Online Learning Transition Based on Internet and E-Commerce Classroom Learning Management System (LMS)

In the era of digital information, especially in the field of education, online learning methods are currently developing rapidly in the learning and teaching process. The aim of this project is to provide a uniform and consistent user interface in the new learning management system (LMS) for students and faculties and to promote super users who will assist the faculty in a smooth transition from. The curriculum template is provided in the LMS for online learning processes or called e-Learning and has various training opportunities with super users that are interactive so that online learning will be effective and quality. (57%) report results from faculty feeling competent or very competent (36%) in their ability to use. Canvas ™ LMS after project implementation; There are several survey comments reflecting a positive response to the transition to Canvas ™. This project produces quality, student-centered online learning. Where is in accordance with the standardized template framework.

P052: Who are the super-users of the emergency department?

Introduction: All emergency departments (EDs) across Canada can identify a group of high frequency users, which are typically defined in the literature as eight to ten visits per year. Although frequent users of the ED are well-studied in the literature, there is little published in terms of identifying the “super-user” group who present to the ED much more often than 10 visits per year. Faced with multiple co-morbidities and a high mortality rate, the ED is often the most appropriate environment to manage this population. In order to inform future initiatives to improve health outcomes, we aimed to identify the specific characteristics of this super-user group. Methods: A retrospective chart review was conducted using the electronic medical record from the Thunder Bay Regional Health Sciences Centre to identify patients who had at least 25 visits in the year 2017. A total of 75 patients presented to the ED greater than 25 times in 2017. The following data was then collected on each individual patient: demographic characteristics including age, gender, address, access to a primary care provider. In addition, we collected date, time, diagnoses at each visit, admission rate and surgical interventions. Results: Our preliminary results reveal this population presents to the ED on average 32 times per year. The population is 53% male. Most have a private address and half have a primary care provider for all 2017 with one quarter having a primary care provider for part of the year. The percentage of visits for infections was 30%, mental health and addictions presentations comprised 28% of the visits, with gastrointestinal and cardiac visits comprising a total 22% of the visits. Approximately 7% of visits required admission to hospital, and the average length of stay was 5 days. Conclusion: Super-users of the ED are a unique population that are typically well connected with primary care and have a very low admission and surgical rate. The most common reasons for visit are infections and mental health and addictions. The next steps include collecting mortality data. This data should be used to inform ED and community initiatives aimed at improved health outcomes for this population.

P034: Computed tomography rates for emergency department super-users

Introduction: Most emergency departments (ED) in Canada have a population of high frequency users that present to the ED on a regular basis. These patients are well described in the literature and typically defined by a frequency of 8-10 visits/year. In Thunder Bay, Ontario we have a significant population of patients that present more often that we have termed “super-users”. These patients often are typically from a vulnerable population with multiple co-morbidities and a high mortality rate. Although their risk for poor health outcomes is well recognized, both the chronicity and complexity of their symptoms often contributes to diagnostic dilemmas. The decision to order a computed tomography (CT) scan can be a difficult balance between ruling out life threatening diagnoses and exposing the patient to excessive radiation. Our objective was to describe how often these super-users of the ED received a CT scan and what types of imaging were completed. Methods: The Thunder Bay Regional Health Sciences Centre is a geographically isolated hospital in Northwestern Ontario with the next closest hospital based CT scanner greater than 300 km away. Based on previous literature and our preliminary scoping of the super-user group, we have identified a minimum of 25 visits as the threshold. A retrospective chart review was conducted for the year 2017 using our electronic medical record. Patient demographic data was collected along with the type and number of CT scans into a standardized collection tool. Results: Our preliminary results showed that our total population of super-users was 75 patients with an average of 32 visits to the ED per year. A total of 76% of the patients had a CT scan completed at least once. On average these patients have a CT during 10% of their visits with head CT comprising 50% of the imaging and abdominal/pelvis imaging comprising another 45%. For 20% of these super-users, they had CTs on 20% of their visits. From this population, only 10% of the patients had surgery in 2017 while 7% of visits required admission to hospital. The most common diagnoses for these patient visits relate to mental health/addictions, gastrointestinal complaints and infection. Conclusion: This study has shown that a significant number of our super-user population are receiving multiple CTs. Our next step is collect data on individual radiation doses and calculate exposure risks. We hope to inform policy and decision-makers who are developing programs to treat the underlying cause of their high resource use.

User Engagement and Attrition in an App-Based Physical Activity Intervention: Secondary Analysis of a Randomized Controlled Trial

Background The success of a mobile phone app in changing health behavior is thought to be contingent on engagement, commonly operationalized as frequency of use. Objective This subgroup analysis of the 2 intervention arms from a 3-group randomized controlled trial aimed to examine user engagement with a 100-day physical activity intervention delivered via an app. Rates of engagement, associations between user characteristics and engagement, and whether engagement was related to intervention efficacy were examined. Methods Engagement was captured in a real-time log of interactions by users randomized to either a gamified (n=141) or nongamified version of the same app (n=160). Physical activity was assessed via accelerometry and self-report at baseline and 3-month follow-up. Survival analysis was used to assess time to nonuse attrition. Mixed models examined associations between user characteristics and engagement (total app use). Characteristics of super users (top quartile of users) and regular users (lowest 3 quartiles) were compared using t tests and a chi-square analysis. Linear mixed models were used to assess whether being a super user was related to change in physical activity over time. Results Engagement was high. Attrition (30 days of nonuse) occurred in 32% and 39% of the gamified and basic groups, respectively, with no significant between-group differences in time to attrition (P=.17). Users with a body mass index (BMI) in the healthy range had higher total app use (mean 230.5, 95% CI 190.6-270.5; F2=8.67; P<.001), compared with users whose BMI was overweight or obese (mean 170.6, 95% CI 139.5-201.6; mean 132.9, 95% CI 104.8-161.0). Older users had higher total app use (mean 200.4, 95% CI 171.9-228.9; F1=6.385; P=.01) than younger users (mean 155.6, 95% CI 128.5-182.6). Super users were 4.6 years older (t297=3.6; P<.001) and less likely to have a BMI in the obese range (χ22=15.1; P<.001). At the 3-month follow-up, super users were completing 28.2 (95% CI 9.4-46.9) more minutes of objectively measured physical activity than regular users (F1,272=4.76; P=.03). Conclusions Total app use was high across the 100-day intervention period, and the inclusion of gamified features enhanced engagement. Participants who engaged the most saw significantly greater increases to their objectively measured physical activity over time, supporting the theory that intervention exposure is linked to efficacy. Further research is needed to determine whether these findings are replicated in other app-based interventions, including those experimentally evaluating engagement and those conducted in real-world settings. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12617000113358; https://www.anzctr.org.au/ACTRN12617000113358.aspx

UPDATE OF THE CRAWL, WALK, RUN METHODOLOGY FRAMEWORK

This study updated the Crawl, Walk, Run methodology framework (CWRM) for the current digital marketing circumstances, observed in the context of the artistic community in virtual space. Four main premises of CRWM have been considered in order to address the effectiveness of online campaigns based on the laddering support through tiers of engagement (personal, social, advocating); empowering super users; providing source materials for user-generated content; and using tools people are familiar with. The analysis was performed on the data collected from the online community which has operated for 43 days. Data on the number of registered users, their interactions with web site content and showcased artworks were gathered. The specific online platform was created for the purpose of this research and the campaign for its promotion was conducted both in Serbia and globally. The materials for direct communications (email, instant messaging), social media promotion (social networks, blogs) and public relations (articles in online and traditional media) were created. CRWM was proved to be efficient framework for the establishment of online presence of the artistic community. However, we propose that social networks should be introduced in the stage three instead of in the stage four, due to the increase of their applications compared to the time when the CRWM was formulated. All activities once they start should be maintained and performed throughout the campaign lifetime. This study represents one of the first efforts aimed at updating of the CRWM theoretical framework and provides business community with hands-on solutions in modern digital marketing.

Improving quality of cancer care: Lessons learned from the journey towards QOPI Certification.

263 Background: To assess the quality of cancer care provided at our institution, we participated in Quality Oncology Practice Initiative (QOPI) of American Society of Clinical Oncology (ASCO). However, our initial two rounds revealed lower score than required for QOPI Certification. Our goal was to implement interventions based on lessons learned from the initial rounds. Methods: Prior to the third round and using plan-do-study-act (PDSA) cycles, we identified and worked on three processes: clarifying and enhancing the function of the team, optimizing communication and improving documentation. We created QOPI multi-disciplinary team to include more members from different disciplines. We enhanced the knowledge of the team regarding our electronic health records system (EHRS) by conducting educational sessions and nominating super users who are very competent in EHRS and peer-to-peer support was created. Members were entering data in group sessions with the help of super users. We established double check system for records to be reviewed by two team members before submission. communication was assured among team members through weekly in person meetings and with ASCO QOPI team via virtual meetings to address queries. Documentation was improved by creating newer templates that conform with QOPI requirements including chemotherapy treatment plan, end of treatment summary and documentation of treatment consent. Results: The implementation of these interventions over three PDSA cycles made noticeable improvement in the previously unmet standards resulting in a score that exceeded the benchmark in fall of 2017 (score of 93%). This made our practice eligible for on-site certification visit by ASCO QOPI surveyors on May 2018 to assess practice compliance with QOPI standards. After addressing the unmet standards from the visit, our center became the first QOPI Certified Center in the Middle East and Asia in October/2018. Conclusions: Our journey towards QOPI Certification highlights the importance of fundamental principles in health care: coordinated multidisciplinary team, effective communication and proper documentation that captures essential and critical items reflecting better quality of care.

Training of Super Users Contributes to Productivity in Molecular Biology Laboratories in Mozambique

HIV viral suppression through antiretroviral (ARV) treatment has public health benefits in potentially reducing the risk of subsequent HIV transmissions. Mozambique has adopted the World Health Organization (WHO) “Test and Start” strategy, which assumes that all people who test positive for HIV start ARV treatment immediately. In order that treatment is guided by the respective HIV viral load (VL) test results, the MOH expanded the network of VL testing laboratories. About 26 VL testing instruments are now operational in the country. Although the increase in testing platforms increased VL tests performed, problems associated with errors, failures in user maintenance, and equipment malfunctions occur frequently. Delays in resolving equipment malfunctions contributed to lower laboratory productivity in certain periods of 2018. Therefore, the MOH, in coordination with the American Society for Clinical Pathology (ASCP) and VL testing instrument manufacturers, provided targeted training for VL laboratory Super Users (SUs). The SUs are primarily composed of laboratory technicians representing all VL laboratories. Training focused on equipment maintenance, software configuration, and troubleshooting the most common instrument-related problems and errors. Following this training, the SUs worked as in-laboratory equipment supervisors, helping laboratory staff to better perform equipment maintenance procedures. Furthermore, they worked remotely with representatives and field technicians of the instrument manufacturers to resolve small problems, such as accessory replacement and adding new users to the systems, in their own laboratories. This has led to a reduction in the overall time to equipment repair, less reliance on external field technicians, and correspondingly increased overall lab productivity and workforce capacity building for VL laboratory SU.