From Bedside to Webside: A Qualitative Study of Pediatric Clinicians’ Use of Telemedicine (Preprint)

2021 ◽  
Author(s):  
Julia B Finkelstein ◽  
Elise S Trembley ◽  
Melissa S Van Cain ◽  
Aaron Farber-Chen ◽  
Caitlin Schumann ◽  
...  
Keyword(s):  
Focus Groups ◽  
Healthcare Delivery ◽  
Virtual Communication ◽  
Bedside Manner ◽  
Virtual Visits ◽  
Clinician Experiences ◽  
General Experience ◽  
And Training ◽  
Level Analysis ◽  
Individual Clinician

BACKGROUND With accelerated use of telemedicine, especially broad adoption with the COVID-19 pandemic, it is essential to maintain care standards and quality through effective communication. Virtual communication or webside manner may require modifications to traditional bedside manner. OBJECTIVE Our aim was to understand how clinicians conduct patient-to-provider virtual visits and communicate with families at a single large-volume children’s hospital to inform program development and training of future clinicians. METHODS Two focus groups of pediatric clinicians performing virtual visits prior to the COVID-19 pandemic, with a range of experience and specialty, were engaged to discuss experiential, implementation, and practice-related issues. Focus groups were facilitated using a semi-structured guide covering general experience, preparedness, rapport strategies, and suggestions. Sessions were digitally recorded and the corresponding transcripts reviewed for data analysis. Transcripts were coded based on the main themes and subthemes identified. Based on higher level analysis of these codes, study authors generated a final set of key themes to describe the collected data. RESULTS Theme consistency was identified across diverse participants, although individual clinician experiences were influenced by their specialty and practice. Three key themes emerged regarding the development of best practices, barriers to scalability, and establishing patient rapport. Issues and concerns related to privacy were salient across all themes. Clinicians felt telemedicine required new skills for patient interaction, and not all were comfortable with their training. CONCLUSIONS Telemedicine provides benefits as well as challenges in healthcare delivery. In interprofessional focus groups, pediatric clinicians emphasized the importance of considering safety and privacy to promote rapport and webside manner when conducting virtual visits. Inclusion of webside manner instruction within training curricula is crucial as telemedicine becomes an established modality for providing healthcare. CLINICALTRIAL n/a

scholarly journals P38 COVID-19 impact on Surgical Training And Recovery Planning (COVID-STAR) Survey

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
◽  
Joshua Clements
Keyword(s):  
Surgical Training ◽  
Negative Impact ◽  
Healthcare Delivery ◽  
Cross Sectional Study ◽  
Surgical Trainee ◽  
Surgical Specialty ◽  
Cross Sectional ◽  
Training Time ◽  
Surgical Trainees ◽  
And Training

Abstract Background The COVID-19 pandemic has resulted in dynamic changes to healthcare delivery. Surgery as a specialty has been significantly affected and with that the delivery of surgical training. Method This national, collaborative, cross sectional study comprising 13 surgical trainee associations distributed a pan surgical specialty survey on the COVID-19 impact on surgical training over a 4-week period (11th May - 8th June 2020). The survey was voluntary and open to medical students and surgical trainees of all specialties and training grades. All aspects of training were qualitatively assessed. This study was reported according to STROBE guidelines. Results 810 completed responses were analysed. (M401: F 390) with representation from all deaneries and training grades. 41% of respondents (n = 301) were redeployed with 74% (n = 223) redeployed > 4 weeks. Complete loss of training was reported in elective operating (69.5% n = 474), outpatient activity (67.3%, n = 457), Elective endoscopy (69.5% n = 246) with > 50% reduction in training time reported in emergency operating (48%, n = 326) and completion of work-based assessments (WBA) (46%, n = 309). 81% (n = 551) reported course cancellations and departmental and regional teaching programmes were cancelled without rescheduling in 58% and 60% of cases respectively. A perceived lack of Elective operative exposure and completions of WBA’s were the primary reported factor affecting potential training progression. Overall, > 50% of trainees (n = 377) felt they would not meet the competencies required for that training period. Conclusion This study has demonstrated a perceived negative impact on numerous aspects of surgical training affecting all training specialties and grades.

scholarly journals SAT0636-HPR PATIENT EXPERIENCE WITH THE PRESCRIPTION, INFORMATION AND USE OF METHOTREXATE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1277.3-1278
Author(s):  
T. Oton ◽  
L. Carmona ◽  
J. L. Andréu Sánchez
Keyword(s):  
Side Effects ◽  
Focus Groups ◽  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Physical Symptoms ◽  
Number Of Factors ◽  
Graphic Information ◽  
Main Barrier ◽  
And Training

Background:Methotrexate (MTX) is currently a mainstream drug in the treatment of rheumatic diseases. However, the response to MTX is not universal and may be conditioned by a number of factors, among which adherence could be crucial.Objectives:The aim of this study is to explore adherence to MTX in patients with rheumatic diseases, facilitators and perceived when taking and maintaining the prescription.Methods:A qualitative study of content analysis was performed. Focus groups with patients taking either oral or subcutaneous MTX (being the main or coadjuvant treatment) for any rheumatic disease was performed. The groups were moderated by a rheumatologist that was unknown for the patients. The speech was recorded and transcribed. Subsequently, an inductive coding was performed with the help of Atlas.ti and main themes and sub-themes were extracted, with examples of verbatim anonymized speech.Results:Three focus groups were conducted, with a total of 12 participants, of whom eight were women, seven had rheumatoid arthritis, three had psoriatic arthritis, one had spondyloarthritis, and one had systemic lupus erythematosus. All patients reported an adequate adherence to treatment. The barriers identified were: information in the leaflet, technical language in the consults, difficult access to doctor´s appointment, social environment, side effects and the subcutaneous device. As facilitators, the following aspects were discussed: good predisposition of the physician, reliable graphic information, role of associations and partners support.The unmet needs detected were: problems with travelling, protocols for eventualities, absence of a plan of care, neglection of “non-physical” symptoms, disinformation on side effects and training in complementary aspects.Conclusion:Getting reliable information was the main barrier identified. The environment and side effects may also negatively impact on adherence. Shared decision making is a goal to be achieved in the future in these patients.Disclosure of Interests:Teresa Oton Consultant of: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution), Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution), José Luis Andréu Sánchez: None declared

Family and Clinician Experiences of Sympathy Cards in the 3 Wishes Project

2020 ◽  
Vol 29 (6) ◽  
pp. 422-428
Author(s):  
Alyson Takaoka ◽  
Meredith Vanstone ◽  
Thanh H. Neville ◽  
Sophia Goksoyr ◽  
Marilyn Swinton ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Focus Groups ◽  
Family Members ◽  
Loved One ◽  
Symptoms Of Depression ◽  
Shared Humanity ◽  
Clinician Experiences ◽  
Conventional Content Analysis ◽  
Bereaved Family

Background A recent randomized trial of bereaved family members of patients who died in an intensive care unit identified symptoms of depression and posttraumatic stress in recipients of semistructured condolence letters. Objectives To explore family member and clinician experiences with receiving or sending handwritten sympathy cards upon the death of patients involved in a personalized end-of-life intervention, the 3 Wishes Project. Methods Interviews and focus groups were held with 171 family members and 222 clinicians at 4 centers to discuss their experiences with the 3 Wishes Project. Interview transcripts were searched to identify participants who discussed sympathy cards. Data related to sympathy cards were independently coded by 2 investigators through conventional content analysis. Results Sympathy cards were discussed during 32 interviews (by 25 family members of 21 patients and by 11 clinicians) and 2 focus groups (8 other clinicians). Family members reported that personalized sympathy cards were a welcome surprise; they experienced them as a heartfelt act of compassion. Clinicians viewed cards as an opportunity to express shared humanity with families, reminding them that they and their loved one were not forgotten. Signing cards allowed clinicians to reminisce individually and collectively with colleagues. Family members and clinicians experienced sympathy cards as a meaningful continuation of care after a patient’s death. Conclusions Inviting clinicians who cared for deceased patients to offer personalized, handwritten condolences to bereaved family members may cultivate sincere and individualized expressions of sympathy that bereaved families appreciate after the death of patients involved in the 3 Wishes Project.

Medical students’ perceptions and expectations regarding digital health education and training: A qualitative study

2020 ◽  
pp. 1357633X2093243
Author(s):  
Sisira Edirippulige ◽  
Sophie Gong ◽  
Malshi Hathurusinghe ◽  
Sarah Jhetam ◽  
Jasmine Kirk ◽  
...  
Keyword(s):  
Health Care ◽  
Medical Students ◽  
Health Education ◽  
Focus Groups ◽  
Online Survey ◽  
Care Delivery ◽  
Digital Health ◽  
Education And Training ◽  
Perceptions And Expectations ◽  
And Training

Introduction Digital health – the convergence of digital technologies within health and health care to enhance the efficiency of health-care delivery – is fast becoming an integral part of routine medical practice. The integration of digital health into traditional practice brings significant changes. Logic dictates that for medical practitioners to operate in this new digitally enabled environment, they require specific knowledge, skills and competencies relating to digital health. However, very few medical programmes in Australia and globally include digital health within their regular curriculum. This pilot study aimed to explore medical students’ perceptions and expectations of digital health education and training (ET). Methods An online survey and focus groups were used to collect information about medical students’ perceptions and expectations relating to digital health and ET relating to this field within the medical programme at the University of Queensland. Sixty-three students took part in the survey, and 17 students were involved in four focus groups. Results Most participants had no formal ET in digital health. Most participants ( n = 43; 68%) expressed a willingness to learn about digital health as part of their medical programme. Discussion Primarily, knowledge- and practice-related factors have motivated students to learn about digital health. The analysis of focus group data identified two superordinate themes: (a) drivers of digital health ET and (b) expectations relating to digital health ET. Students agreed that digital health is a relevant field for their future practice that should be taught as part of their regular curriculum.

scholarly journals Outpatient Urinary Tract Infections in an Era of Virtual Healthcare: Trends From 2008 to 2017

2019 ◽  
Vol 71 (1) ◽  
pp. 100-108 ◽  
Author(s):  
Katia J Bruxvoort ◽  
Zoe Bider-Canfield ◽  
Joan A Casey ◽  
Lei Qian ◽  
Alice Pressman ◽  
...  
Keyword(s):  
Older Adults ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Poisson Regression ◽  
Healthcare Delivery ◽  
The United States ◽  
Diagnosis Code ◽  
Virtual Care ◽  
Virtual Visits ◽  
Tract Infections

Abstract Background Urinary tract infections (UTIs) occur commonly, but recent data on UTI rates are scarce. It is unknown how the growth of virtual healthcare delivery affects outpatient UTI management and trends in the United States. Methods From 1 January 2008 to 31 December 2017, UTIs from outpatient settings (office, emergency, and virtual visits) were identified from electronic health records at Kaiser Permanente Southern California using multiple UTI definitions. Annual rates estimated by Poisson regression were stratified by sex, care setting, age, and race/ethnicity. Annual trends were estimated by linear or piecewise Poisson regression. Results UTIs occurred in 1 065 955 individuals. Rates per 1000 person-years were 53.7 (95% confidence interval [CI], 50.6–57.0) by diagnosis code with antibiotic and 25.8 (95% CI, 24.7–26.9) by positive culture. Compared to office and emergency visits, UTIs were increasingly diagnosed in virtual visits, where rates by diagnosis code with antibiotic increased annually by 21.2% (95% CI, 16.5%–26.2%) in females and 29.3% (95% CI, 23.7%–35.3%) in males. Only 32% of virtual care diagnoses had a culture order. Overall, UTI rates were highest and increased the most in older adults. Rates were also higher in Hispanic and white females and black and white males. Conclusions Outpatient UTI rates increased from 2008 to 2017, especially in virtual care and among older adults. Virtual care is important for expanding access to health services, but strategies are needed in all outpatient care settings to ensure accurate UTI diagnosis and reduce inappropriate antibiotic treatment.

Feminism and Health in the Decade of Behavior

2001 ◽  
Vol 25 (4) ◽  
pp. 312-323 ◽  
Author(s):  
Cheryl Brown Travis ◽  
Jill D. Compton
Keyword(s):  
Health Care Providers ◽  
Women Of Color ◽  
Research Training ◽  
Health Data ◽  
Health Issues ◽  
Care Providers ◽  
Intervention Evaluation ◽  
Women Health ◽  
And Training ◽  
Level Analysis

National health data are presented to demonstrate that important issues of women's health are linked to inequality and to the generalized oppression of women. Health issues of violence, reproductive health, coronary health, and mental health are reviewed as they relate to women of color and diverse ethnicity as well as to women in general. Feminist principles are applied to these issues, pointing out inequalities in assessment, treatment and access to care, bias in research and lack of research on topics particularly relevant to women and minorities, and limitations in the education and training of health care providers. It is imperative that these problems, which are not solely biological, be addressed in light of systems-level analysis that includes a feminist lens. Guided by feminist principles and sensibilities, the relevance of behavioral and social science is outlined for research, training, assessment, intervention, evaluation, and overall social change.

scholarly journals La auditoría y el control como base para minimizar los riesgos en ambiente empresarial moderno

2016 ◽  
Vol 3 (3) ◽  
pp. 106-112
Author(s):  
Sidia Vera Gutiérrez ◽  
Teresa Avilés Flor ◽  
Erika Quiñónez Alvarado
Keyword(s):  
Internal Control ◽  
Code Of Ethics ◽  
Control Process ◽  
Internal Controls ◽  
International Standards ◽  
Virtual Communication ◽  
New Horizons ◽  
Training Institutions ◽  
And Training

Este estudio tiene como objetivo determinar el rol fundamental que tienen las Universidades como entidades de formación, en la difusión y fijación de conceptos, criterios modernos y herramientas de un adecuado control interno integrado, también establecer los riesgos que enfrentan las entidades en el entorno moderno, con el fin de que el auditor logre una buena gestión y adecuada rendición de cuentas a la sociedad. Se discernió sobre los cambios de tendencias en la información y comunicación virtual, para evaluarlas y prever sus efectos, se concluyó que los auditores modernos ante la globalización y la velocidad de la información y comunicación virtual, requieren nuevas y diferentes técnicas, así como habilidades de evaluación de los controles internos pero principalmente un cambio en las conceptualizaciones del proceso de control y una actitud crítica para lograr mayor eficiencia en sus organizaciones, que garantice el cumplimiento de las Normas Internacionales de Auditoría y Código de Ética. Un Auditor tradicional de evaluación de control interno, enfrenta un gran desafío, realizar un trabajo más complejo y de mayor alcance a través de la evaluación de los modelos que se propondrán, a fin de determinar adecuadas estrategias para definir nuevos horizontes que maximicen oportunidades y minimicen riesgos.Abstract This study aims to determine the fundamental role of universities and training institutions in the diffusion and fixing concepts, modern criteria and tools of an adequate integrated internal control also establish the risks faced by entities in the modern environment, in order the auditor to achieve good management and proper accountability to society. He discerned on the changing trends in information and virtual communication, to assess and predict its effects, it was concluded that modern auditors to globalization and the speed of information and virtual communication, require new and different techniques and skills evaluation of internal controls but mainly a change in the conceptualizations of the control process and a critical attitude to achieve greater efficiency in their organizations, to ensure compliance with the International Standards on Auditing and Code of Ethics. A traditional Auditor evaluation of internal control, facing a great challenge, a more complex and far-reaching work through the evaluation of the models proposed, in order to determine appropriate strategies to define new horizons that maximize opportunities and minimize risks  

scholarly journals Education and training policies for research integrity: Insights from a focus group study

2021 ◽  
Author(s):  
Krishma Labib ◽  
Natalie Evans ◽  
Rea Scepanovic ◽  
Panagiotis Kavouras ◽  
Andrea Reyez Elizondo ◽  
...  
Keyword(s):  
Focus Group ◽  
Focus Groups ◽  
Thematic Analysis ◽  
Research Integrity ◽  
Education And Training ◽  
European Countries ◽  
Focus Group Study ◽  
Formal Element ◽  
Inductive Thematic Analysis ◽  
And Training

Education is important for fostering research integrity (RI). Although RI training (a formal element of RI education) is increasingly provided, there is little knowledge on how research stakeholders view institutional RI education and training policies. Here, we present insights about research stakeholders’ views on what research institutions should take into account when developing and implementing RI education and training policies. We conducted 30 focus groups, engaging 147 participants in 8 European countries. Using a mixed deductive-inductive thematic analysis, we identified five themes: 1) RI education should be available to all; 2) education and training approaches and goals should be tailored; 3) motivating trainees is essential; 4) both formal and informal educational formats are necessary; and 5) institutions should take into account various individual, institutional, and system-of-science factors when implementing RI education. Our findings suggest that institutions should make RI education attractive for all, and tailor training to disciplinary-specific contexts.

Physician perspectives on placebo ethics

2021 ◽  
pp. medethics-2021-107446
Author(s):  
John Bliamptis ◽  
Anne Barnhill
Keyword(s):  
Focus Groups ◽  
Ethical Issues ◽  
Physician Attitudes ◽  
Clinical Use ◽  
Open Label ◽  
Ethical Concerns ◽  
Preferable Alternative ◽  
Physician Perspectives ◽  
Primary Focus ◽  
And Training

Clinical use of placebos is controversial among bioethicists. While placebos have been shown to provide benefit for patients with some conditions, offering placebos to patients without disclosing that they are placebos raises ethical concerns, including the concern that this lack of transparency about the nature of placebos amounts to deceiving patients. Some have proposed open-label placebos (OLPs) as an ethically preferable alternative: patients are offered placebos and told that the treatment being offered is a placebo. To contribute to the ongoing discussion about the ethics and feasibility of clinical use of placebos, we conducted focus groups to explore physician attitudes about clinical use of placebos, including non-disclosed and OLPs, and physician attitudes about the underlying ethical issues. We found that while the non-transparency and deceptiveness of offering non-disclosed placebos was a concern for some physicians, their primary focus when considering both non-disclosed and OLPs was identifying and weighing potential harms and benefits to patients. Some participants also felt further research and training in prescribing OLPs would be needed before they would be willing to use them in their practice.

Multi-Level Framework

2021 ◽  
pp. 12-31
Author(s):  
William B. Rouse
Keyword(s):  
Traffic Congestion ◽  
Healthcare Delivery ◽  
Air Transport ◽  
Wide Range ◽  
History Of ◽  
Multi Level ◽  
The Rich ◽  
Rich History ◽  
Level Analysis

This chapter broadens the perspective on causes of failures, enabling the deeper analyses of subsequent chapters addressing proximate, distal, and ultimate causes. The rich history of multi-level analysis and modeling is briefly reviewed, citing key contributions by a wide range of research disciplines. Numerous applications of the multi-level framework in a variety of domains, including healthcare delivery, academia, traffic congestion, and air transport are discussed, including the insights gained from use of the framework. An overall methodology for applying this framework is presented and elaborated. The application of this methodology to the line of reasoning throughout this book is summarized.

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