Pub Date : 2024-09-17DOI: 10.1101/2024.09.16.24313581
Makayla B Lagerman, Lauren Dennis, Traci Deaner, Adam Sigal, David Rabago, Huamei Dong, Joseph P Wiedemer, Alexis Reedy-Cooper, Jessica Parascando, Karl T Clebak, Tara Cassidy-Smith, Robert P Lennon, Olapeju Simoyan
Introduction: Inadequate scholarship is a common concern in graduate medical education. Many barriers to scholarship have been identified, but there are limited data on which are most important. A rank-order of barriers from learners perspectives would better enable programs to address perceived barriers. Methods: Given that learners are experts in their own perceptions, we applied the Delphi method of generating consensus expert opinion to construct ranked lists of physician-perceived barriers to scholarly activity at various sites. The survey was conducted within three separate health systems. Respondents were asked to identify their perceived barriers via free text and the listed barriers were consolidated by the research team. In the second round, respondents were presented with the consolidated lists and asked to rank them. In the third and final round, each respondent was shown a comparison of their own rankings to that of their peers and given an opportunity to make changes. Ranking differences between programs were compared using Rank Biased Overlap (RBO). Results: The Delphi method is a straightforward method to obtain a ranked list of perceived learner barriers to scholarly activity; its primary limitation is learner engagement and, of note in our study, high dropout rates. RBO is an effective method of ranking differences between programs and specialties. Top barriers across programs included time, overwhelm with the research process, and lack of interest or energy. Discussion: Several of the identified barriers may be addressed with enthusiastic mentors, streamlined administrative processes, and education. This could be done within a hospital system or on a national level through specialty organizations.
导言：学术研究不足是医学研究生教育普遍关注的问题。已经发现了许多影响学术研究的障碍，但关于哪些障碍最重要的数据却很有限。从学习者的角度对障碍进行排序，可以更好地帮助项目解决所感知到的障碍。方法：鉴于学习者是他们自己认知的专家，我们采用了德尔菲法（Delphi method of generating consensus expert opinion），对不同地点的医生认知的学术活动障碍进行排序。调查在三个不同的医疗系统内进行。受访者被要求通过自由文本确定他们认为的障碍，研究小组对列出的障碍进行了整合。在第二轮调查中，受访者将看到合并后的清单，并被要求对其进行排序。在第三轮，也就是最后一轮，每个受访者都会看到自己的排名与同行的比较，并有机会做出修改。使用排名偏倚重叠法（RBO）比较了不同计划之间的排名差异：德尔菲法是一种简单易行的方法，可以获得学习者在学术活动中遇到的障碍的排序清单；它的主要局限性在于学习者的参与度，以及在我们的研究中值得注意的高辍学率。RBO 是对不同项目和专业之间的差异进行排序的有效方法。各专业的首要障碍包括时间、对研究过程的不知所措以及缺乏兴趣或精力。讨论：可以通过热心的导师、简化的行政流程和教育来解决所发现的一些障碍。这可以在医院系统内进行，也可以通过专科组织在全国范围内进行。
{"title":"Perceived barriers to research and scholarship among physicians","authors":"Makayla B Lagerman, Lauren Dennis, Traci Deaner, Adam Sigal, David Rabago, Huamei Dong, Joseph P Wiedemer, Alexis Reedy-Cooper, Jessica Parascando, Karl T Clebak, Tara Cassidy-Smith, Robert P Lennon, Olapeju Simoyan","doi":"10.1101/2024.09.16.24313581","DOIUrl":"https://doi.org/10.1101/2024.09.16.24313581","url":null,"abstract":"Introduction: Inadequate scholarship is a common concern in graduate medical education. Many barriers to scholarship have been identified, but there are limited data on which are most important. A rank-order of barriers from learners perspectives would better enable programs to address perceived barriers. Methods: Given that learners are experts in their own perceptions, we applied the Delphi method of generating consensus expert opinion to construct ranked lists of physician-perceived barriers to scholarly activity at various sites. The survey was conducted within three separate health systems. Respondents were asked to identify their perceived barriers via free text and the listed barriers were consolidated by the research team. In the second round, respondents were presented with the consolidated lists and asked to rank them. In the third and final round, each respondent was shown a comparison of their own rankings to that of their peers and given an opportunity to make changes. Ranking differences between programs were compared using Rank Biased Overlap (RBO).\u0000Results: The Delphi method is a straightforward method to obtain a ranked list of perceived learner barriers to scholarly activity; its primary limitation is learner engagement and, of note in our study, high dropout rates. RBO is an effective method of ranking differences between programs and specialties. Top barriers across programs included time, overwhelm with the research process, and lack of interest or energy. Discussion: Several of the identified barriers may be addressed with enthusiastic mentors, streamlined administrative processes, and education. This could be done within a hospital system or on a national level through specialty organizations.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-17DOI: 10.1101/2024.09.13.24313612
Dimitra Kale, Emma Beard, Anna-Marie Marshall, Jodi Pervin, Qi Wu, Elena Ratschen, Lion Shahab
Background: Smoking rates in the UK have declined steadily over the past decades, masking considerable inequalities, as little change has been observed among people with a mental health condition. This trial sought to assess the feasibility and acceptability of supplying an electronic cigarette (e-cigarette) starter kit for smoking cessation as an adjunct to usual care for smoking cessation, to smokers with a mental health condition treated in the community, to inform a future effectiveness trial. Methods: This randomised controlled feasibility trial, conducted March-December 2022, compared the intervention (e-cigarette starter kit with a corresponding information leaflet and demonstration with Very Brief Advice) with a usual care control at 1-month follow-up. Participants were 18+ years, receiving treatment for any mental health condition in primary or secondary care in three Mental Health Trusts in Yorkshire and one in London, UK. They were also willing to address their smoking through either cessation or reduction of cigarette consumption. The agreed primary outcome measure was feasibility (consent~15% of eligible participants; attrition rate<30%). Acceptability, validated sustained abstinence and at least 50% cigarette consumption reduction at 1-month, were also evaluated and qualitative interviews conducted to further explore acceptability in this population. Results: Feasibility targets were partially met; of 201 eligible participants, 43 (mean age = 45.2, SD = 12.7; 39.5% female) were recruited (21.4%) and randomised (intervention:48.8%, n=21; control:51.2%, n=22). Attrition rate was 37.2% at 1-month follow-up and was higher (45.5%) in the control group. At follow-up (n=27), 93.3% (n=14) in the intervention group and 25.0% (n=3) in the control group reported e-cigarette use. The intervention was well received with minimal negative effects. In intention-to-treat analysis, validated sustained abstinence at 1-month was 2/21 (9.5%) and 0/22 (0%) and at least 50% reduction in cigarette consumption 13/21 (61.9%) and 3/22 (13.6%), for the intervention and control group, respectively. Qualitative analysis of participant interviews (N=5) showed the intervention was broadly acceptable, but they also highlighted areas of improvements for the intervention and trial delivery. Conclusions: Offering an e-cigarette starter kit to smokers with a mental health condition treated in the community was acceptable and largely feasible, with harm reduction outcomes (i.e. switching from cigarette smoking to e-cigarette use and substantial reduction in cigarette consumption) favouring the intervention. The findings of the study will be used to help inform the design of a main trial.
{"title":"Providing an e-cigarette starter kit for smoking cessation and reduction as adjunct to usual care to smokers with a mental health condition: Findings from the ESCAPE feasibility study","authors":"Dimitra Kale, Emma Beard, Anna-Marie Marshall, Jodi Pervin, Qi Wu, Elena Ratschen, Lion Shahab","doi":"10.1101/2024.09.13.24313612","DOIUrl":"https://doi.org/10.1101/2024.09.13.24313612","url":null,"abstract":"Background: Smoking rates in the UK have declined steadily over the past decades, masking considerable inequalities, as little change has been observed among people with a mental health condition. This trial sought to assess the feasibility and acceptability of supplying an electronic cigarette (e-cigarette) starter kit for smoking cessation as an adjunct to usual care for smoking cessation, to smokers with a mental health condition treated in the community, to inform a future effectiveness trial.\u0000Methods: This randomised controlled feasibility trial, conducted March-December 2022, compared the intervention (e-cigarette starter kit with a corresponding information leaflet and demonstration with Very Brief Advice) with a usual care control at 1-month follow-up. Participants were 18+ years, receiving treatment for any mental health condition in primary or secondary care in three Mental Health Trusts in Yorkshire and one in London, UK. They were also willing to address their smoking through either cessation or reduction of cigarette consumption. The agreed primary outcome measure was feasibility (consent~15% of eligible participants; attrition rate<30%). Acceptability, validated sustained abstinence and at least 50% cigarette consumption reduction at 1-month, were also evaluated and qualitative interviews conducted to further explore acceptability in this population.\u0000Results: Feasibility targets were partially met; of 201 eligible participants, 43 (mean age = 45.2, SD = 12.7; 39.5% female) were recruited (21.4%) and randomised (intervention:48.8%, n=21; control:51.2%, n=22). Attrition rate was 37.2% at 1-month follow-up and was higher (45.5%) in the control group. At follow-up (n=27), 93.3% (n=14) in the intervention group and 25.0% (n=3) in the control group reported e-cigarette use. The intervention was well received with minimal negative effects. In intention-to-treat analysis, validated sustained abstinence at 1-month was 2/21 (9.5%) and 0/22 (0%) and at least 50% reduction in cigarette consumption 13/21 (61.9%) and 3/22 (13.6%), for the intervention and control group, respectively. Qualitative analysis of participant interviews (N=5) showed the intervention was broadly acceptable, but they also highlighted areas of improvements for the intervention and trial delivery.\u0000Conclusions: Offering an e-cigarette starter kit to smokers with a mental health condition treated in the community was acceptable and largely feasible, with harm reduction outcomes (i.e. switching from cigarette smoking to e-cigarette use and substantial reduction in cigarette consumption) favouring the intervention. The findings of the study will be used to help inform the design of a main trial.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-15DOI: 10.1101/2024.09.13.24313661
Wilnaye A Bain, Sabriquet Pinder-Butler, Terrance Fountain, Ilsa Grant
Objectives: To assess the practices and barriers in evaluating and managing chronic kidney disease among primary care physicians in New Providence, The Bahamas. Methods: A cross-sectional study utilizing an anonymous, self administered questionnaire was given to General Practitioners, Family Medicine, and Internal Medicine physicians after using a simple random sampling approach. Descriptive and inferential statistical analysis was conducted using IBM SPSS software. Results: There were 119 physicians in this study with Family Medicine specialty area representing 52.1%. Seventy-four (74) physicians reported following CKD guidelines. The most common at-risk groups identified were Diabetes Mellitus (100%), Hypertension (98.3%), and use of nephrotoxic agents (97.5%). The most common diagnostic test used to identify CKD was eGFR (97.5%) and 72.2% of physicians used eGFR alone to stage CKD. Physicians overall agreed (40.3 - 50.4%) they were comfortable in diagnosing and managing CKD and its complications except for bone disorders (43.2%) and metabolic acidosis (34.7%) where responses were neutral. Physicians were neutral in having tools/resources to help them manage bone disorders (35.3%) and metabolic acidosis (31.9%) and disagreed to having educational tools for patients to understand bone disorders (32.2%) and metabolic acidosis (32.8%). Physicians agreed-strongly agreed with 12 of 13 perceived barriers, and there were 26 unique barriers expressed (8 patient-level, 7 provider-level, 11 systems-level). Conclusions: Deficits in the evaluation and management of CKD, and numerous barriers to CKD care were discovered. Recommendations include the development of a national CKD guideline, local CKD continuous medical education seminars, and public health campaigns on CKD education.
{"title":"Primary Care Physicians' Practices and Barriers in Evaluating and Managing Chronic Kidney Disease in New Providence, The Bahamas","authors":"Wilnaye A Bain, Sabriquet Pinder-Butler, Terrance Fountain, Ilsa Grant","doi":"10.1101/2024.09.13.24313661","DOIUrl":"https://doi.org/10.1101/2024.09.13.24313661","url":null,"abstract":"Objectives: To assess the practices and barriers in evaluating and managing chronic kidney disease among primary care physicians in New Providence, The Bahamas. Methods: A cross-sectional study utilizing an anonymous, self administered questionnaire was given to General Practitioners, Family Medicine, and Internal Medicine physicians after using a simple random sampling approach. Descriptive and inferential statistical analysis was conducted using IBM SPSS software. Results: There were 119 physicians in this study with Family Medicine specialty area representing 52.1%. Seventy-four (74) physicians reported following CKD guidelines. The most common at-risk groups identified were Diabetes Mellitus (100%), Hypertension (98.3%), and use of nephrotoxic agents (97.5%). The most common diagnostic test used to identify CKD was eGFR (97.5%) and 72.2% of physicians used eGFR alone to stage CKD. Physicians overall agreed (40.3 - 50.4%) they were comfortable in diagnosing and managing CKD and its complications except for bone disorders (43.2%) and metabolic acidosis (34.7%) where responses were neutral. Physicians were neutral in having tools/resources to help them manage bone disorders (35.3%) and metabolic acidosis (31.9%) and disagreed to having educational tools for patients to understand bone disorders (32.2%) and metabolic acidosis (32.8%). Physicians agreed-strongly agreed with 12 of 13 perceived barriers, and there were 26 unique barriers expressed (8 patient-level, 7 provider-level, 11 systems-level).\u0000Conclusions: Deficits in the evaluation and management of CKD, and numerous barriers to CKD care were discovered. Recommendations include the development of a national CKD guideline, local CKD continuous medical education seminars, and public health campaigns on CKD education.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-13DOI: 10.1101/2024.09.11.24313518
Mia Y. Reid, Jamie E. Coates, Naomi Y. Yates, Bennett McDonald
Introduction Current guidelines recommend thiazide/thiazide-type diuretics and dihydropyridine calcium channel blockers as first-line agents in treating African Americans with hypertension. The purpose of this study is to examine the impact that ambulatory care clinical pharmacy specialists (CPSs) had on initiation of first-line antihypertensives in the African American population within an integrated healthcare system. Methods This retrospective, matched, observational cohort analysis included African American patients with hypertension not receiving a first-line antihypertensive as of September 1, 2021. Patients followed by CPSs were matched up to 1:4 on age and sex to patients not followed by CPSs. The primary outcome was the percentage of patients started on first-line antihypertensive(s) after working with CPSs. Conditional logistic regression was used to analyze outcomes. Results A total of 865 patients followed by CPSs were matched to 3,192 patients not followed by CPSs. Patients followed by CPSs were initiated on first-line antihypertensives at a significantly higher rate (adjusted OR 1.98, 95% CI 1.63-2.41), and a clinically significant improvement in blood pressure was observed with systolic improving an average of 22 points and diastolic 13 points. 283 patients managed by CPSs achieved blood pressure less than 135/85 mmHg. Conclusion The initiation of first-line antihypertensives in African American patients by CPSs led to clinically significant reductions in systolic and diastolic blood pressure which supports CPS involvement in hypertension management. The assessment of study outcomes provides guidance to clinical decision-making and contributes to the development of key practice standards across both physician and clinical pharmacy specialist services.
{"title":"Pharmacist Impact on First-Line Antihypertensives in African American Patients","authors":"Mia Y. Reid, Jamie E. Coates, Naomi Y. Yates, Bennett McDonald","doi":"10.1101/2024.09.11.24313518","DOIUrl":"https://doi.org/10.1101/2024.09.11.24313518","url":null,"abstract":"Introduction\u0000Current guidelines recommend thiazide/thiazide-type diuretics and dihydropyridine calcium channel blockers as first-line agents in treating African Americans with hypertension. The purpose of this study is to examine the impact that ambulatory care clinical pharmacy specialists (CPSs) had on initiation of first-line antihypertensives in the African American population within an integrated healthcare system. Methods This retrospective, matched, observational cohort analysis included African American patients with hypertension not receiving a first-line antihypertensive as of September 1, 2021. Patients followed by CPSs were matched up to 1:4 on age and sex to patients not followed by CPSs. The primary outcome was the percentage of patients started on first-line antihypertensive(s) after working with CPSs. Conditional logistic regression was used to analyze outcomes. Results\u0000A total of 865 patients followed by CPSs were matched to 3,192 patients not followed by CPSs. Patients followed by CPSs were initiated on first-line antihypertensives at a significantly higher rate (adjusted OR 1.98, 95% CI 1.63-2.41), and a clinically significant improvement in blood pressure was observed with systolic improving an average of 22 points and diastolic 13 points. 283 patients managed by CPSs achieved blood pressure less than 135/85 mmHg. Conclusion\u0000The initiation of first-line antihypertensives in African American patients by CPSs led to clinically significant reductions in systolic and diastolic blood pressure which supports CPS involvement in hypertension management. The assessment of study outcomes provides guidance to clinical decision-making and contributes to the development of key practice standards across both physician and clinical pharmacy specialist services.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-13DOI: 10.1101/2024.09.11.24313391
Tetyana Perchyk, Isabella de Vere Hunt, Brian D Nicholson, Luke Mounce, Kate Sykes, Yoryos Lyratzopoulos, Agnieszka Lemanska, Katriina L Whitaker, Robert S Kerrison
Background. Primary care electronic health records provide a rich source of information for inequalities research. However, the reliability and validity of the research derived from these records depends on the completeness and resolution of the codelists used to identify marginalised populations. Aim. The aim of this project was to develop comprehensive codelists for identifying ethnic minorities, people with learning disabilities (LD), people with severe mental illness (SMI) and people who are transgender. Design and setting. This study was a codelist development project, conducted using primary care data from the United Kingdom. Method. Groups of interest were defined a priori. Relevant clinical codes were identified by searching Clinical Practice Research Datalink (CPRD) publications, codelist repositories and the CPRD code browser. Relevant codelists were downloaded and merged according to marginalised group. Duplicates were removed and remaining codes reviewed by two general practitioners. Comprehensiveness was assessed in a representative CPRD population of 10,966,759 people, by comparing the frequencies of individuals identified when using the curated codelists, compared to commonly used alternatives. Results. A total of 52 codelists were identified. 1,420 unique codes were selected after removal of duplicates and GP review. Compared with comparator codelists, an additional 48,017 (76.6%), 52,953 (68.9%) and 508 (36.9%) people with a LD, SMI or transgender code were identified. The frequencies identified for ethnicity were consistent with expectations for the UK population. Conclusion. The codelists curated through this project will improve inequalities research by improving standards of identifying marginalised groups in primary care data.
{"title":"Development and evaluation of codelists for identifying marginalised groups in primary care","authors":"Tetyana Perchyk, Isabella de Vere Hunt, Brian D Nicholson, Luke Mounce, Kate Sykes, Yoryos Lyratzopoulos, Agnieszka Lemanska, Katriina L Whitaker, Robert S Kerrison","doi":"10.1101/2024.09.11.24313391","DOIUrl":"https://doi.org/10.1101/2024.09.11.24313391","url":null,"abstract":"Background. Primary care electronic health records provide a rich source of information for inequalities research. However, the reliability and validity of the research derived from these records depends on the completeness and resolution of the codelists used to identify marginalised populations. Aim. The aim of this project was to develop comprehensive codelists for identifying ethnic minorities, people with learning disabilities (LD), people with severe mental illness (SMI) and people who are transgender. Design and setting. This study was a codelist development project, conducted using primary care data from the United Kingdom. Method. Groups of interest were defined a priori. Relevant clinical codes were identified by searching Clinical Practice Research Datalink (CPRD) publications, codelist repositories and the CPRD code browser. Relevant codelists were downloaded and merged according to marginalised group. Duplicates were removed and remaining codes reviewed by two general practitioners. Comprehensiveness was assessed in a representative CPRD population of 10,966,759 people, by comparing the frequencies of individuals identified when using the curated codelists, compared to commonly used alternatives. Results. A total of 52 codelists were identified. 1,420 unique codes were selected after removal of duplicates and GP review. Compared with comparator codelists, an additional 48,017 (76.6%), 52,953 (68.9%) and 508 (36.9%) people with a LD, SMI or transgender code were identified. The frequencies identified for ethnicity were consistent with expectations for the UK population. Conclusion. The codelists curated through this project will improve inequalities research by improving standards of identifying marginalised groups in primary care data.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1101/2024.09.12.24312088
Bridianne O'Dea, Mirjana Subotic-Kerry, Thomas Borchard, Belinda Parker, Bojana Vilus, Frank Iorfino, Alexis E Whitton, Ben Harris-Roxas, Tracey D Wade, Madelaine K de Valle, Nicholas Glozier, Jennifer Nicholas, Michelle Torok, Taylor A Braund, Philip J Batterham
Background: General Practitioners (GPs) play a key role in the treatment of adolescent depression and anxiety, but their capacity to provide effective care may be compromised by long wait times. Aim: To examine the treatments and recommendations of GPs for adolescent patients with depression and/or anxiety in Australia, their referral practices to specialist care and estimated wait times for these, and the perceived impact of long wait times on GPs, their patients and their treatment. Design, Setting and Methods: An online survey of 192 GPs in Australia who treated adolescents (12 to 17 years old) with depression and/or anxiety. Results: GPs frequently referred adolescents with depression and/or anxiety to psychologists. The estimated wait time for psychologists (M: 57 days, SD: 47.9) was four times the proposed acceptable wait time (M: 16.7 days, SD: 27.0). The frequency of medication prescribing almost doubled during the wait time when compared to routine practice (14.6% versus 8.3%, respectively). Almost all GPs (81.8%) increased their level of care due to long wait times but had limited training in youth mental health and knowledge on appropriate strategies to do so effectively. Conclusion: The findings signify the discrepancies between the preferences of GPs for treatment availability in Australia and what they see as the experience for many adolescents with depression and/or anxiety who are referred to specialist care. Greater training, improved communication between referrer and referred services, and digital interventions may help GPs to reduce the negative impacts of long wait times on their adolescent patients.
{"title":"The impact of service wait times on General Practitioners' treatment of adolescent depression and anxiety","authors":"Bridianne O'Dea, Mirjana Subotic-Kerry, Thomas Borchard, Belinda Parker, Bojana Vilus, Frank Iorfino, Alexis E Whitton, Ben Harris-Roxas, Tracey D Wade, Madelaine K de Valle, Nicholas Glozier, Jennifer Nicholas, Michelle Torok, Taylor A Braund, Philip J Batterham","doi":"10.1101/2024.09.12.24312088","DOIUrl":"https://doi.org/10.1101/2024.09.12.24312088","url":null,"abstract":"Background: General Practitioners (GPs) play a key role in the treatment of adolescent depression and anxiety, but their capacity to provide effective care may be compromised by long wait times.\u0000Aim: To examine the treatments and recommendations of GPs for adolescent patients with depression and/or anxiety in Australia, their referral practices to specialist care and estimated wait times for these, and the perceived impact of long wait times on GPs, their patients and their treatment. Design, Setting and Methods: An online survey of 192 GPs in Australia who treated adolescents (12 to 17 years old) with depression and/or anxiety.\u0000Results: GPs frequently referred adolescents with depression and/or anxiety to psychologists. The estimated wait time for psychologists (M: 57 days, SD: 47.9) was four times the proposed acceptable wait time (M: 16.7 days, SD: 27.0). The frequency of medication prescribing almost doubled during the wait time when compared to routine practice (14.6% versus 8.3%, respectively). Almost all GPs (81.8%) increased their level of care due to long wait times but had limited training in youth mental health and knowledge on appropriate strategies to do so effectively. Conclusion: The findings signify the discrepancies between the preferences of GPs for treatment availability in Australia and what they see as the experience for many adolescents with depression and/or anxiety who are referred to specialist care. Greater training, improved communication between referrer and referred services, and digital interventions may help GPs to reduce the negative impacts of long wait times on their adolescent patients.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1101/2024.09.10.24313425
Benjamin W Nelson, Sohrab Saeb, Poulami Barman, Nishant Verma, Hannah Allen, Massimiliano de Zambotti, Fiona C. Baker, Nicole Arra, Niranjan Sridhar, Shannon Sullivan, Scooter Plowman, Erin Rainaldi, Ritu Kapur, Sooyoon Shin
The goal was to evaluate the performance of a multi-sensor wrist-worn wearable device for generating 12 sleep measures in a diverse cohort. Our study technology was the sleep suite of the Verily Numetric Watch (VNW), using polysomnography (PSG) as reference during 1-night simultaneous recording in a sample of N=41 (18 male, age range: 18-78 years). We performed epoch-by-epoch comparisons for all measures. Key specific analyses were: core accuracy metrics for sleep vs wake classification; bias for continuous measures (Bland-Altman); Cohens kappa and accuracy for sleep stage classifications; and mean count difference and linearly weighted Cohens kappa for count metric. In addition, we performed subgroup analyses by sex, age, skin tone, body mass index, and arm hair density. Sensitivity and specificity (95% CI) of sleep versus wake classification were 0.97 (0.96, 0.98) and 0.66 (0.61, 0.71), respectively. Mean total sleep time bias was 14.55 minutes (1.61, 27.16); wake after sleep onset, -11.77 minutes (-23.89, 1.09); sleep efficiency, 3.15% (0.68, 5.57); sleep onset latency, -3.24 minutes (-9.38, 3.57); light-sleep duration, 3.78 minutes (-7.04, 15.06); deep-sleep duration, 3.91 minutes (-4.59, 12.60); rapid eye movement-sleep duration, 6.94 minutes (0.57, 13.04). Median difference for number of awakenings, 0.00 (0.00, 1.00); and overall accuracy of sleep stage classification, 0.78 (0.51, 0.88). Most measures showed statistically significant proportional biases and/or heteroscedasticity. Subgroup results appeared largely consistent with the overall group, although small samples preclude strong conclusions. These results support the use of VNWs in classifying sleep versus wake, sleep stages, and for related overnight sleep measures.
{"title":"Performance Evaluation of the Verily Numetric Watch sleep suite for digital sleep assessment against in-lab polysomnography","authors":"Benjamin W Nelson, Sohrab Saeb, Poulami Barman, Nishant Verma, Hannah Allen, Massimiliano de Zambotti, Fiona C. Baker, Nicole Arra, Niranjan Sridhar, Shannon Sullivan, Scooter Plowman, Erin Rainaldi, Ritu Kapur, Sooyoon Shin","doi":"10.1101/2024.09.10.24313425","DOIUrl":"https://doi.org/10.1101/2024.09.10.24313425","url":null,"abstract":"The goal was to evaluate the performance of a multi-sensor wrist-worn wearable device for generating 12 sleep measures in a diverse cohort. Our study technology was the sleep suite of the Verily Numetric Watch (VNW), using polysomnography (PSG) as reference during 1-night simultaneous recording in a sample of N=41 (18 male, age range: 18-78 years). We performed epoch-by-epoch comparisons for all measures. Key specific analyses were: core accuracy metrics for sleep vs wake classification; bias for continuous measures (Bland-Altman); Cohens kappa and accuracy for sleep stage classifications; and mean count difference and linearly weighted Cohens kappa for count metric. In addition, we performed subgroup analyses by sex, age, skin tone, body mass index, and arm hair density. Sensitivity and specificity (95% CI) of sleep versus wake classification were 0.97 (0.96, 0.98) and 0.66 (0.61, 0.71), respectively. Mean total sleep time bias was 14.55 minutes (1.61, 27.16); wake after sleep onset, -11.77 minutes (-23.89, 1.09); sleep efficiency, 3.15% (0.68, 5.57); sleep onset latency, -3.24 minutes (-9.38, 3.57); light-sleep duration, 3.78 minutes (-7.04, 15.06); deep-sleep duration, 3.91 minutes (-4.59, 12.60); rapid eye movement-sleep duration, 6.94 minutes (0.57, 13.04). Median difference for number of awakenings, 0.00 (0.00, 1.00); and overall accuracy of sleep stage classification, 0.78 (0.51, 0.88). Most measures showed statistically significant proportional biases and/or heteroscedasticity. Subgroup results appeared largely consistent with the overall group, although small samples preclude strong conclusions. These results support the use of VNWs in classifying sleep versus wake, sleep stages, and for related overnight sleep measures.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1101/2024.09.10.24313427
Sohrab Saeb, Benjamin W Nelson, Poulami Barman, Nishant Verma, Hannah Allen, Massimiliano de Zambotti, Fiona C. Baker, Nicole Arra, Niranjan Sridhar, Shannon Sullivan, Scooter Plowman, Erin Rainaldi, Ritu Kapur, Sooyoon Shin
This study evaluated the performance of a wrist-worn wearable, Verily Study Watch (VSW), in detecting key sleep measures against polysomnography (PSG). Methods: We collected data from 41 adults without obstructive sleep apnea or insomnia during a single overnight laboratory visit. We evaluated epoch-by-epoch performance for sleep versus wake classification, sleep stage classification and duration, total sleep time (TST), wake after sleep onset (WASO), sleep onset latency (SOL), sleep efficiency (SE), and number of awakenings (NAWK). Performance metrics included sensitivity, specificity, Cohens kappa, and Bland-Altman analyses. Results: Sensitivity and specificity (95% CIs) of sleep versus wake classification were 0.97 (0.96, 0.98) and 0.70 (0.66, 0.74), respectively. Cohens kappa (95% CI) for 4-class stage detection was 0.64 (0.18, 0.82). Most VSW sleep measures had proportional bias. The mean bias values (95% CI) were 14.0 minutes (5.55, 23.20) for TST, -13.1 minutes (-21.33, -6.21) for WASO, 2.97% (1.25, 4.84) for SE, -1.34 minutes (-7.29, 4.81) for SOL, 1.91 minutes (-8.28, 11.98) for light sleep duration, 5.24 minutes (-3.35, 14.13) for deep sleep duration, and 6.39 minutes (-0.68, 13.18) for REM sleep duration. Mean and median NAWK count differences (95% CI) were 0.05 (-0.42, 0.53) and 0.0 (0.0, 0.0), respectively. Discussion: Results support applying the VSW to track overnight sleep measures in free-living settings. Registered at clinicaltrials.gov (NCT05276362).
{"title":"Performance of the Verily Study Watch for Measuring Sleep Compared to Polysomnography","authors":"Sohrab Saeb, Benjamin W Nelson, Poulami Barman, Nishant Verma, Hannah Allen, Massimiliano de Zambotti, Fiona C. Baker, Nicole Arra, Niranjan Sridhar, Shannon Sullivan, Scooter Plowman, Erin Rainaldi, Ritu Kapur, Sooyoon Shin","doi":"10.1101/2024.09.10.24313427","DOIUrl":"https://doi.org/10.1101/2024.09.10.24313427","url":null,"abstract":"This study evaluated the performance of a wrist-worn wearable, Verily Study Watch (VSW), in detecting key sleep measures against polysomnography (PSG). Methods: We collected data from 41 adults without obstructive sleep apnea or insomnia during a single overnight laboratory visit. We evaluated epoch-by-epoch performance for sleep versus wake classification, sleep stage classification and duration, total sleep time (TST), wake after sleep onset (WASO), sleep onset latency (SOL), sleep efficiency (SE), and number of awakenings (NAWK). Performance metrics included sensitivity, specificity, Cohens kappa, and Bland-Altman analyses. Results: Sensitivity and specificity (95% CIs) of sleep versus wake classification were 0.97 (0.96, 0.98) and 0.70 (0.66, 0.74), respectively. Cohens kappa (95% CI) for 4-class stage detection was 0.64 (0.18, 0.82). Most VSW sleep measures had proportional bias. The mean bias values (95% CI) were 14.0 minutes (5.55, 23.20) for TST, -13.1 minutes (-21.33, -6.21) for WASO, 2.97% (1.25, 4.84) for SE, -1.34 minutes (-7.29, 4.81) for SOL, 1.91 minutes (-8.28, 11.98) for light sleep duration, 5.24 minutes (-3.35, 14.13) for deep sleep duration, and 6.39 minutes (-0.68, 13.18) for REM sleep duration. Mean and median NAWK count differences (95% CI) were 0.05 (-0.42, 0.53) and 0.0 (0.0, 0.0), respectively. Discussion: Results support applying the VSW to track overnight sleep measures in free-living settings. Registered at clinicaltrials.gov (NCT05276362).","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.1101/2024.09.06.24313206
Fangchi Shao, Jiumei Hu, Pengfei Zhang, Patarajarin Akarapipad, Joon Soo Park, Hanran Lei, Kuangwen Hsieh, Tza-Huei Wang
Clustered regularly interspaced short palindromic repeats (CRISPR)/Cas-associated systems have recently emerged as a focal point for developing next-generation molecular diagnosis, particularly for nucleic acid detection. However, the detection of proteins is equally critical across diverse applications in biology, medicine, and the food industry, especially for diagnosing and prognosing diseases like cancer, Alzheimer and cardiovascular conditions. Despite recent efforts to adapt CRISPR/Cas systems for protein detection with immunoassays, these methods typically achieved sensitivity only in the femtomolar to picomolar range, underscoring the need for enhanced detection capabilities. To address this, we developed CRISPR-AMPED, an innovative CRISPR/Cas-based immunoassay enhanced by magnetic proximity extension and detection. This approach combines proximity extension assay (PEA) with magnetic beads that converts protein into DNA barcodes for quantification with effective washing steps to minimize non-specific binding and hybridization, therefore reducing background noise and increasing detection sensitivity. The resulting DNA barcodes are then detected through isothermal nucleic acid amplification testing (NAAT) using recombinase polymerase amplification (RPA) coupled with the CRISPR/Cas12a system, replacing the traditional PCR. This integration eliminates the need for thermocycling and bulky equipment, reduces amplification time, and provides simultaneous target and signal amplification, thereby significantly boosting detection sensitivity. CRISPR-AMPED achieves attomolar level sensitivity, surpassing ELISA by over three orders of magnitude and outperforming existing CRISPR/Cas-based detection systems. Additionally, our smartphone-based detection device demonstrates potential for point-of-care applications, and the digital format extends dynamic range and enhances quantitation precision. We believe CRISPR-AMPED represents a significant advancement in the field of protein detection.
成簇的规则间隔短回文重复序列（CRISPR）/Cas 相关系统最近已成为开发下一代分子诊断的焦点，尤其是在核酸检测方面。然而，蛋白质的检测在生物学、医学和食品工业的各种应用中同样至关重要，尤其是在诊断和预后癌症、老年痴呆症和心血管疾病等方面。尽管最近人们努力将 CRISPR/Cas 系统用于免疫测定的蛋白质检测，但这些方法通常只能达到飞摩尔到皮摩尔范围的灵敏度，这突出表明需要增强检测能力。为了解决这个问题，我们开发了 CRISPR-AMPED，这是一种创新的基于 CRISPR/Cas 的免疫测定方法，通过磁性接近延伸和检测得到了增强。这种方法结合了磁珠近距离延伸检测（PEA），可将蛋白质转化为 DNA 条形码进行定量，并通过有效的清洗步骤将非特异性结合和杂交降至最低，从而降低背景噪声并提高检测灵敏度。然后，利用重组酶聚合酶扩增（RPA）和 CRISPR/Cas12a 系统，通过等温核酸扩增检测（NAAT）来检测生成的 DNA 条形码，从而取代传统的 PCR。这种整合无需热循环和笨重的设备，缩短了扩增时间，并可同时进行目标和信号扩增，从而大大提高了检测灵敏度。CRISPR-AMPED 实现了阿托摩尔级的灵敏度，比 ELISA 高出三个数量级以上，优于现有的基于 CRISPR/Cas 的检测系统。此外，我们基于智能手机的检测设备展示了在护理点应用的潜力，数字格式扩大了动态范围并提高了定量精度。我们相信，CRISPR-AMPED 代表了蛋白质检测领域的一大进步。
{"title":"Enhanced CRISPR/Cas-Based Immunoassay through Magnetic Proximity Extension and Detection","authors":"Fangchi Shao, Jiumei Hu, Pengfei Zhang, Patarajarin Akarapipad, Joon Soo Park, Hanran Lei, Kuangwen Hsieh, Tza-Huei Wang","doi":"10.1101/2024.09.06.24313206","DOIUrl":"https://doi.org/10.1101/2024.09.06.24313206","url":null,"abstract":"Clustered regularly interspaced short palindromic repeats (CRISPR)/Cas-associated systems have recently emerged as a focal point for developing next-generation molecular diagnosis, particularly for nucleic acid detection. However, the detection of proteins is equally critical across diverse applications in biology, medicine, and the food industry, especially for diagnosing and prognosing diseases like cancer, Alzheimer and cardiovascular conditions. Despite recent efforts to adapt CRISPR/Cas systems for protein detection with immunoassays, these methods typically achieved sensitivity only in the femtomolar to picomolar range, underscoring the need for enhanced detection capabilities. To address this, we developed CRISPR-AMPED, an innovative CRISPR/Cas-based immunoassay enhanced by magnetic proximity extension and detection. This approach combines proximity extension assay (PEA) with magnetic beads that converts protein into DNA barcodes for quantification with effective washing steps to minimize non-specific binding and hybridization, therefore reducing background noise and increasing detection sensitivity. The resulting DNA barcodes are then detected through isothermal nucleic acid amplification testing (NAAT) using recombinase polymerase amplification (RPA) coupled with the CRISPR/Cas12a system, replacing the traditional PCR. This integration eliminates the need for thermocycling and bulky equipment, reduces amplification time, and provides simultaneous target and signal amplification, thereby significantly boosting detection sensitivity. CRISPR-AMPED achieves attomolar level sensitivity, surpassing ELISA by over three orders of magnitude and outperforming existing CRISPR/Cas-based detection systems. Additionally, our smartphone-based detection device demonstrates potential for point-of-care applications, and the digital format extends dynamic range and enhances quantitation precision. We believe CRISPR-AMPED represents a significant advancement in the field of protein detection.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-04DOI: 10.1101/2024.09.03.24312982
Jerry Draper-Rodi, Carol Fawkes, Daniel Bailey
Objectives To describe the development of the NCOR Research Network, the first osteopathic Practice-Based Research Network (PBRN) in the UK, and provide data on its members’ characteristics, clinical practices, and patient demographics.
{"title":"Development of a national osteopathic practice-based research network: the NCOR Research Network","authors":"Jerry Draper-Rodi, Carol Fawkes, Daniel Bailey","doi":"10.1101/2024.09.03.24312982","DOIUrl":"https://doi.org/10.1101/2024.09.03.24312982","url":null,"abstract":"<strong>Objectives</strong> To describe the development of the NCOR Research Network, the first osteopathic Practice-Based Research Network (PBRN) in the UK, and provide data on its members’ characteristics, clinical practices, and patient demographics.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142197679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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