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Introduction While recent studies have focused on confirming satisfaction with telemedicine during the coronavirus disease 2019 (COVID-19) era, we leveraged a novel survey instrument to identify associations between patient experience and telemedicine-specific factors such as device selection, audio/visual resolution, and connection stability. Methods Telemedicine visit data were gathered from our institution between June 22, 2020 and February 14, 2021. Each patient indicated their overall visit score, likelihood-to-recommend (LTR) score, and device used for the encounter. Remaining questions were randomly distributed to patients to ensure equal distribution across respondents. Results Over 34 weeks, there were 901 unique neurosurgical telemedicine visits linked to a post-visit survey at our institution. The LTR top box score percentage showed no significant change across 34 weeks (p = 0.218). After adjusting across available covariates, patients who experienced wait times exceeding 20 min were significantly less likely to report high overall scores (aOR: 0.12; 95% CI: 0.03–0.41; p = 0.001). Patients who indicated they were less able to understand the provider (aOR: 0.22; 95% CI: 0.07–0.66; p = 0.007), or who indicated the provider was not able to properly see them (aOR: 0.11; 95% CI: 0.03–0.43; p = 0.002) were associated with substantially lower overall scores. Visits with interrupted connectivity or those forced to move to a regular phone call were not important predictors of overall score. Conclusions In the largest description of patient satisfaction with telemedicine in the neurosurgical setting during the COVID-19 era, we identified timely and high-quality physician-patient visualization and communication as among the most important predictors of patient satisfaction in virtual settings.

The objectives of this study were to determine coronavirus disease 2019 (COVID-19) vaccination hesitancy and influencing factors in China, while broadening the applicability of the Vaccine Hesitancy Scale (VHS). A cross-sectional survey was conducted in China from 4th to 26th February 2021. Convenience sampling method was adopted to recruit participants. A total of 2,361 residents filled out the questionnaire. Confirmatory factor analysis was used on the validation set to confirm the latent structure that resulted from the exploratory factor analysis, which was conducted on the construction set. Multiple linear regression model analyses were used to identify significant associations between the identified the revised version of VHS subscales and hypothesized explanatory variables. Two subscales were identified within the VHS through data analysis, including "lack of confidence in the need for vaccines" and "aversion to the risk of side effects." The results indicated that the hesitancy of the participants in our sample was both driven the two mainly aspects. In addition, more than 40% of the participants expressed hesitation in half of the items in VHS. This study characterized COVID-19 vaccine hesitancy in China, and identified disparities in vaccine hesitancy by socio-demographic groups and knowledge about the vaccine. Knowledge of the vaccine was statistically linked to respondents' answers to the clustered 'lack of confidence' and 'risks perception' items. Our results characterize Chinese citizens' COVID-19 vaccine concerns and will inform targeted health communications.

The knowledge of health workers about magnetic resonance imaging (MRI) safety is essential to ensure patients' safety and comfort, achieve a smooth workflow, and save valuable scan time. The aim of this study was to determine the perception and attitudes of health workers toward MRI safety. A cross-sectional online survey of 194 health workers was conducted between March 27th and April 3rd, 2020. The survey instrument consisted of demographic characteristics, including 15 items on knowledge and 7 items on attitudes on perception and toward MRI safety in Aseer province, Saudi Arabia. Descriptive statistics, chi-square tests, binary logistic regression, t-tests, and one-way analysis of variance (ANOVA) were conducted. The overall knowledge score of the health workers was 60% and the attitude score was 71.4% for the perception of MRI safety. Participants in the age group of 30-39 years were more aware of MRI basic knowledge than other age groups. Nurses were more likely to be aware of basic MRI knowledge than physicians and dentists (AOR = 2.4, 95% CI = 1.11–5.04) and (AOR = 3.06, 95% CI = .96–9.73). Health workers having a Ph.D., master's, or bachelor's degree were more likely aware of basic MRI knowledge than were those with a diploma (AOR = 7, 95%, CI = 1.39–35.35, AOR = 8.17, 95% CI = 1.23–51.40, and AOR = 2.66, 95% CI = .97–7.29, respectively). Participants in the age group of 30-39 years were more aware of MRI safety than were those in the age group of 50- to 59 years (AOR = 4.60, 95% CI = .67–31.76). Nurses were significantly more aware of MRI safety than were other health workers (OR = 4.60, 95% CI = .67–31.76). The education level of health workers had no significant impact on perception of MRI safety (OR 0 .05). The results highlighted the importance of training and higher studies for health workers regarding the perception and attitudes toward MRI safety. The overall knowledge of MRI safety and procedures is generally acceptable; however, more intensive health education programs are needed to improve the level of knowledge.

Background Studies evaluating the efficacy of ATLS in low- and middle-income countries are limited. We followed up ATLS providers certified by the ATLS India program over a decade (2009 to 2019), aiming to measure the benefits in knowledge, skills, attitude and their attrition over time. Methods The survey instrument was developed taking a cue from published literature on ATLS and improvised using the Delphi method. Randomly selected ATLS providers were sent the survey instrument via email as a Google form, along with a statement of purpose. Results are presented descriptively. Results ATLS India trained 7,847 providers over the study period. 2500 providers were selected for the survery using computer-generated random number table. One thousand and thirty doctors (41.2%) responded. Improvement in knowledge (n = 1,013 [98.3%]), psychomotor skills (n = 986 [95.7%]), organizational skills (n = 998 [96.9%]), overall trauma management (n = 1,013 [98.7%]) and self-confidence (n = 939 [91%]) were reported. Majority (904 [87.8%]) started ATLS promulgation at workplace in personal capacity. These benefits lasted beyond 2 years in majority (>60%) of respondents. More than 40% reported cognitive (n = 492 [47.8%]), psychomotor (n = 433 [42%]), and organizational benefits (n = 499 [48.4%]) lasting beyond 3 years. Improvement in self-confidence, ATLS promulgation at the workplace, and retention of organizational skills were more pronounced in ATLS faculties than providers. All other benefits were found to be comparable in both sub-groups. Lack of trained staff (n = 660 [64.1%]) and attitude issues (n = 495 [48.1%]) were the major impediments in implementing ATLS at the workplace. More than a third of respondents (n = 373 [36.2%]) could enumerate one or more incidents where ATLS principles were life- or limb- saving. Conclusions Cognitive, psychomotor, organizational, and affective impact of ATLS is overwhelmingly positive in the Indian scenario. Until formal trauma systems are established, ATLS remains the best hope for critically injured patients in resource-contrained settings.

Background Academic institutions have increasingly focused on educating physicians and surgeons in concepts of value-based care, including quality improvement (QI). The extent to which QI curricular competencies are addressed in specialty surgical residency training is unclear. Methods A survey instrument was developed by content experts and sent to Vascular Surgery and Urology residents electronically. Descriptive statistics and bivariate associations were calculated using StataMP 13.1. Results Vascular Surgery and Urology residents reported exposure to similar types of QI curriculum. Fewer than half of residents reported achieving targets for graduation (Vascular 31%, Urology 42%) related to QI, and few residents in either group felt very well-prepared to lead a QI initiative (Vascular 13%, Urology 8%). Conclusion QI education in surgical specialty training amongst Vascular Surgery and Urology residencies is similar and insufficient. Surgical specialties may benefit from collaborative efforts to improve the quality of QI education.

**Objective:** To evaluate whether “Don’t Know” (DK) responses conveyed meaningful information when provided by oncologists in a national survey on medicinal cannabis (MC). **Study Setting:** This study is a secondary analysis of national survey data (n=237) collected between November 2016 and January 2017. **Methods:** The national survey asked oncologists about views regarding MC’s risks/benefits, and whether they had sufficient knowledge to make MC recommendations clinically. Cognitive testing of the survey instrument (n=5) suggested that physicians did not always feel that they possessed adequate MC knowledge in all domains, so DKs were added to six of 27 survey items. (Three items were batteries of questions while three were single questions.) We constructed bar graphs for the sum of DK responses in each battery and for the sum of all DK responses in the survey. Mann-Whitney tests compared medians for all DK responses within Yes/No responses to the sufficient knowledge question. **Principal Findings:** Statistically significant associations between DK responses and the sufficient knowledge question indicate that DK answers improved data quality by providing all respondents with an answer category that they feel fits their “true” answer. Associations between DK answers and other background variables such as respondents’ age, sex, and race are also discussed. The logistic regressions found that possessing sufficient knowledge was the only variable significant across six of the nine regressions, and the direction was consistent with the bivariate findings. **Conclusion:** In this study, DKs appear to be valid responses, improving data quality by providing some respondents with an answer category that best fits their “true” answer. Future surveys aiming to learn about physicians’ views regarding emerging treatments might consider including the DK response option in some items.

Research on how we deliver healthcare has rapidly expanded in recent years. With nearly 1.7 million individuals diagnosed with cancer each year in the United States and the rising costs of care, ca...

Steroids are man-made chemicals that resemble hormones that are naturally made in the human body. The main role of steroids in sports is to enhance performance and reduce inflammation. The aim of the present study is to assess the awareness of the use of steroid drugs among football players and the ill effects of steroid drug intake. A Cross-sectional study was done on 100 football players and veterans registered with the State Football Association. A pretested structured questionnaire assessing the awareness on the use of steroid drugs was the survey instrument. Both male and female football players and veterans within the age group 18-50 years were selected after obtaining informed consent. The sampling method used was a simple random sampling method. The questionnaire comprised of 10 open-ended questions and were administered through Google forms. 76% of the participants responded that they use steroid drugs at least once and 24% responded that they never used steroid drugs. According to the above survey, we conclude that there is a high rate of usage of steroid drugs among football players.

OBJECTIVE The purpose of this study is to identify perceptions of academic surgeons regarding academic productivity and assess its relationship to clinical productivity. We hypothesized that these perceptions would vary based on respondent characteristics including clinical activity and leadership roles. DESIGN This retrospective, survey-based study was performed from August 26, 2019 to September 26, 2019. SETTING The setting was academic surgical departments across the US. PARTICIPANTS The survey instrument was administered to faculty members of the Association of Program Directors in Surgery. A total of 105 academic surgeons responded. RESULTS Most respondents were Program Directors (59%) of general surgery programs. Of the participants, 30% identified as Professor, 36% as Associate Professor, and 15% as Assistant Professor. Respondents agreed that multiple academic pursuits or factors should count towards academic productivity including the following (in descending order): completing a first-authored manuscript (98.8%), completing a senior-authored manuscript (97.7%), chairing a national committee (94.1%), serving on a national committee (88.2%), completing a second-authored manuscript (88.0%), completing a first lecture (83.7%), completing a middle-authored manuscript (71.8%), completing a lecture (whether or not repeated) (70.9%), impact factor of journal (60.7%), and attendance at grand rounds (57.0%). Perspectives did not vary significantly based on surgeon demographics, clinical setting, or leadership role (p > 0.05). CONCLUSIONS Perceptions regarding what constitutes academic productivity and merit a reduction in clinical expectation are remarkably similar across multiple surgeon characteristics including demographics, academic title, leadership role, and practice environment.

Objective To determine the quality improvement (QI) experiences of urology residents in the United States. Materials and Methods An Institutional Review Board approved national survey of Urology residents was administered in June 2019. The survey instrument sought to understand QI curricular methods and experiences of urology residents as well as their knowledge of QI fundamentals. Results Of 465 invited residents, 159 (34%) responded. Respondents represented all 8 AUA sections. The majority of respondents self-identified as white (66%). Females made up 30% of respondents. Less than 1/3 of residents (32%) report use of online modules, whereas nearly 2/3 (63%) report lecture-based didactics. Fifteen percent of residents report no QI curriculum. While nearly 2/3 of residents report receiving training in QI principles (64%), far less report receiving training in how to apply QI methodology (44%). Only 29% of residents report being required to lead a QI project. No differences were seen by training level. Only 3 respondents had heard of the Institute of Medicine's aims for quality improvement. Respondents had better knowledge of process, balancing and outcome measures, but less than half of respondents (49%) were able to correctly identify all 3. Having any QI curriculum is associated with correctly answering knowledge questions (P = .03). Conclusion From a resident perspective, urology residency programs currently provide QI curricula that are inadequate to ensure residents achieve Accreditation Council for Graduate Medical Education milestones. It is imperative the urology community as a whole address these curricular gaps to ensure graduates are prepared to deliver high-quality, cost-conscious care to their patients once in practice.

Background Over-the-counter, natural product-based (nonvitamin, nonmineral) dietary supplement (NVNM DS) use is common in adults with rheumatoid arthritis (RA), a group at risk for drug-DS interactions, due to polypharmacy, but this use is underreported to health care providers. Recent dramatic changes in US sales of specific NVNM DS suggest that the prevalence and types of NVNM DS used in RA populations may also have shifted. Objectives A study was undertaken to identify current and past use of specific NVNM DS for RA disease treatment and to examine associations between use of NVNM DS, RA pharmaceuticals, and/or vitamin or mineral (VM) DS. Methods We developed a survey instrument to capture current and ever use of specific NVNM DS, VM DS, and RA pharmaceuticals, with 696 subjects self-reporting an RA diagnosis recruited online or in clinic for survey participation. Analyses were limited to 611 subjects reporting RA diagnosis after age 18 y and treatment with specific RA pharmaceuticals. Results Most participants reported DS use, with current usage prevalence 49.6% (n = 303), 83.5% (n = 510), or 87.6% (n = 535) for NVNM, VM, or any DS, respectively. While not having appeared in previous RA surveys, turmeric and ginger were among the top 3 NVNM DS in current use, along with fish oil/ω-3 (n-3) PUFA. Concurrent NVNM DS use was reported by 48.2% (n = 243) of participants currently using RA pharmaceuticals (n = 504) and was more common in those using disease-modifying antirheumatic drugs only (no biologics). Most methotrexate users (83%) reported concurrent folate supplementation, with one-third also using turmeric, which is notable because methotrexate and turmeric have been associated with hepatotoxicity. Conclusion Individuals with RA commonly use NVNM DS in combination with RA pharmaceuticals, including a previously undocumented but popular use of turmeric or ginger supplements with an unclear risk/benefit ratio.

Made available in DSpace on 2020-12-12T02:15:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-09-01 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Objective: To investigate the current scenario in Brazil regarding pain assessment and control in experimental animals. Study design: Prospective survey. Methods: A confidential questionnaire was available online and sent by e-mail to Brazilian scientists working with animal experimentation in Brazil. Data collection was conducted from October 2016 to October 2017. The exclusion criteria included blank questionnaires or with

Emerging infectious diseases, such as the 2019 novel coronavirus (SARS-CoV-2), pose a substantial challenge to United States (US) public health. In the absence of a vaccine, controlling the spread of SARS-CoV-2 depends on social distancing measures, such as school closures and stay-at-home orders. Infectious disease epidemiologists create models to test the effects of these different interventions and to predict their impact on different populations. One key input to these models is data on social contact and mixing patterns. Unfortunately, there is a paucity of this type of data for the US. The Minnesota Department of Health and University of Minnesota launched the Minnesota Social Contact Study (MN SCS) in order to capture social contact and mixing pattern data for MN as different social distancing measures are enacted. This report describes the MN SCS survey and survey methodology. We highlight key differences between the MN SCS and the most widely cited and used social contact survey based on data from eight European countries in 2006. We conclude by highlighting changes others may consider when adopting the survey for use in other populations. A copy of the survey instrument is included in the appendix.

Background Dentists are high prescribers of antibiotics for both treatment and prevention of infection, although there are few guidelines to aid clinicians. Given the worldwide concerns about unnecessary use of antibiotics, there is a need for a better understanding of dentists’ use of these drugs for antibiotic prophylaxis (AP) to prevent distant site infections (i.e., infective endocarditis and prosthetic joint infection). Objective The aim of this study was to develop and implement an effective, self-reporting, cross-sectional, survey instrument that optimized the response rate and maximized reliability and validity for determining the beliefs and behaviors of a large and nationally representative group of generalist and specialist dentists concerning their use of AP. Study Design A 15-question survey (58 items) was developed in a structured process by a multidisciplinary team and configured for automated online dissemination to 3584 national Dental Practice-Based Research Network (DPBRN; hitherto referred to as “Network”) practitioners. The implementation phase consisted of 3 waves of greater than 1000 Network members. Additionally, 47 randomly selected dentists were surveyed twice to assess test–retest reliability. Results Of 3584 eligible Network members, 2169 (60.5%) completed the survey. The age and geographic distributions of responders was similar to those of dentists in the 2019 American Dental Association census. Furthermore, test–retest weighted kappa values for the survey were acceptable (median 0.56; interquartile range 0.42–0.64). Conclusions We developed a highly structured survey with a high response rate and good reliability that will allow us to obtain unique data on dentists’ beliefs and practices regarding AP prescribing.

Objective: This study's objective was to determine the level of career satisfaction among practicing Community Pharmacists (CPs) and the impact of various factors on career satisfaction. Methods: This cross-sectional study used a self-administered instrument to access the current level of career satisfaction among CPs. The survey instrument questions were adopted from previous studies and were contextualized to suit study objectives and revalidated using face and content validation. The study instrument was distributed and collected. Results: A total of 172 responses from CPs were received, 112 (65.1%) from males and 60 (34.9%) from females. The difference in age categories was significantly profound in the less than 34 years old group being 113 (65.7%) compared with the more than 34 years old being 59 (34.3%). Around 98 (57%) were working in chain pharmacies and 74 (43%) in independent pharmacy stores. The study result showed126 (73.3%) were unsatisfied in their careers and 46 (26.7%) were satisfied. Conclusion: Age and working experience are both major contributing factors to career satisfaction levels. Only 36.5% reported having higher career satisfaction levels among total participated CPs.

Objective: The purpose of this study was to assess understanding of the hysterectomy procedure and uterine fibroids among women in a general gynecology clinic. Materials and Methods: This was an anonymous cross-sectional survey. We adapted and pilot tested a survey instrument designed to assess understanding of the hysterectomy procedure and of uterine fibroids. The final version of the survey consisted of basic demographic questions, followed by 28 knowledge questions (Canadian Task Force Classification II-2). The survey was disseminated to women in the waiting room of one of our gynecology clinics. The patient population included women 18 years and older. Results: The mean age of respondents was 33.5 years old. In total, 69.5% of the respondents had at least some college education. In the group of questions related to different types of hysterectomies, the most poorly answered question was “Which type of hysterectomy has the highest risk of damage to the bladder?” Less than 40% of the respondents were able to identify a laparoscopic and robotic hysterectomy based on a written description. Of questions about uterine fibroids, the most poorly answered question was whether cancer that looks like fibroids is common, with >90% of the respondents incorrectly thinking that cancer that resembled fibroids is common. More than half of respondents did not know what a fibroid is. Conclusions: In this analysis of the understanding of the hysterectomy procedure and fibroids among an educated population, overall understanding was poor. Specific areas where knowledge was particularly poor were the different ways of doing a hysterectomy and uterine fibroids.

BACKGROUND: Endotracheal intubation is a common procedure performed by respiratory therapists (RTs). The purpose of this study was to describe current RT intubation practices in North Carolina through the use of a survey instrument. METHODS: A survey was developed by the authors using REDCap. The survey was sent via email to all licensed RTs in North Carolina. Information collected included respondent demographics, intubation practices (including training and skill maintenance), and attitudes about RT intubation practices. RESULTS: Of the 411 respondents, 68% intubated at their facility, representing 81 unique institutions. RTs who performed intubation were more likely to be from community hospitals and less likely to be from level 1 trauma centers. Respondents reported intubating adult (91%), pediatric (61%), and neonatal (65%) patients. The most common areas in which RTs reported performing intubation were the adult ICU (80%), emergency department (76%), outside the operating room for emergencies (76%), neonatal ICU (43%), the delivery room (45%), and pediatric ICU (25%). The median (interquartile range) number of supervised intubations required to be considered competent was 5 (3–5). The most common numbers of intubations required to be considered competent were 5 (32%), 3 (26%), 10 (16%), 2 (4%), and 0 (3%). The perceived number of intubations to achieve competence was 6 (range 5–10) and did not differ based on years of experience. Most respondents believed their RT intubation program was safe (93%) and effective (91%), and that RTs were well-trained (81%), that their intubation skills were objectively evaluated (66%), and that RTs receive sufficient feedback on performance (68%). CONCLUSIONS: RTs in North Carolina frequently performed intubation and had high confidence in their programs. Further studies are needed to establish standardized training for endotracheal intubation, document success rates for intubations, and evaluate the use of video laryngoscopy by RTs.

Objectives Globally, persons with mental illness are victims of stigma, even among healthcare professionals and trainees. However, in Nigeria, little is known about the attitudes of pharmacy students towards people with mental illness. Therefore, the objectives of this paper were to assess and compare the attitudes of pharmacy and non-pharmacy students towards mental illness and explore its associated demographic factors. Methods A cross-sectional survey was conducted among pharmacy and selected non-pharmacy students of a Nigerian university. The Attitude Scale for Mental Illness was used for data collection. The survey instrument was distributed to and completed by selected students in batches after normal class lectures. Descriptive statistics, chi-square test and Student’s t-test were used for data analysis. P < 0.05 was considered statistically significant. Key findings The key findings showed that pharmacy and non-pharmacy students generally demonstrated positive attitudes towards mental illness. Pharmacy students had more positive, less stigmatizing attitudes compared with students of non-pharmacy courses. Students' attitudes towards mental illness were significantly influenced by gender, age, a previous visit to a mental hospital and knowing a family member or friend with a mental illness. Conclusions Our findings suggest that students' attitudes towards mental illness were positive but sub-optimal. Student pharmacists demonstrated more positive attitudes towards mental illness compared with non-pharmacy students. However, the major contributors to positive attitudes were male gender, older age, a previous visit to a mental hospital and having a close associate with a mental illness. Therefore, educational interventions addressing students’ misconceptions of mental illness are recommended.

Purpose The purpose of the study was to pilot test the English and Urdu version of the Colon Cancer Screening Behaviours Survey among South Asians in Canada. The first objective was to evaluate feasibility of administration, data collection using computer assisted personal interviewing software on a tablet, and response burden. The second objective was to examine the prevalence of colorectal cancer screening among South Asians and evaluate the psychometric properties of sub-scales in the survey. Methods Purposive, network and snowball sampling were used to recruit participants for this cross-sectional study. Interviewer-led administration of the Colon Cancer Screening Behaviours Survey was conducted across two cities in Ontario, Canada. Qualitative data analysis assessed feasibility; and sub-scales were evaluated through principal component analysis, item-scale correlations, and construct validity using multiple linear and logistic regression. Results A total of 328 South Asians participated, 47% Urdu speaking, and 53% English speaking. There was a 23% refusal rate to participate. Feasibility identified: (1) successful recruitment despite reasons for refusal; (2) problematic items and response categories; and (3) computer/tablet limitations. Principal component analysis identified 14 components that explained 68.7% of total variance; 34 items were retained after factor analysis. Internal consistency of 4 scales ranged from 0.79–0.91. There were significant differences in perceived barriers scale scores (− 12.21; 95% CI, − 17.13 to - 7.28; p p = 0.783). Conclusions Recruitment and data collection methods are feasible among South Asians if functionality of the tablet selected is improved. The Colon Cancer Screening Behaviours Survey was finalized and retained items in sub-scales demonstrated good psychometric properties to assess behaviours for colon cancer screening among South Asians in Canada. The interviewer-led survey may be used by public health, cancer care or other health practitioners to describe or predict colorectal cancer screening behaviours among South Asians in similar settings or adapted and tested in other contexts.

Self-Efficacy is needed to form self-care to prevent complications from type 2 diabetes mellitus. The purpose of the study was to assess the relationship between self-efficacy and self-care in type 2 diabetes mellitus patients. A descriptive correlation was used in this study. The Diabetes Management Self Efficacy Scale (DMSES) was used to measure self-efficacy and the Summary of Diabetes Self-Care Activities Measure (SDSCA) to measure self-care survey instrument were distributed to type 2 diabetes mellitus patient in one of internist outpatient Bukittinggi (N=81) form October 2018-August 2019. The results showed that mean self-efficacy of respondents was 88.65 and the self-care was 3.2. Statistical significance corelation was found between self-eficacy and self-care (r=0.713; p=0.001). The study adds knowledge regarding health education. Further study is needed to explore other factors related to self-efficacy and self-care of type 2 diabetes mellitus to prevent complication.

Background/Aims There are conflicting opinions regarding the management of recurrent acute pancreatitis (RAP). While some physicians recommend endoscopic retrograde cholangiopancreatography (ERCP) in this setting, others consider it to be contraindicated in patients with RAP. The aim of this study was to assess the practice patterns and clinical features influencing the management of RAP in the US. Methods An anonymous 35-question survey instrument was developed and refined through multiple iterations, and its use was approved by our Institutional Review Board. The survey was distributed via email to 408 gastroenterologists to assess the practice patterns in the management of RAP in multiple clinical scenarios. Results The survey was completed by 65 participants representing 36 of the top academic/tertiary care centers across the country. Approximately 90.8% of the participants indicated that they might offer or recommend ERCP in the management of RAP. Multinomial logistic regression analysis revealed that ductal dilatation and presence of symptoms were the most predictive variables (p

Background: Tobacco use is one of the leading causes of premature death and preventable illness. Tobacco cessation counseling (TCC) is one of the ways to prevent the rising mortality. Dentists hold an important role in TCC. Aim: The aim of this study was to assess the attitudes, practices, and perceived barriers in TCC among dental practitioners in Goa, India. Materials and Methods: A cross-sectional questionnaire study was conducted among 150 dentists in Goa. The survey instrument included a close-ended self-administered 27-item questionnaire, assessing demographics, attitudes toward TCC, practices in TCC, and perceived barriers in performing TCC. The data were evaluated using SPSS version 22.0. Chi-square/Fisher's exact test, Pearson's correlation, and unconditional logistic regression were used keeping P value at 5%. Results: The mean age of the study participants was 30.91 ± 5.28 years (24–42 years) and 111 (74.0%) were female. Seventy-three percent of the dentists agreed that TCC is their responsibility. Very few (18.0%) dentists provide tobacco cessation pamphlets and posters in waiting room. The most common barrier (70.0%) was “patient disinterest” in receiving advice. The respondents who have used tobacco were more likely (odds ratio [OR] =2.02, 1.49–2.46) to have positive attitude toward TCC than those who never used tobacco. Older respondents (OR = 2.10, 2.05–2.80) and those having more years of experience (OR = 3.10, 2.86–3.54) were more likely to practice TCC. Conclusion: This study shows that very few dentists were current smokers in Goa. They showed a constructive attitude toward TCC, especially those who were older than 29 years and never used tobacco. Dentists who were positive for TCC were practicing TCC better.

OBJECTIVES: Outpatient screening for social determinants of health (SDH) improves patient access to resources. However, no studies have examined if and how inpatient pediatric providers perform SDH screening. We aimed to identify inpatient pediatric provider screening practices for SDH, barriers to screening, and the acceptability of screening for hospitalized patients. METHODS: We conducted a multicenter descriptive study at 4 children’s hospitals surveying inpatient hospitalists and nurses on the general wards about their SDH screening practices. A survey instrument was developed on the basis of literature pertaining to SDH, content expert review, cognitive interviews, and survey piloting. Descriptive statistics and logistic regression analyses are reported. RESULTS: Results from 146 hospitalists and 227 nurses were analyzed (58% and 26% response rate, respectively). Twenty-nine percent of hospitalists and 41% of nurses reported screening for ≥1 SDH frequently or with every hospitalized patient. Only 26% of hospitalists reported consistently communicating SDH needs with primary care providers. Most respondents (97% of hospitalists and 65% of nurses) reported they do not use a specific screening tool, and only 34% of hospitalists and 32% of nurses reported feeling competent screening for SDH. Lack of time, resources, and a standardized inpatient screening tool were reported as barriers to screening. CONCLUSIONS: Hospitalization provides an opportunity for SDH screening and connecting patients to resources; however, a minority of pediatric providers currently report screening. Professional development activities training inpatient providers in SDH screening, using a screening instrument, and communicating identified needs to primary care providers may improve the effectiveness of SDH screening in the hospital.

Contains fulltext : 248212.pdf (Publisher’s version ) (Open Access) OBJECTIVE: There is no international consensus on what type of guideline is preferred for care at the limit of viability. We aimed to conceptualize what type of guideline is preferred by Dutch healthcare professionals: 1) none; 2) gestational-age-based; 3) gestational-age-based-plus; or 4) prognosis-based via a survey instrument. Additional questions were asked to explore the grey zone and attitudes towards treatment variation. FINDING: 769 surveys were received. Most of the respondents (72.8%) preferred a gestational-age-based-plus guideline. Around 50% preferred 24(+0/7) weeks gestational age as the lower limit of the grey zone, whereas 26(+0/7) weeks was the most preferred upper limit. Professionals considered treatment variation acceptable when it is based upon parental values, but unacceptable when it is based upon the hospital's policy or the physician's opinion. CONCLUSION: In contrast to the current Dutch guideline, our results suggest that there is a preference to take into account individual factors besides gestational age.

Background The coronavirus disease 2019 (COVID‐19) pandemic has created unprecedented challenges for solid organ transplant programs worldwide. The aim of this study is to assess an international perspective on challenges faced by kidney transplant programs. Methods We administered an electronic survey instrument from 03/01/2021 to 08/06/2021 to staff at transplant programs outside the United States that comprised of 10 questions addressing the management of kidney transplant candidates with asymptomatic COVID‐19 infection or unvaccinated who receive an organ offer. Results Respondents (n = 62) represented 19 countries on 5 continents. Overall, 90.3% of respondents encourage vaccination on the waiting list and prior to planned living donor transplant. 12% of respondents reported that they have decided to inactivate unsensitized candidates (cPRA

Patients often do not disclose domestic violence (DV) to healthcare providers in emergency departments and other healthcare settings. Barriers to disclosure may include fears and misconceptions about whether, and under what circumstances, healthcare providers report DV to law enforcement and immigration authorities. We sought to assess undocumented Latino immigrants (UDLI), Latino legal residents/citizens (LLRC) and non-Latino legal residents/citizens (NLRC) beliefs about disclosure of DV victimization to healthcare providers and healthcare provider reporting of DV to law enforcement and immigration authorities. From 10/2018-2/2020, we conducted this survey study at two urban emergency departments (EDs) in California. Participants, enrolled by convenience sampling, responded to survey questions adapted from a previously published survey instrument that was developed to assess undocumented immigrant fears of accessing ED care. Our primary outcomes were the proportions of UDLI, LLRC and NLRC who knew of someone who had experienced DV in the past year, whether these DV victims were afraid to access ED care, reasons DV victims were afraid to access ED care, and rates of misconceptions (defined according to current California law) about the consequences of disclosing DV to healthcare providers. Of 667 patients approached, 531 (80%) agreed to participate: 32% UDLI, 33% LLRC, and 35% NLRC. Of the 27.5% of respondents who knew someone who experienced DV in the past year, 46% stated that the DV victim was afraid to seek ED care; there was no significant difference in this rate between groups. The most common fears reported as barriers to disclosure were fear the doctor would report DV to police (31%) and fear that the person perpetrating DV would find out about the disclosure (30.3%). Contrary to our hypothesis, UDLI had lower rates of misconceptions about healthcare provider and law enforcement responses to DV disclosure than LLRC and NLRC. Fear of disclosing DV and misconceptions about the consequences of disclosure of DV to healthcare providers were common, indicating a need for provider, patient, and community education and changes that lower barriers to help-seeking.

PURPOSE: The purpose of this study was to develop the Oncology Opportunity Cost Assessment Tool (OOCAT), a survey instrument to evaluate the opportunity costs patients experience when seeking medical oncology care. METHODS: Development of the OOCAT involved extensive patient engagement through both focus groups and interviews. First, the study team developed a list of opportunity cost concepts, which included patients' logistical and financial considerations related to seeking care. We conducted focus groups with patients to expand upon this list of concepts, and then developed a set of questions that incorporated all the concepts generated during the focus groups. To refine these questions, we next performed cognitive interviews with another set of patients to ensure content validity and clarity of instrument items, refining the OOCAT iteratively on the basis of feedback. RESULTS: We engaged 23 participants (17 patients and six caregivers) across four focus groups and 17 participants in cognitive interviews. Focus group participants generated 112 concepts, which resulted in an initial OOCAT with 16 questions. Cognitive interviews resulted in modification of 12 questions and addition of two questions (related to coordination of transportation and impact on home responsibilities). The final OOCAT consisted of 18 items examining time requirements for appointments, financial implications of traveling to appointments for the patient and the caregiver, and logistical and quality-of-life challenges associated with traveling for appointments. CONCLUSION: We developed the OOCAT, an instrument designed to evaluate patient-level opportunity costs of seeking medical oncology care. Further studies to validate the OOCAT are underway.

Equine assisted activities and therapy (EAAT) is a popular therapy option for physical, psychological, and cognitive disorders. A critical component of this treatment option is the horse, and while research has reported the benefits for human participants, there is a lack of knowledge concerning the therapy horse due to limited research documenting the impact of these activities. Nevertheless, those that manage these animals understand the demanding activities placed on the therapy horse, and thus, can play a vital role in educating those new to the industry. Therefore, the objective of this study was to utilize a survey instrument to document management activities associated with pain for the therapy horse. An 11 forced-choice question survey was developed and sent out to 97 EAAT programs within the U.S. Participation was available online for a total of four months. Response rate was 31% (n = 30). From the respondents, 50% answered +46 yrs old for age, 70% answered +15 yrs equine experience, and 60% answered +11 yrs working in EAAT. The most popular answer for number of horses in the respondents’ EAAT program was >11 horses (53%), and as to the horses in the program, 50% answered they had >7 geriatric horses. The majority of the respondents answered “definitely yes” to having functionally lame horses used regularly in their programs (53%) and having experience with pain management practices associated with orthopedic (50%) and gastrointestinal (67%) conditions. The majority of the programs used vital sign measurements (67%), facial expressions (73%), and behavioral changes (87%) to detect equine pain. In conclusion, EAAT horses appear to commonly need healthcare practices for pain management suggesting further research is needed in precision medicine and animal welfare. In addition, educational programs covering pain management practices for individuals going into the EAAT industry would assist in ensuring the welfare of these animals.

Background: Vision-related problems have a negative impact on the learning abilities and school performance of a child. Adequate knowledge and practices of teachers enable the early identification and intervention of school children with visual deficits. Aim: This study aimed to investigate the knowledge and practices of teachers about child eye healthcare in the public education system in Swaziland. Setting: The setting for this study was Swaziland. Methods: This was a cross-sectional quantitative study using a survey instrument containing closed-ended questions to investigate the knowledge and practices of teachers about child eye health in the public sector. Results: Two hundred and forty-three ( N = 243) teachers responded to the questionnaire. The majority (90.1%) of teachers indicated that they were able to detect signs and symptoms of eye diseases. Most teachers without a family member wearing spectacles were more likely to be informed about eye health ( p = 0.001) than those who had family wearing spectacles. A significant proportion (44%) of teachers indicated that refractive errors were not serious among school children. Above one-third (38.7%) of the teachers indicated that they referred children with vision problems to public hospitals. One hundred and fifty-five (63.8%) reported that health officials have never visited their schools. One hundred and forty-nine (61.3%) teachers agreed that they did not monitor children wearing spectacles and 94 (38.7%) monitored them. Monitoring children wearing spectacles was significantly associated with teachers who indicated being well informed about eye health ( p < 0.001) and teachers who were more likely to advise parents to take their children for eye testing ( p = 0.003). Conclusion: The lack of adequate knowledge by some teachers may contribute to the already existing barriers for children to access eye health. Addressing the broader issues of child eye health requires the participation of well-trained and knowledgeable teachers.

ObjectivesResponse rates to physician surveys are typically low. The objective of this study was to determine the effect of a prenotification letter on the response rate of a postal survey of emergency physicians.DesignThis was a substudy of a national, cross-sectional postal survey sent to emergency physicians in Canada. We randomised participants to either receive a postal prenotification letter prior to the survey, or to no prenotification letter.ParticipantsA random sample of 500 emergency physicians in Canada. Participants were selected from the Canadian Medical Directory, a national medical directory which lists more than 99% of practising physicians in Canada.InterventionsUsing computer-generated randomisation, physicians were randomised in a concealed fashion to receive a prenotification letter approximately 1 week prior to the survey, or to not receive a prenotification letter. All physicians received an unconditional incentive of a $3 coffee card with the survey instrument. In both groups, non-respondents were sent reminder surveys approximately every 14 days and a special contact using Xpresspost during the final contact attempt.OutcomeThe primary outcome was the survey response rate.Results201 of 447 eligible physicians returned the survey (45.0%). Of 231 eligible physicians contacted in the prenotification group, 80 (34.6%) returned the survey and among 237 eligible physicians contacted in the no-prenotification group, 121 (51.1%) returned the survey (absolute difference in proportions 16.5%, 95% CI 2.5 to 30.5, p=0.01).ConclusionInclusion of a prenotification letter resulted in a lower response rate in this postal survey of emergency physicians. Given the added costs, time and effort required to send a prenotification letter, this study suggests that it may be more effective to omit the prenotification letter in physician postal surveys.

OBJECTIVE The surveillance and treatment of abdominal aortic aneurysms (AAAs) may impact patient quality of life (QOL). A novel AAA specific QOL instrument was developed and validated to quantify the impact of AAA surveillance on QOL. METHODS The study was performed in two phases: development (2011-2013) and validation (2013-2014) of a survey instrument. Content was informed by focus groups at three centres (22 patients) and two multidisciplinary physician focus groups (6 vascular surgeons, 7 primary care providers). Cognitive interviews (17 patients) ensured questions were understood as intended. The final survey was mailed to AAA patients at six US institutions. Patients were scored on two AAA specific domains of QOL: emotional impact (EIS) and behavioural change (BCS), range 0-100 with higher scores indicating worse quality of life. Test retest reliability and internal consistency were assessed. Discriminant validity was determined by comparing scores between patients under surveillance vs. those who had undergone AAA repair. Scores were externally validated by correlation with the Short Form (SF)-12. RESULTS A total of 1,008 (73%) of 1,373 patients returned surveys: 351 (35%) were under surveillance, 657 (65%) had undergone repair (endovascular, 414; open, 179; unsure, 64). Median EIS was 11 (range 0-95; IQR 7-26). Median BCS was 13 (range 0-100; IQR 9-47). To test reliability, 337 patients repeated the survey after four weeks with no significant differences between scores over time. EIS and BCS demonstrated good internal consistency (Cronbach's Alpha 0.85 and 0.75 respectively). There was strong correlation between scores (r = 0.53) and both related moderately to SF-12 scores (r = 0.45 and r = 0.39, respectively). Patients under AAA surveillance had worse EIS than repair patients (22 vs. 13; p

Our objectives were to identify barriers to the organ donation registration process in Ontario; and to determine the acceptability of using the emergency department (ED) waiting room to provide knowledge and offer opportunities for organ and tissue donor registration.We conducted a paper based in-person survey over nine days in March and April 2017. The survey instrument was created in English using existing literature and expert opinion, pilot tested and then translated into French. Data was collected from patients and visitors in an urban academic Canadian tertiary care ED waiting room. All adults in the waiting room were approached to participate during study periods. We excluded patients who were too ill and required immediate treatment.The number of attempted surveys was 324; 67 individuals (20.7%) declined participation. A total of 257 surveys were distributed and five were returned blank. This gave us a response rate of 77.8% with 252 completed surveys. The median age group was 51-60 years old with 55.9% female. Forty-six percent reported their religion as Christian and 34.1% did not declare a religious affiliation. 44.1% were already registered donors. Most participants agreed or were neutral that the ED waiting room was an acceptable place to provide information on donation, and for registration as an organ and tissue donor (83.3% and 82.1%, respectively).Individuals waiting in the ED are generally supportive of using the waiting room for distributing information regarding organ and tissue donation, and to allow donor registration.L’étude avait pour objectifs : 1) de relever les obstacles au processus d'inscription du don d'organes en Ontario; 2) de déterminer l'acceptabilité sociale de l'utilisation de la salle d'attente du service des urgences (SU) comme lieu de diffusion de l'information sur les dons de matériel biologique, et d'inscription de donneurs d'organes et de tissus.Une enquête a été menée en personne, au moyen d'un questionnaire sur papier, durant 9 jours, en mars et en avril 2017. L'instrument d'enquête a d'abord été élaboré en anglais à l'aide de la documentation existante et de l'avis d'experts, puis soumis à un essai pilote avant d’être traduit en français. La collecte de données s'est faite parmi les patients et les personnes qui les accompagnaient dans une salle d'attente d'un SU d'enseignement, de soins tertiaires, situé en milieu urbain, au Canada. Tous les adultes présents dans la salle d'attente ont été invités à participer à l’étude durant la période en question. Ont été exclus les patients qui étaient trop malades ou dont l’état nécessitait des soins immédiats.Il y a eu 324 demandes d'enquête et 67 personnes (20,7%) ont refusé de participer. Sur un total de 257 questionnaires remis, 5 ont été rendus vierges, ce qui a porté à 77,8% (252 questionnaires remplis) le taux de réponse. L’âge médian était de 51–60 ans, et 55,9% des répondants étaient des femmes. Quarante-six pour cent des participants se sont déclarés chrétiens et 34,1% n'ont rien indiqué quant à leur appartenance religieuse; par ailleurs, 44,1% étaient déjà des donneurs inscrits. La plupart des répondants se sont montrés favorables ou neutres à l’égard de l'utilisation de la salle d'attente du SU comme lieu de diffusion de l'information sur les dons de matériel biologique, ou d'inscription de donneurs d'organes et de tissus (83,3% et 82,1%, respectivement).Dans l'ensemble, les personnes interrogées au SU se sont montrées favorables à l'utilisation de la salle d'attente comme lieu de diffusion de l'information sur les dons d'organes et de tissus, et d'inscription de donneurs.

Residency training in podiatric medicine and surgery includes 3years of comprehensive training. Complementing their podiatric medicine and surgery training, residents complete a series of required nonpodiatric, or off-service, rotations in a range of specialties. However, there has been a lack of formal investigation of these off-service rotation experiences. An online survey was developed and distributed to both program directors and residents nationwide. The survey instrument covered various aspects of off-service rotations, including rotation value, length, goals and objectives, activities, feedback, and resident satisfaction. In total, 122 of 222 directors responded and 151 of 243 residents responded. Resident responses reflected the impact of podiatric responsibilities during off-service rotations and the importance of hands-on, interactive, and dedicated learning opportunities during these rotations. Both similarities and differences were appreciated with regard to perceived rotation value between resident and director perspectives. Perceived satisfaction of certain rotations was correlated with rotation length, feedback, specific rotation activities, and whether residents received goals and objectives. Though perhaps neglected, the off-service rotation experience is an important part of the podiatric medical and surgical residency experience. Considering the perspectives of both directors and residents can be helpful in directing these experiences and in considering future changes.

OBJECTIVES Evaluate clinicians' sentiments about participating in cardiac arrest resuscitations and identify factors associated with confidence in resuscitation of cardiac arrest. DESIGN Electronic survey. SETTING Twenty-one hospitals in Utah and Idaho. SUBJECTS All attending physicians, residents, and nurses in a multilevel healthcare system likely to participate in an in-hospital cardiac arrest resuscitation at least once every 2 years. INTERVENTIONS None. MEASUREMENTS AND METHODS A survey instrument evaluating clinician perceptions of in-hospital cardiac arrest resuscitation participation was developed after literature review and iteratively revised based on expert input and cognitive pretesting. Survey responses were collected anonymously. Sixty percent of 1,642 contacted clinicians (n = 977) submitted complete responses, of whom 874 met study inclusion criteria (190 attending physicians, 576 nurses, and 110 residents). Most respondents (74%) participated in less than or equal to six in-hospital cardiac arrest events per year, and 41% of respondents were most likely to participate in in-hospital cardiac arrest resuscitation at a community, rural, or critical access hospital. Confidence in in-hospital cardiac arrest participation was high overall (92%), but lower among residents (86%) than nurses (91%) or attending physicians (96%; p = 0.008). Fewer residents (52%) than nurses (73%) or attending physicians (95%; p < 0.001) reported feeling confident leading in-hospital cardiac arrest teams. Residents (63%) and attending physicians (36%) were more likely to worry about making errors during an in-hospital cardiac arrest event than nurses (18%; p < 0.001). Only 15% of residents and 50% of respondents overall reported they were both confident participating in in-hospital cardiac arrest resuscitation and did not worry about making errors. In-hospital cardiac arrest participation frequency was the dominant predictor of respondents' confidence leading or participating in an in-hospital cardiac arrest resuscitation. CONCLUSIONS Many clinicians, especially residents, who participate in or lead in-hospital cardiac arrest resuscitation events lack confidence or worry about management errors. Hospitals-particularly smaller hospitals-should consider methods to provide in-hospital cardiac arrest teams additional "effective experience," potentially using simulation or telemedicine consultation.

Purpose: The purpose of this study was to determine the opinions and reported nutrition practices of Canadian Registered Dietitians (RDs) with regard to feeding patients with severe sepsis. Methods: In 2017, surveys were sent to 112 eligible Canadian RDs in 10 provinces who were practicing in an intensive care environment. The survey included embedded branching logic questions developed to address major facets of sepsis, critical illness, and nutrition. The survey instrument assimilated all data in an anonymous manner, so respondents could not be linked to their answers. Results: Of the 64 RDs who responded (57% response rate), the majority practiced in adult intensive care (81%), within an academic center (59%), and in a mixed unit (73%). A wide variability of Canadian RDs’ opinions and practice was reported in determining energy requirements, enteral nutrition (EN) practice, EN with vasoactive agents, parenteral nutrition (PN), and supplemental micronutrients. Conclusions: Practice variability of Canadian RDs likely reflects gaps in both evidence and guidelines for severe sepsis. Further research efforts are needed to customize nutritional requirements in the patient with evolving sepsis, EN with patients at high risk for gastrointestinal dysfunction, optimizing PN, and the role of micronutrients.

Background Community pharmacists play a significant role in depression care. Depression is a health priority in national health strategies around the world, including in Qatar. Objective To describe current practices, attitudes and perceived barriers of community pharmacists towards depression care, and to investigate factors associated with these practices. Setting Community pharmacies in Qatar. Method A cross-sectional online survey using an adapted survey instrument. Scores were measured on a five-point Likert scale. Descriptive univariate and bivariate analyses of study outcomes, followed by multivariate regression examining the association between pharmacists’ practices and their attitudes, socio-demographic and professional characteristics. Main outcome measure Pharmacists’ scores on self-reported attitudes towards depression and depression care practices and the number of perceived barriers for depression care. Result: 358 pharmacists (response rate 39%) completed the questionnaire. Pharmacists’ attitudes to depression were moderately positive (mean score = 3.41, SD = 0.26) but involvement in depression care was very low (mean score = 2.64, SD = 0.94). Three major barriers were lack of access to patients’ medical records (83.21%), lack of patients’ insight on depression and the importance of treatment (81.85%), and lack of knowledge and training on mental health (79.63%). Female pharmacists and those graduated more than 10 years prior were significantly less involved in depression care compared to their counterparts (practice scores (95% CI) −4.36 (−7.46 to −1.26) and -7.51 (−15.10 to −1.35), respectively), while those who had access to private counselling area were more involved (practice score 3.39 (0.20 to 6.59). Pharmacists’ depression practice score was positively associated with attitudes (p = 0.001). Conclusion Pharmacists’ moderately positive attitudes were not reflected in their suboptimal depression-care practices. Action from policymakers is needed to improve pharmacists’ practices and attitudes to depression. This study was partially funded by a Qatar University Post-Graduate Student Grant (QUST-2-CHS-2019-15).

Immuno-oncology is a complex treatment paradigm for many malignancies. As a result, nurses need to increase their knowledge awareness regarding safe, evidence-based care of patients who receive oncologic immunotherapy with their treatment regimen. This pilot study looks at nurse confidence levels specific to the challenges associated with this complex treatment. The Oncology Nurse Immunotherapy Confidence Survey, developed for this project, allowed for 28 confidence measurements, demographic collection, and a brief quasi-thematic analysis. The pre- and posteducation confidence scores demonstrated a 51% overall improvement.

Fluid overload (FO) and acute kidney injury (AKI) occur commonly in children supported with extracorporeal membrane oxygenation (ECMO). Continuous renal replacement therapy (CRRT) may be used to manage AKI and FO in children on ECMO. In 2012, our group surveyed ECMO centers to begin to understand the practice patterns around CRRT and ECMO. Since then, more centers are initiating ECMO for increasingly diverse indications and an increased volume of research quantifies the detrimental impacts of AKI and FO. We, therefore, investigated practice patterns of CRRT utilization during ECMO in children. A multi-point survey instrument was distributed to 116 international neonatal and pediatric ECMO centers. Sixty of 116 (51.7%) international neonatal and pediatric ECMO centers responded. All reports using CRRT on ECMO, compared with 75% from the 2012 survey. Eighty-five percent use CRRT to treat or prevent FO, an increased from 59%. The modality of CRRT therapy differed between in-line (slow continuous ultrafiltration, 84.4%) and machine-based (continuous venovenous hemodiafiltration, 87.3%) methods. Most (65%) do not have protocols for fluid management, AKI, or CRRT on ECMO. Trialing off CRRT is dictated by physician preference in 90% (54/60), with varying definitions of success. In this survey study, we found that CRRT use during pediatric ECMO has increased since 2012 with fluid management representing the predominant indication for initiation. Despite the expanded utilization of CRRT with ECMO, there remains significant practice variation in terms of method, modality, indication, the timing of initiation, fluid management, and discontinuation.

Background The growing burden of Parkinson's disease (PD) in Africa necessitates the identification of available therapies and services to improve patient care. Objective To investigate the availability, affordability, frequency of usage, and insurance coverage of PD therapies (pharmacological, surgical, physical, and speech therapies) and services including specialized clinics, specialists, and nurses across Africa. Methods A comprehensive web-based survey was constructed and distributed to neurologists/physicians with a special interest in PD across Africa. The survey instrument includes components that address availability, affordability, frequency of use, and insurance coverage of different therapies and services. Results Responses were received from 28 (of 43 contacted) countries. Levodopa-based oral preparations were always available in 13 countries (46.4%) with variable affordability and "partial or no" insurance coverage in 60% of countries. Bromocriptine was the most available (50%) and affordable ergot dopamine agonists (DA), whereas non-ergot DA was always available in only six countries (21.4%). Trihexyphenidyl was the most available and affordable anticholinergic drug (46.4%). Tricyclic antidepressants and selective serotonin reuptake inhibitors were available in most countries (89.3% and 85.7% respectively), with variable affordability. Quetiapine and clozapine were less available. Specialized clinics and nurses were available in 25% and 7.1% of countries surveyed, respectively. Other services were largely unavailable in the countries surveyed. Conclusion PD-specific therapies and services are largely unavailable and unaffordable in most African countries. The data provide a platform for organizing strategies to initiate or scale up existing services and drive policies aimed at improving access to care and tailoring education programs in Africa. © 2021 International Parkinson and Movement Disorder Society.

A study assessing the expectations patients and loved ones have of hospital chaplains was conducted at Ascension St. Vincent Indiana hospitals. In-person interviews were conducted with 452 patients and loved ones during an inpatient stay. The survey instrument was a modified version of a survey developed by Dr. Katherine Piderman of the Mayo Clinic. Participants answered questions regarding demographics, awareness of availability, expectations of visits, reasons for wanting to see a chaplain and gave feedback regarding visits if they had seen a chaplain. Results showed that patients and loved ones value chaplains with 93% saying they wanted a chaplain visit. This study was unique in seeking feedback from loved ones as well as patients. It may be equally important to reach out to loved ones during times of crisis when patients themselves are in surgery or sedated and loved ones are experiencing heightened anxiety.

Objective The aim of the study is to investigate the effects of pre-dialysis blood pressure targets on health-related quality of life and prognosis and to determine the optimal target for pre-dialysis blood pressure in haemodialysis patients. Methods A total of 58 haemodialysis patients undergoing dialysis for more than 3 months were enrolled in the study from 1 January 2018 to 31 December 2018. The subjects were divided into two groups according to their pre-dialysis blood pressure: a standard target group (pre-dialysis systolic blood pressure of 110-140 mm Hg) and a relaxed target group (pre-dialysis systolic blood pressure of 155-165 mm Hg). The Quality Metrics SF-36 survey instrument was used to assess health-related quality of life in the study participants. In addition, general clinical data and biochemical indicators including heart rate, respiration rate, blood pressure and ultrafiltration volume and rate during dialysis were observed and recorded. Patients were followed-up for 12 months, and prognostic data were recorded. Death was regarded as the endpoint. Results Scores on the SF-36 in the standard target group were significantly higher than those in the relaxed target group, with the exception of the role-emotional (RE) and mental health (MH) dimensions. At the end of the study, the number of mortality events in the relaxed target group was higher than in the standard target group. There were no other significant differences between the two groups. Conclusion The scores from the health-related quality of life survey were higher in standard target group, but no differences in mortality risk between the two groups were observed.

Objectives Physicians in training may be particularly vulnerable to the negative effects of discrimination and inappropriate behaviors by patients. We sought to determine the frequency of inappropriate behaviors by patients toward Internal Medicine (IM) residents, residents' confidence to manage the behaviors, and differences among demographic characteristics, including race, sex, and level of clinical experience. Methods We developed a curricular session to equip IM residents and faculty to respond to discrimination or inappropriate behaviors by patients. Before the session, we surveyed residents about their experiences with macroaggressions, microaggressions, and other inappropriate behaviors using a 16-question survey instrument. We used descriptive statistics to summarize the participants' characteristics and the χ2 or Fisher exact test for comparison between groups. Results Eighty-two percent (27 of 33) of residents who attended the workshop completed the survey. We found that the majority of residents experienced patient macro- and microaggressions. More than 50% had a personal experience or witnessed experience with a macroaggression related to race (56%) or gender (59%). Seventy percent of residents personally experienced a microaggression by a patient. Women and residents of color are more likely to experience these types of encounters, which become more common in residents with higher postgraduate year level. Confidence in how to appropriately respond to such encounters is low. Conclusions Our study highlights that macro- and microaggressions by patients toward IM residents are common. Curricula are needed to equip trainees with tools to appropriately respond during such encounters.

Background In 2018, the World Health Assembly mandated Member States to take action on rheumatic heart disease (RHD), which persists in countries with weak health systems. We conducted an assessment of the current state of RHD-related healthcare in Uganda. Methodology/Principal findings This was a mixed-methods, deductive simultaneous design study conducted in four districts of Uganda. Using census sampling, we surveyed health facilities in each district using an RHD survey instrument that was modeled after the WHO SARA tool. We interviewed health workers with experience managing RHD, purposively sampling to ensure a range of qualification and geographic variation. Our final sample included 402 facilities and 36 health workers. We found major gaps in knowledge of clinical guidelines and availability of diagnostic tests. Antibiotics used in RHD prevention were widely available, but cardiovascular medications were scarce. Higher levels of service readiness were found among facilities in the western region (Mbarara district) and private facilities. Level III health centers were the most prepared for delivering secondary prevention. Health worker interviews revealed that limited awareness of RHD at the district level, lack of diagnostic tests and case management registries, and absence of clearly articulated RHD policies and budget prioritization were the main barriers to providing RHD-related healthcare. Conclusions/Significance Uganda’s readiness to implement the World Health Assembly RHD Resolution is low. The forthcoming national RHD strategy must focus on decentralizing RHD diagnosis and prevention to the district level, emphasizing specialized training of the primary healthcare workforce and strengthening supply chains of diagnostics and essential medicines., Author summary Rheumatic heart disease is a major cause of cardiovascular death and disability, especially in less-developed parts of Africa and Asia. Unfortunately, medications and surgical procedures to prevent or treat rheumatic heart disease and its precursor rheumatic fever are greatly under-used, even though they are very effective. This study conducted an assessment of health system gaps in delivery of RHD related care in Uganda. We used quantitative and qualitative methods to find out, firstly, what percentage of health facilities are currently providing rheumatic heart disease services and, secondly, what things need to be fixed in order to improve service availability. We found that only 1–2% of health facilities are currently fully equipped to provide rheumatic heart disease prevention and treatment. The two biggest problems are that frontline health workers know very little about the condition and that the tests used to diagnose rheumatic fever and rheumatic heart disease are not widely available in many districts. Our assessment can serve as a baseline in monitoring the implementation of future interventions in Uganda. We are making our methods and tools publicly available so that ministries of health in other countries can use them to develop or expand their rheumatic heart disease programs.

BackgroundMedical graduates from the universities of Oxford and Cambridge have a lower intention to become GPs compared with other UK medical graduates. It is not clear to what extent this difference is present on admission to medical school.AimTo compare the career intention and influencing factors of students on admission to different UK medical schools.Design & settingFirst year of a 6-year prospective cohort study of medical students admitted in autumn 2020 to the three East of England medical schools: University of East Anglia (UEA), University of Cambridge (UOC), and Anglia Ruskin University (ARU).MethodAn online survey instrument was administered at the beginning of the first year. This measured self-reported career interests and various influencing factors, including perceptions of general practice.ResultsUOC students declared a lower intention to become a doctor, a higher likelihood of choosing careers in pathology and public health, and a much lower likelihood of becoming a GP than students of UEA or ARU (all at PPConclusionUOC students’ lower intention to become a GP appears to be present on entry to medical school. This may be explained in part by these students placing a higher importance on research/academic opportunities, combined with the widely held perception that GP careers lack these opportunities.

Purpose: To determine the frequency of computer vision syndrome and its associated risk factors among under graduate medical students. Study Design: Descriptive Cross–sectional study. Place and Duration of Study: Gujranwala Medical College and Rawalpindi Medical University, Pakistan from 5th August to 28th August, 2020. Methods: A validated self-designed questionnaire was used for this study. The survey instrument was tailored from a published questionnaire which comprised of questions on demographics, frequency of symptoms of computer vision syndrome, pattern of computer usage and ergonomic practices. Results: Final analysis was run on 326 under graduate medical students. Females were 228 (69%) and 98 (30%) were males. Age of the participants ranged between 17 to 25 years. Overall frequency of CVS was found to be 98.7%. Twenty nine percent students experienced extra ocular complaints and 71% had ocular symptoms. Symptoms of CVS were more commonly observed among those using desktop/laptop at less than forearm length (p = 0.001). Distance of < 12 inches from mobile phone was found to be associated with eye irritation and neck shoulder pain (p = 0.001). Frequency of break of more than 60 minutes was found to be significantly associated with eye irritation (p = 0.002) and excessive blinking and light sensitivity (p = 0.001). The students not using ergonomically comfortable chair were found to suffer more with symptoms of CVS as compared to those using ergonomically designed chair (p = 0.049). Conclusion: Health issues related to excessive use of digital devices has become alarmingly high during COVID-19 pandemic. Symptoms of CVS are significantly associated with distance from digital device and less frequent break intervals. Key Words: COVID-19, Computer Vision Syndrome, Digital eye syndrome, ergonomics, visual display terminals.

This study explored the characteristics associated with the use of self-care products and practices by people rehabilitating from stroke. A cross-sectional sub-study of the Sax Institute's 45 and Up Study in which 1300 participants who had indicated a doctor had diagnosed them as having had a stroke were mailed a sub-study survey. The survey instrument included questionnaire items on demographics, self-care products and practices, health status and stroke status. The survey was completed by 576 (44.3%) of those eligible. At least one self-care product or practice was used by 39.9% of participants. Female participants were more likely than males to use self-care products (P ≤ .001) and self-care practices (P = .021). Self-care product use was higher amongst those with higher levels of fatigue (OR = 1.07) and/or those reporting slight (OR = 2.05) or moderate disability (OR = 2.28), compared with those who had no symptoms at all. As the burden of stroke survivorship increases because of improved acute stroke care in an ageing population, a stronger focus is needed by researchers, clinicians and policy makers on the self-care strategies used by stroke survivors and the ability for health professionals to appropriately support stroke survivors' in their rehabilitation and long-term management.

Despite the well-established relationship between volume and outcomes, patients continue to have procedures performed at low-volume hospitals. The factors patients use to make the complex decision of where to have hepatopancreaticobiliary (HPB) surgery remain poorly characterized. A novel survey instrument was administered to all patients who had undergone HPB surgery at two university-affiliated community hospitals. 76 patients participated in the study (89% response rate). The majority of patients were unaware of the volume-outcome relationship (58.8%). No demographic factors differed between patients who were or were not aware except for patient research. Physician factors were the most important selection category (64.4%). Only 28.9% of patients were willing to travel more than two hours to have an operation performed at a hospital with a high volume/improved quality. Despite many voices calling for regionalization, patient decision-making factors should be considered before any realistic implementation.

Female representation in surgery is increasing; however, many surgical specialties continue to observe disproportionately fewer females entering their residencies. This study assesses how medical students' gender-based perceptions of surgical careers are impacted by attending the Surgical Exploration and Discovery (SEAD) program, a 2-week, immersive procedural program that offers observerships, mentorship, and workshops across 8 surgical specialties.In this mixed-method prospective cohort study, medical students' awareness, beliefs, and experiences of gender bias in surgery were assessed using a 10-item Gender Bias in Medical Students Assessment-Surgery (GBMSA-S) psychometric survey instrument inspired by the validated Gender Bias in Medical Education Scale (Parker et al., 2016).Undergraduate Medical Education, Faculty of Medicine, at the University of Ottawa in Ottawa, Ontario, Canada.Eighteen first-year medical students in the experimental group (8 male, 10 female) and 18 in the control group (7 male, 11 female).Compared to the control group, SEAD participants had significant changes in agreement with the statements: "surgery is male-dominated," "medical studies are mainly done in males," "gender discrimination is more pronounced in surgery than other medical professions," "consideration of my gender is an important factor in whether or not to pursue surgery as a career," and "I have encountered gender-biased attitudes and/or behaviors among non-physician health care staff" (p0.05). Perceptions of gender bias were reduced post-SEAD. Subgroup analysis by gender suggested that the significance of these changing perspectives was due to female participants' responses. SEAD also produced an increase in the level of interest in surgery (p = 0.04). Receptive and authentic dialogue was identified as a critical step toward social inclusivity (n = 11).Early surgical exposure through SEAD produces a statistically significant increase in surgical interest and reduces certain perceptions of gender bias in surgery, particularly among female medical students.

Objectives: To present an overview of the survey and field procedures developed for the Saudi National Mental Health Survey (SNMHS). Methods: The SNMHS is a face-to-face community epidemiological survey of DSM-IV mental disorders in a nationally representative sample of the household population in the Kingdom of Saudi Arabia (KSA) (n = 4,004). The SNMHS was implemented as part of the WHO World Mental Health (WMH) Survey Initiative. WMH carries out coordinated psychiatric epidemiological surveys in countries throughout the world using standardized procedures designed to provide valid cross-national comparative data on prevalence and correlates of common mental disorders. However, these procedures need to be adapted to the unique experiences in each country. We focus here on the adaptations made for the SNMHS. Results: Modifications were needed to several interview sections and expansions were needed to address issues of special policy importance in KSA. Several special field implementation challenges also had to be addressed because of the need for female interviewers to travel with male escorts and for respondents to be interviewed by interviewers of the same gender. Conclusions: Thoughtful revisions led to a high-quality field implementation in the SNMHS.

International audience; IntroductionThis study aimed to develop and undertake a preliminary validation of a French Survey Questionnaire for the Determinants of HPV Vaccine Hesitancy (FSQD-HPVH).MethodsWe undertook an electronic-based Delphi consultation among a panel of Francophone experts in two rounds. Round 1 consisted of the assessment of a structured questionnaire comprising of three parts ((i) Contextual influences, (ii) Individual and group influences, and (iii) Vaccine/vaccination-specific issues), in line with the WHO Strategic Advisory Group of Experts (SAGE) Vaccine Hesitancy (VH) Model of Determinants. Items included in this questionnaire were based on a literature review. Definitions of the factors included in the SAGE model were provided in the questionnaire. The panel of experts was asked to score each item using a 3-point Likert scale, in which 1 meant “Essential”, 2 “Useful but not essential”, and 3 “Not necessary”. The panel was also invited to comment on the clarity/comprehension of the questions and suggest reformulations/additional items. Lawshe's Content Validity Ratio (CVR) was computed to assess the level of consensus for each statement. Only items upon which agreement was not reached in Round 1 (CVR < 0.6) and newly proposed items were submitted for evaluation in Round 2, using the same procedure.ResultsFifteen experts completed the two rounds. Of 83 items evaluated in Round 1, 35 (42%) had a CVR ≥ 0.6 and were accepted without modification. In Round 2, 66 items were submitted to the same panel and consensus was reached for 22 (33%) items using the threshold of 0.6. The final FSQD-HPVH version includes 57 items.ConclusionThis study developed a survey instrument for the evaluation of HPV VH in France with good content validity. It will be used to assess the determinants of HPV VH, the first step towards an evidence-based approach to improving HPV vaccination rates in France.