The psychosocial and clinical outcomes of surgery for Thyroid Eye Disease (TED)

This study aimed to investigate whether quality of life in patients with thyroid eye disease (TED) improves as a result of having orbital decompression surgery and whether any demographic, clinical or psychosocial factors can predict which patients might benefit from this surgery. One hundred and twenty three adults with TED were recruited from Moorfields Eye Hospital (MEH), London. Clinical measurements were taken by the clinical team at MEH and participants completed a range of psychosocial questionnaires prior to surgery and again 6 weeks and 6 months after surgery. The Appearance Research Collaboration’s (ARC) framework of adjustment to living with a disfiguring condition was used to guide the study’s measures and analysis. The Graves’ Ophthalmopathy Quality of Life Questionnaire (GO-QOL; Terwee et al., 1998) was completed by participants at each time point and was the dependent variable in each hierarchical multiple regression model. Semi-structured interviews were conducted with fourteen patients from Birmingham and Midland Eye Centre (BMEC) to explore expectations of orbital decompression and thematic analysis was performed. Prior to surgery, the regression model explained 55% of the variance in GO-QOL visual function scores and 75% of the variance in GO-QOL appearance scores. Although vision-related quality of life was associated with age and asymmetrical disease, it was intervening psychosocial processes that were more consistently associated with both vision- and appearance-related quality of life. Patients had high expectations for surgery to return them to the “normality” of their lives, and appearance, before TED. High expectations were often a result of great confidence and trust in surgeons and information they had accessed about the surgery online. Significant improvements were found in all clinical characteristics following surgery and in most psychosocial variables. Vision-related quality of life did not change significantly until 6 months after surgery whilst appearance-related quality of life significantly improved 6 weeks post-surgery and continued to significantly increase 6 months post-surgery reaching a minimal clinically important difference (MCID). Ethnicity and a small number of clinical factors patients presented for surgery were unique predictors of the variance in change in vision-related quality of life and appearance-related quality of life. None of the changes in clinical or psychosocial outcomes significantly predicted change in vision-related quality of life. The hierarchical regression model explained 81% of the variance in change in appearance-related quality of life however, with improvement in personal evaluation of appearance uniquely predicting improvement in appearance-related quality of life. Further research is required to establish whether expectations are met after surgery. Recommendations for clinical practice include routine psychological assessment and the provision of clear and comprehensible information about surgery. Patients with TED in the future would benefit from interventions targeting the intervenin

Students’ and tutors’ experiences of remote ‘student–patient’ consultations

Background:Remote consulting has become part of the medical student clinical experience in pri-mary care, but little research exists regarding the impact on learning.Aim:To describe the experiences of General Practitioner (GP) educators and medical students inusing student-led remote consultations as an educational tool.Method:A qualitative, explorative study conducted at four UK medical schools. GP educators andmedical students were purposively sampled and interviewed.Results:Nine themes arose: practical application, autonomy, heuristics, safety, triage of undifferen-tiated patients, clinical reasoning, patient inclusion in student education, student–patient inter-action, and student–doctor interaction.Discussion:Remote consulting has become part of the clinical placement experience. This hasbeen found to expose students to a wider variety of clinical presentations. Verbal communication,history-taking, triage, and clinical reasoning skills were practised through remote consulting, butexamination skills development was lacking. Students found building rapport more challenging,although this was mitigated by having more time with patients. Greater clinical risk was perceivedin remote consulting, which had potential to negatively impact students’psychological safety.Frequent debriefs could ameliorate this risk and positively impact student–doctor relationships.Student autonomy and independence increased due to greater participation and responsibility.Pre-selection of patients could be helpful but had potential to expose students to lowercomplexity patients

Digital undergraduate medical education and patient and carer involvement: a rapid systematic review of current practice

BACKGROUND: Involving patients and carers in medical students' learning aims to centralise the perspective of healthcare users and supports our future medical workforce in the development of key skills. Medical schools are increasingly using digital technology for teaching and it is timely to understand how to maintain patient and carer involvement in this context. METHODS: Ovid MEDLINE, Ovid EMBASE and medRxiv were searched in October 2020 and reference lists of key articles were hand searched. Eligible studies reported authentic patient or carer involvement in undergraduate medical education where technology was also used. Study quality was assessed by the Mixed Methods Appraisal Tool (MMAT). Levels of patient or carer involvement were assessed using Towle et al.'s (2010) taxonomy, from Level 1 (lowest level) to Level 6 (highest level). RESULTS: Twenty studies were included in this systematic review. In 70% of studies, patients and carers featured in video or web-based case scenarios with no interaction between healthcare users and students. The remaining 30% of studies reported real-time interactions between students and patients via remote clinical encounters. Digital teaching sessions involving patients or carers were perceived to be valuable by students and educators, and increased student engagement, patient-centred attitudes, clinical knowledge, and communication skills. No studies reported the perspective of patients or carers. DISCUSSION: Digital technology has not yet driven higher levels of patient and carer involvement in medical training. "Live" interactions between students and patients are becoming more common but challenges need addressing to ensure positive experiences for all involved. Future teaching should enhance the role of patients and carers in medical education and support them to overcome any potential barriers to doing so remotely

Adaptation of the methotrexate in rheumatoid arthritis knowledge questionnaire (MiRAK) for use with parents of children with juvenile idiopathic arthritis: a qualitative study

BACKGROUND: Although Methotrexate (MTX) is one of the most commonly prescribed disease-modifying drugs in JIA no questionnaire exists that assesses the knowledge of parents about this drug. A 60-item questionnaire was recently developed to measure rheumatoid arthritis (RA) patients\u27 knowledge about MTX; the Methotrexate in Rheumatoid Arthritis Knowledge Test (MiRAK; Ciciriello et al. (Arthritis Rheum 62:10-1009, 2010)). This study aimed to adapt the MiRAK for parents of children with JIA. METHODS: Adaption of the MiRAK involved: 1) email consultations with clinicians working in the field of paediatric rheumatology (Panel 1) to ascertain the potential adaptations of the MiRAK from a clinical perspective, 2) synthesis of clinicians\u27 suggestions by a panel of experts, researchers and MiRAK developers (Panel 2) to reach consensus on which items needed to be modified and create a draft Methotrexate in Juvenile Idiopathic Arthritis Knowledge Test (MiJIAK), 3) a review of the draft by 5 parents of children with JIA (Panel 3) using the cognitive \u27think-aloud\u27 method, 4) a second consultation with Panel 2 to review parents\u27 suggestions and determine the final items. RESULTS: A total of 9 items remained unchanged, e.g. "Methotrexate is effective at relieving joint stiffness", 19 were deemed inappropriate in the paediatric setting and deleted, e.g. "It is safe to become pregnant 3 weeks after methotrexate has been stopped", 32 underwent editorial changes largely to indicate that the questionnaire was about the children with JIA, e.g. "If you forget to give a dose of Methotrexate, you can still take it the next day" became "If your child misses a dose of Methotrexate, they can still take it the next day", and 1 new item was added. A new 42-item questionnaire was produced and was found to be well understood by parents of children with JIA. CONCLUSIONS: The systematic modification of the MiRAK, a patient-centred MTX knowledge questionnaire, has generated a comprehensive new questionnaire for use in the JIA setting. The wide consultation process, including cognitive testing, has ensured the tool is both relevant and acceptable to clinicians and will therefore be a valuable addition in understanding the parents\u27 perspective of this treatment in JIA

Students’ and tutors’ experiences of remote ‘student–patient’ consultations

Background: Remote consulting has become part of the medical student clinical experience in primary care, but little research exists regarding the impact on learning. Aim: To describe the experiences of General Practitioner (GP) educators and medical students in using student-led remote consultations as an educational tool. Method: A qualitative, explorative study conducted at four UK medical schools. GP educators and medical students were purposively sampled and interviewed. Results: Nine themes arose: practical application, autonomy, heuristics, safety, triage of undifferentiated patients, clinical reasoning, patient inclusion in student education, student–patient interaction, and student–doctor interaction. Discussion: Remote consulting has become part of the clinical placement experience. This has been found to expose students to a wider variety of clinical presentations. Verbal communication, history-taking, triage, and clinical reasoning skills were practised through remote consulting, but examination skills development was lacking. Students found building rapport more challenging, although this was mitigated by having more time with patients. Greater clinical risk was perceived in remote consulting, which had potential to negatively impact students’ psychological safety. Frequent debriefs could ameliorate this risk and positively impact student–doctor relationships. Student autonomy and independence increased due to greater participation and responsibility. Pre-selection of patients could be helpful but had potential to expose students to lower complexity patients

Effectiveness and cost-effectiveness of a patient-initiated botulinum toxin treatment model for blepharospasm and hemifacial spasm: a study protocol for a randomised controlled trial

Background Blepharospasm and hemifacial spasm are debilitating conditions that significantly impact on patient quality of life. Cyclical treatment with botulinum toxin injections offers temporary relief, but the duration of treatment efficacy is variable. The standard model of patient care defines routine fixed-time based scheduled treatment cycles which may lead to unnecessarily frequent treatment for some patients and experience of distressing symptoms in others, if symptoms return before the scheduled follow-up period. Methods/Design A randomised controlled trial will compare a patient-initiated model of care, where patients determine botulinum toxin treatment timing, to the standard model of care in which care is scheduled by the clinical team. A sample of 266 patients with blepharospasm or hemifacial spasm will be recruited from Moorfields Eye Hospital (MEH), London. The trial will be accompanied by a mixed methods evaluation of acceptability of the new service. Patients who meet eligibility criteria will be assessed at baseline and those in the intervention group will be provided instructions on how to book their own treatment appointments. Patients in both groups will be followed up 3 and 9 months into the trial and all patients will be returned to usual care after 9 months to meet safety protocols. Primary outcome measures include disease severity (questionnaire), functional disability (questionnaire) and patient satisfaction with care (questionnaire). Secondary outcomes include disease-specific quality of life (questionnaire), mood (questionnaire), illness and treatment perceptions (questionnaire and semi-structured interviews), economic impact (questionnaire) and acceptability (questionnaire and semi-structured interviews). Discussion This trial will assess the effectiveness and cost-effectiveness of a patient-led care model for botulinum toxin therapy. If the new model is shown to be effective in reducing distress and disability in these populations and is found to be acceptable to patients, whilst being cost-effective, this will have significant implications for service organisation across the NHS. Trial registration UK Clinical Research Network (UKCRN) Portfolio 18660. Clinicaltrials.gov ID NCT102577224 (registered 29th October 2015

What influences people’s responses to public health messages for managing risks and preventing infectious diseases? A rapid systematic review of the evidence and recommendations

Background: Individual behaviour changes, such as hand hygiene and physical distancing, are required on a population scale to reduce transmission of infectious diseases such as COVID-19. However, little is known about effective methods of communicating risk reducing information, and how populations might respond. Objective: To synthesise evidence relating to what (1) characterises effective public health messages for managing risk and preventing infectious disease and (2) influences people’s responses to messages. Design: A rapid systematic review was conducted. Protocol is published on Prospero CRD42020188704. Data sources: Electronic databases were searched: Ovid Medline, Ovid PsycINFO and Healthevidence. org, and grey literature (PsyarXiv, OSF Preprints) up to May 2020. Study selection: All study designs that (1) evaluated public health messaging interventions targeted at adults and (2) concerned a communicable disease spread via primary route of transmission of respiratory and/or touch were included. Outcomes included preventative behaviours, perceptions/awareness and intentions. Non-English language papers were excluded. Synthesis: Due to high heterogeneity studies were synthesised narratively focusing on determinants of intentions in the absence of measured adherence/ preventative behaviours. Themes were developed independently by two researchers and discussed within team to reach consensus. Recommendations were translated from narrative synthesis to provide evidence-based methods in providing effective messaging. Results: Sixty-eight eligible papers were identified. Characteristics of effective messaging include delivery by credible sources, community engagement, increasing awareness/knowledge, mapping to stage of epidemic/ pandemic. To influence intent effectively, public health messages need to be acceptable, increase understanding/perceptions of health threat and perceived susceptibility. Discussion: There are four key recommendations: (1) engage communities in development of messaging, (2) address uncertainty immediately and with transparency, (3) focus on unifying messages from sources and (4) frame messages aimed at increasing understanding, social responsibility and personal control. Embedding principles of behavioural science into public health messaging is an important step towards more effective health-risk communication during epidemics/pandemics

A rapid systematic review of public responses to health messages encouraging vaccination against infectious diseases in a pandemic or epidemic

Public health teams need to understand how the public responds to vaccination messages in a pandemic or epidemic to inform successful campaigns encouraging the uptake of new vaccines as they become available. A rapid systematic review was performed by searching PsycINFO, MED-LINE, healthevidence.org, OSF Preprints and PsyArXiv Preprints in May 2020 for studies including at least one health message promoting vaccine uptake of airborne-, droplet-and fomite-spread vi-ruses. Included studies were assessed for quality using the Mixed Methods Appraisal Tool (MMAT) or the Assessment of Multiple Systematic Reviews (AMSTAR), and for patient and public involvement (PPI) in the research. Thirty-five articles were included. Most reported messages for seasonal influenza (n = 11; 31%) or H1N1 (n = 11; 31%). Evidence from moderate to high quality studies for improving vaccine uptake included providing information about virus risks and vaccination safety, as well as addressing vaccine misunderstandings, offering vaccination reminders, including vaccination clinic details, and delivering mixed media campaigns across hospitals or communities. Behavioural influences (beliefs and intentions) were improved when: shorter, risk-reducing or relative risk framing messages were used; the benefits of vaccination to society were emphasised; and beliefs about capability and concerns among target populations (e.g., vaccine safety) were addressed. Clear, credible, messages in a language target groups can understand were associated with higher accept-ability. Two studies (6%) described PPI in the research process. Future campaigns should consider the beliefs and information needs of target populations in their design, including ensuring that vaccine eligibility and availability is clear, and messages are accessible. More high quality research is needed to demonstrate the effects of messaging interventions on actual vaccine uptake

A Rapid Systematic Review of Public Responses to Health Messages Encouraging Vaccination against Infectious Diseases in a Pandemic or Epidemic

Public health teams need to understand how the public responds to vaccination messages in a pandemic or epidemic to inform successful campaigns encouraging the uptake of new vaccines as they become available. A rapid systematic review was performed by searching PsycINFO, MEDLINE, healthevidence.org, OSF Preprints and PsyArXiv Preprints in May 2020 for studies including at least one health message promoting vaccine uptake of airborne-, droplet- and fomite-spread viruses. Included studies were assessed for quality using the Mixed Methods Appraisal Tool (MMAT) or the Assessment of Multiple Systematic Reviews (AMSTAR), and for patient and public involvement (PPI) in the research. Thirty-five articles were included. Most reported messages for seasonal influenza (n = 11; 31%) or H1N1 (n = 11; 31%). Evidence from moderate to high quality studies for improving vaccine uptake included providing information about virus risks and vaccination safety, as well as addressing vaccine misunderstandings, offering vaccination reminders, including vaccination clinic details, and delivering mixed media campaigns across hospitals or communities. Behavioural influences (beliefs and intentions) were improved when: shorter, risk-reducing or relative risk framing messages were used; the benefits of vaccination to society were emphasised; and beliefs about capability and concerns among target populations (e.g., vaccine safety) were addressed. Clear, credible, messages in a language target groups can understand were associated with higher acceptability. Two studies (6%) described PPI in the research process. Future campaigns should consider the beliefs and information needs of target populations in their design, including ensuring that vaccine eligibility and availability is clear, and messages are accessible. More high quality research is needed to demonstrate the effects of messaging interventions on actual vaccine uptake

Optimising vaccination uptake for Covid-19

Geo-spatial data on village locations, their size, population and other parameters is scarcely available to decision makers in many developing countries. In this paper, we demonstrate an automatic ?crawler? which can segment nucleated villages from satellite imagery freely available in public domain geographic information systems such as Google EarthTM. Our approach is to use frequency and color features to generate a number of weak classifiers, which are then combined through Adaboost to produce the final classifier. We use a total of 69 features in the generation of the weak classifiers, including phase gradients, cornerness measures and color features. Our primary dataset consists of 60 images having more than 345 million pixels and covering more than 100 km2 of area, containing nucleated villages in fifteen countries, spread over four continents and captured by different sensors. Using six manual annotations for ground-truth, we perform five-fold cross validation, using 25% of data for testing. Our results show an Equal Error Rate (EER) of around 3.4%. Using the trained classifier, we detect villages on a 50 km2 image (close to 184 million pixels) from a different site than the images used in training, and demonstrate highly accurate extraction of villages with 2.3% false positives and 0.01% false negatives