Improving the Diagnosis of Rib Fractures in the Emergency Department: A Quality Improvement Project in a District General Hospital in the United Kingdom.

Background Falls in older people are a common presentation in emergency departments (ED) in the United Kingdom. They can lead to multiple injuries, including chest wall injuries (CWIs). Untreated CWI carries significant morbidity and mortality. However, its diagnosis remains challenging during the initial ED encounter. This led to a quality improvement project (QIP) to improve the diagnosis of CWI in patients presenting to William Harvey Hospital, a district general, trauma-unit ED in Willesborough, England. Methods The QIP was run from February 2020 to April 2021 for 14 months. A series of plan-do-study-act (PDSA) cycles were completed to increase the proportion of CWIs diagnosed during the initial ED encounter to 90%. The primary interventions involved designing a new thoracic trauma proforma and the introduction of the modified pain, inspiratory effort, and cough (PIC) score to evaluate and triage patients with CWI. Other interventions included the delivery of an education programme on CWI. The secondary aims were to increase modified PIC score use and to reduce the time between ED presentation and computerised tomography (CT) scanning. Results A total of 147 patients were included in three PDSA cycles. The diagnosis of CWI during the initial ED encounter increased from 61% at baseline to 91%. The median time from ED attendance to the first CT reduced from 477 minutes to 169 minutes. Lastly, following the introduction of the thoracic trauma proforma, the modified PIC score was used in 26% of cases of CWI by the end of the QIP period. Conclusion Our QIP led to improvement in the early diagnosis of CWIs in ED, with significant improvements in door to CT time and the creation of a thoracic injury pathway in the trust leading to multi-specialty improvement of care of such patients.

The COVID-19 ambulance response assessment (CARA) study: a national survey of ambulance service healthcare professionals' preparedness and response to the COVID-19 pandemic.

Background: The COVID-19 pandemic placed significant demand on the NHS, including ambulance services, but it is unclear how this affected ambulance service staff and paramedics in other clinical settings (e.g. urgent and primary care, armed services, prisons). This study aimed to measure the self-perceived preparedness and impact of the first wave of the pandemic on paramedics' psychological stress and perceived ability to deliver care. Methods: Ambulance clinicians and paramedics working in other healthcare settings were invited to participate in a three-phase sequential online survey during the acceleration (April 2020), peak (May 2020) and deceleration (September/October 2020) phases of the first wave of COVID-19 in the United Kingdom. Recruitment used social media, Trust internal bulletins and the College of Paramedics' communication channels, employing a convenience sampling strategy. Data were collected using purposively developed open- and closed-ended questions and the validated general health questionnaire-12 (GHQ-12). Data were analysed using multi-level linear and logistic regression models. Results: Phase 1 recruited 3717 participants, reducing to 2709 (73%) by phase 2 and 2159 (58%) by phase 3. Participants were mostly male (58%, n = 2148) and registered paramedics (n = 1992, 54%). Mean (standard deviation) GHQ-12 scores were 16.5 (5.2) during phase 1, reducing to 15.2 (6.7) by phase 3. A total of 84% of participants (n = 3112) had a GHQ-12 score ≥ 12 during the first phase, indicating psychological distress. Participants that had higher GHQ-12 scores were feeling unprepared for the pandemic, and reported a lack of confidence in using personal protective equipment and managing cardiac arrests in confirmed or suspected COVID-19 patients. Conclusions: Most participants reported psychological distress, the reasons for which are multi-factorial. Ambulance managers need to be aware of the risks to staff mental health and take action to mitigate these, to support staff in the delivery of unscheduled, emergency and urgent care under these additional pressures.

Modelling the Predictors of Mobile Health (mHealth) Adoption among Healthcare Professionals in Low-Resource Environments.

This study was conducted with objectives to measure and validate the unified theory of the acceptance and use of technology (UTAUT) model as well as to identify the predictors of mobile health (mHealth) technology adoption among healthcare professionals in limited-resource settings. A cross-sectional survey was conducted at the six public and private hospitals in the two districts (Lodhran and Multan) of Punjab, Pakistan. The participants of the study comprised healthcare professionals (registered doctors and nurses) working in the participating hospitals. The findings of the seven-factor measurement model showed that behavioral intention (BI) to mHealth adoption is significantly influenced by performance expectancy (ß = 0.504, CR = 5.064, p < 0.05) and self-concept (ß = 0.860, CR = 5.968, p < 0.05) about mHealth technologies. The findings of the structural equation model (SEM) showed that the model is acceptable (χ2 (df = 259) = 3.207; p = 0.000; CFI = 0.891, IFI = 0.892, TLI = 0.874, RMSEA = 0.084). This study suggests that the adoption of mHealth can significantly help in improving people's access to quality healthcare resources and services as well as help in reducing costs and improving healthcare services. This study is significant in terms of identifying the predictors that play a determining role in the adoption of mHealth among healthcare professionals. This study presents an evidence-based model that provides an insight to policymakers, health organizations, governments, and political leaders in terms of facilitating, promoting, and implementing mHealth adoption plans in low-resource settings, which can significantly reduce health disparities and have a direct impact on health promotion.

An overview of the capabilities of ChatGPT for medical writing and its implications for academic integrity.

The artificial intelligence (AI) tool ChatGPT, which is based on a large language model (LLM), is gaining popularity in academic institutions, notably in the medical field. This article provides a brief overview of the capabilities of ChatGPT for medical writing and its implications for academic integrity. It provides a list of AI generative tools, common use of AI generative tools for medical writing, and provides a list of AI generative text detection tools. It also provides recommendations for policymakers, information professionals, and medical faculty for the constructive use of AI generative tools and related technology. It also highlights the role of health sciences librarians and educators in protecting students from generating text through ChatGPT in their academic work.

Feasibility and impact of a bespoke pre-hospital point of care ultrasound teaching and training programme at London's air ambulance service.

Introduction: Point-of-care ultrasound has seen an increase in its use in pre-hospital emergency care. There is lack of literature around the training requirement for point-of-care ultrasound of pre-hospital clinicians. This service evaluation assesses the effectiveness of a bespoke hybrid teaching programme. Methods: This is a service evaluation of the point-of-care ultrasound teaching programme at London's Air Ambulance from 1 April to 28 May 2021. Subjects' knowledge, image interpretation and confidence were assessed at two different points. Data were gathered using REDCap and exported to Excel for analysis. Mean values and delta were calculated, and t-test was applied for statistical significance. Results: In total, 57 participants were included; out of which 11 were excluded, as they did not complete a post-course survey. Of these, 41.3% participants were point-of-care ultrasound naïve. Mean pre- and post-course scores were 76.5% and 81.7%, respectively, with an average delta improvement of 5.2% (95% confidence interval = 4.70%-5.68%) which was statistically significant (p < 0.002). There was a statistically significant mean improvement of pre- and post-course scores between point-of-care ultrasound naïve and point-of-care ultrasound experienced groups (p = 0.014). Confidence in using point-of-care ultrasound showed mean overall improvement from 2.36/4 to 3.34/4, a mean difference of 0.98 (95% confidence interval = 0.61-1.34), which was statistically significant (p = 0.0039). Conclusion: Our service evaluation highlighted that a hybrid teaching model used by London's Air Ambulance was feasible and had shown significant improvement in the knowledge, image interpretation and confidence of both the point-of-care ultrasound naïve and the PoCUS experienced cohort of clinicians.

Sonographic Features of a Tuberculous Cold Abscess: A Case Report and Literature Review.

The use of point of care ultrasound (POCUS) to aid diagnosis of tuberculosis has been investigated in countries where concomitant endemic prevalence of HIV increases the incidence of extrapulmonary tuberculosis (EPTB). In such cases, using a focused assessment with sonography for HIV-associated tuberculosis (FASH) scan has found to be immensely advantageous as a rapid diagnostic tool in low resource settings where other imaging modalities are scarce. The prevalence of EPTB in immunocompetent patients in industrialised countries is growing. Since EPTB can manifest itself in almost any part of the human body, symptomatic patients present with constitutional and non-specific symptoms. In our case, a 44-year-old male presented to the emergency department (ED) with a 3-month history of left-sided chest pain and swelling of the chest wall. Clinical examination revealed a swollen and tender lump above the left first rib. Palpation of the thoracic (T7) vertebral body demonstrated localised pain. POCUS showed a collection of heterogenous material with fluid content and specks of hyperechoic 'ring-like' structures. Further investigations led to the diagnosis of EPTB. The patient was admitted and treated for EPTB where he went on to make a full recovery. This case report highlights the role of integrating POCUS in clinical examination of patients with suspected EPTB, which can expedite its diagnosis and management.

The prevalence of low health literacy in undergraduate students in Pakistan.

This Regular Feature is based on a PhD study assessing the level of health literacy among university students in Pakistan. A cross-sectional survey was carried out using the validated European Health Literacy Survey (HLS-EU-Q) and non-parametric tests used to analyse data with the aim of determining the influence of personal determinants on health literacy skills. The findings of the study concluded that the population had a low health literacy level with limited skills in accessing, understanding, appraising and applying information for health care. Gender, age, and native languages, all had a statistically significant influence on health literacy skills. Practical implications are presented for the role of university libraries in supporting the development of health literacy in their undergraduate student populations are presented, including the need for the provision of health information in native languages.

Academic integrity among medical students and postgraduate trainees in the teaching hospitals of South Punjab Pakistan.

This study investigated the topic of the academic integrity among medical students and postgraduate trainees in the teaching hospitals of South Punjab, Pakistan. A cross-sectional survey was conducted involving 318 medical students and postgraduate trainees of teaching hospitals. The results found that medical students of pre-clinical years engaged in unethical behaviour, that is, exam cheating and plagiarism to cope with internal and external evaluation and the range of subjects needed to be studied. For postgraduate trainees, results showed trainees unintentionally engaged in the practice of plagiarism due to lack of understanding about what constitutes plagiarism, coupled with externally perceived pressures associated with expectations of research publication, promotions and tenured positions. To address these concerns, it is recommended that information literacy sessions for undergraduate and postgraduate medical students on plagiarism prevention and ethical practice be designed and facilitated by medical librarians in collaboration of faculty members.

Lung ultrasound in blunt chest trauma: A clinical review.

INTRODUCTION: Bedside lung sonography is recognized as a reliable diagnostic modality in trauma settings due to its ability to detect alterations both in lung parenchyma and in pleural cavities. In severe blunt chest trauma, lung ultrasound can identify promptly life-threatening conditions which may need direct intervention, whereas in minor trauma, lung ultrasound contributes to detection of acute pathologies which are often initially radio-occult and helps in the selection of those patients that might need further investigation. TOPIC DESCRIPTION: We did a literature search on databases EMBASE, PubMed, SCOPUS and Google Scholar using the terms 'trauma', 'lung contusion', 'pneumothorax', 'hemothorax' and 'lung ultrasound'. The latest articles were reviewed and this article was written using the most current and validated information. DISCUSSION: Lung ultrasound is quite accurate in diagnosing pneumothorax by using a combination of four sonographic signs; absence of lung sliding, B-lines, lung pulse and presence of lung point. It provides a rapid diagnosis in hemodynamically unstable patients. Lung contusions and hemothorax can be diagnosed and assessed with lung ultrasound. Ultrasound is also very useful for evaluating rib and sternal fractures and for imaging the pericardium for effusion and tamponade. CONCLUSION: Bedside lung ultrasound can lead to rapid and accurate diagnosis of major life-threatening pathologies in blunt chest trauma patients.

Integrating Social and Family Support as a Measure of Health Outcomes: Validity Implications from the Integrated Model of Health Literacy.

(1) Background: Health literacy (HL) is one of the key determinants of health and healthcare outcomes. The objectives of this study are to measure and validate Sørensen et al.'s integrated model of health literacy (IMHL) in a developing country's youth population, as well as to assess the impact of family affluence and social and family support on healthcare domains. (2) Methods: A cross-sectional survey was carried out of undergraduate university students in 19 public and private sector universities in Pakistan during June-August 2022. A nine-factor measurement model was tested using confirmatory factor analysis (CFA), and structural equation modeling (SEM) based on the 56 valid items obtained from three different validated scales, such as the family affluence scale (FAS-II), the multidimensional scale of perceived social support (MSPSS), and the European Health Literacy Questionnaire (the HLS-EU-Q). (3) Results: The data were collected from 1590 participants with a mean age of 21.16 (±2.027) years. The model fit indices indicate that the model partially fitted the data: χ2 = 4.435, df = 1448, p = 0.000, RMSEA = 0.048, TLI = 0.906, CFI = 0.912, IFI = 0.912, GFI = 0.872, NFI = 0.889, RFI = 0.882, PGFI = 0.791. The structural equation model showed acceptable goodness of fit indices, indicating a significant direct influence of social and family support on healthcare and disease prevention. (4) Conclusions: Social and family support are the most influential factors, with regard to HL dimensions, in improving healthcare, disease prevention, and health promotion in low-income settings and among non-English-speaking communities.

Bradycardia as a Rare Sign of Pulmonary Embolism: A Case Report of Pulmonary Embolism Diagnosis in Cardiac Arrest Using Point-of-Care Ultrasound.

We describe a case of cardiac arrest with pulmonary embolism and deep venous thrombosis diagnosed by point-of-care ultrasound, which resulted in a favorable outcome. In this article, we have also delineated bradycardia as an atypical sign of pulmonary embolism and explained the potential mechanism behind it.

A National Survey of Prehospital Care Services of United Kingdom for Use, Governance and Perception of Prehospital Point of Care Ultrasound.

Introduction: Point of care ultrasound (POCUS) has become a common practice in prehospital care over the last 10 years. There is lack of literature on its use and governance structure in United Kingdom (UK) prehospital care services. We aimed to survey the use, governance of prehospital POCUS among UK prehospital services and perceptions of clinicians and services regarding its utility and barriers to its implementation. Methods: Four electronic questionnaire surveys were delivered to UK helicopter emergency medical service (HEMS) & clinicians, ambulance and community emergency medicine (CEM) services between 1st of April and 31st of July 2021 investigating current use, governance structure for POCUS and perception about its benefits and barriers. Invitations were sent via email to medical directors or research leads of services and using social media. Survey links remained live for two months each. Results: Overall, 90%, 62% and 60% of UK HEMS, ambulance and CEM services respectively, responded to surveys. Most of the services used prehospital POCUS, however only two HEMS organisations fulfilled the Royal College of Radiology governance criteria for POCUS. The most commonly performed POCUS modality was echo in cardiac arrest. Majority of clinicians judged POCUS to be beneficial and the common perceived benefit was promotion of enhanced and effective clinical care. Major barriers to its implementation included a lack of formal governance, limited literature supporting its use and difficulties in performing POCUS in prehospital environment. Conclusion: This survey demonstrates that prehospital POCUS is being provided by a majority of the prehospital care services and clinicians have found it beneficial in providing enhanced clinical care to their patients. However, the barriers to its implementation are relative lack of governance structure and supportive literature.

COVID-19 Misinformation Online and Health Literacy: A Brief Overview.

Low digital health literacy affects large percentages of populations around the world and is a direct contributor to the spread of COVID-19-related online misinformation (together with bots). The ease and 'viral' nature of social media sharing further complicate the situation. This paper provides a quick overview of the magnitude of the problem of COVID-19 misinformation on social media, its devastating effects, and its intricate relation to digital health literacy. The main strategies, methods and services that can be used to detect and prevent the spread of COVID-19 misinformation, including machine learning-based approaches, health literacy guidelines, checklists, mythbusters and fact-checkers, are then briefly reviewed. Given the complexity of the COVID-19 infodemic, it is very unlikely that any of these approaches or tools will be fully effective alone in stopping the spread of COVID-19 misinformation. Instead, a mixed, synergistic approach, combining the best of these strategies, methods, and services together, is highly recommended in tackling online health misinformation, and mitigating its negative effects in COVID-19 and future pandemics. Furthermore, techniques and tools should ideally focus on evaluating both the message (information content) and the messenger (information author/source) and not just rely on assessing the latter as a quick and easy proxy for the trustworthiness and truthfulness of the former. Surveying and improving population digital health literacy levels are also essential for future infodemic preparedness.

An exploration of how fake news is taking over social media and putting public health at risk.

Recent statistics show that almost 1/4 of a million people have died and four million people are affected either with mild or serious health problems caused by coronavirus (COVID-19). These numbers are rapidly increasing (World Health Organization, May 3, 2020c). There is much concern during this pandemic about the spread of misleading or inaccurate information. This article reports on a small study which attempted to identify the types and sources of COVID-19 misinformation. The authors identified and analysed 1225 pieces of COVID-19 fake news stories taken from fact-checkers, myth-busters and COVID-19 dashboards. The study is significant given the concern raised by the WHO Director-General that 'we are not just fighting the pandemic, we are also fighting infodemic'. The study concludes that the COVID-19 infodemic is full of false claims, half backed conspiracy theories and pseudoscientific therapies, regarding the diagnosis, treatment, prevention, origin and spread of the virus. Fake news is pervasive in social media, putting public health at risk. The scale of the crisis and ubiquity of the misleading information require that scientists, health information professionals and journalists exercise their professional responsibility to help the general public identify fake news stories. They should ensure that accurate information is published and disseminated.J.M.

The Covid-19 'infodemic': a new front for information professionals.

The virus, commonly known as COVID-19 which emerged in Wuhan, China, in December 2019, has spread in 213 countries, areas or territories around the globe, with nearly 144 683 deaths worldwide on 18 April 2020. In the wake of this pandemic, we have witnessed a massive infodemic with the public being bombarded with vast quantities of information, much of which is not scientifically correct. Fighting fake news is now the new front in the COVID-19 battle. This regular feature comments on the role of health sciences librarians and information professionals in combating the COVID-19 infodemic. To support their work, it draws attention to the myth busters, fact-checkers and credible sources relating to COVID-19. It also documents the guides that libraries have put together to help the general public, students and faculty recognise fake news.

Outcome of upper respiratory tract infections in healthy children: Antibiotic stewardship in treatment of acute upper respiratory tract infections.

OBJECTIVE: The objective of the study was to assess the outcome of upper respiratory tract infections (URTI) in healthy children. METHODS: This descriptive study was conducted on 314 children aged 3-36 months in the paediatric outpatient clinic and emergency department with symptoms of URTI (fever, cough, rhinorrhoea) for ≤5 days. Patient's demographics, clinical features, laboratory data and outcome were recorded. Follow up phone calls were made to parents on day 7 (response 93.6%) and day 14 (response 94.6%) to record outcome. RESULTS: A total of 314 children with URTIs were included. Majority (57.6%) were males and <1year of age (40%). Common manifestations of URTI were fever (89%), cough (79%), rhinorrhoea (62%), pharyngitis (79%) and conjunctivitis (46%). More than half (53%) had history of contact with URTI in a family member. Mean duration of symptoms was 2.7±1.3 days. Majority (93%) of children were given supportive treatment and only 6.7% received antibiotics initially. Most of children (76%) recovered within one week and 91.8% within two weeks with supportive care only. Only 4% children were hospitalized and 12% required follow up visit of which 16% needed oral antibiotics. Complications or deaths did not occur. CONCLUSIONS: Majority of URTIs in healthy children resolved with supportive treatment and do not require antibiotics. Antibiotic stewardship in simple URTIs should be practiced using awareness and advocacy campaigns.

Measures of self-efficacy among doctors in conducting an online search for clinical decision making.

OBJECTIVES: To measure the perceived ability and level of confidence among doctors in performing the different tasks involved in conducting an online search for clinical decision making. METHODS: A large-scale cross-sectional survey was conducted in 36 District Headquarter Hospitals (DHQs), 89 Tehsil Headquarter Hospitals (THQs), 293 Rural Health Centers (RHCs) and 2455 Basic Health Units (BHUs) in Punjab, Pakistan. Using a quota sampling, data were collected from 517 doctors on a set of 11 statements. The collected data were analysed statistically. RESULTS: Of the 517 doctors, 73 (14.1%) had 'never accessed health care information online' for clinical decision making. Mean values of the doctors' response to the 11 statements ranged from 1.66 to 2.30 indicating that most of the doctors were 'not confident' in their ability to perform the tasks. CONCLUSION: The majority of doctors perceived themselves able to perform the different tasks involved in conducting an online search. Age and working experience were significant factors in the perception of their ability in performing the tasks. The study recommends promotional and educational activities to motivate interest, increase awareness, develop knowledge and skills for doctors to access information that would help in their clinical decision making.

Proposed information outreach programme in primary and secondary health care of Punjab, Pakistan.

The study reported is part of Dr. Naeem's doctoral research, supervised by Professor Bhatti, with the objective to propose an information outreach programme for health care professionals working in rural areas of the Punjab province, Pakistan. A cross-sectional survey was conducted involving 517 practitioners from across different health care facilities in the area. The goals of the outreach programme are identified on the basis of the findings regarding practitioners' current usage and awareness of, as well as attitude and self-efficacy towards using health information resources. The identification of these goals and their related activities, including logistical, promotional and educational, results in a model of the required inputs and investments to achieve both the short term, intermediate and long term results of the programme. F.J.

Clinical information needs and access in primary health care: a comparative cross-sectional study of rural and non-rural primary care physicians.

BACKGROUND: Primary care physicians (PCPs) need a wide range of clinical information (CI) resources to manage their patients. Continued access to these resources in their practice settings provides self-reliance and a better approach towards clinical decision making. OBJECTIVE: To compare the PCPs CI needs and access to CI in rural versus non-rural practice setting. METHODS: A comparative cross-sectional survey was conducted in the Government health centres of the District of Multan, Pakistan. PCPs were classified into rural and non-rural according to their practice setting using the State Office of Rural Health definition. Rural means 'more than 10 miles from a population centre of 30 000 or more'. RESULTS: The CI needs of rural and non-rural PCPs were the same, but rural PCPs had significantly less access to nearly all CI resources when compared to non-rural PCPs. Age was a major determining factor of perceived information needs for continuing medical education but not for accessing CI. DISCUSSION: Primary care physicians in rural settings face innumerable difficulties in accessing the required CI due to non-existence of libraries and poor information infrastructure. CONCLUSION: Despite no difference in information needs, rural PCPs have significantly less access to CI resources. The study suggests ways to address the inequality in provision of CI resources.