Tele-Ethics in Communication Disorders: Asking the Right Questions, Finding the Right Answers

Purpose: A hypothetical case is used to illustrate legal and ethical issues involving the decision to replace the traditional in-person service delivery model with telepractice in schools beyond the context of the initial COVID-19 health emergency. In this clinical focus article, the reader follows Maria, the lead speech-language pathologist (SLP) in the district, as she determines the feasibility of continuing telepractice in her district now that students and clinicians are returning to schools. First, she considers the support needed to implement this service delivery model within the school setting given the anticipated changes to the rules and regulations governing lawful and ethical provision of telepractice after the health emergency ends. Next, she decides if telepractice is warranted in the district by considering the rationales behind the requests. Faced with balancing school, student, and clinician needs, Maria uses an ethical decision-making model to determine if requests for telepractice, tied to health safety concerns and potentially influenced by implicit bias, reflect legal, ethical, and/or moral issues driven by fear or unconscious discriminatory motives. Conclusions: The health emergency gave SLPs working in schools the unique opportunity to experience the benefits and utility of telepractice. Following the return to schools, continuation of telepractice services will require support and training of SLPs. Many factors must be considered including equivalency of services, technology, and protection of privacy as they relate to the changes to the laws and regulations governing telepractice after the health emergency allowances end. Of primary importance is the selection of telepractice to address student needs, not to avoid specific schools because of their characteristics or location. An ethical decision-making model can be used as a framework to guide service delivery model decisions that balance the needs of the student, the clinician, and the district.

Tele-Audiology: Current State and Future Directions

The importance of tele-audiology has been heightened by the current COVID-19 pandemic. The present article reviews the current state of tele-audiology practice while presenting its limitations and opportunities. Specifically, this review addresses: (1) barriers to hearing healthcare, (2) tele-audiology services, and (3) tele-audiology key issues, challenges, and future directions. Accumulating evidence suggests that tele-audiology is a viable service delivery model, as remote hearing screening, diagnostic testing, intervention, and rehabilitation can each be completed reliably and effectively. The benefits of tele-audiology include improved access to care, increased follow-up rates, and reduced travel time and costs. Still, significant logistical and technical challenges remain from ensuring a secure and robust internet connection to controlling ambient noise and meeting all state and federal licensure and reimbursement regulations. Future research and development, especially advancements in artificial intelligence, will continue to increase tele-audiology acceptance, expand remote care, and ultimately improve patient satisfaction.

Case Study Analysis of an Adaptive Academic School Service Delivery Model With Multiple Disabilities/Handicapped Students

This chapter focuses on multiple disability (MD) or multiple handicapped (MH) students. Being considered equal to their grade- and age-level peers is essential for MD/MH students. Thus, in this chapter, use of the adaptive academic service delivery model with MD/MH students is examined through a case study within a junior and high school setting. This chapter includes a discussion about the causes and characteristics, the educational placement and instructional strategies, and the eligibility criteria for students with multiple disabilities or multiple handicaps. The chapter concludes with a discussion about future trends for MD/MH students and service providers.

Comparing Patients’ Experiences in Three Differentiated Service Delivery Models for HIV Treatment in South Africa

Differentiated service delivery for HIV treatment seeks to enhance medication adherence while respecting the preferences of people living with HIV. Nevertheless, patients’ experiences of using these differentiated service delivery models or approaches have not been qualitatively compared. Underpinned by the tenets of descriptive phenomenology, we explored and compared the experiences of patients in three differentiated service delivery models using the National Health Services’ Patient Experience Framework. Data were collected from 68 purposively selected people living with HIV receiving care in facility adherence clubs, community adherence clubs, and quick pharmacy pick-up. Using the constant comparative thematic analysis approach, we compared themes identified across the different participant groups. Compared to facility adherence clubs and community adherence clubs, patients in the quick pharmacy pick-up model experienced less information sharing; communication and education; and emotional/psychological support. Patients’ positive experience with a differentiated service delivery model is based on how well the model fits into their HIV disease self-management goals.

The Speech-Language Pathologist Evaluating Appropriateness of Learning Apps as a Service Delivery Model for Children With Hearing Loss

Purpose: This study aimed to gain insight from speech-language pathologists (SLPs) regarding appealing features of speech and language applications to use as a service delivery model in schools for children who have a hearing loss. Method: A 1-hr focus group was conducted with three SLPs to identify appealing design features of speech and language apps, their benefits, and potential concerns. Participants were provided two speech and language applications to navigate through and review. Participants responded to Likert scale surveys and verbally provided benefits and drawbacks of the features as part of the structured discussion. Results: SLPs identified a range of appealing features for speech and language apps to utilize as a service delivery model for children with hearing loss. They preferred interfaces that allowed the opportunity for SLP and student collaboration rather than student isolation. Conclusions: SLPs have valuable input in regard to future speech and language app design informed by their experiences with children with hearing loss. SLPs are key stakeholders in the design process and should be included in future design and research endeavors.

Towards an efficient post Covid-19 ict based extension service delivery model for the sugar industry of eSwatini

This study presents a designed ICT based extension service delivery system for the sugar industry of Eswatini. The model is an improvement of the current system and it presents a delivery system that is void of many limitations. This model emanates from findings of a survey which involved all smallholder sugarcane farmers (N=172) and their extension officers (N=17). The survey investigated how information and knowledge are currently managed within the sugar industry. Basically, the model revolves around the use of mobile phones to relay information among the sugar industry stakeholders in a timely, more organised, productive and cost-effective ways, without contravention of the COVID-19 pandemic protocols. Sugarcane stakeholders can now be able to exchange information using the model without having to meet physically, which is what most of the traditional approaches required. The exchange of information can be in a form of voiced, pre-recorded information in the form of texts, audio, or audio visuals. This would go a long way in enhancing smallholder farmer’s productivity as it has the potential of empowering more rural sugarcane farmers with crucial information for improved productivity. The model has the potential to sustain itself as the participation of the stakeholders is promoted.

Effect of integrating Family Planning (FP) with Maternal, Newborn and Child Health (MNCH) services on uptake of voluntary modern contraceptive methods in rural Pakistan: Protocol for a Quasi-experimental study (Preprint)

BACKGROUND Background: The uptake of the Modern Contraceptive Methods (MCM) cumulatively remains low at 25% of women reporting the use in Pakistan. The overarching interventions covering service delivery platforms at facility and community levels necessitates the integration and scaling up of Family Planning (FP) and Maternal Newborn Child Health (MNCH) services OBJECTIVE The main objective of the study is to evaluate the impact of an integrated FP-MNCH service delivery model to increase coverage of MCM in a rural Pakistan. Moreover, to measure the level of effectiveness of interventions on the uptake MCM. METHODS A Quasi-experimental sequential mixed methods study design with pre and post evaluation will be adopted to design and evaluate the integrated FP with MNCH service delivery model. The Interventions include. (1) Capacity Strengthening of Health Care Providers including technical trainings, training for Counseling of women attending immunization centers and ANC and PNC clinics and Provision of Job aids. (2)Counseling of women and girls attending ANC, postnatal and pediatrics clinics. (3)Ensure sustained Provision of Supplies and Commodities. (4)Community Engagement including establishment adolescent friendly spaces, and (5) use of District health Information Data (DHIS) data in decision making. Descriptive statistics will be used to estimate prevalence (proportions) and frequencies of outcome indicators. A univariate difference-in-difference (DID) analytical approach will be used to estimate the effect of the interventions. In additions, a Blinder-Oaxaca decomposition analysis will be conducted to identify and quantifying determinants of mCPR. RESULTS Ethical clearance for this project was sought from Ethical Review Committee (ERC) of Aga Khan University on 26th June, 2020. The project started in January 2021 and will be completed in September 2022. CONCLUSIONS This project will evaluate the impact of integrated family planning with maternal newborn and child health services. Furthermore, identify the drivers and barriers in uptake of modern contraceptive methods and simultaneously helps in modifying the interventional strategies that can be scales up through existing service delivery platforms within public and private sector according to local socio-cultural and health system context. CLINICALTRIAL clinicaltrials.gov NCT05045599: https://clinicaltrials.gov/ct2/show/NCT05045599

FEATURES OF MOLECULAR ANALYSIS AS A REAL-TIME INTERNET SERVICE

Приведен обзор особенностей применения портативныхNIR спектрометров общего назначения, используемых для анализа состава продуктов питания и лекарственных средств. Представлена модель агрегированного потока сетевого трафика от нескольких спектрометров и модель предоставления услуги, обеспечивающая снижение сетевой задержки и объема передаваемых данных. Рассмотрен метод построения сети на основе граничных вычислений для снижения сетевой задержки. Для проверки предложенной модели и метода проведено имитационное моделирование в среде AnyLogic. The Bonch-Bruevich Saint-Petersburg State University of Telecommunications The article provides an overview of the features of the use of portable general-purpose NIR spectrometers to analyze the composition of food or medicines. A model of the aggregated network traffic flow of several spectrometers and a service delivery model, which provides the reduction of network delay and amount of transmitted data, are presented. A method of constructing a network based on edge computing for reduction of network delay is considered. To verify the proposed model and method simulation modeling was carried out in the software environment AnyLogic.

The Acceptability and Appropriateness of a Collaborative, Sport-Centered Mental Health Service Delivery Model for Competitive, and High-Performance Athletes

The purpose of this study was to evaluate the acceptability and appropriateness of a sport-centered, collaborative mental health service delivery model implemented within the Canadian Center for Mental Health and Sport (CCMHS) over a period of 16 months. The study is situated within a larger Participatory Action Research (PAR) project to design, implement and evaluate the CCMHS. Primary data were collected from CCMHS practitioners (n = 10) and service-users (n = 6) through semi-structured interviews, as well as from CCMHS stakeholders (n = 13) during a project meeting, captured via meeting minutes. Secondary data derived from documents (e.g., clinical, policy, procedural; n = 48) created by the CCMHS team (i.e., practitioners, stakeholders, board of directors) during the Implementation Phase of the project were reviewed and analyzed to triangulate the primary data. The Framework Method was used to organize, integrate and interpret the dataset. Overall, results indicate that both practitioners and service-users found the model to be both acceptable and appropriate. In particular, practitioners' knowledge and experience working in sport, a robust intake process carried out by a centralized Care Coordinator, and the ease and flexibility afforded by virtual care delivery significantly contributed to positive perceptions of the model. Some challenges associated with interprofessional collaboration and mental health care costs were highlighted and perceived as potentially hindering the model's acceptability and appropriateness.

Specialist consultation activity and costs in Australia: Before and after the introduction of COVID-19 telehealth funding

This study describes and analyses the Medicare Benefits Schedule (MBS) activity and cost data for specialist consultations in Australia, as a result of the coronavirus disease 2019 (COVID-19) pandemic. To achieve this, activity and cost data for MBS specialist consultations conducted from March 2019 to February 2021 were analysed month-to-month. MBS data for in-person, videoconference and telephone consultations were compared before and after the introduction of COVID-19 MBS telehealth funding in March 2020. The total number of MBS specialist consultations claimed per month did not differ significantly before and after the onset of COVID-19 ( p = 0.717), demonstrating telehealth substitution of in-person care. After the introduction of COVID-19 telehealth funding, the average number of monthly telehealth consultations increased ( p < 0.0001), representing an average of 19% of monthly consultations. A higher proportion of consultations were provided by telephone when compared to services delivered by video. Patient-end services did not increase after the onset of COVID-19, signifying a divergence from the historical service delivery model. Overall, MBS costs for specialist consultations did not vary significantly after introducing COVID-19 telehealth funding ( p = 0.589). Telehealth consultations dramatically increased during COVID-19 and patients continued to receive specialist care. After the onset of COVID-19, the cost per telehealth specialist consultation was reduced, resulting in increased cost efficiency to the MBS.