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This study examined caregiver impressions of an electronic consultation and referral (ECR) system. Participants included 56 caregivers of primary care patients referred through the ECR system. Semistructured interviews and surveys were conducted between August 2018 and April 2019. Transcripts were coded and themes developed using thematic content analysis. A total of 51% of caregivers stated that they would prefer to see their child's primary care provider (PCP) for a specialty issue if they could receive the same quality of care. All caregivers who received an electronic consult (n = 28) said that they would utilize that process again. Three themes emerged: (1) caregivers expect immediate action prior to or instead of a specialty referral; (2) caregiver preferences for PCP versus specialist are mediated by both child and provider characteristics; (3) caregiver attitudes toward the ECR system are influenced by external considerations and experiences with the system. Results suggest caregivers value enhanced communication and immediate access to specialty input facilitated by the ECR system.

The digitalization process for organizations, which was inevitably accelerated by the COVID-19 pandemic, raises relevant challenges for Human Resource Management (HRM) because every technological implementation has a certain impact on human beings. Between many organizational HRM practices, recruitment and assessment interviews represent a significant moment where a social interaction provides the context for evaluating candidates' skills. It is therefore relevant to investigate how different interaction frames and relational conditions affect such task, with a specific focus on the differences between face-to-face (FTF) and remote computer-mediated (RCM) interaction settings. In particular, the possibility of qualifying and quantifying the mechanisms shaping the efficiency of interaction in the recruiter-candidate dyad-i.e. interpersonal attunement-is potentially insightful. We here present a neuroscientific protocol aimed at elucidating the impact of FTF vs. RCM modalities on social dynamics within assessment interviews. Specifically, the hyperscanning approach, understood as the concurrent recording and integrated analysis of behavioural-physiological responses of interacting agents, will be used to evaluate recruiter-candidate dyads while they are involved in either FTF or RCM conditions. Specifically, the protocol has been designed to collect self-report, oculometric, autonomic (electrodermal activity, heart rate, heart rate variability), and neurophysiological (electroencephalography) metrics from both inter-agents to explore the perceived quality of the interaction, automatic visual-attentional patterns of inter-agents, as well as their cognitive workload and emotional engagement. The proposed protocol will provide a theoretical evidence-based framework to assess possible differences between FTF vs. RMC settings in complex social interactions, with a specific focus on job interviews., Competing Interests: The authors have declared that no competing interests exist.

Importance: An interview is considered the gold standard method of assessing global functional outcomes in clinical trials among patients with acute traumatic brain injury (TBI). However, several multicenter clinical trials have used questionnaires completed by a patient or caregiver to assess the primary end point., Objective: To examine agreement between interview and questionnaire formats for assessing TBI outcomes and to consider whether an interview has advantages., Design, Setting, and Participants: This cohort study used data from patients enrolled in the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) project from December 2014 to December 2017. Data were analyzed from December 2020 to April 2021. Included patients were aged 16 years or older with TBI and a clinical indication for computed tomography imaging. Outcome assessments were completed using both an interview and a questionnaire at follow-up 3 and 6 months after injury., Exposures: Traumatic brain injury of all severities., Main Outcomes and Measures: Ratings on the Glasgow Outcome Scale-Extended (GOSE) administered as a structured interview rated by an investigator and as a questionnaire completed by patients or caregivers and scored centrally were compared, and the strength of agreement was evaluated using weighted κ statistics. Secondary outcomes included comparison of different sections of the GOSE assessments and the association of GOSE ratings with baseline factors and patient-reported mental health, health-related quality of life, and TBI symptoms., Results: Among the 3691 eligible individuals in the CENTER-TBI study, both GOSE assessment formats (interview and questionnaire) were completed by 994 individuals (26.9%) at 3 months after TBI (654 [65.8%] male; median age, 53 years [IQR, 33-66 years]) and 628 (17.0%) at 6 months (409 [65.1%] male; median age, 51 years [IQR, 31-64 years]). Outcomes of the 2 assessment methods agreed well at both 3 months (weighted κ, 0.77; 95% CI, 0.73-0.80) and 6 months (weighted κ, 0.82; 95% CI, 0.78-0.86). Furthermore, item-level agreement between the 2 methods was good for sections regarding independence in everyday activities (κ, 0.70-0.79 across both time points) and moderate for sections regarding subjective aspects of functioning such as relationships and symptoms (κ, 0.41-0.51 across both time points). Compared with questionnaires, interviews recorded more problems with work (294 [30.5%] vs 233 [24.2%] at 3 months and 161 [26.8%] vs 136 [22.7%] at 6 months), fewer limitations in social and leisure activities (330 [33.8%] vs 431 [44.1%] at 3 months and 179 [29.7%] vs 219 [36.4%] at 6 months), and more symptoms (524 [53.6%] vs 324 [33.1%] at 3 months and 291 [48.4%] vs 179 [29.8%] at 6 months). Interviewers sometimes assigned an overall rating based on judgment rather than interview scoring rules, particularly for patients with potentially unfavorable TBI outcomes. However, for both formats, correlations with baseline factors (ρ, -0.13 to 0.42) and patient-reported outcomes (ρ, 0.29 to 0.65) were similar in strength., Conclusions and Relevance: In this cohort study, GOSE ratings obtained by questionnaire and interview methods were in good agreement. The similarity of associations of the ratings obtained by both GOSE methods with baseline factors and other TBI outcome measures suggests that despite some apparent differences, the core information collected by both interviews and questionnaires was similar. The findings support the use of questionnaires in studies in which this form of contact may offer substantial practical advantages compared with interviews.

Objective: To evaluate the experience and perceptions of reproductive endocrinology and infertility fellowship applicants and program directors (PDs) regarding the current and future use of web-based interviews (WBIs)., Design: Cross-sectional study., Setting: Nationwide cohort., Patient(s): Reproductive endocrinology and infertility fellowship applicants and PDs participating in the 2020 application cycle., Intervention(s): Anonymous survey sent to applicants and PDs., Main Outcome Measure(s): Descriptive study evaluating the experience and satisfaction of applicants and PDs with WBIs., Result(s): Forty-six percent of applicants and eligible PDs responded to our survey. Most applicants and PDs responded that WBIs were adequate for conveying a sense of a program's strengths, faculty, diversity, clinical training, and research opportunities, but less than half responded that WBIs were adequate in providing a sense of the program's clinical site and facilities. After WBIs, both applicants (73%) and PDs (86%) were able to rank with confidence. The cost of WBIs was significantly lower for both applicants (median: $100) and programs (median: $100) than the costs previously reported for in-person interviews. The applicants interviewed at more programs than they would have if the interviews were on-site, and Zoom was the highest rated platform used. Most applicants and PDs responded that WBIs were an adequate substitute, and that they should continue after the coronavirus disease 2019 pandemic. Furthermore, most of the PDs were planning to continue to use WBIs in some capacity., Conclusion(s): Both applicants and PDs had favorable experiences with and perceptions of WBIs, and most endorse the continued use of this interview modality. The findings of this study can help guide and optimize future WBI practices., (Copyright © 2021 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: Compassion is central to health care. Efforts to promote compassion through educational interventions for health professionals show promise, yet such education has not gained widespread dissemination. Adapting compassion education through technology-enhanced learning may provide an opportunity to enhance the scale and spread of compassion education. However, challenges are inherent in translating such curricula for online delivery. In this study, the authors explored how technology influences the delivery of compassion education for health professionals., Method: Using constructivist grounded theory methodology, the authors conducted semistructured interviews with 13 participants from across Ontario, Canada, from March to October 2019. The sample consisted of individuals who had experience with the design and evaluation of compassion education for health professionals. The interviews were coded and inductively analyzed to identify pertinent themes using constant comparative analysis. The study originated at the Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada., Results: Participants provided a range of responses regarding technology and compassion education. While participants revealed concerns about the constraints of technology on human interaction, they also described technology as both inevitable and necessary for the delivery of future compassionate care curricula. Participants also shared ways in which technology may enhance compassion education for health professionals by increasing accessibility and learner comfort with vulnerability. Addressing technological ambivalence, improving facilitation, and maintaining a balance between face-to-face instruction and technology-enhanced learning were identified as elements that could advance compassion education into the future., Conclusions: Compassion education can be enhanced by technology; however, evidence-informed adaptation may require deliberate efforts to maintain some level of face-to-face interaction to ensure that technology does not erode human connection. Further research is required to address the uncertainties surrounding technology and compassion education as identified by participants. These findings provide educators with guidance for adapting compassionate care curricula into a digital domain., (Copyright © 2021 by the Association of American Medical Colleges.)

Competing Interests: None declared.

Competing Interests: Conflicts of interest and sources of funding: none declared.

Background: As a result of the coronavirus disease 2019 pandemic, many Pediatric Surgery Fellowship programs were forced to convert their normal in-person interviews into virtual interviews. This study sought to determine the perceived value of virtual interviews for Pediatric Surgery Fellowship., Methods: An anonymous survey was distributed to the applicants and faculty at a university-affiliated, free-standing children's hospital with a Pediatric Surgery fellowship program that conducted one of three interview days using a virtual format., Results: All applicants who responded to the survey had at least one interview that was converted to a virtual interview. Faculty (75%) and applicants (87.5%) preferred in-person interviews over virtual interviews; most applicants (57%) did not feel they got to know the program as well with the virtual format. Applicants and faculty felt that virtual interviews could potentially be used as a screening tool in the future (7/10 Likert) but did not recommend they be used as a complete replacement for in-person interviews (3.5-5/10 Likert). Applicants were more likely than faculty to report that interview type influenced their final rank list (5 versus 3/10 Likert)., Conclusions: Faculty and applicants preferred in-person interviews and did not recommend that virtual interviews replace in-person interviews. As the coronavirus disease 2019 pandemic continues, more virtual interviews will be necessary, and innovations may be necessary to ensure an optimal interview process., Type of Study: Survey., Level of Evidence: N/A., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Tuberculosis (TB) control relies on early diagnosis and treatment. International guidelines recommend systematic TB screening at health facilities, but implementation is challenging. We investigated completion of recommended TB screening steps in Blantyre, Malawi., Methods: A prospective cohort recruited adult outpatients attending Bangwe primary clinic. Entry interviews were linked to exit interviews. The proportion of participants progressing through each step of the diagnostic pathway were estimated. Factors associated with request for sputum were investigated using multivariable logistic regression., Results: Of 5442 clinic attendances 2397 (44%) had exit interviews. In clinically indicated participants (n = 445) 256 (57.5%) were asked about cough, 36 (8.1%) were asked for sputum, 21 (4.7%) gave sputum and 1 (0.2%) received same-day results. Significant associations with request for sputum were: any TB symptom (aOR:3.20, 95%CI:2.02-5.06), increasing age (aOR:1.02, 95%CI:1.01-1.04 per year) and for HIV-negative participants only, a history of previous TB (aOR:3.37, 95%CI:1.45-7.81). Numbers requiring sputum tests (26/day) outnumbered diagnostic capacity (8-12/day)., Conclusions: Patients were lost at every stage of the TB care cascade, with same day sputum submission following all steps of the diagnosis cascade achieved in only 4.7% if clinically indicated. Infection control strategies should be implemented, with reporting on early steps of the TB care cascade formalised. High-throughput screening interventions, such as digital CXR, that can achieve same-day TB diagnosis are urgently needed to meet WHO End TB goals.

Family caregivers exhibit a wide variety of needs and concerns while providing care to stroke survivors after discharge to the home setting. We report the results of two related studies utilizing a multimethod design in which stroke family caregivers (N = 12; N = 10) were interviewed using open-ended questions, followed by written caregiver ratings regarding the types of telehealth technologies they preferred for the telephone assessment and skill-building kit (TASK III). Qualitative data were analyzed using content analysis procedures with a provisional "start list" of codes in a matrix template based on the types of telehealth technologies in the rating forms. Descriptive statistics were used to analyze ratings with response scales ranging from 1 = strongly disagree to 5 = strongly agree. Average ratings for the telehealth technologies for the TASK III resource guide were obtained for the mailed hard copy binder (M = 3.58-4.13; SD = 0.35-1.00), an interactive website (https://www.task3web.com/; M = 3.86-4.17; SD = .72-1.07), an eBook (M = 3.17-3.67; SD = 0.84-1.17), and a USB drive (M = 3.75-4.00; SD = .82-.96). Average ratings for the telehealth technologies for the TASK III calls with the nurse were obtained for the use of a telephone (M = 4.36-5.00; SD = 0.00-0.89), FaceTime on an iOS device (e.g., iPhone or iPad; M = 3.73-4.40; SD = 0.79-0.98), or online videoconferencing (M = 3.17-3.50; SD = 0.82-1.47). Qualitative data revealed a wide variety of preferences for each type of telehealth technology, with advantages and disadvantages of each. The findings underscored the importance of offering multiple telehealth technology options to stroke family caregivers. Future studies are recommended that employ randomized control trial methodology to test theoretically-based interventions that are based on stroke family caregiver preferences for telehealth technologies., (© 2020 Wiley Periodicals LLC.)

Background: Cognitive interviewing is a qualitative methodology for generating valid, reliable patient-centered outcome measures. There are challenges inherent in research on sensitive topics that require thoughtful approach by the scientist for data collection methods, analysis, and interpretation., Objective: The purpose of this article is to provide principles of cognitive interviewing for sensitive health topics., Methods: We review the challenges inherent in cognitive interviewing for sensitive topics scale development. We illustrate adaptations to general cognitive interviewing for sensitive topics through the presentation and analysis of a research exemplar., Results: Researchers must consider threats to quality of sensitive topic data collection and potential harms to participants and researchers. We provide specific examples of how these risks were mitigated in a sensitive topic scale development study., Discussion: Unique challenges of cognitive interviewing for sensitive health topics can be addressed with a well-planned data collection strategy, anticipating participant safety concerns, and consideration to researcher well-being., Competing Interests: The authors declare no conflicts of interest to report., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Coronavirus disease-19 (COVID-19) has forced upon all academic institutions to conduct virtual interviewing (VI) instead of face-to-face interviewing (FTFI) this interviewing cycle. The purpose of this systematic review was to understand the process of VI, its effectiveness as an alternative to FTFI, and the experiences of applicants and institutions with VI. We also share best practice strategies for applicants and institutions in VI preparation., Method: PubMed/MEDLINE, Cochrane Library of Systematic Reviews, Web of Science Core Collection, Scopus and CINAHL databases were searched through May 2020. Articles in English evaluating the effectiveness of VI were included, without applying any date limits. Two reviewers selected articles and extracted data., Results: Of the 934 articles screened, 22 articles underwent full-text article analysis to include 15 studies. There were 4 studies that reported the use of VI as a screening tool. 11 studies completely replaced FTFI with VI. Most applicants could appropriately convey themselves through VI. Most applicants and interviewing programs expressed reservations about VI's use as an alternative to FTFI., Conclusion: There is dearth of evidence supporting the efficacy of VI. There is an opportunity for potential research at multi-institutional level to gain better understanding of the efficacy of VI. The knowledge obtained from this systematic review has the potential of helping applicants and institutions in preparing for VI process. Additionally, authors propose supportive strategies to help prepare applicants and institutions for VI., Competing Interests: The authors have declared that no competing interests exist.

This study compared different methods for collecting data on falls among people with dementia to identify which is most feasible and accurate. Eighty-three dyads, comprised of a community-dwelling person with dementia and their informal carer, participated in the TAi ChI for people with demenTia (TACIT) trial. Falls were collected prospectively over 6 months using monthly calendars, weekly and monthly telephone interviews, and 3-monthly telephone interviews with the carer. Unique falls identified across the reporting methods were combined, and this total was compared against each reporting method in isolation and combinations. A higher frequency of falls indicated greater accuracy. Falls data collection was most feasible with weekly telephone interviews (84%), and most accurate with the combination of weekly telephone interviews with monthly calendars (96%). For the greatest completeness and accuracy of falls data with community-dwelling people with dementia, researchers should use both weekly telephone interviews and monthly calendars.

Objectives: Prevalence of SLE varies among studies, being influenced by study design, geographical area and ethnicity. Data about the prevalence of SLE in Spain are scarce. In the EPISER2016 study, promoted by the Spanish Society of Rheumatology, the prevalence estimate of SLE in the general adult population in Spain has been updated and its association with sociodemographic, anthropometric and lifestyle variables has been explored., Methods: Population-based multicentre cross-sectional study, with multistage stratified and cluster random sampling. Participants were contacted by telephone to carry out a questionnaire for the screening of SLE. Investigating rheumatologists evaluated positive results (review of medical records and/or telephone interview, with medical visit if needed) to confirm the diagnosis. To calculate the prevalence and its 95% CI, the sample design was taken into account and weighing was calculated considering age, sex and geographic origin. Multivariate logistic regression models were defined to analyse which sociodemographic, anthropometric and lifestyle variables included in the telephone questionnaire were associated with the presence of SLE., Results: 4916 subjects aged 20 years or over were included. 16.52% (812/4916) had a positive screening result for SLE. 12 cases of SLE were detected. The estimated prevalence was 0.21% (95% CI: 0.11, 0.40). SLE was more prevalent in the rural municipalities, with an odds ratio (OR) = 4.041 (95% CI: 1.216, 13.424)., Conclusion: The estimated prevalence of SLE in Spain is higher than that described in most international epidemiological studies, but lower than that observed in ethnic minorities in the United States or the United Kingdom., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Introduction: Residency applications via virtual-interview could potentially mitigate the extensive cost and time required for customary in-person interviews. We outline the perception of medical students and residents on the use of virtual-interview for residency applications in lieu of in-person interviews., Methods: We obtained 1824 responses from medical students and residents through an online questionnaire between March2019-Feb2020 in Texas-United States. The survey had 11 statements (five in favor of in-person interviews and 6 in favor of virtual interviews) that respondents could rank on a 5-point Likert scale. All statements' scores were summed based on the response given by each participant to create a total score between 11 and 55. The perception of the two groups was analyzed using an independent sample T-test and ANOVA., Results: We received a total of 1711 responses from medical students and 113 from medical residents. Respondents were more female (82.2% of medical students and 47.8% of residents), with a mean age of 22.87±3.42 years old for medical students and 28.72±4.35 years old for residents. Both groups preferred in-person interviews; however, the residents were significantly more in favor (P = 0.03). Both groups agree that virtual-interviews should be as an option, though this was considerably higher in the medical students (P = 0.001). In the multivariate analysis, "travel distance" and "type of medical school" had a significant impact on choosing the virtual-interviews in both groups (p<0.01)., Conclusions: In-person interviews are favored by both medical students and residents compared to virtual-interview services in normal circumstances. However, both groups agree that programs should offer the option of having virtual-interviews as an available choice. Distance to an interview location and the type of medical school were the factors that had a significant impact on perception of using virtual-interviews. Knowing about the applicants' attitude toward residency interviews and the national circumstances are essential when preparing the interview guides. Our findings are limited by the small sample size and the low response rate. Further extensive studies are warranted to better understand the perception of residency applicants toward virtual-interviews to improve the interview process in the United States., Competing Interests: The authors have declared that no competing interests exist.

Introduction: The multiple mini interview (MMI) has been incorporated into the holistic review process in the selection of students to US medical schools. The MMI has been used to evaluate interpersonal and intrapersonal attributes which are deemed as necessary for future physicians. We hypothesized that there would be little difference in overall MMI evaluation data compared with traditional interview ratings., Methods: The University of North Carolina School of Medicine developed an interview process that included a traditional interview and MMI format during the 2019 admissions cycle. Evaluation data along with key demographic variables for 608 MD program applicants were analyzed using descriptive and inferential statistical analyses., Results: The MMI format slightly favored female over male applicants (p = 0.002) but did not select for or against applicants based on age, race/ethnicity, underserved/rural area upbringing, or indicators of disadvantage. Out of 608 applicants, 356 (59%) completed a post-interview survey in which the experience was positively rated., Discussion: Based on our experience, the use of a hybrid model of traditional interviews complemented with MMI stations provided greater details in the assessment of medical school applicants while obtaining equivalent data and acceptability amongst applicants.

Introduction: Studies reveal positive interviewer perceptions of multiple mini-interview (MMI) upon MMI completion. No studies evaluate change in interviewer perceptions during MMI implementation. The objective was to evaluate the change in interviewer perceptions during the implementation of the MMI model at the University of Toledo College of Pharmacy and Pharmaceutical Sciences., Methods: Interviewers (faculty volunteers, preceptors, student pharmacists) were eligible for inclusion in the prospective cohort. Consenting individuals (1) completed a pre-MMI training survey regarding perceptions of MMI, (2) participated in a 90-minute MMI training program (PowerPoint presentation and review of videos demonstrating MMI practices), (3) completed a post-MMI training survey, and (4) after interviews, completed a post-interview survey. The six Likert-scale MMI perception questions were independently analyzed for changes in the rank response across the three survey time points using Friedman's nonparametric repeated-measures analysis. Each question was evaluated for all respondents together, and for nine different respondent subgroups. The overall criteria for significance was α = 0.05 for each question, with Bonferroni correction for the ten overall comparisons made for each question., Results: Thirty-two interviewers participated (20 faculty members, five preceptors, and seven student pharmacists). From the pre-MMI training survey through the post-interview survey, interviewers gained confidence in their ability to explain the rationale behind the MMI model, were more likely to agree that six minutes was adequate time to assess an applicant and believed MMI provides a fair assessment of an applicant's noncognitive attributes., Conclusions: After interviewers received training and gained experience with MMI, perceptions of MMI improved., Competing Interests: Declaration of competing interest The authors received no financial support for the research, authorship, and/or publicaiton of this article. Conflict of interest None. Disclosure(s). None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Understanding health beliefs is important to facilitate health promotion and disease prevention as they influence health behaviors, outcomes, and disease management. Given the rise of hypertension-related diseases in the Dominican Republic, the purpose of our study was to identify hypertension-related health beliefs of Dominicans in order to inform the development of culturally appropriate interventions for hypertension prevention, care, and treatment. Semi-structured interviews were conducted with 20 Dominicans, 15 of whom were receiving treatment for hypertension. Operating within the interpretative paradigmatic framework, we conducted thematic analyses of interview data to identify hypertension-related health beliefs and practices. Iterative data analysis revealed the following themes: 1) Negative emotions are a primary cause of hypertension, 2) Medication is the best treatment but adherence is challenging, 3) Systemic barriers impede treatment access, 4) Hypertension negatively impacts mental and physical well-being, and 5) Lifestyle changes, relaxation, and social support help manage hypertension. Data gathered from member checking validated these findings. This study enhances understanding of the beliefs and experiences of Dominicans and emphasize the importance of implementing culturally competent health programming and care., Competing Interests: The authors have declared that no competing interests exist.

Background: We aimed to assess the feasibility of using multiple technologies to recruit and conduct cognitive interviews among young people across the United States to test items measuring sexual and reproductive empowerment. We sought to understand whether these methods could achieve a diverse sample of participants. With more researchers turning to approaches that maintain social distancing in the context of COVID-19, it has become more pressing to refine these remote research methods., Methods: We used several online sites to recruit for and conduct cognitive testing of survey items. To recruit potential participants we advertised the study on the free online bulletin board, Craigslist, and the free online social network, Reddit. Interested participants completed an online Qualtrics screening form. To maximize diversity, we purposefully selected individuals to invite for participation. We used the video meeting platform, Zoom, to conduct the cognitive interviews. The interviewer opened a document with the items to be tested, shared the screen with the participant, and gave them control of the mouse and keyboard. After the participant self-administered the survey, the interviewer asked about interpretation and comprehension. After completion of the interviews we sent participants a follow-up survey about their impressions of the research methods and technologies used. We describe the processes, the advantages and disadvantages, and offer recommendations for researchers., Results: We recruited and interviewed 30 young people from a range of regions, gender identities, sexual orientations, ages, education, and experiences with sexual activity. These methods allowed us to recruit a purposefully selected diverse sample in terms of race/ethnicity and region. It also may have offered potential participants a feeling of safety and anonymity leading to greater participation from gay, lesbian, and transgender people who would not have agreed to participate in-person. Conducting the interviews using video chat may also have facilitated the inclusion of individuals who would not volunteer for in-person meetings. Disadvantages of video interviewing included participant challenges to finding a private space for the interview and problems with electronic devices., Conclusions: Online technologies can be used to achieve a diverse sample of research participants, contributing to research findings that better respond to young people's unique identities and situations.

Background: Effective strategies for participant retention are critical in health research to ensure validity, generalizability and efficient use of resources. Yet standardized guidelines for planning and reporting on retention efforts have been lacking. As with randomized controlled trial (RCT) and systematic review (SR) protocols, retention protocols are an opportunity to improve transparency and rigor. An RCT being conducted in British Columbia (BC), Canada provides a case example for developing a priori retention frameworks for use in protocol planning and reporting., Methods: The BC Healthy Connections Project RCT is examining the effectiveness of a nurse home-visiting program in improving child and maternal outcomes compared with existing services. Participants (N = 739) were girls and young women preparing to parent for the first time and experiencing socioeconomic disadvantage. Quantitative data were collected upon trial entry during pregnancy and during five follow-up interviews until participants' children reached age 2 years. A framework was developed to guide retention of this study population throughout the RCT. We reviewed relevant literature and mapped essential retention activities across the study planning, recruitment and maintenance phases. Interview completion rates were tracked., Results: Results from 3302 follow-up interviews (in-person/telephone) conducted over 4 years indicate high completion rates: 90% (n = 667) at 34 weeks gestation; and 91% (n = 676), 85% (n = 626), 80% (n = 594) and 83% (n = 613) at 2, 10, 18 and 24 months postpartum, respectively. Almost all participants (99%, n = 732) provided ongoing consent to access administrative health data. These results provide preliminary data on the success of the framework., Conclusions: Our retention results are encouraging given that participants were experiencing considerable socioeconomic disadvantage. Standardized retention planning and reporting may therefore be feasible for health research in general, using the framework we have developed. Use of standardized retention protocols should be encouraged in research to promote consistency across diverse studies, as now happens with RCT and SR protocols. Beyond this, successful retention approaches may help inform health policy-makers and practitioners who also need to better reach, engage and retain underserved populations., Trial Registration: ClinicalTrials.gov, NCT01672060. Registered on 24 August 2012.

Background: Accidental awareness during general anaesthesia (AAGA) is a complex and rare outcome to investigate in surgical patient populations, particularly obstetric patients. We report the protocol of the Direct Reporting of Awareness in Maternity patients (DREAMY) study, illustrating how the research was designed to address practical and methodological challenges for investigating AAGA in an obstetric cohort., Methods: This is the trial protocol of a prospective, multicentre cohort study of patients undergoing obstetric surgery under general anaesthesia. Accidental awareness during general anaesthesia will be detected using three repetitions of standardised direct questioning over 30 days, with responses indicating memories during general anaesthesia verified using structured interviews. Reports will be adjudicated, then classified, in accordance with pre-defined and pre-validated structures, including the Michigan Awareness Classification tool. Quantitative data will be collected on general anaesthesia conduct for all participants. This descriptive study is being conducted in England and aims to recruit a minimum of 2015 patients., Results: The DREAMY study was prospectively registered (ClinicalTrials.gov Identifier: NCT03100396) and ethical approval granted. Participant recruitment began in May 2017 and one year follow up concluded in August 2019. Publication of the results is anticipated in 2020., Conclusions: The DREAMY study will provide data on incidence, experience and implications of AAGA for obstetric patients, using a robust methodology that will reliably detect and translate subjective AAGA reports into objective outcomes. In addition, the study is expected to improve vigilance for AAGA in participating hospitals and encourage adoption of recommendations for support of patients experiencing AAGA., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background and Purpose: Conventional onsite interview methods often make comparing applicants difficult. Literature has noted conventional interviews leave room for bias and high interrater variability, making non-cognitive attributes difficult to ascertain. In 2016, the residency committee of a small, multi-site, academic-based postgraduate year one residency program implemented a modified multiple mini-interview (MMI) approach as a component of the residency interview process to better qualify candidate attributes., Educational Activity and Setting: A modified MMI was developed to address the non-cognitive attributes, ethical reasoning, communication, and professionalism. Scenarios, scripts, questions, and rubrics were developed by residency committee members. The author of the case was assigned to role play that scenario with candidates while other committee members silently observed. Candidates and residency committee members were surveyed to explore their perception of the MMI as a component of the residency interview process., Findings: Thirty-one candidates have been interviewed since the incorporation of the modified MMI. Of those, 20 completed the post-interview survey. The majority of resident candidates (55%) completing the survey felt they were able to portray strengths and abilities more effectively vs. a conventional interview. Of the five residency committee members, all (100%) completed the survey and all (100%) perceived implementation of the modified MMI provided increased confidence in determining candidate ranking., Summary: Implementation of a modified MMI approach to an onsite residency interview process assisted residency committee members in assessing non-cognitive attributes and contributed to greater confidence in determining resident candidate ranking., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Dermatology is arguably the most competitive residency (81.6% match rate for United States allopathic seniors) with significantly more applicants than available positions. To objectify this process, the National Residency Match Program (NRMP) has produced bi-annual Charting Outcomes in Match (COM) datasets, which aggregate data from the prior two application cycles and tabulate statistics to aid applicants. In parallel, online forums provide medical trainees with vast amounts of information, including residency application insights. Reddit medical school subforum compiles annual spreadsheets of anonymous, individualized applicant data to aid future applicants. We compared this data to NRMP data to show that although the data means are similar (e.g. Step 1), the Reddit dermatology spreadsheet collects more data and the individualized nature aids applicants in a personalized way unlike the mean aggregate data in NRMP. Under univariate analysis, Alpha Omega Alpha status, overall publications, and dermatology-specific publications are associated with interview invitation rates. Although limitations of the study include small data size and reporting bias, this is the first of its kind to our knowledge to compare these two often-used tools to aid dermatology applicants. Future endeavors should expand anonymous data reporting and use the data to carry out more extensive studies to investigate factors influencing the application process.

In this update of Clark and Watson (1995), we provide a synopsis of major points of our earlier article and discuss issues in scale construction that have become more salient as clinical and personality assessment has progressed over the past quarter-century. It remains true that the primary goal of scale development is to create valid measures of underlying constructs and that Loevinger's theoretical scheme provides a powerful model for scale development. We still discuss practical issues to help developers maximize their measures' construct validity, reiterating the importance of (a) clear conceptualization of target constructs, (b) an overinclusive initial item pool, (c) paying careful attention to item wording, (d) testing the item pool against closely related constructs, (e) choosing validation samples thoughtfully, and (f) emphasizing unidimensionality over internal consistency. We have added (g) consideration of the hierarchical structures of personality and psychopathology in scale development, discussion of (h) codeveloping scales in the context of these structures, (i) "orphan," and "interstitial" constructs, which do not fit neatly within these structures, (j) problems with "conglomerate" constructs, and (k) developing alternative versions of measures, including short forms, translations, informant versions, and age-based adaptations. Finally, we have expanded our discussions of (l) item-response theory and of external validity, emphasizing (m) convergent and discriminant validity, (n) incremental validity, and (o) cross-method analyses, such as questionnaires and interviews. We conclude by reaffirming that all mature sciences are built on the bedrock of sound measurement and that psychology must redouble its efforts to develop reliable and valid measures. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Introduction: Brazil presented a high proportion of ill-defined causes of death (IDCD) in 2000, compromising accurate cause-of-death analysis., Objective: To analyze specific underlying causes for deaths originally assigned as IDCD in the Mortality Information System (SIM - Sistema de Informação sobre Mortalidade), after investigation activities implemented in country between 2006 and 2017., Method: For all IDCD identified in the SIM, municipal health professionals collected information about the final disease obtained from hospital records, autopsies, forms of family health teams, and home investigation. Specific causes among reclassified IDCD after investigation were evaluated according to age groups and four calendar periods., Results: Proportions of IDCD reassigned to other causes after review increased over time, reaching 30.1% in 2017. From a total of 257,367 IDCD reclassified in 2006-2017, neonatal-related conditions, injury, ischemic heart disease and stroke were the leading causes detected in the age groups 0-9 years, 10-29 years, 30-69 years, 70 years and over, respectively., Discussion: The similarity and plausibility of cause-specific proportions derived from the reclassification of IDCD by age group over time indicate the accuracy of the investigation data., Conclusion: High proportions of IDCD reassigned to more informative causes after review indicate the success of this approach to correct misclassification in the SIM, an initiative that should be maintained. Training physicians on death certification along with better quality of medical care and access to health services would lead to further improvement.

Purpose: Thorough and accurate preoperative anesthesia interviews may help improve perioperative efficiency by reducing unnecessary preoperative testing and preventable surgical cancellations, both of which create financial burdens. Standardized anesthesia preoperative interview guidelines and online educational modules for registered nurses (RNs) conducting preoperative interviews may improve this process., Design: Predesign and postdesign, retrospective chart review., Methods: Online educational modules and standardized preoperative anesthesia interview guidelines were developed for RNs conducting preoperative interviews. A retrospective chart review compared preoperative anesthesia interview record completion rates, compliance with laboratory testing, and the total number of preventable surgical cancellations., Findings: Documentation of preoperative anesthesia interview records increased, whereas unnecessary preoperative testing decreased, neither with statistical significance. Preventable cancellation rates decreased significantly from 34.3% to 20% (P < .5) contributing to a 3-month postimplementation cost savings of approximately $30,000., Conclusions: A standardized preoperative anesthesia interview guideline and online anesthesia educational modules for RNs conducting preoperative anesthesia interviews improved preoperative record completion rates, reduced unnecessary laboratory testing, and averted surgical cancellations., (Copyright © 2019 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Background and Purpose: Literature demonstrates that the primary concerns for entry-level graduates relate to standards covering professional competencies and outcome expectations; knowledge, skills, attitudes, and values; and pharmacy practice experiences. Implementing patient interviewing team simulation assessments (PITSA) into the curriculum is an option to address these concerns., Educational Activity and Setting: PITSA are formative or summative assessment tools that can measure student's ability to communicate with a healthcare provider in addition to evaluating the student's clinical knowledge and skills during scheduled class time. At the University of Texas at Tyler Fisch College of Pharmacy, PITSA were implemented into an OSCE remediation course as an alternative strategy to allow students to review past content and practice counseling and interviewing techniques., Findings: Students identified the PITSA as a strength of the OSCE remediation course. Students reported the PITSA allowed them to improve their pharmacy practice skills. In addition, students stated the PITSA were beneficial to have prior to starting advanced pharmacy practice experiences., Summary: Although PITSA have some limitations, it can be a cost-effective instrument to prepare students for capstone OSCE assessments as well as advanced pharmacy practice experiences., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Social processes that change quickly are difficult to study, because they require frequent survey measurement. Weekly, daily, or even hourly measurement may be needed depending on the topic. With more frequent measurement comes the prospect of more complex patterns of missing data. The mechanisms creating the missing data may be varied, ranging from technical issues such as lack of an Internet connection to refusal to complete a requested survey. We examine one approach to mitigating the damage of these missing data - a follow-up or closeout interview that is completed after the frequent measurement. The Relationship Dynamics and Social Life (RDSL) study used this approach. The study asked women weekly about their attitudes and behaviors related to sexual relationships and pregnancy. The surveys were carried out for 130 weeks and concluded with a closeout interview. We explore the patterns of missing data in the RDSL study and then examine associations between the data collected in the closeout survey and key variables collected in the weekly survey. We then assess the extent to which data from the closeout survey are useful in repairing the damage caused by missing data., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Despite the growing interest in screening for food insecurity in the clinical setting, little evidence exists regarding screening formats that maximize disclosure and caregiver comfort., Methods: In this randomized trial, we asked English-speaking adult caregivers of pediatric patients in the emergency department at an urban, freestanding children's hospital to complete a validated, 2-question screen for food insecurity. Respondents were assigned via block randomization to complete the survey by either verbal interview or electronic tablet. Caregivers reported the perceived importance of the screening questions, comfort level with screening in the emergency department or in their child's primary care site, and their preferred screening modality., Results: Of the 1818 participants, 20.6% screened positive for food insecurity. There was a significantly higher rate of reported food insecurity for those screened by tablet (23.6%) compared to those screened verbally (17.7%) (P = .002). Of those who had a preference of screening modality, 83.2% of all participants and 84.5% of patients reporting food insecurity preferred the tablet-based screen over verbal interview. Overall, more participants reported comfort completing the screen in the emergency department compared to their child's doctor's office; however, comfort in both of these setting was rated highly (86.1% vs 80.2%; P < .001)., Conclusions: Although both verbal interview and tablet-based screening modalities were effective in identifying food insecurity, tablet-based screening had a higher disclosure rate and was the participants' preferred screening method. There is a high level of comfort with screening regardless of clinical setting; it is possible that an added level of anonymity in the emergency department enhanced participants' comfort levels., (Copyright © 2019 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Introduction: The Civil Rights Act prohibits employers from making employment decisions based on sex, race, color, religion, or national origin. Questions regarding these topics during a residency interview are therefore prohibited., Methods: A questionnaire was sent to all female orthopaedic surgeons who had an e-mail address in the American Academy of Orthopaedic Surgeons directory. Participants were asked to describe what, if any, inappropriate questions they were asked during interviews., Results: Four hundred eighty-eight of 997 invited female orthopaedic surgeons completed the questionnaire (48.9%). Their residency interviews took place from 1971 to 2015. Overall, 61.7% of participants were asked an inappropriate question during an interview. This proportion neither increased nor decreased from 1971 to 2015 (P = 0.315). The most common themes of questions included "raising children during residency" (37.9%), "marital status" (32.4%), and "pregnancy during residency" (29.7%). Of those who were asked an inappropriate question, only 1.4% reported the inappropriate question to authorities., Discussion: The present study suggests that over half of female applicants have been asked inappropriate questions at orthopaedic surgery residency interviews, and that there has been no improvement in that percentage over nearly five decades. It is the responsibility those interviewing to be aware of this issue and to be in compliance with national guidelines., Level of Evidence: Level IV.

Background: Colorectal cancer (CRC) is among the leading cancer diagnoses affecting both men and women worldwide. Prevention and early detection of CRC is possible by increasing access to and utilisation of screening tests. Although CRC screening is highly recommended, screening rates remain suboptimal in the USA, particularly among underserved populations. Our project site, an urban federally qualified health centre, was not meeting the national screening target of 80% of eligible adults., Objective: The aim of this quality improvement project was to increase the number of orders for CRC screening to eligible patients by using unlicensed assistive personnel and automated telephone outreach calls to offer 100 patients CRC screening during an 8-week period., Methods: 40 patients received outreach calls from care coordinators (CC). 40 patients received automated telephone call reminders to call a CC to obtain an order for CRC screening. 20 patients were offered CRC screening by a medical assistant (MA) as part of their scheduled office visits. We used two plan-do-study-act (PDSA) cycles to deliver these three screening interventions., Results: A total of 100 patients received one of the interventions. Ten of those patients received an order for either colonoscopy or faecal immunochemical testing by the conclusion of the second PDSA cycle. The MA-offered screening resulted in the highest percentage of patients accepting CRC screenings and patients preferred this outreach approach compared with CC outreach or automated voice messages. CC outreach yielded a lower rate of accepted screenings. None of the patients who received the automated calls followed up to obtain a screening order., Conclusion: Our project demonstrates that unlicensed assistive personnel have the potential to increase patient access to CRC screening., Competing Interests: Competing interests: None declared.

Objectives: We sought to understand healthcare-seeking patterns and delays in obtaining effective treatment for rural Rwandan children aged 1-5 years by analysing verbal and social autopsies (VSA). Factors in the home, related to transport and to quality of care in the formal health sector (FHS) were thought to contribute to delays., Design: We collected quantitative and qualitative cross-sectional data using the validated 2012 WHO VSA tool. Descriptive statistics were performed. We inductively and deductively coded narratives using the three delays model, conducted thematic content analysis and used convergent mixed methods to synthesise findings., Setting: The study took place in the catchment areas of two rural district hospitals in Rwanda-Kirehe and Southern Kayonza. Participants were caregivers of children aged 1-5 years who died in our study area between March 2013 and February 2014., Results: We analysed 77 VSAs. Although 74% of children (n=57) had contact with the FHS before dying, most (59%, n=45) died at home. Many caregivers (44%, n=34) considered using traditional medicine and 23 (33%) actually did. Qualitative themes reflected difficulty recognising the need for care, the importance of traditional medicine, especially for 'poisoning' and poor perceived quality of care. We identified an additional delay-phase IV-which occurred after leaving formal healthcare facilities. These delays were associated with caregiver dissatisfaction or inability to adhere to care plans., Conclusion: Delays in deciding to seek care (phase I) and receiving quality care in FHS (phase III) dominated these narratives; delays in reaching a facility (phase II) were rarely discussed. An unwillingness or inability toadhere to treatment plans after leaving facilities (phase IV) were an important additional delay. Improving quality of care, especially provider capacity to communicate danger signs/treatment plans and promote adherence in the presence of alternative explanatory models informed by traditional medicine, could help prevent childhood deaths., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Although improving the average patient experience is at the center of recent efforts to make cancer care more patient centered, extreme experiences may be more informative for quality improvement. Little is known about the most deeply dissatisfying experiences that predispose disengagement and negatively influence patient outcomes. We sought to establish a framework for emotionally adverse patient experiences and identify the range of common causes., Study Design: Qualitative study including in-depth interviews and free-text survey comments., Methods: Thematic analysis of 20 open-ended patient interviews and 2389 free-text survey comments collected in a medical center's cancer clinics., Results: Emotionally adverse experiences were rarely reported in survey comments (96; 4.0%) but more frequently discussed in interviews (12 interview participants). Such experiences were identified through explicit statements of negative emotion, language, syntax, and tone. Among these rare comments, hostility as an indicator was easiest to identify, whereas passive expressions of fear or hopelessness were less reliably identified. We identified 3 mutually inclusive high-level domains of triggers of negative emotion-system issues, technical processes, and interpersonal processes-and 10 themes within those domains. There was wide variation in the causes of emotionally adverse experiences and evidence of a complex interplay of patient expectations and preconditions that influenced the perception of negative experiences., Conclusions: This study presents a taxonomy for classifying emotionally adverse patient experiences expressed in free-text format. Further research should test how perceptions of adverse experiences correspond to recorded ratings of patient satisfaction and subsequent enrollment or utilization.

Food allergies are frequently reported to co-occur with autism spectrum disorder (ASD), but the prevalence of this co-occurrence remains uncertain. In the present study, we examined parent-reported prevalence of co-occurring food allergy and ASD in a nationally representative sample of US children ages 2-17 in the National Health Interview Survey, study years 2011-2015. All analyses used survey weights to account for the complex sampling design. In the analytic sample of 53,365 children ages 2-17, there were 905 children with parent-reported ASD (prevalence of 1.7%) and 2,977 children with parent-reported food allergy (prevalence of 5.6%). Parent-reported food allergies were nearly 2.5 times more common in children with ASD (prevalence of 13.1%) than in children without ASD (5.4%). These results indicate that food allergies commonly co-occur with ASD, which may have etiological implications. Autism Research 2019, 12: 802-805. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Food allergies are frequently reported to occur with autism spectrum disorder (ASD), but the prevalence of this co-occurrence remains uncertain. In the present study, we examined parent-reported prevalence of co-occurring food allergy and ASD in a nationally representative sample of United States children. In the sample of 53,365 children ages 2-17, 1.7% of children were reported to have ASD, and 5.6% were reported to have food allergies. Parent-reported food allergies were nearly 2.5 times more common in children with ASD (13.1%) than in children without ASD (5.4%)., (© 2019 International Society for Autism Research, Wiley Periodicals, Inc.)

Objectives: Otolaryngology applicants routinely decry conflicting interview dates because this limits the number of interviews that one can attend, despite being offered an interview. Conversely, applicants also perceive that a large number of interviews are offered to a minority of applicants. We sought to verify and quantify the inequality in distribution of interviews attended., Study Design: Retrospective analysis of the National Resident Matching Program (NRMP) 2016 Charting Outcomes in the Match and Electronic Residency Application Service (ERAS) historic specialty data., Methods: The Gini coefficient, a commonly used indicator of economic inequality, was calculated using data from the 2016 Charting Outcomes in the Match to estimate the distribution of interviews attended. This data was compared to nine other specialties, comprising a wide range of competitiveness and specialty size., Results: 26% (110 of 416) of otolaryngology applicants accounted for half (1,721 of 3,426) of all possible interview positions. The Gini coefficient ranged from 0.43 to 0.84 across 10 specialties, with a higher coefficient indicating higher inequality. The Gini coefficient among otolaryngology applicants was 0.43, indicating lower inequality than most other specialties. When including only applicants who interviewed, the Gini coefficient was 0.23., Conclusion: There is an unequal distribution of interview invitations, which likely reflects the reality of asymmetry in applicant competitiveness. Otolaryngology demonstrates the greatest equality in distribution, which may stem from a greater burden of hoarding. The specialty's perceived competitiveness mitigates factors such as cost and time, essentially encouraging more people to take as many interviews as they can., Level of Evidence: NA Laryngoscope, 129:627-633, 2019., (© 2018 The American Laryngological, Rhinological and Otological Society, Inc.)

Purpose: Admissions criteria for physician assistant (PA) schools vary considerably, but they often involve a combination of academic measures, noncognitive "humanistic" qualities, and mission-related items. To address noncognitive attributes, some PA schools have implemented the multiple mini-interview (MMI) format developed at McMaster University in Canada. This research project looked at differences in interview scores by gender over 3 consecutive admissions cycles at one PA program., Methods: Three years of pre-existing de-identified data gathered as part of the routine admissions process were analyzed retrospectively using SPSS-v25., Results: Data were available for all interviewees for 2015, 2016, and 2017 (N = 350 total). Between-group differences were not statistically significant by gender. Reliability (Cronbach's α) was 0.865 for academic scoring and 0.694 for MMI scoring., Discussion: Analysis of 3 years of admissions data from a single program did not show evidence for gender bias in MMI scores. Although this result is reassuring, it requires continued monitoring and replication.

Background: Interpersonal relationships among professionals drive both the adoption and rejection of consequential innovations. Through relationships, decision-makers learn which colleagues are choosing to adopt innovations, and why. The purpose of our study was to understand how and why long-term care (LTC) leaders in a pan-Canadian interpersonal network provide and seek advice about care improvement innovations, for the eventual dissemination and implementation of these innovations., Methods: We used a mixed methods approach. An online survey was sent to senior leaders in 958 LTC facilities in 11 Canadian provinces and territories. Participants were asked to name up to three individuals whose advice they most value when considering care improvement and practice innovations. Sociometric analysis revealed the structure of provincial-level advice networks and how those networks were linked. Using sociometric indicators, we purposively selected 39 key network actors to interview to explore the nature of advice relationships. Data were analyzed thematically., Results: In this paper, we report our qualitative findings. We identified four themes from the data. One theme related to characteristics of particular network roles: opinion leaders, advice seekers, and boundary spanners. Opinion leaders and boundary spanners have long tenures in LTC, a broad knowledge of the network, and share an interest in advancing the sector. Advice seekers were similarly committed to LTC; they initially seek and then, over time, exchange advice with opinion leaders and become an important source of information for them. A second theme related to characterizing advice seeking relationships as formal, peer-to-peer, mentoring, or reciprocal. The third and fourth themes described motivations for providing and seeking advice, and the nature of advice given and sought. Advice seekers initially sought information to resolve clinical care problems; however, over time, the nature of advice sought expanded to include operational and strategic queries. Opinion leaders sought to expand their networks and to solicit information from their more established advice seekers that might benefit the network and advance LTC., Conclusions: New knowledge about the distinct roles that different network actors play vis-a-vis one another offers healthcare professionals, researchers, and decision- and policy-makers insights that are useful when formulating best practice dissemination strategies.

Objectives: The objectives of this study were to evaluate the association between a student's Myers-Briggs Type Indicator (MBTI) preference pairs and resulting types and his or her multiple-mini interview (MMI) scores upon admission, and to determine the proportions of types among veterinary classes over five years., Methods: A cross-sectional study was conducted for data collected from 706 students admitted into the University of California Davis School of Veterinary Medicine (UCDSVM) program beginning in the fall of 2013 and ending in the fall of 2018. Data consisted of a candidate's MBTI preference pairs and types which were collected during the first week of enrollment and multiple-mini interview scores from his or her admission data., Results: A total of 706 students from 5 classes completed the MBTI survey. Multivariate analysis showed no significant association between the MBTI preference pairs of extroversion and introversion (F( 1, 697) = 3.30, p=0.0959), sensing and intuition (F (1, 697) = 0.40, p=0.4395), thinking and feeling (F (1, 697) = 3.59, p=0.0591), or judging and perceiving (F (1, 697) = 0.38, p = 0.5657) and MMI score. Analysis showed no trends (χ 2 (60, N=706) =76.51, p=0.074) in the student's MBTI types over the 5-year period., Conclusions: The MMI score of a candidate admitted into the UCDSVM is unlikely to be affected by personality preferences. Therefore, it is unlikely that multiple-mini interview scores included in the admission process will affect the personality diversity of candidates admitted into a veterinary class.

Background: Physical activity (PA) can improve a range of outcomes following a cancer diagnosis. These include an improvement in experience of side effects of treatment (eg, fatigue) and management of comorbid conditions. PA might also increase survival and reduce recurrence. Digital interventions have shown potential for PA promotion among cancer survivors, but most in a previous review were Web-based, and few studies used mobile apps. There are many PA apps available for general public use, but it is unclear whether these are suitable as a PA intervention after a cancer diagnosis., Objective: This study sought posttreatment nonmetastatic breast, prostate, and colorectal cancer survivors' opinions of using smartphone apps to promote PA and gathered their views on existing publicly available PA apps to inform a future intervention., Methods: Each participant was randomly assigned to download 2 of 4 apps (Human, The Walk, The Johnson & Johnson Official 7 Minute Workout, and Gorilla Workout). Participants used each app for 1 week consecutively. In-depth semistructured telephone interviews were then conducted to understand participants' experiences of using the apps and how app-based PA interventions could be developed for cancer survivors. The interviews were analyzed using thematic analysis., Results: Thirty-two participants took part: 50% (16/32) had prostate cancer, 25% (8/32) had breast cancer, and 25% (8/32) had colorectal cancer. Three core themes were identified. The first theme was that multiple factors affect engagement with PA apps and this is highly personalized. Factors affecting engagement included participants' perceptions of (1) the advantages and disadvantages of using apps to support PA, (2) the relevance of the app to the user (eg, in terms of cancer-related factors, their PA goals, the difficulty level of the app, the way in which they interact with their mobile phone, and the extent to which the app fits with their self-identity), (3) the quality of the app (eg, usability, accuracy, quality of production, and scientific evidence-base), and (4) the behavior change techniques used to promote PA. In the second theme, participants recommended that apps that promote walking are most appealing, as walking removes many barriers to PA. Finally, the participants suggested that PA apps should be integrated into cancer care, as they valued guidance and recommendations from health care professionals., Conclusions: This sample of breast, prostate, and colorectal cancer survivors was receptive to the use of apps to promote PA. Although no publicly available PA app was deemed wholly suitable, many suggestions for adaptation and intervention development were provided. The results can inform the development of an app-based PA intervention for cancer survivors. They also highlight the wide-ranging and dynamic influences on engagement with digital interventions, which can be applied to other evaluations of mobile health products in other health conditions and other health behaviors., (©Anna L Roberts, Henry WW Potts, Dimitrios A Koutoukidis, Lee Smith, Abigail Fisher. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 04.01.2019.)

Introduction: Suicide prevention is a major objective in public health. The development of alternative approaches to the prevention of suicide, such as monitoring systems, is growing quickly. The results are encouraging, but the analysis of the effectiveness remains complex. The objective of this study is to evaluate the medico-economic impact of the ALGOS brief contact intervention (BCI) on the consumption of medical care., Method: ALGOS is a prospective, comparative, multicentre, single-blind, randomized, controlled trial, which compared two groups after a suicide attempt (SA). The ALGOS algorithm assigned each BCI to the subgroup of participants. The medico-economic impact of each intervention was evaluated at 6 and 13 months after inclusion., Results: In all, 987 patients were included. There was no significant difference between the two groups at 6 months and at 13 months after SA in the total number of patients who had been hospitalized in psychiatry or other care services. However, the average number of rheumatology visits was significantly higher in the control group (P=0.01) at 13 months. The total number of rheumatologist and physiotherapist visits was significantly higher in the control group at 6 and 13 months., Conclusion: Our results suggest that the use of a BCI after SA does not lead to increased consumption of medical care., (Copyright © 2018 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

In Brief: This study used telephone surveys as a novel method of measuring health outcomes and tracking healthcare utilization in pediatric head trauma patients at the national referral hospital in Uganda. As the first-ever long-term follow-up of this patient population in Uganda, this work establishes a baseline of pediatric head trauma outcomes and lays the groundwork for tracking and improving outcomes for similar patients in low-resource settings.

Brief psychiatric assessment tools are needed for evaluating children affected by HIV for emotional and behavioral problems. We compared a self-administered symptom rating scale (CASI-4R) to a semi-structured diagnostic interview (DICA-P) in 136 U.S. children affected by HIV. Agreement and performance measures for the two instruments were computed for attention deficit hyperactivity disorder, depression, anxiety, and disruptive behavior. Correlations and regression analyses were conducted to compare the two instruments, and to evaluate their associations with social, academic, and global function. Higher CASI-4R symptom severity scores were associated with DICA diagnoses (p < 0.02 for all disorders). Agreement (κ) between DICA diagnoses and CASI-4R Clinical Cutoffs (which incorporated symptoms and impairment) was low to moderate (0.19-0.40 for all disorders). Thirty-two percent of cases with a DICA diagnosis were identified by the CASI-4R Clinical Cutoff (sensitivity), yet over 90% of DICA-negative cases were negative by the CASI-4R (specificity). Sensitivity was higher using CASI-4R Severity Score thresholds based on median scores compared to the DICA diagnoses. The presence and severity of psychiatric symptoms and impairment were associated with poorer academic, social, and global function. The CASI-4R symptom checklist can be used to inexpensively screen youth affected by HIV for emotional and behavioral problems, although it is important that there be appropriate mental health evaluation follow-up.

The Charting Outcomes resource is useful in gauging an applicant's competiveness for a given specialty. However, many variables are not reported in Charting Outcomes that may influence an applicant's ability to match. A significant proportion of applicants record their experiences in an anonymous, self-reported applicant spreadsheet. We analyzed factors associated with a successful match using this dataset to test the hypothesis that research productivity and high academic performance correlates with success rates. A retrospective analysis of "RadOnc Interview Spreadsheet" for the 2015, 2016, and 2017 radiation oncology match was performed. Data were accessed via studentdoctor.net. Board scores, research characteristics, Sub-I participation, and interview invitation rates were available. Mann-Whitney U, Kruskal-Wallis, and chi-square tests were used for statistical analysis. When possible, results were compared to those reported in the National Residency Match Program's "Charting Outcomes" report. A total of 158 applicants were examined for the applicant characteristics. Applicants applied to a median of 61 programs and received a median of 14 interviews. The mean step 1 score was 248 (range: 198 to 272) and most were in the highest grade point average quartile (68.3%). 21.7% participated in additional research year(s), and 19% obtained a PhD. The majority of applicants took three radiation oncology electives (48.7%). On multivariate analysis, alpha-omega-alpha (AOA) honors society status (p=0.033), participating in a research year (p=0.001) and number of journal publications (p=0.047) significantly correlated with higher interview invitation rates. In summary, this study identifies important considerations for radiation oncology applicants that have not been previously reported, such as induction into AOA and number of journal publications.

Objective: To analyze trends in risk and protective factors for non-communicable diseases (NCD) and access to preventive tests in the population with health insurance in Brazilian state capitals between 2008 and 2015., Methods: This is a cross-sectional study that analyzed data collected from the Surveillance of Risk and Protective Factors for non-communicable diseases (NCD) Telephone Survey (Sistema Nacional de Vigilância de Doenças Crônicas por Inquérito Telefônico - Vigitel) on adults aged 18 years and older. We analyzed trends in NCD indicators among health insurance users in approximately 30 thousand interviews done between 2008 and 2015. We used the simple linear regression model to calculate the trends., Results: Health insurance users showed an increase in the prevalence of protective factors such as fruit and vegetable consumption, and physical activity in leisure time. Also, there was a decrease in risk factors such as smoking and soft drink consumption, increase in mammography coverage, and a drop in smoking prevalence. However, overweight, obesity, and diabetes increased., Conclusion: There are differences according to gender, and, in general, women accumulate more protective factors and men, more risk factors.

Background: Choosing a suitable sample size in qualitative research is an area of conceptual debate and practical uncertainty. That sample size principles, guidelines and tools have been developed to enable researchers to set, and justify the acceptability of, their sample size is an indication that the issue constitutes an important marker of the quality of qualitative research. Nevertheless, research shows that sample size sufficiency reporting is often poor, if not absent, across a range of disciplinary fields., Methods: A systematic analysis of single-interview-per-participant designs within three health-related journals from the disciplines of psychology, sociology and medicine, over a 15-year period, was conducted to examine whether and how sample sizes were justified and how sample size was characterised and discussed by authors. Data pertinent to sample size were extracted and analysed using qualitative and quantitative analytic techniques., Results: Our findings demonstrate that provision of sample size justifications in qualitative health research is limited; is not contingent on the number of interviews; and relates to the journal of publication. Defence of sample size was most frequently supported across all three journals with reference to the principle of saturation and to pragmatic considerations. Qualitative sample sizes were predominantly - and often without justification - characterised as insufficient (i.e., 'small') and discussed in the context of study limitations. Sample size insufficiency was seen to threaten the validity and generalizability of studies' results, with the latter being frequently conceived in nomothetic terms., Conclusions: We recommend, firstly, that qualitative health researchers be more transparent about evaluations of their sample size sufficiency, situating these within broader and more encompassing assessments of data adequacy. Secondly, we invite researchers critically to consider how saturation parameters found in prior methodological studies and sample size community norms might best inform, and apply to, their own project and encourage that data adequacy is best appraised with reference to features that are intrinsic to the study at hand. Finally, those reviewing papers have a vital role in supporting and encouraging transparent study-specific reporting.