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Background/Purpose: This presentation highlights the benefits and challenges of implementing speech therapy trainings utilizing a train-the-trainer model. Children born with CL+/-P need comprehensive care from a cleft team to ensure that they can meet their highest potential and engage in all aspects of life in their communities. However, in these areas it can be difficult to locate health professionals with the capacity to address cleft palate speech characteristics. As a result, many children speak with these characteristic speech patterns post-palate repair. Research has shown that in low- and middle-income countries (LMICs) a partner hospital model improves the quantity and quality of cleft care services (Purnell, McGrath, & Gosain, 2015). However, there are varying models as to how to structure and build these programs once a partner hospital is established. Limited research has been conducted focusing on the efficacy of speech therapy trainings intended to provide a sustainable impact on these communities. Methods/Description: This poster shares comprehensive data from a survey distributed to training attendees from the past 5 years. Trainings were organized by Smile Train and facilitated by local health professionals who went on to become future trainers. The survey was distributed in August 2020 and consisted of three sections: Personal & Demographic information, Global Impact & Outreach, and Speech Training Feedback. The survey elicited a group of respondents (n=55) who each attended one or more of 14 trainings over a five year span (2015-2020). Authors collected demographic data of respondents, measured respondents' self perception of competency in this area before and after speech therapy trainings, and gathered trainee feedback for future trainings. Results: Surveys were analyzed via SurveyMonkey platform. Researchers analyzed trainee's multiple choice selections, scaled scores, and open-ended responses. Results indicated that trainee confidence in treating those with speech conditions resulting from a CL +/-P significantly increased after the training (on average, trainee confidence was scored a 4/10 before training and improved to 9/10 after training). Further, 56% of trainees have now begun to train other health professionals in their communities. Constructive feedback included the need for continuing education after trainings concluded and the need to address the lack of resources/funding in home countries. Finally, trainees report difficulties in implementing tools acquired from the trainings as a result of the COVID-19 pandemic. Conclusions: Utilization of a train-the-trainer model for speech trainings can provide a lasting, sustainable impact for LIMCs based on respondent feedback. Continued survey distribution is imperative to continuously evaluate the efficacy of these trainings. Further discussion is also needed to determine how trainings can effectively provide tools and education within the constraints of the COVID-19 pandemic.
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Study Objectives: The COVID-19 pandemic imposed both constraints and opportunities for innovation in emergency care delivery. Visits to the emergency department (ED) plunged by as much as 42% in the US, resulting in excess morbidity and mortality due to patients deferring or avoiding emergency care. With the declaration of a public health emergency, payors such as Medicare authorized emergency physicians (EPs) to bill for evaluation and management services delivered through telehealth—potentially allowing EPs to project emergency care beyond the four walls of the physical ED. If adopted, the provision of emergency care via telehealth could expand the reach of emergency medicine, not only during a pandemic but also more broadly, and especially as aging populations choose to receive more care at home. Such expansion of emergency care could benefit from perspectives of EPs in terms of the motivations, barriers, and necessary capabilities. Thus, our objectives were to survey and profile EPs to better understand the potential for telehealth in emergency care delivery. Methods: In collaboration with ACEP and the Emergency Medicine Practice Resource Network (EMPRN), we designed a survey instrument comprising of 5 main questions that provided ranked choice selections. The survey was sent electronically to a group of EMPRN volunteers representing EPs from diverse geographic, age, and practice levels. Results: The survey was sent to a total number of 765 participants, of which a total of 140 (18%) responded. In terms of motivations, respondents identified early engagement with the option to escalate care to the ED if necessary (77% ranked as very important or somewhat important). Respondents also identified the opportunity to quickly address non-life-threatening complaints that may not have needed an ED visit (76% ranked as very important or somewhat important). The top two identified barriers ranked as very significant or somewhat significant were the inability to obtain an adequate evaluation of the patient (76%) and a lack of support personnel in patients’ homes to assist with virtual visits (64%). A related series of responses ranked the needed capabilities necessary for supportive personnel to address barriers to telehealth use. (Table 1). Conclusions: This survey is a mechanism to begin understanding EPs’ perceptions and what they would need to feel comfortable to safely provide telehealth services in the ED. The results revealed that EPs recognize certain opportunities in terms of the potential future of telehealth in emergency care delivery. However, specific barriers were identified. This survey suggests that the ability to escalate care and obtain adequate telehealth exams with presenters and diagnostic support will be important for EPs to feel safe delivering telehealth services. [Formula presented]
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Since the COVID-19 pandemic began, there has been increased reliance on new infrastructure projects to counter economic fallout and underpin employment security. Urban and inter-urban transportation projects, such as major road, rail and port facilities, are popular choices for national and state governments in Australia as they provide broad fiscal support across all sectors of the economy. The problem with stimulus is making sure that the quality of the new infrastructure provides collective utility to a community or region. Whether the benefits will be worthwhile and represent best use of resource inputs requires financial, social, ethical and environmental consequences to be evaluated in a comparable format. The aim in this paper is to analyse the Gold Coast Light Rail (GCLR) Stage 1&2 project using a method that is capable of merging tangible and intangible criteria using an ordinal ranking algorithm. While the GCLR case study is undertaken with the benefit of hindsight, normally these types of evaluations are performed in real time as a project progresses from initiation (design) to implementation (deliver) and influence (delight). The method adopted in this study represents a modern form of multi-criteria decision-making, which enables successful projects to be distinguished from unsuccessful ones using a time period from commencement until one full year of operation has occurred. The i3d3 model, developed by a team from Bond University, has the unique benefit of ranking projects from best to worst across an organisational portfolio, geographic region or industry sector. It also supports past project performance to inform new design through application of a continuous improvement process of recording lessons learned. The GCLR case study calculated 100% of the critical success factors in the model to be positive and produced an overall success ranking of 23 (on a scale of -100 to +100). This paper presents the approach taken to evaluate GCLR's level of success and the calculations that took place to reach this finding. This is the first time i3d3 has been used on an Australian project.
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Introduction: Variable rate intravenous insulin infusion(VRIII) is a cornerstone treatment for controlling elevatedblood glucose (BG) in inpatients who are missing meals,and/or have a critical illness. VRIII can cause serious harmto patients if used incorrectly. Traditional approaches toimproving safety have focused on identifying errors, thenfinding solutions to prevent future recurrence. Such approaches fail to fully take into account the complex adaptive nature of healthcare systems, which cannot be controlledsolely by standards or procedures. The Resilient Health Care(RHC) approach proposes that understanding the variabilityin healthcare practitioners' everyday work e.g. a physical andcognitive activity directed toward achieving a specific goal, iskey to enhancing patient safety (1). There are a considerablenumber of studies on using RHC to enhance safety, however,no studies to date have researched resilience in the use ofVRIII.Aim: This study sought to comprehensively understand,within a RHC framework, how VRIIIs are used in the clinicalenvironment.Methods: A qualitative observational study was conducted in a Vascular Surgery Unit. A purposive sample of twoinpatients and all healthcare practitioners caring for VRIIIaspects for these patients were recruited. The researcher video-recorded healthcare practitioners while prescribing,administering and monitoring VRIII. The video data werethen transcribed and inductively coded to construct a deepunderstanding of the use of VRIII. A hierarchical task analysis (HTA) which is a core human factors approach (2) wasused to represent the actual task for the use of VRIII.Results: Twenty-two hours of video recordings of 10healthcare practitioners were used to develop the final HTAwith a top-level goal of controlling elevated BG using VRIII.The HTA clearly illustrated the complexity of using VRIIIsby highlighting more than 100 practical activities to achievethe goal. The observed challenges were mainly related tolack of knowledge e.g. the co-prescription of appropriateconcurrent IV fluids, and system and technology problemse.g. the need for frequent BG monitoring. The analysis ofthe video data identified various strategies that healthcarepractitioners used to respond to variability in work includingknowledge, standardising practice e.g. the using of ready-toadminister insulin infusions, and context-dependent adaptations including asking available colleagues to countersign administration and assigning the monitoring task to other staffwhen the nurses were busy. Most of the observed adaptationshad positive outcomes in terms of patient care delivery.Conclusion: This study was the first to have exploredhow 'work is done' in reference to the use of VRIII usingHTA. The study was limited by time, the Covid-19 pandemicand number of participants. However, the developed HTAprovided detailed tasks and, by highlighting when and howadaptations were used, systematically presented the processas it was actually done. Future work will focus on using thedata from this study to model RHC in the use of VRIII in away that allows the study site to better enhance patient safety.
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Forestry education has always had to adapt to global changes and accommodate students and society’s needs. To address the issues of the day, forestry education has cultivated human capacity to understand the complexity of ever-changing environments, master resource management technologies, and engage in global issues. Educational technology and online learning are important in providing flexible, accessible, and effective forest education at the rate and scale needed within the forestry sector. The transition during the COVID-19 pandemic further illustrates the role of online learning in worldwide education. In this context, this paper shares a case study from the Sustainable Forest Management Online Program led by the Faculty of Forestry, University of British Columbia (UBC) and Partner Universities. This study shows that appropriately integrating educational technologies into an internationally developed and recognized high-quality curriculum is an effective way to create accessible and affordable forestry education in meeting the demand of evolving societal and environmental conditions. © 2020, North American Business Press. All rights reserved.