Free-text analysis of general practice out-of-hours (GPOOH) use by people with advanced cancer: an analysis of coded and uncoded free-text data.

BACKGROUND: People with advanced cancer frequently use the GP out-of-hours (GPOOH) service. Considerable amounts of routine GPOOH data are uncoded. Therefore, these data are omitted from existing healthcare datasets. AIM: To conduct a free-text analysis of a GPOOH dataset, to identify reasons for attendance and care delivered through GPOOH to people with advanced cancer. DESIGN AND SETTING: An analysis of a GPOOH healthcare dataset was undertaken. It contained all coded and free- text information for 5749 attendances from a cohort of 2443 people who died from cancer in Tayside, Scotland, from 2013-2015. METHOD: Random sampling methods selected 575 consultations for free-text analysis. Each consultation was analysed by two independent reviewers to determine the following: assigned presenting complaints; key and additional palliative care symptoms recorded in free text; evidence of anticipatory care planning; and free-text recording of dispensed medications. Inter-rater reliability concordance was established through Kappa testing. RESULTS: More than half of all coded reasons for attendance (n = 293; 51.0%) were 'other' or 'missing'. Free-text analysis demonstrated that nearly half (n = 284; 49.4%) of GPOOH attendances by people with advanced cancer were for pain or palliative care. More than half of GPOOH attendances (n = 325; 56.5%) recorded at least one key or additional palliative care symptom in free text, with the commonest being breathlessness, vomiting, cough, and nausea. Anticipatory care planning was poorly recorded in both coded and uncoded records. Uncoded medications were dispensed in more than one- quarter of GPOOH consultations. CONCLUSION: GPOOH delivers a substantial amount of pain management and palliative care, much of which is uncoded. Therefore, it is unrecognised and under-reported in existing large healthcare data analyses.

Use of a multi-method approach to rapidly assess the impact of public health policies at the state and local level: a case study of flavored e-cigarette policies.

BACKGROUND: E-cigarettes are the most-commonly used tobacco product by youth since 2014. To prevent youth access and use of e-cigarettes, many U.S. states and localities have enacted policies over a relatively short period of time. The adoption of these policies has necessitated timely data collection to evaluate impacts. METHODS: To assess the impact of flavored e-cigarette policies in select states and local jurisdictions across the United States, a multi-method, complementary approach was implemented from July 2019 to present, which includes analyses of cross-sectional online surveys of young people ages 13-24 years with retail sales data. RESULTS: From February 2020 through February 2023, cross-sectional surveys have been conducted in three cities, one county, and eight states where policy changes have been enacted or are likely to be enacted. Data collection occurred every six months to provide near real-time data and examine trends over time. Additionally, weekly retail sales data were aggregated to showcase monthly sales trends at the national level and for the selected states. DISCUSSION: This rapid and efficient method of coupling online survey data with retail sales data provides a timely and effective approach for monitoring a quickly changing tobacco product landscape, particularly for states and localities where rapidly-available data is often not available. This approach can also be used to monitor other health behaviors and relevant policy impacts.

The Measurement of Dose and Response for Smoking Behavior Change Interventions in the Digital Age: Systematic Review.

BACKGROUND: There is little consensus regarding effective digital health interventions for diverse populations, which is due in part to the difficulty of quantifying the impact of various media and content and the lack of consensus on evaluating dosage and outcomes. In particular, digital smoking behavior change intervention is an area where consistency of measurement has been a challenge because of emerging products and rapid policy changes. This study reviewed the contents and outcomes of digital smoking interventions and the consistency of reporting to inform future research. OBJECTIVE: This study aims to systematically review digital smoking behavior change interventions and evaluate the consistency in measuring and reporting intervention contents, channels, and dose and response outcomes. METHODS: PubMed, Embase, Scopus, PsycINFO, and PAIS databases were used to search the literature between January and May 2021. General and journal-based searches were combined. All records were imported into Covidence systematic review software (Veritas Health Innovation) and duplicates were removed. Titles and abstracts were screened by 4 trained reviewers to identify eligible full-text literature. The data synthesis scheme was designed based on the concept that exposure to digital interventions can be divided into intended doses that were planned by the intervention and enacted doses that were completed by participants. The intended dose comprised the frequency and length of the interventions, and the enacted dose was assessed as the engagement. Response measures were assessed for behaviors, intentions, and psychosocial outcomes. Measurements of the dose-response relationship were reviewed for all studies. RESULTS: A total of 2916 articles were identified through a database search. Of these 2916 articles, the title and abstract review yielded 324 (11.11%) articles for possible eligibility, and 19 (0.65%) articles on digital smoking behavior change interventions were ultimately included for data extraction and synthesis. The analysis revealed a lack of prevention studies (0/19, 0%) and dose-response studies (3/19, 16%). Of the 19 studies, 6 (32%) reported multiple behavioral measures, and 5 (23%) reported multiple psychosocial measures as outcomes. For dosage measures, 37% (7/19) of studies used frequency of exposure, and 21% (4/19) of studies mentioned the length of exposure. The assessment of clarity of reporting revealed that the duration of intervention and data collection tended to be reported vaguely in the literature. CONCLUSIONS: This review revealed a lack of studies assessing the effects of digital media interventions on smoking outcomes. Data synthesis showed that measurement and reporting were inconsistent across studies, illustrating current challenges in this field. Although most studies focused on reporting outcomes, the measurement of exposure, including intended and enacted doses, was unclear in a large proportion of studies. Clear and consistent reporting of both outcomes and exposures is needed to develop further evidence in intervention research on digital smoking behavior change.

SARS-CoV-2 outbreak impact on a trauma unit.

BACKGROUND: From February 2020 onwards, our country has been hit by the coronavirus severe acute respiratory syndrome-2 (SARS-CoV-2) infection. At a glance, hospitals became overrun and had to reformulate all the assistance guidelines, focusing on the coronavirus disease 2019. One year after the start of the pandemic, we present the results of a morbimortality study. AIM: To analyze how our department was affected by the outbreak in terms of morbimortality, and to analyze demographic data, admission to hospital-related data, and subgroups analyses for patients with hip fractures and polytrauma. METHODS: We designed a study comparing data from patients who were admitted to our unit due to a lower limb fracture or a high energy trauma during the pandemic (from March to April 2020) to those admitted during the same period in 2019 before the pandemic. during the pandemic situation. Both cohorts completed a minimum of 6 mo of follow-up. RESULTS: The number of patients admitted to hospital in 2020 was nearly half of those in 2019. Hip fractures in the elderly represented 52 out of 73 of the admitted patients. Twenty patients had a positive test result for SARS-CoV-2 infection. Patients with SARS-CoV-2 infection were admitted to the hospital for a longer time than the non-infected (P < 0.001), and had a higher mortality rate during hospitalization and follow-up (P = 0.02). Patients with a hip fracture associated with a severe respiratory syndrome were mostly selected for conservative treatment (P = 0.03). CONCLUSION: Mortality and readmission rates were higher in the 2020 cohort and during follow-up, in comparison with the cohort in 2019.

Training Residents in Virtual Advance Care Planning: A New Twist in Telehealth.

CONTEXT: Advance care planning (ACP) conversations represent an important physician skill, a need further highlighted by the COVID-19 pandemic. Most resident ACP training occurs in inpatient, settings, often featuring goals of care (GOC) conversations during a crisis. Outpatient clinics are valuable but underutilized settings to provide skills training for residents, yet little research has been done in these spaces. OBJECTIVE: We sought to 1) create an ACP curriculum harnessing the principles of a community of practice in a virtual format, and 2) obtain residents' perspectives regarding their skills and confidence in having early GOC conversations in the outpatient setting. METHODS: We interviewed 48 internal medicine residents using questionnaires, reflective narratives, and transcripts of debriefing conversations. We created a virtual curriculum during the ambulatory week which included didactics, virtual role plays, ACP phone conversations with five patients, and group debriefings. Quantitative data were analyzed for changes in resident confidence. Qualitative data were coded using thematic analysis, guided by instructor field notes. RESULTS: Residents reported decreased confidence in navigating advance directive conversations following training [Z=2.24, P=0.03, r = 0.33]. Resident reflections indicated that they felt more practiced at inpatient late GOC conversation skills, and that these skills were not fully transferable to the outpatient early GOC setting. Residents also endorsed the ambulatory environment as the best space for ACP conversations. CONCLUSION: This study illustrates the feasibility of a virtual format for ACP curriculum. The virtual community of practice created space for a metacognitive unmasking of prior resident unconscious incompetence. Also, inpatient, crisis-oriented late GOC conversation skills may translate poorly to the outpatient setting requiring early and ongoing GOC skills. Residents need more training to navigate ACP conversations in ambulatory environments.

Joint ACPGBI and The Duke's Club statement on colonoscopy training.

Colorectal surgeons across the UK currently undertake a large proportion of routine diagnostic and therapeutic colonoscopy in most NHS Trusts [1]. Meanwhile, the new UK General Surgical curriculum now includes an indicative requirement of 200 diagnostic colonoscopies for surgical trainees who have declared a colorectal subspecialty interest (hereafter termed 'colorectal trainees'), indicating the JCST's (Joint Committee on Surgical Training) commitment to colonoscopy training. However, several studies have reported a marked deficiency in colonoscopy training opportunities and accreditation for surgical trainees compared with gastroenterology trainees [2-4].

CRC COVID: Colorectal cancer services during COVID-19 pandemic. Study protocol for service evaluation.

INTRODUCTION: COVID-19 has had an impact on the provision of colorectal cancer care. The aim of the CRC COVID study is to describe the changes in colorectal cancer services in the UK and USA in response to the pandemic and to understand the long-term impact. METHODS AND ANALYSIS: This study comprises 4 phases. Phase 1 is a survey of colorectal units that aims to evaluate adherences and deviations from the best practice guidelines during the COVID-19 pandemic. Phase 2 is a monthly prospective data collection of service provision that aims to determine the impact of the service modifications on the long-term cancer specific outcomes compared to the national standards. Phase 3 aims to predict costs attributable to the modifications of the CRC services and additional resources required to treat patients whose treatment has been affected by the pandemic. Phase 4 aims to compare the impact of COVID-19 on the NHS and USA model of healthcare in terms of service provision and cost, and to propose a standardised model of delivering colorectal cancer services for future outbreaks. ETHICS AND DISSEMINATION: This study is a service evaluation and does not require HRA Approval or Ethical Approval in the UK. Local service evaluation registration is required for each participating centre. In the USA, Ethical Approval was granted by the Research and Development Committee. The results of this study will be disseminated to stakeholders, submitted for peer review publications, conference presentations and circulated via social media. REGISTRATION DETAILS: Nil.