Expanding Virtual Health Capabilities Into Trainee Health

ABSTRACT Virtual health and secure messaging gained newfound relevance in medicine during the coronavirus disease (COVID)-19 pandemic. For a military trainee health care clinic located on Joint Base San Antonio, the McWethy Troop Medical Clinic (TMC), implementation of virtual health and secure messaging services meant decreased risk of COVID-19 exposure for trainees and clinical staff. Through ongoing utilization, these services also made impacts to reduce loss of instruction time and improve access to care for the McWethy TMC trainee population. In defining the challenges, successes, and future implications for virtual health and secure messaging at the McWethy TMC, key lessons emerge for other military trainee clinics. The key concepts explored in this article are virtual health and secure messaging.

A qualitative study of hospital clinical staff perceptions of their interactions with healthcare middle managers

PurposeThe authors explored clinical staff perceptions of their interactions with middle management and their experiences of the uncongeniality of their working environment.Design/methodology/approachSemi-structured interviews of clinical staff from an Australian public health service's Emergency, Surgery and Psychiatry departments. Volunteer interview transcripts were inductively coded using a reflexive thematic content analysis.FindingsOf 73 interviews, 66 participants discussed their interactions with management. Most clinicians considered their interactions with middle management to be negative based on a violation of their expectations of support in the workplace. Collectively, these interactions formed the basis of clinical staff perceptions of management's lack of capacity and fit for the needs of staff to perform their roles.Practical implicationsStrategies to improve management's fit with clinicians' needs may be beneficial for reducing uncongenial workplaces for healthcare staff and enhanced patient care.Originality/valueThis article is among the few papers that discuss interactions with management from the perspective of clinical staff in healthcare. How these perspectives inform the perception of workplace uncongeniality for clinicians contributes greater understanding of the factors contributing to adversarial relationships between clinicians and managers.

Perception regarding clinical learning environment among undergraduate nursing students

Clinical experience is an integral aspect of nursing education as it transforms the theoretical knowledge into practice and the cornerstone of nursing as a health profession. The experience gained through a good and supportive clinical environment includes the atmosphere of the clinical placement unit, and the relationships shared with clinical staff supervisors (staff nurses) and mentors (Clinical instructors) that will affect the students learning. Elements like good teaching, relationship with the clinical staff and opportunity to practice, need to be assessed to have an understanding of the student’s perception regarding clinical learning environment. The aim of the present study was to assess the clinical learning environment among undergraduate nursing students of various colleges of Punjab. Materials and methods: A non experimental, descriptive research design was used to assess the perception regarding clinical learning environment among undergraduate nursing students. SECEE inventory (student evaluation of clinical education environment) by Kari Jecklin - Sand was used to determine the clinical learning environment. Five Nursing institutions were selected conveniently to select 500 under graduate nursing students randomly. Results and Major Findings: The findings of the study revealed that Majority (68%) of the study subjects were satisfied with their clinical learning environment followed by 30.8% who were moderately satisfied and only 1.2% were unsatisfied with their clinical learning environment. As per the Personal Profile of the study subjects, age and gender were found highly significant with the perceived clinical environment score at the 0.01 level of significance whereas no significant association was found out with the habitat, marital status, type of family, place of stay during study and financing during study. As per the family background, mother’s occupation was found highly associated with the clinical learning environment score whereas no association was found with the annual income of parents, education of mother, education of father, father’s occupation and number of siblings.

Postnatal Unit Experiences Associated With Exclusive Breastfeeding During the Inpatient Stay: A Cross-Sectional Online Survey

Background: Efforts to provide accessible and effective infant feeding support are advancing to set up new families to meeting their goals. However, data continue to be limited for understanding how inpatient postpartum support and experiences contribute to exclusive breastfeeding during hospitalization. Research Aims: To explore postnatal unit experiences including skin-to-skin contact, overnight support, rooming-in, responsive clinicians, and understandable communication that correlate with early infant feeding outcomes among a sample of mothers who intended to breastfeed. Methods: This was a prospective cross-sectional survey study. Through secure online survey, participants submitted ( N = 2,401) responses from November 2016 to May 2017 about their experiences with maternity healthcare and offered thoughts on the postnatal unit environment. Descriptive statistics were used to examine distributions of maternal characteristics, postpartum experience, and birthing facility characteristics. Results: Exclusive breastfeeding was positively correlated with the following postnatal unit experiences: mother did not ask that her infant be taken out of the postnatal unit room; infant staying in postnatal unit room except for treatment(s); mother got help from clinical staff when needed after pressing the call button; and nurse, midwife, and/or doctor always explained information to mother in ways that they understood. Conclusion: Postnatal unit experiences associated with exclusive breastfeeding during postpartum hospitalization were rooming in; parents who did not ask for their infant to be taken out of the unit room; whether mothers received timely help from clinical staff; and information was explained in a way they could understand.

Death Be Not Proud: A Commentary on Muslim Acceptance of Death in the Intensive Care Unit

Technologies used in medicine have meant that treatments can keep people biologically alive but often fail to provide meaningful recovery and quality of life. Many of those from the Islamic faith have relied on these technologies for recovery on religious grounds, even when it may be against clinical advice. This commentary seeks to challenge this notion among many Muslims and suggests there is a psycho-spiritual motivation within the Islamic tradition in not pursuing intensive care treatment that is deemed futile by clinicians. A wish to embrace death in these situations should be expressed to loved ones, and the dying person’s loved ones should be encouraged to embrace death, in order to minimise harm from disagreements between clinical staff and family.

Clinical ethics support services during the COVID-19 pandemic in the UK: a cross-sectional survey

BackgroundThe COVID-19 pandemic highlighted the need for clinical ethics support provision to ensure as far as possible fair decision making and to address healthcare workers’ moral distress.PurposeTo describe the availability, characteristics and role of clinical ethics support services (CESSs) in the UK during the COVID-19 pandemic.MethodA descriptive cross-sectional online survey was developed by the research team. The survey included questions on CESSs characteristics (model, types of support, guidance development, membership, parent and patient involvement) and changes in response to the pandemic. Invitations to participate were widely circulated via National Health Service institutional emails and relevant clinical ethics groups known to the research team.ResultsBetween October 2020 and June 2021, a total of 53 responses were received. In response to the pandemic, new CESSs were established, and existing provision changed. Most took the form of clinical ethics committees, groups and advisory boards, which varied in size and membership and the body of clinicians and patient populations they served. Some services provided moral distress support and educational provision for clinical staff. During the pandemic, services became more responsive to clinicians’ requests for ethics support and advice. More than half of respondents developed local guidance and around three quarters formed links with regional or other local services. Patient and/or family members’ involvement in ethics discussions is infrequent.ConclusionsThe pandemic has resulted in an expansion in the number of CESSs. Though some may disband as the pandemic eases, the reliance on CESSs during the pandemic demonstrates the need for additional research to better understand the effectiveness of their various forms, connections, guidance, services and modes of working and for better support to enhance consistency, transparency, communication with patients and availability to clinical staff.

Evaluating the Impact of Therapy Related Healthcare Team Burden on Selection of Novel Therapies for Chronic Lymphocytic Leukemia and Lymphoid Malignancies

Introduction Multiple factors drive specific therapy selection for patients with hematologic malignancies including efficacy, toxicity, patient and physician preferences, comorbid conditions, cost, and logistics. However, the advent of many highly effective and generally well-tolerated targeted therapies for chronic lymphocytic leukemia (CLL) and lymphoid malignancies makes objective distinction between various therapeutic agents more difficult. As a result, the eventual therapy selection is often based on physician preference. Secure electronic communication portals (ECP) are federally mandated and frequently used in health care. Although important, ECPs impose a significant burden on the entire healthcare team. However, the extent of ECP use on healthcare burden is poorly ascertained particularly in hematology. While limited available data suggests that cancer patients are more likely than urology or family medicine patients to use ECP, healthcare utilization studies have historically not included this metric as a measure of therapy-related healthcare team burden (THTB). Our study not only uniquely evaluates the quantitative impact of ECP use on THTB, it also addresses qualitative domains that are used in ECPs to provide a holistic and granular assessment of THTB. Methods Patient and ECP data were retrospectively collected at a comprehensive cancer center after institutional IRB approval. The dataset included 412 patients with CLL and lymphoid malignancies treated with ibrutinib (n=237), acalabrutinib (n=70), and venetoclax (n=105). A subset of these patients with AML treated with venetoclax were also included to address disease and therapy specific issues. By leveraging common taxonomy from published literature, we created multiple domains specific to the evaluable metrics as detailed in the tables and utilized the Naranjo adverse drug reaction probability scale and provider documentation to code each message. Results Patients who had at least one patient-initiated or clinician-initiated ECP message thread were included in the final analysis (n=95, 23.06%). Table 1 shows patient, treatment, and disease characteristics. Ibrutinib was used mostly as initial or second-line therapy, while acalabrutinib and venetoclax were mostly used for later lines. We coded 3338 message threads, comprising 3272 patient-generated messages, and 2050 messages generated by 354 unique clinical staff. Our sampled population generated an average of 25.83 messages per patient and our healthcare clinical staff generated an average of 17.96 messages. Table 2 contains domain specific ECP interactions. Patient and healthcare team-generated messages were highest in the first six months of starting therapy and varied with treatment (p<0.01). Venetoclax use was associated with the highest frequency of interactions during the first 6 months of starting therapy. Both treatment-related and unrelated adverse events domains, as well as administrative and supportive care domains, as coded from the ECP, were highest in patients with CLL treated with venetoclax (p=0.005). This was similar for patients with AML treated with venetoclax (p=0.07), suggesting a drug effect rather than the disease process. Patients on venetoclax were also more likely to discuss supportive care and scheduling issues. Adverse event domain specific qualitative measures included comments like "have a scalloped tongue and metallic taste since starting acalabrutinib", "diarrhea, nausea, and vomiting persists since starting the ibrutinib", and "watery diarrhea persists despite the loperamide since starting the venetoclax". Conclusion Our study highlights an important but poorly described measure of THTB that can significantly impact therapy selection, especially when multiple therapeutic options with comparable outcomes are available. A non-reimbursed increase in ECP utilization poses significant THTB which is not easily offset by increased staffing efforts and might result in under-utilization of potentially effective therapies, especially in resource limited settings. In addition, our domain-specific appraisal of ECP allows for identification for improvements in healthcare delivery and intervention with structured enhancements that can maximize patient-centered care while decreasing THTB. THTB should therefore include ECP use and be evaluated as part of a comprehensive assessment tool. Figure 1 Figure 1. Disclosures Madanat: Geron Pharmaceutical: Consultancy; Blue Print Pharmaceutical: Honoraria; Stem line pharmaceutical: Honoraria; Onc Live: Honoraria. Patel: PVI: Honoraria; Celgene-BMS: Membership on an entity's Board of Directors or advisory committees; Agios: Membership on an entity's Board of Directors or advisory committees. Anderson: Celgene, BMS, Janssen, GSK, Karyopharm, Oncopeptides, Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Awan: Beigene: Consultancy; Incyte: Consultancy; Celgene: Consultancy; Karyopharm: Consultancy; Kite pharma: Consultancy; Dava Oncology: Consultancy; Johnson and Johnson: Consultancy; Verastem: Consultancy; MEI Pharma: Consultancy; Gilead sciences: Consultancy; Pharmacyclics: Consultancy; Janssen: Consultancy; BMS: Consultancy; Cardinal Health: Consultancy; Merck: Consultancy; ADCT therapeutics: Consultancy; Abbvie: Consultancy; Astrazeneca: Consultancy; Genentech: Consultancy.