Operationalizing a Rideshare Intervention for Colonoscopy Completion: Barriers, Facilitators, and Process Recommendations

IntroductionTransportation is a common barrier to colonoscopy completion for colorectal cancer (CRC) screening. The study aims to identify the barriers, facilitators, and process recommendations to implement a rideshare non-emergency medical transportation (NEMT) intervention following colonoscopy completion within a safety-net healthcare setting.MethodsWe used informal stakeholder engagement, story boards—a novel user-centered design technique, listening sessions and the nominal group technique to identify the barriers, facilitators, and process to implementing a rideshare NEMT program following colonoscopy completion in a large safety-net healthcare system.ResultsBarriers to implementing a rideshare NEMT intervention for colonoscopy completion included: inability to expand an existing NEMT program beyond Medicaid patients and lack of patient chaperones with rideshare NEMT programs. Facilitators included: commercially available rideshare NEMT platforms that were lower cost and had shorter wait times than the alternative of taxis. Operationalizing and implementing a rideshare NEMT intervention in our healthcare system required the following steps: 1) identifying key stakeholders, 2) engaging stakeholder groups in discussion to identify barriers and solutions, 3) obtaining institutional sign-off, 4) developing a process for reviewing and selecting a rideshare NEMT program, 5) executing contracts, 6) developing a standard operating procedure and 7) training clinic staff to use the rideshare platform.DiscussionRideshare NEMT after procedural sedation is administered may improve colonoscopy completion rates and provide one solution to inadequate CRC screening. If successful, our rideshare model could be broadly applicable to other safety-net health systems, populations with high social needs, and settings where procedural sedation is administered.

Paradigm shift in medical education due to the COVID-19 pandemic: guidelines for developing a blended learning curriculum in medical education

Background: The coronavirus disease 2019 (COVID-19) pandemic has transformed the world’s economy, health and education in a blink of an eye. Almost 1 billion learners have been affected across the globe. This has resulted in a paradigm shift to blended learning. Therefore, it was felt necessary to provide practical guidelines for the development of blended curriculum in medical education. It would help to overcome the challenges faced due to unprecedented transformation of medical education on account of pandemic. Methods: Guidelines based on personal experience of the authors and literature search were developed using the complex adapted blended learning system (CALBS) framework. Seven experts developed these guidelines using the nominal group technique. The consent form and literature for CABLS framework was shared with experts. The experts developed the guidelines independently during phase one of the technique. After a given time, phase 2 started with moderator mediated discussion about the individual guidelines developed by the experts. After discussion and mutual consensus four types of guideline ideas were developed. During the third phase the experts ranked the guideline ideas on a scale of 1 to 5. The guideline idea that ranked highest was selected as a final guideline for developing a blended learning curriculum. Results: The group consensus resulted in developing seven guidelines for a blended course or curriculum in medical education. These guidelines are based on a conceptual framework supplemented by expert’s own personal experience and current evidence from literature. Conclusions: These guidelines would provide a comprehensive and systematic approach to develop a blended learning curriculum in medical education.

Development of a blended emergent research training program for clinical nurses (part 1)

Background Nursing research training is important for improving the nursing research competencies of clinical nurses. Rigorous development of such training programs is crucial for ensuring the effectiveness of these research training programs. Therefore, the objectives of this study are: (1) to rigorously develop a blended emergent research training program for clinical nurses based on a needs assessment and related theoretical framework; and (2) to describe and discuss the uses and advantages of the ADDIE model (Analysis, Design, Development, Implementation, Evaluation) in the instructional design and potential benefits of the blended emergent teaching method. Methods This intervention development study was conducted in 2017, using a mixed-methods design. A theoretical framework of blended emergent teaching was constructed to provide theoretical guidance for the training program development. Nominal group technique was used to identify learners’ common needs and priorities. The ADDIE model (Analysis, Design, Development, Implementation, Evaluation) was followed to develop the research training program for clinical nurses based on the limitations of current nursing research training programs, the needs of clinical nurses, and the theoretical foundation of blended emergent teaching. Results Following the ADDIE model, a blended emergent research training program for clinical nurses to improve nursing research competence was developed based on the needs of clinical nurses and the theoretical framework of blended emergent teaching. Conclusions This study indicates that nominal group technique is an effective way to identify learners’ common needs and priorities, and that the ADDIE model is a valuable process model to guide the development of a blended emergent training program. Blended emergent teaching is a promising methodology for improving trainees’ learning initiative and educational outcomes. More empirical studies are needed to further evaluate blended emergent teaching to promote the development of related theories and practice in nursing education.

Explaining Challenges Experienced and Evaluation of the Working Condition of Midwives: A Mixed-method Study Protocol

BackgroundMidwifery is one of the most important jobs in maintaining community health. Various factors can reduce job productivity and cause physical and psychological complications in midwives. The present study aims to: a) explain challenges experienced by midwives; b) evaluate the working condition in midwifery working settings. MethodsThis mixed-methods study consists of three phases. The first phase is a qualitative study explaining challenges experienced by midwives. In this phase, the subjects will be selected through purposive sampling; moreover, in-depth individual interviewing will be used for data collection. Then, the conventional content analysis approach will be employed for data analysis. The second phase will be used a cross-sectional approach for evaluating the working condition in midwifery working settings. In this regard, a multistage cluster sampling method will be used to select 293 subjects who work in the hospital and health care centers. Finally, using findings of the qualitative and quantitative phases and nominal group technique some strategies will be given to reduce challenges of the midwifery working settings.DiscussionThe present research is the first study to investigate the challenges experienced and working conditions among midwives in working settings. For the purposes of the study, a mixed-methods approach will be used which aims to develop strategies for creating suitable working conditions. It is hoped that the strategy proposed in the current study could lead to improvements in midwife’s satisfaction and health care services.Ethical codeIR.TBZMED.REC.1400.113.

Disease Modification in Gout: A Qualitative Study of Gout Expert Rheumatologists

Objective To examine healthcare provider views of disease modification in gout to potentially derive a provisional set of domains for disease modification in gout. Methods We performed a qualitative nominal group (NG) study with 20 gout experts (15 were authors/expert panel members of the 2012 and/or 2020 ACR gout guidelines, and/or 2015 ACR/EULAR gout classification criteria) about what constitutes “disease modification” in gout – “What sorts of things do you think constitute a change in the course of disease in gout? (positive); What are all the ways in which gout as a disease can be modified?” Results Decrease in gout flares was rated #1 rank in all six NGs as indicative of disease modification in gout, followed by serum urate (SU) lowering, which was rated #1 rank in 1 of the 6 NGs (tied score with flares in one NG). Other components of gout disease modification were to improve quality of life/productivity; restore function; reduce/eliminate pain; reduce tophi burden; and joint preservation or resolution of joint damage. Potential additional components that were not ranked in the top 3 votes within each NG were: Decrease healthcare cost/utilization; cardiovascular/renal morbidity/mortality reduction; and stop urate crystals formation. Conclusion This qualitative study provides a provisional set of domains for disease modification in gout. Future studies for the development of thresholds for disease modification domains, and wider consensus on this definition are needed.