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Long-term cancer survivors may suffer from significant bio-psycho-social burden even years after treatment. Yet, a structured approach to detect and address bio-psycho-social burden of long-term cancer survivors in primary care is missing in Germany, although family physicians are the primary medical contact for most patients. In this paper, we describe the DELPHIN study aiming to develop and test a structured care model for long-term cancer survivors. The DELPHIN study and intervention will facilitate networking of regional medical and non-medical services. This protocol describes the intervention as well as the pilot study.
The DELPHIN study comprises a developmental and a feasibility phase. In the developmental phase, we will assess (1) the current care needs of long-term cancer survivors (n=1000) using a cross-sectional questionnaire survey; (2) in an additional cross-sectional questionnaire survey, we will address medical and non-medical care providers to assess current care practice for this patient group (n≥250); (3) a qualitative interview study with both long-term cancer survivors (n=12) and family physicians (n=10) will assess patients’ needs and barriers for effective care. Results will then be triangulated to inform development of the DELPHIN intervention. The intervention shall include the following elements: the DELPHIN mobile app for patients with a digital screening tool, a digital treatment plan, a survivorship passport and information on regional medical and non-medical providers. Additionally, a DELPHIN website and a DELPHIN eLearning tool for family physicians will be developed. The subsequent feasibility study will follow 100 long-term cancer survivors using the DELPHIN app for 4 months, with two assessments (t0=baseline; t1=4 months follow-up) regarding the usability of the app and their health-related quality of life. The eLearning tool will be tested by 50 family physicians using three measurement points to evaluate learning success (ta=before; tb=directly after eLearning; tc=after 4 weeks).
The DELPHIN study seeks to address cancer survivors’ unmet bio-psycho-social needs through implementing a digital mobile application. Positive results in the feasibility study will provide the basis for a future effectiveness study and integration into routine care.
The study was reviewed by the Ethics Committee of the University of Bonn, Germany (No: 2024-409 BO) which did not object to the study.
DRKS00035726.
by Ana Caroline Bini de Lima, Vanessa Cristini Sebastião da Fé, Maria Simara Palermo Hernandes, Emily Caroline Pfeifer de Cristo, Ana Gabrieli dos Santos Fagundes Euzébio, Maria Vitória e Silva Sousa, Fabiana Ribeiro Caldara, Viviane Maria Oliveira dos Santos
This study aimed to evaluate the ability of social noncontact environmental enrichment to facilitate social buffering and to characterize the emotional experience of horses subjected to restraint in stock by assessing physiological parameters and facial expressions. Pantaneiro horses (n = 11) were evaluated in a crossover design with two treatments: social noncontact enrichment during stock restraint and social isolation during stock restraint. Physiological parameters (heart rate, heart rate variability, respiratory rate, ocular temperature by infrared thermography, and auricular temperature by infrared thermometer) and facial expressions (EquiFACS) were assessed throughout the 24-minute restraint period. When horses were accompanied by a conspecific, heart rate, respiratory rate, and eye temperature were lower (p nostril dilator (AD38), inner brow raiser (AU101), upper eyelid raiser (AU5), eye white increase (AD1), ears forward (EAD101), and ears back (EAD104), was also lower (pby Lauren Riehm, Keean Nanji, Moiz Lakhani, Evelina Pankiv, Dean Hasanee, Wesla Pfeifer
PurposeLarge language models (LLMs) have the potential to change medical education. Whether LLMs can generate multiple-choice questions (MCQs) that are of similar quality to those created by humans is unclear. This investigation assessed the quality of MCQs generated by LLMs compared to humans.
MethodsThis review was registered with PROSPERO (CRD42025608775). A systematic review and frequentist random-effects network meta-analysis (NMA) or pairwise meta-analysis was performed. Ovid MEDLINE, Ovid EMBASE, and Scopus were searched from inception to November 1, 2024. The quality of MCQs was assessed with seven pre-defined outcomes: question relevance, clarity, accuracy/correctness; distractor quality; item difficulty analysis; and item discrimination analysis (point biserial correlation and item discrimination index). Continuous data were transformed to a 10-point scale to facilitate statistical analysis and reported as mean differences (MD). The MERSQI and the Grade of Recommendations, Assessment, Development and Evaluation (GRADE) NMA guidelines were used to assess risk of bias and certainty of evidence assessments.
ResultsFive LLMs were included. NMA demonstrated that ChatGPT 4 generated similar quality MCQs to humans with regards to question relevance (MD −0.13; 95% CI: −0.44,0.18; GRADE: VERY LOW), question clarity (MD −0.03; 95% CI: −0.15,0.10; GRADE: VERY LOW), and distractor quality (MD −0.10; 95% CI: −0.24,0.04; GRADE: VERY LOW); however, MCQs generated by Llama 2 performed worse than humans with regards to question clarity (MD −1.21; 95% CI: −1.60,-0.82; GRADE: VERY LOW) and distractor quality (MD −1.50; 95% CI: −2.03,-0.97; GRADE: VERY LOW). Exploratory post-hoc t-tests demonstrated that ChatGPT 3.5 performed worse than Llama 2 and ChatGPT 4 with regards to question clarity and distractor quality (p Conclusion
ChatGPT 4 may create similar quality MCQs to humans, whereas ChatGPT 3.5 and Llama 2 may be of worse quality. Further studies that directly compare these LLMs to human-generated questions and administer MCQs to students are required.
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