Bridging the Gap between Structured and Free-form Radiology Reporting: A Case-study on Coronary CT Angiography

Free-form radiology reports associated with coronary computed tomography angiography (CCTA) include nuanced and complicated linguistics to report cardiovascular disease. Standardization and interpretation of such reports is crucial for clinical use of CCTA. Coronary Artery Disease Reporting and Data System (CAD-RADS) has been proposed to achieve such standardization by implementing a strict template-based report writing and assignment of a score between 0 and 5 indicating the severity of coronary artery lesions. Even after its introduction, free-form unstructured report writing remains popular among radiologists. In this work, we present our attempts at bridging the gap between structured and unstructured reporting by natural language processing. We present machine learning models that while being trained only on structured reports, can predict CAD-RADS scores by analysis of free-text of unstructured radiology reports. The best model achieves 98% accuracy on structured reports and 92% 1-margin accuracy (difference of \le 1 in the predicted and the actual scores) for free-form unstructured reports. Our model also performs well under very difficult circumstances including nuanced and widely varying terminology used for reporting cardiovascular functions and diseases, scarcity of labeled data for training our model, and uneven class label distribution.

Improving primary palliative care – a Delphi consensus study on measures for general practice in Germany

Background The majority of severely ill and dying people in Germany can be administered primary palliative care (PPC) by general practitioners (GP). However, the current provision of PPC does not match the needs of the population. Although several public health strategies aim at strengthening the role of GPs in PPC provision, it remains challenging for GP teams to integrate PPC into their daily routines. Aim A Delphi study with GPs was conducted to achieve consensus on specific measures for improving the integration of PPC into everyday GP practice. Methods The study is part of the junior research project “Primary Palliative Care in General Practice” (ALLPRAX). After having developed, tested and evaluated 26 practical measures for GP practices to improve their PPC, a Delphi consensus study among GPs took place. In 2020, 569 GPs were asked to rate the relevance and feasibility of the measures on a 4-point Likert scale via an anonymous online questionnaire. Consensus was defined as a sum percentage of ‘strongly agree’ and ‘somewhat agree’ responses ≥75% after two rounds. Between these rounds, measures that were not consented in the first round were adapted in light of respondents’ free text comments and suggestions. Results The response rate was 11.3% in round 1 (n = 64) and 53.1% in round 2 (n = 34). From the initial n = 26 measures, n = 20 measures achieved consensus and were included in the final intervention package. The consented measures pertained to four main topics: advance care planning with patients, consulting and informing patients and family caregivers, GP office organisation and continuing education. N = 6 measures did not achieve consensus, predominantly due to time and workload constraints. Conclusion The consented measures provide valuable support to improve the provision of PPC by GPs. They can be used freely and flexibly, according to the needs of individual GP teams, and are thus suitable for implementation nationwide. Trial registration The study was registered in the German Clinical Trials Register (Registration N° DRKS00011821; 4 December 2017; https://apps.who.int/trialsearch/) and the German Register of Health Care Research (Registration N° VfD_ALLPRAX_16_003817; 30 March 2017).

Companionship and worries in uncertain times: Australian parents’ experiences of children and pets during COVID-19

Companion animals (pets), especially cats and dogs, have featured regularly in the media and public discourse during the global COVID-19 pandemic, including increased demand for pet adoption and more time spent with existing pets. This qualitative study aimed to describe the experiences of Australian parents with a child under 18 years and a cat or dog. Within a broader survey, parents were asked open-ended questions about the benefits and challenges for their family of living with a cat or dog during COVID-19, and where relevant, about reasons for adopting a new pet. Data were collected between July and October 2020, during Australia’s ‘second wave’ of COVID-19, when some Australians were subject to strict physical distancing or ‘stay at home’ orders. A total of 611 parents provided at least one free-text response. Inductive template analysis was conducted on all responses; 33 unique codes were identified and mapped onto a biopsychosocial model under three themes: (i) “Trying to Stay Healthy and Well” (biological), (ii) “Comfort, Coping and Worries” (psychological), and “Spending More Time Together” (social). Findings highlight the therapeutic role of pets for families during times of change and uncertainty, as well as the significant social impact of pandemic-related restrictions on family units. Benefits included support for the family’s physical and mental health, maintenance of family routines, distraction, comfort, and pets as an opportunity to connect with others. Challenges were numerous and diverse, such as cost and access to pet care, behavioural concerns, worries about pet and child wellbeing, and reflections about the pet’s mortality. These findings demonstrate the complex and varied impacts of the pandemic on families with children and pets; some families are likely to require ongoing psychological, financial, and veterinary supports.

Patients’ perspective on supposedly patient-relevant process and outcome parameters: a cross-sectional survey within the ‘PRO patients study’

Background To be able to make informed choices based on their individual preferences, patients need to be adequately informed about treatment options and their potential outcomes. This implies that studies measure the effects of care based on parameters that are relevant to patients. In a previous scoping review, we found a wide variety of supposedly patient-relevant parameters that equally addressed processes and outcomes of care. We were unable to identify a consistent understanding of patient relevance and therefore aimed to develop an empirically based concept including a generic set of patient-relevant parameters. As a first step we evaluated the process and outcome parameters identified in the scoping review from the patients’ perspective. Methods We conducted a cross-sectional survey among German general practice patients. Ten research practices of Witten/Herdecke University supported the study. During a two-week period in the fall of 2020, patients willing to participate self-administered a short questionnaire. It evaluated the relevance of the 32 parameters identified in the scoping review on a 5-point Likert scale and offered a free-text field for additional parameters. These free-text answers were inductively categorized by two researchers. Quantitative data were analyzed using descriptive statistics. Bivariate analyses were performed to determine whether there are any correlations between rating a parameter as highly relevant and patients’ characteristics. Results Data from 299 patients were eligible for analysis. All outcomes except ‘sexuality’ and ‘frequency of healthcare service utilization’ were rated important. ‘Confidence in therapy’ was rated most important, followed by ‘prevention of comorbidity’ and ‘mobility’. Relevance ratings of five parameters were associated with patients’ age and gender, but not with their chronic status. The free-text analysis revealed 15 additional parameters, 12 of which addressed processes of care, i.e., ‘enough time in physician consultation’. Conclusion Patients attach great value to parameters addressing processes of care. It appears as though the way in which patients experience the care process is not less relevant than what comes of it. Relevance ratings were not associated with chronic status, but few parameters were gender- and age-related. Trial registration Core Outcome Measures in Effectiveness Trials Initiative, registration number: 1685.

General practitioners’ experiences with, views of, and attitudes towards, general practice-based pharmacists: a cross-sectional survey

Background There is limited United Kingdom (UK) literature on general practice-based pharmacists’ (PBPs’) role evolution and few studies have explored general practitioners’ (GPs’) experiences on pharmacist integration into general practice. Therefore, this study aimed to investigate GPs’ experiences with, views of, and attitudes towards PBPs in Northern Ireland (NI). Methods A paper-based self-administered questionnaire comprising four sections was mailed in 2019 to 329 general practices across NI and was completed by one GP in every practice who had most contact with the PBP. Descriptive analyses were used and responses to open-ended questions were analysed thematically. Results The response rate was 61.7% (203/329). There was at least one PBP per general practice. All GPs had face-to-face meetings with PBPs, with three-quarters (78.7%, n = 159) meeting with the PBP more than once a week. Approximately two-thirds of GPs (62.4%, n = 126) reported that PBPs were qualified as independent prescribers, and 76.2% of these (n = 96/126) indicated that prescribers were currently prescribing for patients. The majority of GPs reported that PBPs always/very often had the required clinical skills (83.6%, n = 162) and knowledge (87.0%, n = 167) to provide safe and effective care for patients. However, 31.1% (n = 61) stated that PBPs only sometimes had the confidence to make clinical decisions. The majority of GPs (> 85%) displayed largely positive attitudes towards collaboration with PBPs. Most GPs agreed/strongly agreed that PBPs will have a positive impact on patient outcomes (95.0%, n = 192) and can provide a better link between general practices and community pharmacists (96.1%, n = 194). However, 24.8% of GPs (n = 50) were unclear if the PBP role moved community pharmacists to the periphery of the primary care team. An evaluation of the free-text comments indicated that GPs were in favour of more PBP sessions and full-time posts. Conclusion Most GPs had positive views of, and attitudes towards, PBPs. The findings may have implications for future developments in order to extend integration of PBPs within general practice, including the enhancement of training in clinical skills and decision-making. Exploring PBPs’, community pharmacists’ and patients’ views of this role in general practice is required to corroborate study findings.

Prediction of acute appendicitis among patients with undifferentiated abdominal pain at emergency department

Background Early screening and accurately identifying Acute Appendicitis (AA) among patients with undifferentiated symptoms associated with appendicitis during their emergency visit will improve patient safety and health care quality. The aim of the study was to compare models that predict AA among patients with undifferentiated symptoms at emergency visits using both structured data and free-text data from a national survey. Methods We performed a secondary data analysis on the 2005-2017 United States National Hospital Ambulatory Medical Care Survey (NHAMCS) data to estimate the association between emergency department (ED) patients with the diagnosis of AA, and the demographic and clinical factors present at ED visits during a patient’s ED stay. We used binary logistic regression (LR) and random forest (RF) models incorporating natural language processing (NLP) to predict AA diagnosis among patients with undifferentiated symptoms. Results Among the 40,441 ED patients with assigned International Classification of Diseases (ICD) codes of AA and appendicitis-related symptoms between 2005 and 2017, 655 adults (2.3%) and 256 children (2.2%) had AA. For the LR model identifying AA diagnosis among adult ED patients, the c-statistic was 0.72 (95% CI: 0.69–0.75) for structured variables only, 0.72 (95% CI: 0.69–0.75) for unstructured variables only, and 0.78 (95% CI: 0.76–0.80) when including both structured and unstructured variables. For the LR model identifying AA diagnosis among pediatric ED patients, the c-statistic was 0.84 (95% CI: 0.79–0.89) for including structured variables only, 0.78 (95% CI: 0.72–0.84) for unstructured variables, and 0.87 (95% CI: 0.83–0.91) when including both structured and unstructured variables. The RF method showed similar c-statistic to the corresponding LR model. Conclusions We developed predictive models that can predict the AA diagnosis for adult and pediatric ED patients, and the predictive accuracy was improved with the inclusion of NLP elements and approaches.

Saving Time for Patient Care by Optimizing Physician Note Templates: A Pilot Study

Background: At times, electronic medical records (EMRs) have proven to be less than optimal, causing longer hours behind computers, shorter time with patients, suboptimal patient safety, provider dissatisfaction, and physician burnout. These concerning healthcare issues can be positively affected by optimizing EMR usability, which in turn would lead to substantial benefits to healthcare professionals such as increased healthcare professional productivity, efficiency, quality, and accuracy. Documentation issues, such as non-standardization of physician note templates and tedious, time-consuming notes in our mother-baby unit (MBU), were discussed during meetings with stakeholders in the MBU and our hospital's EMR analysts.Objective: The objective of this study was to assess physician note optimization on saving time for patient care and improving provider satisfaction.Methods: This quality improvement pilot investigation was conducted in our MBU where four note templates were optimized: History and Physical (H and P), Progress Note (PN), Discharge Summary (DCS), and Hand-Off List (HOL). Free text elements documented elsewhere in the EMR (e.g., delivery information, maternal data, lab result, etc.) were identified and replaced with dynamic links that automatically populate the note with these data. Discrete data pick lists replaced necessary elements that were previously free texts. The new note templates were given new names for ease of accessibility. Ten randomly chosen pediatric residents completed both the old and new note templates for the same control newborn encounter during a period of one year. Time spent and number of actions taken (clicks, keystrokes, transitions, and mouse-keyboard switches) to complete these notes were recorded. Surveys were sent to MBU providers regarding overall satisfaction with the new note templates.Results: The ten residents' average time saved was 23 min per infant. Reflecting this saved time on the number of infants admitted to our MBU between January 2016 and September, 2019 which was 9373 infants; resulted in 2.6 hours saved per day, knowing that every infant averages two days length of stay. The new note templates required 69 fewer actions taken than the old ones (H and P: 11, PN: 8, DCS: 18, HOL: 32). The provider surveys were consistent with improved provider satisfaction.Conclusion: Optimizing physician notes saved time for patient care and improved physician satisfaction.

Daily uplifts during the COVID-19 pandemic: what is considered helpful in everyday life?

Background Knowledge of what is uplifting and helpful during pandemics could inform the design of sustainable pandemic recommendations in the future. We have explored individuals’ views on helpful and uplifting aspects of everyday life during the coronavirus disease 2019 (COVID-19) pandemic. Methods Participants answered a brief, daily survey via text messages during 14 consecutive days in July–August, 2020. The survey included the question: “During the past 24 hours, is there anything that has made you feel good or helped you in your life?” We used content analysis to compile responses from 693 participants, who provided 4,490 free-text answers, which resulted in 24 categories subsumed under 7 themes. Results Positive aspects during the COVID-19 pandemic primarily related to social interactions, in real life or digitally, with family, friends and others. Other important aspects concerning work, colleagues and maintaining everyday life routines. One theme concerning vacations, going on excursions and being in nature. Leisure and recreation activities, such as hobbies and physical exercise, also emerged as important, as did health-related factors. Bodily sensations, thoughts, feelings and activities that benefited well-being were mentioned frequently. Lastly, people commented on the government strategies for containing COVID-19, and whether to comply with restrictions. Conclusions To summarize, daily uplifts and helpful aspects of everyday life centered around social relationships. To comply with recommendations on physical distancing, people found creative ways to maintain social connections both digitally and face-to-face. Social interaction, maintenance of everyday life routines, hobbies and physical activity appeared to be important for well-being.

Healthcare workers' views on mandatory SARS-CoV-2 vaccination in the United Kingdom: findings from the UK-REACH prospective longitudinal cohort study

Background Several countries now have mandatory SARS-CoV-2/COVID-19 vaccination for healthcare workers (HCWs) or the general population. HCWs' views on this are largely unknown. Methods We administered an online questionnaire to 17891 United Kingdom (UK) HCWs in Spring 2021 as part of the United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH) nationwide prospective cohort study. We categorised responses to a free-text question 'What should society do if people don't get vaccinated against COVID-19?' using content analysis. We collapsed categories into a binary variable: favours mandatory vaccination or not and used logistic regression to calculate its demographic predictors, and occupational, health and attitudinal predictors adjusted for demographics. Findings Of 5633 questionnaire respondents, 3235 answered the freetext question; 18% (n=578) of those favoured mandatory vaccination but the most frequent suggestion was education (32%, n=1047). Older HCWs, HCWs vaccinated against influenza (OR 1.48; 95%CI 1.10-1.99, vs none) and with more positive vaccination attitudes generally (OR 1.10; 95%CI 1.06-1.14) were more likely to favour mandatory vaccination (OR 1.26; 95%CI 1.17-1.37, per decade increase), whereas female HCWs (OR= 0.80, 95%CI 0.65-0.99, vs male), Black HCWs (OR= 0.48, 95%CI 0.26-0.87, vs White), those hesitant about COVID-19 vaccination (OR= 0.56; 95%CI 0.43-0.71, vs not hesitant), in an Allied Health Profession (OR 0.67; 95%CI 0.51-0.88, vs Medical), or who trusted their organisation (OR 0.78; 95%CI 0.63-0.96) were less likely to. Interpretation Only one in six of the HCWs in this large, diverse, UK-wide sample favoured mandatory vaccination. Building trust, educating and supporting HCWs who are hesitant about vaccination may be more acceptable, effective and equitable. Funding MRC-UK Research and Innovation grant (MR/V027549/1) and the Department of Health and Social Care via the National Institute for Health Research.

Oral piercings and orthodontic treatment: A questionnaire-based national survey

Objective: To obtain opinions from orthodontic colleagues nationally on how they currently manage orthodontic patients with oral piercings. The secondary objectives were to assimilate the national opinions from the survey and attempt to generate educational material as an advice sheet and a patient information leaflet for the professionals and the patients respectively for the British Orthodontic Society (BOS). Design: Cross-sectional survey. Setting: Primary and secondary care orthodontic providers. Participants: Members of the BOS. Methods: An electronic questionnaire was developed and circulated to members of the BOS to obtain their opinions on the effects of oral piercings on their patients’ orthodontic treatment ‘journey’. In addition, the need for the development of informative material around the management of orthodontic treatment and appliances in patients with oral piercings was explored. Results: A total of 110 responses were received. However, only 88 respondents out of 110 attempted all the questions within the survey. There were 22 respondents who attempted it partially. We did include these partial responses well while analysing the results, since many of these offered personalised comments in the free-text boxes within the survey. Conclusion: The most common general complications associated with oral piercings were inflammation of the surrounding tissue and enamel/dentine wear. Moreover, orthodontic complications, reported commonly, were inadequate oral hygiene maintenance, entanglement with the orthodontic appliance causing damage and interference with retainers. Most respondents expressed the need for the development of a web-based patient information leaflet and an advice sheet as educational tool, both of which have been proposed to and agreed by the BOS before submission of this publication.