Development and Implementation of a Family Presence Facilitator Curriculum for Interprofessional Use in Pediatric Medical Resuscitations.

Introduction: Family presence during pediatric medical resuscitation has myriad benefits. However, there is significant heterogeneity in provider acceptance and implementation of the family support role. We designed this curriculum to teach all members of the health care team best practices in the Family Presence Facilitator (FPF) role during pediatric medical resuscitations. Methods: We applied Kern's six-step approach to develop an FPF curriculum comprising didactic and interactive elements, along with training for simulated participants. We implemented the curriculum through (a) live sessions (30-minute didactic or 90-minute workshop) for learners; (b) a 20-minute asynchronous version of the didactic curriculum for self-directed learning; and (c) a 1-hour, monthly, in situ simulation curriculum in a pediatric emergency department setting. Curriculum evaluation surveys queried self-reported engagement, satisfaction, relevance, confidence, commitment, knowledge, skills, and attitudes in a retrospective pre/post format. Results: We collected data from 153 learners, including attendings, fellows, residents, advanced practice providers, medical students, and child life specialists, between October 2022 and September 2023. Only 22% of participants had received similar prior training. One hundred percent of learners found the curriculum enjoyable and engaging; learners also agreed the curriculum improved their knowledge and skills in providing empathetic and respectful communication (99%); nonspeculative, clear information (100%); and nonverbal support (99%). Of respondents, 100% believed the curriculum would improve the patient care experience. Discussion: Facilitating family presence during pediatric medical resuscitations is a crucial skill. Our curriculum improves self-reported confidence, knowledge, and skills among interprofessional learners. Next steps include expanding this curriculum beyond the pediatric setting.

Current approaches to diagnosing and treating idiopathic granulomatous mastitis: A summary from in-depth clinician interviews.

Background: Idiopathic granulomatous mastitis (IGM) is a rare, chronic inflammatory breast condition primarily affecting women of reproductive age. Its diagnosis is challenging due to similarities with other breast disorders, necessitating exclusion of other granulomatous diseases. The management of IGM remains inconsistent and unclear, with high recurrence rates and varying practices. Methods: This qualitative study involved semi-structured interviews with nine clinicians from Singapore, Malaysia, and Egypt to examine current diagnostic and therapeutic approaches for IGM. Transcripts were analysed using NVivo software for coding and summarisation. Findings: Clinicians predominantly used imaging and histopathology for diagnosis. Treatment commonly involved corticosteroids, though dosages and tapering regimens varied widely. Methotrexate was used sparingly for refractory cases due to associated risks. Surgical interventions were infrequent, reflecting a preference for medical management. There was a consensus on the need for randomised controlled trials (RCTs) to establish standardised treatment protocols. Interpretation: This study reveals the complex nature of IGM diagnosis and treatment from clinicians in Singapore, Malaysia and Egypt. This underscores the need for more specific and definitive diagnostic tests, rather than relying on exclusionary methods, and standardised treatment guidelines. Multi-centre RCTs are essential for developing evidence-based protocols to improve patient outcomes and address regional differences effectively.

Not From Around Here: Evaluation of In-Person Interviews in an Urban General Surgery Residency Program.

OBJECTIVE: This study used a program evaluation approach to investigate the perceptions of utilizing in-person applicant interviews for a general surgery residency program. DESIGN: The study utilized de-identified data routinely collected during the residency program applicant interviews in the General Surgery Residency Program during the fall of 2023. Applicant and faculty/resident exit interview questionnaires were developed to evaluate perceptions of in-person interviewing; the questions were informed by domains for considering the appropriateness and feasibility of continuing in-person interviews as identified by the institution's Graduate Medical Education Committee. Applicants completed the survey at the end of their interview day; faculty and resident interviewers completed the survey following the applicant rank meeting. SETTING: The Sponsoring Institution approved a pilot transition from virtual to in-person interviews for the General Surgery Residency Program 2023 recruitment cycle. Surveys were completed electronically. PARTICIPANTS: Sixty-four applicants were interviewed and requested to complete the exit survey. The survey was completed by 55 (Response rate = 86%) program applicants and eight (Response rate = 100%) faculty and residents in the program. RESULTS: 49.1% of applicants indicated a preference for in-person interviews, 40.0% of applicants indicated a preference to choose and only 10.9% indicated a preference for virtual interviews. Applicants from out-of-state had a significantly higher preference for in-person interviews than those from in-state. Applicants and faculty interviewers perceived in-person interviews to provide a strong assessment of applicants. Applicants from out-of-state had a significantly higher confidence in their ability to demonstrate their strength and assess fit than those from in-state. CONCLUSIONS: While most applicants and faculty interviewers were generally comfortable with an in-person interviewing format, applicants from out-of-state had a particularly high preference for and perception of in-person interviews. General surgery residency programs and sponsoring institutions would benefit from the development of a comprehensive program evaluation strategies for their residency program interviews to make evidence-informed decisions about how best to structure interviews for their programs.

Exploring Journey Maps as Products From Qualitative Research: Application Through Food Insecure Veterans' Experiences.

Journey maps are graphic representations of participant, user, customer, or patient experiences or "journeys" with a particular phenomenon, product, business, or organization. Journey maps help visualize complex pathways and phases in accessible, digestible ways. They also capture emotions, reactions, and values associated with the processes participants undergo, complemented by images or quotes from participants. Here, we outline the foundations of journey maps in research and in practice settings. Our goal is to describe journey maps to researchers new to the product and emphasize the novelty and utility of journey maps as visual products from qualitative research particularly in a health setting. To explore journey maps-including their benefits, drawbacks, and relevance-we discuss examples including our own process for designing a journey map of food insecure Veterans' experiences using qualitative, in-depth interviews and supported by member checking. Our journey map depicts food insecurity as a repetitive process, a unique contribution given that many journey maps are designed with discrete starting and stopping points. We conclude by discussing the novelty of journey maps as innovative products that researchers can use to identify opportunities for process improvements and innovation using multiple data sources or methods.

Applicability of a digital health application for cancer patients: a qualitative non-participation analysis.

BACKGROUND: The use of digital health applications (German acronym DiGA) for comprehensive patient care is increasing rapidly. Patients with non-organic insomnia can be prescribed an application to manage insomnia. Due to the high prevalence of insomnia in patients with cancer, we were interested in the effect of it and what barriers need to be overcome for its use. The focus of existing studies on acceptance and benefits prompted us to emphasise the analysis of barriers and thus to formulate possible solutions. METHODS: To analyse the barriers of use, the study population (patients with self-reported tiredness or sleep disturbance via validated instruments and cancer disease) was divided into 3 groups. In groups 1 (patients who refused to participate in advance) and 2 (patients who refused a prescription), short close-ended questionnaires were used for non-response assessment by treating oncologists. Problem-centred guidelines were used for the telephone interviews with group 3 (patients who did not provide information on DiGA use). Alternatively, group 3 was invited to complete and return the close-ended questionnaire. A quantitative analysis of the non-response reasons was conducted using SPSS in groups 1 and 2, while MAXQDA was used for the qualitative data in group 3. RESULTS: Patients refused to participate at several stages of our study. Quantitative data are available for groups 1 and 2. In the largest group 1, 62% of patients refused to participate due to non-subjective sleep disturbance (177 out of 189 patients) during recruitment by treating oncologists, despite high scores on the screening tool. In the small group 2 (11 out of 15), the most common reasons for withdrawal documented by the oncologists were loss of interest and deteriorating health. The problem-centred qualitative interviews with group 3 (17 patients) revealed that some of them used the prescribed DiGA, despite not being included in the main study and being categorized as lost to follow-up. CONCLUSION: Analysis of barriers to DiGA use showed that reducing administrative barriers and providing digital and personal support can increase acceptance of the use of DiGAs among cancer patients. Additionally, screening tools can act as a door opener to further communication regarding DiGAs. TRIAL REGISTRATION: German Register of Clinical Trials DRKS00034198, registration date: 7/05/24 (retrospectively registered).

Perspectives on advance research directives from individuals with mild cognitive impairment and family members: a qualitative interview study.

Background: Advance research directives (ARDs) provide a promising way to involve individuals with mild cognitive impairment (MCI) in research decisions before they lose the capacity to consent. At the same time, the views of people with MCI on ARDs are underexplored. This study assesses the perceptions of people with MCI and family members on the benefits and challenges associated with ARDs. Aims: The aim of this study was to investigate the perspectives of individuals with MCI and family members of individuals with MCI on ARDs. We focus specifically on willingness to participate in nontherapeutic research, understanding of ARDs and the ethical considerations involved. Methods: Thirteen open-ended, face-to-face interviews were conducted using a semi-structured format. Seven interviews were conducted with individuals with MCI, and six with family members of individuals with MCI. The narratives were transcribed verbatim and qualitative content analysis was carried out. Results: Research participation and ARDs were viewed positively, largely based on altruistic motives and the desire to contribute to society. The participants recognized the potential advantages of ARDs in reducing the decision-making burden on family members and maintaining personal autonomy. They also highlighted challenges in comprehending ARDs and navigating the complexities surrounding potential conflicts between current preferences versus preferences described in an ARD. Conclusions: ARDs were predominantly seen as valuable instruments that enable individuals with MCI to participate in research. This study provides insights into the reasons why affected individuals are interested in drafting ARDs. These insights can guide the development of supportive interventions that are tailored to assist individuals with MCI and their families in navigating ARD processes.

Scheduling of methylphenidate: Preventing misuse or impeding ADHD treatment adherence?

Background: Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, with a chronic, and potentially debilitating course if untreated. Medication adherence is poor - negatively affecting emotional, social, educational and employment outcomes. The current Schedule 6 status of methylphenidate (MPH) drives healthcare resource utilisation and costs - a potential barrier to care. Aim: This study explored stakeholders' understanding and perceptions of the potential impact of a regulatory shift in the scheduling of MPH on treatment accessibility and adherence for ADHD. Setting: Participants from multiple stakeholder groups, involved in ADHD management in South Africa, were recruited via professional networks. Methods: A qualitative analysis of semi-structured interviews with 23 stakeholders was conducted to explore their views on the utility, benefits and risks associated with rescheduling MPH. Results: Six key themes emerged from the interviews: 'adherence', 'accessibility', 'affordability', 'stigma', 'rescheduling of MPH' and 'risk mitigation'. Core to these themes is the role of the scheduling of MPH - which can have a protective societal role, but also acts as a barrier to care for individuals with ADHD. Conclusion: The current Schedule 6 status of MPH is not an effective strategy to prevent misuse and diversion but negatively impacts on treatment adherence. The positive outlook from stakeholders on rescheduling MPH holds significant implications for the ADHD landscape in South Africa. Contribution: It is crucial to address stigma, facilitate fundamental change in service delivery and remove structural and practical barriers to care to improve outcomes for individuals with ADHD. A framework for ADHD treatment adherence is provided.

"To exercise sustainably" - Patients' experiences of compulsive exercise in eating disorders and the Compulsive Exercise Activity Therapy (LEAP) as a treatment: a qualitative interview study.

BACKGROUND: Compulsive exercise is common in eating disorders (EDs), but a systematic treatment model is lacking. The CompuLsive Exercise Activity TheraPy (LEAP) is a cognitive behavioral therapy treatment for compulsive exercise in EDs, delivered by trained therapists in groups over four consecutive weeks (8 groupsessions and 1 individual session), aiming to promote healthy physical activity. LEAP is currently evaluated in a randomized efficacy trial. In parallel, it is crucial to learn more about how it is perceived by qualitatively investigating participants' subjective experiences. METHODS: Nine patients with various EDs participating in the LEAP trial were interviewed about their experiences of taking part in LEAP and about compulsive exercise as an ED symptom using a semi-structured interview guide. The interview transcripts were analyzed according to thematic analysis. RESULTS: The informants expressed that compulsive exercise had not been addressed in their standard ED treatment and that LEAP as such provided an important complement, spurring reflection, awareness, and changed feelings and behaviors in relation to compulsive exercise. Initially, increased PA was triggered for some, but this side effect was transitory. A wish for more treatment time, in terms of longer or additional sessions, was expressed. CONCLUSIONS: Overall, LEAP seemed to fill an important treatment need and seemed both acceptable and feasible to patients. However, treatment time and the initial increase in PA may need further investigation and attention in order to optimize this treatment. TRIAL REGISTRATION: The trial is registered with the ISRCTN registry (registration date 20200325), trial ID ISRCTN80711391.

Compulsive exercise (CE) is very common in individuals with eating disorders (EDs) often tightly connected with the eating pathology. Even so, most standard treatments do not specifically target CE, leaving patients without strategies to normalize their exercise. The CompuLsive Exercise Activity TheraPy (LEAP) is delivered as an adjunctive treatment to standard ED treatment (targeting CE in patients with EDs. In this study, nine former LEAP patients were interviewed about their experiences of taking part in LEAP and about CE as an ED symptom. The informants were in general satisfied with LEAP and indicated that participation had positive effects on their exercise-related thoughts and attitudes, as well as actual exercise behaviors. They all experienced that CE was not addressed in their standard treatment, although they were motivated to work towards changing it. LEAP was therefore viewed as an important complement. Participating in LEAP initially triggered some informants to exercise more, which fortunately ceased over time and is similar to the temporal negative effect (increased food occupation) often observed initially in cognitive behavioral therapy for eating disorders. The content of LEAP was experienced as valid, informative, and eye-opening, and being able to discuss CE-related topics in a group setting was for many a positive experience. The experiences expressed in this study are very useful for continued development of LEAP. Although preliminary, the results also suggest that LEAP may be a valuable add-on treatment within ED care.

Valuation of the EQ-5D-3L in Jordan.

BACKGROUND: In Jordan, no national value set is available for any preference-accompanied health utility measure. OBJECTIVE: This study aims to develop a value set for EQ-5D-3L based on the preferences of the Jordanian general population. METHODS: A representative sample of the Jordanian general population was obtained through quota sampling involving age, gender, and region. Participants aged above 18 years were interviewed via videoconferencing using the EuroQol Valuation Technology 2.1 protocol. Participants completed ten composite time trade-offs (cTTO) and ten discrete choice experiments (DCE) tasks. cTTO and DCE data were analyzed using linear and logistic regression models, respectively, and hybrid models were applied to the combined DCE and cTTO data. RESULTS: A total of 301 participants with complete data were included in the analysis. The sample was representative of the general population regarding region, age, and gender. All model types applied, that is, random intercept model, random intercept Tobit, linear model with correction for heteroskedasticity, Tobit with correction for heteroskedasticity, and all hybrid models, were statistically significant. They showed logical consistency in terms of higher utility decrements with more severe levels. The hybrid model corrected for heteroskedasticity was selected to construct the Jordanian EQ-5D-3L value set as it showed the best fit and lowest mean absolute error. The predicted value for the most severe health state (33333) was - 0.563. Utility decrements due to mobility had the largest weight, followed by anxiety/depression, while usual activities had the smallest weight. CONCLUSION: This study provides the first EQ-5D-3L value set in the Middle East. The Jordanian EQ-5D-3L value set can now be used in health technology assessments for health policy planning by the Jordanian health sector's decision-makers.

Understanding how and why travel mode changes: analysis of longitudinal qualitative interviews.

BACKGROUND: Encouraging alternatives to the car such as walking, cycling or public transport is a key cross-sector policy priority to promote population and planetary health. Individual travel choices are shaped by individual and environmental contexts, and changes in these contexts - triggered by key events - can translate to changes in travel mode. Understanding how and why these changes happen can help uncover more generalisable findings to inform future intervention research. This study aimed to identify the mechanisms and contexts facilitating changes in travel mode. METHODS: Prospective longitudinal qualitative cohort study utilising semi-structured interviews at baseline (in 2021), three- and six-month follow up. Participants were residents in a new town in Cambridgeshire, UK, where design principles to promote walking, cycling and public transport were used at the planning stage. At each interview, we followed a topic guide asking participants about previous and current travel patterns and future intentions. All interviews were audio recorded and transcribed. Data analysis used the framework approach based on realist evaluation principles identifying the context and mechanisms described by participants as leading to travel behaviour change. RESULTS: We conducted 42 interviews with 16 participants and identified six mechanisms for changes in travel mode. These entailed increasing or reducing access, reliability and financial cost, improving convenience, increasing confidence and raising awareness. Participants described that these led to changes in travel mode in contexts where their existing travel mode had been disrupted, particularly in terms of reducing access or reliability or increasing cost, and where there were suitable alternative travel modes for their journey. Experiences of the new travel mode played a role in future travel intentions. IMPLICATIONS: Applying realist evaluation principles to identify common mechanisms for changes in travel mode has the potential to inform future intervention strategies. Future interventions using mechanisms that reduce access to, reduce reliability of, or increase the financial cost of car use may facilitate modal shift to walking, cycling and public transport when implemented in contexts where alternative travel modes are available and acceptable.

Perspectives of stakeholders on the implementation of a dietary and exercise intervention for postpartum mothers with a history of gestational diabetes mellitus (GDM): a community-based qualitative study.

Women with a history of Gestational diabetes mellitus (GDM) have a high risk of developing Type 2 diabetes mellitus (T2DM) in their future life. Lifestyle interventions are known to reduce this progression. The success of a lifestyle intervention mainly depends on its feasibility. Therefore, this study aimed to evaluate the feasibility of a lifestyle intervention programme aimed to attenuate the development of T2DM in mothers with a history of GDM. This qualitative phenomenological study was carried out in selected Medical offices of Health (MOH) areas in Sri Lanka. Postpartum mothers with a history of GDM who have undergone a comprehensive, supervised lifestyle intervention program for 1 year, their family members, and public health midwives (PHM) were recruited for this study. Focus group discussions (FGD) were carried out with mothers and PHM while In-depth interviews (IDI) were conducted with family members. Framework analysis was used for the analysis of data. A total of 94 participants (45 mothers, 40 healthcare workers, and 9 family members) participated in FGDs and IDIs to provide feedback regarding the lifestyle intervention. Sixteen sub-themes emerged under the following four domains; (1) Feelings and experiences about the lifestyle intervention programme for postpartum mothers with a history of GDM (2) Facilitating factors (3) Barriers to implementation and (4) Suggestions for improvement. Spouse support and continued follow-up were major facilitating factors. The negative influence of healthcare workers was identified as a major barrier to appropriate implementation. All participants suggested introducing continuing education programmes to healthcare workers to update their knowledge. The spouse's support and follow-ups played a pivotal role in terms of the success of the programme. Enhancing awareness of the healthcare workers is also essential to enhance the effectiveness of the programme. It is imperative to introduce a formal intervention programme for the postpartum management of mothers with a history of GDM. It is recommended that the GDM mothers should be followed up in the postpartum period and this should be included in the national postpartum care guidelines.

"I remember most of my family seeing it": The presence of others during child physical abuse, as conveyed in forensic interviews with Israeli children.

Child physical abuse is often perceived as a crime perpetrated within the family and out of sight. However, recent studies have indicated the presence of others during incidents of physical abuse. The current study was designed to examine the experiences and perceptions of children who were physically abused in their families concerning the presence of others, as conveyed during their forensic interviews. A thematic analysis of 26 forensic interviews was conducted with Israeli children aged 5-13. Three main themes were identified: (1) Patterns, roles, and coping mechanisms: The multifaceted spectrum of familial abuse; (2) The echoes of family reactions: Shaping children's abuse experiences; and (3) Navigating the storm together: Sibling bonds amidst familial abuse. The children's narratives highlighted their distress and pointed to the abusive and chaotic daily routine in which they lived. In spotlighting their encounters with physical abuse, the children focused on their need to be seen and gain certainty in their daily routines. The discussion highlights the unique and elusive dynamics of families in which child physical abuse occurs and challenges the social perception that physical abuse occurs secretly. The characteristics of such abuse highlight the urgent need for policymakers and professionals to treat the phenomenon of physical abuse within the family as a visible phenomenon.

"Goldmine" or "big mess"? An interview study on the challenges of designing, operating, and ensuring the durability of Clinical Data Warehouses in France and Belgium.

OBJECTIVES: Clinical Data Warehouses (CDW) are the designated infrastructures to enable access and analysis of large quantities of electronic health record data. Building and managing such systems implies extensive "data work" and coordination between multiple stakeholders. Our study focuses on the challenges these stakeholders face when designing, operating, and ensuring the durability of CDWs for research. MATERIALS AND METHODS: We conducted semistructured interviews with 21 professionals working with CDWs from France and Belgium. All interviews were recorded, transcribed verbatim, and coded inductively. RESULTS: Prompted by the AI boom, healthcare institutions launched initiatives to repurpose data they were generating for care without a clear vision of how to generate value. Difficulties in operating CDWs arose quickly, strengthened by the multiplicity and diversity of stakeholders involved and grand discourses on the possibilities of CDWs, disjointed from their actual capabilities. Without proper management of the information flows, stakeholders struggled to build a shared vision. This was evident in our interviewees' contrasting appreciations of what mattered most to ensure data quality. Participants explained they struggled to manage knowledge inside and across institutions, generating knowledge loss, repeated mistakes, and impeding progress locally and nationally. DISCUSSION AND CONCLUSION: Management issues strongly affect the deployment and operation of CDWs. This may stem from a simplistic linear vision of how this type of infrastructure operates. CDWs remain promising for research, and their design, implementation, and operation require careful management if they are to be successful. Building on innovation management, complex systems, and organizational learning knowledge will help.

Supporting Stewardship: Funding, Utilization, and Sustainability as Ethical Concerns in Networked Biobanking.

BACKGROUND: The literature on the ethics of biobanking often overlooks the practical operations of biobanks. The ethics of stewardship requires that biobank resources are used to conduct beneficial science. Networked biobanks have emerged to increase the scientific benefit of biobank resources, but little is known about whether and how operations of networking may accomplish this goal. METHODS: As part of a larger study on the ethical, legal, and social implications (ELSI) of networked biobanking, we conducted 38 interviews with representatives of 31 networked biobanks. Interviews explored operations of the networks. We used thematic analysis to examine how respondents describe three topics associated with stewarding biobank resources-funding, utilization, and sustainability. RESULTS: Our results highlight that funding, utilization, and sustainability are critical not only to the operation of biobanks, but also to the ethical obligations that biobankers owe to stakeholders to steward the resources. Based on prior research, we hypothesized that respondents would describe networking as beneficial to increasing funding, utilization, and sustainability of the network. Respondents generally found value in networked biobanking, but networking did not necessarily increase funding, utilization, and sustainability. CONCLUSION: The results presented here support inclusion of funding, utilization, and sustainability as topics of ethical concern in the practice of biobanking and networked biobanking. These issues are rooted in the stewardship obligations that biobankers feel to their partners, client investigators, and participants. The goal of promoting stewardship through networking requires significant time and effort to build governance models that honor the obligations of each individual biobank to their donors and advance the collective goals of the network. We conclude with suggestions offered by respondents to address improving these aspects of stewardship.

Physicians and nurses experiences of providing care to patients within a mobile care unit - a qualitative interview study.

INTRODUCTION: There is a growing need for alternative forms of care to address citizen demands and ensure a competent healthcare workforce across municipalities and regions. One of these forms of care is the use of mobile care units. The aim of the current study was to describe physicians and nurses experiences of providing care to patients within a mobile care unit in Sweden. METHOD: Data were collected between March 2022 and January 2023 through qualitative interviews with 14 physicians and nurses employed in various mobile care units in different regions in Sweden. These interviews were transcribed verbatim and subjected to content analysis, with the study adhering to the Standards for Reporting Qualitative Research (SRQR). RESULTS: The analysis resulted in two main categories: "Unlocking the potential of mobile care", and "The challenges of moving hospitals to patients' homes"; and seven subcategories. The respondents viewed mobile care at home as highly advantageous, positively impacting both patients and caregivers. They believed their contributions enhanced patients' well-being, fostering a welcoming atmosphere. They also noted receiving more quality time for each patient, enabling thorough assessments, and promoting a person-centered approach, which resulted in more gratifying mutual relationships. However, they experienced that mobile care also had challenges such as geographical limitations, limited opening hours and logistical complexity, which can lead to less equitable and efficient care. CONCLUSIONS: Physicians and nurses in mobile care units emphasized positive outcomes, contributing to patient well-being through a person-centered approach. They highlighted increased quality time, comprehensive assessments, and overall satisfaction, praising the mobile care unit's unique continuity for enhancing safety and fostering meaningful relationships in the patient's home environment. In order for mobile care to develop and become a natural part of healthcare, challenges such as geographical limitations and logistics need to be addressed.

Exploring the Perceptions of Families and Nurses After Signing a Do-Not-Resuscitate Order for Patients in Respiratory Care Wards.

Introduction: This study aimed to explore the perceptions and experiences of family caregivers and nurses after the signing of a do-not-resuscitate (DNR) order for patients in respiratory care wards (RCWs). The goal was to facilitate nurses' preparedness for responding to family reactions and feelings in future DNR situations. Methods: The study employed semi-structured interviews with ventilator-dependent patients' families and nurses recruited from RCWs in regional and district hospitals in New Taipei City. It explored the feelings, motivations, and decision-making processes concerning DNR orders. Thematic analysis identified key themes and patterns. Results: Twenty-two family members and 12 nurses, caring for 22 patients, participated in the interviews, resulting in 44 interview transcripts. The majority of family members were male (54.5%), whereas all nurses were female. Family caregivers and nurses had nuanced perceptions and showed emotional responses after the signing of DNR orders. Family caregivers grappled with feelings of guilt, uncertainty, and the weight of decision-making, while nurses navigated ethical dilemmas and sought to support families through the process. Common themes included the desire to minimize the patient's suffering, concerns about quality of life, and the need for clear communication and support. Conclusion: The understanding of family caregivers' and nurses' perceptions of DNR orders for patients in RCWs illuminates complex end-of-life care challenges. A key gap in the study was its limited generalizability due to focusing on specific RCWs. Nonetheless, the insights gained may enable health care providers to tailor support, facilitate informed decision-making, and promote compassionate care for ventilator-dependent patients and their families.

Experiences as a clinical teaching fellow: interviews with clinical teaching fellows in the West Midlands.

BACKGROUND: The majority of junior doctors in the UK do not proceed directly into specialty training after completing mandatory foundation training but instead take a year out of training. A common post undertaken during a year out of training is a clinical teaching fellow (CTF) role which is used to provide undergraduate medical student teaching. There is only a small amount of literature available regarding CTF posts, and very little of this explores experiences or reasons for taking up such as post. An understanding of the reasons why doctors are choosing to work as CTFs and what their experiences are in post will contribute to how the role is further developed and utilised within the NHS. This study aimed to explore the experiences of CTFs employed in the West Midlands at NHS hospital Trusts. METHODS: CTFs working in Trusts in the West Midlands region registered as students on the Education for Healthcare Professionals Post Graduate Certificate course at the University of Birmingham in August 2019 and 2020 who were enrolled in a longitudinal study were invited to take part in an individual interview asking about their experiences as CTFs. RESULTS: Nine CTFs participated in an interview. Five main themes were identified which related to their experiences in post and plans for future careers. Participants reported choosing to undertake a CTF role due to wanting a break from clinical work and having previously enjoyed delivering teaching. Positive experiences in post included lifestyle related benefits and self-development opportunities. Challenges identified with the role included the impact of COVID-19 and volume of students. CONCLUSION: This is the first study to use interview methodology to explore experiences of CTFs, and has provided a valuable insight into the experiences of those in post in the West Midlands region. Understanding why doctors chose this job and what their experiences are could help to further develop and refine the role. To guarantee demands for teaching staff are met those employing CTFs should be aware of reasons why doctors apply for the post and ensure the post remains a desirable option.

Children's and adolescents' views of health and mental health concepts - A qualitative group interview study.

BACKGROUND: Definitions and perceptions of health and mental health have not remained static over time. This is also true for statistics over Swedish children's and adolescents' health and mental health status. The majority of Swedish school-aged children and adolescents report good physical health and good life satisfaction. However, there are some warning signs when it comes to children's and adolescents' health and mental health status, for instance, an increased overweight or obesity in children and adolescents, as well as a higher proportion reporting psychological problems and stress. There is also a need for knowing more about the younger population's voices in this matter. The aim was therefore to explore children's and adolescent's conceptualizations and perceptions of health in general, and mental health in particular. METHODS: Open semistructured group interviews with 44 Swedish children and adolescents (10-14 years old) recruited from four schools were conducted. The interviews were conducted between April 2022 and January 2023. Data were analyzed with qualitative content analysis. RESULTS: Children's and adolescents' conceptualizations of health included aspects of both the body and the mind, with a focus on the latter. Mental health was expressed as a state of being, illustrated by various lived experiences of emotions, moods, and thoughts. The social world was ever present in their understanding of health, e.g., through the lenses of social and gender norms. CONCLUSIONS: This study revealed children's and adolescents' recognition of health terms and their ability to observe nuances between mental health problems and everyday struggles. The participants discussed mental health problems to a greater extent than positive mental health. An implication of this study is the highlighted need to focus more on mental health promotion in future preventive programs. These findings might potentially influence how school staff and student health teams communicate with children and adolescents about these concepts.

Quality of interaction between clinicians and artificial intelligence systems. A systematic review.

Introduction: Artificial intelligence (AI) has the potential to improve healthcare quality when thoughtfully integrated into clinical practice. Current evaluations of AI solutions tend to focus solely on model performance. There is a critical knowledge gap in the assessment of AI-clinician interactions. We systematically reviewed existing literature to identify interaction traits that can be used to assess the quality of AI-clinician interactions. Methods: We performed a systematic review of published studies to June 2022 that reported elements of interactions that impacted the relationship between clinicians and AI-enabled clinical decision support systems. Due to study heterogeneity, we conducted a narrative synthesis of the different interaction traits identified from this review. Two study authors categorised the AI-clinician interaction traits based on their shared constructs independently. After the independent categorisation, both authors engaged in a discussion to finalise the categories. Results: From 34 included studies, we identified 210 interaction traits. The most common interaction traits included usefulness, ease of use, trust, satisfaction, willingness to use and usability. After removing duplicate or redundant traits, 90 unique interaction traits were identified. Unique interaction traits were then classified into seven categories: usability and user experience, system performance, clinician trust and acceptance, impact on patient care, communication, ethical and professional concerns, and clinician engagement and workflow. Discussion: We identified seven categories of interaction traits between clinicians and AI systems. The proposed categories may serve as a foundation for a framework assessing the quality of AI-clinician interactions.