Monitoring real-time junior doctor sentiment from comments on a public social media platform: a retrospective observational study.

OBJECTIVES: To investigate whether sentiment analysis and topic modelling can be used to monitor the sentiment and opinions of junior doctors. DESIGN: Retrospective observational study based on comments on a social media website. SETTING: Every publicly available comment in r/JuniorDoctorsUK on Reddit from 1 January 2018 to 31 December 2021. PARTICIPANTS: 7707 Reddit users who commented in the r/JuniorDoctorsUK subreddit. MAIN OUTCOME MEASURE: Sentiment (scored -1 to +1) of comments compared with results of surveys conducted by the General Medical Council. RESULTS: Average comment sentiment was positive but varied significantly during the study period. Fourteen topics of discussion were identified, each associated with a different pattern of sentiment. The topic with the highest proportion of negative comments was the role of a doctor (38%), and the topic with the most positive sentiment was hospital reviews (72%). CONCLUSION: Some topics discussed in social media are comparable to those queried in traditional questionnaires, whereas other topics are distinctive and offer insight into what themes junior doctors care about. Events during the coronavirus pandemic may explain the sentiment trends in the junior doctor community. Natural language processing shows significant potential in generating insights into junior doctors' opinions and sentiment.

'Learning from home': role of e-learning methodologies and tools during novel coronavirus pandemic outbreak.

BACKGROUND: During the crucial time of coronavirus pandemic, education is being remodelled: opening the doors of electronic learning (e-learning). The review emphasises on the various e-learning methods that can be used in the current scenario. METHODS: The review was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines on databases, namely, PubMed, Google Scholar and Cochrane. Out of 1524 identified articles, after the process of screening and based on the eligibility criteria, 45 full-text articles were reviewed. RESULTS: Though there are many caveats on the path of successful implementation this is the right time that we step towards e-learning. The article discusses the methods and tools in e-learning that can modify the traditional ways of content delivery, record maintenance, assessment and feedback. CONCLUSION: During the period of 'planet arrest', when the whole world is locked down with the motive of social distancing, let us stay connected with e-learning.

Facilitators and barriers of digital health technologies implementation in hospital settings in lower-income and middle-income countries since the COVID-19 pandemic: a scoping review protocol.

INTRODUCTION: The implementation of digital health technologies (DHTs) in hospitals worldwide has been uneven since the COVID-19 pandemic. Ambiguity in defining the landscape of DHTs adds to the complexity of this process. To address these challenges, this scoping review aims to identify the facilitators and barriers of implementing DHTs in hospitals in lower-income and middle-income countries (LMIC) since COVID-19, describe the DHTs that have been adopted in hospital settings in LMIC during this period, and develop a comprehensive classification framework to define the landscape of DHTs implemented in LMIC. METHODS AND ANALYSIS: We will conduct a systematic search in PubMed, Scopus, Web of Science and grey literature. Descriptive statistics will be used to report the characteristics of included studies. The facilitators and barriers to DHTs implementation, gathered from both quantitative and qualitative data, will be synthesised using a parallel-results convergent synthesis design. A thematic analysis, employing an inductive approach, will be conducted to categorise these facilitators and barriers into coherent themes. Additionally, we will identify and categorise all available DHTs based on their equipment types and methods of operation to develop an innovative classification framework. ETHICS AND DISSEMINATION: Formal ethical approval is not required, as primary data collection is not involved in this study. The findings will be disseminated through peer-reviewed publications, conference presentations and meetings with key stakeholders and partners in the field of digital health.

Study to evaluate the readability and visual appearance of online resources for blunt chest trauma: an evaluation of online resources using mixed methods.

OBJECTIVES: Blunt chest trauma (BCT) is characterised by forceful and non-penetrative impact to the chest region. Increased access to the internet has led to online healthcare resources becoming used by the public to educate themselves about medical conditions. This study aimed to determine whether online resources for BCT are at an appropriate readability level and visual appearance for the public. DESIGN: We undertook a (1) a narrative overview assessment of the website; (2) a visual assessment of the identified website material content using an adapted framework of predetermined key criteria based on the Centers for Medicare and Medicaid Services toolkit and (3) a readability assessment using five readability scores and the Flesch reading ease score using Readable software. DATA SOURCES: Using a range of key search terms, we searched Google, Bing and Yahoo websites on 9 October 2023 for online resources about BCT. RESULTS: We identified and assessed 85 websites. The median visual assessment score for the identified websites was 22, with a range of -14 to 37. The median readability score generated was 9 (14-15 years), with a range of 4.9-15.8. There was a significant association between the visual assessment and readability scores with a tendency for websites with lower readability scores having higher scores for the visual assessment (Spearman's r=-0.485; p<0.01). The median score for Flesch reading ease was 63.9 (plain English) with a range of 21.1-85.3. CONCLUSIONS: Although the readability levels and visual appearance were acceptable for the public for many websites, many of the resources had much higher readability scores than the recommended level (8-10) and visually were poor.Better use of images would improve the appearance of websites further. Less medical terminology and shorter word and sentence length would also allow the public to comprehend the contained information more easily.

IMproving psYchosocial adjustment to Traumatic Brain Injury from acute to chronic injury through development and evaluation of the myTBI online psychoeducation platform: protocol for a mixed-methods study.

INTRODUCTION: This protocol describes the myTBI study which aims to: (1) develop an online psychoeducation platform for people with traumatic brain injury (TBI), their family members/caregivers, and healthcare staff to improve psychosocial adjustment to TBI across different phases of injury (acute, postacute, and chronic), and (2) undertake an evaluation of efficacy, acceptability, and feasibility. METHODS AND ANALYSIS: A three-stage mixed-methods research design will be used. The study will be undertaken across four postacute community-based neurorehabilitation and disability support services in Western Australia. Stage 1 (interviews and surveys) will use consumer-driven qualitative methodology to: (1) understand the recovery experiences and psychosocial challenges of people with TBI over key stages (acute, postacute, and chronic), and (2) identify required areas of psychosocial support to inform the psychoeducation platform development. Stage 2 (development) will use a Delphi expert consensus method to: (1) determine the final psychoeducation modules, and (2) perform acceptance testing of the myTBI platform. Finally, stage 3 (evaluation) will be a randomised stepped-wedge trial to evaluate efficacy, acceptability, and feasibility. Outcomes will be measured at baseline, postintervention, follow-up, and at final discharge from services. Change in outcomes will be analysed using multilevel mixed-effects modelling. Follow-up surveys will be conducted to evaluate acceptability and feasibility. ETHICS AND DISSEMINATION: Ethics approval was granted by North Metropolitan Health Service Mental Health Research Ethics and Governance Office (RGS0000005877). Study findings will be relevant to clinicians, researchers, and organisations who are seeking a cost-effective solution to deliver ongoing psychoeducation and support to individuals with TBI across the recovery journey. TRIAL REGISTRATION NUMBER: ACTRN12623000990628.

Usability of technological tools to overcome language barriers in health care: a scoping review protocol.

INTRODUCTION: In many healthcare contexts globally, where the languages of care providers and patients do not match, miscommunication or non-communication can lead to inaccurate diagnoses and subpar treatment outcomes. In order to bridge these language barriers, a range of informal practices are used, such as family members or staff acting as interpreters, 'receptive multilingualism' or machine translation. The development and use of technological tools are increasing, but factors such as translation quality for complex health-related texts vary widely between languages. The objective of this scoping review is to (1) identify and describe the technological tools used in direct patient-provider communication to overcome a language barrier in a healthcare setting, (2) identify how the usability of these tools was evaluated and (3) assess the usability of the technological tools. METHODS AND ANALYSIS: The scoping review will follow the Joanna Briggs Institute methodology. A search strategy using variations of the keywords 'technological tools', 'language barrier' and 'healthcare' will be applied in the following databases and research platforms: PubMed, PsycArticle, Scopus, EBSCOhost, ProQuest and Web of Science. All literature where individuals use a technological tool to overcome a language barrier in a healthcare context will be included and exported into the screening assistant software Rayyan. The search will be limited to articles written in German or English. Two independent reviewers will screen the articles, and all relevant extracted data will be presented in a descriptive summary. ETHICS AND DISSEMINATION: This scoping review does not require ethical approval, as the study's methodology consists of collecting data from publicly available sources. The findings will be disseminated through publication in an open-access, peer-reviewed journal and presentations at scientific conferences. The scoping review results will also guide future research in a multinational project investigating multilingualism in providing (mental) healthcare to migrants.

How is primary care access changing? A retrospective, repeated cross-sectional study of patient-initiated demand at general practices in England using a modern access model, 2019-2022.

OBJECTIVES: To explore trends in patient-initiated requests for general practice services and the association between patient characteristics including demographics, preferences for care and clinical needs and modes of patient contact (online vs telephone), and care delivery (face-to-face vs remote) at practices using a modern access model. DESIGN: Retrospective repeated cross-sectional study spanning March 2019 to February 2022. SETTING: General practices in England using the askmyGP online consultation system to implement a modern general practice access model using digital and non-digital (multimodal) access pathways and digitally supported triage to manage patient-initiated requests. PARTICIPANTS: 10 435 465 patient-initiated requests from 1 488 865 patients at 154 practices. RESULTS: Most requests were initiated online (72.1% in 2021/2022) rather than by telephone. Online users were likely to be female, younger than 45 years, asking about existing medical problems, had used the system before and frequent attenders (familiar patients). During the pandemic, request rates for face-to-face consultations fell while those for telephone consultations and online messages increased, with telephone consultations being most popular (53.8% in 2021/2022). Video was seldom requested. More than 60% of requests were consistently delivered in the mode requested. Face-to-face consultations were more likely to be used for the youngest and oldest patients, new medical problems, non-frequent attenders (unfamiliar patients) and those who requested a face-to-face consultation. Over the course of the study, request rates for patients aged over 44 years increased, for example, by 15.4% (p<0.01) for patients aged over 74 years. Rates for younger patients decreased by 32.6% (p<0.001) in 2020/2021, compared with 2019/2020, before recovering to prepandemic levels in 2021/2022. CONCLUSIONS: Demand patterns shed light on the characteristics of patients making requests for general practice services and the composition of the care backlog with implications for policy and practice. A modern general practice access model can be used effectively to manage patient-initiated demand.

Web-based interventions to improve blood pressure control in patients with hypertension: a protocol for a systematic review.

INTRODUCTION: Hypertension is the major cause of cardiovascular disease and mortality in the world. Blood pressure control (BPC) is recognised as a key measure in the management of hypertension. Several studies have been conducted assessing the impact of specific web-based interventions in improving BPC. Our systematic review intends to identify all the available web-based interventions and determine if and which are more effective than usual care in improving BPC. METHODS AND ANALYSIS: We will include randomised control trials completed until April 2023 including patients diagnosed with hypertension comparing the effect of receiving usual care versus web-based interventions in BPC. No language restriction will be applied. We will start with an extensive electronic database search, in the Cochrane Central Register of Controlled Trials, PubMed, Embase, Scopus, EU Clinical Trials Register, Pan-African Clinical Trials Registry and ClinicalTrials.gov. Eligibility criteria will be applied blindly and independently by two researchers to the title and abstract of the references, in the first stage, and to the full version of the ones selected. All divergences will be solved by a third researcher. We will conduct a narrative description and meta-analysis (if adequate) of the results of the included studies, structured according to the type of intervention, characteristics of the population and outcome measurement. We will extract features of the web-based interventions, selecting the ones with the best outcomes regarding BPC, to later propose an ideal web-based intervention to improve BPC in hypertensive patients and/or guide future research on this topic. The risk of bias will be assessed using Cochrane's RoB2 Tool. ETHICS AND DISSEMINATION: Ethical approval is not required since this is a protocol for a systematic review. The findings of this study will be disseminated through peer-reviewed publications and national or international conference presentations. Updates of the review will be conducted, as necessary. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42020184166.

CPD in the remote environment: a role for practice-based small group learning?

BACKGROUND: Continuous professional development (CPD) is recognised as essential and mandated by the Royal College of General Practitioners and other medical professional colleges. However, it can be difficult to maintain when deployed and remote from normal training and support structures. There is no literature directly discussing how military doctors in the deployed and remote environment maintain CPD and if practice-based small group learning (PBSGL) could be an appropriate tool to facilitate this in future. AIM: To describe the CPD experience of medical officers (MOs) working for the Defence Medical Services (DMS) and assess if offering PBSGL would be welcomed and likely beneficial. DESIGN AND SETTING: This is a quantitative survey of doctors working in primary care within the DMS. METHOD: A questionnaire was designed to elicit opinions, current practice and previous experience of CPD within the deployed and firm base environments. It also aimed to elicit prior experience of and appetite for PBSGL as a solution. This was then distributed via email to MOs working for the DMS. RESULTS: 130 responses (25%) were received. 122 (96%) had heard of PBSGL, 56% had participated in PBSGL in the firm base. 60% agreed or strongly agreed PBSGL was an effective way to maintain CPD. 73% reported eLearning as a mode of maintaining CPD while deployed or working in a remote environment. CONCLUSION: This study demonstrated that many general practitioners deployed to remote locations feel that CPD provision could be improved and that PBSGL is a potential solution.

Investigating online activity in UK adolescent mental health patients: a feasibility study using a natural language processing approach for electronic health records.

OBJECTIVES: To assess the feasibility of using a natural language processing (NLP) application for extraction of free-text online activity mentions in adolescent mental health patient electronic health records (EHRs). SETTING: The Clinical Records Interactive Search system allows detailed research based on deidentified EHRs from the South London and Maudsley NHS Foundation Trust, a large south London Mental Health Trust providing secondary and tertiary mental healthcare. PARTICIPANTS AND METHODS: We developed a gazetteer of online activity terms and annotation guidelines, from 5480 clinical notes (200 adolescents, aged 11-17 years) receiving specialist mental healthcare. The preprocessing and manual curation steps of this real-world data set allowed development of a rule-based NLP application to automate identification of online activity (internet, social media, online gaming) mentions in EHRs. The context of each mention was also recorded manually as: supportive, detrimental or neutral in a subset of data for additional analysis. RESULTS: The NLP application performed with good precision (0.97) and recall (0.94) for identification of online activity mentions. Preliminary analyses found 34% of online activity mentions were considered to have been documented within a supportive context for the young person, 38% detrimental and 28% neutral. CONCLUSION: Our results provide an important example of a rule-based NLP methodology to accurately identify online activity recording in EHRs, enabling researchers to now investigate associations with a range of adolescent mental health outcomes.

Differences in humble leadership and team performance in nursing: an online cross-sectional study.

OBJECTIVES: The current study measures the differences in humble leadership and team performance in nursing based on the sample's characteristics. DESIGN: A cross-sectional study. SETTING: In 2022, the current study sample was recruited from governmental and private universities and hospitals using an online survey. PARTICIPANTS: A convenience snowball sample of 251 nursing educators, nurses and students was recruited. RESULTS: A leader's humble leadership, a team's humble leadership and overall humble leadership were at moderate levels. The overall mean team performance was 'working well'. The single male humble leaders, aged more than 35 years and working full-time in an organisation with quality initiatives, have a higher leader's humble leadership. Members of the team aged more than 35 years working full-time in organisations with quality initiatives have a higher team's humble leadership. Team performance in organisations with quality initiatives was higher in resolving many conflicts by compromising between team members, with each one giving in a little. There was a moderate correlation (r=0.644) between the total scores of the overall humble leadership and team performance. Humble leadership correlated significantly but negatively and weakly with quality initiatives (r=-0.169) and the participant's role (r=-0.163). There was no significant correlation between team performance and the sample's characteristics. CONCLUSIONS: Humble leadership has positive outcomes, such as team performance. The shared sample characteristic that sets the differences between a leader's and a team's humble leadership and team performance was the presence of quality initiatives in the organisation. The shared sample characteristics that set the differences in a leader's and a team's humble leadership were working full-time and the presence of quality initiatives in the organisation. Humble leaders are contagious; they will produce creative team members by 'social contagion', 'behavioural similarity', 'team potency' and 'collective focus'. Thus, leadership protocols and interventions are mandated to fuel humble leadership and team performance.

Testing the effectiveness of a mobile approach avoidance intervention and measuring approach biases in an ecological momentary assessment context: study protocol for a randomised-controlled trial.

INTRODUCTION: Unhealthy eating behaviour is a major contributor to obesity and related diseases and is associated with a behavioural bias to approach rather than avoid desired foods, as measured with reaction time tasks. Approach-avoidance interventions (AAIs) have been proposed as a way to modify food evaluations and help people to eat in accordance with their dietary goals. Mobile implementations of AAI might be easily accessible, low threshold interventions, but their effectiveness has not been established yet. METHODS AND ANALYSIS: Participants who aim to change their eating behaviour are randomised to intervention or control groups. They complete six sessions of a smartphone-based AAI, in which they push (ie, avoid) or pull (ie, approach) personalised food images. Intervention group participants always avoid foods that they personally want to eat less often and approach foods that they personally want to eat more often. In the control group, images are paired equally often with both response directions. To evaluate contextual and dynamic intervention effects, ecological momentary assessment (EMA) is measured throughout, with questions about food intake, hunger, stress, emotions, eating intentions, food craving and impulsivity twice a day. Additional EMA preintervention and postintervention measures are administered before and after the intervention phase (4 days each) with a 1-day follow-up EMA 4 weeks after the intervention. Multilevel models will examine the temporal covariance between approach bias and self-reported variables as well as short-term and long-term intervention effects on approach bias, food intake and craving. ETHICS AND DISSEMINATION: The study was approved by the Ethics Committee of the University of Salzburg. Results will be published in peer-reviewed scientific journals and presented at scientific conferences. TRIAL REGISTRATION NUMBER: German Clinical Trials Register DRKS, registration number DRKS00030780.