innovative and engaging fashion.

Information seeking amongst informal caregivers of people with dementia: a qualitative study

Purpose

This paper both supports previous findings relating to, and presents new insights into: the information needs and the information seeking processes of a sample of informal caregivers of people with dementia (in relation to their own needs and the interrelated needs of the people they are caring for); the extent to which such information needs are and are not being met; and the factors facilitating and hindering access to the right information.

Design/methodology/approach

The study adopted a qualitative approach in the form of a thematic analysis of in-depth, semi-structured interviews with a sample of 20 informal caregivers from a range of different age groups, genders and caring roles.

Findings

Thematic analysis identified significant informational challenges, with a common perception that information seeking was onerous, requiring a proactive approach. Further challenges arose from a perceived lack of focus on carer needs coming up against the boundaries of professional knowledge and inconsistent information provision across the sample. Distance carers faced specific issues. A second theme of negative impacts described burdens arising from: difficulties in accessing information from a complex array of support services closure or change in services and unfulfilled information needs. Participants employed strategies to enable access to information, for example, being open about their caring role; and building formal or informal support networks. It is important to address emotional as well as cognitive dimensions of information needs.

Practical implications

This research highlights a need for health and social care, practice and policy to acknowledge and address information needs of this diverse population and build resilience. Above all, information seeking and sharing must be understood within the context of the emotional impact of caring, and recognition of these twin needs is crucial.

Originality/value

Whilst previous research has focussed on identifying specific needs and knowledge acquisition at cross-sections, a more holistic understanding of experiences is underexplored. This approach is needed to take into account broader contexts, diversity of experiences and different caring roles, e.g. primary and secondary carers, and in situ and distance carers.

The information trust formation process for informal caregivers of people with dementia: a qualitative study

Purpose

This paper provides new insights on trust formation during information-seeking processes of informal caregivers of people with dementia and identifies the sources of information deemed as trustworthy by caregivers.

Design/methodology/approach

The study adopts a phenomenological qualitative approach in the form of in-depth, semi-structured interviews with a sample of 20 informal caregivers.

Findings

Caregivers trust sources that are perceived as authoritative and particularly value the information and advice provided by other caregivers. Trust in information can be divided into subjective and objective, but both are important precursors to the actual use of the information. The information available to caregivers is sufficient in quantity but inadequate in terms of ease of use, clarity and usefulness. Often, some key information needs remain unsatisfied due to the lack of timeliness, relevance and personalisation of the information.

Practical implications

This paper provides recommendations for information and healthcare providers on how to improve communication and information relevance for informal caregivers of people with dementia.

Originality/value

This paper contributes to a more comprehensive perspective on caregivers’ information trust formation processes, which takes into account both the characteristics of the information and caregivers’ individual factors.

Research Data Management Policy and Practice in China

On April 2, 2018, the State Council of China formally released a national research data management (RDM) policy “Measures for Managing Scientific Data”. Literature review shows that university libraries have played an important role in supporting Research Data Management at an institutional level in countries in North America, Europe and Australasia. The aim of this paper is to capture the current status of RDM in Chinese universities, in particular how university libraries have involved in taking the agenda forward. This paper uses mixed methods: a website analysis of university policies and services; a questionnaire for university librarians; and semi-structured interviews. Findings from website analysis and questionnaires indicate that RDS at a local level in Chinese Universities are in their infancy. On the whole there is more evidence of activity in developing data repositories than support services. Despite the existence of a national policy there remain significant barriers to further service development, such as the lag in the creation of local policy, insufficient funding for technical infrastructure, shortages of staff skills in data curation, and language barriers to international data sharing and open science. RDS in Chinese university libraries are still lagging behind the English-speaking countries and Europe.

Factors influencing researchers’ journal selection decisions

The scholarly publication landscape continues to grow in complexity, presenting researchers with ever-increasing dilemmas regarding journal choice. However, research into the decision-making processes associated with journal choice is limited. This article contributes by reporting on an international survey of researchers in various disciplines and with varying levels of experience. The study examines the extent to which various journal characteristics affect journal selection, perceptions of the extent to which university and national research policies impact on their journal choice, and the influence of academics’ familiarity, confidence and objectives on journal choice. The most important factors influencing journal choice were as follows: reliability of reviewing, usefulness of reviewers’ feedback, the reputation of the journal and confidence that their article is in scope for the journal. Publishing productivity, publishing experience, researcher role and discipline had little impact on the ranking of journal choice factors, suggesting that the research community is homogeneous.

Information Overload in Emergency Medicine Physicians: A Multisite Case Study Exploring the Causes, Impact, and Solutions in Four North England National Health Service Trusts

Background

Information overload is affecting modern society now more than ever because of the wide and increasing distribution of digital technologies. Social media, emails, and online communications among others infuse a sense of urgency as information must be read, produced, and exchanged almost instantaneously. Emergency medicine is a medical specialty that is particularly affected by information overload with consequences on patient care that are difficult to quantify and address. Understanding the current causes of medical information overload, their impact on patient care, and strategies to handle the inflow of constant information is crucial to alleviating stress and anxiety that is already crippling the profession.

Objective

This study aims to identify and evaluate the main causes and sources of medical information overload, as experienced by emergency medicine physicians in selected National Health Service (NHS) trusts in the United Kingdom.

Methods

This study used a quantitative, survey-based data collection approach including close- and open-ended questions. A web-based survey was distributed to emergency physicians to assess the impact of medical information overload on their jobs. In total, 101 valid responses were collected from 4 NHS trusts in north England. Descriptive statistics, principal component analysis, independent sample two-tailed t tests, and one-way between-group analysis of variance with post hoc tests were performed on the data. Open-ended questions were analyzed using thematic analysis to identify key topics.

Results

The vast majority of respondents agreed that information overload is a serious issue in emergency medicine, and it increases with time. The always available culture (mean 5.40, SD 1.56), email handling (mean 4.86, SD 1.80), and multidisciplinary communications (mean 4.51, SD 1.61) are the 3 main reasons leading to information overload. Due to this, emergency physicians experience guideline fatigue, stress and tension, longer working hours, and impaired decision making, among other issues. Aspects of information overload are also reported to have different impacts on physicians depending on demographic factors such as age, years spent in emergency medicine, and level of employment.

Conclusions

There is a serious concern regarding information overload in emergency medicine. Participants identified a considerable number of daily causes affecting their job, particularly the traditional culture of emergency departments being always available on the ward, exacerbated by email and other forms of communication necessary to maintain optimal, evidence-based practice standards. However, not all information is unwelcome, as physicians also need to stay updated with the latest guidelines on conditions and treatment, and communicate with larger medical teams to provide quality care.

Electronic Health Record and Problem Lists in Leeds, United Kingdom: Variability of general practitioners' views

Data sharing of Electronic Health Records from general practices to secondary care in Leeds occurs through the so-called Leeds Care Records, which collects a specific set of codes from primary care, known as 'Active Problems', and presents it to the user. Variability on its content is a known issue. To explore general practitioners' views on their use of 'Active Problems' and on sharing data, so lessons could be learnt on how to homogenise and improve shared data. Assessing Leeds general practitioners' views through two parallel processes (60 online surveys and 17 interviews). General practitioners feel they do not have the time nor the training required for keeping a shared approach to concise and current Problem Lists in electronic patient records. Action is needed to reduce current variability, and to improve the quality of shared information. Some types of codes currently present in Problem Lists have very little support among general practitioners who consider the focus should be on long-term conditions and probably adding current acute diagnoses and life expectancy items and not omitting sensitive information. There is a perceived need of training and time to update Problem Lists if their quality is to improve.

Online Support Groups as a Source of Empowerment for People with Type 2 Diabetes

People with Type 2 Diabetes (T2D) control much of their illness by making daily decisions regarding their health behaviours. They require certain skills, information, and support, which might not be obtainable from healthcare providers, and they may seek support through other media, such as online support groups (OSGs). This study seeks to understand the role of OSGs in empowering people with T2D by thematically analysing threads and posts from two UK OSGs.

Progress in Research Data Services

University libraries have played an important role in constructing an infrastructure of support for Research Data Management at an institutional level. This paper presents a comparative analysis of two international surveys of libraries about their involvement in Research Data Services conducted in 2014 and 2018. The aim was to explore how services had developed over this time period, and to explore the drivers and barriers to change. In particular, there was an interest in how far the FAIR data principles had been adopted. Services in nearly every area were more developed in 2018 than before, but technical services remained less developed than advisory. Progress on institutional policy was also evident. However, priorities did not seem to have shifted significantly. Open ended answers suggested that funder policy, rather than researcher demand, remained the main driver of service development and that resources and skills gaps remained issues. While widely understood as an important reference point and standard, because of their relatively recent publication date, FAIR principles had not been widely adopted explicitly in policy.

Information Literacy in Food and Activity Tracking Among Parkrunners, People With Type 2 Diabetes, and People With Irritable Bowel Syndrome: Exploratory Study

BACKGROUND

The tracking, or logging, of food intake and physical activity is increasing among people, and as a result there is increasing evidence of a link to improvement in health and well-being. Crucial to the effective and safe use of logging is a user's information literacy.

OBJECTIVE

The aim of this study was to analyze food and activity tracking from an information literacy perspective.

METHODS

An online survey was distributed to three communities via parkrun, diabetes.co.uk and the Irritable Bowel Syndrome Network.

RESULTS

The data showed that there were clear differences in the logging practices of the members of the three different communities, as well as differences in motivations for tracking and the extent of sharing of said tracked data. Respondents showed a good understanding of the importance of information accuracy and were confident in their ability to understand tracked data, however, there were differences in the extent to which food and activity data were shared and also a lack of understanding of the potential reuse and sharing of data by third parties.

CONCLUSIONS

Information literacy in this context involves developing awareness of the issues of accurate information recording, and how tracked information can be applied to support specific health goals. Developing awareness of how and when to share data, as well as of data ownership and privacy, are also important aspects of information literacy.

Cross-Classified Multilevel Modelling of the Effectiveness of Similarity-Based Virtual Screening

The screening effectiveness of a chemical similarity search depends on a range of factors, including the bioactivity of interest, the types of similarity coefficient and fingerprint that comprise the similarity measure, and the nature of the reference structure that is being searched against a database. This study introduces the use of cross-classified multilevel modelling as a way to investigate the relative importance of these four factors when carrying out similarity searches on the ChEMBL database. Two principal conclusions can be drawn from the analyses: that the fingerprint plays a more important role than the similarity coefficient in determining the effectiveness of a similarity search, and that comparative studies of similarity measures should involve many more reference structures than has been the case in much previous work.

Academics’ attitudes towards peer review in scholarly journals and the effect of role and discipline

This research contributes to the knowledge on academics’ attitudes towards peer review, through an international and inter-disciplinary survey of academics, which profiles academics’ views on the value of peer review, its benefits and the prevalence of unethical practices. Generally, academics regarded peer review as beneficial to improving their article and felt that peer review contributed significantly to the effectiveness of scholarly communication. Academics agreed that peer review could improve the readability and quality of the published paper, as well as check for accuracy, appropriate methodology, novelty and relevance to the journal. There are significant differences in the views of respondents on the basis of role, with those involved as reviewers and editors being less positive about peer review than authors. In addition, there is evidence of some disciplinary differences in views on the benefits of peer review.

Medical and health sciences academics’ behaviours and attitudes towards open access publishing in scholarly journals: a perspective from South Korea

This article seeks to extend the knowledge of the behaviour and attitudes towards open access publishing through a survey that focusses on the attitudes and behaviours of academic researchers in Korea working in medicine and healthcare. Issues covered include: use of and intentions regarding OAP, and perceptions regarding advantages and disadvantages of OAP, journal article publication services, peer review, and re-use. A significant proportion of the articles (mean 58%) published by this group are published gold open access, consistent with the push in Korea towards international impact for their research. Researchers were more positive about the benefits of OAP than they were negative about its disadvantages. Analysis of responses on the basis of gender, and experience in publishing, showed some significant differences in attitudes to some statements.

Competencies for bibliometrics

Universities are increasingly offering support services for bibliometrics, often based in the library. This paper describes work done to produce a competency model for those supporting bibliometrics. The results of a questionnaire in which current practitioners rated bibliometric tasks as entry level, core or specialist are reported. Entry level competencies identified were explaining bibliometric concepts, doing basic calculations and some professional skills. Activities identified by participants as core are outlined. Reflecting on items that were considered in scope but specialist there was less stress on evaluating scholars, work at a strategic level, working with data outside proprietary bibliometric tools and consultancy-type services as opposed to training for disintermediated use. A competency model is presented as an appendix.

Trust and Credibility in Web-Based Health Information: A Review and Agenda for Future Research

Background

Internet sources are becoming increasingly important in seeking health information, such that they may have a significant effect on health care decisions and outcomes. Hence, given the wide range of different sources of Web-based health information (WHI) from different organizations and individuals, it is important to understand how information seekers evaluate and select the sources that they use, and more specifically, how they assess their credibility and trustworthiness.

Objective

The aim of this study was to review empirical studies on trust and credibility in the use of WHI. The article seeks to present a profile of the research conducted on trust and credibility in WHI seeking, to identify the factors that impact judgments of trustworthiness and credibility, and to explore the role of demographic factors affecting trust formation. On this basis, it aimed to identify the gaps in current knowledge and to propose an agenda for future research.

Methods

A systematic literature review was conducted. Searches were conducted using a variety of combinations of the terms WHI, trust, credibility, and their variants in four multi-disciplinary and four health-oriented databases. Articles selected were published in English from 2000 onwards; this process generated 3827 unique records. After the application of the exclusion criteria, 73 were analyzed fully.

Results

Interest in this topic has persisted over the last 15 years, with articles being published in medicine, social science, and computer science and originating mostly from the United States and the United Kingdom. Documents in the final dataset fell into 3 categories: (1) those using trust or credibility as a dependent variable, (2) those using trust or credibility as an independent variable, and (3) studies of the demographic factors that influence the role of trust or credibility in WHI seeking. There is a consensus that website design, clear layout, interactive features, and the authority of the owner have a positive effect on trust or credibility, whereas advertising has a negative effect. With regard to content features, authority of the author, ease of use, and content have a positive effect on trust or credibility formation. Demographic factors influencing trust formation are age, gender, and perceived health status.

Conclusions

There is considerable scope for further research. This includes increased clarity of the interaction between the variables associated with health information seeking, increased consistency on the measurement of trust and credibility, a greater focus on specific WHI sources, and enhanced understanding of the impact of demographic variables on trust and credibility judgments.

Modelling trust formation in health information contexts

This study explores trust formation in the context of health information. Trust as an interpersonal notion, when formed in a vulnerable state, is a response or belief about how the trusted will behave towards the trustor. This study focuses on the process of assessing the trustworthiness of information, in a dependency state of information need, through the identification of the many factors influencing this assessment. A set of propositions are developed to suggest the criteria by which trustworthiness is assessed as well as the factors that influence these judgements. The proposed model is tested in a large-scale survey using a trust inventory with factor analysis to explore the constructs of trust formation. Structural equation modelling is used to explore the relationship among the identified criteria and their influencing factors. The resulting framework contributes to the understanding of trust formation in digital information contexts on the criteria of usefulness and credibility and further research into the influencing factors is recommended.

Students' trust judgements in online health information seeking

As one of the most active groups of Internet users, students and other young people are active users of digital health information. Yet, research into young people's evaluation of health information is limited, and no previous studies have focused on trust formation. In addition, prior studies on adults' use of digital information do not reach a consensus regarding the key factors in trust formation. This study seeks to address this gap. A questionnaire-based survey was used to collect data from undergraduate students studying a variety of disciplines in one UK university. The Trust in Online Health Information Scale is proposed, and it includes the following dimensions: authority, style, content, usefulness, brand, ease of use, recommendation, credibility, and verification. In addition, inspection of responses to specific items/questions provides further insights into aspects of the information that were of specific importance in influencing trust judgements.

Public libraries and non-users: A comparison between Manchester and Rome

This paper presents the findings of a study conducted with library managers from two major metropolitan areas, Greater Manchester in England and Rome in Italy. The study aims to compare practices, activities and policies adopted in the two cities to attract non-users, with particular attention to the approach that librarians take to resolving the non-user issue. This research also revealed differences in the way public libraries are used in the two areas. In Manchester, libraries are predominantly task orientated, offering access points for community services, whereas in Rome the focus is more on entertainment, leisure, and social events. The non-user profiles differ between cities, with non-users being mostly older teenagers and young adults in Manchester and mostly younger teenagers and pensioners in Rome. Reading groups, a key service for encouraging reading and familiarising with library facilities, are well established in England, with 90% of the libraries in Manchester accommodating one or more groups, compared to only 50% of the libraries in Rome offering usually a single group. In addition, Manchester libraries often have a range of specialised reading groups to suit a large variety of reading tastes. Libraries in both cities are aware of the need for proactive marketing and management of their web presence but should look at other countries’ strategies to expand their range of activities and programmes to attract more public.