UNASSIGNED: Chronic cough, a cough lasting >8 weeks, includes refractory chronic cough (RCC) and unexplained chronic cough (UCC). Patient-reported outcome (PRO) measures are needed to better understand chronic cough impacts that matter most to patients. The 19-item Leicester Cough Questionnaire (LCQ), an existing PRO measure of chronic cough, assesses impacts of cough across physical, psychological, and social domains. However, the content validity of the LCQ evaluating these concepts in patients with RCC/UCC had not been established.
UNASSIGNED: To evaluate the content validity of the LCQ in patients with RCC/UCC.
UNASSIGNED: A cross-sectional, qualitative interview study.
UNASSIGNED: First, previously completed qualitative interview results in adults with RCC/UCC (N = 30) were evaluated and mapped to LCQ concepts. Next, a clinical cough expert reviewed each LCQ item and assessed the salience of its concepts for patients with RCC/UCC. Finally, semistructured interviews-including both concept elicitation and cognitive debriefing-were conducted in adults with RCC/UCC (N = 20) to elicit a comprehensive set of participant experiences and to assess the appropriateness of using the LCQ in this population.
UNASSIGNED: Concepts reported in the past and present qualitative interviews were included across all LCQ items, and most impacts reported to be the \"most bothersome\" were assessed in the LCQ. In the current study, all participants indicated that reduced cough frequency would be an important treatment target. During cognitive debriefing, each LCQ item was endorsed by ⩾70% of participants. Additionally, participants were generally able to understand, recall, and select a response for each LCQ item. All participants and the clinical expert indicated that the LCQ was appropriate and assessed the impacts most relevant to patients with RCC/UCC.
UNASSIGNED: Our findings support the content validity of the LCQ and demonstrate that this measure is fit-for-purpose and includes important cough impacts in adults with RCC/UCC.

BACKGROUND: Optimal care for seriously ill and older patients often involves advance care planning (ACP), goals-of-care (GOC) conversations, and specialty palliative care consultation, three sometimes overlapping, yet distinct practices. Insufficient staffing and investment in these areas have limited their availability.
OBJECTIVE: We explored the facilitators and barriers to successful implementation of the VIDEO-PCE trial. The intervention aimed to increase patient engagement in ACP, GOC, and by establishing Palliative Care Educators, a new clinical role integrated into existing hospital wards.
METHODS: This qualitative interview study employed a semi-structured interview guide tailored to the interviewee\'s clinical role. The interviews elicited perceptions of the facilitators and barriers to integration of palliative care educators (PCEs) into existing workflows. We developed deductive codes a priori and inductive codes as we coded interview transcripts.
METHODS: Medical/surgical floor clinical colleagues, palliative care team members, and PCEs from both participating sites were interviewed.
RESULTS: Twenty-four individuals were interviewed (12 clinical staff of medical and surgical wards, seven palliative care team members, and five PCEs). Four themes were identified: (1) The work completed by the PCEs provided a foundation for future palliative care involvement; (2) Constituting the new role in practice required revision and creativity; (3) Communication was important to providing continuity of care; and (4) Establishing trust catalyzed the acceptance of the role.
CONCLUSIONS: The creation and implementation of a new role within existing clinical workflows posed some challenges but were felt to relieve staff from some work burden and allow more patients to engage in ACP and GOC conversations.
BACKGROUND: ClinicalTrials.gov Identifier: NCT04857060.

UNASSIGNED: Preventing childhood obesity and associated comorbidities is often hampered by disproportionate disparity in healthcare provision in minority ethnic populations. This study contextualized factors influencing childhood obesity and related comorbidity from the perspectives and experiences of parents of ethnic minority populations.
UNASSIGNED: Following ethical approval, families (n = 180) from ethnic minority populations in the Northeast of England were contacted through flyers, community social groups and online forum. Of the 180 families contacted, 22 expressed interests, of whom 12 parents were eligible to participate in the study, and one family dropped out due to time constraints. Therefore 11 parents from ethnic minority communities living with at least one child with obesity were interviewed. Each family was separately visited at home and took part in a semi-structured interview based on the study\'s qualitative, descriptive phenomenological design. Nine of the families had one child who was diagnosed with an obesity-related comorbidity (non-alcoholic fatty liver disease, musculoskeletal problems or respiratory disorder). Semi-structured interviews were standardized around parents\' perspective and experience on how their children were impacted by obesity and comorbidities, healthcare preventative interventions including lifestyle physical activity and nutrition, and views on tackling obesity impact on their lives. All interviews were analyzed using qualitative thematic analysis.
UNASSIGNED: Parents\' perspectives revealed 11 themes centered around experience of living with a child with obesity, risks, and impact of obesity related Non-Communicable Diseases; and access to support, and barriers unique to minority ethnic groups. Parents revealed social disadvantages, fear of victimization by social services, perceptions on their cultural and religious traditions, and racial stigmatization related to their child\'s weight. Parents reported closer bonding with their children to protect them from the untoward consequences of overweight, and little awareness of healthcare obesity prevention programs. Work pressure, lack of time, absence of guidance from professionals were seen as barriers to healthy lifestyle, while support from friends and closer family bond in adopting healthy lifestyle behaviors were facilitators. However, there was little awareness or access to current healthcare obesity preventive offerings.
UNASSIGNED: Minority ethnic communities\' perspective on childhood obesity prevention does not match the healthcare system preventative offerings. Community and family-oriented obesity preventative approaches, especially lifestyle interventions are needed beyond those administered by the primary healthcare system.

Despite significant advances in long COVID research, many aspects of the condition remain unknown. There is a persisting need for further research to improve the management of long COVID symptoms. This study aimed to explore the experiences and psychological needs of patients who were previously hospitalised with COVID-19, and who subsequently developed long COVID symptoms. Twelve patients with long COVID were interviewed between October 2021 and June 2022. Transcripts were analysed thematically. An overarching theme of \'Existential Crisis\' was developed, incorporating three interconnecting sub-themes: \'Facing Psychological Threat\', \'Seeking Legitimisation\' and \'Forging a Path Through Uncertainty\'. Findings suggest that the psychological impact of emergency hospitalisation for COVID-19 can be severe, particularly for those with ongoing long COVID symptoms, and that early psychological intervention should be available. Our findings also suggest the importance of further planning for future pandemics to ensure the presence of patient advocates during hospitalisation at points of critical decision-making.

BACKGROUND: Large language models including GPT-4 (OpenAI) have opened new avenues in health care and qualitative research. Traditional qualitative methods are time-consuming and require expertise to capture nuance. Although large language models have demonstrated enhanced contextual understanding and inferencing compared with traditional natural language processing, their performance in qualitative analysis versus that of humans remains unexplored.
OBJECTIVE: We evaluated the effectiveness of GPT-4 versus human researchers in qualitative analysis of interviews with patients with adult-acquired buried penis (AABP).
METHODS: Qualitative data were obtained from semistructured interviews with 20 patients with AABP. Human analysis involved a structured 3-stage process-initial observations, line-by-line coding, and consensus discussions to refine themes. In contrast, artificial intelligence (AI) analysis with GPT-4 underwent two phases: (1) a naïve phase, where GPT-4 outputs were independently evaluated by a blinded reviewer to identify themes and subthemes and (2) a comparison phase, where AI-generated themes were compared with human-identified themes to assess agreement. We used a general qualitative description approach.
RESULTS: The study population (N=20) comprised predominantly White (17/20, 85%), married (12/20, 60%), heterosexual (19/20, 95%) men, with a mean age of 58.8 years and BMI of 41.1 kg/m2. Human qualitative analysis identified \"urinary issues\" in 95% (19/20) and GPT-4 in 75% (15/20) of interviews, with the subtheme \"spray or stream\" noted in 60% (12/20) and 35% (7/20), respectively. \"Sexual issues\" were prominent (19/20, 95% humans vs 16/20, 80% GPT-4), although humans identified a wider range of subthemes, including \"pain with sex or masturbation\" (7/20, 35%) and \"difficulty with sex or masturbation\" (4/20, 20%). Both analyses similarly highlighted \"mental health issues\" (11/20, 55%, both), although humans coded \"depression\" more frequently (10/20, 50% humans vs 4/20, 20% GPT-4). Humans frequently cited \"issues using public restrooms\" (12/20, 60%) as impacting social life, whereas GPT-4 emphasized \"struggles with romantic relationships\" (9/20, 45%). \"Hygiene issues\" were consistently recognized (14/20, 70% humans vs 13/20, 65% GPT-4). Humans uniquely identified \"contributing factors\" as a theme in all interviews. There was moderate agreement between human and GPT-4 coding (κ=0.401). Reliability assessments of GPT-4\'s analyses showed consistent coding for themes including \"body image struggles,\" \"chronic pain\" (10/10, 100%), and \"depression\" (9/10, 90%). Other themes like \"motivation for surgery\" and \"weight challenges\" were reliably coded (8/10, 80%), while less frequent themes were variably identified across multiple iterations.
CONCLUSIONS: Large language models including GPT-4 can effectively identify key themes in analyzing qualitative health care data, showing moderate agreement with human analysis. While human analysis provided a richer diversity of subthemes, the consistency of AI suggests its use as a complementary tool in qualitative research. With AI rapidly advancing, future studies should iterate analyses and circumvent token limitations by segmenting data, furthering the breadth and depth of large language model-driven qualitative analyses.

Novel strategies are needed to improve low rates of lung cancer screening (LCS) in the US. Seeking to determine hospitalists\' perspectives on leveraging hospitalizations to identify patients eligible for LCS, we performed qualitative interviews with eight hospitalists from two hospitals within a large integrated healthcare system. The interviews used semi-structured questions to assess (1) knowledge and practice of general screening and LCS guidelines from the United States Preventive Services Task Force (USPSTF), (2) identification of smoking history, and (3) hospitalists\' views on how data obtained during hospitalization may be utilized to improve general screening and LCS post hospitalization. We ultimately reached the conclusion that hospitalists would support a dedicated program to identify hospitalized patients eligible for LCS and facilitate testing after discharge. Efforts to identify patients and arrange subsequent screening should be performed by team members outside the inpatient team.

Integrated regulations for medical and nursing care in long-term care: qualitative results of the process evaluation: Innovative form of care in long-term care Abstract: Background: Long-term care patients, most of whom suffer from multimorbidity, are dependent on appropriate medical and nursing care. Inadequate interdisciplinary cooperation structures and processes pose a challenge for nursing care when residents\' conditions deteriorate and can lead to hospital admissions that could potentially be avoided. Objective: Structures and processes of interdisciplinary cooperation were developed and implemented as part of the SaarPHIR innovation fund project \"Saarländische PflegeHeim Versorgung Integriert Regelhaft\". The aims of the qualitative part of the process evaluation were the subjective assessment of the structural and process level of the complex intervention across all project phases from the perspective of the participants as well as an analysis of the context factors. Method: Qualitative interviews were conducted with all participating facilities and the medical care communities formed as part of the project in order to record the subjective experiences gained in the implementation and impact of the complex intervention. The data analysis was carried out using qualitative content analysis. Results: Both professional groups perceive a structural organizational change that has a positive effect on interdisciplinary cooperation. The benefits in terms of care are rated as high. Conclusion: Various measures (e.g. pre-weekend ward rounds, extended on-call duty) at the structural and process level should be retained when transferring to standard care.
Zusammenfassung: Hintergrund: Die zumeist von Multimorbidität betroffenen Pflegebedürftigen in der Langzeitpflege sind auf eine angemessene medizinisch-pflegerische Versorgung angewiesen. Unzureichende interdisziplinäre Kooperationsstrukturen und -prozesse stellen bei Zustandsverschlechterung von Bewohner_innen für die Pflege eine Herausforderung dar und können zu Krankenhauseinweisungen führen, die potenziell vermeidbar wären. Ziel: Im Rahmen des Innovationsfonds-Projektes SaarPHIR „Saarländische PflegeHeim Versorgung Integriert Regelhaft“ wurden Strukturen und Prozesse der interdisziplinären Kooperation entwickelt und umgesetzt. Ziele des qualitativen Teils der Prozessevaluation waren die subjektive Bewertung der Struktur- und Prozessebene der komplexen Intervention über alle Projektphasen aus Sicht der Beteiligten sowie eine Analyse der Kontextfaktoren. Methode: Zur Erfassung der subjektiven Erfahrungen in Durchführung und Auswirkung der komplexen Intervention wurden qualitative Befragungen mit allen teilnehmenden Einrichtungen und den im Rahmen des Projektes gebildeten ärztlichen Versorgergemeinschaften durchgeführt. Die Datenanalyse erfolgte mittels qualitativer Inhaltsanalyse. Ergebnisse: Beide Berufsgruppen nehmen einen strukturellen Organisationswandel wahr, der sich positiv auf die interdisziplinäre Zusammenarbeit auswirkt. Der Nutzen hinsichtlich der Versorgung wird als hoch bewertet. Schlussfolgerung: Verschiedene Maßnahmen (z.B. Vor-Wochenend-Visite, erweiterte Rufbereitschaft) auf der Struktur- und Prozessebene sollten bei Überführung in die Regelversorgung beibehalten werden.

The aim was to explore patients\' early experiences of symptoms after hemithyroidectomy and how these symptoms influenced their daily lives. An inductive explorative qualitative research design was performed. Sixteen patients from two hospitals were interviewed between two-three weeks after the surgery. All the patients experienced compression symptoms before the surgery. The study was analyzed with conventional manifest content analysis. The inductive analysis yielded two main categories and one subcategory. The two main categories were: Early postoperative symptoms that caused disadvantage in daily life and Early postoperative symptoms and coping strategies. The subcategory was: Early postoperative experiences of concerns about the future. Key points: 1. Patients experienced early postoperative symptoms that affected their lives in multiple levels, making them develop coping strategies and awaking concerns about remaining symptoms in the future. 2. The effect of hemithyroidectomy influenced patients\' daily life in the early postoperative phase considerably. 3. The study shows that tailored preoperative patient information is important. The findings may guide professionals to tailored preoperative information to optimize the care for this patient group.

BACKGROUND: A longer duration of untreated psychosis (DUP) is associated with poorer treatment outcomes. Screening for psychosis spectrum disorders in the primary care setting could help support the earlier detection and treatment of individuals in need. However, the acceptability of screening for psychosis in this setting as part of routine care is currently unknown.
METHODS: We conducted a qualitative interview study with providers and service users who participated in an early psychosis screening program conducted in an integrated behavioral health primary care (IBH-PC) setting. Interviews were recruited from one of eight WellSpace Federally Qualified Health Center IBH-PC clinics in the Sacramento, CA area. Transcripts of the recorded interviews were analyzed using thematic analysis.
RESULTS: In total, 12 providers and eight service users participated in the interviews. Most service user and provider participants were supportive of psychosis screening in an IBH-PC setting, but not as part of the general practitioner consultation due to the brief, non-behavioral health nature of many of the appointments, and the expected low prevalence of psychosis in this population. The support of leadership, adequate training and support, staff turnover, and organizational changes were all seen to impact the successful implementation of the program. Different barriers and facilitators were considered important at each stage of the process from introducing the screening procedures to service users; to determining when, where, and how to screen; and how to effectively manage the referral and post-referral stages.
CONCLUSIONS: Despite the additional challenges of screening in an IBH-PC setting relative to secondary mental health services, the process was considered acceptable and feasible to providers and service users. Services that plan to conduct psychosis screening in their clinics need to consider the challenges and their potential solutions to implementation at each stage of the screening process.

BACKGROUND: Hereditary Angioedema (HAE) due to C1-inhibitor deficiency (C1INH) is a rare condition, clinically characterised by recurrent swelling. The unpredictability of attacks affects the patients\' quality of life (QoL). HAE patients and their families have vast unmet physical, psychological, and social needs. A human-centred design (HCD) approach to describing the needs of different user types is to utilise personas, a data-driven narrative tool for communicating user archetypes that capture the individuals\' attitudes, goals, and behaviours. The aim of this study was to create and analyse personas based on HAE patients\' and their caregivers\' interviews. Semi-structured interviews were conducted through anthropological conversations with patients, patient-caregivers (double role of patient and caregiver), and non-affected caregivers. Qualitative and quantitative insights from analyses formed the basis to create personas.
RESULTS: We enrolled 17 subjects: 15 patients (6 of them were patient-caregivers) and 2 non-affected caregivers. The mean age of participants was 50.3 ± 14.4 years. Eight patients were on treatment with prophylactic therapy. The mean percentage score of Angioedema Quality of Life (AE-QoL) for HAE patients was 19.8 ± 12.0. Six personas were identified describing the participants\' personal history, disease management, and needs: four personas referred to patients, one to patient-caregivers, and one non-affected caregiver personas were identified. Across patient personas, the most expressed needs were psychological support and better awareness amongst healthcare professionals. Caregivers, on their side, desired better information about the disease, including the latest therapies, and higher awareness within the community.
CONCLUSIONS: A Human Centred Innovative Approach Based on Persona extends beyond the physical symptoms to encompass the psychological and social aspects of the individual\'s well-being also including the family in the evaluation.