Symptom-BERT: Enhancing Cancer Symptom Detection in EHR Clinical Notes.

CONTEXT: Extracting cancer symptom documentation allows clinicians to develop highly individualized symptom prediction algorithms to deliver symptom management care. Leveraging advanced language models to detect symptom data in clinical narratives can significantly enhance this process. OBJECTIVE: This study uses a pretrained large language model to detect and extract cancer symptoms in clinical notes. METHODS: We developed a pretrained language model to identify cancer symptoms in clinical notes based on a clinical corpus from the Enterprise Data Warehouse for Research at a healthcare system in the Midwestern United States. This study was conducted in 4 phases:1 pretraining a Bio-Clinical BERT model on one million unlabeled clinical documents,2 fine-tuning Symptom-BERT for detecting 13 cancer symptom groups within 1112 annotated clinical notes,3 generating 180 synthetic clinical notes using ChatGPT-4 for external validation, and4 comparing the internal and external performance of Symptom-BERT against a non-pretrained version and six other BERT implementations. RESULTS: The Symptom-BERT model effectively detected cancer symptoms in clinical notes. It achieved results with a micro-averaged F1-score of 0.933, an AUC of 0.929 internally, and 0.831 and 0.834 externally. Our analysis shows that physical symptoms, like Pruritus, are typically identified with higher performance than psychological symptoms, such as anxiety. CONCLUSION: This study underscores the transformative potential of specialized pretraining on domain-specific data in boosting the performance of language models for medical applications. The Symptom-BERT model's exceptional efficacy in detecting cancer symptoms heralds a groundbreaking stride in patient-centered AI technologies, offering a promising path to elevate symptom management and cultivate superior patient self-care outcomes.

Machine Learning Approaches to Predict Symptoms in People With Cancer: Systematic Review.

BACKGROUND: People with cancer frequently experience severe and distressing symptoms associated with cancer and its treatments. Predicting symptoms in patients with cancer continues to be a significant challenge for both clinicians and researchers. The rapid evolution of machine learning (ML) highlights the need for a current systematic review to improve cancer symptom prediction. OBJECTIVE: This systematic review aims to synthesize the literature that has used ML algorithms to predict the development of cancer symptoms and to identify the predictors of these symptoms. This is essential for integrating new developments and identifying gaps in existing literature. METHODS: We conducted this systematic review in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. We conducted a systematic search of CINAHL, Embase, and PubMed for English records published from 1984 to August 11, 2023, using the following search terms: cancer, neoplasm, specific symptoms, neural networks, machine learning, specific algorithm names, and deep learning. All records that met the eligibility criteria were individually reviewed by 2 coauthors, and key findings were extracted and synthesized. We focused on studies using ML algorithms to predict cancer symptoms, excluding nonhuman research, technical reports, reviews, book chapters, conference proceedings, and inaccessible full texts. RESULTS: A total of 42 studies were included, the majority of which were published after 2017. Most studies were conducted in North America (18/42, 43%) and Asia (16/42, 38%). The sample sizes in most studies (27/42, 64%) typically ranged from 100 to 1000 participants. The most prevalent category of algorithms was supervised ML, accounting for 39 (93%) of the 42 studies. Each of the methods-deep learning, ensemble classifiers, and unsupervised ML-constituted 3 (3%) of the 42 studies. The ML algorithms with the best performance were logistic regression (9/42, 17%), random forest (7/42, 13%), artificial neural networks (5/42, 9%), and decision trees (5/42, 9%). The most commonly included primary cancer sites were the head and neck (9/42, 22%) and breast (8/42, 19%), with 17 (41%) of the 42 studies not specifying the site. The most frequently studied symptoms were xerostomia (9/42, 14%), depression (8/42, 13%), pain (8/42, 13%), and fatigue (6/42, 10%). The significant predictors were age, gender, treatment type, treatment number, cancer site, cancer stage, chemotherapy, radiotherapy, chronic diseases, comorbidities, physical factors, and psychological factors. CONCLUSIONS: This review outlines the algorithms used for predicting symptoms in individuals with cancer. Given the diversity of symptoms people with cancer experience, analytic approaches that can handle complex and nonlinear relationships are critical. This knowledge can pave the way for crafting algorithms tailored to a specific symptom. In addition, to improve prediction precision, future research should compare cutting-edge ML strategies such as deep learning and ensemble methods with traditional statistical models.

Role transition from education to practice and its impact on the career futures of Omani nurses.

AIM: The aim of this study was to examine new Omani graduate nurses' role transition from education to practice. We also sought to describe factors that may affect the effective transition of new Omani graduates to their professional nurse role. BACKGROUND: There is a substantial literature on the process of transition from graduation to being a professional nurse in countries across the globe; however, little is known about new Omani graduate nurses' role transition from education to practice. DESIGN: This study had a descriptive cross-sectional design. METHODS: Data were collected from nurses who at the time of the study had been working for at least 3 months but not longer than 2 years. Role transition was assessed with the Comfort and Confidence subscale of the Casey-Fink Graduate Nurse Experience Survey (Casey et al., 2004). The survey consists of a 24-items that are rated on a 4-point Likert scale. We conducted a multivariate regression analysis to assess the factors that influence nurses' role transition. These factors included participants' demographic information, employment orientation durations, preceptorship duration and length of time before employment. RESULTS: The total sample consisted of 405 nurses working in 13 hospitals in Oman. Most (68.89%) had worked as a nurse for less than 6 months. The average internship and orientation durations were approximately 6 months (SD = 1.58) and 2 weeks (SD = 1.79), respectively. The number of preceptors assigned to new graduate nurses ranged from none to four. The average score on the Comfort and Confidence subscale was 2.96 (SD = 0.38). Results from the regression analysis demonstrated that age (ß = 0.029, SE = 0.012, p = .021), waiting time before employment (ß = -0.035, SE = 0.013, p = .007) and employment orientation duration (ß = -0.007, SE = 0.003, p = .018) were statistically significant factors influencing role transition experience among newly joined nurses. CONCLUSION: The results suggest that appropriate intervention strategies at the national level are needed to enhance the transition of nursing school graduates to their professional role. Strategies directed toward shortening the waiting time before employment and improving the internship experience are examples of priority-level tactics that can enhance Omani nursing graduates' transition to their professional role.

A qualitative exploration of goals-of-care discussions with seriously ill patients in Jordan.

OBJECTIVES: This study aims to explore seriously ill patients' experiences during goals-of-care discussions and perspectives of end-of-life (EOL) decision-making in the Middle Eastern country of Jordan. METHODS: This is a qualitative descriptive study with semi-structured, one-on-one interviews. Settings were 2 large hospitals in Jordan. Patients were a purposeful sample of 14 Arabic-speaking adults who were seriously ill and hospitalized with palliative care needs. RESULTS: Conventional content analysis identified 4 main themes: perceived suffering during serious illness, attitudes toward discussing EOL decision-making, goals of care and preferences for EOL, and actions to enhance EOL decision-making. Disease and treatment burdens and concerns about life, family, and death were sources of suffering during serious illness. What matters most to patients at EOL were alleviating suffering and getting support from family, friends, and care providers. Although patients expressed reluctance and inaction toward EOL decision-making due to uncertainties, lacking awareness, and assumptions of fear, their potential goals of care were to live longer, be with their families, and die with dignity. SIGNIFICANCE OF RESULTS: Jordanians and culturally similar Arabs could benefit from goals-of-care discussions. The proper, culturally sensitive implementation of goals-of-care discussions in Arab populations with similar cultural norms requires raising public awareness and clarifying the legitimacy of goals-of-care discussions, preparing patients and their families for the discussions, and considering individual variations in handling the discussions.

Sleep, circadian rhythm characteristics, and melatonin levels in later life adults with and without coronary artery disease.

STUDY OBJECTIVES: The purpose of this study was to conduct a comprehensive assessment of sleep and circadian rhythms in individuals with and without coronary artery disease (CAD). METHODS: This was a cross-sectional study. Participants were 32 individuals, mean age = 70.9, female 46.9%, 19 with CAD, and 13 without CAD. We assessed sleep quality and 24-hour rest-activity rhythms for 14 days using wrist actigraphy and self-report measures, and circadian rhythm using dim light melatonin onset. RESULTS: Melatonin levels prior to habitual bedtime were significantly lower in individuals with CAD than in those without CAD (median area under the curve = 12.88 vs 26.33 pg/ml × h, P = .049). The median circadian timing measured by dim light melatonin onset was the same for the 2 groups with 20:26 [hours:minutes] for individuals with CAD and 19:53 for the control group (P = .64, r = .14). Compared to the control group, the CAD group had significantly lower amplitude (P = .03, r =-.48), and lower overall rhythmicity (pseudo-F-statistic P = .004, r = -.65) in their 24-hour rest-activity rhythms. CONCLUSIONS: This is one of the first studies to comprehensively assess both sleep and circadian rhythm in individuals with CAD. Compared to non-CAD controls, individuals with CAD had lower levels of melatonin prior to habitual bedtime and a lower 24-hour rest-activity rhythm amplitude and overall rhythmicity. Future studies using larger sample sizes should further investigate the possibility of suppressed circadian rhythmicity in individuals with CAD. CITATION: Moon C, Benson CJ, Albashayreh A, Perkhounkova Y, Burgess HJ. Sleep, circadian rhythm characteristics, and melatonin levels in later life adults with and without coronary artery disease. J Clin Sleep Med. 2023;19(2):283-292.

Nursing Work Environment, Turnover Intention, Job Burnout, and Quality of Care: The Moderating Role of Job Satisfaction.

PURPOSE: The purpose of this study was twofold: (a) to assess predictors of the turnover intention, burnout, and perceived quality of care among nurses working in Oman, and (b) to examine the potential moderating role of job satisfaction on the relationship between work environment and nurse turnover intention. DESIGN: A cross-sectional design was used to collect data from a sample of 207 nurses working in a public hospital in Muscat, Oman. METHODS: An electronic survey was used to assess nurses' perceptions of work environment, burnout, job satisfaction, turnover intention, and quality of care. FINDINGS: Participation in hospital affairs, a foundation for quality of care, and staffing adequacy were predictors of burnout among nurses and perceived quality of care. Logistic regression analysis revealed that working in a favorable environment was associated with less turnover intention, but only when job satisfaction was high. CONCLUSIONS: Improving nurse job satisfaction is a mechanism through which future interventions could enhance working conditions and promote better nurse retention. CLINICAL RELEVANCE: Organizational strategies are needed to increase nurse job satisfaction by empowering nurses to take more active roles in hospital affairs as a strategy to reduce turnover intention and enhance the quality of patient care.

Healthy work environments are critical for nurse job satisfaction: implications for Oman.

AIMS: To (1) examine the level and variability of nurse work environment and job satisfaction and (2) explore how nurse job satisfaction in tertiary hospitals in Oman is influenced by the nurses' characteristics and work environment. BACKGROUND: In Oman and the Middle East, a scarcity of research addressing nurse work environment and job satisfaction exists. Such evidence is necessary for policymaking to positively impact nurse job outcomes, and therefore, quality of care. METHODS: We used a cross-sectional descriptive design employing a sample of 454 local and expatriate nurses who responded to a self-administered questionnaire. RESULTS: The work environment was favourable, and it positively correlated with job satisfaction. Nationality, education, hospital type, staffing, resources and participation in hospital affairs were significant predictors of nurse job satisfaction. The greatest amount of variation in nurse job satisfaction was explained by the work environment. CONCLUSION: The influence of work environment on nurse job satisfaction is greater than nurse characteristics and hospital and unit types. Enhancing nurse participation in hospital affairs and providing adequate staffing and resources are central means of establishing healthy work environments, which is an auspicious, cost-effective strategy for satisfying, and therefore, retaining nurses. IMPLICATIONS FOR NURSING AND HEALTH POLICY: To enhance nurse work environment and job satisfaction in Oman and the Middle East, nurse and health leaders need to consider developing work and professional regulations and adopting policies to promote staffing, resources, wages, and benefits for nurses and encourage their promotion and career advancement; and foster nurse participation in hospital affairs.

Correction to: Human Development Index and its association with staff spiritual care provision: a Middle Eastern oncology study.

Incorrect family name of Layth Mula-Hussain.

Human Development Index and its association with staff spiritual care provision: a Middle Eastern oncology study.

BACKGROUND: Although staff spiritual care provision plays a key role in patient-centered care, there is insufficient information on international variance in attitudes toward spiritual care and its actual provision. METHODS: A cross-sectional survey of the attitudes of Middle Eastern oncology physicians and nurses toward eight examples of staff provision of spiritual care: two questionnaire items concerned prayer, while six items related to applied information gathering, such as spiritual history taking, referrals, and encouraging patients in their spirituality. In addition, respondents reported on spiritual care provision for their last three advanced cancer patients. RESULTS: Seven hundred seventy responses were received from 14 countries (25% from countries with very high Human Development Index (HDI), 41% high, 29% medium, 5% low). Over 63% of respondents positively viewed the six applied information gathering items, while significantly more, over 76%, did so among respondents from very high HDI countries (p value range, p < 0.001 to p = 0.01). Even though only 42-45% overall were positively inclined toward praying with patients, respondents in lower HDI countries expressed more positive views (p < 0.001). In interaction analysis, HDI proved to be the single strongest factor associated with five of eight spiritual care examples (p < 0.001 for all). Significantly, the Middle Eastern respondents in our study actually provided actual spiritual care to 47% of their most recent advanced cancer patients, compared to only 27% in a parallel American study, with the key difference identified being HDI. CONCLUSIONS: A country's development level is a key factor influencing attitudes toward spiritual care and its actual provision. Respondents from lower ranking HDI countries proved relatively more likely to provide spiritual care and to have positive attitudes toward praying with patients. In contrast, respondents from countries with higher HDI levels had relatively more positive attitudes toward spiritual care interventions that involved gathering information applicable to patient care.

Training for awareness of one's own spirituality: A key factor in overcoming barriers to the provision of spiritual care to advanced cancer patients by doctors and nurses.

OBJECTIVE: When patients feel spiritually supported by staff, we find increased use of hospice and reduced use of aggressive treatments at end of life, yet substantial barriers to staff spiritual care provision still exist. We aimed to study these barriers in a new cultural context and analyzed a new subgroup with "unrealized potential" for improved spiritual care provision: those who are positively inclined toward spiritual care yet do not themselves provide it. METHOD: We distributed the Religion and Spirituality in Cancer Care Study via the Middle East Cancer Consortium to physicians and nurses caring for advanced cancer patients. Survey items included how often spiritual care should be provided, how often respondents themselves provide it, and perceived barriers to spiritual care provision.ResultWe had 770 respondents (40% physicians, 60% nurses) from 14 Middle Eastern countries. The results showed that 82% of respondents think staff should provide spiritual care at least occasionally, but 44% provide spiritual care less often than they think they should. In multivariable analysis of respondents who valued spiritual care yet did not themselves provide it to their most recent patients, predictors included low personal sense of being spiritual (p < 0.001) and not having received training (p = 0.02; only 22% received training). How "developed" a country is negatively predicted spiritual care provision (p < 0.001). Self-perceived barriers were quite similar across cultures.Significance of resultsDespite relatively high levels of spiritual care provision, we see a gap between desirability and actual provision. Seeing oneself as not spiritual or only slightly spiritual is a key factor demonstrably associated with not providing spiritual care. Efforts to increase spiritual care provision should target those in favor of spiritual care provision, promoting training that helps participants consider their own spirituality and the role that it plays in their personal and professional lives.

Psychometric Properties of an Arabic Version of the Patient Satisfaction With Nursing Care Quality Questionnaire.

BACKGROUND: Quality measurements are crucial to healthcare quality improvement, and patient satisfaction with nursing care is widely adopted as a key outcome indicator of the overall quality of healthcare. There is a lack of instruments to measure patient satisfaction with nursing care in an Arabic context. PURPOSE: The purpose of this study was to develop and validate an Arabic version of the Patient Satisfaction with Nursing Care Quality Questionnaire and to explore patient satisfaction with nursing care across hospital units. METHODS: This was a cross-sectional, methodological research study. A forward-backward translation process and face and content validation using a panel of experts and a pilot test were used to produce an Arabic version of the Patient Satisfaction with Nursing Care Quality Questionnaire. A convenience sampling technique was employed to recruit 292 adult patients who were hospitalized for more than 48 hours. Data were collected over the first quarter of 2016 using a secure electronic survey method. RESULTS: The item-level content validity index ranged from .83 to 1, and the scale-level content validity index was .94. Evidence of construct validity was obtained. Exploratory factor analysis revealed a two-factor model that explained 69.3% of the total variance. Confirmatory factor analysis showed that the two-factor model fits the observed data. Internal consistency was satisfactory and similar across different hospital units. Cronbach's alpha estimates for Factors 1 and 2 were .83 and .96, respectively, with an overall Cronbach's alpha estimate of .96. Level of patient satisfaction with nursing care was quite high (mean = 4.30/5, SD = 0.74). CONCLUSIONS: This study provides a 17-item, Likert-scaled, self-reporting instrument, which is psychometrically sound for its content, comprehension, readability, and practicality, to measure patient satisfaction with nursing care quality in an Arabic context.

Systematic Review of Nonpharmacologic Approaches for the Management of Gastrointestinal Symptoms.

PROBLEM IDENTIFICATION: To summarize and critique the literature for nonpharmacologic complementary approaches to manage gastrointestinal (GI) symptoms attributed to chemotherapy. LITERATURE SEARCH: A literature search was conducted using CINAHL®, MEDLINE®, and PsycINFO® from database inception through January 2018. DATA EVALUATION: Studies were independently appraised by each author regarding inclusion eligibility and summary of GI symptom outcomes and the nonpharmacologic complementary intervention. SYNTHESIS: 57 studies met inclusion criteria. GI symptoms most commonly evaluated as a chemotherapy outcome were nausea and vomiting and nausea alone. GI symptoms infrequently evaluated as outcomes included diarrhea, anticipatory nausea, and dysgeusia. Ten GI symptoms associated with chemotherapy were not evaluated by any study. Nonpharmacologic interventions included 15 different interventions. IMPLICATIONS FOR RESEARCH: Studies evaluating nonpharmacologic interventions for managing chemotherapy-related GI symptoms have been growing but tend to focus on nausea and vomiting to the exclusion of other relevant GI symptoms. Studies evaluating nonpharmacologic effects on other GI symptoms may make great strides in reducing patient symptom burden.