Preferences for Follow-Up Procedures among Patients Lost to Follow-Up after Smoking Cessation Intervention among Therapists-An Interview Study.

Achieving high follow-up rates after smoking cessation interventions (SCIs) is a general challenge. The aim of this study was to identify preferences among patients and therapists for improving follow-up rates and to assess smoking status at 6 months among patients lost to follow-up. From the Danish STOPbase for Tobacco and Nicotine, which collects data on SCI across health care, 20 representative patients lost to follow-up by routine procedures were identified together with 11 therapists. All participated in individual semi-structured phone interviews, which for patients also included 6-month smoking status. Deductive and inductive analyses were performed. Four themes emerged from the analyses with several subthemes, all regarding contacts. Both patients and therapists preferred to intensify the follow-up process by boosting it with additional attempts and using voice messages, e-mail and/or SMS, calling at specified times of the day and avoiding calls from unknown numbers. In addition, some patients mentioned that they were busy or were not carrying their mobile devices at the time of a call as a barrier. Some therapists mentioned that barriers could include an expectation of relapse, but also a poor mental state, the time of day and patient fear of public systems. Among the patients originally lost to follow-up, 35% (95% CI 16%-59%) experienced continuous smoking cessation for 6 months, and the overall national rate was 22% (21.6-23.3%). In conclusion, both patients and therapists preferred intensified follow-up. The 6-month smoking status for patients lost to follow-up seemed to be similar to that of the routinely followed-up patients. These findings will be examined experimentally in a larger study.

Two novel prehabilitation apps to help patients stop smoking and risky drinking prior to hip and knee arthroplasty.

PURPOSE: Daily smoking or risky drinking increases the risk of complications after surgery by ~50%. Intensive prehabilitation aimed at complete cessation reduces the complication rate but is time-consuming. The purpose of this study was to carry out preoperative pilot tests (randomized design) of the feasibility (1A) and validation (1B) of two novel prehabilitation apps, habeat® (Ha-app) or rehaviour® (Re-app). METHODS: Patients scheduled for hip or knee arthroplasty with daily smoking, risky drinking, or both were randomised to one of the two apps. In part 1A, eight patients and their staff measured feasibility on a visual analog scale (VAS) and were interviewed about what worked well and the challenges requiring improvement. In part 1B, seven patients and their staff tested the improved apps for up to two weeks before validating the understanding, usability, coverage, and empowerment on a VAS and being interviewed. RESULTS: In 1A, all patients and staff returned scores of ≥5 for understanding the apps and mostly suggested technical improvements. In 1B, the scores varied widely for both apps, with no consensus achieved. Two of four patients (Ha-app) and one-third of the patients (Re-app) found the apps helpful for reducing smoking, but without successful quitting. The staff experienced low app competencies among patients and high time consumption. Specifically, patients most often needed help for the Ha-app, and the staff most often for Re-app; however, the staff reported the Re-app dashboard was more user-friendly. Support and follow-up from an addiction specialist staff member were suggested to complement the apps, thereby increasing the time consumption for staff. CONCLUSIONS: This pilot study to test prototype apps generated helpful feedback for the app developers. Based on the patient and staff comments, multiple improvements in functionality seem required before scaling up the evaluation for effect on prehabilitation and postoperative complications.

From Targeted Needs Assessment to Course Ready for Implementation-A Model for Curriculum Development and the Course Results.

This article contributes guidance on how to approach the development of a course curriculum in general and presents a specific example from medical research education. The purpose of this study is to discuss a model for translating needs assessments of targeted learners into a course curriculum. The model employs established methods for data collection, such as different interview approaches and surveys. The authors argue that there is value in going from exploratory in-depth qualitative data collection methods to more conclusive rigorous quantitative methods when developing a course curriculum. In this way, the model is especially sensitive to the needs of targeted learners in the initial phase and at the same time offers a systematic and practical approach to curriculum development. The model is presented step-by-step with the aid of an empirical example of how to assess the needs of medical doctors in the publication process and develop an introductory course in writing an initial manuscript for publication. The article concludes that the proposed model gives curriculum developers a unique opportunity to explore the needs of targeted learners in depth, while systematically aiming towards conclusive decisions on curriculum content ready for implementation.

Working from home during COVID-19 in a Danish hospital research setting: experiences of researchers and healthcare providers, explored by Group Concept Mapping.

OBJECTIVES: The COVID-19 pandemic has changed the working environment, how we think of it and how it stands to develop into the future. Knowledge about how people have continued to work on-site and adjusted to working from home during the COVID-19 lockdown will be vital for planning work arrangements in the post-pandemic period. Our primary objective was to investigate experiences of working from home or having colleagues working from home during a late stage of the COVID-19 lockdown among researchers and healthcare providers in a hospital research setting. Second, we aimed to investigate researchers' productivity through changes in various proxy measures during lockdown as compared with pre-lockdown. DESIGN: Mixed-method participatory Group Concept Mapping (GCM). SETTING AND PARTICIPANTS: GCM, based on a mixed-method participatory approach, was applied involving researchers' and healthcare providers' online sorting and rating experiences working from home during the COVID-19 pandemic. At a face-to-face meeting, participants achieved consensus on the number and labelling of domains-the basis for developing a conceptual model. RESULTS: Through the GCM approach, 47 participants generated 125 unique statements of experiences related to working from home, which were organised into seven clusters. Using these clusters, we developed a conceptual model that illustrated the pros and cons of working from home. CONCLUSION: The future work setting, the role of the office and the overall work environment need to respond to workers' increased wish for flexible work arrangements and co-decision.

Facilitators and Barriers for Young Medical Doctors Writing Their First Manuscript for Publication.

Although scientific publication is often mandatory in medical professions, writing the first research article for publication is challenging, especially as medical curricula have only a minor focus on scientific writing. The aim was therefore to identify facilitators and barriers experienced by medical doctors writing their first scientific article for publication. An explorative inductive approach made use of semi-structured interviews for collecting data until saturation. Data were analyzed with systematic text condensation. Several barriers were identified: (a) writing in general; (b) writing in English; (c) dealing with content, structure, and presentation; and (d) navigating in the author group. Good supervision in the initial writing phase was a facilitating factor. Medical doctors requested a course in which they could work on their own articles and give feedback to fellow students. They valued skilled lecturers and individual supervision, and they wanted to learn about author instructions, how to present text correctly, and how to sell their core message. Their goal was to create a useful end product and to obtain European Credit Transfer System (ECTS) points. The facilitators and barriers that medical doctors experience when writing their first scientific article for publication and their course requests should be reflected in the learning objectives and content of future courses.

The right to smoke and the right to smoke-free surroundings: international comparison of smoke-free psychiatric clinic implementation experiences.

BACKGROUND: In Scandinavia, people with a severe mental disorder have a reduced life expectancy of 15-20 years compared with the general public. Smoking is a major contributor, and smoke-free policies are increasingly adopted in psychiatric clinics around the world. We compared potential facilitators and barriers among staff and management, for the implementation of smoke-free psychiatric clinics. AIMS: To investigate the attitudes and experiences regarding smoke-free policies among managers and staff involved in the implementation processes of smoke-free psychiatric clinics at hospitals in Malmö (Sweden) and Barcelona (Spain). METHOD: We used a qualitative methodology, with 15 semi-structured interviews. The interviews were conducted with each participant individually, and were subsequently transcribed. The data were analysed with systematic text condensation. RESULTS: There were notable differences in how the smoke-free policies were carried out and experienced, and attitudes regarding the policy changes differed in the two settings. Key differences were the views on the right to smoke in compulsory care and to stay in smoke-free surroundings supported by smoking cessation intervention; the prioritisation of staff facilitation of smoking breaks; and views on smoking and smoke-free psychiatry. In contrast, participants agreed on the importance of staff education and management support. A smoking ban by law and belonging to a network of smoke-free hospitals were also relevant. CONCLUSIONS: Staff education, and support from staff and management for the patients' right to stay in smoke-free surroundings, facilitated successful implementation of smoke-free policies in the psychiatric clinics, whereas supporting the right to smoke was a barrier.

Compliance with the Very Integrated Program (VIP) for Smoking Cessation, Nutrition, Physical Activity and Comorbidity Education Among Patients in Treatment for Alcohol and Drug Addiction.

Meeting adherence is an important element of compliance in treatment programmes. It is influenced by several factors one being self-efficacy. We aimed to investigate the association between self-efficacy and meeting adherence and other factors of importance for adherence among patients with alcohol and drug addiction who were undergoing an intensive lifestyle intervention. The intervention consisted of a 6-week Very Integrated Programme. High meeting adherence was defined as >75% participation. The association between self-efficacy and meeting adherence were analysed. The qualitative analyses identified themes important for the patients and were performed as text condensation. High self-efficacy was associated with high meeting adherence (ρ = 0.24, p = 0.03). In the multivariate analyses two variables were significant: avoid complications (OR: 0.51, 95% CI: 0.29-0.90) and self-efficacy (OR: 1.28, 95% CI: 1.00-1.63). Reflections on lifestyle change resulted in the themes of Health and Wellbeing, Personal Economy, Acceptance of Change, and Emotions Related to Lifestyle Change. A higher level of self-efficacy was positively associated with meeting adherence. Patients score high on avoiding complications but then adherence to the intervention drops. There was no difference in the reflections on lifestyle change between the group with high adherence and the group with low adherence.

Self-reported needs for improving the supervision competence of PhD supervisors from the medical sciences in Denmark.

BACKGROUND: Quality of supervision is a major predictor for successful PhD projects. A survey showed that almost all PhD students in the Health Sciences in Denmark indicated that good supervision was important for the completion of their PhD study. Interestingly, approximately half of the students who withdrew from their program had experienced insufficient supervision. This led the Research Education Committee at the University of Copenhagen to recommend that supervisors further develop their supervision competence. The aim of this study was to explore PhD supervisors' self-reported needs and wishes regarding the content of a new program in supervision, with a special focus on the supervision of PhD students in medical fields. METHODS: A semi-structured interview guide was developed, and 20 PhD supervisors from the Graduate School of Health and Medical Sciences at the Faculty of Health and Medical Sciences at the University of Copenhagen were interviewed. Empirical data were analysed using qualitative methods of analysis. RESULTS: Overall, the results indicated a general interest in improved competence and development of a new supervision programme. Those who were not interested argued that, due to their extensive experience with supervision, they had no need to participate in such a programme. The analysis revealed seven overall themes to be included in the course. The clinical context offers PhD supervisors additional challenges that include the following sub-themes: patient recruitment, writing the first article, agreements and scheduled appointments and two main groups of students, in addition to the main themes. CONCLUSIONS: The PhD supervisors reported the clear need and desire for a competence enhancement programme targeting the supervision of PhD students at the Faculty of Health and Medical Sciences. Supervision in the clinical context appeared to require additional competence. TRIAL REGISTRATION: The Scientific Ethical Committee for the Capital Region of Denmark. Number: H-3-2010-101, date: 2010.09.29.

Fractures and alcohol abuse - patient opinion of alcohol intervention.

PURPOSE: To clarify patient opinions about alcohol intervention in relation to surgery before investigating the effect in a Scandinavian multi-centre randomized trial. MATERIAL AND METHODS: A qualitative study. Thirteen consecutive alcohol patients with fractures participated after informed consent. They were interviewed during their hospital stay. The number of participants was based on the criteria of data-saturation. The analysis followed the applied qualitative framework model aimed at evaluation of specific participant needs within a larger overall project. RESULTS: All patients regarded alcohol intervention in relation to surgery as a good idea. They did not consider quit drinking as a major problem during their hospital stay and had all remained abstinent in this period. About half of the patients were ready or partly ready to participate in an alcohol intervention. Patient opinions and their readiness to participate were expressed in four groups, which also reflected their readiness to stop drinking in the perioperative period, their general acceptance of supportive disulfiram as part of an alcohol intervention as well as their awareness of postoperative complications. CONCLUSION: This study clarified that the patients found alcohol intervention relevant in relation to surgery.